Low and very low carbohydrate diets for diabetes remission

Dietary interventions that restrict carbohydrate intake for the management of diabetes are of particular interest to researchers, healthcare providers, and patients. Based on evidence of moderate to low certainty from 23 randomized trials (n=1357), evidence synthesis suggests that patients who adhere to low or very low carbohydrate diets for six months might achieve diabetes remission without adverse consequences. But the definition of low and very low carbohydrate diets, the long term health effects of carbohydrate restricted diets, and the working definitions of diabetes remission are debated, requiring further investigation, particularly for longer term health outcomes based on evidence from randomized trials. Definition of low or very low carbohydrate diets Carbohydrate restriction has a long history of use in the management of diabetes, and authoritative organizations have recently highlighted the potential benefits and harms of low carbohydrate diets.1 The definition of such diets can, however, vary widely and can be confusing to both patients and providers.2 Over the past few decades, the average carbohydrate intake for adults in the United States has been estimated to range between 39% and 51% of daily kilocalories (subsequently referred to as calories).2 Historically, authoritative organizations have recommended carbohydrate intake varying from 45% to 65% of daily calories. Diets with a carbohydrate intake of less than 45% of daily calories therefore have been commonly considered as carbohydrate restricted.3 What is meant by a low carbohydrate diet can vary depending on the reference source. For example, a formal definition was proposed in 2015, defining a low carbohydrate diet as one where less than 26% of daily calories are derived from carbohydrates (<130 g/day),3 yet in its review of the literature the 2019 American Diabetes Association consensus statement on nutrition therapy for diabetes and prediabetes describes a low-carbohydrate eating pattern as reducing carbohydrates to 26-45% of total calories (<225 g/day of a 2000 calorie diet).1 The definitions of very low carbohydrate diets also vary (eg, thresholds ranging from <10% to <26% of

Automated summary

Restricting carbohydrate intake through dietary interventions may lead to diabetes remission without adverse consequences, but there is ongoing debate regarding the definition of low and very low carbohydrate diets, the long term health effects, and the working definitions of diabetes remission, requiring further research.