Low carb diets and heart & kidneys

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In this slide deck, I describe the up-to-date evidence on Low Carbs and heart health. The evidence is based mainly on two recent meta-analyses (Hession et al. & Kodama et al.) and prospective cohort …

In this slide deck, I describe the up-to-date evidence on Low Carbs and heart health. The evidence is based mainly on two recent meta-analyses (Hession et al. & Kodama et al.) and prospective cohort studies. Limited evidence on renal aspects is also demonstrated.

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  • 1. Low Carb Diet for heart and kidneys, what is the evidence? 21.12.141 http://twitter.com/pronutritionist Reijo Laatikainen, Authorized Nutritionist, MBA http://twitter.com/pronutritionist http://www.facebook.com/pronutritionist
  • 2. Effect of Low Carb and Low Fat diets on cardiovascular risk factors (RCT trials) Better* Comment LDL cholesterol Low Fat Hession et al. Δ 0,2-0,4 mmol/l HDL cholesterol Low Carb Hession et al. Δ 0,05 mmol/l Triglycerides Low Carb Hession et al. Δ 0,2 mmol/l f-glucose Equal Kodama et al. + Hession et al. 2 h glucose Low Carb Kodama et al. 10 % lower f-insulin Low Carb Kodama et al. 8 % lower 2 h insulin Low Carb Kodama et al. 13 % lower Blood pressure Low Carb Hession et al. Δ in systolic 2 mmHg Insulin sensitivity ? Shai et al. +Samaha et al: Low Carb better Endothelial function ? In favour of Low Fat (2 vs 1 study) (Phillips et al. & Wyscherley vs Volek) 21/12/14 References on the last page 2 http://twitter.com/pronutritionist
  • 3. Effect of Low Carb and Low Fat diets on mortality and morbidity (cohort studies) Better* Comment All cause mortality Low Fat Trichopoulou, Lagiou and Fung et al. Cardiovascular mortality Low Fat Lagiou & Trichopoulou et al. Coronary Heart Disease Equal or Low Carb Halton et al. (Low Carb better if plant-based) CV event (any) Low Fat Sjögren et al. Strokes Equal No difference or N/A 21/12/143 Additional points • Fung et al. showed in line with Halton et al. that plant-based Low Carb Diet is linked to reduced risk of cardiac death. References on the last page http://twitter.com/pronutritionist
  • 4. Effect of Low Carb and Low Fat diets on renal function (RCT trials) Better Comment Progression to ESRD* ? No studies Microalbuminuria Equal Brinkworth et al GFR Equal Brinkworth et al S-Creatinine Equal Brinkworth et al 21/12/144 Additional points • In addition, Skov et al. & Noakes et al. have shown in short term trials (<6 months) equal effects of high & low protein diets on key parameters of renal function (normal kidney function at baseline) • Some cohort studies have linked the high intake of saturated fat to impaired renal function (Lin et al. 2010) • In renal failure, low protein diets delay progression to dialysis (Robertson et al. 2007) *) End Stage Renal Disease References on the last page http://twitter.com/pronutritionist
  • 5. References Cardiovascular risk factors Mortality & CV morbidity Kidney function Hession E et al. Systematic review of randomized controlled trials of low-carbohydrate vs. low-fat/low- calorie diets in the management of obesity and its comorbidities. Obesity reviews (2009) 10, 36–50 Fung T et al. Low-Carbohydrate Diets and All-Cause and Cause-Specific Mortality Two Cohort Studies. Ann Intern Med 2010;153:289-298 Brinkworth et la. Renal function following long-term weight loss in individuals with abdominal obesity on a very low carbohydrate diet vs. high carbohydrate diet. Journal of the American Dietetic Association 110:633- 638, 2010. Kodama S et al. Influence of Fat and Carbohydrate Proportions on the Metabolic Profile in Patients With Type 2 Diabetes: A Meta-Analysis. Diabetes Care. 2009 May; 32(5): 959–965 Halton TL et al. Low-carbohydrate-diet score and the risk of coronary heart disease in women. N Engl J Med. 2006;355:1991-200 Skov et al. Changes in renal function during weight loss induced by high vs low-protein low-fat diets in overweight subjects. Int J Obes Relat Metab Disord. 1999 Nov;23(11):1170-7.Smaha Samaha et al. A Low-Carbohydrate as Compared with a Low-Fat Diet in Severe ObesityN Engl J Med 2003;348:2074-81 Lagiou P et al. Low carbohydrate-high protein diet and mortality in a cohort of Swedish women. J Intern Med. 2007;261:366-74 Noakes et al. Effect of an energy-restricted, high-protein, low-fat diet relative to a conventional high-carbohydrate, low-fat diet on weight loss, body composition, nutritional status, and markers of cardiovascular health in obese women. Am J Clin Nutr June 2005vol. 81 no. 6 1298- 1306 Shai et al. Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet. NEJM 2008: 359(3); 229-41 Sjögren P et al. Mediterranean and carbohydrate- restricted diets and mortality among elderly men: a cohort study in Sweden. Am J Clin Nutr 2010; Sept 8,E- pub ahead of print Lin J et al. Associations of dietary fat with albuminuria and kidney dysfunction. Am J Clin Nutr. 2010 Oct;92(4):897-904. Epub 2010 Aug 11. Phillips et al. Benefit of low-fat over low-carbohydrate diet on endothelial health in obesity.Hypertension. 2008 Feb;51(2):376-82 Trichopoulou A et al. Low-carbohydrate-high-protein diet and long-term survival in a general population cohort. Eur J Clin Nutr. 2007;61:575-81 Lin J et al. Associations of diet with albuminuria and kidney function decline. Clin J Am Soc Nephrol. 2010 May;5(5):836-43. Epub 2010 Mar 18. Volet E et al.Effects of dietary carbohydrate restriction versus low-fat diet on flow-mediated dilation.Metabolism. 2009 Dec;58(12):1769-77. Robertson et al. Protein restriction for diabetic renal disease. Cochrane Database of Systematic Reviews. 2007, Issue 4. Art. No.: CD002181. DOI: 10.1002/14651858.CD002181.pub2 Wycherley TP et al. Long-term effects of weight loss with a very low carbohydrate and low fat diet on vascular function in overweight and obese patients.J Intern Med. 2010 May;267(5):452-61. Epub 2009 Oct 6. 21.12.145 http://twitter.com/pronutritionist
  • 6. References Cardiovascular risk factors Mortality & CV morbidity Kidney function Hession E et al. Systematic review of randomized controlled trials of low-carbohydrate vs. low-fat/low- calorie diets in the management of obesity and its comorbidities. Obesity reviews (2009) 10, 36–50 Fung T et al. Low-Carbohydrate Diets and All-Cause and Cause-Specific Mortality Two Cohort Studies. Ann Intern Med 2010;153:289-298 Brinkworth et la. Renal function following long-term weight loss in individuals with abdominal obesity on a very low carbohydrate diet vs. high carbohydrate diet. Journal of the American Dietetic Association 110:633- 638, 2010. Kodama S et al. Influence of Fat and Carbohydrate Proportions on the Metabolic Profile in Patients With Type 2 Diabetes: A Meta-Analysis. Diabetes Care. 2009 May; 32(5): 959–965 Halton TL et al. Low-carbohydrate-diet score and the risk of coronary heart disease in women. N Engl J Med. 2006;355:1991-200 Skov et al. Changes in renal function during weight loss induced by high vs low-protein low-fat diets in overweight subjects. Int J Obes Relat Metab Disord. 1999 Nov;23(11):1170-7.Smaha Samaha et al. A Low-Carbohydrate as Compared with a Low-Fat Diet in Severe ObesityN Engl J Med 2003;348:2074-81 Lagiou P et al. Low carbohydrate-high protein diet and mortality in a cohort of Swedish women. J Intern Med. 2007;261:366-74 Noakes et al. Effect of an energy-restricted, high-protein, low-fat diet relative to a conventional high-carbohydrate, low-fat diet on weight loss, body composition, nutritional status, and markers of cardiovascular health in obese women. Am J Clin Nutr June 2005vol. 81 no. 6 1298- 1306 Shai et al. Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet. NEJM 2008: 359(3); 229-41 Sjögren P et al. Mediterranean and carbohydrate- restricted diets and mortality among elderly men: a cohort study in Sweden. Am J Clin Nutr 2010; Sept 8,E- pub ahead of print Lin J et al. Associations of dietary fat with albuminuria and kidney dysfunction. Am J Clin Nutr. 2010 Oct;92(4):897-904. Epub 2010 Aug 11. Phillips et al. Benefit of low-fat over low-carbohydrate diet on endothelial health in obesity.Hypertension. 2008 Feb;51(2):376-82 Trichopoulou A et al. Low-carbohydrate-high-protein diet and long-term survival in a general population cohort. Eur J Clin Nutr. 2007;61:575-81 Lin J et al. Associations of diet with albuminuria and kidney function decline. Clin J Am Soc Nephrol. 2010 May;5(5):836-43. Epub 2010 Mar 18. Volet E et al.Effects of dietary carbohydrate restriction versus low-fat diet on flow-mediated dilation.Metabolism. 2009 Dec;58(12):1769-77. Robertson et al. Protein restriction for diabetic renal disease. Cochrane Database of Systematic Reviews. 2007, Issue 4. Art. No.: CD002181. DOI: 10.1002/14651858.CD002181.pub2 Wycherley TP et al. Long-term effects of weight loss with a very low carbohydrate and low fat diet on vascular function in overweight and obese patients.J Intern Med. 2010 May;267(5):452-61. Epub 2009 Oct 6. 21.12.145 http://twitter.com/pronutritionist