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Recommendations Summary

Adult Weight Management (AWM) Low Carbohydrate Diet

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.

  • Recommendation(s)

    AWM: Low Carbohydrate Diet

    Having patients focus on reducing carbohydrates rather than reducing calories and/or fat may be a short term strategy for some individuals. Research indicates that focusing on reducing carbohydrate intake (<35% of kcals from carbohydrates) results in reduced energy intake. Consumption of a low-carbohydrate diet is associated with a greater weight and fat loss than traditional reduced calorie diets during the first 6 months, but these differences are not significant after 1 year.

    Rating: Fair

    • Risks/Harms of Implementing This Recommendation

      Safety has not been evaluated for long term, extreme restrictions of carbohydrates (<35% of kcals from carbohydrates).

      Because of the limited research, practitioner should use caution in suggesting a low carbohydrate diets for even short term use for the following groups:

      • patients with osteoporosis
      • patients with kidney disease
      • patients with increased LDL

    • Conditions of Application

      Recommendation applies to individuals who can more easily reduce carbohydrate in their diets than calories and/or fat.

    • Potential Costs Associated with Application


    • Recommendation Narrative

      • Five RCTs (two positive-quality, three neutral-quality) show that ad libitum low-carbohydrate diets, when compared with reduced-calorie diets, result in significant body weight loss and fat loss during the first 6 months (Brehm et al, 2003; Brehm et al, 2005; Nickols-Richardson et al, 2005; Samaha et al, 2003; Yancy et al, 2004)  
      • Three RCTs (one positive-quality and two neutral-quality) show that after 1 year, differences between ad libitum low-carbohydrate diets and reduced-calorie diets are not significant (Dansinger et al, 2005; Foster et al, 2003; Stern et al, 2004)

    • Recommendation Strength Rationale

      • Conclusion statement is Grade II
      • Long term safety has not been evaluated, therefore,  relative risks and benefits of using this dietary approach in all populations cannot be determined.

    • Minority Opinions

      Consensus reached.