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.
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.
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
- 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.
- Risks/Harms of Implementing This Recommendation
The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).
Aude YW, Agatston AS, Lopez-Jimenez F, Lieberman EH, Almon M, Hansen M, Rojas G, Lamas GA, Hennekens CH. The National Cholesterol Education Program diet vs a diet lower in carbohydrates and higher in protein and monounsaturated fat: a randomized trial. Arch Intern Med 2004; 164(19): 2141-2146.
Brehm BJ, Seeley RJ, Daniels SR, D'Alessio DA. A randomized trial comparing a very low carbohydrate diet and a calorie-restricted low fat diet on body weight and cardiovascular risk factors in healthy women. J Clin Endocrinol Metab 2003; 88: 1617-1623.
Brehm BJ, Spang SE, Lattin BL, Seeley RJ, Daniels SR, D'Alessio DA. The role of energy expenditure in the differential weight loss in obese women on low-fat and low-carbohydrate diets. J Clin Endocrinol Metab 2005; 90: 1475-1482.
Dansinger ML, Gleason JA, Griffith JL, Selker HP, Schaefer EJ. Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction. JAMA 2005; 293: 43-53.
Foster FD, Wyatt HR, Hill JO, McGuckin BG, Brill C, Mohammed BS, Szapary PO, Rader DJ, Edman JS, Klein S A Randomized Trial of a Low-Carbohydrate Diet for Obesity. N Engl J Med 348;21: 2082-90. May 22, 2003.
Landers P, Wolfe MM, Glore S, Guild R, Phillips L. Effect of weight loss plans on body composition and diet duration. J Okla State Med Assoc. 2002 May;95(5):329-31.
Lean MEJ, Han TS, Prvan T, Richmond PR, Avenell A. Weight loss with high and low carbohydrate 1200 kcal diets in free living women. Eur J Clin Nutr 1997; 51(4): 243-248.
Luscombe-Marsh ND, Noakes M, Wittert GA, Keogh JB, Foster P, Clifton PM. Carbohydrate-restricted diets high in either monounsaturated fat or protein are equally effective at promoting fat loss and improving blood lipids. Am J Clin Nutr 2005; 81: 762-772.
Meckling KA, O'Sullivan C, Saari D. Comparison of a low-fat diet to a low-carbohydrate diet on weight loss, body composition, and risk factors for diabetes and cardiovascular disease in free-living, overweight men and women. J Clin Endocrinol Metab. 2004; 89(6): 2717-2723.
Nickols-Richardson SM, Coleman MD, Volpe JJ, Hosig KW. Perceived hunger is lower and weight loss is greater in overweight premenopausal women consuming a low-carbohydrate/high-protein vs. high-carbohydrate/low-fat diet. J Am Diet Assoc. 2005; 105: 1,433-1,437.
Samaha FF, Iqbal N, Seshadri P, Chicano KL, Daily DA, McGrory J, Williams T, Williams M, Gracely EJ, Stern L. A low-carbohydrate as compared with a low-fat diet in severe obesity. N Engl J Med 2003; 348(21): 2074-2081.
Sharman MJ, Volek JS. Weight loss leads to reductions in inflammatory biomarkers after a very-low-carbohydrate diet and a low-fat diet in overweight men. Clin Sci 2004; 107(4): 365-369.
Stern L, Iqbal N, Seshadri P, Chicano KL, Daily DA, McGrory J, Williams M, Gracely EJ, Samaha FF. The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: one-year follow-up of a randomized trial. Ann Intern Med 2004; 140(10): 778-785.
Yancy WS, Olsen MK, Guyton JR, Bakst RP, Westman EC. A low-carbohydrate, ketogenic diet vs. a low-fat diet to treat obesity and hyperlipidemia: a randomized controlled trial. Ann Intern Med, 2004; 140: 769-777.