abstract: ABSTRACT Objective: This research examined the effectiveness of a weight loss diet incorporating high protein pasta and breakfast cereal products as compared to a weight loss diet using conventional versions of gluten-free pasta and breakfast cereal. Design: In a 6-week parallel-arm food trial (representing the first phase of a 12-week cross-over trial), 26 overweight and obese (Mean BMI 43.1 ± 12.4 kg/m²) participants, free of related comorbidities, were randomly assigned to the Zone diet (~29% energy intake from protein) or a control diet (~9% energy from protein). Participants were included in the trial if they satisfied the criteria for elevated risk for metabolic syndrome (top half of the TG/HDL ratios of all who were tested). Participants were instructed to eat prepared meals (total of 7 cereal packets and 14 pasta meals weekly) that included patented food technologies for the Zone diet and commercially available gluten-free rice pasta and a conventional name brand boxed cereal for the control diet. Body composition was measured with a bioelectrical impedance scale at weeks 1, and 6. Food records and diet adherence were recorded daily by the participants. Results: Both the Zone and control diets resulted in significant weight loss (-2.9 ± 3.1 kg vs. -2.7 ± 2.6 kg respectively) over time (p = 0.03) but not between groups (p = 0.96). Although not statistically significant, the Zone diet appears to have influenced more weight loss at trial weeks 3, 4, and 5 (p = 0.46) than the control diet. The change in FFM was significant (p = 0.02) between the Zone and control groups (1.4 ± 3.6 kg vs. -0.6 ± 1.5 kg respectively) at week-6. Study adherence did not differ significantly between diet groups (p = 0.53). Conclusions: Energy-restricted diets are effective for short-term weight loss and high protein intake appears to promote protein sparing and preservation of FFM during weight loss. The macronutrient profile of the diet does not appear to influence calorie intake, but it does appear to influence the quality of weight loss. Other measures of body composition and overall health outcomes should be examined by future studies to appropriately identify the potential health effects between these diet types. / Dissertation/Thesis / Masters Thesis Nutrition 2015

Bakgrund: Diagnostiserade fall av personer med typ 1-diabetes ökar globalt och komplikationer kan uppstå i samband med sjukdomen. Lågkolhydratkost har visat sig vara en potentiell metod för att förbättra blodsockerreglering. Sjuksköterskor ansvarar för kostrådgivning och därav behövs mer kunskap om ämnet då det vetenskapliga underlaget är otillräckligt. Syfte: Uppsatsens syfte var att undersöka påverkan av lågkolhydratkost hos personer med typ 1-diabetes. Metod: En litteraturstudie av 10 vetenskapliga artiklar genomfördes med en induktiv ansats. Resultat: Följande huvudkategorier presenterades i studiens resultat: kroppsliga förändringar och upplevelser. Underkategorierna var: blodsocker, insulin, blodfetter, ketoner, vikt och BMI, vitalparametrar, positiva erfarenheter och utmaningar. Effekter av lågkolhydratkost varierade avseende blodsocker, insulin, blodfetter, vikt och blodtryck. BMI förbättrades, ketonnivåer höjdes och diabetes ketoacidos förekom i samband med lågkolhydratkost. Erfarenheter av lågkolhydratkost varierade. Konklusion: Sjuksköterskor och sjuksköterskestudenter behöver information om lågkolhydratkost och typ 1-diabetes. På så sätt kan adekvat information, evidensbaserad vård och personcentrerad vård erbjudas till personer med typ 1- diabetes. / Background: Diagnosed cases of people with type 1 diabetes are growing globally and complications can occur in correlation with the disease. Low carbohydrate diets have shown to be a potential method to improve blood sugar regulation. Nurses are responsible for dietary advice and therefore more knowledge is needed on the subject as the scientific basis is insufficient. Aim: The aim of this thesis was to examine the impact of a low carbohydrate diet for people with type 1 diabetes. Method: A literature study of 10 scientific articles was conducted with an inductive approach. Results: The following main categories was presented: bodily changes and experiences. The subcategories were: blood sugar, insulin, blood fats, ketones, weight and BMI, vital parameters, positive experiences and challenges. The effects of low carbohydrate diets varied regarding blood sugar, insulin, blood fats, weight and blood pressure. BMI improved, ketone levels were raised, diabetic ketoacidosis occurred and experiences with a low-carbohydrate diet varied. Conclusion: Nurses and nursing students need information about low carbohydrate diets and type 1 diabetes. In this way adequate information, evidence-based care and person-centered care can be offered to people with type 1 diabetes.

Low carbohydrate diets have been studied for many years as nutritional therapy for treating patients with type 2 diabetes mellitus (T2DM). Type 2 diabetes is an inflammatory disease that is defined by high blood glucose and HbA1c, lipid levels, BMI, central adiposity, and cholesterol levels, are some among the many indicators that can signal risk for diabetes or help to diagnose diabetes. These indicators are used in studies to evaluate the effectiveness of the nutritional therapy in producing positive health outcomes. Many medications are available for the treatment of T2DM; however, they have a host of side effects, and nutritional therapy has been shown to at least help reduce the dosage of these medications needed by the patients. There are other forms of nutritional therapy besides low carbohydrate diets, and some controversy remains about low carbohydrate diets that in the long term, replacing carbohydrates with fats and proteins could result in increased cholesterol and lipid levels, creating an increased risk for cardiovascular disease. Although some studies have found that low carbohydrate diets, especially very low carbohydrate ketogenic diets (VLCK), do result in increased cholesterol, it is generally an increase in HDL, which is considered good cholesterol and not harmful. Overall weight loss benefits from reduced central adiposity, BMI, and reduced HbA1c levels outweigh the increase in HDL as a side effect. A few different variations of low carbohydrate diets are compared in this review, such as very low carbohydrate ketogenic diets, moderate carbohydrate calorie restricted diets, and moderate carbohydrate low (MCD) Glycemic Index (GI) diets. Due to the ability to exchange carbohydrates with high GI for carbohydrates with low GI, the MCD with low GI sounds promising for good adherence and positive health outcomes in the long run. Although very low carbohydrate ketogenic diets produce many positive health outcomes, the nutritional therapy must be very well designed and followed up, and care must be taken that fiber and nutrients are maintained in the diet. Adherence is a key part of the success of nutritional therapy and a study design plays a major role in that. Providing behavioral development classes, nutritional information classes, and intermittent classes focused on physical activity and healthy habit formation leads to overall increased positive affect which is better for the patient and thus, for the study as well. The easier the nutritionist or dietician can make the therapy transition for the participant, the more likely they are also to stay and try to stick with it. For example, in the studies where the study coordinator provided some small food provisions at the beginning or throughout the study seemed to be successful because the patients were less likely to fall to making their own choices poorly and being inconsistent. Although there were many diets that resulted in many positive health outcomes, ultimately a well-designed, adherence focused, very low carbohydrate ketogenic diet seemed to be the most effective at decreasing HbA1c and producing other positive health outcomes as well. In the long term however, a VLCKD, may be unsustainable for the patient and the body, given the extreme reduction in important carbohydrates.

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Background: Type 2 diabetes mellitus is one of the leading chronic diseases affecting Americans. There is a lack of literature discussing the link between diet and prognosis of those already diagnosed with DM. Objective: To provide insight into which diet is better for the outlook of diabetes mellitus by examining the associations between the low-carbohydrate diet (LCD) score and three diabetes-related health indicators: blood hemoglobin (HbA1c), triglycerides, and retinopathy. Methods: A total of 3,313 U.S. adults with DM were selected from the National Health and Nutrition Examination Survey 2005-2016. Presence of retinopathy was ascertained through self-reporting. Dietary intake was measured with 24- hour dietary recalls, and LCD scores were calculated from the proportion of energy of three macronutrients. Scores ranged from 0-30, with a higher score indicating lower carbohydrate intake. Results: There was no significant difference in HbA1c levels between the highest and the lowest quintile of LCD score (mean = 7.42% [95% CI: 7.23, 7.61] vs. 7.32% [95% CI: 7.13, 7.51]). There was no significant association between blood triglyceride levels and LCD score, comparing quintile 1 to quintile 5 (mean= 168.64 mg/dl; 95% CI = [150.14, 187.14] vs. mean= 162.44 mg/dl; 95% CI = [143.76, 181.11]). In multivariable logistic regression analysis, the odds ratio of having retinopathy comparing the highest to the lowest quintile was 1.01 (95% CI: 0.59, 1.72). Conclusion: Proportion of carbohydrate in diet was not associated with DM prognosis factors. Future studies should focus on carbohydrate quality as well as quantity.

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Low-carbohydrate, high-protein (LCHP) diets have been shown to induce weight loss and beneficial changes in blood lipids that suggest cardiovascular disease risk reduction; however, LCHP diets have not been adequately investigated for health effects on the skeleton. A randomized trial to determine the effects of a LCHP diet on bone mineral status, biomarkers of bone turnover, indicators of acid-base balance, calcium homeostasis and fasting lipids in healthy pre-menopausal women was conducted. Women, aged 32 - 45 y, with a body mass index between 25-41 kg/m2 were randomized into one of two diet groups: LCHP (n = 13) or high-carbohydrate, low-fat (HCLF) (n = 12). Anthropometric (body weight, lean mass, fat mass) and bone mineral density (BMD) and content (BMC) measures and markers of lipid metabolism were taken at weeks 0, 6, and 12. Measures of acid-base balance, protein metabolism, and calcium homeostasis were conducted at weeks 0, 1-4, 6, and 12. Serum osteocalcin was analyzed at weeks 0, 1, 2, 6, and 12, while urinary NTx was analyzed at weeks 0, 1 and 2. Weight loss was significant at the end of 12 weeks in both diet groups (P < 0.05) but there was no Diet x Time interaction. Total proximal femur BMD was lower in the LCHP group (P < 0.05) compared to the HCLF group by week 12. Femoral neck BMC decreased in the LCHP diet group (P < 0.05), whereas total forearm BMC increased (P < 0.05) in the HCLF diet group by week 12 of the study. Serum osteocalcin showed significant main effects of diet (P < 0.05) and time (P < 0.0001), but a Diet x Time interaction was not observed. Urinary NTx exhibited no main diet effect, time effect or Diet x Time interaction at weeks 1 or 2. Urinary pH was lower in the LCHP group compared to the HCLF group throughout the study (P < 0.0001). Urinary calcium excretion was higher in the LCHP group and lower in the HCLF group (P < 0.0001) compared to baseline values at all intervals of the study. Urinary phosphorus excretion exhibited a significant diet effect (P < 0.001) and time effect (P < 0.002), while no Diet x Time interaction was observed. Total cholesterol, high-density and low-density lipoprotein cholesterol, and triacylglycerol concentrations did not differ between diets during the study. In conclusion, a LCHP diet appears to stimulate bone loss, while a HCLF diet appears to attenuate bone loss in healthy pre-menopausal women undergoing 12 weeks of weight loss. / Ph. D.

The purpose of this study was to determine attitudes toward low carbohydrate diets among consumers and the attributes that influence their purchase decision. A growing number of diet trends are spreading across the nation in an effort to improve health and lose weight such as the Atkins diet and the South Beach diet.