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Practices and theories

 

The term low-carbohydrate diet today is most strongly associated with the Atkins Diet. However, there is an array of other diets that share to varying degrees the same principles (e.g. the Zone Diet, the Protein Power Lifeplan, and the South Beach Diet). Therefore, there is no widely accepted definition of what precisely constitutes a low-carbohydrate diet. It is important to note that the level of carbohydrate consumption defined as low-carbohydrate by medical researchers may be different than the level of carbohydrate defined by diet advisors. For the purposes of this discussion, we focus on diets that reduce (nutritive) carbohydrate intake sufficiently to dramatically reduce or eliminate insulin production in the body and to encourage ketosis (production of ketones to be used as energy in place of glucose).

 

Although originally low-carbohydrate diets were created based on anecdotal evidence of their effectiveness, today there is a much greater theoretical basis on which these diets rest. The key scientific principle which forms the basis for these diets is the relationship between consumption of carbohydrates and their effects on blood sugar (i.e. blood glucose) and hormone production. Blood sugar levels in the human body must be maintained in a fairly narrow range to maintain health. The two primary hormones related to regulating blood sugar levels, produced in the pancreas, are insulin, which lowers blood sugar levels, and glucagon, which raises blood sugar levels. In general, most western diets (and many others) are sufficiently high in nutritive carbohydrates that virtually every meal causes substantial insulin production and avoids ketosis, thus causing excess energy in the diet to be stored as fat (discussed in the next section). By contrast, low-carbohydrate diets, or more properly, diets that are very low in nutritive carbohydrates, discourage insulin production and tend to cause ketosis. Some researchers suggest that this causes excess dietary energy and body fat to be eliminated from the body. However, a review study of the scientific data published in the Lancet concluded that in the case of Atkins that there was no proof that the diet was effective beyond six months, and that it was unlikely that weight loss came through ketosis because ‘urinary traces of ketones were so low that very little energy would be used up this way’. Other studies have shown that small amounts of weight loss (approx. 1lb every 1 or 2 months) are achievable with such diets.

 

Low-carbohydrate diet advocates in general recommend reducing nutritive carbohydrates (commonly referred to as “net carbs,” i.e. grams of total carbohydrates reduced by the non-nutritive carbohydrates) to very low levels. This means sharply reducing consumption of desserts, breads, pastas, potatoes, rice, and other sweet or starchy foods. Some recommend levels as low as 20-30 grams of “net carbs” per day, at least in the early stages of dieting (for comparison, a single slice of white bread typically contains 15 grams of carbohydrate, almost entirely starch). By contrast, more standard nutrition guides typically recommend consumption levels in the neighborhood of 225-325 grams of carbohydrate per day (based on a 2000 calorie a day diet). Low-carbohydrate diets often differ in the specific amount of carbohydrates allowed, whether certain types of foods are preferred, whether occasional exceptions are allowed, etc. Generally they all agree that processed sugar should be eliminated, or at the very least greatly reduced, and similarly generally discourage heavily processed grains (white bread, etc.). They vary greatly in their recommendations as to the amount of fat allowed in the diet although the most popular versions today (including Atkins) generally recommend at most a moderate fat intake.

 

As a related note, there is a set of diets known as low-glycemic-index diets (low-GI diets) or low-glycemic-load diets (low-GL diets), in particular the Low GI Diet by Brand-Miller et al. In reality, low-carbohydrate diets are, literally speaking, low-GL diets (and vice versa) in that they specifically limit what contributes to the glycemic load in foods. In practice, though, “low-GI”/”low-GL” diets differ from “low-carb” diets in the following ways. First, low-carbohydrate diets treat all nutritive carbohydrates as having the same effect on metabolism and generally assume that their effect is independent of other nutrients in food. Low-GI/low-GL diets base their recommendations on the actual measured metabolic (glycemic) effects of the foods eaten. Second, as a practical matter, low-GI/low-GL diets generally do not recommend diets with glycemic loads low enough to minimize insulin production and induce ketosis, whereas low-carbohydrate diets generally do.

 

Another related diet type, the low-insulin-index diet, is very similar except that it is based on measurements of direct insulemic responses (i.e. the amount of insulin in the bloodstream) to food rather than glycemic response (the amount of glucose in the bloodstream). Although the diet recommendations mostly involve lowering nutritive carbohydrates, there are some low-carbohydrate foods that are discouraged as well (e.g. beef).

 

In contrast to these diets, based on evidence for risk of heart disease and obesity, the Institute of Medicine recommends that American and Canadian adults get between 40-65% of dietary energy from carbohydrates. The Food and Agriculture Organization and World Health Organization jointly recommend that national dietary guidelines set a goal of 55-75% of total energy from carbohydrates, but only 10% should be from Free sugars (their definition of simple carbohydrates).

 

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