**4. The controversy about high fat intake**

body. Lowering sugar levels reduces need for insulin and this can also help reduce insulin

Insulin is also being the fat storage (anabolic) hormone in the body; thus, reducing insulin in the body with a low-carb diet can help with losing weight. People also generally reduce their calorie intake. This together with the satiating influence of fat helps with further weight loss. However, people on medications, such as insulin, sulphonylurea or glinides, should be care-

Low-carbohydrate diets have been said to provide diabetes patients with more energy levels through the day. There is less craving for sugary and snack foods. As a result of lower glucose results and improved HbA1c, there is clearer thinking process and less 'brain fog'. People

There are various ways of following a low-carbohydrate diet—one will need to cut down on common foods like bread, pasta, rice, potatoes and sweet processed foods. There are a number of other ways to replace starchy foods—such as using swede or celeriac instead of potato and using cauliflower instead of rice. A healthy low-carb diet should also have a strong vegetable intake and moderate protein (unprocessed meat) and fat intake from natural sources (to provide a balance of monounsaturated, polyunsaturated

In 2015, Diabetes UK launched the Low Carb Program [7], which has helped thousands of people with type 2 diabetes to improve their diabetes control and reduce their dependency

The counterargument against low-carb diets for people with diabetes is that there is not enough evidence to support the effectiveness and safety of low-carbohydrate diets in the medium to long term. However, more and more research and evidence seems to be favouring

Diabetes UK has put together a position statement [8] to explain how low-carb diets might be used to help manage diabetes using the best level of evidence from systematic reviews, meta-

Diabetes UK suggests that low-carb diets can be safe and effective for people with type 2 diabetes. They can help with weight loss and glucose management and reduce the risk of cardiovascular disease. So, they recommend a low-carb diet for some people with type 2 diabetes. But there is no consistent evidence that a low-carb diet is any more effective than other approaches in the long term, so it shouldn't be seen as the diet for everyone. Currently, there is no strong evidence to say that a low-carb diet is safe or effective for people with type 1 diabetes. Because of this, Diabetes UK does not recommend low-carb diets to people with

Evidence for low-carb diets in children reports adverse effects such as poor growth, a greater risk of cardiovascular disease and psychological problems. So, low-carb diets are not recom-

have also found that low-carb diets can improve cholesterol and triglyceride levels.

resistance and improve metabolic profile.

ful about hypoglycaemia.

74 Diabetes Food Plan

and saturated fat).

on diabetes medication.

low-carb diets in general.

type 1 diabetes.

analyses and randomised controlled trials.

mended for children with diabetes.

Consuming fats have very little direct effect on blood glucose levels, and as a result does not lead to an increase in insulin levels. The principle of LCHF diet is to replace carbohydrate intake with fat, thus reducing insulin levels and increase the body's ability to utilise its own fat stores for energy.

Metabolic syndrome is a conglomeration of three or more risk factors (elevated waist circumference, elevated triglycerides, low HDL-c, high blood pressure and elevated glucose). Metabolic syndrome is a condition of insulin resistance and can lead to obesity, type 2 diabetes, fatty liver and many other conditions [9]. A LCHF dietary approach can be used to reduce insulin levels and therefore can also be an effective method for treating or preventing the metabolic syndrome [10].

With LCHF diets, there is an increased intake from fats and proteins, and concerns have been raised about the potential dangers of their increased intake. As has been shown a number of times in the past [11–15], a reduction in dietary carbohydrate intake does not necessarily cause a concomitant increase in total fat and protein intake. The absolute amounts of energy intake often remain very similar, as total energy intake decreases on LCHF diets (although proportional amounts of energy supplied from fat and protein increase). Nevertheless, it is this absolute or relative increase in fat intake that causes a lot of anxiety within the medical profession.

Current dietary guidelines do not define a specific limit in terms of fat intake [16, 17]. Moreover, a few articles in the lay and scientific literature suggest that the intake of total fat (mainly, saturated fats) may not need to be limited [2, 18, 19]. American Diabetes Association position statement for type 2 diabetes recommends that a total fat intake of 20–35% may be desirable for reducing the risk of obesity and suggests minimising carbohydrate intake, but it has refrained from specifying ideal amounts of macronutrients [16].

The diet heart hypothesis based largely on Ancel Keys' original Seven Countries Study [20] suggested that saturated fat intake is the direct cause of coronary atherosclerosis. This theory is now being questioned as it is not supported by current evidence [21–31], which finds no association between saturated fat intake and all-cause mortality or progression of coronary atherosclerosis [32]. Instead, higher fat intakes have been associated with lower rates of ischaemic stroke in men [33] as evidenced by a continued decline in coronary mortality in the Japanese with high blood cholesterol levels [34] and high fat intake [35]. To the contrary, it has been shown that LCHF diets sometimes show significant improvements in coronary risk factors [36–39] and the fear of adverse effects from the increased (saturated) fat intake on this diet would appear to be groundless.

Benefits of replacing saturated fats with dietary polyunsaturated fats may not be as strong [40–44] and even harmful [44, 45]. Again, there is no evidence to suggest that the intake of moderate amounts of red meat has detrimental effects on conventional coronary risk factors [46, 47].
