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12 month trial LCK vs MCLF diets for Diabetes

A new 12 month trial published in Nature, by Laura Saslow with Steve Phinney. Benefits in lower HbA1c, fewer medications and more weight loss with a Low Carb Ketogenic Diet vs Moderate Carb, Low Fat.

https://www.nature.com/articles/s41...s_not_supported

Quote:

Twelve-month outcomes of a randomized trial of a moderate-carbohydrate versus very low-carbohydrate diet in overweight adults with type 2 diabetes mellitus or prediabetes.

Abstract:

Dietary treatment is important in management of type 2 diabetes or prediabetes, but uncertainty exists about the optimal diet. We randomized adults (n = 34) with glycated hemoglobin (HbA1c) > 6.0% and elevated body weight (BMI > 25) to a very low-carbohydrate ketogenic (LCK) diet (n = 16) or a moderate-carbohydrate, calorie-restricted, low-fat (MCCR) diet (n = 18). All participants were encouraged to be physically active, get sufficient sleep, and practice behavioral adherence strategies based on positive affect and mindful eating. At 12 months, participants in the LCK group had greater reductions in HbA1c levels (estimated marginal mean (EMM) at baseline = 6.6%, at 12 mos = 6.1%) than participants in MCCR group (EMM at baseline = 6.9%, at 12 mos = 6.7%), p = .007. Participants in the LCK group lost more weight (EMM at baseline = 99.9 kg, at 12 mos = 92.0 kg) than participants in the MCCR group (EMM at baseline = 97.5 kg, at 12 mos = 95.8 kg), p < .001. The LCK participants experienced larger reductions in diabetes-related medication use; of participants who took sulfonylureas or dipeptidyl peptidase-4 inhibitors at baseline, 6/10 in the LCK group discontinued these medications compared with 0/6 in the MCCR group (p = .005). In a 12-month trial, adults with elevated HbA1c and body weight assigned to an LCK diet had greater reductions in HbA1c, lost more weight, and reduced more medications than those instructed to follow an MCCR diet.

Quote:

Dietary treatment is important in management of type 2 diabetes or prediabetes, but uncertainty exists about the optimal diet.

There's no uncertainty in my mind about the optimal diet, at least as it relates to carbs.

Jean

Those results pretty much mirror my experience with moderate carb vs keto. After 12 months of moderate carb my A1c was considered pre-diabetic. Switching to keto lowered my A1c back to the normal range. I did find it interesting that both groups in this study seemed to have 5 participants whose HbA1c dropped at 6 months and then had increased at 12 months. It is also interesting that the remaining trends continued to drop in the moderate carb group while leveling off in the keto group. I'm not sure that means anything but it does make me wonder about the factors not mentioned.

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However, the ability to generalize from this study is limited by its relatively small size, which did not allow us to perform subgroup analyses.

So maybe not enough power to be sure those trends you mention mean anything at all.

Even something like when the study began can have an effect here. People do well in six month studies, 12 month studies include Thanksgiving, Christmas, etc.