Investigating the experiences of low-carbohydrate diets for people living with Type 2 Diabetes: A thematic analysis.

Low-Carbohydrate Diets (LCDs) are becoming increasingly popular to manage Type 2 diabetes mellitus (T2DM). However, there is a need to identify people with T2DM's understanding of LCDs, their reasons for engaging in such a diet, how they sustain it and any challenges they face. This study aimed to assess the experience of adhering to a LCD within a sample of individuals with T2DM. Ten participants with T2DM were recruited using a self-selecting sampling method from an online diabetes community that promotes LCDs. Participants completed one-to-one digitally recorded semi-structured interviews, which were later transcribed verbatim and data subjected to Thematic Analysis. Five core themes and twelve subthemes were developed during the analysis: (1) Lack of professional guidance; (2) Fear of complications & long-term medication use; (3) Dietary control as motivation; (4) Positive health outcomes; and (5) Social support. The findings are discussed with reference to a psychological model of behaviour, COM-B. Participants reported gaining knowledge and skills to increase their Capability to engage in LCDs, Motivation to manage diabetes outcomes influenced adherence. However, challenges were reported with the Opportunity to engage in behaviour, mainly influenced by social support. Health professionals and significant others may benefit from resources to help build knowledge and understanding and assist with maintaining a LCD long-term.

Maternal Knowledge, Attitude and Practices toward Free Sugar and the Associations with Free Sugar Intake in Children.

Research addressing factors related to free sugar (FS) consumption among children in Saudi Arabia is lacking. We aimed to evaluate maternal knowledge, attitude, and practices toward FS and the associations with children's intake of FS. This cross-sectional study included 424 Saudi children aged 6-12 years and their mothers. Data related to maternal knowledge, attitude, and practices were collected using an online survey. Data concerning children's habitual intake of FS were collected through phone interviews using a validated food frequency questionnaire. Limited knowledge on FS was observed among mothers of children [median 7.00 [interquartile range 6.00-8.00] out of 11.0. Maternal knowledge was not correlated with maternal attitude or practices toward FS. Maternal knowledge towards FS did not predict children's intake of FS, whereas maternal attitude and practices toward limiting the consumption of FS predicted lower intake of FS among Saudi children, particularly the FS consumed from solid food sources (B: -5.73 [95% confidence interval (CI): -9.79 to -1.66]) and (B: -6.85 [95% CI: -11.9 to -1.80]), respectively. Despite the limited knowledge pertaining to FS among mothers in Saudi Arabia, they were making efforts to limit their children's consumption of FS.

Carbohydrate knowledge, dietary guideline awareness, motivations and beliefs underlying low-carbohydrate dietary behaviours.

To explore the factors (including knowledge and attitude) influencing the decision to follow a low-carbohydrate diet (LCD) or not in a sample of the UK population. An online questionnaire was distributed electronically to adults who had either followed LCD or not (February-December 2019). Demographics and self-reported "LCD-status" (current, past and non-follower) were collected. Multivariable linear regression was used with carbohydrate knowledge, dietary guideline agreement and theory of planned behaviour (TPB) constructs (all as predictors) to explain the intention to follow a LCD (outcome). Respondents (n = 723, 71% women, median age 34; 85% white-ethnicity) were either following (n = 170, 24%) or had tried a LCD in the preceding 3 months (n = 184, 25%). Current followers had lower carbohydrate knowledge scores (1-2 point difference, scale - 11 to 11) than past and non-followers. A majority of current LCD followers disagreed with the EatWell guide recommendations "Base meals on potatoes, bread, rice and pasta, or other starchy carbohydrates. Choose whole grains where possible" (84%) and "Choose unsaturated oils and spreads and eat in small amounts such as vegetable, rapeseed, olive and sunflower oils" (68%) compared to past (37%, 10%, respectively) and non-followers (16%, 8%, respectively). Weight-loss ranked first as a motivation, and the internet was the most influencial source of information about LCDs. Among LCD-followers, 71% reported ≥ 5% weight loss, and over 80% did not inform their doctor, nurse, or dietitian about following a diet. Approximately half of LCD followers incorporated supplements to their diets (10% used multivitamin/mineral supplements), despite the restrictive nature of the diet. TPB constructs, carbohydrate knowledge, and guideline agreement explained 60% of the variance for the intention to follow a LCD. Attitude (std-ß = 0.60), perceived behavioural control (std-ß = 0.24) and subjective norm (std-ß = 0.14) were positively associated with the intention to follow a LCD, while higher knowledge of carbohydrate, and agreeing with national dietary guidelines were both inversely associated (std-ß = - 0.09 and - 0.13). The strongest primary reason behind UK adults' following a LCD is to lose weight, facilitated by attitude, perceived behavioural control and subjective norm. Higher knowledge about carbohydrate and agreement with dietary guidelines are found among people who do not follow LCDs.

Feasibility of Low Fermentable Oligosaccharide, Disaccharide, Monosaccharide, and Polyol Diet and Its Effects on Quality of Life in an Italian Cohort.

The low Fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet has demonstrated excellent results in terms of symptom control and health-related quality of life (HRQoL) in irritable bowel syndrome (IBS) sufferers, but patients have complained about unsatisfying taste, difficulty in following the diet, and time consumption. To investigate the feasibility of the low FODMAP diet in an Italian (Sardinian) cohort, sixty consecutive eligible outpatients (11 men and 49 women) with IBS were enrolled and followed a low FODMAP diet (gluten allowed, restriction phase of four weeks, reintroduction phase of four weeks). Food habits were assessed using 24-hour dietary recall, Bristol Stool Scale for stool consistency, Visual Analogue Scale for abdominal bloating, VAS (Visual Analogue Scale) for abdominal pain, IBS Severity Scoring System for perceived disease severity, and a 12-item Short Form Survey for HRQoL (psychological component summary + mental component summary) were applied at baseline (T0) and at the end of each phase (T1-four weeks and T2-eight weeks). Statistical analysis was performed by dividing the cohort into diarrhoea-dominant IBS (IBS-D) and other IBS subtypes (selected IBS-others). Comparisons between T1 and T2 vs. T0 and T2 vs. T1 were performed. The low FODMAP diet lowered VASp (VAS pain), VASb (VAS bloating), and IBS SSS (IBS Severity Scoring System), and increased PCS (Physical Component Summary) and MCS (Mental Component Summary) in both subgroups. Bristol Stool Scale (BSS) only improved in the IBS-D subgroup. The dropout mean values for MCS were higher than treated subjects and the percentage of unemployment was lower in the dropouts. According to the dropout features, the low FODMAP diet seems to show greater feasibility for patients with more time to dedicate to the diet (unemployed, homemakers, housewives, or students), more motivation, and more severe clinical features, independent of their place of residence.

Ketogenic and low-sugar diets for patients with cancer: perceptions and practices of medical oncologists in Canada.

PURPOSE: Many patients with cancer are interested in complementary therapies, including strategies such as reduced carbohydrate diets. Guidelines regarding the use of these diets during cancer treatment are lacking; therefore, we aimed to explore the perceptions and practices of medical oncologists in Canada regarding low-sugar and ketogenic diets. METHOD: A cross-sectional, online multiple-choice survey was distributed to 206 Canadian medical oncologists. Questions explored frequency of patient interactions, oncologist perceptions of efficacy, advice given to patients, and concerns about side effects related to reduced carbohydrate diets. RESULTS: Responses were received from 57 medical oncologists in seven of thirteen provinces and territories, with an overall response rate of 28%. Forty-nine percent of respondents were asked at least weekly about a low-sugar diet, and 9% about the ketogenic diet. Eighty-five percent supported the use of a low-added sugar diet in patients with diabetes or hyperglycemia, while conversely 87% did not support the use of a ketogenic diet for any of their patients undergoing active cancer treatment. Respondents felt either that a ketogenic diet was not effective (31%) or that the effect on cancer outcomes was unknown (69%). Ninety-six percent of respondents had concerns about a ketogenic diet for patients receiving active cancer treatment. CONCLUSION: The role of reduced carbohydrate diets during cancer treatment is topical. Canadian oncologists are particularly reluctant to support a ketogenic diet for patients on active cancer treatment, with concerns about side effects and unknown efficacy. There may be a role for continuing medical education and institutional guidelines to inform these discussions with patients.

Affective and Enjoyment Responses to Short-Term High-Intensity Interval Training with Low-Carbohydrate Diet in Overweight Young Women.

Low-carbohydrate diets (LCs) seem effective on weight reduction and maintenance. However, the affect and enjoyment of exercise during LCs is not clear. The purpose of the present study was to compare the psychological responses to high-intensity interval training (HIIT) and to moderate-intensity continuous training (MICT) during the consumption of a 4-week LC diet in overweight young women. With LCs (~10% carbohydrate, 65%-70% fat, 20%-25% protein), forty-three eligible women (age: 20.9 ± 3.1 years; body weight: 65.8 ± 8.2 kg) were randomly assigned to one of three groups: HIIT (10 sets of 6 s all-out cycling interspersed with 9 s of rest), MICT (30 min cycling at 50%-60% of peak oxygen consumption, V̇O2peak) or no-exercise controls (CON). Anthropometric indices and V̇O2peak were measured pre- and post-training. Feeling Scale (FS), Felt Arousal Scale (FAS), Exercise Enjoyment Scale (EES), and Physical Activity Enjoyment Scale (PACES) scores were collected before and immediately after each training session throughout the study. After intervention, all three groups reduced by more than 2.5 kg of body weight whereas both exercise groups improved ~15% V̇O2peak. Participants in the HIIT and MICT group exhibited similar affect points as indicated by FS and FAS. Post-exercise enjoyment scores in PACES were lower in HIIT (73-78 points) than MICT (83-87 points) despite similarly positive responses being observed in EES (corresponding to ~4 points of a 7-point scale). Short-term LCs were effective in weight loss and exercise training had an additive improvement on cardiorespiratory fitness. The overweight young women had similar affect valence, arousal levels, and comparable pleasurable feelings to HIIT and MICT with LCs. Furthermore, as indicated by PACES, MICT was more enjoyable which may elicit better adherence, whereas HIIT with LCs seems to be more arduous despite its time-efficiency.

No improvement in quality of life in children with epilepsy treated with the low glycemic index diet.

BACKGROUND: Up to 30% of children with epilepsy show a poor therapeutic response to pharmacologic treatment. Ketogenic diets, including the less strict low glycemic index treatment (LGIT), may improve seizure control in pharmacoresistant epilepsy. However, little is known about the quality of life (QoL) in children on LGIT. To explore psychosocial implications of the LGIT on pediatric patients and their caregivers, we have conducted a pilot study to explore the QoL of children and adolescents on the diet. METHODS: Pediatric patients on LGIT and their parents completed standardized, validated QoL questionnaires (Pediatric Quality of Life Epilepsy Module), one retrospectively and one while being on LGIT. An additional questionnaire included two open-ended questions in order to gain a better understanding of personal experiences of families. RESULTS: We enrolled six patients with epilepsy on LGIT between the age of 3 and 13 years. Self-reported QoL decreased in all adolescents, regardless of improvement in seizure control. Parent-reported QoL improved in three of six participants, remained stable in one, and decreased in two patients (both displayed no seizure improvement). Parents and adolescents reported positive experiences of trying new foods and being more health conscious, as well as negative themes such as social isolation and meal preparation difficulties. CONCLUSIONS: The lack of improvement in patient-reported QoL points towards an overall negative impact of the LGIT on patient well-being, despite positive effects on seizure control. Our preliminary results indicate that the benefits of seizure control may subjectively be outweighed by adverse social effects of the LGIT. Families should be made aware of psychosocial risks of the diet. Whenever possible, children should be part of the therapeutic decision-making process. Larger prospective studies are required to fully assess the overall impact of the LGIT.

I was truly addicted to sugar: A consumer-focused classification system of behaviour change strategies for sugar reduction.

The reduction of free sugars has been identified as a priority issue internationally. A range of public health initiatives have been recommended, including the provision of information and support for sugar reduction. To inform these approaches, it is important to know what people actually do in real world settings to reduce their consumption. This study documents and defines the range of consumer-based behaviour change strategies for sugar reduction. A total of 1145 strategies were extracted from 47 internet sources (i.e., consumer, popular and professional). Using a pragmatic content analysis, hundreds of strategies were organized into 25 discrete categories of strategies. Categories were grouped into the Rubicon Model of Action Phases and classified as pre-decisional (i.e., decisional balance, feedback, realisation, seek knowledge and information), post-decisional (i.e., action planning, coping planning, set goal intention, sugar guidelines) and actional phase. Actional strategies were the most prolific and included avoidance, consumption control, consumption planning, environmental restructuring, healthy eating focus, maintain readiness, professional support, refocusing, self-monitoring, social support, substance substitution, tapering, address underlying issues, urge management, well-being and withdrawal management. There was one post-actional strategy which was associated with self-evaluation (i.e., reviewing a change attempt in order to plan for the future). Four categories of strategies differed according to the source. Substance substitution was substantially less frequently discussed by consumers than professionals and few professional sites acknowledged or advised strategies to manage the struggle of maintaining readiness following a change attempt. Hundreds of individual strategies are discussed or promoted in online settings, and more information is needed on the effectiveness of these self-initiated approaches.

The long-term effect and adherence of a low fermentable oligosaccharides disaccharides monosaccharides and polyols (FODMAP) diet in patients with irritable bowel syndrome.

BACKGROUND: Short-term trials with a low-FODMAP (fermentable oligosaccharides disaccharides monosaccharides and polyols) diet (LFD) show promising results in the symptomatic management of irritable bowel syndrome (IBS). The present study investigated the long-term adherence to an LFD diet, factors associated with adherence, and associations between LFD and quality of life (QOL), IBS symptoms and disease course on a long-term basis. METHODS: A retrospective cross-sectional study was conducted. Two hundred and thirty-four patients were enrolled from Ghent University hospital. Health-related QOL, long-term adherence to the LFD, disease course and IBS symptoms were assessed using a validated and self-developed questionnaire. RESULTS: Ninety (38.5%) patients completed the questionnaires. The median time span between the first dietary consultation and completion of the questionnaires was 99.5 weeks (approaching 2 years). The predominant disease course was mild IBS with an indolent course (43.0%). Eighty percent reported still following a diet in which certain FODMAP-rich food types are avoided. Eighty patients (88.9%) were satisfied that they follow or had followed the diet. The IBS-QOL did not differ between patients following the diet strictly and patients deviating from the diet (P = 0.669). Patients still following the LFD experienced less severe abdominal pain than patients who stopped following the diet (P = 0.044). CONCLUSIONS: The long-term adherence and satisfaction with the LFD is high in patients with IBS. Nevertheless, patients indicated that it was difficult to follow the LFD in daily life. Practical issues, social factors and the absence of symptoms were indicated as the main reasons for a drop in adherence.

Food choice motivations: Profiling low-carbohydrate, high-fat dieters.

We sought to determine the motivational profile of low-carbohydrate, high-fat (LCHF) dieters compared to other-dieter and non-dieter groups, in terms of both absolute food choice motivations (FCMs) and relative FCMs (how one motivation is prioritised against others). Participants (N = 330, 287 female, 43 male) completed a 12-scale food choice questionnaire online. Results showed that all three groups prioritised the FCM of health highly. Differences between the dietary groups (adjusting for age) showed that the "LCHF diet" and "other-diet" group rated FCM's weight control and natural content (absolute and relative motivation scores) significantly higher than those in the "no-diet" group. Whereas, FCM's price and convenience (absolute and relative motivation scores) were rated significantly lower than the "no-diet" group. Importantly, FCM Natural content was the top priority for the "LCHF diet" group, and its level of importance significantly differed from the "other-diet" group, who scored natural content significantly lower in both absolute and relative terms. In contrast, the "LCHF diet" group scored significantly lower on relative animal welfare as compared to both other groups. The pattern of both absolute and relative food choice motivation scores between each group is discussed. These results show a novel profile of differences for absolute and relative FCMs between LCHF dieters, other-dieters and non-dieters.

How Patients with IBS Use Low FODMAP Dietary Information Provided by General Practitioners and Gastroenterologists: A Qualitative Study.

There is a lack of dietitians trained to deliver the low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet (LFD) for irritable bowel syndrome (IBS). Many patients receive nutritional information from general practitioners (GPs) or gastroenterologists (GEs). Since the LFD is dietitian-led, the aim of this research was to qualitatively explore the effects of GP- and GE-delivered LFD information, in IBS self-management. Semi-structured interviews were conducted in a purposive sample of 8 people with IBS (6 female), who used the LFD as their primary treatment. Interpretive Phenomenological Analysis (IPA) was used to develop themes on the lived experience of the participant's use of LFD information from GPs and GEs. This information was perceived as trustworthy but simplistic; often just "food lists" with little personalisation to meet individual needs and difficult to apply in "real life". The information required substantial interpretation and the familial and social effects of implementation were not addressed in the materials provided. Supplementary digital resources were regarded as more practical but the participants expressed concern in relation to the validity of these materials. The findings in this study support current clinical guidelines proposed by both the National Institute for Health and Care Excellence and the British Dietetic Association that the LFD should be considered a dietitian-led only intervention.

Decreasing the Consumption of Foods with Sugar Increases Their Reinforcing Value: A Potential Barrier for Dietary Behavior Change.

BACKGROUND: The Dietary Guidelines for Americans (DGA) have recommended reducing added sugar intake since its inception in 1980. Nearly 40 years later, added sugar consumption still exceeds 2015-2020 DGA recommendations among most of the population. The reinforcing value of food influences eating behaviors, and foods high in added sugars are highly reinforcing. Restricting intake of foods high in added sugars as part of a low-sugar diet may increase their reinforcing value such that reducing consumption may be difficult to maintain. If so, this would present a mechanistic barrier to making the necessary dietary changes to meet 2015-2020 DGA recommendations. PURPOSE: To determine whether the relative reinforcing value of foods high in added sugars is altered when reducing intake of all foods high in sugars. METHODS: Obese (n=19) and normal weight (n=23) men and woman who habitually consumed over 10% of their calories from added sugars completed the study. Reinforcing value of foods high in added sugars was measured via progressive ratio schedules of reinforcement before and on day 7 of a weeklong controlled feeding intervention where added sugars comprised 2.5% to 4.0% of daily calories and total sugars 7.3% to 8.6% of daily calories. RESULTS: The reinforcing value of foods high in added sugars increased (P<0.01) after consuming a diet low in total added sugars for 1 week in both obese and normal weight participants. CONCLUSION: Adhering to a low-sugar diet for 1 week increases the reinforcing value of foods high in added sugars. Future studies should examine whether consuming a diet low in added sugars, but not other sugar, increases reinforcing value of foods high in added sugars and whether high-added sugar food reinforcement returns to baseline after longer-term reductions in added sugars.

Low-FODMAP Diet Is Associated With Improved Quality of Life in IBS Patients-A Prospective Observational Study.

BACKGROUND: The low fermentable oligosaccharide, disaccharide, monosaccharide, and polyol (FODMAP) diet is effectively manages irritable bowel syndrome (IBS) symptoms. Long-term low-FODMAP studies rarely report quality of life (QoL). We aimed to determine the effect of low-FODMAP diet on long-term QoL, gastrointestinal (GI) and non-GI symptoms in IBS patients. METHODS: A prospective observational study of IBS patients referred for low-FODMAP dietary advice was performed. The primary outcome of QoL and secondary outcomes of GI symptoms, anxiety/depression, fatigue, sleep quality, and happiness were obtained at baseline, 6 weeks (T6), and 6 months (T26). RESULTS: 111 patients were recruited. 91.0%, 71.6%, and 50.5% of participants completed baseline, T6, and T26 assessments, respectively. There were significant improvements in QoL from baseline at T6 and T26 (both P < 0.001). Significant reductions were seen in GI symptoms at T6 and T26 (both P < 0.001), fatigue at T6 and T26 (both P < 0.003), and anxiety at T6 and T26 (both P < 0.007), compared with baseline. A significant reduction was seen for depression (P < 0.010) from baseline at T26, and a significant increase was seen for both happiness and vitality (both P < 0.04) from baseline at T26. There was a significant correlation between GI symptom response and change in QoL, anxiety, depression, and fatigue (all P < 0.034). CONCLUSION: Low-FODMAP diet was associated with improved long-term QoL and GI symptoms, reduced fatigue and anxiety/depression, and increased happiness and vitality. These data support a wider range of benefits for IBS patients consuming a low-FODMAP diet.

Adherence with a low-FODMAP diet in irritable bowel syndrome: are eating disorders the missing link?

OBJECTIVES: The low-FODMAP diet has emerged as an option for the treatment of irritable bowel syndrome (IBS). This diet is very restrictive, and compliance is usually low. Preliminary findings suggest an association between eating disorders (EDs) and the risk of developing IBS. The aim of this study was to assess the correlation between compliance with a low-FODMAP diet and the risk of ED behaviours among patients with IBS. PATIENTS AND METHODS: A single-centre prospective study was carried out among 233 IBS patients (79.8% females) at University College London Hospital, who commenced a low FODMAPs group programme for IBS (Rome III or IV). Self-reported diet adherence at the end of the 6-week programme was measured. At baseline, and at the 6-week follow-up visit, participants completed the validated IBS-Symptom Severity Score, the SCOFF ED screening questionnaire and the Hospital Anxiety and Depression Scale. RESULTS: Adherence with a low-FODMAP diet was found in 95 (41%) patients. Overall, 54 (23%) patients were classified to be at risk for ED behaviour. Adherence was 57% in the ED group (31/54) versus 35% in the non-ED group (64/179); P<0.05. Adherence with a low-FODMAP diet was highest (51%) in the IBS with diarrhoea subtype and lowest (10%) in IBS with constipation. There was no significant correlation between IBS-Symptom Severity Score and either adherence (P=0.39) or ED behaviour (P=0.28). CONCLUSION: In this IBS cohort, greater adherence to a low-FODMAP diet is associated with ED behaviour. The implications of our study are important in clinical practice for a clinician to have a high index of suspicion of EDs in IBS patients when a high level of low-FODMAP diet achieved.

Nutritional, microbiological and psychosocial implications of the low FODMAP diet.

Dietary restriction of certain fermentable carbohydrates (low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet) is effective for managing symptoms of irritable bowel syndrome (IBS). However, there are potential consequences of this diet that relate to its impact on nutritional, microbiological, and health-related quality of life outcomes. Evidence suggests that the low FODMAP diet leads to some alterations in nutrient intake. For example, carbohydrate intake is reduced, and there is a decrease in the proportion of patients meeting the recommended intake for calcium. Intake of other macro and micro-nutrients appears to be adequate in the short term. As well as the impact on nutrient intake, extensive dietary modification can have a pronounced impact on the gastrointestinal microbiota. Indeed, recent data suggests the diet markedly reduces luminal Bifidobacteria concentration, and there is limited evidence that it reduces total bacteria abundance and concentration of other bacterial groups, for example, Faecalibacterium prausnitzii. Finally, despite the evidence for its clinical effectiveness in patients with IBS, the restrictive nature of the diet could pose a significant burden on patients, thereby limiting improvements, or indeed worsening health-related quality of life. In conclusion, while robust evidence supports the clinical effectiveness of the low FODMAP diet, it is important, considering the likelihood of its continued widespread use in IBS and other functional bowel disorders, that we extend our understanding of the impact of the diet on endpoints that may have potential consequences for long term health.

Weight Loss: A Patient and Physician's Perspective.

This article, co-authored by a patient affected by obesity and an obesity medicine specialist, discusses the patient's experience of living with the disease and using many different weight loss approaches until finding a lifestyle program that was appropriate for her metabolism. The physician discusses the scientific basis of insulin resistance, and why the chosen lifestyle program worked so well for this individual.

The social construction of competence: Conceptions of science and expertise among proponents of the low-carbohydrate high-fat diet in Finland.

The article looks at conceptions of science and expertise among lay proponents of the low-carbohydrate high-fat diet in Finland. The research data consist of comments on a webpage related to a debate on the health dangers of animal fats screened in Finnish national television in autumn 2010. The article shows that contrary to the prevailing image advocated by the national nutritional establishment, which is based on the deficit model of public understanding of science, the low-carbohydrate high-fat proponents are neither ignorant about scientific facts nor anti-science. Rather, they express nuanced viewpoints about the nature of science, the place of individual experience in nutritional recommendations and the reliability of experts. Inspired by discussions on the social construction of ignorance, the article argues that the low-carbohydrate high-fat proponents are engaged in what it callsthe social construction of competencewhen they present their position as grounded in science and stylize themselves as lay experts.

From 'pleasure to chemistry': the experience of carbohydrate counting with and without carbohydrate restriction for people with Type 1 diabetes.

INTRODUCTION: Matching carbohydrate intake with insulin dosage is recommended management for people with Type 1 diabetes. However, international interest in restricted carbohydrate diets is growing. General practitioners and practice nurses need to know how to advise people with Type 1 diabetes regarding low-carbohydrate diets. This study aimed to explore the carbohydrate counting experiences of people with Type 1 diabetes in a trial with and without a diet restricted to 75 g of carbohydrate per day. METHODS: Eight participants were interviewed by focus group or interview 12 weeks after a carbohydrate counting course with individual dietary choice or the same course with information on restricted carbohydrate eating and a daily maximum intake of 75 g of carbohydrate. Data were analysed using a qualitative thematic analysis approach. FINDINGS: Themes included the need for insulin management skills, impact of the dietary experience, and need for dietary knowledge. The restricted-carbohydrate group encountered mealtime insulin resistance and difficulty managing insulin dosages when transitioning on and off the low-carbohydrate diet. The diet impacted on mood, feelings of satiety and it was reported that food changed from being 'a pleasure to chemistry'. Both groups described feeling empowered to manage their diabetes as a result of the carbohydrate counting course. CONCLUSION: Participants reported increased knowledge and challenging insulin management. The restricted-carbohydrate group reported mealtime insulin resistance and a strong dietary impact. Extra health professional support may be required, especially at dietary transition periods. More research is warranted into the reported mealtime insulin resistance.

Changes in endothelial function and depression scores are associated following long-term dietary intervention: a secondary analysis.

OBJECTIVE: Cross-sectional studies show associations between depression and endothelial function (as measured by endothelium-dependent brachial artery flow-mediated dilatation [FMD]); but it is not known whether changes in these parameters are associated following dietary management. We have previously reported that compared with consumption of a high-carbohydrate (HC) diet, despite comparable weight loss, a very low-carbohydrate (LC diet) impaired FMD and increased depression. The purpose of this study was to conduct a secondary analysis to examine whether there was an association between changes in FMD and depression. METHODS: Forty-seven overweight men and women (body mass index 26-43 kg/m(2) and ages 24-64 y) completed a 12-mo randomized controlled trial during which participants consumed either an energy-restricted, isocaloric LC or HC diet. Weight, body composition, Homeostasis Assessment of Insulin Resistance (HOMA), depression (Beck Depression Inventory [BDI]), Anxiety (Spielberger State-Trait Anxiety Inventory [STAI]) and FMD were assessed before and after the intervention. This secondary analysis focused on multiple regression analysis of these parameters. RESULTS: Changes in BDI were independently predicted by changes in FMD (ß = -0.356; P = 0.026) but not by diet intervention assignment or changes in weight or HOMA. No variables were significant predictors of the change in STAI. CONCLUSIONS: Over time, impairments in FMD were independently associated with increased depression, independent of diet composition, or changes in weight and insulin resistance. This data supports a mechanistic association between depression and endothelial function, which may influence long-term health.

Change in food cravings, food preferences, and appetite during a low-carbohydrate and low-fat diet.

The study objective was to evaluate the effect of prescribing a low-carbohydrate diet (LCD) and a low-fat diet (LFD) on food cravings, food preferences, and appetite. Obese adults were randomly assigned to a LCD (n = 134) or a LFD (n = 136) for 2 years. Cravings for specific types of foods (sweets, high-fats, fast-food fats, and carbohydrates/starches); preferences for high-sugar, high-carbohydrate, and low-carbohydrate/high-protein foods; and appetite were measured during the trial and evaluated during this secondary analysis of trial data. Differences between the LCD and LFD on change in outcome variables were examined with mixed linear models. Compared to the LFD, the LCD had significantly larger decreases in cravings for carbohydrates/starches and preferences for high-carbohydrate and high-sugar foods. The LCD group reported being less bothered by hunger compared to the LFD group. Compared to the LCD group, the LFD group had significantly larger decreases in cravings for high-fat foods and preference for low-carbohydrate/high-protein foods. Men had larger decreases in appetite ratings compared to women. Prescription of diets that promoted restriction of specific types of foods resulted in decreased cravings and preferences for the foods that were targeted for restriction. The results also indicate that the LCD group was less bothered by hunger compared to the LFD group and that men had larger reductions in appetite compared to women.