Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Milan 20132, Italy.
Nutrients. 2019 Apr 26;11(5):962. doi: 10.3390/nu11050962.
Low-carb and ketogenic diets are popular among clinicians and patients, but the appropriateness of reducing carbohydrates intake in obese patients and in patients with diabetes is still debated. Studies in the literature are indeed controversial, possibly because these diets are generally poorly defined; this, together with the intrinsic complexity of dietary interventions, makes it difficult to compare results from different studies. Despite the evidence that reducing carbohydrates intake lowers body weight and, in patients with type 2 diabetes, improves glucose control, few data are available about sustainability, safety and efficacy in the long-term. In this review we explored the possible role of low-carb and ketogenic diets in the pathogenesis and management of type 2 diabetes and obesity. Furthermore, we also reviewed evidence of carbohydrates restriction in both pathogenesis of type 1 diabetes, through gut microbiota modification, and treatment of type 1 diabetes, addressing the legitimate concerns about the use of such diets in patients who are ketosis-prone and often have not completed their growth.
低碳水化合物和生酮饮食在临床医生和患者中很受欢迎，但在肥胖患者和糖尿病患者中减少碳水化合物摄入的适当性仍存在争议。文献中的研究确实存在争议，可能是因为这些饮食通常定义不明确；这一点，加上饮食干预的内在复杂性，使得很难比较来自不同研究的结果。尽管有证据表明减少碳水化合物的摄入可以降低体重，并且在 2 型糖尿病患者中可以改善血糖控制，但关于长期的可持续性、安全性和疗效的数据很少。在这篇综述中，我们探讨了低碳水化合物和生酮饮食在 2 型糖尿病和肥胖发病机制和治疗中的可能作用。此外，我们还回顾了碳水化合物限制在 1 型糖尿病发病机制中的作用，通过肠道微生物群的改变，以及 1 型糖尿病的治疗，解决了在易发生酮症且经常未完成生长的患者中使用此类饮食的合理担忧。
