Kleissl-Muir Sabine, Rasmussen Bodil, Owen Alice, Zinn Caryn, Driscoll Andrea
School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia.
Centre for Quality and Patient Safety, School of Nursing and Midwifery, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia.
Front Nutr. 2022 Apr 20;9:865489. doi: 10.3389/fnut.2022.865489. eCollection 2022.
Elevated blood glucose levels, insulin resistance (IR), hyperinsulinemia and dyslipidemia the key aspects of type 2 diabetes mellitus (T2DM), contribute to the development of a certain form of cardiomyopathy. This cardiomyopathy, also known as diabetic cardiomyopathy (DMCM), typically occurs in the absence of overt coronary artery disease (CAD), hypertension or valvular disease. DMCM encompasses a variety of pathophysiological processes impacting the myocardium, hence increasing the risk for heart failure (HF) and significantly worsening outcomes in this population. Low fat (LF), calorie-restricted diets have been suggested as the preferred eating pattern for patients with HF. However, LF diets are naturally higher in carbohydrates (CHO). We argue that in an insulin resistant state, such as in DMCM, LF diets may worsen glycaemic control and promote further insulin resistance (IR), contributing to a physiological and functional decline in DMCM. We postulate that CHO restriction targeting hyperinsulinemia may be able to improve tissue and systemic IR. In recent years low carbohydrate diets (LC) including ketogenic diets (KD), have emerged as a safe and effective tool for the management of various clinical conditions such as T2DM and other metabolic disorders. CHO restriction achieves sustained glycaemic control, lower insulin levels and successfully reverses IR. In addition to this, its pleiotropic effects may present a metabolic stress defense and facilitate improvement to cardiac function in patients with HF. We therefore hypothesize that patients who adopt a LC diet may require less medications and experience improvements in HF-related symptom burden.
血糖水平升高、胰岛素抵抗（IR）、高胰岛素血症和血脂异常是2型糖尿病（T2DM）的关键方面，它们会导致某种形式的心肌病的发展。这种心肌病，也称为糖尿病性心肌病（DMCM），通常发生在没有明显冠状动脉疾病（CAD）、高血压或瓣膜疾病的情况下。DMCM包括多种影响心肌的病理生理过程，从而增加了心力衰竭（HF）的风险，并显著恶化了该人群的预后。低脂（LF）、热量限制饮食被建议作为HF患者的首选饮食模式。然而，LF饮食中的碳水化合物（CHO）含量自然较高。我们认为，在胰岛素抵抗状态下，如在DMCM中，LF饮食可能会恶化血糖控制并促进进一步的胰岛素抵抗（IR），导致DMCM患者生理和功能下降。我们推测，针对高胰岛素血症的CHO限制可能能够改善组织和全身的IR。近年来，包括生酮饮食（KD）在内的低碳水化合物饮食（LC）已成为治疗各种临床疾病（如T2DM和其他代谢紊乱）的一种安全有效的工具。CHO限制可实现持续的血糖控制、降低胰岛素水平并成功逆转IR。除此之外，其多效性作用可能提供代谢应激防御，并有助于改善HF患者的心脏功能。因此，我们假设采用LC饮食的患者可能需要更少的药物治疗，并在HF相关症状负担方面有所改善。
