Low carb

from Wikipedia, the free encyclopedia
Pie charts showing the composition of various nutritional concepts:
typical western diet (corresponds to the DGE recommendation with approx. 50% carbohydrate content); the Atkins diet in its introductory phase; Ketogenic diet with 4: 1 ratio of fat to carbohydrates / protein; Medium-chain triglycerides (MCT) ketogenic diet.
Percentages in the graphs (carbs, proteins, fat, MCT fat): Normal: 50, 15, 35, 0; Atkins: 5, 35, 59, 0; Classic ketogenic: 1.6, 8.4, 90, 0; MCT ketogenic: 19, 10, 11, 60.

The term carbohydrate minimization or low-carb (from English carb , abbreviation for carbohydrates 'carbohydrates') describes various forms of nutrition or diets in which the proportion of carbohydrates in the daily diet is reduced. Motivation is often a desired weight reduction , as a therapy for a metabolic disease or as a general form of nutrition with hoped-for positive prophylactic health effects .

The daily meals consist mainly of vegetables, dairy products, fish and meat, with fats and proteins replacing the carbohydrates that are lost. The recommended energy intake through carbohydrates, compared to a typical western diet with about 50% share, varies greatly depending on the form of the low-carb diet , from the ketogenic diet , in which the proportion can be theoretically reduced to zero, to forms which only recommend small reductions.

Studies have shown that prolonged low-carbohydrate (<40%) low-carb and high-carbohydrate diets (> 70%) are associated with increased mortality . Diets high in carbohydrates were found to increase your risk of infection. Mortality is minimized if the energy intake is made up of 50–55% carbohydrates, although diets free of fiber are also not beneficial to health.

effect

The cells of the human body are supplied with energy by simple sugars such as glucose and fructose in the blood. These sugars can also be ingested directly with food. Carbohydrates, which are made up of longer chains, such as those found in cereals or potatoes, can be very easily (but not very quickly) converted into usable simple sugars by the digestive system.

If not enough carbohydrates are taken in with food, the metabolism changes towards catabolism . In this state, the organism in the liver uses acetyl-CoA to generate the body's own energy carriers from the fat reserves , the so-called ketones , which it makes available to its cells as alternative energy suppliers.

In this way, the body is forced to use its own fat reserves as an energy supplier, which leads to weight loss. The change in metabolism is initiated by a drop in the insulin level so that the typical anabolic insulin effects no longer occur. Instead, more glucagon is released, whereby the energy stores ( glycogen , fats etc.) are attacked and broken down.

development

The principle of the low-carbohydrate diet dates back to the 19th century and was first made known by the Englishman William Banting (1797–1878) through his book Letter on Corpulence , which has been translated into several languages. The very meat-based diet was prescribed for him by his doctor for weight loss, and he said he lost 23 kg with it within a year. This diet was also known in Germany as the Banting cure at the end of the 19th century . The Göttingen doctor Wilhelm Ebstein also recommended a “meat-fat diet” and largely avoiding carbohydrates in the 19th century. The French restaurateur Jean Anthelme Brillat-Savarin also took the view that the starch in bread and flour in particular makes you fat. Wolfgang Lutz, an Austrian doctor (see Lutz diet ), limited his daily carbohydrate intake to 72 grams (6 BE ) from the spring of 1958  , which, according to his own statements, improved his health. In 1967 he published his book "Leben ohne Brot", which was initially little noticed. The low-carb diet became popular again in the 1970s with the Atkins diet published by Robert Atkins , a US doctor . Atkins reviewed and reevaluated research from the 1950s. A variant of the low-carb diet are diets that include the glycemic index (e.g. Logi method ).

Theories and approaches

The low-carb advocates assume that a diet with a high proportion of carbohydrates generally has negative effects on health and favors the development of so-called lifestyle diseases and is more likely to lead to obesity than a low-carbohydrate diet. One of the basic ideas behind it is the concept of a person who is genetically only partially adapted to the carbohydrate-heavy diet with grain products , which was available with the appearance of arable farming around 10,000 years ago. It is postulated that humans are physiologically better adapted to the nutritional composition of a hunter's and gatherer culture with a lot of fat and protein and few short-chain carbohydrates, which also led to the recommendation of a so-called Stone Age diet .

Carbohydrate metabolism

In the picture, the fluctuations in blood sugar (red) and the blood sugar-controlling hormone insulin (blue) in healthy people over the course of the day with three meals. The influence of a sugary meal (dashed line) versus a starchy meal (solid line) is also shown.

As one of the relevant physiological mechanisms of action of the ingested carbohydrates on the human metabolism , the influence on the blood sugar level is mentioned by low-carb representatives . When you consume carbohydrates in the form of certain simple sugars (such as glucose and galactose ), blood sugar levels rise rapidly and sharply. This happens because the body can immediately absorb these two simple sugars. In response to this, the pancreas secretes more of the hormone insulin in order to keep the sugar content in the normal range, since the insulin regulates the absorption of sugar for energy production and storage in the various body cells.

Carbohydrates are also not an essential part of food, as the body can produce them in gluconeogenesis using energy from other food components such as proteins and glycerine . The daily glucose requirement of an adult person is approximately 160 g, of which the brain alone requires 120 g , in contrast to the ability of the liver to synthesize approximately 180 to 200 g glucose daily. Accordingly, an independent human disease caused by a lack of carbohydrates is also unknown.

body weight

It is also assumed that if the blood sugar level is already high enough due to the intake of certain carbohydrates, the body no longer has to break down existing fat reserves. Low-carbohydrate diets try to keep this insulin release as low as possible and to stimulate the body's energy supply through body fat ( ketosis ), which then leads to the breakdown of the body's fat reserves. The mechanism behind this is the adipogenic effect of insulin, the only hormone in the human body that builds up body fat and ensures that the fat remains in the depots.

Some low-carb advocates assume that if the food supply is temporarily lost due to circumstances or situation-related, the consequences are less dramatic, because one is already used to the utilization of fat through the high-fat diet and it is therefore easier to do that in sufficient quantities Utilize the amount of existing body fat.

Another mechanism of action for weight loss through low-carb diets could be a stronger or earlier feeling of satiety , which is triggered by the higher protein content in the diet, as studies suggest. Scientists working with Rachel L. Batterham were able to show that peptide tyrosyl tyrosine (PYY) is released when protein is absorbed by the body.

diabetes

An explanatory model states that either too often excessively high glucose levels or too rapid changes in glucose levels, due to the high (short-chain) carbohydrate content of a typical Western diet, leads to overload and adaptation of the carbohydrate metabolism. On the one hand, a stressed pancreas is assumed, with a long-term failure of the insulin secretion functionality. It is also postulated that frequent, strong insulin release by the body leads to insulin resistance in the long term , an adaptation of some body cells with a reduced reaction to insulin.

Reduced insulin secretion (absolute insulin deficiency) and insulin resistance (first hyperinsulinism , later relative insulin deficiency) can be partial aspects of type 2 diabetes with too much sugar in the bloodstream.

Forms of low carb diets

The dietary rules of the various low-carb representatives are inconsistent and sometimes differ greatly from one another. At the beginning, the Atkins diet almost completely dispenses with carbohydrates , while with some (for example the Logi method ) only the intake of carbohydrates with a high glycemic index should be avoided. The line between low-carb and ketogenic diets is not clearly defined; it is between 30 and 50 g of carbohydrates per day.

Limiting the daily amount of carbohydrates

In this variant, the amount of carbohydrates is limited, for example to a maximum of 70 to 110 g per day, although the exact amount can be different for everyone ( Atkins diet ). Six bread units are recommended for the Lutz diet .

For Wolfgang Lutz, Jan Kwasniewski, A. Felix the composition of the food consists mainly of animal foods. The fuel carbohydrate is replaced by the fuel fat. Products with sugar and starch should largely be left out.

Observe the glycemic index or the glycemic load

This type of low-carb diet not only looks at the amount of carbohydrates, but also at the rate at which they increase blood sugar.

Lange was sorted according to the size of the carbohydrate molecule: a distinction was made between monosaccharides (simple sugars) and polysaccharides (multiple sugars). In the meantime, however, carbohydrates are rated according to the glycemic index (GI) in order to find out how quickly a food increases the blood sugar level (see GI list ).

The reason for paying attention to the speed of the blood sugar rise is the fact that a rapid rise in the blood sugar level leads to a strong release of insulin , which is why the blood sugar level falls again quickly. That way you get hungry faster, so the theory goes.

Recently, the glycemic load (GL) has been used more and more instead of the glycemic index , as it more accurately reflects the actual load on the human body (see there).

Overview of the low-carb nutrition concepts

  • The goal of the anabolic diet is to maintain or increase the body's own muscle mass despite fat loss. It is also based on the guidelines of the Atkins diet.
  • The Atkins diet hardly allows carbohydrates in the beginning and is very rich in fat and protein.
  • In the first phase of the Dukan diet , carbohydrates are almost completely avoided, in the second phase only vegetables with a low percentage of carbohydrates are allowed.
  • The Glyx diet , which is based on the lowest possible glycemic index, differentiates between “good” and “bad” carbohydrates based on their effect on the blood sugar level. Glyx Diet is based on vegetables, fruits and whole grain products with a Glyx value of less than 50.
  • The name of the Hollywood diet is derived from the familiar environment of the film studios. This is also an extremely protein-rich diet.
  • The LCHF (low-carb high-fat) diet reduces carbohydrates to a minimum (typically 0–50 g / day) and balances the missing amount of food with natural fat (e.g. animal fat such as butter, fatty meat, nuts, avocados ) and low-carbohydrate vegetables (e.g. cauliflower, broccoli, spinach, lettuce). The amount of protein remains moderate. LCHF aims to use foods that are as natural as possible without artificial additives (sweeteners, etc.) and to use oils and fats that cause the lowest possible inflammatory reaction in the body. LCHF is particularly widespread in Sweden, where the LCHF approach is implemented by more than 20% of the population. In South Africa, LCHF is also known as the Banting diet. With less than 20 g of carbohydrates per day, LCHF is ketogenic .
  • The Logi method according to Nicolai Worm is mainly based on GI / GL. It is based on meat, fish, vegetables, fruit and oils. The diet is very rich in protein.
  • The Lutz diet limits the carbohydrates to 6  BE .
  • The paleo diet (also stone age diet ) is a form of nutrition as practiced by the stone age people. The food supply that our ancestors had available over 10,000 years ago is used.
  • The ketogenic diet , medically induced therapy method , mainly used in children with pharmacoresistant epilepsy , glucose transport disorder ( e.g. GLUT1 deficit syndrome ) and pyruvate dehydrogenase deficiency .
  • The Montignac method is based on the GI, does not limit the amount of carbohydrates and is a form of food combining . The fat content is a maximum of 30%.
  • The New York Diet , developed by the American personal trainer and nutritionist David Kirsch and therefore also known as the David Kirsch Diet, allows carbohydrates from fruits, vegetables and pulses, but largely prohibits starchy side dishes such as pasta, rice, potatoes, Bread and sugar. This crash diet also consists of three phases, with phase 1 completely eliminating carbohydrates.
  • The complete avoidance of high-carbohydrate foods while proteins act as the main energy source is known as No Carb .
  • The South Beach Diet by Arthur Agatston also based on the GI. Here, low-carbohydrate and low-fat diets are combined. With this protein-based diet, we recommend three meals a day, each with a source of protein (fish, soy, eggs).
  • The Strunz diet is a low-carbohydrate diet and exercise program. The nutrition program is divided into three phases (vital fat burning, interval diet, continuous nutrition).

Controversy and discussion

Recommendations from authorities

The Nutrition Societies in Germany, Austria and Switzerland recommend that carbohydrates contain more than 50% of the calories in food. The European Food Safety Authority (EFSA) recommends 45-60% calories, 45-65% is recommended in the US and the WHO recommends 55-75% calories. The WHO also recommends that no more than 10% of the daily calorie intake should be sugar. Carbohydrates with a high glycemic index, such as sugar, promote excessive intake of calories and hyperphagia . Soluble carbohydrates make you feel less satiated . For long-term vigorous physical activity, an intake of 30 to 60 g per hour is recommended, for more than 2.5 hours an intake of 90 g per hour is recommended.

Studies

In April 2003 the renowned medical journal Journal of the American Medical Association (JAMA) published the first systematic data analysis from 96 relevant studies (from 2503 articles between 1966 and 2003) regarding the effectiveness and safety of low-carbohydrate diets. The result of this meta-analysis (i.e. a study that summarizes the current state of research) was the determination of insufficient data in the research to make an informed recommendation for or against low-carb diets with regard to effectiveness and safety for broader population groups, especially for the strong low-carbohydrate diets, long periods and elderly patients.

In the same journal in 2012, scientists came to the conclusion that a low-fat diet following the weight reduction of a previous diet reduced energy consumption more than a low-carbohydrate diet. Lower energy consumption would lead to faster regain of the lost weight. The underlying study was carried out with three arms over a period of four years with 21 overweight men and women between the ages of 10 and 40 at a children's clinic in Boston .

A 2004 review article in The Lancet described weight loss with low-carb diets as ineffective than low-fat, and primarily caused by water flushing and increased satiety. Studies were also requested to research the long-term effects of a low-carb diet.

A meta-analysis from 2008 in the journal Obesity Reviews in turn confirmed the effect of low-carbohydrate diets over longer periods of time, as did a comparative study in 2008 between Mediterranean, low-fat and low-carb diets.

A US study with a strain of mice with an increased genetic susceptibility (mutation of apolipoprotein E ) to arteriosclerosis showed that a "low-carb diet" resulted in increased fat deposits in the arteries and thus an increased risk of heart attack and stroke, but is one Transferability of the results to humans controversial. However, a 2010 US meta-analysis in humans showed that the amount of saturated fat in the diet had no effect on coronary heart disease (CHD) or cerebral infarction.

Like all dietary interventions, there is none that is suitable for everyone. In some studies, for example the DIRECT study, low-carb diets achieve comparable or better results than low-fat diets. Low-carb diets are also not tolerated in the long term by many, but a long-term study on children and young adults also confirms that the very low-carbohydrate ketogenic diet is harmless to health.

A comparative meta-study on the question of whether a low-carb or low-fat diet is more suitable for type 2 diabetes and against insulin resistance found better blood values ​​on average with low-carb approaches. Another study from 2012 on this subject also confirmed that the low-carb diet did better than the low-fat diet.

A recent study published in January 2013 found that people who eat high-fat dairy products have a lower risk of developing obesity than people who eat low-fat.

Criticism of low carb

Many nutritionists criticize low-carb as malnutrition, in Germany above all the German Society for Nutrition , which basically advocates a carbohydrate- focused diet, but published new guidelines in 2011 in which, under certain circumstances, “falling below the guideline value for carbohydrates is justifiable” has been. Arguments against this form of nutrition follow both from the one-sided diet due to the avoidance of carbohydrates and the related increased intake of proteins and fats as well as from the higher energy density of fats compared to carbohydrates.

Most of the points of criticism are based on epidemiological indications about connections between health and dietary fats or proteins. In randomized studies that compared low-carb diets with other approaches to weight loss (mainly low-fat diets), the points of criticism could not be substantiated. On the contrary, in addition to a greater weight reduction, there is also a better development of the risk factors for cardiovascular diseases with low-carb diets.

Carbohydrates are assigned a role in mental health, popularly spoken: "Carbohydrates make you happy". Some people who are prone to stress or who have intermittent depression can influence their mood by following a high-carbohydrate and low-protein diet, others more by avoiding food. Fish, which is also rich in protein, is also said to have a positive effect against depression.

A study published in the BMJ (British Medical Journal) in June 2012 found an increased risk of cardiovascular disease with a low-carb diet. The risk of heart attack or stroke , for example, would increase by 5 percent with 20 grams less carbohydrates and 5 grams more protein per day. The risk also increases the lower carbohydrate and protein one eats. In the context of this study, however, only women were questioned about their diet for the past 15 years, and no further statement was made about the exact diet (e.g. complete avoidance of fruit / vegetables, a lot of meat instead of other protein sources, etc.) met.

According to a study conducted in mice, prolonged ketogenic diets would lead to glucose intolerance, steatosis, cell damage, and foam cells; however, an insulin intolerance as a result of the ketogenic diet could not be proven.

A systematic review evaluated other systematic reviews of the ketogenic diet with the aim of evaluating the effectiveness of the low-carb diet for the purpose of reducing body weight in overweight adults. The methods, the quality of the studies and their significance, as well as the weight reduction achieved, were used as criteria for classifying the review articles examined. In particular, the low-quality studies showed an alleged benefit of the low-carb diet, while high-quality systematic reviews indicate little or no difference from a healthy diet that restricts energy intake. It was concluded that the study situation is insufficient and that better peer reviews and methods are needed. In conclusion, the low-carb diet for the purpose of reducing body weight in overweight adults was no more recommended than a healthy diet that limits energy intake.

literature

  • Arthur Agatston: The South Beach Diet . Knaur, Munich 2004, ISBN 3-426-66963-3 .
  • Robert C. Atkins: The New Atkins Diet. Lose weight without hunger. Goldmann, Munich 1999, ISBN 3-442-14113-3 .
  • Wolfgang Lutz: Life without bread: The scientific basis of the low-carbohydrate diet . 16th edition. Informed, 2004, ISBN 3-88760-100-9 . (from the American: Living Low Carb - The complete Guide to Long-Term Low-Carb Dieting )
  • Jan Kwasniewski: Eat optimally . Podgorski, G, 2000, ISBN 83-8753414-5 .
  • Nicolai Worm: LOGI method: happy and slim . 5th edition. Systemed, 2006, ISBN 3-927372-26-9 .
  • Michel Montignac: The Montignac Diet . 2nd Edition. Dorling Kindersley, 2005, ISBN 3-8310-1641-0 .

Web links

Individual evidence

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