This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (169)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in JAMA  Topic Collections  • Nutritional and Metabolic Disorders  • Nutrition/ Malnutrition  • Obesity  • Review  • Alert me on articles by topic  Social Bookmarking   What's this?

A Systematic Review

Dena M. Bravata, MD, MS; Lisa Sanders, MD; Jane Huang, MD; Harlan M. Krumholz, MD, SM; Ingram Olkin, PhD; Christopher D. Gardner, PhD; Dawn M. Bravata, MD

JAMA. 2003;289:1837-1850.

Context  Low-carbohydrate diets have been popularized without detailed evidence of their efficacy or safety. The literature has no clear consensus as to what amount of carbohydrates per day constitutes a low-carbohydrate diet.

Objective  To evaluate changes in weight, serum lipids, fasting serum glucose, and fasting serum insulin levels, and blood pressure among adults using low-carbohydrate diets in the outpatient setting.

Data Sources  We performed MEDLINE and bibliographic searches for English-language studies published between January 1, 1966, and February 15, 2003, with key words such as low carbohydrate, ketogenic, and diet.

Study Selection  We included articles describing adult, outpatient recipients of low-carbohydrate diets of 4 days or more in duration and 500 kcal/d or more, and which reported both carbohydrate content and total calories consumed. Literature searches identified 2609 potentially relevant articles of low-carbohydrate diets. We included 107 articles describing 94 dietary interventions reporting data for 3268 participants; 663 participants received diets of 60 g/d or less of carbohydrates—of whom only 71 received 20 g/d or less of carbohydrates. Study variables (eg, number of participants, design of dietary evaluation), participant variables (eg, age, sex, baseline weight, fasting serum glucose level), diet variables (eg, carbohydrate content, caloric content, duration) were abstracted from each study.

Data Extraction  Two authors independently reviewed articles meeting inclusion criteria and abstracted data onto pretested abstraction forms.

Data Synthesis  The included studies were highly heterogeneous with respect to design, carbohydrate content (range, 0-901 g/d), total caloric content (range, 525-4629 kcal/d), diet duration (range, 4-365 days), and participant characteristics (eg, baseline weight range, 57-217 kg). No study evaluated diets of 60 g/d or less of carbohydrates in participants with a mean age older than 53.1 years. Only 5 studies (nonrandomized and no comparison groups) evaluated these diets for more than 90 days. Among obese patients, weight loss was associated with longer diet duration (P = .002), restriction of calorie intake (P = .03), but not with reduced carbohydrate content (P = .90). Low-carbohydrate diets had no significant adverse effect on serum lipid, fasting serum glucose, and fasting serum insulin levels, or blood pressure.

Conclusions  There is insufficient evidence to make recommendations for or against the use of low-carbohydrate diets, particularly among participants older than age 50 years, for use longer than 90 days, or for diets of 20 g/d or less of carbohydrates. Among the published studies, participant weight loss while using low-carbohydrate diets was principally associated with decreased caloric intake and increased diet duration but not with reduced carbohydrate content.

Author Affiliations: Center for Primary Care and Outcomes Research, Stanford University School of Medicine (Drs Dena Bravata and Huang), Department of Statistics (Dr Olkin), School of Education (Dr Olkin), and Stanford Center for Research in Disease Prevention (Dr Gardner), Stanford University, Stanford, Calif; California Pacific Medical Center, San Francisco, Calif (Dr Dena Bravata); Department of Internal Medicine (Dr Sanders) and Robert Wood Johnson Clinical Scholars Program (Drs Krumholz and Dawn Bravata), Yale University School of Medicine, New Haven, Conn; and Clinical Epidemiology Research Center, Veterans Affairs Connecticut Healthcare System, West Haven, Conn (Dr Dawn Bravata).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

Low-Carbohydrate Diets and Realities of Weight Loss
George A. Bray
JAMA. 2003;289(14):1853-1855.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Low-Fat Versus Low-Carbohydrate Weight Reduction Diets: Effects on Weight Loss, Insulin Resistance, and Cardiovascular Risk: A Randomized Control Trial
Bradley et al.
Diabetes 2009;58:2741-2748.
ABSTRACT | FULL TEXT  

One-year weight maintenance after significant weight loss in healthy overweight and obese subjects: does diet composition matter?
Delbridge et al.
Am. J. Clin. Nutr. 2009;90:1203-1214.
ABSTRACT | FULL TEXT  

Biomarkers of Dietary Energy Restriction in Women at Increased Risk of Breast Cancer
Ong et al.
Cancer Prevention Research 2009;2:720-731.
ABSTRACT | FULL TEXT  

High Protein Intake Associates with Cardiovascular Events but not with Loss of Renal Function
Halbesma et al.
J. Am. Soc. Nephrol. 2009;20:1797-1804.
ABSTRACT | FULL TEXT  

Influence of Fat and Carbohydrate Proportions on the Metabolic Profile in Patients With Type 2 Diabetes: A Meta-Analysis
Kodama et al.
Diabetes Care 2009;32:959-965.
ABSTRACT | FULL TEXT  

Themed Review: Lifestyle Treatment of the Metabolic Syndrome
Janiszewski et al.
AMERICAN JOURNAL OF LIFESTYLE MEDICINE 2008;2:99-108.
ABSTRACT  

Long-term effects of a high-protein weight-loss diet
Clifton et al.
Am. J. Clin. Nutr. 2008;87:23-29.
ABSTRACT | FULL TEXT  

Differential long-term dietary regulation of adipokines, ghrelin, or corticosterone: impact on adiposity
Beck and Richy
J Endocrinol 2008;196:171-179.
ABSTRACT | FULL TEXT  

Nutrition Review: Dietary Considerations for Obesity Treatment
Melanson
AMERICAN JOURNAL OF LIFESTYLE MEDICINE 2007;1:433-436.
ABSTRACT  

Recommendations for Treatment of Child and Adolescent Overweight and Obesity
Spear et al.
Pediatrics 2007;120:S254-S288.
ABSTRACT | FULL TEXT  

Is there a role for low carbohydrate diets in the management of type 2 diabetes?
Worth and Soran
QJM 2007;100:659-663.
FULL TEXT  

Low-carbohydrate nutrition and metabolism
Westman et al.
Am. J. Clin. Nutr. 2007;86:276-284.
ABSTRACT | FULL TEXT  

Portion Control Plate for Weight Loss in Obese Patients With Type 2 Diabetes Mellitus: A Controlled Clinical Trial
Pedersen et al.
Arch Intern Med 2007;167:1277-1283.
ABSTRACT | FULL TEXT  

Review: Drug treatments for obesity: where are we heading and how do we get there?
Sonnenberg et al.
British Journal of Diabetes & Vascular Disease 2007;7:111-117.
ABSTRACT  

2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children [summary]
Lau et al.
CMAJ 2007;176:S1-S13.
FULL TEXT  

Lignes directrices canadiennes de 2006 sur la prise en charge et la prevention de l'obesite chez les adultes et les enfants [sommaire]
Lau et al.
CMAJ 2007;176:SF1-SF14.
FULL TEXT  

Comparison of the Atkins, Zone, Ornish, and LEARN Diets for Change in Weight and Related Risk Factors Among Overweight Premenopausal Women: The A TO Z Weight Loss Study: A Randomized Trial
Gardner et al.
JAMA 2007;297:969-977.
ABSTRACT | FULL TEXT  

Perilipin Gene Variation Determines Higher Susceptibility to Insulin Resistance in Asian Women When Consuming a High-Saturated Fat, Low-Carbohydrate Diet.
Corella et al.
Diabetes Care 2006;29:1313-1319.
ABSTRACT | FULL TEXT  

Effects of Low-Carbohydrate vs Low-Fat Diets on Weight Loss and Cardiovascular Risk Factors: A Meta-analysis of Randomized Controlled Trials.
Nordmann et al.
Arch Intern Med 2006;166:285-293.
ABSTRACT | FULL TEXT  

Effects of variation in protein and carbohydrate intake on body mass and composition during energy restriction: a meta-regression 1
Krieger et al.
Am. J. Clin. Nutr. 2006;83:260-274.
ABSTRACT | FULL TEXT  

Ketoacidosis during a Low-Carbohydrate Diet
Shah and Isley
NEJM 2006;354:97-98.
FULL TEXT  

Diet in the management of weight loss
Strychar
CMAJ 2006;174:56-63.
ABSTRACT | FULL TEXT  

Low-glycemic-index treatment: A liberalized ketogenic diet for treatment of intractable epilepsy
Pfeifer and Thiele
Neurology 2005;65:1810-1812.
ABSTRACT | FULL TEXT  

A Popular Diets Project
Powers
Diabetes Spectr. 2005;18:251-256.
FULL TEXT  

Diets and Cardiovascular Disease: An Evidence-Based Assessment
Parikh et al.
J Am Coll Cardiol 2005;45:1379-1387.
ABSTRACT | FULL TEXT  

Effects of an ad libitum low-glycemic load diet on cardiovascular disease risk factors in obese young adults
Ebbeling et al.
Am. J. Clin. Nutr. 2005;81:976-982.
ABSTRACT | FULL TEXT  

Pharmacologic and Surgical Management of Obesity in Primary Care: A Clinical Practice Guideline from the American College of Physicians
Snow et al.
ANN INTERN MED 2005;142:525-531.
ABSTRACT | FULL TEXT  

Candidate Metabolic Network States in Human Mitochondria: IMPACT OF DIABETES, ISCHEMIA, AND DIET
Thiele et al.
J. Biol. Chem. 2005;280:11683-11695.
ABSTRACT | FULL TEXT  

Low-Carbohydrate Diets, Con: The Mythical Phoenix or Credible Science?
Kushner
Nutr Clin Pract 2005;20:13-16.
ABSTRACT | FULL TEXT  

One Size Does Not Fit All
Hendry
DOC News 2005;2:14-15.
FULL TEXT  

Helping Women Lose Weight
JWatch Women's Health 2005;2005:4-4.
FULL TEXT  

Case Study: Man With Type 2 Diabetes and Stage 1 Kidney Disease on Atkins-Like Diet
Thomas-Dobersen and Casey
Clin. Diabetes 2005;23:46-48.
FULL TEXT  

Is a calorie a calorie? Biologically speaking, no
Manninen
Am. J. Clin. Nutr. 2004;80:1445-1445.
FULL TEXT  

Weighing the Risks: the Use of Low-Carbohydrate Diets During Lactation
Heinig and Doberne
J Hum Lact 2004;20:283-285.
 

High-Protein Low-Carbohydrate Diets Enhance Weight Loss in Dogs
Bierer and Bui
J. Nutr. 2004;134:2087S-2089S.
FULL TEXT  

The Pediatric Obesity Epidemic: Causes and Controversies
Slyper
J. Clin. Endocrinol. Metab. 2004;89:2540-2547.
ABSTRACT | FULL TEXT  

The diet-heart hypothesis: a critique
Weinberg
J Am Coll Cardiol 2004;43:731-733.
ABSTRACT | FULL TEXT  

Cardiovascular Disease Resulting From a Diet and Lifestyle at Odds With Our Paleolithic Genome: How to Become a 21st-Century Hunter-Gatherer
O'Keefe and Cordain
Mayo Clin Proc. 2004;79:101-108.
ABSTRACT  

ADDITIONAL ARTICLES ABSTRACTED IN ACP JOURNAL CLUB
Evid. Based Med. 2003;8:163-163.
FULL TEXT  

OTHER ARTICLES NOTED (25 Apr 2003 to 18 Jul 2003)
Evid. Based Nurs. 2003;6:e1-12.
FULL TEXT  

Obesity Treatments and Controversies
Kazaks and Stern
Diabetes Spectr. 2003;16:231-235.
ABSTRACT | FULL TEXT  

Insufficient Evidence to Recommend Low-Carb Diets
Journal Watch Cardiology 2003;2003:2-2.
FULL TEXT  

Principles and Practices in the Management of Obesity
Foster
Am. J. Respir. Crit. Care Med. 2003;168:274-280.
FULL TEXT  

Low-Carb Diets: Is the Medical Evidence For or Against?
JWatch Women's Health 2003;2003:3-3.
FULL TEXT  

Diet, Obesity, and Cardiovascular Risk
Bonow and Eckel
NEJM 2003;348:2057-2058.
FULL TEXT  

News About Obesity from JAMA
JWatch General 2003;2003:6-6.
FULL TEXT  

Low-Carbohydrate Diets and Realities of Weight Loss
Bray
JAMA 2003;289:1853-1855.
FULL TEXT