Increasing the intake of one nutrient and reducing that of another has always been our strategy for promoting weight loss, lower diabetes and likewise. Macronutrients, fats, carbohydrates and proteins, have been played around with for decades now to introduce individuals to the best means to achieve their goals. In this regard, weight loss has been the most sought-after end result with altered nutrient intakes. Though the results might satisfy us the side effects are not clearly understood. Metabolic diseases have developed into one of the major problems affecting individuals across the world. Diet, especially diet quantity, plays a major role in designating risk factors associated with metabolic diseases but timing and macronutrient composition of food intake are seeking more attention as critical factors contributing towards metabolic health.
Researchers have tried and are still trying to come up with the best carbohydrate-fat combination that could work best on individuals. The low carbohydrate-high fat (LCHF) diet combination has been in existence but became extremely popular since the revolutionization of the Atkins Diet in 1972. There are supporters and haters for this diet plan: supporters call it an aid for treating type 2 diabetes mellitus (T2DM), obesity and metabolic syndrome while haters find it in contrast to the low fat-high carbohydrate (LFHC) diet that’s recommended to reduce the risk of cardiovascular disease. If you notice, there has been a steady rise in carbs intake which is directly linked to obesity and metabolic syndrome (MetS) that is potential enough to increase total mortality rates. Such high carbohydrate intake stimulates insulin secretion accommodating fat storage thereby restricting adipose tissue lipolysis and fatty acid oxidation. This seems to convey that a high-carbohydrate (HC) intake acts as a trigger point for MetS. Fats too play an integral role in maintaining metabolic health by regulating fat oxidation without which weight gain and insulin resistance are sure to happen. Besides macronutrient quantity timing of their intake has clear effect on fuel utilization (proven by animal models). Mice fed a high fat meal for 12 weeks showed greater 24-h fat oxidation and metabolic flexibility that those fed a high-carb breakfast meal. Fat-dominant meals promoted lower body weight and body fat, greater glucose tolerance, lower insulin and lower TGs compared to carbohydrate-dominant meals. Human beings too show similar effects when timing of intake differs. Shift workers are at a greater risk of obesity, T2DM and CVD besides showing changes in resting energy expenditure, fasting carbohydrate oxidation, glucose tolerance, cortisol rhythms and reducing chances of weight loss.
We do know that a high-carb diet prevents weight gain but a high-fat diet accelerates weight loss and improves lipid profile. But we don’t have any idea about how the timing of macronutrient intake affects fuel utilization across a 24-h day. A group of researchers focused on the effects of consumption of a high-fat breakfast or a high-carbohydrate breakfast for 4 weeks to compare fuel utilization using a respiratory quotient (RQ).
Timing of Macronutrient Intake & Fuel Utilization
The study included 29 sedentary or moderately active men and women ≥55 years who were analysed for obesity, diabetes, smoking, alcohol intake, weight changes and other medical conditions. All the participants were randomly assigned into one of the two groups to receive either a fat-based (FB, n=12) or a carbohydrate-based (CB, n=17) breakfast. Individuals in the fat-based group received ∼45% of energy from fat, 20% from protein and 35% from carbohydrates during breakfast with lunch and dinner designed to be metabolically neutral with a macronutrient content of 50%, 20% and 30% energy from carbohydrates, protein and fat respectively. All the meals contained <10% saturated fats. All the participants consumed ≥1 whole egg 5d/wk during breakfast as this is an optimal choice for increasing fat content as well as providing rich nutrient contents such as proteins and likewise.
24-hour resting, sleeping and energy expenditure was measured using calorimetry during which the participants were provided meals with a macronutrient concentration of 50% of energy from carbohydrates, 20% from proteins and 30% from fat across the day. All of them were advised against strenuous physical activity before the day of the test. Body composition was measured using DXA and insulin sensitivity were measured for using glucose levels.
All the participants were around 64 years of age of which 30% were men and 20% were African Americans. All the participants belonged to the overweight category based on BMI and all of them lost weight after the 4-week intervention period: 0.50±0.8 kg in the FB group and 1.10±1.1 kg in the CB group.
The study clearly shows that a high-fat breakfast significantly impacts substrate utilization. This also shows that regularly consuming a high fat-low carbohydrate breakfast is helpful in reducing risk of chronic disease, especially in elderly people who are at a higher risk of diabetes, CVD and obesity.
Restricting Carbs Intake Improves Metabolic Syndrome
Individuals with MetS aged between 21 and 65 years were included in a study that wanted to analyse the effects of consuming a carbohydrate-restricted diet on MetS improvement. Exclusion criteria such as high total cholesterol, gastrointestinal disorder, smoking, lactose intolerance, alcohol consumption, liver or endocrine dysfunction and medication use for cholesterol or diabetes in the last 3 months were imposed before selecting the participants for study. Finally, 16 participants were included all of whom completed 3 controlled-feeding periods each lasting 4 weeks with a 2-week washout period in between diets. During the 2-week run-in period participants were fed an MC (moderate diet) to find the accurate energy expenditure required to maintain body mass. Three kinds of diet, low (LC), moderate (MC) and high (HC) diets were designed with a caloric intake base of 2500 kcal. All the foods were prepared and given to the participants, all the diet contained an optimal amount of cheese and the MC diet was planned to be similar to the standard American diet with one-third of energy from fat and one-third from carbohydrates. The MC diet was rich in potatoes, whole and processed grains and 5 servings of fruits and vegetables. The HC diet avoided fat, especially that from animal products and scaled carbs proportionally with at least 5 servings of fruits and vegetables per day. Sources of polyunsaturated fat included nuts, fatty meats and condiments.
Metabolic analysis, body composition, MRI-based fat quantification, fatty acid profiling, lipoprotein particle analysis and statistical analysis to determine the differences in outcome variables after 3 diet periods was performed. Results showed no significant changes in body mass, whole-body composition and waist circumference. MetS was evident in the form of increased abdominal adiposity and hepatic fat content. All the three diets showed no difference in visceral adipose tissue (VAT) or liver fat. Mean hepatic fat measures were 13.9% at baseline and above 5% in all but 1 person. Another person showed 26.8% fat content at baseline having the highest liver fat content and hence was removed from the study. After this, there was a trend for lower liver fat after the LC diet (9.7%) than the MC (10.1%) and HC (11.5%) diets.
At baseline, all participants had at least 3 of the 5 MetS criteria. The number of participants who met 3, 4 and5 MetS criteria include 7, 6 and 3 respectively. After 4 weeks of intervention more than 50% of those in the LC group (9 of 16) did not meet MetS criteria but only 3 of 16 in the MC and 1 of 16 in the HC group were reversed of MetS criteria. Levels of triglycerides and glucose decreased while HDL-C levels increased. Insulin resistance was lower in the LC group compared to those following the MC diet but HC diet showed no changes. BP values showed no great change but the decrease in numbers were good enough to bring the values below that required for MetS classification in 14,9 and 5 participants after the LC, MC and HC diets.
Studies Supporting the LCHF Diet
The LCHF diet has been approved by the Swedish government as a treatment method for people with type 2 diabetes and also for effective weight loss. But we do have studies showing that insulin-stimulated glucose uptake into muscles and adipose tissue improves well with weight loss when a person follows a LCHF diet. There are no evidence of weight loss in animals when they are provided with a LCHF diet but they have been proved to cause lipid accumulation in the liver which affects insulin’s ability to reduce hepatic glucose production. An overview of studies showed advantageous effects of following a LCHF diet in diabetes patients and researchers were able to observe greater weight loss in favour of greater carbohydrates restriction.
A meta-analysis by Mansoor et al. on 11 randomized controlled studies showed that participants experienced a greater decrease in body weight and triglycerides when following a LCHF diet but there were also increased LDL levels observed in these individuals. Two other reviews concluded that LCHF diets had short-term benefits on diabetes management and weight loss but their long-term benefits have not yet been studied.
A High-fat Compared with a High-Carbohydrate Breakfast Enhances 24-hour Fat Oxidation in Older Adults: https://academic.oup.com/jn/article/148/2/220/4913034
Dietary Carbohydrate Restriction Improves Metabolic Syndrome Independent of Weight Loss: https://insight.jci.org/articles/view/128308
Overweight and Diabetes Prevention: Is a Low-carbohydrate—High-fat Diet Recommendable? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5959976/
Low-carbohydrate High-Fat Diet: Evidence of its Benefits: https://www.intechopen.com/books/diabetes-food-plan/low-carbohydrate-high-fat-lchf-diet-evidence-of-its-benefits
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