Asploro Journal of Biomedical and Clinical Case Reports
ISSN: 2582-0370
Article Type: Commentary
DOI: 10.36502/2023/ASJBCCR.6325
Asp Biomed Clin Case Rep. 2023 Nov 04;7(1):1-4

Beneficial and Convenient Method of Low Carbohydrate Diet (LCD) as Petite, Standard and Super LCD

Hiroshi Bando^1,2iD*, Koji Ebe^2,3
1Medical Research/Tokushima University, Tokushima, Japan
²Japan Low Carbohydrate Diet Promotion Association (JLCDPA), Kyoto, Japan
³Takao Hospital, Ukyo Ward, Kyoto, Japan

Corresponding Author: Hiroshi Bando ^{ORCID iD}
Address: Tokushima University /Medical Research, Nakashowa 1-61, Tokushima 770-0943, Japan.
Received date: 14 September 2023; Accepted date: 27 October 2023; Published date: 04 November 2023

Citation: Bando H, Ebe K. Beneficial and Convenient Method of Low Carbohydrate Diet (LCD) as Petite, Standard and Super LCD. Asp Biomed Clin Case Rep. 2023 Nov 04;7(1):1-4.

Copyright © 2023 Bando H, Ebe K. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium provided the original work is properly cited.

Keywords: Low-Carbohydrate Diet, Super-LCD, Japan LCD Promotion Association, Ketone Bodies, Mean Amplitude of Glycemic Excursions

Abbreviations: LCD: Low-Carbohydrate Diet; JLCDPA: Japan LCD Promotion Association; MAGE: Mean Amplitude of Glycemic Excursions

Abstract

For type 2 diabetes (T2D), the recommended meal has shifted from calorie restriction (CR) to a low carbohydrate diet (LCD). LCD gained worldwide prevalence through the efforts of Atkins and Bernstein, and we further developed LCD both medically and socially through the Japan LCD Promotion Association (JLCDPA). The beneficial and convenient methods of LCD include petite, standard, and super LCD, which have carbohydrate ratios of 40%, 26%, and 12%, respectively. For these three types, the approximate permitted carbohydrate amounts in each meal appear to be 20g, 30g, and 40g. Some foods with lower carbohydrate content include eggs (0.1g), a piece of cheese (0.2g), chicken meat (180g) (0.4g), and Japanese tofu (300g) (4g).

In recent years, type 2 diabetes (T2D) and obesity have become crucial problems from medical, social, and economic points of view [1]. The former standard nutritional treatment for adequate weight control in T2D was calorie restriction (CR). However, low carbohydrate diet (LCD) has been evaluated for controlling applicable body weight for some decades [2]. Historically, LCD was initiated by two well-known doctors, Atkins and Bernstein, in North American and European areas [3,4]. They have provided evidence of the clinical efficacy of LCD, and various reports have supported its satisfactory effects [5].

On the other hand, the author and collaborators initiated LCD in Japan [6]. We have spearheaded various movements in LCD through the Japan LCD Promotion Association (JLCDPA) in the medical and health care regions [7]. The fundamental evidence for LCD arises from the fact that the oral intake of carbohydrates leads to post-prandial elevation of blood glucose, a well-known aspect of glucose metabolism and basic biochemical information [8]. When 1g of carbohydrate is ingested orally, the resulting increase in glucose levels is 1mg/dL for healthy individuals, 3 mg/dL for T2D patients, and 5 mg/dL for type 1 diabetes (T1D) patients [9].

Among the various activities of JLCDPA, we have introduced three useful and convenient types of LCD methods. They are petite LCD, standard LCD, and super LCD, in which the carbohydrate amounts are included as 40%, 26%, and 12% of the calorie involvement ratio, respectively [7]. In Japan, we previously recommended a standard CR meal for T2D, which had 50-60% of carbohydrate content. This was inadequate for blood glucose control in T2D. The commonly popular diet therapy for T2D recommended 1400 kcal per day for CR. In the case of super-LCD, where 12% of the diet consists of carbohydrates, this means 1400 x 0.12 = 168 kcal of carbohydrate intake per day. When divided by 4 kcal/g of carbohydrate, super-LCD includes 42 g of carbohydrate per day in total for breakfast, lunch, and supper [10]. For reference, the general tendency of the three main nutrients and calorie content for CR, petite, standard, and super LCD can be understood from Fig-1. Super-LCD includes lower carbohydrate content and higher fat content, which can be fully tolerated by T2D patients, individuals with obesity, and in various other situations.

Fig-1: The Ratio of Three Main Nutrients and Calorie for LCD

To understand and maintain adequate LCD meals every day, several references have been prepared for patients with T2D, atherosclerotic cardiovascular diseases (ASCVDs), and non-communicable diseases (NCDs) [11]. Every meal requires some limitation of carbohydrate content, accompanied by correct information in terms of nutrition. The approximately permitted carbohydrate amounts in each meal seem to be 20g, 30g, and 40g in super, standard, and petite LCD [10]. According to each person’s lifestyle and health concerns, individuals can choose to follow either method of LCD. A simple way to continue with petite LCD would be to avoid carbohydrates in one meal out of the three meals in a day. For example, one can consume carbohydrates in breakfast and lunch, whereas they can opt for no carbohydrates in the supper.

Some recommendations are provided for starting and continuing a successful LCD. Each food has a certain amount of carbohydrate, and representative foods are highlighted in educational seminars. For example, foods with lower carbohydrate content typically include 0.1g of egg (50g), 0.2g of cheese piece (20g), 0.4g of chicken meat (180g), 4g of Japanese tofu (300g), and 8g of beans (100g) 10 (Fig-2).. When a patient begins to adopt an LCD meal, the recommended order for consuming various dishes is as follows: i) start with a salad with oily dressing, ii) intake animal meat, fish meat, or eggs for protein, iii) consume some liquids that do not contain sugar or carbohydrates, iv) avoid foods with high carbohydrate content, such as bread, rice, pasta, and others [12].

Fig-2: Recommended Some Foods with Less Carbohydrate Amount

As a matter of fact, LCD can be applied to in-patients with T2D in the hospital setting, where three meals contain fewer carbohydrates to educate about actual daily lifestyle [13]. After becoming accustomed to LCD meals apart from the previous CR meal, T2D patients usually experience reduced sensations of hunger. This is because the mean amplitude of glycemic excursions (MAGE) is consistently reduced, leading to mental stability throughout the day. The detailed definition of LCD has not been clearly established yet. However, Feinman et al. have provided guidelines for defining LCD based on carbohydrate ratio and/or amount/day in a typical daily meal [14]. They include four categories as follows: i) High carbohydrate (45%<), ii) Moderate carbohydrate (26-44%), iii) Low carbohydrate (<26%) and/or < 130 grams of carbohydrate per day, iv) very low carbohydrate (< 10% carbohydrate) and/or 20-50 grams per day.

In summary, LCD appears to demonstrate efficacy for glucose control, weight reduction, and other effects arising from hyperketonemia, such as anti-inflammatory and anti-oxidative efficacy [15]. This article serves as a hopefully valuable reference for clinical metabolism and diabetes.

Conflict of Interest

The authors have read and approved the final version of the manuscript. The authors have no conflicts of interest to declare.

Funding

There was no funding received for this paper.

References

[1] ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, Collins BS, Hilliard ME, Isaacs D, Johnson EL, Kahan S, Khunti K, Leon J, Lyons SK, Perry ML, Prahalad P, Pratley RE, Seley JJ, Stanton RC, Gabbay RA, on behalf of the American Diabetes Association. 1. Improving Care and Promoting Health in Populations: Standards of Care in Diabetes-2023. Diabetes Care. 2023 Jan 1;46(Supple 1):S10-S18. [PMID: 36507639]

[2] Pavlidou E, Papadopoulou SK, Fasoulas A, Mantzorou M, Giaginis C. Clinical Evidence of Low-Carbohydrate Diets against Obesity and Diabetes Mellitus. Metabolites. 2023 Feb 6;13(2):240. [PMID: 36837859]

[3] Bernstein RK. Dr. Bernstein’s Diabetes Solution: The Complete Guide to Achieving Normal Blood Sugars. New York, USA: Hachette Book Group; 1997. Available from: https://www.hachettebookgroup.com/titles/matt-kugler/dr-bernsteins-diabetes-solution/9781478969853/?lens=little-brown

[4] Atkins RC. Dr. Atkins’ New Carbohydrate Gram Counter. New York, USA: M. Evans and Company; 1996.

[5] Feinman RD. The biochemistry of low-carbohydrate and ketogenic diets. Curr Opin Endocrinol Diabetes Obes. 2020 Oct;27(5):261-68. [PMID: 32796164]

[6] Ebe K, Bando H. New era of diet therapy and research including Low Carbohydrate Diet (LCD). Asp Biomed Clin Case Rep. 2018;2(s1):1-3.

[7] Muneta T, Hayashi M, Nagai Y, Matsumoto M, Bando H, Ebe K, Watanabe H, Watanabe S. Ketone Bodies in the Fetus and Newborn During Gestational Diabetes and Normal Delivery. Int J Diabetes 2023;5(1):157-63.

[8] McGuinness OP. Chapter 19: Gluconeogenesis & the Control of Blood Glucose. Kennelly P.J., & Botham K.M., & McGuinness O.P., & Rodwell V.W., & Weil P(Eds.). Harper’s Illustrated Biochemistry, 32^nd ed. United States: McGraw Hill; 2023. Available from: Harper’s Illustrated Biochemistry, 32e | AccessMedicine | McGraw Hill Medical (mhmedical.com)

[9] Bando H. Type 2 Diabetes Mellitus (T2DM) may have Four Subtypes Beneficial for Adequate Treatment. Asp Biomed Clin Case Rep. 2021 Jan 21;4(1):38-41.

[10] Bando H, Ebe K, Muneta T, Bando M, Yonei Y. Clinical Effect of Low Carbohydrate Diet (LCD): Case Report. Diabetes Case Rep. 2017;2:124.

[11] Saleem SM, Bhattacharya S, Deshpande N. Non-communicable diseases, type 2 diabetes, and influence of front of package nutrition labels on consumer’s behaviour: Reformulations and future scope. Diabetes Metab Syndr. 2022 Feb;16(2):102422. [PMID: 35150963]

[12] Ebe K, Bando H, Yamamoto K, Bando M, Yonei Y. Daily carbohydrate intake correlates with HbA1c in low carbohydrate diet (LCD). J Diabetol 2019;1(1):4-9.

[13] Kusumoto T, Bando H, Hayashi K, Yasuoka E, Shibata M, Takagishi H. Actual Meal of Low Carbohydrate Diet (LCD) for Diabetic Patient Treated by Effective Imeglimin (Twymeeg). Asp Biomed Clin Case Rep. 2023 Jul 31;6(3):178-85.

[14] Feinman RD, Pogozelski WK, Astrup A, Bernstein RK, Fine EJ, Westman EC, Accurso A, Frassetto L, Gower BA, McFarlane SI, Nielsen JV, Krarup T, Saslow L, Roth KS, Vernon MC, Volek JS, Wilshire GB, Dahlqvist A, Sundberg R, Childers A, Morrison K, Manninen AH, Dashti HM, Wood RJ, Wortman J, Worm N. Dietary carbohydrate restriction as the first approach in diabetes management: critical review and evidence base. Nutrition. 2015 Jan;31(1):1-13. Erratum in: Nutrition. 2019 Jun;62:213. [PMID: 25287761]

[15] Miller VJ, Villamena FA, Volek JS. Nutritional Ketosis and Mitohormesis: Potential Implications for Mitochondrial Function and Human Health. J Nutr Metab. 2018 Feb 11;2018:5157645. [PMID: 29607218]