How low should one go in reducing carbohydrate?

Published:November 02, 2022DOI:


      • Carbohydrate-restricted dietary patterns may improve cardiometabolic risk factors.
      • Severe carbohydrate restriction limits intake of foods with putative health benefits.
      • Recommended healthy dietary patterns can be modified to be lower in carbohydrate.
      • The quality of foods consumed is as important as quantity of macronutrients.
      • High-quality carbohydrates promote benefits within a carbohydrate-restricted diet.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Clinical Lipidology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Jayedi AZMS
        • Jabbarzadeh B
        • Hosseini Y
        • Jibril AT
        • Shahinfar H
        • Mirrafiei A
        • Hosseini F
        • Shab-Bidar S.
        Dose-dependent effect of carbohydrate restriction for type 2 diabetes management: a systematic review and dose-response meta-analysis of randomized controlled trials.
        Am J Clin Nutr. 2022; 116: 40-56
        • Kirkpatrick CF
        • Bolick JP
        • Kris-Etherton PM
        • Sikand G
        • Aspry KE
        • Soffer DE
        • et al.
        Review of current evidence and clinical recommendations on the effects of low-carbohydrate and very-low-carbohydrate (including ketogenic) diets for the management of body weight and other cardiometabolic risk factors: a scientific statement from the National Lipid Association Nutrition and Lifestyle Task Force.
        J Clin Lipidol. 2019; 13: 689-711
        • Draznin B
        • Aroda VR
        • Bakris G
        • Benson G
        • et al.
        • American Diabetes Association Professional Practice Committee; American Diabetes Association Professional Practice Committee
        Facilitating behavior change and well-being to improve health outcomes: standards of medical care in diabetes-2022.
        Diabetes Care. 2022; 45 (Suppl): S60-S82
        • Paoli A.
        Ketogenic diet for obesity: friend or foe?.
        Int J Environ Res Public Health. 2014; 11: 2092-2107
        • Adam-Perrot A
        • Clifton P
        • Brouns F.
        Low-carbohydrate diets: nutritional and physiological aspects.
        Obesity Rev. 2006; 7: 49-58
        • Feinman RD
        • Pogozelski WK
        • Astrup A
        • Bernstein RK
        • Fine EJ
        • Westman EC
        • et al.
        Dietary carbohydrate restriction as the first approach in diabetes management: critical review and evidence base.
        Nutrition. 2015; 31: 1-13
        • Choi YJ
        • Jeon SM
        • Shin S.
        Impact of a ketogenic diet on metabolic parameters in patients with obesity or overweight and with or without type 2 diabetes: a meta-analysis of randomized controlled trials.
        Nutrients. 2020; 12: 2005
        • Petersen MC
        • Vatner DF
        • Shulman GI.
        Regulation of hepatic glucose metabolism in health and disease.
        Nat Rev Endocrinol. 2017; 13: 572-587
        • Tay J
        • Thompson CH
        • Luscombe-Marsh ND
        • Wycherley TP
        • Noakes M
        • Buckley JD
        • et al.
        Effects of an energy-restricted low-carbohydrate, high unsaturated fat/low saturated fat diet versus a high-carbohydrate, low-fat diet in type 2 diabetes: a 2-year randomized clinical trial.
        Diabetes Obes Metab. 2018; 20: 858-871
        • Huntriss R
        • Campbell M
        • Bedwell C.
        The interpretation and effect of a low-carbohydrate diet in the management of type 2 diabetes: a systematic review and meta-analysis of randomised controlled trials.
        Eur J Clin Nutr. 2018; 72: 311-325
        • Nasa P
        • Chaudhary S
        • Shrivastava PK
        • Singh A.
        Euglycemic diabetic ketoacidosis: a missed diagnosis.
        World J Diabetes. 2021; 12: 514-523
        • Murdoch C
        • Unwin D
        • Cavan D
        • Cucuzzella M
        • Patel M.
        Adapting diabetes medication for low carbohydrate management of type 2 diabetes: a practical guide.
        Br J Gen Pract. 2019; 69: 360-361
        • Westman EC
        • Tondt J
        • Maguire E
        • Yancy Jr., WS
        Implementing a low-carbohydrate, ketogenic diet to manage type 2 diabetes mellitus.
        Expert Rev Endocrinol Metab. 2018; 13: 263-272
        • Dattilo AM
        • Kris-Etherton PM.
        Effects of weight reduction on blood lipids and lipoproteins: a meta-analysis.
        Am J Clin Nutr. 1992; 56: 320-328
        • Chawla S
        • Tessarolo-Silva F
        • Amaral-Medeiros S
        • Mekary RA
        • Radenkovic D
        The effect of low-fat and low-carbohydrate diets on weight loss and lipid levels: a systematic review and meta-analysis.
        Nutrients. 2020; 12
        • Gardner CD
        • Landry MJ
        • Perelman D
        • Petlura C
        • Durand LR
        • Aronica L
        • et al.
        Effect of a ketogenic diet versus mediterranean diet on hba1c in individuals with prediabetes and type 2 diabetes mellitus: the Interventional Keto-Med Randomized Crossover Trial.
        Am J Clin Nutr. 2022;
        • Goldberg IJ
        • Ibrahim N
        • Bredefeld C
        • Foo S
        • Lim V
        • Gutman D
        • et al.
        Ketogenic diets, not for everyone.
        J Clin Lipidol. 2021; 15: 61-67
        • Schaffer AE
        • D'Alessio DA
        • Guyton JR
        Extreme elevations of low-density lipoprotein cholesterol with very low carbohydrate, high fat diets.
        J Clin Lipidol. 2021; 15: 525-526
        • Jenkins DJ
        • Wong JM
        • Kendall CW
        • Esfahani A
        • Ng VW
        • Leong TC
        • et al.
        The effect of a plant-based low-carbohydrate ("Eco-Atkins") diet on body weight and blood lipid concentrations in hyperlipidemic subjects.
        Arch Intern Med. 2009; 169: 1046-1054
      1. US Department of Agriculture and US. Department of Health and Human Services. Dietary Guidelines for Americans 2020-2025. 9th Edition. 2020. Available at:

        • Petersen KS
        • Flock MR
        • Richter CK
        • Mukherjea R
        • Slavin JL
        • Kris-Etherton PM.
        Healthy dietary patterns for preventing cardiometabolic disease: the role of plant-based foods and animal products.
        Curr Dev Nutr. 2017; 1
        • Li J
        • Lee DH
        • Hu J
        • Tabung FK
        • Li Y
        • Bhupathiraju SN
        • et al.
        Dietary inflammatory potential and risk of cardiovascular disease among men and women in the U.S.
        J Am Coll Cardiol. 2020; 76: 2181-2193
        • Marx W
        • Veronese N
        • Kelly JT
        • Smith L
        • Hockey M
        • Collins S
        • et al.
        The Dietary Inflammatory Index and human health: an umbrella review of meta-analyses of observational studies.
        Adv Nutr. 2021; 12: 1681-1690
        • Mazidi M
        • Katsiki N
        • Mikhailidis DP
        • Sattar N
        • Banach M.
        Lower carbohydrate diets and all-cause and cause-specific mortality: a population-based cohort study and pooling of prospective studies.
        Eur Heart J. 2019; 40: 2870-2879
        • Noto H
        • Goto A
        • Tsujimoto T
        • Noda M.
        Low-carbohydrate diets and all-cause mortality: a systematic review and meta-analysis of observational studies.
        PLoS One. 2013; 8: e55030
        • Seidelmann SB
        • Claggett B
        • Cheng S
        • Henglin M
        • Shah A
        • Steffen LM
        • et al.
        Dietary carbohydrate intake and mortality: a prospective cohort study and meta-analysis.
        Lancet Public Health. 2018; 3: e419-ee28
        • Morze J
        • Danielewicz A
        • Hoffmann G
        • Schwingshackl L.
        Diet Quality as assessed by the Healthy Eating Index, Alternate Healthy Eating Index, Dietary Approaches to Stop Hypertension Score, and health outcomes: a second update of a systematic review and meta-analysis of cohort studies.
        J Acad Nutr Diet. 2020; 120 (e15): 1998-2031
        • Shan Z
        • Li Y
        • Baden MY
        • Bhupathiraju SN
        • Wang DD
        • Sun Q
        • et al.
        Association between healthy eating patterns and risk of cardiovascular disease.
        JAMA Intern Med. 2020; 180: 1090-1100
        • Monteiro CA
        • Cannon G
        • Levy RB
        • Moubarac JC
        • Louzada ML
        • Rauber F
        • et al.
        Ultra-processed foods: what they are and how to identify them.
        Public Health Nutr. 2019; 22: 936-941
        • Sievenpiper JL.
        Low-carbohydrate diets and cardiometabolic health: the importance of carbohydrate quality over quantity.
        Nutr Rev. 2020; 78 (Suppl): 69-77
        • Neuenschwander M
        • Hoffmann G
        • Schwingshackl L
        • Schlesinger S.
        Impact of different dietary approaches on blood lipid control in patients with type 2 diabetes mellitus: a systematic review and network meta-analysis.
        Eur J Epidemiol. 2019; 34: 837-852
        • Salas-Salvado J
        • Bullo M
        • Babio N
        • Martinez-Gonzalez MA
        • Ibarrola-Jurado N
        • Basora J
        • et al.
        Reduction in the incidence of type 2 diabetes with the Mediterranean diet: results of the PREDIMED-Reus nutrition intervention randomized trial.
        Diabetes Care. 2011; 34: 14-19
        • Estruch R
        • Ros E
        • Salas-Salvado J
        • Covas MI
        • Corella D
        • Aros F
        • et al.
        Primary prevention of cardiovascular disease with a mediterranean diet supplemented with extra-virgin olive oil or nuts.
        N Engl J Med. 2018; 378: e34
        • Delgado-Lista J
        • Alcala-Diaz JF
        • Torres-Pena JD
        • Quintana-Navarro GM
        • Fuentes F
        • Garcia-Rios A
        • et al.
        Long-term secondary prevention of cardiovascular disease with a Mediterranean diet and a low-fat diet (CORDIOPREV): a randomised controlled trial.
        Lancet. 2022; 399: 1876-1885
        • Kirkpatrick CF
        • Willard KE
        • Maki KC.
        Keto is trending: implications for body weight and lipid management.
        Curr Cardiol Rep. 2022;
        • Arnett DK
        • Blumenthal RS
        • Albert MA
        • Buroker AB
        • Goldberger ZD
        • Hahn EJ
        • et al.
        2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: executive summary: a report of the american college of cardiology/american heart association task force on clinical practice guidelines.
        J Am Coll Cardiol. 2019; 74: 1376-1414