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Devi Dinghoor
NTR 401
November 14, 205
Article Summary Assignment
The article, Comparison of Low and High Carbohydrates for Type 2 Diabetes management: a
randomized trial, was done at the Commonwealth Scientific and Industrial Research
Organization Clinical Research unit in Adelaide, Australia. It was published by the American
Journal of Clinical Nutrition on July 29, 2015. It was conducted from May 2013 to September
2013 by Jeannie Tay, Natalie D Luscombe- Marsh, Campbell H Thompson, Manny Noakes,
Jonsthan D Buckley, Gary A Wittert, Willam S yancy Jr. and Grant D Brinkworth. The purpose
of this study was to test the effects of a low carbohydrate diet on obese patients that have type 2
diabetes. In order to test this, a high carbohydrate diet was used to compare the effects of the low
carbohydrate diet on glycemic control and cardiovascular risk factors in type 2 diabetic patients.
The low carbohydrate diet consist of foods with high unsaturated fat, low saturated fat, and low
carbohydrates while the high carbohydrate diet consist of foods high in carbs, and low in fat.
The design overview of this experiment included 115 obese participants between the ages
of 51 to 63 years old with a BMI range of 36-45 kg/m. Approximately, 57 participants were
randomly assigned on the low carbohydrate diet, and 58 participants was assigned to be on the
high carbohydrate diet for 52 weeks. These participants were matched through a computer
generated assignment based on their age, sex, BMI, HbA1c (glycated hemoglobin), and diabetes
medication. Each participant had a specific diet they had to follow, which was matched for
energy with moderate (30%) restriction to facilitate weight loss (500-1000 kcal/d deficit. The
hypocaloric diet and hyper-caloric diet were constructed to contain certain food to achieve
targeted macronutrient outcomes. Participants had to keep a daily food log of the food they
consumed, and met with a registered dietitian twice a week for twelve weeks and monthly
thereafter. Additionally, they were required to partake in a one hour supervised exercise class 3
days per week. They had to go to a follow up appointment where their weight, height, glucose
profile, and medication changes were measured.

After 52 weeks, 68% members completed the experiment. The key finding of the
experiment were the changes in HbA1c. Additionally, there were changes in Glycemic
variability, fasting blood glucose, diabetes medication, weight, blood lipids, and blood pressure.
The fasting blood glucose, and HbA1c both decreased in the high and low carbohydrate group.
Both groups also experienced weight loss during the study. The low carbohydrate (LC) group
spent more time in the hyperglycemic range. Participants in the lower carbohydrate group
reduced using their anti-glycemic medications than the opposite group. The low carbohydrate
group also saw improvements in diurnal blood glucose stability, and lipid profile. Because LC
participants were able to maintain the benefits for over a year, it showed the experiments long
term effects.
The pathway that is involved in this study is the glycolysis pathway. The glycolysis
pathway will occur in both groups: the low and high carbohydrate diet. Participants in both of
these groups will break down carbohydrates into glucose, which is convert to pyruvate. During
this ten step process of glycolysis, ATP is being produced, and used for energy. The energy that is
produced from carbohydrate metabolism was being used by participants to perform their one
hour exercise. During short term activities, more carbohydrates were used, while during less
intense prolong activities, more fat was used as fuel. The glycolytic pathway is used for about 15
to 20 seconds and it only produces 2-3 moles of ATP. Therefore, another system must take over
to bring oxygen to the muscles during exercise.
Another metabolic mechanism that could have occurred during this study was ketosis. In
the study it was found that participants on the low carbohydrate diet saw a reduction in weight.
Ketosis is a metabolic process that occurs when the body does not have enough carbohydrate to
use for energy. Therefore, it forces the body to break down the stored fats to provide energy,
which can result in a build- up of acids call ketones. Ketosis occurs in patients who are diabetic,
because high levels of ketones causes the body to develop ketoacidosis. Ketosis could have
occurred in almost everyone that participated in the low carbohydrate diet because all
participants were diabetic. Even though ketosis is more common in patients that have type 1
diabetes than type 2 diabetes, it can still occur in people who have type 2 diabetes.

Reference Page
Tay, J., Luscombe-Marsh, N., Thompson, C., Noakes, M., Buckley, J., Wittert, G., . . .
Brinkworth, G. (2015). Comparison of low- and high-carbohydrate diets for type 2 diabetes
management: A randomized trial. American Journal of Clinical Nutrition, 1-11.