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Background Low carbohydrate high fat (LCHF) diet has been a popular low carbohydrate diet in Sweden for 15 years. Many people choose LCHF to lose weight or control diabetes, but there are concerns about the effect on long-term cardiovascular risks. There is little data on how a LCHF diet is composed in real-life. The aim of this study was to evaluate the dietary intake in a population with self-reported adherence to a LCHF diet. Methods A cross-sectional study of 100 volunteers that considered themselves eating LCHF was conducted. Diet history interviews (DHIs) and physical activity monitoring for validation of the DHIs were performed. Results The validation shows acceptable agreement of measured energy expenditure and reported energy intake. Median carbohydrate intake was 8.7 E% and 63% reported carbohydrate intake at potentially ketogenic levels. Median protein intake was 16.9 E%. The main source of energy was dietary fats (72.0 E%). Intake of saturated fat was 32 E% and cholesterol was 700 mg per day, both of which exceeded the recommended upper limits according to nutritional guidelines. Intake of dietary fiber was very low in our population. The use of dietary supplements was high, and it was more common to exceed the recommended upper limits of micronutrients than to have an intake below the lower limits. Conclusions Our study indicates that in a well-motivated population, a diet with very low carbohydrate intake can be sustained over time and without apparent risk of deficiencies. High intake of saturated fats and cholesterol as well as low intake of dietary fiber remains a concern.

Background Knee osteoarthritis (KOA) is a prevalent chronic pain condition that can significantly impact quality of life and contribute to recognized chronic pain racial disparities. We have shown that a low-carbohydrate diet (LCD) can reduce KOA-related pain. Our previous work suggested that the LCD was more beneficial for women and non-Hispanic Black (NHB) adults, but our sample was not sufficiently diverse. Thus, we sought to determine whether the LCD may be beneficial for NHB women with KOA on measures of self-reported and evoked pain. Methods Fourteen NHB women (M = 55.93, S.D. = 7.79 years of age) with KOA were recruited to participate in a pilot 6-week LCD intervention. Measures of pain sensitivity, disability, physical functioning, overall chronic pain, quality of life, and dietary habits were taken at baseline and at 3- and 6-weeks of the LCD intervention. Results Overall, participants showed significant differences in self-reported measures of daily pain, pain interference, stiffness, physical functioning, depressive symptoms, food knowledge and food security. Participants also showed reduced evoked pain in the timed walk and chair stand tasks. Conclusion A 6-week LCD provided a range of benefits related to pain and quality of life in NHB women with KOA. The utilization of a LCD is a modifiable, non-pharmacological and accessible alternative for chronic KOA that may reduce pain disparities and improve quality of life. Trial registration This article reports the original results of a dietary healthcare intervention registered at clinicaltrials.gov (NCT 04343716, registered on 13/04/2020).

\"An expert guide to long-term, low-carb eating for weight loss and health, with over 150 recipes.\"

Background Long‐term weight loss success with dietary interventions is notoriously limited. Mobile health (mHealth) interventions offering personalized dietary guidance combined with real‐time biofeedback may enhance long‐term adherence and provide a sustainable solution for weight management. Objectives This study reports the prespecified secondary outcome of weight loss at 48 weeks from a parallel‐arm randomized clinical trial (ClinicalTrials.gov: NCT04165707) that aimed to evaluate the long‐term effectiveness and sustainability of a Mediterranean‐style low‐carbohydrate diet delivered via an mHealth application paired with breath biofeedback compared with a calorie‐restricted low‐fat diet application. Methods Adults with overweight or obesity (N = 155; mean ± SD age, 41 ± 11 years; 71% female; BMI, 33.5 ± 4.7 kg/m2) were randomized to either an intervention promoting a Mediterranean‐style low‐carbohydrate diet combined with biofeedback from a handheld breath acetone device or an evidence‐based comparator promoting a calorie‐restricted, low‐fat diet. Participants recorded their daily weights using Bluetooth scales. Weight loss over 48 weeks was analyzed using a linear mixed‐effects model, incorporating all available daily weight measurements from participants who provided at least one follow‐up measurement. Results At 48 weeks, participants using the breath biofeedback mHealth app achieved clinically meaningful weight loss (−9.54 kg, 95% CI: −12.27 to −6.81 kg). In contrast, participants using the low‐fat diet app did not achieve statistically significant weight loss (−2.68 kg, 95% CI: −5.49 to 0.14 kg), resulting in a statistically significant between‐group difference (−6.9 kg, 95% CI: −10.8 to −2.9, p < 0.001). No adverse effects were reported in either group. Conclusions This study demonstrates that a Mediterranean‐style diet promoting carbohydrate restriction coupled with biofeedback support delivered via an mHealth app results in clinically meaningful sustained weight loss at 48 weeks. Given its practicality and demonstrated effectiveness, this approach presents a promising non‐pharmacological alternative or complement for longer‐term weight management.

Type 2 diabetes is a prevalent, chronic disease for which diet is an integral aspect of treatment. In our previous trial, we found that recommendations to follow a very low-carbohydrate ketogenic diet and to change lifestyle factors (physical activity, sleep, positive affect, mindfulness) helped overweight people with type 2 diabetes or prediabetes improve glycemic control and lose weight. This was an in-person intervention, which could be a barrier for people without the time, flexibility, transportation, social support, and/or financial resources to attend. The aim was to determine whether an online intervention based on our previous recommendations (an ad libitum very low-carbohydrate ketogenic diet with lifestyle factors; \"intervention\") or an online diet program based on the American Diabetes Associations' \"Create Your Plate\" diet (\"control\") would improve glycemic control and other health outcomes among overweight individuals with type 2 diabetes. In this pilot feasibility study, we randomized overweight adults (body mass index ≥25) with type 2 diabetes (glycated hemoglobin [HbA ] 6.5%-9.0%) to a 32-week online intervention based on our previous recommendations (n=12) or an online diet program based around a plate method diet (n=13) to assess the impact of each intervention on glycemic control and other health outcomes. Primary and secondary outcomes were analyzed by mixed-effects linear regression to compare outcomes by group. At 32 weeks, participants in the intervention group reduced their HbA levels more (estimated marginal mean [EMM] -0.8%, 95% CI -1.1% to -0.6%) than participants in the control group (EMM -0.3%, 95% CI -0.6% to 0.0%; P=.002). More than half of the participants in the intervention group (6/11, 55%) lowered their HbA to less than 6.5% versus 0% (0/8) in the control group (P=.02). Participants in the intervention group lost more weight (EMM -12.7 kg, 95% CI -16.1 to -9.2 kg) than participants in the control group (EMM -3.0 kg, 95% CI -7.3 to 1.3 kg; P<.001). A greater percentage of participants lost at least 5% of their body weight in the intervention (10/11, 90%) versus the control group (2/8, 29%; P=.01). Participants in the intervention group lowered their triglyceride levels (EMM -60.1 mg/dL, 95% CI -91.3 to -28.9 mg/dL) more than participants in the control group (EMM -6.2 mg/dL, 95% CI -46.0 to 33.6 mg/dL; P=.01). Dropout was 8% (1/12) and 46% (6/13) for the intervention and control groups, respectively (P=.07). Individuals with type 2 diabetes improved their glycemic control and lost more weight after being randomized to a very low-carbohydrate ketogenic diet and lifestyle online program rather than a conventional, low-fat diabetes diet online program. Thus, the online delivery of these very low-carbohydrate ketogenic diet and lifestyle recommendations may allow them to have a wider reach in the successful self-management of type 2 diabetes. ClinicalTrials.gov NCT01967992; https://clinicaltrials.gov/ct2/show/NCT01967992 (Archived by WebCite at http://www.webcitation.org/6o0fI9Mkq).