Low-carbohydrate diets do not uniquely treat hyperglycemia and cannot reduce risk for COVID-19 death arising from hyperglycemia.

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A very non-smart tweet recently caught my eye:

To get right to the point.

Studies linking COVID death and hyperglycemia use HbA1c to do so. Current evidence suggests carbohydrate restriction independent of weight loss does not cause lower HbA1c. Studies show low-carb and low-fat diets are comparably efficacious in causing weight loss, especially in the long run and especially when matched for quality. Therefore, carbohydrate restriction cannot be said to be more effective than other diets for reducing COVID risk related to hyperglycemia.

Well-meaning health misinformation contributes to our inability to discuss and address the epidemics of obesity and metabolic disease. This tweet from Ms. Teicholz is well-meaning health misinformation.

I want to support these claims with references, because they are at odds with received wisdom on the Internet.

First, here are many studies that call into question a weight loss advantage of low-carbohydrate over healthy low-fat diets: DIETFITS, Kevin Hall and Juen Guo’s meta-analysis analyzing trials that looked at differences in metabolic rate between low-fat vs. low-carbohydrate diets, Kevin Hall’s metabolic ward study comparing the impact of low-fat and a ketogenic diets on metabolic rate, and finally, Kevin Hall’s most recent metabolic ward study comparing ad libitum calorie intake on low-carb vs. low-fat diets.

Next, here are some passages in from a document prepared by the National Lipid Association that call into any weight-independent advantage in average glycemia (as measured indirectly by HbA1c):

And, while low-carb diets reduce weight and HbA1c more than a standard American diet, there are two problems:
1. This is not the case compared to healthy high-carbohydrate diets;
2. Average adherence to low-carb diets declines to the point of seeing no difference beyond a year.

Advocacy of low-carb diets in the context of HbA1c and glycemic control is a distraction (at least on a population level), preventing us from having a fact-based conversation about effective interventions for obesity and metabolic disease in America. We need to make our decisions based on facts, not misinformation.

We really do need to move past the diet wars in the first place. Might I direct readers…

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