Zusammenfassung
Kohlenhydratreduzierte Diäten (low carb diets) stellen ein umstrittenes Therapieprinzip
zur Gewichtsreduktion dar. In jüngster Zeit erfreuen sich diese Diäten v. a. in den
USA einer enormen Popularität. Das bekannteste Verfahren ist die so genannte Atkins
Diät. Unter weitgehendem Meiden von Kohlenhydraten (anfängliche Zufuhr zirka 20 g/Tag)
kommt es trotz unbegrenzter Zufuhr von Fett und Eiweiß zur Gewichtsreduktion. Dabei
gelingt es nicht, nur mit Protein und einem weiteren Hauptnährstoff unserer Nahrung
(Fett oder Kohlenhydrate) die sonst übliche Energiemenge aufzunehmen. Das resultierende
Energiedefizit liegt bei 600 - 800 kcal. Anhänger energetisch unlimitierter Diäten
sehen den eintretenden Gewichtsverlust hierdurch nur unzureichend erklärt. - In eigenen
Untersuchungen war eine ausgeprägtere Gewichtsreduktion unter der kohlenhydratreduzierten
Variante einer energetisch limitierten Diät im Vergleich zu einer isoenergetischen
kohlenhydratreichen Reduktionsdiät gefunden worden. Eine Fülle neuerer Untersuchungen
bestätigen die Richtigkeit dieser Ergebnisse. Ferner finden sich eine Reihe positiver
Stoffwechseleffekte (u. a. Abfall der Insulin- und Triglyzerid-, Anstieg der HDL-Konzentration).
Den Königsweg in der Adipositastherapie gibt es nicht. Kohlenhydratreduzierte Diäten
stellen jedoch eine Möglichkeit dar, bei denen mit einem guten Sättigungseffekt, einem
besseren Durchhaltevermögen und damit einer im Vergleich zu anderen Diätformen besseren
Gewichtsreduktion gerechnet werden kann.
Abstract
Low carbohydrate diets represent a controversial therapeutic principle for weight
reduction. Very recently, especially in USA, such diets have gained enormous popularity.
The best known version is the so-called Atkins diet. Under the best possible avoidance
of carbohydrates (initial consumption of about 20 g/day) weight losses occur in spite
of unlimited uptake of fats and protein. However, it is not possible in this way to
take up the otherwise usual amount of energy with only one major component of a nutrition
(fat or carbohydrate). The resultant energy deficit amounts to about 600 - 800 kcal.
Supporters of energy-unlimited diets do not believe that the achieved weight loss
can be adequately explained by this energy deficit. Our own investigations have revealed
a pronounced loss of weight under the low carbohydrate variant of an energy-limited
diet in comparison to an isoenergetic, high carbohydrate weight-reducing diet. Many
recent studies have confirmed this finding. In addition, a series of positive metabolic
effects is observed (among others, decreases of insulin and triglyceride concentrations,
increase of HDL level). There is no infallible therapeutic principle in the treatment
of adiposity. However, low carbohydrate diets do represent one possibility by which
a good feeling of satiety, a better compliance and thus, in comparison to other forms
of diet, a better weight reducing effect can be expected.
Schlüsselwörter
Kohlenhydratreduzierte Diät - low carb diets - Adipositastherapie - klinische Ergebnisse
- vergleichende Studien
Key words
Low carbohydrate diets - low carb diets - therapy of obesity - clinical results -
comparative studies
Literatur
- 1 Atkins R C. Dr. Atkins' new diet revolution. Rev. ed. New York; Avon Books 1998
- 2
Baba N H, Sawaya S, Torbay N. et al .
High protein vs. high carbohydrate hypoenergetic diet for the treatment of obese hyperinsulinemic
subjects.
Int J Obes.
1999;
23
1202-1206
- 3
Bailes jr J R, Strow M T, Werthammer J, Mcginnis R A, Elistur Y.
Effect of low-carbohydrate, unlimited calorie diet on the treatment of childhood obesity.
Metabolic syndrome and related disorders.
2003;
1
221-225
- 4 Banting W. Letter on corpulence. Adressed to the Public. Third edition. London;
Harrison 1864
- 5
Blackburn G L, Morreale J CS.
Physician's guide to popular low carbohydrate weight-loss diets.
Cleve Clin J Med.
2001;
68
761-774
- 6
Bray G A.
Low-carbohydrate diets and realities of weight loss.
Am Med Assoc.
2003;
289
1853-1855
- 7
Brehm B J, Seely R J, Daniels S R, Dalessio D A.
A randomized trial of a very low carbohydrate diet and a calorie-restricted low fat
diet on body weight and cardovascular risk factors in healthy woman.
J Clin Endocrinol & Metabolism.
2003;
88
1617-1623
- 8 O'Brien K D, Brehm B J, Seely R J, Wener M, Daniels S, D'Alassio D A. Greater reduction
in inflammatory markers with a low carbohydrate diet than with a caloricalla matched
low fat diet. American Heart Association's Scientific Sessions Chicago II (Abstract
117 597)
- 9
Dansinger M L, Gleason J A, Griffith J J. et al .
Comparison of the Atkins, Ornish, Weight watchers, and Zone diets for weight loss
and heart disease risk reduction.
JAMA.
2005;
293
43-53
- 10
Flegal K M, Caroll M D, Ogden C L, Johnson C L.
Prevalence and trends in obesity among US adults, 1999 - 2000.
JAMA.
2002;
288
1723-1727
- 11
Foster G D, Holly R, Wyatt M D, McGuckin B G.
A randomized trial of low-carbohydrate diet for obesity.
N Engl J.
2003;
348
2082-2090
- 12
Freedman M R, King J, Kennedy E.
Popular diets: A scientific review.
Obesity Res.
2001;
9 (Suppl 1)
1-40
- 13
Gannon M C, Nuttal P Q.
Effect of a high protein, low-carbohydrate diet on blood glucose control in people
with type 2 diabetes.
Diabetes.
2004;
53
2357-2382
- 14
Kasper H, Thiel H, Ehl M.
Response on body weight to a low carbohydrate, high fat diet in normal and obese subjects.
Am J Clin Nutr.
1973;
26
197-204
- 15
Keckwick A, Pawan G LS.
Calorie intake in relation to body-weight changes in the obese.
Lancet.
1956;
II
155
- 16
Rabast U, Schönborn J, Kasper H.
Dietetic Treatment of obesity with low and high carbohydrate diets.
Int J Obes.
1979;
3
201-211
- 17
Rabast U, Vornberger K H, Ehl M.
Loss of weight - sodium and water in obese persons consuming a high or low carbohydrate
diet.
Ann Nutr Metab.
1981;
25
341-349
- 18
Rabast U, Kasper H, Schönborn J.
Comparative studies in obese subjects fed carbohydrate-restricted and high carbohydrate
1000-calorie formula diets.
Nutr Metab.
1978;
22
269-277
- 19
Rabast U, Krumm M, Ehl M, Küstner H, Zang E.
Ballaststoff- und kohlenhydratreiche sowie kohlenhydratreduzierte und fettreiche Diät
in der ambulanten Adipositas-Therapie.
Akt Ernähr.
1983;
8
166-171
- 20
Samaha F F, Igbal N, Seshdri P, Chicano K L, Daily D A, Mc Grory J, Williams T, Williams M,
Gracely E J, Stern L.
A low-carbohydrate as compared with a low-fat diet in severe obesity.
Engl J Med.
2003;
348
2074-2081
- 21
Schönborn J, Eysselein V, Rabast U, Kasper H.
Vergleichende Untersuchungen des Stoffwechsels unter kohlenhydrat- und fettreicher
Formuladiäten.
Verh Dtsch Ges Inn Med.
1974;
80
1224-1227
- 22
Serdula M K, Mokdad A H, Williamson D F, Galuska D A, Mendlein J M, Heath G W.
Prevalence of attempting weight loss and strategies for controlling weight.
JAMA.
1999;
282
1353-1358
- 23 Taubes G. Nutrition: The soft science of dietary fat. Science 2001
- 24
Volek J S, Westman E C.
Very-low-carbohydrate weight-loss diets revisited.
Cleveland clin J Med.
2002;
69
849-861
- 25
Volek J S, Sharman M J, Gomez A L, Schett T P, Kraemer W J.
An isoenergetic very low carbohydrate diet improves serum HDL-cholesterol and triacylglycerol
concentrations, the total cholesterol to HDL-cholesterol ratio and postprandial lipemic
responses compared with low fat diet in normal weight, normallipidemic women.
J Nutr.
2003;
133
2756-2761
- 26
Volek J S, Sharman M J, Love D M. et al .
Body composition and hormonal responses to a carbohydrate restricted diet.
Metabolism.
2002;
51
864-870
- 27
Westman E C, Yancy W S, Edman J S, Tomlin K F, Perkins C E.
Effect of 6-month adherence to a very low carbohydrate diet program.
Am J Med.
2002;
113
30-36
- 28
Yancy W S, Olsen M K, Guyton J R, Bakst R P, Westman E C.
A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia.
A randomized controlled trial.
Ann Intern Med.
2004;
140
769-777
- 29
Yanowski S Z, Yanowski J A.
Obesity.
N Engl J Med.
2002;
346
591-602
- 30
Yoshimura M, Hori S, Yoshimura H.
Effect of high-fat diet on thermal acclimation with special reference to thyroid activity.
Jap J Physiol.
1972;
22
517
- 31
Yudkin J, Carey M.
The treatment of obesity by the high fat diet: the inevitability of calories.
Lancet.
1960;
7157
939-941
Prof. Dr. U. Rabast
Med. Klinik · Kath. Kliniken Ruhrhalbinsel
Essener Straße 31
45529 Hattingen
