Low Carbohydrate Diets for Diabetic Cardiomyopathy: A Hypothesis

Area of Science:

• Cardiology
• Endocrinology
• Nutritional Science

Background:

• Diabetic cardiomyopathy (DMCM) is linked to type 2 diabetes mellitus (T2DM) complications like insulin resistance (IR), hyperinsulinemia, and dyslipidemia.
• DMCM increases heart failure (HF) risk and worsens outcomes, often without traditional cardiac risk factors.
• Low-fat (LF) diets, common for HF, are high in carbohydrates (CHO), potentially worsening IR in DMCM.

Purpose of the Study:

• To evaluate the impact of carbohydrate restriction on insulin resistance and cardiac function in DMCM.
• To explore low carbohydrate (LC) diets, including ketogenic diets (KD), as a therapeutic strategy for T2DM and metabolic disorders.
• To hypothesize that LC diets can improve glycaemic control, reduce insulin levels, and reverse IR, potentially benefiting cardiac function in HF patients.

Main Methods:

• Review of existing literature on DMCM, LF diets, and LC diets.
• Analysis of the pathophysiological mechanisms linking T2DM, IR, and cardiac dysfunction.
• Postulation of a hypothesis regarding the effects of CHO restriction on IR and HF symptoms.

Main Results:

• LF diets, high in CHO, may exacerbate IR and negatively impact DMCM.
• LC diets, including KD, have shown efficacy in managing T2DM and metabolic disorders.
• CHO restriction can lead to sustained glycaemic control, lower insulin, and improved IR.

Conclusions:

• LC diets may offer a metabolic advantage by improving IR and cardiac function in patients with DMCM and HF.
• Patients on LC diets might experience reduced medication needs and improved HF symptom burden.
• Targeting hyperinsulinemia through CHO restriction presents a promising approach for managing DMCM.