Effects of a Self-Prepared Carbohydrate-Reduced High-Protein Diet on Cardiovascular Disease Risk Markers in Patients with Type 2 Diabetes

Nutrients. 2021 May 17;13(5):1694. doi: 10.3390/nu13051694.


We previously observed beneficial effects of a carbohydrate-reduced, high-protein (CRHP) diet on cardiovascular risk markers in patients with type 2 diabetes mellitus (T2DM) in a crossover 2 × 6-week trial, when all food was provided to subjects as ready-to-eat meals. Here, we report the results from a 6-month open label extension: 28 patients with T2DM were instructed to self-prepare the CRHP diet with dietetic guidance. At weeks 0, 6, 12, and 36, fasting and postprandial (4-h meal test) blood samples were collected for measurements of total, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol, triacylglycerol (TG), apolipoproteins A1 and B, non-esterified fatty acids (NEFA), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and interleukin-6. Diurnal blood pressure and heart rate were also assessed. At the end of the study (week 36), concentrations of fasting total and LDL-cholesterol, fasting and postprandial NEFA and TG, and fasting apolipoprotein-B, CRP and TNF-α concentrations were significantly lower compared with week 0 (p < 0.05). A significant decrease in diurnal heart rate was also observed. From week 12 to 36, an increase in HDL-cholesterol and apolipoprotein-A1 concentrations and a further reduction in fasting and postprandial NEFA (p < 0.05) were found. These changes were independent of minor fluctuations in body weight. We conclude that the substitution of dietary carbohydrate for protein and fat has beneficial effects on several cardiovascular risk markers in patients with T2DM, which are maintained or augmented over the next 6 months when patients select and prepare the CRHP diet on their own in a dietitian-supported setting.

Keywords: cardiovascular; high-protein; lipids; low-carbohydrate.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Apolipoproteins / blood
  • Biomarkers / blood
  • Cardiovascular Diseases / etiology
  • Cardiovascular Diseases / prevention & control
  • Cholesterol / blood
  • Cholesterol, HDL / blood
  • Cholesterol, LDL / blood
  • Cooking
  • Cross-Over Studies
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / complications
  • Diabetes Mellitus, Type 2 / diet therapy*
  • Diet, High-Protein Low-Carbohydrate / methods*
  • Diet, High-Protein Low-Carbohydrate / psychology
  • Fasting / blood
  • Fatty Acids, Nonesterified / blood
  • Female
  • Follow-Up Studies
  • Food Preferences / psychology*
  • Heart Disease Risk Factors
  • Humans
  • Lipids / blood
  • Male
  • Middle Aged
  • Postprandial Period
  • Prospective Studies
  • Triglycerides / blood


  • Apolipoproteins
  • Biomarkers
  • Cholesterol, HDL
  • Cholesterol, LDL
  • Fatty Acids, Nonesterified
  • Lipids
  • Triglycerides
  • Cholesterol