Circulating lipids in men with type 2 diabetes following 3 days on a CHO-free diet vs 3 days of fasting

Frank Q Nuttall, Rami M Almokayyad, Mary C Gannon

Research output: Contribution to journalArticlepeer-review


Objective: We have been interested in determining the effects of dietary changes onfuel metabolism and regulation in men with type 2 diabetes mellitus (T2DM). In thisstudy, the changes in 24-hr circulating lipid profiles were determined when the majorfuel source was endogenous versus exogenous fat.
Methods: Seven males with T2DM were randomized in a crossover design with a
4-week washout period. A standard mixed (control) diet (30%fat:15%protein:55%c
arbohydrate) was provided initially. Subsequently, a 72-hr (3-day) fast, or a high fat(85%), 15% protein, essentially carbohydrate-free (CHO-free) diet was provided for
72 hr. Triacylglycerol (TAG), non-esterified fatty acids (NEFA), β-hydroxybutyrate
(bHB), and insulin-like growth factor-binding protein-1 (IGFBP-1) profiles were determinedduring the last 24 hr of intervention, as well as during the control diet.
Results: Regardless of the amount of dietary fat (30% vs 85%) and differences in
24-hr profiles, TAG, NEFA, and bHB all returned to the previous basal concentrations
within 24 hr. TAGs and NEFAs changed only modestly with fasting; bHB was
elevated and increasing. The IGFBP-1 profile was essentially unchanged with either
diet but increased with fasting.
Conclusion: A CHO-free diet resulted in a large increase in TAG and NEFA versus
the control diet; however, both were cleared by the following morning. A negative
NEFA profile occurred with the control diet. Thus, mechanisms are present to restore
lipid concentrations to their original AM concentrations daily. Fasting resulted in
stable concentrations, except for a continuing increase in bHB. Glucose and insulin,
common fuel regulators, could not explain the results.
Original languageEnglish (US)
Pages (from-to)1-18
JournalPhysiological Reports
StatePublished - Oct 19 2020


  • carbohydrate-free diet
  • high fat diet
  • non-esterified fatty acids
  • triacylglycerol (TAG)


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