they could eat and the types of food that should be avoided. Initially, the
participants were allowed to eat unlimited amounts of meats, poultry, fish, and
eggs. In addition, the participants were asked to take 2 cups of salad vegetables
per day, hard cheese (100–120 g), and limited amounts of cream, olives, and
lemon juice. Although fats and oils were allowed, the participants were
instructed not to take trans-fats. Antidiabetic medications were decreased with
the diet initiation. In general, the insulin doses were halved and the sulfonylurea
doses were halved or discontinued. The participants also were instructed to take
a standard multivitamin/multimineral tablet and drink approximately six to
eight glasses of water daily.
The participants returned every other week for 24 wk for further counseling
on diet and medication. When a participant neared half the weight loss goal or
developed cravings, he or she was advised to increase the carbohydrate intake by
approximately 5 g/d each week as long as the weight loss continued. The
participants could choose 5-g carbohydrate portions from one of the following
foods each week: salad vegetables, low-carbohydrate vegetables, hard or soft
cheese, nuts, or low-carbohydrate snacks. The participants in the LCD group were
given appropriate guidelines and a sample LCD menu of 2200 calories is presented
in Table 1.
The initial dose of some antidiabetic medications was decreased to half in the
LCKD group at the beginning of the dietary program. The antidiabetic medication
dosage was modified based on twice-daily glucometer measurements and
hypoglycemic episodes, and diuretic and other antihypertensive medication
adjustments were based on the orthostatic symptoms, blood pressure, and lower
extremity edema.