In Reply We value the comments by Hecht and Yancy et al regarding our Viewpoint.1 In response to Hecht, we indeed welcome further research, but it should not overshadow efforts to increase consumption of unrefined carbohydrates such as fruits, vegetables, legumes, and whole grains, which have been demonstrated in numerous studies to promote health.2 Although the study cited by Hecht showed a statistically significant improvement in glycosylated hemoglobin at 12 months, the improvement was only 0.3% above the control arm—which falls short of being clinically significant. Further, there are 4 other randomized, long-term (≥12 months) trials of very low-carbohydrate diets (VLCDs) that failed to show benefit for type 2 diabetes mellitus (T2DM) over high-carbohydrate diets (HCDs).3
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Joshi S, Ostfeld RJ, McMacken M. Ketogenic Diets for Diabetes and Obesity—Reply. JAMA Intern Med. 2019;179(12):1735–1736. doi:10.1001/jamainternmed.2019.5111
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