Efficacy of a low-carbohydrate or ketogenic diet in preventing patient morbidity and mortality

Clinical Inquiries question: What is the efficacy of a low-carbohydrate or ketogenic diet in the prevention of patient morbidity and mortality? Evidence-based answer: Ketogenic diets can reduce seizure incidence in refractory epilepsy (strength of recommendation [SOR] A: based on randomized controlled trials [RCTs] and systematic review). Low-carbohydrate diets are associated with weight loss in obese patients, although long-term evidence of weight-loss maintenance is not available (SOR A: based on meta-analysis of RCTs). Treatment of type 2 diabetes mellitus with low-carbohydrate diets demonstrated a decrease in hemoglobin A1c (HbA1c) levels (SOR C: disease-oriented evidence based on meta-analysis or RCTs). Low-carbohydrate diets paired with animal-based proteins are associated with increased mortality compared with moderate-carbohydrate diets, whereas low-carbohydrate diets with plant-based protein are associated with decreased mortality (SOR B: based on meta-analysis of prospective cohort studies).Roselyn W. Clemente Fuentes, MD, FAAFP, FAWM; Christine M. Broszko, MD; Elizabeth S. Pietralcyzk, MD, FAAFP; Joan Nashelsky, MLSDrs Clemente Fuentes and Brozsko are family physicians in the Eglin Family Medicine Residency program at Eglin Air Force Base in Florida. Dr Pietralcyzk is a family physician in the Flight Medicine Clinic at Elmendorf Air Force Base in Anchorage, Alaska. Ms Nashelsky is a medical librarian with the Family Physicians Inquiries Network in Iowa City, Iowa.Includes bibliographical reference

Acupuncture for low back pain

Clinical Inquiries question: Is acupuncture effective in improving pain relief for low back pain? Evidence-based answer: Acupuncture is an effective treatment for relief from low back pain, even when compared with other interventions (sham acupuncture, usual care, or no treatment), with stronger effects observed immediately after treatment. Clinically significant reduction in pain is more reliably observed in chronic rather than acute low back pain (strength of recommendation: A, based on systematic review and meta-analysis of randomized controlled trials [RCTs]).Roselyn Clemente Fuentes, MD, FAAFP, FAWM; Brooke Organ, DO; Julie Creech, DO; Christine M. Broszko, MD; Joan Nashelsky, MLSDr Organ is an osteopath and family medicine resident, Dr Creech is an osteopath and family medicine resident, Dr Clemente Fuentes is a family physician, and Dr Brozsko is a family physician, all in the Eglin Family Medicine Residency program at Eglin Air Force Base in Florida. Ms Nashelsky is a medical librarian with the Family Physicians Inquiries Network in Iowa City, Iowa.Includes bibliographical reference

Is exercise therapy effective treatment for low back pain?

Yes, it is somewhat effective. Exercise therapy-including general exercise, yoga, Pilates, and motor control exercise-has been shown to modestly decrease pain in chronic low back pain (LBP); levels of benefit in short- (≤ 3 months) and long- (≥ 1 year) term follow-up range from 4% to 15% improvement (strength of recommendation [SOR] A, based on a systematic review of randomized controlled trials [RCTs]).Exercise therapy may improve function and decrease work disability in subacute and chronic LBP, respectively (SOR A, based on a meta-analysis of RCTs). Exercise therapy has not been associated with improvement in acute LBP (SOR A, based on a meta-analysis of RCTs)

Q Is exercise therapy effective treatment for low back pain?

Evidence-based answer: Yes, it is somewhat effective. Exercise therapy—including general exercise, yoga, Pilates, and motor control exercise—has been shown to modestly decrease pain in chronic low back pain (LBP); levels of benefit in short-([less than or equal to] 3 months) and long- ([grater than or equal to] 1 year) term follow-up range from 4% to 15% improvement (strength of recommendation [SOR] A, based on a systematic review of randomized controlled trials [RCTs]). Exercise therapy may improve function and decrease work disability in subacute and chronic LBP, respectively (SOR A, based on a meta-analysis of RCTs). Exercise therapy has not been associated with improvement in acute LBP (SOR A, based on a meta-analysis of RCTs).Christine Broszko, MD, FAAFP; Krystyna Golden, MD; Cody R. Holmes, MD; Stephanie Fulleborn, MD (Eglin Air Force Base Family Medicine Residency), Carolyn Biglow, MLIS, CAS (Carnegie Library of Pittsburgh)Includes bibliographical reference