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Dietary carbohydrate restriction in type 2 diabetes mellitus and metabolic syndrome: time for a critical appraisal

Anthony Accurso1, Richard K Bernstein2, Annika Dahlqvist3, Boris Draznin4, Richard D Feinman1*, Eugene J Fine5, Amy Gleed1, David B Jacobs1, Gabriel Larson1, Robert H Lustig6, Anssi H Manninen7, Samy I McFarlane1, Katharine Morrison8, Jørgen Vesti Nielsen9, Uffe Ravnskov10, Karl S Roth11, Ricardo Silvestre12, James R Sowers13, Ralf Sundberg14, Jeff S Volek15, Eric C Westman16, Richard J Wood17, Jay Wortman18 and Mary C Vernon19

Author Affiliations

1 State University of New York Downstate Medical Center, Brooklyn, New York, USA

2 New York Diabetes Center, Mamaroneck, New York, USA

3 Private Practice, Njurunda, Sweden

4 University of Colorado Health Sciences Center, Denver, Colorado, USA

5 Albert Einstein College of Medicine, Bronx, New York, USA

6 Division of Pediatric Endocrinology, University of California Medical Center, San Francisco, California, USA

7 Manninen Nutraceuticals Oy, Oulu, Finland

8 Ballochmyle Medical Group, Mauchline Ayrshire, UK

9 County Hospital, Karlshamn, Sweden

10 Independent Researcher, Lund, Sweden

11 Department of Pediatrics, Creighton University, Omaha, Nebraska, USA

12 Portuguese Sports Institute, Cruz Quebrada, Portugal

13 Cosmopolitan International Diabetes Center, University of Missouri, Columbia, Missouri, USA

14 Slottsstadens Läkarhus, Malmö, Sweden

15 Department of Kinesiology, University of Connecticut, Storrs, Connecticut, USA

16 Lifestyle Medicine Clinic, Duke University Medical Center, Durham, North Carolina, USA

17 Springfield College, Springfield, Massachusetts, USA

18 Health Canada, First Nations Division, Vancouver, British Columbia, Canada

19 Private Practice, Lawrence, Kansas, USA

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Nutrition & Metabolism 2008, 5:9  doi:10.1186/1743-7075-5-9

Published: 8 April 2008


Current nutritional approaches to metabolic syndrome and type 2 diabetes generally rely on reductions in dietary fat. The success of such approaches has been limited and therapy more generally relies on pharmacology. The argument is made that a re-evaluation of the role of carbohydrate restriction, the historical and intuitive approach to the problem, may provide an alternative and possibly superior dietary strategy. The rationale is that carbohydrate restriction improves glycemic control and reduces insulin fluctuations which are primary targets. Experiments are summarized showing that carbohydrate-restricted diets are at least as effective for weight loss as low-fat diets and that substitution of fat for carbohydrate is generally beneficial for risk of cardiovascular disease. These beneficial effects of carbohydrate restriction do not require weight loss. Finally, the point is reiterated that carbohydrate restriction improves all of the features of metabolic syndrome.