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

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

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

New York Diabetes Center, Mamaroneck, New York, USA

Private Practice, Njurunda, Sweden

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

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

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

Manninen Nutraceuticals Oy, Oulu, Finland

Ballochmyle Medical Group, Mauchline Ayrshire, UK

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

author email corresponding author email

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

Published: 8 April 2008

Abstract

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.


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