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

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

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

³Private Practice, Njurunda, Sweden

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

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

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

⁷Manninen Nutraceuticals Oy, Oulu, Finland

⁸Ballochmyle Medical Group, Mauchline Ayrshire, UK

⁹County Hospital, Karlshamn, Sweden

¹⁰Independent Researcher, Lund, Sweden

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

¹²Portuguese Sports Institute, Cruz Quebrada, Portugal

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

¹⁴Slottsstadens Läkarhus, Malmö, Sweden

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

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

¹⁷Springfield College, Springfield, Massachusetts, USA

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

¹⁹Private 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.