Diabetes is considered a health risk in the United States, with an estimated 29.1 million American adults having diabetes, and another 79 million have metabolic syndrome, or pre-diabetes, meaning more than 46 percent of adults in the United States have diabetes or pre-diabetes. The study compiled by a group pf 26 physicians and nutrition researchers suggests that there is a need for the re-appraisal of dietary guidelines to control the epidemic of diabetes. The researchers cite the specific failure of current low fat diets to improve obesity, cardiovascular risk or general health and have cited 12 specific points to advocate for a low-carbohydrate diet.
“Diabetes is a disease of carbohydrate intolerance,” said Barbara Gower, Ph.D., professor and vice chair for research in the UAB Department of Nutrition Sciences and one of the study authors. “Reducing carbohydrates is the obvious treatment. It was the standard approach before insulin was discovered and is, in fact, practiced with good results in many institutions. The resistance of government and private health agencies is very hard to understand.”
The research group specified that their review of the medical literature shows that low-carbohydrate diets reliably reduce high blood sugar and reveal the general benefit for risk of cardiovascular disease.
The 12 points advocating for a low-carbohydrate diet are:
• High blood sugar is the most salient feature of diabetes. Dietary carbohydrate restriction has the greatest effect on decreasing blood glucose levels.
• During the epidemics of obesity and Type 2 diabetes, caloric increases have been due almost entirely to increased carbohydrates.
• Benefits of dietary carbohydrate restriction do not require weight loss.
• Although weight loss is not required for benefit, no dietary intervention is better than carbohydrate restriction for weight loss.
• Adherence to low-carbohydrate diets in people with Type 2 diabetes is at least as good as adherence to any other dietary interventions and frequently is significantly better.
• Replacement of carbohydrates with proteins is generally beneficial.
• Dietary total and saturated fats do not correlate with risk of cardiovascular disease.
• Plasma-saturated fatty acids are controlled by dietary carbohydrates more than by dietary lipids.
• The best predictor of microvascular and, to a lesser extent, macrovascular complications in patients with Type 2 diabetes is glycemic control (HbA1c).
• Dietary carbohydrate restriction is the most effective method of reducing serum triglycerides and increasing high-density lipoprotein.
• Patients with Type 2 diabetes on carbohydrate-restricted diets reduce and frequently eliminate medication. People with Type 1 usually require less insulin.
• Intensive glucose-lowering by dietary carbohydrate restriction has no side effects comparable to the effects of intensive pharmacologic treatment.
“We’ve tried to present clearly the most obvious and least controversial arguments for going with carbohydrate restriction,” said Richard David Feinman, Ph.D., professor of cell biology at SUNY Downstate Medical Center and lead author of the paper.
“Here we take a positive approach and look to the future, while acknowledging this paper calls for change. The low-fat paradigm, which held things back, is virtually dead as a major biological idea. Diabetes is too serious a disease for us to try to save face by holding onto ideas that fail.”
“For many people with Type 2 diabetes, low-carbohydrate diets are a real cure,” said Gower. “They no longer need drugs. They no longer have symptoms. Their blood glucose is normal, and they generally lose weight.”
Richard David Feinman, Wendy Knapp Pogozelski, Arne Astrup, Richard K. Bernstein, Eugene J. Fine, Eric C. Westman, Anthony Accurso, Lynda Frasetto, Samy McFarlane, Jörgen Vesti Nielsen, Thure Krarup, Barbara A. Gower, Laura Saslow, Karl S. Roth, Mary C. Vernon, Jeff S. Volek, Gilbert B. Wilshire, Annika Dahlqvist, Ralf Sundberg, Ann Childers, Katharine Morrison, Anssi H. Manninen, Hussein Dashti, Richard J. Wood, Jay Wortman, Nicolai Worm. Dietary Carbohydrate restriction as the first approach in diabetes management. Critical review and evidence base. Nutrition, 2014; DOI: 10.1016/j.nut.2014.06.011