Elsevier

Nutrition

Volume 31, Issue 1, January 2015, Pages 1-13
Nutrition

Critical review
Dietary carbohydrate restriction as the first approach in diabetes management: Critical review and evidence base

https://doi.org/10.1016/j.nut.2014.06.011Get rights and content
Under a Creative Commons license
open access

Highlights

  • We present major evidence for low-carbohydrate diets as first approach for diabetes.

  • Such diets reliably reduce high blood glucose, the most salient feature of diabetes.

  • Benefits do not require weight loss although nothing is better for weight reduction.

  • Carbohydrate-restricted diets reduce or eliminate need for medication.

  • There are no side effects comparable with those seen in intensive pharmacologic treatment.

Abstract

The inability of current recommendations to control the epidemic of diabetes, the specific failure of the prevailing low-fat diets to improve obesity, cardiovascular risk, or general health and the persistent reports of some serious side effects of commonly prescribed diabetic medications, in combination with the continued success of low-carbohydrate diets in the treatment of diabetes and metabolic syndrome without significant side effects, point to the need for a reappraisal of dietary guidelines. The benefits of carbohydrate restriction in diabetes are immediate and well documented. Concerns about the efficacy and safety are long term and conjectural rather than data driven. Dietary carbohydrate restriction reliably reduces high blood glucose, does not require weight loss (although is still best for weight loss), and leads to the reduction or elimination of medication. It has never shown side effects comparable with those seen in many drugs. Here we present 12 points of evidence supporting the use of low-carbohydrate diets as the first approach to treating type 2 diabetes and as the most effective adjunct to pharmacology in type 1. They represent the best-documented, least controversial results. The insistence on long-term randomized controlled trials as the only kind of data that will be accepted is without precedent in science. The seriousness of diabetes requires that we evaluate all of the evidence that is available. The 12 points are sufficiently compelling that we feel that the burden of proof rests with those who are opposed.

Keywords

Diabetes
Carbohydrate
Low-carbohydrate diet
Ketogenic diet
Triglyceride
Hemoblobin A1c

Cited by (0)

RDF wrote the original draft and incorporated changes and corrections from the other authors. All authors approved the final manuscript. AA is consultant/member of advisory boards for the Dutch Beer Knowledge Institute, NL, Global Dairy Platform, USA, Jenny Craig, USA, McCain Foods Limited, USA, McDonald's, USA, and Gerson Lehrman Group, USA (ad hoc consultant for clients). He is recipient of honoraria and travel grants as speaker for a wide range of Danish and international concerns. He has conducted research funded by a number of organizations with interests in the food production and marketing sector. RDF writes reviews for Fleishman-Hillard, whose client is the Corn Refiners Association and he has received grant support from the Veronica and Robert C. Atkins Foundation. EJF has received grant support from the Veronica and Robert C. Atkins Foundation. TK sits on an advisory board for Eli Lilly and gives lectures for Lilly about the diabetic diet. NW has written popular-audience books on low-carbohydrate diets and is a consultant and promoter for Leberfasten/Hepafast, a specific low-carbohydrate meal replacement program. JW is on the Scientific Advisory Board of Atkins Nutritionals Inc. with paid retainer, honoraria, and travel costs. None of the other authors have anything to declare.