Seminal Paper: Carbohydrate Restriction for Type 2 Diabetes and Metabolic Syndrome

Carbohydrate-restricted eating is slowly gaining mainstream acceptance as treatment for type 2 diabetes and metabolic syndrome.  I thought it would be useful to present one of the watershed reports that summarize the potential benefits.  The article is from 2008.  Among the co-authors are some of the brightest names in this field: Richard K. Bernstein, Annika Dahlqvist, Richard Feinman, Eugene J. Fine, Robert Lustig, Uffe Ravnskov, Jeff Volek, Eric Westman, and Mary C. Vernon.

ResearchBlogging.orgThese are not wild-eyed, bomb-throwing radicals.  They are on faculty at some of the best institutes of higher learning.  They note that while many of the national diabetes organizations downplay the benefits of carb restriction, we have enough evidence now to warrant careful reconsideration.

Here are some of their major points, all backed up by references (68) from the scientific literature:

  1. Glucose (blood sugar) is a “major control element,” whether directly or indirectly through insulin, in glycogen metabolism, production of new glucose molecules, and in formation and breakdown of fat.
  2. The potential adverse effects of dietary fat are typically seen with diets high in carbohydrate.
  3.  Carb restriction improves control of blood sugars, a major target of diet therapy.  Many of the supportive studies were done with overweight or obese people (85% of type 2 diabetics are overweight).  Very low-carb diets are often so effective that diabetic medications have to be reduced at the outset of the diet. 
  4. For weight loss, carb-restricted diets work at least as well as low-fat diets.  They are usually superior. 
  5. Carb-restricted diets usually replace carbs with fat, resulting in improve markers for cardiovascular disease (lower serum triglycerides and higher HDL cholesterol levels). Replacing dietary fat with carbohydrate—the goal of many expert nutrition panels over the last 40 years—tends to increase the amount of artery-damaging “small, dense LDL cholesterol” in most of the population. 
  6. Carbohydrate restriction improves all five components of the metabolic syndrome: obesity, low HDL cholesterol, high triglycerides, high blood pressure, elevated blood sugar.
  7. Beneficial effects of carbohydrate restriction seem to occur even without weight loss
  8. Still worried about excessive fat consumption?  Many low-carb dieters demonstrate a significant increase in the percentage of total calories from fat, but without an increase in the absolute amount of fat eaten.  That’s because they simply reduced their total calories by reducing carb consumption. 

This post was chosen as an Editor's Selection for ResearchBlogging.orgThe authors in 2008 called for a widespread reappraisal of carbohydrate restriction for type 2 diabetes and metabolic syndrome.  It’s been happening, and many patients are reaping the benefits.

Steve Parker, M.D.

Reference: Accurso A, Bernstein RK, Dahlqvist A, Draznin B, Feinman RD, Fine EJ, Gleed A, Jacobs DB, Larson G, Lustig RH, Manninen AH, McFarlane SI, Morrison K, Nielsen JV, Ravnskov U, Roth KS, Silvestre R, Sowers JR, Sundberg R, Volek JS, Westman EC, Wood RJ, Wortman J, & Vernon MC (2008). Dietary carbohydrate restriction in type 2 diabetes mellitus and metabolic syndrome: time for a critical appraisal. Nutrition & metabolism, 5 PMID: 18397522


Filed under Carbohydrate, Fat in Diet

13 responses to “Seminal Paper: Carbohydrate Restriction for Type 2 Diabetes and Metabolic Syndrome

  1. Vivian

    I’ve lived every one of those recommendations over the last few years and as have 3 other members of my family. A carb-restricted primal type diet has made the difference between health and illness, obesity and normal weight, drugs and no drugs. I’m thrilled to see it start going mainstream. It’s hard not to be an evangelist for the health gains (the sustained weight loss speaks for itself).

  2. Vivian, as you know, there’s a fair amount of overlap between paleo and low-carb eating.

    On of these days I’ll have to surf more of the paleo sites to see how many grams of carbs they eat daily.

    Most paleos don’t eat grains, so that cuts out a lot of carbs right there. Final carb count probably depends on fruit and starchy vegetable consumption.

    My recollection is that many insects are low-carb.


  3. Vivian

    Whoa, insects – I guess there’s a primal limit for all of us… 🙂

    If you wander over to some of the more popular primal sites you’ll find a lot of disagreement over acceptable levels of carbs. From 0% to upwards of 60%. I think the only thing agreed on is that the food has to be nature’s, not manufactured. Since I’m a T2 diabetic, I went the low carb route (keeping my carbs under 50 a day during my weight loss/health regain phase , moving up to between 75-100 a day during maintenance. Low-carb is what I meant to emphasize in my comment, although of course I think the natural food way is the best way to do it.

    I’m just glad to see these studies and wish they got more play in the mainstream media.

  4. Dan

    I have found that I prefer moderate to low carbs. Im sitting around 100 – 150g carbs. Certainly this is not high and there are many hunter gatherer groups that eat high carbs. But like you said its starchy turbers, fruits and vegetables (which is what I eat). I feel better with a bit more carbs but thats just me. But paleo people do need to accept that carbs are an important component in many many hunter gatherer groups. So they shouldn’t be too anti! I feel carbs give me energy, while fat and protein make me satiated.

  5. Three cheers for low carbohydrate treatment of type II diabetes! I practice in Massachusetts, the center of the Joslin “carbohydrates increase insulin sensitivity” universe. Now, even the Joslin dietitians are advising carb counting and a more mediterranean-style diet. Hooray!

  6. Thanks for the comments, Dr. Dan and Dr. Deans.

    [Everybody else, why not click on their names when you have time for some very interesting reading?]

  7. Awesome points! Interesting reading. Thank you.

  8. Robin

    Thanks for the great article. I have T2 and have managed to keep my blood sugar under control with a lower carb diet (no meds).

    I listened to your interview on the Jimmy Moore Podcast and was so encouraged by your gentle and open thoughts regarding healthy living using diet and exercise as a major factor.

    Your blog has become a must read for me. Thank you. May your number increase in the medical field.

  9. Gee, thanks, Robin! Jimmy is a great interviewer, brings out the best in people.


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  12. Karen Kneeshaw

    Having enjoyed a very low carb lifestyle and a health life for many years, I succumbed to the nutritional zealots and began to gradually increase my carb levels. Not long after, my D.O. announced that I was diabetic with an A1c of over 8%. I was immediately referred to a nutritionist where it was recommended that I consume 45 carbs per meal with 2 15-gram snacks per day. Begrudgingly, I went along with it and my weight ballooned while my health status plummeted. I am taking a handful of oral medications and 20 units of insulin a day.

    So, I didn’t really have to ask myself what’s wrong with this picture? I know what it is and I’m going back to my Atkins lifestyle-this time for life! It’s my bet that my A1c, fasting blood sugar and cholestrol levels will all improve and soon I’ll be off all the meds, too!