title: Dietary carbohydrate restriction as the first approach in diabetes management: critical review and evidence base.
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.
authors.affiliation: Department of Cell Biology, State University of New York Downstate Medical Center, Brooklyn, New York, USA. Electronic address: richard.feinman@downstate.edu.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Feinman
authors.affiliation: Department of Chemistry, State University of New York Geneseo, Geneseo, NY, USA.
authors.forename: Wendy K
authors.initials: WK
authors.lastname: Pogozelski
authors.affiliation: Department of Nutrition, Exercise and Sports, Copenhagen University, Denmark.
authors.forename: Arne
authors.initials: A
authors.lastname: Astrup
authors.affiliation: New York Diabetes Center, Mamaroneck, NY, USA.
authors.forename: Richard K
authors.initials: RK
authors.lastname: Bernstein
authors.affiliation: Department of Radiology (Nuclear Medicine), Albert Einstein College of Medicine, Bronx, New York, USA.
authors.forename: Eugene J
authors.initials: EJ
authors.lastname: Fine
authors.affiliation: Duke University Medical Center, Durham, NC, USA.
authors.forename: Eric C
authors.initials: EC
authors.lastname: Westman
authors.affiliation: Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Accurso
authors.affiliation: Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Lynda
authors.initials: L
authors.lastname: Frassetto
authors.affiliation: Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Gower
authors.affiliation: Departments of Medicine and Endocrinology, State University of New York Downstate Medical Center, Brooklyn, NY, USA.
authors.forename: Samy I
authors.initials: SI
authors.lastname: McFarlane
authors.affiliation: Karlshamn, Sweden.
authors.forename: Jörgen Vesti
authors.initials: JV
authors.lastname: Nielsen
authors.affiliation: Department of Endocrinology I, Bispebjerg University Hospital, Copenhagen, Denmark.
authors.forename: Thure
authors.initials: T
authors.lastname: Krarup
authors.affiliation: University of California San Francisco, San Francisco, CA, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Saslow
authors.affiliation: Department of Pediatrics, Creighton University, Omaha, NE, USA.
authors.forename: Karl S
authors.initials: KS
authors.lastname: Roth
authors.affiliation: Private Practice, Lawrence, KS, USA.
authors.forename: Mary C
authors.initials: MC
authors.lastname: Vernon
authors.affiliation: Department of Human Sciences (Kinesiology Program) Ohio State University, Columbus, OH, USA.
authors.forename: Jeff S
authors.initials: JS
authors.lastname: Volek
authors.affiliation: Mid-Missouri Reproductive Medicine and Surgery, Columbia, MO, USA.
authors.forename: Gilbert B
authors.initials: GB
authors.lastname: Wilshire
authors.affiliation: Hälsocentralen Centrum, Sundsvall, Sweden.
authors.forename: Annika
authors.initials: A
authors.lastname: Dahlqvist
authors.affiliation: Private Practice, Malmö, Sweden.
authors.forename: Ralf
authors.initials: R
authors.lastname: Sundberg
authors.affiliation: Private Practice, Lake Oswego, OR, USA.
authors.forename: Ann
authors.initials: A
authors.lastname: Childers
authors.affiliation: Ballochmyle Medical Group, Mauchline, East Ayrshire, Scotland, UK.
authors.forename: Katharine
authors.initials: K
authors.lastname: Morrison
authors.affiliation: Metabolia Oulu, Oulu, Finland.
authors.forename: Anssi H
authors.initials: AH
authors.lastname: Manninen
authors.affiliation: Faculty of medicine, Department of Surgery, Kuwait university, Kuwait.
authors.forename: Hussain M
authors.initials: HM
authors.lastname: Dashti
authors.affiliation: Springfield College, Springfield, MA, USA.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Wood
authors.affiliation: First Nations Division, Vancouver, BC, Canada.
authors.forename: Jay
authors.initials: J
authors.lastname: Wortman
authors.affiliation: German University for Prevention and Health Care Management, Saarbrücken, Germany.
authors.forename: Nicolai
authors.initials: N
authors.lastname: Worm
mesh_terms: D001786:Blood Glucose / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000178:diet therapy* / Q000453:epidemiology; D050528:Diet, Carbohydrate-Restricted; D004040:Dietary Carbohydrates / Q000008:administration & dosage*; D019468:Disease Management; D019317:Evidence-Based Medicine; D006801:Humans; D006943:Hyperglycemia / Q000178:diet therapy; D016032:Randomized Controlled Trials as Topic; D015431:Weight Loss
chemical_list: D001786:Blood Glucose; D004040:Dietary Carbohydrates
keywords: Carbohydrate; Diabetes; Hemoblobin A(1c); Ketogenic diet; Low-carbohydrate diet; Triglyceride