Retrospective #239: “Low-Carb Diet Should Be First Approach for Diabetes”

Andreas Eenfeldt, M.D., founder of the very popular Diet Doctor, headlined a 2014 blog post with “Scientists: A Low-Carbohydrate Diet Should Be First Approach for Diabetes!” In it he provides a link to the full-text document (29 pages, with 99 foot-noted references). The paper was published in the mainstream journal Nutrition under the title, “Dietary Carbohydrate restriction as the first approach in diabetes management. Critical review and evidence base.”

Richard Feinman, PhD, was the lead author, among 26 co-authors. Eenfeldt comments, “Behind the article is a large group of scientists who have long focused on low-carb diets. But the name that stands out to me is Arne Astrup, the influential Danish professor and nutrition researcher who in recent years became convinced and changed sides in the debate. And dared to admit it. A scientist with integrity” (Eenfeldt’s emphasis).

Highlights from the “In Press Accepted Manuscript”:

·         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 medication.

·         There are no side effects comparable to those seen in intensive treatment with drugs.

The Abstract from the accepted manuscript:

“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 Abstract is followed by Definitions of Very Low and Low Carb diets and then by “12 Points,” each with fully footnoted exposition and links to references. There is then a Discussion, Conclusion and Recommendations.

Point 1. Hyperglycemia is the most salient feature of diabetes. Dietary carbohydrate restriction has the greatest effect on decreasing blood glucose levels.

Point 2. During the epidemics of obesity and type 2 diabetes, caloric increases have been due almost entirely to increased carbohydrate.

Point 3. Benefits of dietary carbohydrate restriction do not require weight loss.

Point 4. Although weight loss is not required for benefit, no dietary intervention is better than carbohydrate restriction for weight loss.

Point 5. Adherence to low-carbohydrate diets in people with type 2 diabetes is at least as good as adherence to any other dietary interventions and is frequently significantly better.

Point 6. Replacement of carbohydrate with protein is generally beneficial.

Point 7. Dietary total and saturated fat do not correlate with risk of CVD.

Point 8. Plasma saturated fatty acids are controlled by dietary carbohydrate more than by dietary lipids.

Point 9. The best predictor of microvascular and, to a lesser extent, macro-vascular complications in patients with type 2 diabetes, is glycemic control (HbA1c).

Point 10. Dietary carbohydrate restriction is the most effective method (other than starvation) of reducing serum triglycerides and increasing high-density lipoprotein (HDL).

Point 11. Patients with type 2 diabetes on carbohydrate-restricted diets reduce and frequently eliminate medication. People with type 1 usually require lower insulin.

Point 12. Intensive glucose lowering by dietary carbohydrate restriction has no side effects comparable to the effects of intensive pharmacologic treatment.

The Diet Doctor concludes his commentary on this published scientific paper in Nutrition with this suggestion: “The article in Nutrition is excellent for print out and hand out to curious physicians and diabetes nurses. Recommended!”

I couldn’t agree more. It is a very well-made case and should be widely disseminated in the medical community.