Abstract
Current nutritional approaches to metabolic syndrome and type 2 diabetes generally rely on reductions in dietary fat. The success of such approaches has been limited and therapy more generally relies on pharmacology. The argument is made that a re-evaluation of the role of carbohydrate restriction, the historical and intuitive approach to the problem, may provide an alternative and possibly superior dietary strategy. The rationale is that carbohydrate restriction improves glycemic control and reduces insulin fluctuations which are primary targets. Experiments are summarized showing that carbohydrate-restricted diets are at least as effective for weight loss as low-fat diets and that substitution of fat for carbohydrate is generally beneficial for risk of cardiovascular disease. These beneficial effects of carbohydrate restriction do not require weight loss. Finally, the point is reiterated that carbohydrate restriction improves all of the features of metabolic syndrome.
Highlights
The epidemic of diabetes continues unabated, and impassioned calls for better treatment and prevention strategies are common features of scientific conferences
The effects of obesity that lead to insulin resistance in peripheral tissues, largely increased fatty acids, are downstream from the primary impact of diet
This argues for an emphasis of treatment on glycemic control and improved hepatic metabolism rather than weight loss
Summary
The epidemic of diabetes continues unabated, and impassioned calls for better treatment and prevention strategies are common features of scientific conferences. The effects of obesity that lead to insulin resistance in peripheral tissues, largely increased fatty acids, are downstream from the primary impact of diet This argues for an emphasis of treatment on glycemic control and improved hepatic metabolism rather than weight loss. Two additional lines of evidence support this idea: In a prospective study testing the hypothesis linking carbohydrate restriction to MetS, the carbohydrate-restricted group showed greater improvements in weight loss and multiple markers of atherogenic dyslipidemia 2) Experiments in which change in macronutrients and weight loss are separated in time show that eucaloric carbohydrate reduction leads to greater improvement in atherogenic lipid markers (TG, HDL, apoB/apoA1 and mean LDL particle size) even in the presence of higher saturated fat[57,58]. A critical re-appraisal could form the basis for an alternative for those patients for whom current recommendations are not successful
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
