Article

The case for low carbohydrate diets in diabetes management

Division of Endocrinology, Diabetes and Hypertension, SUNY Downstate Medical Center, Kings County Hospital Center, Brooklyn, NY 11203, USA.
Nutrition & Metabolism (Impact Factor: 3.36). 07/2005; 2(1):16. DOI: 10.1186/1743-7075-2-16
Source: PubMed

ABSTRACT A low fat, high carbohydrate diet in combination with regular exercise is the traditional recommendation for treating diabetes. Compliance with these lifestyle modifications is less than satisfactory, however, and a high carbohydrate diet raises postprandial plasma glucose and insulin secretion, thereby increasing risk of CVD, hypertension, dyslipidemia, obesity and diabetes. Moreover, the current epidemic of diabetes and obesity has been, over the past three decades, accompanied by a significant decrease in fat consumption and an increase in carbohydrate consumption. This apparent failure of the traditional diet, from a public health point of view, indicates that alternative dietary approaches are needed. Because carbohydrate is the major secretagogue of insulin, some form of carbohydrate restriction is a prima facie candidate for dietary control of diabetes. Evidence from various randomized controlled trials in recent years has convinced us that such diets are safe and effective, at least in short-term. These data show low carbohydrate diets to be comparable or better than traditional low fat high carbohydrate diets for weight reduction, improvement in the dyslipidemia of diabetes and metabolic syndrome as well as control of blood pressure, postprandial glycemia and insulin secretion. Furthermore, the ability of low carbohydrate diets to reduce triglycerides and to increase HDL is of particular importance. Resistance to such strategies has been due, in part, to equating it with the popular Atkins diet. However, there are many variations and room for individual physician planning. Some form of low carbohydrate diet, in combination with exercise, is a viable option for patients with diabetes. However, the extreme reduction of carbohydrate of popular diets (<30 g/day) cannot be recommended for a diabetic population at this time without further study. On the other hand, the dire objections continually raised in the literature appear to have very little scientific basis. Whereas it is traditional to say that more work needs to be done, the same is true of the assumed standard low fat diets which have an ambiguous record at best. We see current trends in the national dietary recommendations as a positive sign and an appropriate move in the right direction.

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    • "The metabolic disturbances associated with obesity can therefore place older adults at increased risk of diabetes, and the subsequent glucose dysregulation and insulin resistance associated with diabetes may adversely affect appetite regulation and lead to excessive food intake. Thus, the adverse metabolic effects of obesity may ultimately dysregulate appetite and further predispose obese older adults to develop diabetes (Anora and McFarlane, 2005). Since increased levels of inflammation have been shown to be detrimental to muscle (Anker et al., 1999), a negative cycle can occur whereby the pathophysiological effects of obesity and diabetes may interact in such a manner to dramatically increase risk of sarcopenia in this subpopulation of obese older adults with diabetes (Dominquez and Barbagallo, 2007). "
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    • "For example, 20 percent of people with diabetes with public coverage and 23 percent of those without insurance spend more than et al., 2004). They point out that rising rates of obesity in the U.S. are coincident with the steady increase in the share of calories from carbohydrates (Arora and McFarlane, 2005). "
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