Dietary carbohydrate restriction as the first approach in diabetes

management: Critical review and evidence base

Richard D. Feinman Ph.D. a, *, Wendy K. Pogozelski Ph.D. b, Arne Astrup M.D. c,

Richard K. Bernstein M.D. d, Eugene J. Fine M.S., M.D. e,

Eric C. Westman M.D., M.H.S. f, Anthony Accurso M.D. g, Lynda Frassetto M.D. h,

Barbara A. Gower Ph.D. i, Samy I. McFarlane M.D. j, Jörgen Vesti Nielsen M.D. k,

Thure Krarup M.D. l, Laura Saslow Ph.D. m, Karl S. Roth M.D. n, Mary C. Vernon M.D. o,

Jeff S. Volek R.D., Ph.D. p, Gilbert B. Wilshire M.D. q, Annika Dahlqvist M.D. r,

Ralf Sundberg M.D., Ph.D. s, Ann Childers M.D. t, Katharine Morrison M.R.C.G.P. u,

Anssi H. Manninen M.H.S. v, Hussain M. Dashti M.D., Ph.D., F.A.C.S., F.I.C.S. w,

Richard J. Wood Ph.D. x, Jay Wortman M.D. y, Nicolai Worm Ph.D. z


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 random-

ized 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.


Here is Dr. Feinman's blog post, in which he discusses this paper, and his new book.