Dietary carbohydrate restriction as the first approach in diabetes management: Critical review and evidence base
"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"
Low carbohydrate diet to achieve weight loss and improve HbA1c in type 2 diabetes and pre-diabetes: experience from one general practice
"Patients with diabetes have long been exhorted to give up sugar, encouraged instead to take in fuel as complex carbohydrate such as the starch found in bread, rice or pasta (especially if ‘wholemeal’). However, bread has a higher glycaemic index than table sugar itself. There are no essential nutrients in starchy foods and people with diabetes struggle to deal with the glycaemic load they bring. The authors question why carbohydrate need form a major part of the diet at all. The central goal of achieving substantial weight loss has tended to be overlooked. The current pilot study explores the results of a low carbohydrate diet for a case series of 19 type 2 diabetes and pre-diabetes patients over an eight-month period in a suburban general practice."
Abstract: Unwin, D. and Unwin, J. (2014), Low carbohydrate diet to achieve weight loss and improve HbA1c in type 2 diabetes and pre-diabetes: experience from one general practice. Practical Diabetes, 31: 76–79. doi: 10.1002/pdi.1835
Systematic review and meta-analysis of different dietary approaches to the management of type 2 diabetes
"Low-carbohydrate, low-GI, Mediterranean, and high-protein diets are effective in improving various markers of cardiovascular risk in people with diabetes and should be considered in the overall strategy of diabetes management."
Abstract: Olubukola Ajala, Patrick English, and Jonathan Pinkney, Systematic review and meta-analysis of different dietary approaches to the management of type 2 diabetes Am J Clin Nutr 2013 97: 3 505-516; First published online January 30, 2013. doi:10.3945/ajcn.112.042457
Low carbohydrate diet in type 1 diabetes, long-term improvement and adherence: A clinical audit
"It is therefore virtually impossible to match carbohydrates and insulin which leads to unpredictable blood glucose levels after meals. By reducing the carbohydrates and insulin doses the size of the blood glucose fluctuations can be minimized. The risk of hypoglycemia is therefore minimized as well. Around-the-clock euglycemia was seen with 40 g carbohydrates in a group of people with type 1 diabetes."
Full Text: Nielsen JV1, Gando C, Joensson E, Paulsson C, Low carbohydrate diet in type 1 diabetes, long-term improvement and adherence: A clinical audit. Diabetol Metab Syndr. 2012 May 31;4(1):23. doi: 10.1186/1758-5996-4-23.
The hypocaloric diet in type 2 diabetes - déjà vu
"It is interesting to note that a low carbohydrate diet in association with reduced caloric intake is as effective at 'curing' obese type 2 diabetes now as it was in the 18th century. However, the biochemical and technical advances of the past couple of centuries have permitted modern studies to add to knowledge and perhaps more importantly reawaken interest in this non-pharmacological approach to treatment. This is particularly pertinent given the increasing burden of diabesity on healthcare systems."
Full Text: Caroline Day and Clifford J Bailey, The hypocaloric diet in type 2 diabetes - déjà vu The British Journal of Diabetes & Vascular Disease January/February 2012 12: 48-51, doi:10.1177/1474651412437503
Influence of Fat and Carbohydrate Proportions on the Metabolic Profile in Patients With Type 2 Diabetes: A Meta-Analysis
"Our findings suggested that replacing fat with carbohydrate could deteriorate insulin resistance while the adverse effect on triglycerides from the LFHC diet could be avoided by restricting energy intake to a degree sufficient for the attainment of weight reduction."
Full Text: Kodama et al, Influence of Fat and Carbohydrate Proportions on the Metabolic Profile in Patients With Type 2 Diabetes: A Meta-Analysis Diabetes Care May 2009 32:959-965; doi:10.2337/dc08-1716
The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus
"The LCKD group had greater improvements in hemoglobin A1c (-1.5% vs. -0.5%, p=0.03), body weight (-11.1 kg vs. -6.9 kg, p=0.008), and high density lipoprotein cholesterol (+5.6 mg/dL vs. 0 mg/dL, p
Low-carbohydrate diet in type 2 diabetes: stable improvement of bodyweight and glycemic control during 44 months follow-up
"A reduced carbohydrate diet is effective in motivated patients and can be recommended for overweight patients with type 2 diabetes. There has been no sign of a negative cardiovascular effect."
Dietary carbohydrate restriction in type 2 diabetes mellitus and metabolic syndrome: time for a critical appraisal
"Current nutritional approaches to metabolism 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."
A low-carbohydrate, ketogenic diet to treat type 2 diabetes
"In summary, the LCKD had positive effects on body weight, waist measurement, serum triglycerides, and glycemic control in a cohort of 21 participants with type 2 diabetes. Most impressive is that improvement in hemoglobin A1c was observed despite a small sample size and short duration of follow-up, and this improvement in glycemic control occurred while diabetes medications were reduced substantially in many participants."
Nutrition in patients with Type 2 diabetes: are low carbohydrate diets effective, safe or desirable? (Review)
"It does appear from recent studies that risks associated with short-term use of low-carbohydrate diets have been exaggerated. Many professionals feel that the diets should not be promoted until we have more evidence. A very recent systematic review of diet interventions for patients with Type 2 diabetes  serves to remind us that we have remarkably little long-term evidence for any dietary intervention in this condition."
The case for low carbohydrate diets in diabetes management
"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."
Effect of a High-Protein, Low-Carbohydrate Diet on Blood Glucose Control in People With Type 2 Diabetes
"Thus, a LoBAG diet ingested for 5 weeks dramatically reduced the circulating glucose concentration in people with untreated type 2 diabetes. Potentially, this could be a patient-empowering way to ameliorate hyperglycemia without pharmacological intervention"
Full Text: Mary C. Gannon and Frank Q. Nuttall, Effect of a High-Protein, Low-Carbohydrate Diet on Blood Glucose Control in People With Type 2 Diabetes Diabetes September 2004 53:2375-2382; doi:10.2337/diabetes.53.9.2375
The Effects of a Low-Carbohydrate Regimen on Glycemic Control and Serum Lipids in Diabetes Mellitus
"A carbohydrate-restricted regimen improved glycemic control and lipid profiles in selected motivated patients. Therefore, further investigation of the effects of this protocol on treating diabetes mellitus should be considered. Additionally, the reduction of insulin afforded by this diet could theoretically lead to a reduction in hypoglycemic events."