GENESEO, N.Y. – Scientific evidence supporting the treatment of type 2 diabetes with a low-carbohydrate diet as the first line of attack is so overwhelming that awaiting long-term results from randomized clinical trials on the effectiveness of such an approach could heighten the incidence of the disease, a new study suggests.
In a study published in the January 2015 issue of the journal Nutrition, Wendy Pogozelski, Distinguished Teaching Professor and chair of the Department of Chemistry at SUNY Geneseo and one of two lead authors of the article, describes 12 points of evidence from clinical and experimental studies that support the carbohydrate-restriction approach. She and her fellow co-authors contend the evidence convincingly merits the reevaluation of current recommendations for treating diabetes, already at epidemic levels in the United States. The other lead author is Richard Feinman, professor of cell biology at SUNY Downstate Medical Center. A group of 24 additional physicians and researchers from around the world also are co-authors of the publication.
The authors include physicians who saw diabetics get worse under the current dietary recommendations but improve with carbohydrate restriction, as well as scientists who have investigated the effect of carbohydrate restriction on specific health markers.
Pogozelski and her fellow co-authors contend that prevailing low-fat, high-carbohydrate diets that rely heavily on drug interventions to treat type 2 diabetes have been widely unsuccessful and suggest that the evidence is sufficiently compelling on the effectiveness of low-carbohydrate diets that those in opposition carry a significant burden of proof on how delaying such an approach is in the best interest of public health.
Clinical trials are research studies that test how well medical approaches work in people and often take years to yield results, and the researchers have encountered resistance in getting these trials funded.
“The evidence we present is not just episodic on the impact of a carbohydrate-restricted diet on the treatment of diabetes,” said Pogozelski. “The aggregate evidence supporting this approach points to immediate and long-term benefits and must be carefully considered because of the serious complications associated with both type 1 and type 2 diabetes.”
The 12 points of evidence cited in the study are:
Hyperglycemia (high blood sugar) is the most salient feature of diabetes. Dietary carbohydrate restriction has the greatest effect in decreasing these dangerous blood glucose levels.
• During the epidemics of obesity and type 2 diabetes, caloric increases have been due almost entirely to increased carbohydrates.
• Benefits of dietary carbohydrate restriction do not require weight loss.
• Although weight loss is not required for benefit, no dietary intervention is better than carbohydrate restriction for weight loss.
• 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.
• Replacement of carbohydrate with protein is generally beneficial.
• Dietary total and saturated fat have not been shown to correlate with risk for cardiovascular disease to the degree that high triglycerides (related to carbohydrate intake) and high blood glucose have been shown to correlate with risk.
• Plasma saturated fatty acids are controlled by dietary carbohydrate more than by dietary lipids.
• The best predictor of microvascular and, to a lesser extent, macrovascular complications in patients with type 2 diabetes, is glycemic control (HbA1C).
• Dietary carbohydrate restriction is the most effective method (other than starvation) of reducing serum triglycerides, whose levels correlate with heart disease risks and increasing high-density lipoprotein levels that are considered to be cardio-protective.
• Patients with type 2 diabetes on carbohydrate-restricted diets reduce and frequently eliminate medication. People with type 1 diabetes usually require lower insulin doses and eliminate large blood sugar swings.
• Intensive glucose lowering by dietary carbohydrate restriction has far fewer side effects comparable than that of intensive pharmacologic treatment.
“My co-authors and I believe that resistance to carbohydrate restriction is partly due to the erroneous belief that high fat intake is more detrimental than high carbohydrate intake,” said Pogozelski. “Reducing fat leads patients to compensate with the intake of more carbohydrates, which we now see has exacerbated the diabetes problem, leading to less glycemic control, more complications and increased and oftentimes unnecessary treatment through medication.”
The authors of the study recommend that government or private health agencies conduct open hearings on the carbohydrate restriction approach in the treatment of diabetes.
According to the Centers for Disease Control and Prevention, diabetes is the seventh-leading cause of death in the United States. In 2012, 9.3% of the U.S. population had type 2 diabetes, up from 8.3% in 2010.