Carbohydrate restriction as the default treatment for type 2 diabetes and metabolic syndrome

Figures & data

Figure 1.  Nutrient consumption in the United States. National Health and Nutrition Education Study (NHANES). Data from reference 6. B. Incidence of diabetes in the United States. Data from Centers for Disease Control and Prevention (http://www.cdc.gov/diabetes/statistics/incidence/fig2.htm)

Table I.  Comparison of low CHO vs. LF diets on markers for Metabolic Syndrome Data shown in bold indicate low CHO (or mod-PROT) shows greater improvement in marker than LF; plain, LF is better. Original references in Volek & Feinman 5. Data below the double line are from experiments carried out under conditions designed to maintain body weight.

				CHANGE
Reference	Subjects	Duration	Diet	CHO (g/d)	weight (%)	HDL (%)	TAG (%)	TAG/HDL (%)	Glucose (%)	Insulin (%)	DBP (mm)
Brehm et al. 2003	Obese Women	6 mo	Low-CHO	41–97	−9.3	13.4	−23.4	−32.4	−9.1	−14.8	−5
			LF	163–169	−4.2	8.4	1.6	−6.3	−4.0	−23.0	−1
Sondike et al. 2003	Overweight Adolescents	12 wk	Low-CHO	37	−10.7	8.7	−40.5	−45.2
			LF	154	−4.1	4.2	−5.4	−9.2
Samaha et al. 2003	Obese Men/Women	6 mo	Low-CHO	150	−4.5	0.0	−20.2	−20.2	−8.6	−27.3
			LF	201	−1.4	−2.4	−4	−1.6	−1.6	5.6
Foster et al. 2003	Obese Men/Women	1 yr	Low-CHO	ad lib	−7.3	18.2	−28.1	−29.5
			LF	ad lib	−4.5	1.4	0.7	−2.6
Volek et al. 2004	Overweight Women	4 wk	Low-CHO	29	−3.9	1.3	−23	−28.3	−3.8	−8.8
			LF	186	−1.4	−8.6	−11.2	−4.2	1.3	23.2
Sharman et al. 2004	Overweight Men	6 wk	Low-CHO	36	−5.6	−3.3	−44.1	−42.3	−5.8	−41.5
			LF	224	−3.6	−6.6	−15	−8.3	−5.2	−28.1
Brehm et al. 2004	Obese Women	4 mo	Low-CHO	69	−10.8	16.3	−37.3	−46.1			−9
			LF	174	−6.8	4.5	−10.3	−14.2			−3
Meckling et al. 2004	Obese Men/Women	10 wk	Low-CHO	59	−7.7	12.2	−29.4	−37.1	−8.0	−28.7	−6.1
			LF	225	−7.4	−15.4	−25.4	−11.8	−10.2	−3.3	−5
Stern et al. 2004	Obese Men/Women	1 yr	Low-CHO	120	−3.9	−2.8	−28.6	−26.8
			LF	230	−2.3	−12.3	2.7	29.6
Yancy et al. 2004	Obese Men/Women	24 wk	Low-CHO	30	−12.3	9.8	−47.2	−51.8			−6
			LF	198	−6.7	−2.9	−14.4	−12.1			−5.2
Aude et al. 2004	Obese Men/Women	12 wk	Low-CHO	ad lib	−6.2	−2.6	−23.2	−21.1
			LF	ad lib	−3.4	−7	−10.5	−3.8
Seshadri et al. 2004	Obese Men/Women	6 mo	Low-CHO	113	(−8.5)	−2.4	−7.4			−40
			LF	198	(−3.5 kg)	−2.4	−2.3			11.2
McAuley et al. 2004	Obese Women	8 wk	Low-CHO	41	−6.9	0.9	−38.8	−44.2	−5.9	−39.3
			LF	172	−4.4	−6	−17.5	−15.1	−0.1	−28.4
			Mod-PRO	130	−5.8	−4.1	−33.9	−31.8	−3.9	−24.4
Sharman et al. 2002	Normal Weight Men	6 wk	Ketogenic	46	−2.8	11.5	−33.0	−39.9	−0.2	−34.2
		6 wk	Low-Fat	271	0.5	0.0	−5.3	−5.3	1.8	13.0
Volek et al. 2003	Normal Weight Women	4 wk	Ketogenic	43	−2.0	32.0	−30.2	−47.2	−1.9	11.6
		4 wk	Low-Fat	249	−1.3	−7.7	3.8	0.5	−5.3	18.7
Allick et al. 2004	Type 2 Diabetics	2 wk	Ketogenic	0	0	23.5	−43.9	−55	−16.9	−16.7
		2 wk	Low-Fat	775

Figure 2.  Effect of diet on plasma glucose. Meal points are Breakfast (B), lunch (L), dinner (D, snacks (S, S1, S2). A. Mean plasma glucose concentrations for 13 patients with type 2 diabetes followed two diets for six weeks: a diet containing moderate amounts of fiber (total, 24 g; 8 g of soluble fiber and 16 g of insoluble fiber), as recommended by the American Diabetes Association (ADA), and a high-fiber diet (total, 50 g; 25 g of soluble fiber and 25 g of insoluble fiber), containing foods not fortified with fiber (unfortified foods). Figure redrawn from reference 10. B. Mean plasma glucose concentration before (triangles) and after 5 weeks on control diet (light circles: (CHO:fat:protein = 55:30:15)) or 5 weeks on lower carbohydrate diet (dark circles: (20:50:30)). Data from reference 9.

Figure 3.  Changes in markers of inflammation in people with metabolic syndrome with diet. Forty overweight men women with MetS were randomly assigned to an ad libitum very low carbohydrate ketogenic diet (VLCKD) (1510 kcal:%CHO:fat:protein = 13:59:28) or a low fat diet (LFD) (1521 kcal:%CHO:fat:protein = 56:24:20). Data from reference 3F.

Figure 4.  Theories of mechanisms of insulin resistance.

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