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Nutrition. 2015 Jan;31(1):1-13. doi: 10.1016/j.nut.2014.06.011. Epub 2014 Jul 16.

Dietary carbohydrate restriction as the first approach in diabetes management: critical review and evidence base.

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  • 1Department of Cell Biology, State University of New York Downstate Medical Center, Brooklyn, New York, USA. Electronic address:
  • 2Department of Chemistry, State University of New York Geneseo, Geneseo, NY, USA.
  • 3Department of Nutrition, Exercise and Sports, Copenhagen University, Denmark.
  • 4New York Diabetes Center, Mamaroneck, NY, USA.
  • 5Department of Radiology (Nuclear Medicine), Albert Einstein College of Medicine, Bronx, New York, USA.
  • 6Duke University Medical Center, Durham, NC, USA.
  • 7Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.
  • 8Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
  • 9Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA.
  • 10Departments of Medicine and Endocrinology, State University of New York Downstate Medical Center, Brooklyn, NY, USA.
  • 11Karlshamn, Sweden.
  • 12Department of Endocrinology I, Bispebjerg University Hospital, Copenhagen, Denmark.
  • 13University of California San Francisco, San Francisco, CA, USA.
  • 14Department of Pediatrics, Creighton University, Omaha, NE, USA.
  • 15Private Practice, Lawrence, KS, USA.
  • 16Department of Human Sciences (Kinesiology Program) Ohio State University, Columbus, OH, USA.
  • 17Mid-Missouri Reproductive Medicine and Surgery, Columbia, MO, USA.
  • 18Hälsocentralen Centrum, Sundsvall, Sweden.
  • 19Private Practice, Malmö, Sweden.
  • 20Private Practice, Lake Oswego, OR, USA.
  • 21Ballochmyle Medical Group, Mauchline, East Ayrshire, Scotland, UK.
  • 22Metabolia Oulu, Oulu, Finland.
  • 23Faculty of medicine, Department of Surgery, Kuwait university, Kuwait.
  • 24Springfield College, Springfield, MA, USA.
  • 25First Nations Division, Vancouver, BC, Canada.
  • 26German University for Prevention and Health Care Management, Saarbrücken, Germany.


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 randomized 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.


Carbohydrate; Diabetes; Hemoblobin A(1c); Ketogenic diet; Low-carbohydrate diet; Triglyceride

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