What more Evidence do we Need? Carbohydrate Restriction for Therapeutic Uses

What More Evidence


Blind is also the one who doesn’t want to see. The science of carbohydrate restriction and its use for therapeutic purposes has been out there for decades. It’s just that it’s still totally ignored by the community.

It is put into silence by big decision makers. I personally don’t think the situation is going to last much longer because more power is given to the people by technology.

It’s easy to see (at least from my perspective) that the most efficient way to approach diabetes is from a dietary point of view: that of restricting carbohydrates. Yet we keep seeing doctors prescribe drugs as primary intervention in diabetes care. I think that’s insane.

The 12 Major Points

But enough with my perspective! There’s a recently written paper entitled:

Dietary carbohydrate restriction as a first approach in diabetes management. Critical review and evidence based.

I think it’s probably the first piece of knowledge that people suffering from diabetes should read. I’m driving attention to this paper as it includes more than 20 authors. They joined forces in an effort to supply strong evidence for the critical importance of carbohydrate restriction in diabetes management.

Eugene Fine, Jeff Volek, Jay Wortman, Eric Westman, Richard David Feinman, Mary Vernon, and Richard Bernstein are only a few of them. The full paper is available for free.

The authors bring 12 major points to support their claim. Their references list includes approximately 100 other articles. Here are the 12 major points (+my personal intervention):

1. Hyperglycemia is the most salient feature of diabetes. Dietary carbohydrate restriction has the greatest effect on decreasing blood glucose levels.

What More Evidence - Point 1

Since T2D (Type 2 Diabetes) patients cannot efficiently use insulin to reduce blood glucose levels, reducing carbohydrate intake will result in a reduced need of insulin activity.

2. During the epidemics of obesity and T2D caloric increases have been almost entirely due to increased carbohydrate intake.

Ever since the first Dietary Guidelines in the 1970s, fat has been a demonized macronutrient. Carbohydrates have been recommended as the primary and most important macronutrient on the other hand, making up for more than 50% of the total caloric intake of a person per day.

Hence, big industries have been developed around them and it would not be difficult to assume that it would take some time until this dogma is abolished.

What More Evidence - NHANES

3. Benefits of dietary carbohydrate restriction do not require weight loss.

The authors say that one does not have to lose weight on a carbohydrate restricted diet to experience improvements in their diabetic condition. I would assume that lower insulin levels promote fat release from adipocytes and many folks with lower insulin levels will experience some form of weight loss.

4. Although weight loss is not required for benefit, no dietary intervention is better than carbohydrate restriction for weight loss.

I’d recommend the reader to research on the activity of insulin inside the human body, as well as its relationship with other hormones.

5. Adherence to low-carbohydrate diets in people with T2D is at least as good as adherence to any other dietary interventions and is frequently significantly better.

My personal experience with very-low-carb (ketogenic) nutrition makes me think of the hunger suppression effect that long-term lower insulin levels promote. In this context, I would advocate for prolonged ketosis. Yet, I cannot know if other people would experience the same benefits that I do.

What More Evidence - What did they eat

I’d want to see clearer information on what these subjects ate while following the approach.

6. Replacement of carbohydrate with protein is generally beneficial.

Even though many big names in the low-carb crew advocate for low protein intake, I think it would be better to focus on carbohydrate restriction even with a moderate or higher protein intake because I think GNG (gluconeogenesis) is an expensive and complex metabolic pathway over the long-term.

I also assume that people replacing carbs with protein will reduce protein intake as time goes by because protein is believed to be the most satiating macronutrient.

7. Dietary and total saturated fat do not correlate with risk for cardio-vascular disease.

I have not found any clearly written study to point out that increased fat intake is solely correlated with higher risk of CVD. In fact, many studies (labeled high-fat) are misleading because they are also higher in carbohydrates.

So, it’s important to clearly define what a low-carbohydrate approach consists of, in terms of macronutrient partitioning. One will see different results in studies that are high-fat-high-carb compared to studies that are high-fat-very-low-carb.

Besides, very-low-carb-high-fat diets have the opposed effect (in my opinion) because of the benefits (weight loss – fat loss, better lipid profile, better blood glucose levels, etc) contribute to a lower risk of CVD.

8. Plasma saturated fatty acids are controlled by dietary carbohydrates more than by dietary lipids.

In light of what I said in #7, lipogenesis and higher blood lipids are dictated by insulin activity. Hence, I think that a good marker of conversion of carbs to fat (lipogenesis) is POA (palmitoleic acid). Phinney and Volek explain this concept in their book.

What More Evidence - Point 8

9. The best predictor of microvascular and, to a lesser extent, macrovascular complications in patients with T2D is glycemic control (HbA1C).

HbA1C or glycated hemoglobin is a good measure of blood glucose levels over a period of 3-4 months. It measures how long glucose stays in the blood over the lifetime of hemoglobin (90-120 days).

10. Dietary carbohydrate restriction is the most effective method (other than starvation) over reducing serum TGs and increasing HDL.

What More Evidence - Point 10

“Despite their routine measurement, a number of studies have failed to support any connection with LDL-cholesterol lowering and improved mortality. During the first 14 years of the Framingham study for every 1mg/dL per year drop in cholesterol levels there was a 14% increase in cardiovascular death and an 11% increase in overall mortality [69]. Similar increase in mortality following drop in cholesterol was seen in studies by Iso 77 and 78.” [Taken from Feinman et al. (2014)]

11. Patients with T2D on carbohydrate restricted diets reduce and frequently eliminate medication. People with T1D usually require lower insulin.

Again, I come and ask:

What more evidence?

Why drugs then?

Is it because of pharma giants?

Big money?

12. Intensive glucose lowering by dietary carbohydrate restriction has no side effects compared to the effects of intensive pharmacologic treatment.


People need to know. Doctors need to change their textbooks and move away from this misguided and misleading dogma.

The authors conclude following the same line:

“What evidence would be required to change the current recommendations for dietary treatment in diabetes?”

I personally encourage the reader to do personal research. There is a lot of highly valuable and free information available online. People need to know and to start taking better care of their lives.


1. Feinman, R. D., Pogozelski, W. K., Astrup, A., Bernstein, R. K., Fine, E. J., Westman, E. C., … & Worm, N. (2014). Dietary Carbohydrate restriction as the first approach in diabetes management. Critical review and evidence base. Nutrition.

2. Fine, E. & Feinman, R. D. (2014). Insulin, Carbohydrate restriction, metabolic syndrome and cancer. Unpublished – pending review.

3. Phinney and Volek – The Art and Science of Low Carbohydrate Living.

4. Westman, Phinney, and Volek – The New Atkins for a New You

5. Ron Rosedale – The Rosedale Diet

6. Terry Wahls – The Wahls Protocol

Photos: here

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