More Proof that Low-Carb Diets Are Good

As if we needed any, right?

I know it's been a long time since I last posted--medical school's insane. Yeah, I knew what I was getting myself into, but I still wasn't expecting this kind of volume of work. Ah, well. Pushing on!

Yesterday, a doctor I met recommended I read this paper about the efficacy of low-carb diets in managing diabetes. I'm posting the link here--please let me know if you can't access the full paper from this link and I'll see what I can do. It's a bit long, but it has a lot of data supporting low-carb and (believe it or not) high-fat diets. I was surprised to see that there, since I thought that was something we seemed to agree worked but was strongly opposed by the medical field. It turns out that a high-fat, low-carb diet actually helps with cholesterol and triglyceride levels. I believe I remember someone here posting something about that, but now there's more proof!

Obviously this paper is geared more towards T2's, but they do mention T1's in a couple of places. I'm pretty sure it was only about the law of small numbers, but I still think it's worth reading because the health benefits appear to be for the general populace, not just T2's.

Thanks for posting about this. I read this study last summer when it was first published. I continue to be amazed at the intransigence of main stream medicine in its reluctance to recommend restricted carb diets as a first response to diabetes, no matter the type. It's effective and safe without any serious side effects.

I wish you well with your continued studies. With your academic success in medical school. society will benefit from one more doctor understanding an important truth about carbs and diabetes.

thanks so much for posting this. i havent seen it before. i really feel like dropping it off at the diabetes day unit at my hospital. every time i go there the nurses try to tell me im gonna die from my low carb diet. really interesting info and easy for a layperson to understand!

good luck with the rest of your semester!

Couple of points. Firstly this is primarily about T2's. Second it is about lowering calorie levels, which they use carbs as the primary factor, and it's not mentioning a single thing about high fat, probably as it goes against the rest of the study to lower calorie intake (probably as the lower the fat the better for T2's as other studies have shown that flushing the fat which is attached to the pancreas in those diagnosed earlier enough can make it recover). What they are classing as low carb is 130g per day on a LOW FAT diet. And the conclusion is that it works at lowering A1c's as people stick to the diet more easily than other diets thus where the improvements are coming from over the control they had before when they "didn't care" and carried on as always regardless. The current LCHF Swedish studies currently ongoing are the most interesting currently in showing why it is such a bad idea through susceptibility to DKA in T1's.

Since this study is a survey of existing research, different levels of carbohydrate consumption are referenced in the study. In fact several studies quoted are referred to as VLCKD (Very low-carbohydrate ketogenic diet) VLCKD is referenced in the studies in Point 1, Point 3, Point 10 and Point 11.

You are incorrect in stating that the diets studied are not high fat. In the section in the Discussion titled "Role of starch versus mono- and disaccharides" the first sentence is "Replacement of carbohydrate with fat or, in some cases, with protein, is beneficial in both types of diabetes leading to better glycemic control, weight loss, cardiovascular risk markers, and reduction in medication".

Most carb lowering diets substitute for the macronutrient carbohydrate with fat and to a lesser extent, protein. Points 7, 8 and 9 address the fact that despite the fact that fat consumption is typically up in a low carb diet there does not seem to be an association with increased risk of cardiovascular disease.

Personally I eat a VLCKD, as defined in this paper, and find protein consumption to be self limiting. For me carbs are replaced mostly with fat. My experience is that my blood glucose immediately got better despite the fact that I had not lost any weight at that point. As the study notes this is one of the positive aspects of this approach to treating T2. I think this immediate positive reinforcement is an important factor in a successful response to a T2 diagnosis.

Please do! There is no evidence to support the "danger" of very low carb diets, except in cases where someone has kidney issues, in which case clearing the extra protein is difficult. Even when we covered the breakdown and use of carbohydrates in the body in class, NO ONE mentioned that low-carb diets are bad, or even might be. They said the brain needs a certain amount of glucose per day, but our bodies are perfectly capable of synthesizing glucose from protein. I especially love how this paper correlates the rise of carbohydrates as the main food source with the upswing in obesity--it goes against everything everyone says about very low-carb diets being "bad."

ill have to look for it in spanish, i live in spain. do you think its translated?dont get me wrong, i dont want to be diabetic or anything, but i have learned so much about nutrition and the human body and for that i am grateful. not being one of the sheeple following the food pyramid. when i go to my primary care physician she sometimes tells me i know more than her. not comforting, but at least shes honest!

I don't know if it's translated, but I could contact the author for you and find out.

My endo is supportive of my low-carb diet, but I've slacked off a bit lately and have been following a "moderate carbohydrate diet" according to the standards set by this paper. I still avoid most grains, which appear to be the biggest issue for me, but milk, fruit, sweet potatoes are a part of my diet. I actually think my endo would love this paper. I guess it's a good thing I don't need a translated copy for him!

My Nutritionist is a professor at a large medical school in Dallas, she is teaching low carb, more important she is teaching calorie restriction. Here in the US we have lost control of our total calorie consumption for each day. We will not see most of the new Doctors for 5 -10 years but it is slowly changing. The new trend is toward lower calorie totals and any balanced diet is OK according to her, plus Pwd's should eat a restricted carbohydrate diet...No cereals, starch, only 2 bread exchanges per day if you insist (30g) and no more than 3oz of protein per meal. My diet is simple and it works, no more than 400cal for breakfast, 500 for lunch, and 600 for dinner but I can pretty much eat anything.

I'm a Type 1 and my A1c has been under 6.2 for over a decade, What lowered my A1c ? Restricting carbs and a CGM.

It's not a mystery the DOC knows what works...and the young Doctors are paying attention to the on line community.

"As noted previously, in many studies, the low-carbohydrate group is allowed unlimited access to food as long as carbohydrate is reduced"

So basically open access to fatty food.

"whereas the low-fat control is explicitly constrained to reduction in calories, an obvious benefit for compliance."

Here's eat a lettuce leaf! Which while is great for the T2's due to the need to remove the fat attached to the pancreas in the majority of cases at the point of diagnosis (see current ongoing studies with over 10,000 T2's at point of diagnosis), at least for a short period of time anyhow it is not beneficial to a T1 as the major studies (involving people being actually studied and not pasting together bits from other papers which themselves was pieced together bits of other papers which might one day of some form of study involved off someone, which also just happens to of been all combined together by someone working for a low carb diet company who is complaining that every other study is biased as it's funded by basically anyone who aren't themselves...odd that isn't it!).

"Role of starch versus mono- and disaccharides" the first sentence is "Replacement of carbohydrate with fat or, in some cases, with protein, is beneficial in both types of diabetes leading to better glycemic control, weight loss, cardiovascular risk markers, and reduction in medication".

Oddly not supported by proper scientific studies not from a company making millions from selling books about this diet. Strange that isn't it?

So let's have a look at some proper science for once not a load of marketing fluff. Let's take some studies from University of Athens Medical School US, Medical Schools from Scandinavia and Europe. With funding provided by grants from the Swedish Cancer Society and the Swedish Research Council and charity groups (please note not someone trying to market some diet books!). The study was then published in the peer-reviewed medical journal British Medical Journal which made it an open access article.

This large study (50,000 people) provides evidence of a link between low-carbohydrate, high-protein diets and increased risk of cardiovascular events such as strokes.

The focus of the coverage upon the Atkins diet is because the dietary pattern in the study mimicked some of the Atkins diet’s recommendations of a low-carbohydrate, high-protein diet.

The study followed people for an average of 15.7 years, and the researchers used national registries to identify hospital discharge information and reported deaths to look for first diagnoses of cardiovascular diseases (as recorded by recognised disease classification codes).

The researchers’ analysis found that both high-protein and low-carbohydrate scores were significantly associated with an increased rate of these cardiovascular events. A one-tenth (one point) increase in protein intake was associated with a 4% increase in the risk of any new cardiovascular events (rate ratio 1.04, 95% confidence interval 1.02 to 1.06). A one-tenth decrease in carbohydrate intake was associated with a (borderline significant) 4% increase in the risk of any new cardiovascular event (rate ratio 1.04, 95% confidence interval 1.0 to 1.08). A two-unit increase in a composite low-carbohydrate, high-protein score was associated with a 5% increase in the risk of any new cardiovascular event (rate ratio 1.05, 95% confidence interval 1.2 to 1.08).

Researchers also found a reduced risk of cardiovascular disease with increasing levels of education and physical activity. Risk of cardiovascular disease was increased with tobacco smoking and a history of high blood pressure.

The researchers concluded that “low-carbohydrate, high-protein diets, used on a regular basis and without consideration of the nature of carbohydrates or the source of proteins, are associated with increased risk of cardiovascular disease”. They estimated that a 20g decrease in daily carbohydrate intake and a 5g increase in daily protein intake would lead to a 5% increased risk of cardiovascular disease.

"Low-carbohydrate diets generally have better compliance (point 5)"

Which pretty much confirms that it's easier to stick to a set regime where it's a case of avoid one thing, and follow the testing and correction procedure more tightly. Whereas those given incredibly strict diets with low calorie but open carbs found the diet to restrictive and thus gave up on keeping with the regime and control.

Being diabetic is about control, nothing much else. What we can eat, or do is pretty much an open book as long as we have control and know what we are doing. This is just simple education and giving people something they want to stick to. If we the patients want to stick to something which controls us well, as this study shows those patients will have better control. Give them something so restrictive it causes them to lose faith in control it shows they give in and their BG control goes to hell. They spin it many ways to show their way is better than anyone else's, but they do touch occasionally on the point that in reality the correct way is the one which makes the patient interested in keeping good control. And that is a far better way. Education leading to better control, not crackpot diets!

the dietician at my endos office could not believe it when i told her i dont eat bread, that i save most of my carbs for dark chocolate, yougurt and fruit. she told me i HAD to eat bread and i told her if there was an ingredient in it to cure diabetes then i would eat it! she sounded more like a spanish grandmother than a health professional. if its in spanish i will really bring it in to them.

The study you quote has been roundly criticized for poor methodology.

Here's an article in Forbes that contrasts the design of the Swedish Women's study with a study the author considers to be better designed.

Quoting from the article

"the BMJ study is highly flawed. It relies on a self-administered questionnaire at one single point in time. No attempt was made to assess the accuracy or validity of the individual responses. It should come as no surprise that people often don’t reveal the complete truth about their diet and other sensitive subjects in questionnaires.

No attempt was made to find out whether people changed their diet over the course of the study. How much have you changed your eating habits in the past 15 years?"

Other criticisms include the fact that the diets weren't really low carb. This article contends that

"The ‘low-carbohydrate’ women weren’t very ‘low-carbohydrate’ at all
Women with the highest low-carbohydrate score were, according to their dietary logs were consuming up to about 125 g of carbohydrate a day. In reality, the low-carbohydrate diets that are the whipping boys of just this sort of study often allow less than 50 grams of carbohydrate a day. In other words, this study was not able to determine the effect of genuinely low-carbohydrate diets."

Finally no attempt was made to control for the quality of the diet. Did some consume large quantities of cured meat? Did others include lots of fresh vegetables? Did some vegie eaters favor large quantities of broccoli while others preferred squash? What difference did these variations in diet make? To answer these questions studies need to control for one variable at a time.

The conclusions of this study may in fact be true....or not. Unfortunately there is no way to determine this due to the poor design of the study.

But this study actually did involve people unlike at the top. It wasn't based on cobbling together paragraphs from here there and everywhere by a bookseller and claiming it was a study which actually had no patients whatsoever. While gathering of data on 50k people over 15 years is a difficult process there are bound to be issues. But the fact they did actually gather data and it did actually involve patients is far better than the utter tripe above which had no data or patients involved. Even worse when the whole thing is funded by the bookseller who after all is totally impartial.

This study from Sweden has some history. But first let me note that when we consider "evidence" we need to consider all evidence, not just a single study. And we have a hierarchy of evidence ranging from expert opinion to observational studies up to the gold standard of randomized, controlled intervention studies. You don't trump the results of gold standard studies with opinion or observational studies. The Swedish study is an observational study.

And now the history. In 2008, a lawsuit brought by two Swedish dieticians against Swedish doctor Dr. Anna Dahlqvists was resolved with a landmark finding. The court found that Dr. Dahlqvists's dietary recommendations were "in accordance with science and well-tried experience for reducing obesity and Type 2 diabetes." You can see the diet that Dr. Dahlqvists recommends here, and it is a classic very low carb diet. Well after this decision the stuff really hit the fan in Sweden and for a while there was an outright war trying to keep low carb from becoming the primary dietary recommendation for obesity and T2 diabetes. Well this study was part of the efforts to bring down those recommendations. And I have to tell you the fact that the study ended in 2007 and it was not published for 5 years and ended up on not in JAMA or Lancet but in BMJ says a lot. This study was not perceived by the community as very well done or important.

Today, low carb diets are wildly fashionable in Sweden and have quickly become part of the dietary guidance. Sadly the US lags far behind.

ps. The paper cited by guitarnut is important because it collects the high quality evidence for low carb diets (those gold standard studies I mentioned). Despite this the paper has been criticized because the authors are all widely recognized researchers and clinicians that advocate low carb diet. You may hate the messenger but we need to be objective about the message.

Sorry but I don't give any credit to the Swedish Womens study for attempting a tough job. The rules of logic make it impossible to draw any conclusions from this study. I am certainly not going to change my diet from one that has helped successfully control my T2 to one I know will result in poorer control and having to take more medication based on it's conclusions.

The study referenced by the OP is a review of existing research concerning diabetes and carb restriction. There are 99 footnotes some refer to books but most are referencing studies in scholarly journals such as The American Journal of Clinical Nutrition, JAMA etc. Most of these studies concerned actual people although their actual diets varied. Studies like these are published everyday in the scientific literature and provide a valuable overview of the current state of our knowledge.I found it refreshing that it points out things that haven't been studied and point's the way for further research.

The lead author is Richard D. Feinman, according to the footnotes he

wrote the original draft and incorporated changes and corrections from the other authors. All authors approved the final manuscript

According to Wikipedia

Richard David Feinman (born 1940) is a professor of biochemistry and medical researcher at State University of New York Health Science Center at Brooklyn, better known as SUNY Downstate Medical Center who studies nutrition and metabolism. His current area of research is the area of diet composition and energy balance. He is generally credited for doing the first serious scientific research on the Atkins Diet.

As far as I can see he has no book to sell. Besides rejecting research because an author has written a book would mean rejecting an awful lot of good research.

So I was told by the author that the paper hasn't officially come out yet--it's only online. It's supposed to be published in January 2015, at which time it might be in Spanish but that's up to the journal people. Sorry!

Actually, Dr. Feinman is an author. His book is coming out this December (

What I like about this paper is that it's a review article. That by definition means that it take information from many different places. The studies cited here are all good quality, whereas the single Swedish study has too many issues to use as an indicator for anything.

ill keepp an eye out for it then, thanks! id really like these nurses to understand where im coming from!do you know where it will be published?

Here's Feinman's take on the current quality of nutritional research. An interesting read if a bit dense.

Some of us simply can’t support our metabolism with so few calories though… I’m 6’2 and quite lean at 175 lbs. it took me years to get my weight back up where I’m comfortable after dropping to 160 due to hyperglycemia at my initial diagnosis… If I ate as few calories as you do, I’d start losing weight fast (weight I don’t have anywhere to lose). Since I need to consume more calories, and most carbohydrates are not the best options for the sake of diabetes management… I have to eat a lot more protein and fat…