Science Marches On

In March 2005, Dr. Guenther Boden and colleagues from Temple University and UMDNJ published an important paper in the Annals of Internal Medicine (Vol 142; Issue 6: 403-411, 15 March 2005). These clinicians assessed the effect of low carbohydrate diets in obese, type 2 diabetics. Although the findings were, in fact, a simple re-hash of what is widely known by in-the-know healthcare providers, it is significant because it is a well-done, well-documented piece of science; and because it was published in one of the most respected journals in the US.

In summary, they compared the effects of a truly low carb diet (i.e. approximately 20 grams per day) to the “usual” diet of these diabetic individuals. Each patient served as his own control. The study participants were kept in-house for the entire three week duration of the study, so food intake was precisely known (no cheating!) and high quality metabolic data was obtained.

The high points of their findings included:

• Caloric content of the daily diets spontaneously dropped approximately 1000 Kcal;
  The average weight loss observed in the group over the two weeks of carbohydrate restriction (approximately 4 lbs) could be totally attributed to the spontaneous caloric deficit (i.e. it was not simply due to water loss);
• Blood sugars normalized and insulin sensitivity improved by 75%;
• Triglyceride, cholesterol, and HgbA1c levels all improved.

To reiterate, none of these findings are surprising when we look at the numerous studies available today.

What I find sadly amusing – to the point of absurdity – are the editors’ comments: “...we know little about how low-carbohydrate diets cause weight loss or how they affect glycemic control.” It goes to show you that even the editors of the prestigious Annals can live in a biased vacuum.

If I am not mistaken, the literature on controlled carbohydrate nutrition begins in the late 1800’s and is replete with case studies, prospective randomized trials, mechanisms of action, thermodynamic investigations, and metabolic pathway elucidation.

We, in fact, know quite a lot about this topic.