Skip to main content

Advertisement

Springer Nature Link
Log in

Low-carbohydrate or low-fat diets for the metabolic syndrome?

  • Published:
Current Diabetes Reports Aims and scope Submit manuscript

Abstract

This report discusses a variety of considerations and reviews recent clinical trial data relevant to the question of which dietary approach is optimal for treatment and prevention of the metabolic syndrome. Special emphasis is given to the question of whether the degree to which metabolic syndrome features are observed in an individual patient should correspond to the degree to which carbohydrate restriction should be recommended. Short-term metabolic studies lend support to this concept, but longer-term effectiveness trials suggest the degree of dietary adherence and associated weight losses, rather than diet type, are the key predictors of metabolic cardiac risk factor reduction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Canada)

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Kylin E: Hypertonie-hyperglykamie-hyperurikamiesyndrome. Zentralbl Innere Med 1923, 44.

  2. Reaven GM: Banting lecture 1988. Role of insulin resistance in human disease. Diabetes 1988, 37:1595–1607.

    Article  PubMed  CAS  Google Scholar 

  3. DeFronzo R A, Ferrannini E: Insulin resistance. A multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidemia, and atherosclerotic cardiovascular disease. Diabetes Care 1991, 14:173–194.

    Article  PubMed  CAS  Google Scholar 

  4. Kaplan NM: The deadly quartet. Upper-body obesity, glucose intolerance, hypertriglyceridemia, and hypertension. Arch Intern Med 1989, 149:1514–1520.

    Article  PubMed  CAS  Google Scholar 

  5. Eckel RH, Grundy SM, Zimmet PZ: The metabolic syndrome. Lancet 2005, 365:1415–1428.

    Article  PubMed  CAS  Google Scholar 

  6. Grundy SM, Cleeman JI, Daniels SR, et al.: Diagnosis and management of the metabolic syndrome. An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Executive Summar y. Circulation 2005, 112:e285–290.

    Article  Google Scholar 

  7. Lee YH, Pratley RE: The evolving role of inf lammation in obesity and the metabolic syndrome. Curr Diab Rep 2005, 5:70–75.

    PubMed  CAS  Google Scholar 

  8. Minehira K, Tappy L: Dietar y and lifestyle inter ventions in the management of the metabolic syndrome: present status and future perspective. Eur J Clin Nutr 2002, 56:7 p following 1262.

    Article  Google Scholar 

  9. Pritchett AM, Foreyt JP, Mann DL: Treatment of the metabolic syndrome: the impact of lifestyle modification. Curr Atheroscler Rep 2005, 7:95–102.

    PubMed  Google Scholar 

  10. Maki KC: Dietar y factors in the prevention of diabetes mellitus and coronar y ar ter y disease associated with the metabolic syndrome. Am J Cardiol 2004, 93:12C-17C.

    Article  PubMed  CAS  Google Scholar 

  11. Lara-Castro C, Gar vey WT: Diet, insulin resistance, and obesity: zoning in on data for Atkins dieters living in South Beach. J Clin Endocrinol Metab 2004, 89:4197–4205.

    Article  PubMed  CAS  Google Scholar 

  12. Riccardi G, Giacco R, Rivellese AA: Dietary fat, insulin sensitivity and the metabolic syndrome. Clin Nutr 2004, 23:447–456.

    Article  PubMed  CAS  Google Scholar 

  13. Reaven G: Metabolic syndrome: pathophysiology and implications for management of cardiovascular disease. Circulation 2002, 106:286–288.

    Article  PubMed  Google Scholar 

  14. Miranda PJ, DeFronzo R A, Califf RM, Guyton JR: Metabolic syndrome: definition, pathophysiolog y, and mechanisms. Am Heart J 2005, 149:33–45.

    Article  PubMed  CAS  Google Scholar 

  15. Pi-Sunyer FX: Pathophysiology and long-term management of the metabolic syndrome. Obes Res 2004, 12(suppl):174S-180S.

    PubMed  CAS  Google Scholar 

  16. Executive Summar y of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III) [no authors listed]. JAMA 2001, 285:2486–2497.

  17. Alberti KG, Zimmet PZ: Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 1998, 15:539–553.

    Article  PubMed  CAS  Google Scholar 

  18. Balkau B, Charles MA: Comment on the provisional report from the WHO consultation. European Group for the Study of Insulin Resistance (EGIR). Diabet Med 1999, 16:442–443.

    Article  PubMed  CAS  Google Scholar 

  19. Einhorn D, Reaven GM, Cobin RH, et al.: American College of Endocrinolog y position statement on the insulin resistance syndrome. Endocr Pract 2003, 9:237–252.

    PubMed  Google Scholar 

  20. Reaven GM: Do high carbohydrate diets prevent the development or attenuate the manifestations (or both) of syndrome X? A viewpoint strongly against. Curr Opin Lipidol 1997, 8:23–27.

    PubMed  CAS  Google Scholar 

  21. Katan MB, Grundy SM, Willett WC: Should a lowfat, high-carbohydrate diet be recommended for ever yone? Beyond low-fat diets. N Engl J Med 1997, 337:563–566; discussion 566–567.

    PubMed  CAS  Google Scholar 

  22. Connor WE, Connor SL: Should a low-fat, high-carbohydrate diet be recommended for ever yone? The case for a low-fat, high-carbohydrate diet. N Engl J Med 1997, 337:562–563; discussion 566–567.

    Article  PubMed  CAS  Google Scholar 

  23. Astrup A, Meinert Larsen T, Harper A: Atkins and other low-carbohydrate diets: hoax or an effective tool for weight loss? Lancet 2004, 364:897–899.

    Article  PubMed  Google Scholar 

  24. Ornish D: Was Dr Atkins right? J Am Diet Assoc 2004, 104:537–542.

    Article  PubMed  CAS  Google Scholar 

  25. Katz DL: Competing dietar y claims for weight loss: finding the forest through truculent trees. Annu Rev Public Health 2005, 26:61–88.

    Article  PubMed  Google Scholar 

  26. Wolever TM: The glycemic index: f logging a dead horse? Diabetes Care 1997, 20:452–456.

    Article  PubMed  CAS  Google Scholar 

  27. Willett WC: Reduced-carbohydrate diets: no roll in weight management? Ann Intern Med 2004, 140:836–837.

    PubMed  Google Scholar 

  28. Westman EC, Yancy WS Jr, Vernon MC: Is a low-carb, low-fat diet optimal? Arch Intern Med 2005, 165:1071–1072.

    Article  PubMed  Google Scholar 

  29. Eckel RH: The dietary approach to obesity: is it the diet or the disorder? JAMA 2005, 293:96–97.

    Article  PubMed  CAS  Google Scholar 

  30. St Jeor ST, Howard BV, Prewitt TE, et al.: Dietary protein and weight reduction: a statement for healthcare professionals from the Nutrition Committee of the Council on Nutrition, Physical Activity, and Metabolism of the American Heart Association. Circulation 2001, 104:1869–1874.

    PubMed  CAS  Google Scholar 

  31. Schwenke DC: Insulin resistance, low-fat diets, and low-carbohydrate diets: time to test new menus. Curr Opin Lipidol 2005, 16:55–60.

    Article  PubMed  CAS  Google Scholar 

  32. Ludwig DS: Diet and development of the insulin resistance syndrome. Asia Pac J Clin Nutr 2003, 12(suppl):S4.

    PubMed  Google Scholar 

  33. Anderson JW, Konz EC, Jenkins DJ: Health advantages and disadvantages of weight-reducing diets: a computer analysis and critical review. J Am Coll Nutr 2000, 19:578–590.

    PubMed  CAS  Google Scholar 

  34. Blackburn GL, Phillips JC, Morreale S: Physician’s guide to popular low-carbohydrate weight-loss diets. Cleve Clin J Med 2001, 68:761, 765–766, 768–769, 773–774.

    Article  PubMed  CAS  Google Scholar 

  35. Kennedy ET, Bowman SA, Spence J T, et al.: Popular diets: correlation to health, nutrition, and obesity. J Am Diet Assoc 2001, 101:411–420.

    Article  PubMed  CAS  Google Scholar 

  36. Barnard ND, Scialli AR, Turner-McGriev y G, et al.: The effects of a low-fat, plant-based dietar y inter vention on body weight, metabolism, and insulin sensitivity. Am J Med 2005, 118:991–997.

    Article  PubMed  CAS  Google Scholar 

  37. US Department of Health and Human Services: Dietary Guidelines for Americans 2005. Available at http:// www.healthierus.gov/dietaryguidelines/. Accessed October 12, 2005.

  38. Heshka S, Anderson JW, Atkinson RL, et al.: Weight loss with self-help compared with a structured commercial program: a randomized trial. JAMA 2003, 289:1792–1798.

    Article  PubMed  Google Scholar 

  39. Ludwig DS: Dietar y glycemic index and the regulation of body weight. Lipids 2003, 38:117–121.

    Article  PubMed  CAS  Google Scholar 

  40. Sears B, ed: The Zone: A Dietary Road Map. New York: HarperCollins Publishers; 1995.

    Google Scholar 

  41. Westman EC, Mavropoulos J, Yancy WS, Volek JS: A review of low-carbohydrate ketogenic diets. Curr Atheroscler Rep 2003, 5:476–483.

    PubMed  Google Scholar 

  42. Brehm BJ, Seeley RJ, Daniels SR, D’Alessio DA: A randomized trial comparing a Very low carbohydrate diet and a calorie-restricted low fat diet on body weight and cardiovascular risk factors in healthy women. J Clin Endocrinol Metab 2003, 88:1617–1623.

    Article  PubMed  CAS  Google Scholar 

  43. Foster GD, Wyatt HR, Hill JO, et al.: A randomized trial of a low-carbohydrate diet for obesity. N Engl J Med 2003, 348:2082–2090.

    Article  PubMed  CAS  Google Scholar 

  44. Samaha FF, Iqbal N, Seshadri P, et al.: A low-carbohydrate as compared with a low-fat diet in severe obesity. N Engl J Med 2003, 348:2074–2081.

    Article  PubMed  CAS  Google Scholar 

  45. Stern L, Iqbal N, Seshadri P, et al.: The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: one-year follow-up of a randomized trial. Ann Intern Med 2004, 140:778–785. In severely obese patients with a high prevalence of the metabolic syndrome or type 2 diabetes, a low-carbohydrate diet was associated with more favorable changes in body weight, triglyceride levels, HDL cholesterol levels, and hemoglobin A1c versus a conventional diet at 1 year.

    PubMed  Google Scholar 

  46. Yancy WS Jr, Olsen MK, Guyton JR, et al.: A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia: a randomized, controlled trial. Ann Intern Med 2004, 140:769–777.

    PubMed  Google Scholar 

  47. Brinkworth GD, Noakes M, Keogh JB, et al.: Long-term effects of a high-protein, low-carbohydrate diet on weight control and cardiovascular risk markers in obese hyperinsulinemic subjects. Int J Obes Relat Metab Disord 2004, 28:661–670.

    Article  PubMed  CAS  Google Scholar 

  48. Brinkworth GD, Noakes M, Parker B, et al.: Long-term effects of advice to consume a high-protein, low-fat diet, rather than a conventional weight-loss diet, in obese adults with type 2 diabetes: one-year follow-up of a randomised trial. Diabetologia 2004, 47:1677–1686.

    Article  PubMed  CAS  Google Scholar 

  49. Due A, Toubro S, Skov AR, Astrup A: Effect of normalfat diets, either medium or high in protein, on body weight in over weight subjects: a randomised 1-year trial. Int J Obes Relat Metab Disord 2004, 28:1283–1290.

    Article  PubMed  CAS  Google Scholar 

  50. Dansinger ML, Gleason JA, Griffith JL, et al.: Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial. JAMA 2005, 293:43–53. In obese adults with cardiac risk factors, four popular diets ranging from low carbohydrate to low fat each reduced body weight to a similar extent at 1 year, according to dietar y adherence level. Weight loss rather than diet type predicted reduction of metabolic syndrome features.

    Article  PubMed  CAS  Google Scholar 

  51. Ebbeling CB, Leidig MM, Sinclair KB, et al.: Effects of an ad libitum low-glycemic load diet on cardiovascular disease risk factors in obese young adults. Am J Clin Nutr 2005, 81:976–982.

    PubMed  CAS  Google Scholar 

  52. Mc Auley K A, Smith KJ, Taylor RW, et al.: Long-term effects of popular dietar y approaches on weight loss and features of insulin resistance. Int J Obes (Lond) 2005 Sep 13; [Epub ahead of print]. In obese women with insulin resistance, moderate- and lowcarbohydrate diets improved metabolic syndrome features to a greater extent than a conventional diet at 6 months, with the best maintenance in the moderate protein group at 1 year.

  53. Cornier MA, Donahoo WT, Pereira R, et al.: Insulin sensitivity determines the effectiveness of dietar y macronutrient composition on weight loss in obese women. Obes Res 2005, 13:703–709.

    Article  PubMed  CAS  Google Scholar 

  54. Sharman MJ, Gomez AL, Kraemer WJ, Volek JS: Very low-carbohydrate and low-fat diets affect fasting lipids and postprandial lipemia differently in overweight men. J Nutr 2004, 134:880–885.

    PubMed  CAS  Google Scholar 

  55. Pereira MA, Swain J, Goldfine AB, et al.: Effects of a low-glycemic load diet on resting energ y expenditure and heart disease risk factors during weight loss. JAMA 2004, 292:2482–2490.

    Article  PubMed  CAS  Google Scholar 

  56. Brehm BJ, Spang SE, Lattin BL, et al.: The role of energy expenditure in the differential weight loss in obese women on low-fat and low-carbohydrate diets. J Clin Endocrinol Metab 2005, 90:1475–1482.

    Article  PubMed  CAS  Google Scholar 

  57. Seshadri P, Iqbal N, Stern L, et al.: A randomized study comparing the effects of a low-carbohydrate diet and a conventional diet on lipoprotein subfractions and C-reactive protein levels in patients with severe obesity. Am J Med 2004, 117:398–405.

    Article  PubMed  CAS  Google Scholar 

  58. Due A, Toubro S, Stender S, et al.: The effect of diets high in protein or carbohydrate on inflammatory markers in overweight subjects. Diabetes Obes Metab 2005, 7:223–229.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Tufts-New England Medical Center, Boston Dispensary Suite #342, sr750 Washington Street, Box 216, 02111, Boston, MA, USA

    Michael L. Dansinger MD

Authors
  1. Michael L. Dansinger MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ernst J. Schaefer MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael L. Dansinger MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Dansinger, M.L., Schaefer, E.J. Low-carbohydrate or low-fat diets for the metabolic syndrome?. Curr Diab Rep 6, 55–63 (2006). https://doi.org/10.1007/s11892-006-0053-4

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11892-006-0053-4

Keywords

Search

Navigation