While searching for the full text of the article Susan
posted on low-carb and type 2, I came across this letter to
the editor of AJCN from 2006. Possibly you've read it before
but it was new to me. The references also look interesting
so I'll spend some time today trying to find links to them;
if anyone can supply links to full texts, or at least
abstracts, please do so.
http://www.ajcn.org/cgi/reprint/84/6/1549
Letters to the Editor
Carbohydrate restriction is effective in improving
atherogenic dyslipidemia even in the absence of weight loss
Dear Sir:
Krauss et al (1) are to be congratulated on the data
presented in their recent article in the Journal, one of the
strongest cases for dietary carbohydrate restriction to
date. At the same time, we have concerns about the
misleading and confusing way in which the data were
presented and interpreted and about the scarcity of
citations of other publications that are supportive of these
findings (2– 4). Because of the significance of these data
for health, careful and appropriate conclusions are
extremely important.
The abstract conclusion, “Moreover, beneficial lipid changes
resulting from a reduced carbohydrate intake were not
significant after weight loss,” is in contradiction to their
data, which showed that HDL cholesterol is significantly
increased by weight loss after carbohydrate restriction, and
even more so in the subjects receiving a greater percentage
(15%) of energy from saturated fatty acids (SFA).
The negative conclusion stands in stark contrast to the data
in the paper that show that carbohydrate restriction is
effective for improving atherogenic dyslipidemia even in the
absence of weight loss. The reason most markers were less
responsive to weight loss induced by the low-carbohydrate
diet was that they had been improved by carbohydrate
restriction before weight loss was instituted.
Krauss et al chose not to mention their data on a comparison
between the high-carbohydrate diet and the low-carbohydrate
diet higher in SFA. SFA are generally considered
atherogenic, but the question of whether such an effect
would be manifest when carbohydrates are restricted remains
unanswered (5, 6).
The increase in LDL peak particle diameter reported by
Krauss et al (1) shows the substantial advantage of low
carbohydrate (with or without SFA) over low fat, again a
finding previously reported (2, 4, 6–9) but not cited by
Krauss et al.
Given how difficult it is to lose weight, the data of Krauss
et al support the notion that carbohydrate restriction is
the default diet for treatment of atherogenic dyslipidemia.
Because low-carbohydrate strategies are at least as
effective at fat reduction as are low-fat diets, it is
reasonable to conclude that carbohydrate restriction, lower
or higher in SFA, is the preferred diet for most people and
especially those with the complex of health markers referred
to as metabolic syndrome, as we previously suggested (10).
Remarkably, despite these data on the advantages of
carbohydrate restriction, the report concludes with tired
“concerns” about lowcarbohydrate diets and a tribute to
exercise and fiber, variables not included in the study.
Overall, the authors seem to have had a goal of trying to
support current official health guidelines rather than a
goal of trying to bring those guidelines into concordance
with the scientific data. As suggested by the results of the
study by Krauss et al, further research should concentrate
on the lower-carbohydrate, higher-saturated fat diets as a
therapy for atherogenic dyslipidemia.
None of the authors had a personal or financial conflict of
interest with respect to the study by Krauss et al.
Eric C Westman
Department of Medicine
Duke University Medical Center
(address details edited)
Jeff S Volek
Department of Kinesiology
University of Connecticut
(address details edited)
Richard D Feinman
Department of Biochemistry
SUNY Downstate Medical Center
(address details edited)
REFERENCES
1. Krauss RM, Blanche PJ, Rawlings RS, Fernstrom HS,
Williams PT.
Separate effects of reduced carbohydrate intake and weight
loss on atherogenic dyslipidemia. Am J Clin Nutr
2006;83:1025–31.
2. 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.
3. Volek JS, Sharman MJ, Forsythe CE. Modification of
lipoproteins by very low-carbohydrate diets. J Nutr
2005;135:1339–42.
4. Westman EC, Yancy WS Jr, Olsen MK, Dudley T, Guyton JR.
Effect of a low-carbohydrate, ketogenic diet program
compared to a low-fat diet on fasting lipoprotein
subclasses. Int J Cardiol 2006;110:212– 6.
5. Volek JS, Forsythe CE. The case for not restricting
saturated fat on a low carbohydrate diet. Nutr Metab (Lond)
2005; 2:21.
6. Feinman RD, Volek JS. Low carbohydrate diets improve
atherogenic dyslipidemia even in the absence of weight loss.
Nutr Metab (Lond) 2006;3:24.
7. Hays JH, DiSabatino A, Gorman RT, Vincent S, Stillabower
ME. Effect of a high saturated fat and no-starch diet on
serum lipid subfractions in patients with documented
atherosclerotic cardiovascular disease. Mayo Clin Proc
2003;78:1331– 6.
8. Volek J, Sharman M, Gomez A, et al. Comparison of
energy-restricted very low-carbohydrate and low-fat diets on
weight loss and body composition in overweight men and
women. Nutr Metab (Lond) 2004;1:13.
9. Wood RJ, Volek JS, Liu Y, Shachter NS, Contois JH,
Fernandez ML.
Carbohydrate restriction alters lipoprotein metabolism by
modifying VLDL, LDL, and HDL subfraction distribution and
size in overweight men. J Nutr 2006;136:384 –9.
10. Volek JS, Feinman RD. Carbohydrate restriction improves
the features of metabolic syndrome. Metabolic syndrome may
be defined by the response to carbohydrate restriction. Nutr
Metab (Lond) 2005;2:31.
Am J Clin Nutr 2006;84:1549 –55. Printed in USA. © 2006
American Society for Nutrition 1549
Cheers, Alan, T2, Australia.
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