|عنوان فارسی مقاله:||محدودیت کربوهیدرات رژیم غذایی در سندرم متابولیک وmellitus دیابت نوع 2|
|عنوان انگلیسی مقاله:||Dietary carbohydrate restriction in type 2 diabetes mellitus and metabolic syndrome: time for a critical appraisal|
|رشته های مرتبط:||پزشکی، زیست شناسی، علوم تغذیه، بیوشیمی، میکروبیولوژی و دیابت|
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Current nutritional approaches to metabolic syndrome and type 2 diabetes generally rely on reductions in dietary fat. The success of such approaches has been limited and therapy more generally relies on pharmacology. The argument is made that a re-evaluation of the role of carbohydrate restriction, the historical and intuitive approach to the problem, may provide an alternative and possibly superior dietary strategy. The rationale is that carbohydrate restriction improves glycemic control and reduces insulin fluctuations which are primary targets. Experiments are summarized showing that carbohydrate-restricted diets are at least as effective for weight loss as low-fat diets and that substitution of fat for carbohydrate is generally beneficial for risk of cardiovascular disease. These beneficial effects of carbohydrate restriction do not require weight loss. Finally, the point is reiterated that carbohydrate restriction improves all of the features of metabolic syndrome.
The epidemic of diabetes continues unabated, and impassioned calls for better treatment and prevention strategies are common features of scientific conferences. While it is generally acknowledged that total dietary carbohydrate is the major factor in glycemic control, strategies based on reduction of dietary carbohydrate have received little support. The American Diabetes Association, for example, has traditionally recommend against low carbohydrate diets (less than 130 g/day; while the most recent guidelines  admit such diets as an alternative approach to weight loss, they continue to emphasize concerns and downplay benefits. Similarly, the Diabetes and Nutrition Study Group of the European Association for the Study of Diabetes  reported “no justification for the recommendation of very low carbohydrate diets in persons with diabetes.” We feel, however, that there is ample evidence to warrant an alternative perspective and that diets based on carbohydrate restriction should be re-evaluated in light of current understanding of the underlying biochemistry and available clinical data. Whatever success low fat dietary approaches have had in improving diabetes is to be applauded but it is reasonable for patients to be aware of the potential benefits of an alternative approach which we present here. The key feature is that low carbohydrate diets are based on mechanism. That is, glucose directly or indirectly through insulin, is a major control element in gluconeogenesis, glycogen metabolism, lipolysis and lipogenesis. The downstream stimulus-response processes are a current research interest (see e.g. [4,5]) but, according to the view considered here, dietary fat has a generally passive role and deleterious effects of fat are almost always seen in the presence of high carbohydrate. While low carbohydrate diets may not be appropriate for everyone, choices should be left to individual physicians and patients. Key points that bear on the assessment of benefit vs. risk of carbohydrate restriction are presented below. The discussion focuses on type 2 diabetes but many of the principles will apply to metabolic syndrome and possibly to type 1 as well[6,7].
1. Carbohydrate restriction improves glycemic control, the primary target of nutritional therapy and reduces insulin fluctuations. 2. Carbohydrate-restricted diets are at least as effective for weight loss as low-fat diets. 3. Substitution of fat for carbohydrate is generally beneficial for markers for and incidence of CVD. 4. Carbohydrate restriction improves the features of metabolic syndrome. 5. Beneficial effects of carbohydrate restriction do not require weight loss. Carbohydrate restriction is an intuitive and rational approach to improvement of glycemic and metabolic control. Data demonstrating that weight loss and cardiovascular risk are also improved remove these barriers to the acceptance of carbohydrate restriction as a reasonable if not the preferred treatment for type 2 diabetes. Finally, carbohydrate restriction is a potentially favorable diet for improving components of the metabolic syndrome and thereby for the prevention of diabetes.