Volume 44, Issue 4 p. 297-309
Original Article

Carbohydrate Restriction has a More Favorable Impact on the Metabolic Syndrome than a Low Fat Diet

Jeff S. Volek

Corresponding Author

Jeff S. Volek

Department of Kinesiology, University of Connecticut, 2095 Hillside Road, Unit 1110, Storrs, CT, 06269-1110 USA

Department of Nutritional Science, University of Connecticut, Storrs, CT, USA

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Stephen D. Phinney

Stephen D. Phinney

School of Medicine, University of California, Davis, Davis, CA, USA

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Cassandra E. Forsythe

Cassandra E. Forsythe

Department of Kinesiology, University of Connecticut, 2095 Hillside Road, Unit 1110, Storrs, CT, 06269-1110 USA

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Erin E. Quann

Erin E. Quann

Department of Kinesiology, University of Connecticut, 2095 Hillside Road, Unit 1110, Storrs, CT, 06269-1110 USA

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Richard J. Wood

Richard J. Wood

Department of Kinesiology, University of Connecticut, 2095 Hillside Road, Unit 1110, Storrs, CT, 06269-1110 USA

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Michael J. Puglisi

Michael J. Puglisi

Department of Kinesiology, University of Connecticut, 2095 Hillside Road, Unit 1110, Storrs, CT, 06269-1110 USA

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William J. Kraemer

William J. Kraemer

Department of Kinesiology, University of Connecticut, 2095 Hillside Road, Unit 1110, Storrs, CT, 06269-1110 USA

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Doug M. Bibus

Doug M. Bibus

Lipid Technologies, LLC, Austin, MN, USA

University of Minnesota, Minneapolis, MN, USA

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Maria Luz Fernandez

Maria Luz Fernandez

School of Medicine, University of California, Davis, Davis, CA, USA

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Richard D. Feinman

Richard D. Feinman

Department of Biochemistry, SUNY Downstate Medical Center, Brooklyn, NY, USA

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First published: 12 December 2008
Citations: 272

Electronic supplementary material:

The online version of this article (doi:10.1007/s11745-008-3274-2) contains supplementary material, which is available to authorized users.

Abstract

We recently proposed that the biological markers improved by carbohydrate restriction were precisely those that define the metabolic syndrome (MetS), and that the common thread was regulation of insulin as a control element. We specifically tested the idea with a 12-week study comparing two hypocaloric diets (~1,500 kcal): a carbohydrate-restricted diet (CRD) (%carbohydrate:fat:protein = 12:59:28) and a low-fat diet (LFD) (56:24:20) in 40 subjects with atherogenic dyslipidemia. Both interventions led to improvements in several metabolic markers, but subjects following the CRD had consistently reduced glucose (−12%) and insulin (−50%) concentrations, insulin sensitivity (−55%), weight loss (−10%), decreased adiposity (−14%), and more favorable triacylglycerol (TAG) (−51%), HDL-C (13%) and total cholesterol/HDL-C ratio (−14%) responses. In addition to these markers for MetS, the CRD subjects showed more favorable responses to alternative indicators of cardiovascular risk: postprandial lipemia (−47%), the Apo B/Apo A-1 ratio (−16%), and LDL particle distribution. Despite a threefold higher intake of dietary saturated fat during the CRD, saturated fatty acids in TAG and cholesteryl ester were significantly decreased, as was palmitoleic acid (16:1n-7), an endogenous marker of lipogenesis, compared to subjects consuming the LFD. Serum retinol binding protein 4 has been linked to insulin-resistant states, and only the CRD decreased this marker (−20%). The findings provide support for unifying the disparate markers of MetS and for the proposed intimate connection with dietary carbohydrate. The results support the use of dietary carbohydrate restriction as an effective approach to improve features of MetS and cardiovascular risk.