Dietary Carbohydrate restriction as the first approach in diabetes management. Critical review and evidence base
Mukana mm. Anssi Manninen, Ralf Sundberg, Annika Dahlqvist, Arne Astrup ja Richard Feinman. Ja moni muu VHH-tuttu.
Richard David Feinman, PhD, ∗, Wendy Knapp Pogozelski, PhD, Arne Astrup, MD, Richard K. Bernstein, MD, Eugene J. Fine, MD, Eric C. Westman, MD, MHS., Anthony Accurso, MD, Lynda Frasetto, MD, Samy McFarlane, MD, Jörgen Vesti Nielsen, MD, Thure Krarup, MD, Barbara A. Gower, PhD, Laura Saslow, PhD, Karl S. Roth, MD, Mary C. Vernon, MD, Jeff S. Volek, RD, PhD, Gilbert B. Wilshire, MD, Annika Dahlqvist, MD, Ralf Sundberg, MD, , PhD, Ann Childers, MD, Katharine Morrison, MD, Anssi H. Manninen, MHS, Hussein Dashti, MD, Richard J. Wood, PhD, Jay Wortman, MD, Nicolai Worm, PhD
Received 18 April 2014, Revised 28 June 2014, Accepted 28 June 2014, Available online 16 July 2014
Conclusion and Recommendations
What evidence would be required to change the current recommendations for dietary treatment in diabetes? Evidence based medicine tends to emphasize random controlled trials (RCTs) as a gold standard. Such absolute requirements, however, are unknown in any scientific discipline. As in a court of law, science admits whatever evidence is relevant . Following the legal analogy, one has to ask: Who decides on the admissibility of the evidence? The parody by Smith and Pell  has been described as both funny and profound in illustrating how there is not a single type of experiment that fits every scientific question. Given the current state of research funding and the palpable bias against low-carbohydrate approaches , it is unlikely that an RCT can be performed that will satisfy everybody. The seriousness of diabetes suggests that we have enough evidence of different types to re-evaluate our current recommendations for treatment.
This review has described 12 points of evidence based on published clinical and experimental studies and the experience of the authors. The points are supported by established principles in biochemistry and physiology and emphasize that the benefits are immediate and documented while the concerns about risk are conjectural and long term.
We would recommend that government or private health agencies hold open hearings on these issues in which researchers in carbohydrate restriction can make their case. We think that traditional features of the analysis of evidence such as vigorous cross-examination should be part of the process. We suggest that open discussion with all sides contributing will be valuable. The seriousness of diabetes suggests that a bench decree will be inappropriate.