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• February 3, 2009 9:27 a.m.

  I hope the authors will reconsider their "aha" moments. "Study participants eating low-carb diets got 45 percent of their total calories from carbohydrates" is not reflective of a low-carb diet. To brand it as such and then promote the logic that low-carb diets actually cause increased insulin usage is irresponsible. There are many studies that show true low carb diets absolutely reduce insulin usage and increase control. I know from personal experience that using an extremely low carb diet reduced my insulin usage by 70% and moved my A1c from 8.0 to 5.0 in 3 months time. Please be careful in making sweeping "aha" generalizations or leaps from one or two published studies without disclosing the studies shortfalls.

  - Ryan Whitaker

• February 3, 2009 7:48 a.m.

  If it's true that eating fewer carbohydrates and more fat improves glycemic control, why did the people in this study who ate more carbs and less fat have better glycemic control?

  - Julie

• February 3, 2009 6:37 a.m.

  This information is completely contrary to what I see. I am an active member of every major diabetic forum on the web. 100% of the diabetics I see that low carb both lose weight and improve their lipid panels. This type 1 is included in those statistics.

  - John Hanson

• February 2, 2009 4:17 p.m.

  I note that you are both nutritionists. In my experience, dieticians/ nutritionists are more than happy to spout the same sort of rubbish as you have done in this article. for your information, 45% carb in the diet is hardly "low carb". Try half of that and you will be closer to the mark. I am uncertain as to the confounding factors which probably account for the "eggs = death" study that you quote, but it is an established fact that dietary cholesterol has little correlation with serum cholesterol for most people. If you don't eat enough, the liver will make it for you. Lack of proper dietary advice, is in my opinion, a major factor in the increase in diabetes incidence and it's continued rising complications that cause misery to many. I see the damage that is done from visual, kidney and nerve impairment, long after these people can even get to a dietician's outpatient appointment. I can also see the REVERSAL in complications that goes hand in hand with the improvements in blood sugars from following low carb eating plans. Perhaps, you both would benefit from seeing these effects for yourselves, if you could only stifle your cynicism/arrogance for a few months.

  - Dr Katharine Morrison

• February 1, 2009 3:13 p.m.

  This article represents the very worst example of cherry-picking data that I have ever read. The VAST majority of large studies show absolutely no link between saturated fat and dietary choloesterol and heart disease...or all-cause mortality, for that matter. I treat hundreds of patients annually with true carb restriction (far far less than the 45% "low carb" straw man listed in the-above article) and see virtually universal improvement in diabetes, insulin resistance, and markers of inflammation and dyslipidemia. This article is a disgrace. Shame on you.

  - Gil Wilshire

• January 31, 2009 9:56 a.m.

  I have three questions and three additional references for these health providers: Questions: 1. Have you ever tried a low carbohydrate diet to see what it is like? 2. Have you ever tried to communicate with those clinicians who have good success with low carbohydrate diets? 3. Do you really keep up on the low carbohydrate literature? References: 1. Tinker et al: Low-fat dietary pattern … the Women's Health Initiative. Arch Intern Med 2008, 168(14):1500-1511. Conclusion: “A low-fat dietary pattern among generally healthy postmenopausal women showed no evidence of reducing diabetes risk after 8.1 years.” 2. Westman , et al: The Effect of a Low-Carbohydrate, Ketogenic Diet Versus a Low-Glycemic Index Diet…Type 2 Diabetes Mellitus. Nutr Metab (Lond) 2008, 5(36). http://www.nutritionandmetabolism.com/content/pdf/1743-7075-5-36.pdf Conclusion: “The diet lower in carbohydrate led to greater improvements in glycemic control, and more frequent medication reduction/elimination than the low glycemic index diet.” 3. The third reference demonstrates that a diet with high carbohydrate as recommended by the Mayo Clinic with “plenty of vegetables, fruits, whole grains,” reliably leads to the kind of glycemic control, improvement in atherogenic dyslipidemia and reduction or elimination of medication seen with carbohydrate restriction. We’ve been waiting for that paper for forty years.

  - Richard Feinman

• January 30, 2009 10:05 p.m.

  I really cannot believe that this article is posted, and that it's posted on Mayo Clinic's site. A low carb diet with 45% of calories from carbohydrates? That doesn't even make sense.

  - John Broady

• January 29, 2009 10:53 p.m.

  May I suggest to Jennifer and Katherine in your future articles to include links to the relevant articles/abstracts on pubmed, please.

  - Morten Strunge Meyer

• January 29, 2009 8:06 a.m.

  “Diabetics should note that low-carb in the short term may mean high-fat and worsening diabetes management in the long run.” I find this statement to be blatantly irresponsible. The most renown diabetologist in the world, Dr. Richard K Bernstein has successfully managed his Type 1 diabetes for over 50 years using a very low carb diet. He is 73 and healthy. He has successfully helped thousands of people eliminate symptoms and lower medications by prescribing a vlcd for many many years. You can read their testimonials in the beginning of his book Dr. Bernstein’s Diabetes Solution. Dr. Mary Vernon from Lawrence KS and Dr. Eric Westman of the Duke Lifestyle Clinic in NC have both essentially cured people with Type 2 diabetes simply by keeping them on a vlcd for life. A diet high in both fat & carbohydrates is not good for anyone. The advice you offer is inaccurate and potentially harmful to people already suffering from a debilitating disease.

  - Ivan C part 2

• January 29, 2009 8:03 a.m.

  What should you take away from these studies, you ask? Nothing. I am surprised and disturbed that the Mayo Clinic has allowed this article to be printed under their name. What I would like to point out first is probably obvious to most people reading this. 45% of calories from carbohydrates in no way constitutes a low-carb diet. Based on an 1800 calorie a day diet, 45% of carbs would be over 200g of carbohydrates. Although it has not been firmly established as to exactly what number constitutes “low carb” most researchers and medical doctors agree that it is less than 130 grams daily in order to provide the metabolic changes associated with low carb. The ADA designates low carbohydrate diets as less than 130 g/d or 26% of a nominal 2000 kcal diet – not 45%. Since diabetes is a disease of carbohydrate intolerance, it is important for people with the disease to keep carb counts very low. Secondly, diets high in fat have been proven to benefit people with metabolic syndrome and diabetes - BUT - the diet must be carb restricted to realize the benefits. Replacing carbs with fat has many advantages for people with diabetes but you can’t do both. The metabolic changes will not occur on a diet containing in excess of 200 grams of carbohydrates daily. This is based on science and you can familiarize yourself with some of it by looking at the research done by Dr.’s Feinman, Volek, Westman, Yancy, Phinney, Nielsen and so many more. “Diabetics should note that low-carb in the s

  - Ivan Cohen

• January 29, 2009 1:31 a.m.

  The evidence is just not in favour of what you are saying. Diabetics who go on low-carb, high-fat diets do much better than on 65% of carbs a day!!! People with insulin problems can't cope with so many carbs in their diet: it's why they became diabetic in the first place. And saturated fat and cholesterol are not the demons you make them out to be. Epidemiological studies have extremely limited value as an analytical tool and you can use them to prove anything and nothing. Read "Good Calories, Bad Calories" by Gary Taubes and read the truth about carbohydrates, insulin and the cholesterol myth.

  - merryweather