Original Article

Lipids

, Volume 44, Issue 4, pp 297-309

First online:

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

  • Jeff S. VolekAffiliated withDepartment of Kinesiology, University of ConnecticutDepartment of Nutritional Science, University of Connecticut Email author 
  • , Stephen D. PhinneyAffiliated withSchool of Medicine, University of California, Davis
  • , Cassandra E. ForsytheAffiliated withDepartment of Kinesiology, University of Connecticut
  • , Erin E. QuannAffiliated withDepartment of Kinesiology, University of Connecticut
  • , Richard J. WoodAffiliated withDepartment of Kinesiology, University of Connecticut
  • , Michael J. PuglisiAffiliated withDepartment of Kinesiology, University of Connecticut
  • , William J. KraemerAffiliated withDepartment of Kinesiology, University of Connecticut
  • , Doug M. BibusAffiliated withLipid Technologies, LLCUniversity of Minnesota
  • , Maria Luz FernandezAffiliated withSchool of Medicine, University of California, Davis
    • , Richard D. FeinmanAffiliated withDepartment of Biochemistry, SUNY Downstate Medical Center

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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.

Keywords

Metabolic syndrome HDL LDL Lipoprotein metabolism Plasma lipids Triglyceride metabolism Dietary fat Human