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


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.

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Fig. 1A–B
Fig. 2
Fig. 3





Carotid artery intima-media thickness


Cholesteryl ester


Carbohydrate-restricted diets


Carbohydrate response element binding protein


Diagnostics Systems Laboratory


HDL cholesterol


LDL cholesterol


Low-fat diets


Metabolic syndrome


Nuclear magnetic resonance


Polyacrylamide gel electrophoresis


Retinol binding protein 4


Stearoyl-coenzyme A desaturase 1


Saturated fatty acid


Sterol response element binding protein




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We thank Timothy E. Graham and Barbara B. Kahn at the Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA for measuring serum RBP4 concentrations. This work was supported in part by funds from the Graduate School and the Health Disparity EXPORT Center at the University of Connecticut, USDA Hatch, the Dr. Robert C. Atkins Foundation, the Egg Nutrition Center, and the Research Foundation of the State University of New York.

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Correspondence to Jeff S. Volek.

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Volek, J.S., Phinney, S.D., Forsythe, C.E. et al. Carbohydrate Restriction has a More Favorable Impact on the Metabolic Syndrome than a Low Fat Diet. Lipids 44, 297–309 (2009).

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