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最新研究揭示，傳統低脂飲食對抗糖尿病效果有限，反觀低碳水化合物飲食在治療2型糖尿病上展現顯著優勢。此飲食法不僅迅速降低血糖，減少藥物依賴，且副作用極小。專家呼籲重新評估現行飲食指南，將低碳水化合物飲食列為治療首選。

膳食碳水化合物限制作為糖尿病管理的首選方法：批判性審查與證據基礎。

Dietary carbohydrate restriction as the first approach in diabetes management: critical review and evidence base

Richard D Feinman 1, Wendy K Pogozelski 2, Arne Astrup 3, Richard K Bernstein 4, Eugene J Fine 5, Eric C Westman 6, Anthony Accurso 7, Lynda Frassetto 8, Barbara A Gower 9, Samy I McFarlane 10, Jörgen Vesti Nielsen 11, Thure Krarup 12, Laura Saslow 13, Karl S Roth 14, Mary C Vernon 15, Jeff S Volek 16, Gilbert B Wilshire 17, Annika Dahlqvist 18, Ralf Sundberg 19, Ann Childers 20, Katharine Morrison 21, Anssi H Manninen 22, Hussain M Dashti 23, Richard J Wood 24, Jay Wortman 25, Nicolai Worm 26
Affiliations expand
PMID: 25287761 DOI: 10.1016/j.nut.2014.06.011

https://pubmed.ncbi.nlm.nih.gov/25287761/

訂正

對於“膳食碳水化合物限制作為糖尿病管理的首選方法：批判性審查與證據基礎”[營養 31 (2015) 1-13]的訂正。
Feinman RD, Pogozelski WK, Astrup A, Bernstein RK, Fine EJ, Westman EC, Accurso A, Frassetto L, Gower BA, McFarlane SI, Nielsen JV, Krarup T, Saslow L, Roth KS, Vernon MC, Volek JS, Wilshire GB, Dahlqvist A, Sundberg R, Childers A, Morrison K, Manninen AH, Dashti HM, Wood RJ, Wortman J, Worm N。
營養。2019年6月;62:213. doi: 10.1016/j.nut.2018.12.002. 2019年3月29日發布。
PMID: 30935711 無摘要可用。

摘要

當前的建議無法控制糖尿病的流行，現行低脂肪飲食在改善肥胖、心血管風險或整體健康方面的具體失敗，以及對一些常規開處方的糖尿病藥物的嚴重副作用的持續報告，加上低碳水化合物飲食在治療糖尿病和代謝綜合症方面的持續成功而沒有顯著副作用，都指向了對飲食指南的重新評估的需要。碳水化合物限制在糖尿病中的好處是即時的且有充分文獻記載。關於其療效和安全性的擔憂是長期的和推測的，而非基於數據的。膳食碳水化合物限制可靠地降低高血糖，不需要減重（儘管對減重仍然最有效），並導致減少或消除藥物。它從未顯示出與許多藥物中見到的副作用相當的副作用。在此，我們提供了12項支持使用低碳水化合物飲食作為治療2型糖尿病的首選方法，以及作為1型藥物治療中最有效的輔助方法的證據。它們代表了最有文獻記載、最不具爭議的結果。堅持只接受長期隨機對照試驗作為唯一被接受的數據在科學上是史無前例的。糖尿病的嚴重性要求我們評估所有可用的證據。這12點足夠令人信服，我們認為舉證的責任在於那些反對的人。

關鍵詞：碳水化合物；糖尿病；血紅蛋白A(1c)；生酮飲食；低碳水化合物飲食；甘油三酯。

Abstract

The inability of current recommendations to control the epidemic of diabetes, the specific failure of the prevailing low-fat diets to improve obesity, cardiovascular risk, or general health and the persistent reports of some serious side effects of commonly prescribed diabetic medications, in combination with the continued success of low-carbohydrate diets in the treatment of diabetes and metabolic syndrome without significant side effects, point to the need for a reappraisal of dietary guidelines. The benefits of carbohydrate restriction in diabetes are immediate and well documented. Concerns about the efficacy and safety are long term and conjectural rather than data driven. Dietary carbohydrate restriction reliably reduces high blood glucose, does not require weight loss (although is still best for weight loss), and leads to the reduction or elimination of medication. It has never shown side effects comparable with those seen in many drugs. Here we present 12 points of evidence supporting the use of low-carbohydrate diets as the first approach to treating type 2 diabetes and as the most effective adjunct to pharmacology in type 1. They represent the best-documented, least controversial results. The insistence on long-term randomized controlled trials as the only kind of data that will be accepted is without precedent in science. The seriousness of diabetes requires that we evaluate all of the evidence that is available. The 12 points are sufficiently compelling that we feel that the burden of proof rests with those who are opposed.

Keywords: Carbohydrate; Diabetes; Hemoblobin A(1c); Ketogenic diet; Low-carbohydrate diet; Triglyceride.