Carbohydrate restriction for diabetes: rediscovering centuries-old wisdom
Belinda S. Lennerz,1,2,3 Andrew P. Koutnik,4,5 Svetlana Azova,1,2,3 Joseph I. Wolfsdorf,2,3 and David S. Ludwig1,2,3
1New Balance Foundation Obesity Prevention Center, Boston Children’s Hospital, and
2Division of Endocrinology, Boston Children’s Hospital, Boston, Massachusetts, USA.
3Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.
4Human Health, Resilience & Performance, Institute for Human and Machine Cognition, and
5Department of Molecular Pharmacology and Physiology, University of South Florida, Tampa, Florida, USA.
Address correspondence to: Belinda S. Lennerz or David S. Ludwig, Boston Children’s Hospital, 300 Longwood Avenue, Boston, Massachusetts 02115, USA. Email: belinda.lennerz@childrens.harvard.edu (BSL). Email: david.ludwig@childrens.harvard.edu (DSL).
Find articles by Lennerz, B. in: JCI | PubMed | Google Scholar
1New Balance Foundation Obesity Prevention Center, Boston Children’s Hospital, and
2Division of Endocrinology, Boston Children’s Hospital, Boston, Massachusetts, USA.
3Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.
4Human Health, Resilience & Performance, Institute for Human and Machine Cognition, and
5Department of Molecular Pharmacology and Physiology, University of South Florida, Tampa, Florida, USA.
Address correspondence to: Belinda S. Lennerz or David S. Ludwig, Boston Children’s Hospital, 300 Longwood Avenue, Boston, Massachusetts 02115, USA. Email: belinda.lennerz@childrens.harvard.edu (BSL). Email: david.ludwig@childrens.harvard.edu (DSL).
Find articles by Koutnik, A. in: JCI | PubMed | Google Scholar
1New Balance Foundation Obesity Prevention Center, Boston Children’s Hospital, and
2Division of Endocrinology, Boston Children’s Hospital, Boston, Massachusetts, USA.
3Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.
4Human Health, Resilience & Performance, Institute for Human and Machine Cognition, and
5Department of Molecular Pharmacology and Physiology, University of South Florida, Tampa, Florida, USA.
Address correspondence to: Belinda S. Lennerz or David S. Ludwig, Boston Children’s Hospital, 300 Longwood Avenue, Boston, Massachusetts 02115, USA. Email: belinda.lennerz@childrens.harvard.edu (BSL). Email: david.ludwig@childrens.harvard.edu (DSL).
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Azova, S.
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1New Balance Foundation Obesity Prevention Center, Boston Children’s Hospital, and
2Division of Endocrinology, Boston Children’s Hospital, Boston, Massachusetts, USA.
3Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.
4Human Health, Resilience & Performance, Institute for Human and Machine Cognition, and
5Department of Molecular Pharmacology and Physiology, University of South Florida, Tampa, Florida, USA.
Address correspondence to: Belinda S. Lennerz or David S. Ludwig, Boston Children’s Hospital, 300 Longwood Avenue, Boston, Massachusetts 02115, USA. Email: belinda.lennerz@childrens.harvard.edu (BSL). Email: david.ludwig@childrens.harvard.edu (DSL).
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Wolfsdorf, J.
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1New Balance Foundation Obesity Prevention Center, Boston Children’s Hospital, and
2Division of Endocrinology, Boston Children’s Hospital, Boston, Massachusetts, USA.
3Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.
4Human Health, Resilience & Performance, Institute for Human and Machine Cognition, and
5Department of Molecular Pharmacology and Physiology, University of South Florida, Tampa, Florida, USA.
Address correspondence to: Belinda S. Lennerz or David S. Ludwig, Boston Children’s Hospital, 300 Longwood Avenue, Boston, Massachusetts 02115, USA. Email: belinda.lennerz@childrens.harvard.edu (BSL). Email: david.ludwig@childrens.harvard.edu (DSL).
Find articles by Ludwig, D. in: JCI | PubMed | Google Scholar
Published January 4, 2021 - More info
J Clin Invest. 2021;131(1):e142246. https://doi.org/10.1172/JCI142246.
© 2021 American Society for Clinical Investigation
Carbohydrate restriction, used since the 1700s to prolong survival in people with diabetes, fell out of favor after the discovery of insulin. Despite costly pharmacological and technological developments in the last few decades, current therapies do not achieve optimal outcomes, and most people with diabetes remain at high risk for micro- and macrovascular complications. Recently, low-carbohydrate diets have regained popularity, with preliminary evidence of benefit for body weight, postprandial hyperglycemia, hyperinsulinemia, and other cardiometabolic risk factors in type 2 diabetes and, with more limited data, in type 1 diabetes. High-quality, long-term trials are needed to assess safety concerns and determine whether this old dietary approach might help people with diabetes attain clinical targets more effectively, and at a lower cost, than conventional treatment.
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