Low-Carbohydrate Diets in the Treatment of the Metabolic Syndrome
In addition to physical activity, diet is a crucial component of lifestyle management. However, consensus as to which dietary approach is most efficacious remains elusive. Overall, energy restriction has been shown to consistently result in weight loss an
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Low-Carbohydrate Diets in the Treatment of the Metabolic Syndrome Marc-Andre Cornier and Boris Draznin
7.1
Introduction
Definitions, epidemiology, pathophysiology and various aspects of treatment of the metabolic syndrome are described thoroughly elsewhere in this book. The goal of this chapter is to outline the role of low-carbohydrate diets in the overall therapeutic approach to this important entity. The metabolic syndrome by definition is a constellation of medical disorders related to excess adiposity, including dyslipidaemia, cardiovascular abnormalities, insulin resistance and inadequate utilisation of glucose [1, 2]. It remains unresolved whether all components of the metabolic syndrome are united by a single pathophysiological mechanism or simply co-exist in the various symbiotic relations based on genetic background and lifestyle choices [3]. Even though lifestyle modifications remain the keystone of therapy [4–6], other aspects of therapeutic interventions are critical for normalisation of many individual components of the metabolic syndrome in these patients, such as blood pressure, dyslipidaemia, glucose tolerance, etc. It is highly likely that treatment of the metabolic syndrome will remain multifaceted requiring a combination of therapeutic modalities. In addition to physical activity, diet is a crucial component of lifestyle management [4]; however, consensus as to which dietary approach is most efficacious remains elusive [7]. Overall, energy restriction has been shown to consistently result in weight loss and to benefit adiposity-associated comorbidities, such as, dyslipidaemia, hypertension and insulin resistance. Most individuals are, however, unable to sustain long-term weight loss induced by chronic energy restriction because of hunger, dietary monotony, lack of variability of food items and
M.-A. Cornier • B. Draznin (*) Division of Endocrinology, Diabetes and Metabolism, University of Colorado School of Medicine, Anschutz Medical Campus, Mail Stop 8106, 12801 E 17th Ave, Aurora, CO, USA e-mail: [email protected] H. Beck-Nielsen (ed.), The Metabolic Syndrome, DOI 10.1007/978-3-7091-1331-8_7, # Springer-Verlag Wien 2013
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adaptations in energy expenditure [8, 9]. Recently, nutritional intervention studies have been focusing on decreasing hunger and promoting satiety in attempt to improve adherence to dietary interventions, the strongest predictor of ultimate weight loss success [10–12]. In experimental animals, metabolic syndrome can be induced by a combination of high-fat and high-fructose (carbohydrate) diet [13]. Even though both of these dietary interventions can induce certain cardiometabolic changes compatible with the metabolic syndrome, the combination of the two appears to rapidly and consistently induce a constellation of findings comparable to human metabolic syndrome [14]. Because high-fat and high-carbohydrate diets have been implicated in the pathogenesis of the metabolic syndrome [15], many investigators have used either low-fat
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