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.
•We present major evidence for low-carbohydrate diets as first approach for diabetes.
•Such diets reliably reduce high blood glucose, the most salient feature of diabetes.
•Benefits do not require weight loss although nothing is better for weight reduction.
•Carbohydrate-restricted diets reduce or eliminate medication.
•There are no side effects comparable to those seen in intensive treatment with drugs.