Low carbohydrate diets, pro: time to rethink our current strategies.

Obesity-attributable medical expenditures in the United States are estimated at 75 billion dollars annually, half of which are financed by Medicare and Medicaid. In 2002, the estimated 80,000 bariatric surgical procedures cost between 15,000 to 30,000 dollars per patient. It is now believed that poor diet and physical inactivity may soon overtake tobacco as the leading cause of death. These findings, along with escalating health care costs and an aging population, are compelling reasons for US health care and public health systems to create more effective preventive approaches than have been used to date to reverse this epidemic. According to current trends, obesity will become the #1 cause of death by 2005, with the toll surpassing 500,000 deaths a year, rivaling the annual deaths from cancer. Conditions of overweight and obesity are associated with diabetes, hypertension, hypercholesterolemia, asthma, arthritis, and poor health status. The successful experiences by many individuals who have limited their carbohydrate intake and mounting scientific studies supporting low- or controlled-carbohydrate diets' physiologic and metabolic action warrant a closer look at this dietary regimen as a potentially viable option to current conventional approaches. For individuals with high serum triglyceride and low high-density lipoprotein (HDL) levels, truncal obesity, or insulin resistance (metabolic syndrome or hyperinsulinemia), reducing carbohydrate intake has been shown to improve these parameters without adverse clinical effects. Studies are beginning to validate the benefit of controlling carbohydrate intake for individuals with type 2 diabetes. The controlled-carbohydrate regimen could be a viable alternative dietary approach for weight management used by clinicians managing patients who are failing with conventional approaches. This can be achieved by either restricting carbohydrates initially and then adding back healthy carbohydrate choices until the individual's carbohydrate threshold is achieved or by eliminating carbohydrate foods one at a time from the diet until carbohydrates are limited enough to achieve weight loss and improve clinical parameters. One diet approach does not fit all patients. Some individuals might do best on a very-low-fat, high-carbohydrate diet, whereas others may respond to lowering carbohydrate intake. Identifying specific needs and health conditions of each individual is key to successful application of the best approach and management for long-term success of weight loss in conjunction with improved health.