Once again, you have written a great, on-point, article. Dr. Boden is being overly cautious when he says there is no long-term study supporting the healthy aspects of a highly restricted diet. One of Dia Healthcare’s (www.diahealthcare.com) science advisors, a nationally know expert in the use of low carbohydrate diets, Dr. Steve Phinney, has studied the effects of low carbohydrate, Ketogenic diets since 1970. While he has not compiled all his results into a published document to make the point, the collective evidence of he and his colleagues represents approximately 3,000 patients that have utilized a very low carbohydrate, Ketogenic diet for long periods of time. Collectively, the same results hold up with no known or observed negative side effects. This is very suggestive of the safety and efficacy of this nutritional approach.
One of the standards used by the FDA in its evaluation of drugs is called “History of Safe Use” when there has not been a formal study on a subject. If there is enough history of the safe use of a drug, it may qualify for various marketing claims under FDA rules using this standard. Dr. Phinney recently pulled together a set of slides, which Dia used in a presentation to a state university medical school and center to demonstrate a history of safe use of a low carbohydrate regimen. In fact, the regimen he described was a "no carbohydrate" diet, one of just protein and natural fats. This way of eating was the staple for the Inuit people (Eskimos) and many of the First Nations people of Canada (comparable to our American Indians) for millennia. These people suffered no adverse health effects from eating no carbohydrates all their lives (i.e., stating the conclusion as if the glass was “half empty”), including not getting scurvy from supposed lack of Vitamin C (raw meat has enough natural Vitamin C to supply a persons needs in this regard). Or stated more positively, these people were very healthy on such a diet. There is a concerted movement among many of the Canadian First Nations people to return to their “traditional” diets to get away from the ill effects inflicted upon them from adapting to the more western diets replete with carbohydrates (including rates of diabetes at 200% or more compared to overall national averages).
Lest one makes the argument that there might be a genetic difference between these people and people of European ancestry, Dr. Phinney also cites the experience of over 30 19th century explorers who traded with these peoples. Several of these explorers with European ancestry were medical doctors and kept extensive diaries of their "no carbohydrate" diets and health. As you would guess, they suffered no ill effects, or put positively, they flourished as healthy individuals, sometimes eating this diet for several years before retuning to “civilization.” Dr. Phinney’s slides show that there is a deep "history of safe use” for low carbohydrate nutrition programs.
As I have mentioned to you in the past, Dia’s interest in joining you and others to keep the facts straight about low carbohydrate diets is that these diets have been shown in numerous studies (e.g., the Boden study you cite) to be the most successful way for a person that is metabolically challenged (obese, pre-diabetic, or with Type 2 diabetes) to arrest the progression of their disease. Using a low carbohydrate nutrition approach allows people on the continuum towards or with diabetes to be able to reduce or cease altogether taking blood sugar control medications and insulin. The critics of a low carbohydrate diet should understand that even if they have a quarrel with this approach as a weight loss mechanism (though there is on reason to other than based upon personal choice), there is no better method for controlling and arresting the progression of diabetes than using a low carbohydrate approach. For people with metabolic challenges, alternative diets are not a matter of choice but are an imperative if one wants to get the best possible treatment for their condition, including all other types of diets and diabetes medications.

Bruce G. Rossiter, JD, MBA
CEO
Dia Healthcare