The take home message is very simple. If you have severe metabolic problems the answer is not simply carbohydrate restriction. It also involves protein limitation, to adequate but not gluconeogenic levels. Low carb, adequate protein, high fat. With the emphasis on the fat.
The high fat brigade are correct. http://www.ncbi.nlm.nih.gov/pm...
Accumulating evidence suggests that low-carbohydrate, high-fat diets are safe and effective to reduce glycemia in diabetic patients without producing significant cardiovascular risks. Most of these studies have been carried out specifically restricting carbohydrates, which tends to lead to increased protein intake, thus reducing the ketosis. However, diets that limit protein as well as carbohydrates, entailing a composition very high in fat, appear even more effective to reduce glucose and whole-body glucose metabolism in humans. In animal models, low-carbohydrate, high-protein diets do not produce ketosis or reduce glycemia but rather cause obesity. However, limiting both protein and carbohydrates as in a classic ketogenic diet remarkably reduces blood glucose in animal models of type 1 and type 2 diabetes and reverses diabetic nephropathy. Future studies should assess if ketogenic diets would be effective to reverse diabetic complications in humans.
That study is looking at serum glucose. In people with fat bellies, the invisible elephant is serum NEFAs. In the short term, keto diets reduce serum glucose. If weight is lost and the fat belly goes away, there isn't a problem with keto diets, long-term.
A problem only occurs if the Taubsian dream/nightmare of "You can be as gluttonous as you like..." is observed. If too much fat is eaten (e.g. JM's several sticks of butter on the plate) and the fat belly isn't lost, hepatic IR develops and serum glucose rises ever higher and higher. Glycosolve, anyone?
This, I believe, can explain why a sub-set of low-carbers and paleo converts seem to experience improvements. I think a diet with lesser bulk and bacteria promoting properties, coupled with easily digesting fat and protein in the form of fresh meat, eggs, etc., can help with the healing process.