Low Carb Diets and Heart Disease – What Are We Afraid of?

I find it extraordinary how carbohydrate restriction is repeatedly rejected by the medical community as an alternative approach for obesity, the metabolic syndrome and type 2 diabetes.

Obesity has reached epidemic proportions in many countries around the world. Diabetes and other obesity related disorders have become increasingly common.

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Public health organizations and medical societies usually advocate a low-fat, high-carbohydrate, energy-deficient diet to manage weight. Nonetheless, clinical experience and scientific studies indicate that other approaches may be more effective.

The main argument against carbohydrate-restricted, high-fat diets are concerns regarding their long-term safety. Most such diets encourage increased consumption of animal products and therefore they often contain high amounts of saturated fat and cholesterol. It has been suggested that this may cause unfavorable changes in blood lipids and thereby increase the risk of heart disease. Therefore, several professional organizations have cautioned against the use of low-carbohydrate, high-fat diets.

According to a statement from the American Heart Association AHA, updated January 2012, “eating large amounts of high-fat foods for a sustained period raises the risk of coronary heart disease, diabetes, stroke and several types of cancer.”

An older statement from the Heart and Stroke Foundation of Canada claims that ” low carbohydrate diets often lack vitamins and are low in fibre. A low fibre diet can result in constipation and can increase your risk of colon cancer. Low carbohydrate diets tend to replace carbohydrate with fat and protein. High intake of protein can result in large amounts of calcium in the urine, and loss of bone mass. High intake of fat, particularly saturated and trans fat, can lead to atherosclerosis, heart disease or stroke”.

These statements are based on observational data at best. Randomized clinical trials generally don’t support these conclusions. In fact, low carbohydrate diets have demonstrated their therapeutic value in numerous studies, and often outperform other diets when comparisons are made. Nonetheless, they are still ignored by governments and medical societies. Keep in mind though, that carbohydrate restriction is a matter of definition. Some diabetic associations have accepted moderate carbohydrate restriction as an alternative approach for weight loss in type 2 diabetes.

Doctors, cardiologists included, commonly recommend low-fat, high-carbohydrate diets to patients with heart disease, as well as for cardiovascular prevention. Limitation of saturated fats and cholesterol is advocated. This is what doctors are urged to do by clinical guidelines. The guidelines are written by specially selected experts and published by professional organizations.

Interestingly, there is often no mention of individual differences between patients. The low-fat, low saturated fat, low cholesterol, high-carbohydrate approach is recommended for all. It doesn’t matter whether you have high blood pressure, whether  you are obese or overweight, have the metabolic syndrome, or whether you have diabetes.

I have nothing against low fat diets. Look at the DASH diet for example. Extensive research indicates that this diet lowers blood pressure and cholesterol, and is associated with lower risk of several diseases, including heart disease. Furthermore, it was recently suggested that the DASH diet may be used for weight loss as well. I would be very satisfied if may patients would stick to the DASH diet. I usually urge them to do so. I am sure it benefits their health. The same thing can be said about a vegetarian diet. I consider such a diet to be a very heart healthy diet. Furthermore, I very often recommend a Mediterranean type diet to my patients. There is a lot of scientific date supporting the use of this diet for cardiovascular prevention as well as for patients with heart disease.

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Low Carb, Obesity and Metabolic Syndrome

The role of diets takes on a different perspective when it comes to obese patients, and those with the metabolic syndrome, where weight loss is a priority. For years I have struggled with the low-fat, high-carbohydrate, energy-deficient dietary approach to manage these conditions. Simply put, the results have been disappointing. Often weight loss is limited and not sustained, and there are very limited improvements in metabolic function. However, I might admit the lack of result is more often due to lack of compliance than something else. Maybe we provide instructions and recommendations that patients are unable to comply with, no matter how hard they try.

Low carb diets and heart disease - What are we afraid of?

I have found that people suffering from obesity or the metabolic syndrome are much more likely to lose weight and improve their metabolic function on a low-carb, high-fat diet.

However, my clinical experience is that the effects of such a dietary approach on blood lipids are a bit hard to predict. Commonly there is an elevation of total cholesterol and LDL-cholesterol (“bad cholesterol”) which may be considered harmful. However, at the same time there is most often an elevation of HDL-cholesterol (“good cholesterol) and triglycerides are lowered.

So the question is; Should I not recommend a dietary approach that works in terms of weight loss and metabolic control, because there may be a slight elevation of LDL-cholesterol? According to the medical associations and the clinical guidelines, I should not.

Low Carb Diets and Heart Disease – The Scientific Studies

My purpose is not to go through all available scientific data on the issue of carbohydrate restriction and heart disease. However, I will try to convince you that the available data does not support the conclusion that low-carbohydrate diets are less safe than other dietary approaches for people who are obese, overweight or suffer from the metabolic syndrome.

The initial recommendations to avoid saturated fat and cholesterol were based on observations from epidemiological research. Some of this research was led by the famous American scientist, Ancel Keys. In a personal reflection from 1995

Keys wrote: “These observations led to our subsequent research in the Seven Countries Study, in which we demonstrated that saturated fat is the major dietary villain.” Keys observed that death rates were related positively to the average percentage of dietary energy from saturated fatty acids, but negatively to dietary energy percentage from monounsaturated fatty acids. In short; saturated fats seemed to increase risk, while monounsaturated fats appeared to lower risk.

Since then, an independent association of saturated fats with the risk of heart disease has not been consistently found in epidemiologic studies. Replacing saturated fats with carbohydrates has not been shown to be beneficial. In fact, replacement of saturated fats with refined carbohydrate can worsen blood lipids when insulin resistance is present, by increasing triglycerides, the number of small LDL particles, and by decreasing HDL-cholesterol. Some studies have indicated that replacing saturated fat with monounsaturated or polyunsaturated fat may be beneficial, although the latter was not supported by the recently published Sidney Diet Heart Study.

The relationship between the consumption of fat, saturated fat in particular was studied in the Swedish Malmö Diet and Cancer Study published in 2007. In this large prospective observational study, no trend towards higher cardiovascular event risk for women or men with higher total or saturated fat intakes, was observed. This study was later included in the much cited Siri-Tarino meta-analysis published 2010, showing no significant evidence for concluding that dietary saturated fat is associated with an increased risk of heart disease.

A number of randomized clinical trials have compared low-carbohydrate diets with other dietary approaches. In many of these studies, low carb diets have resulted in more short-term weigh loss in healthy womenindividuals with severe obesity with high prevalence of the metabolic syndrome and type 2 diabetes, overweight adolescents, overweight individuals with hyperlipidemia, and  premenopausal women, compared with low-fat diets. Furthermore, negative effects on blood lipids with low-carbohydrate diets were not observed in these studies and markers of the metabolic syndrome were generally improved.

Most of these randomized trials are short term studies. Thus, the long-term effects of low-carbohydrate diets still remain to be clarified. Recently, it has been suggested that such diets may be harmful.

In a systematic review and meta-analysis of observational studies, published November last year, Noto and coworkers found that low-carbohydrate diets were associated with a significantly higher risk of all-cause mortality. However, they did not find an association between low-carb diets and the incidence of, and mortality from cardiovascular disease. The authors acknowledge that their analysis is based on limited observational studies, and that large-scale trials on the complex interactions between low-carbohydrate diets and long-term outcomes are needed. It is also necessary to point out that there was a substantial difference between studies, regarding both study design and definitions. Such heterogeneity may make meta-analysis problematic.

A Few Final Words

There are many different versions of low-carbohydrate, high-fat diets. Some promote the consumption of saturated fat, while others don’t. For a patient with heart disease or someone with elevated cholesterol, I usually recommend monounsaturated fat and polyunsaturated fats rich in omega-3. I find that using the Mediterranean approach, when selecting which fats to eat may be very helpful.

Although it does not comply with guidelines, I commonly recommend individuals who are obese or suffer from the metabolic syndrome to cut down on carbohydrates and increase fats. In most instances, I find these recommendations very useful. I don’t recommend my patients to stay in ketosis for long periods of time. However, if they choose to do so, if they feel well, and if their health is improving, I find no reason to tell them not to.

If an obese person with metabolic dysfunction manages to achieve weight loss and improve his or her metabolic function on a low carbohydrate diet, it is hard to understand how such an achievement may be harmful.

I look forward to the day when low-carb, high-fat diets are accepted by public health representatives and medical associations for the treatment of obesity, metabolic syndrome and type 2 diabetes. The medical community, which I am a part of, accepts that drugs that lower cholesterol, and slightly reduce the risk of heart disease (although having considerable side effects, among them increased risk of diabetes) are given to 25 percent of adults in many countries around the world. I find it a bit hard to accept that the same medical community does not accept and recommend a dietary approach for obesity and the metabolic syndrome, that causes weight loss, increases wellbeing and improves metabolic function, and indeed appears to outperform other diets in this respect.

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Someone
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Someone

Thanks for the great article. One diet for everyone type of thinking should be dumped and patients should be treated as individuals. Especially if type 2 diabetics can avoid/reduce insulin treatment due the diet, it’s even better. There seems to be growing amount of evidence that insulin treatment has lots of unwanted “side” effects(https://jcem.endojournals.org/content/early/2013/01/31/jc.2012-3042.abstract).

I’ve enjoyed reading your blog which seems to be free of bias 🙂

Axel F Sigurdsson
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Axel F Sigurdsson

Thanks for the encouragement “Someone”. You are right. Prevention is most important. Like someone said: “Medicine is not healthcare. Food is healthcare. Medicine is sickcare.”

Judit Victor
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Judit Victor

Hi Doc, I am totally convinced. i have Heterozygous Familial Hypercholesterolemia. So do my sons and I fear for them. My total cholesterol, especially trigs, plunged dramatically on a LCHF (and I really mean high fat – like they do with kids with epilepsy) – I KNOW in my knower that I can never go off this diet again. We cannot tolerate statins – we get rhabdomyolises within a week. This diet is a lifeline for us-wise, but I cannot find a single person with this disease in cyberspace who has gone for this diet – they are scared to… Read more »

Franziska Spritzler
Guest

Fantastic article, Dr. Sigurdsson. My favorite line: “I look forward to the day when low-carb, high-fat diets are accepted by public health representatives and medical associations for the treatment of obesity, metabolic syndrome and type 2 diabetes.” This is something I’ve said repeatedly. Keep up the good work!

David Brown
Guest

The question of whether saturated fats are healthy or not probably would have been settled decades ago had the United States Government not put a end to scientific debate by declaring saturated fats the cause of clogged arteries because they raise cholesterol and omega-6 industrial seed oils the cure because they lower cholesterol. Excerpt: “The point so far is that in order to gauge our current prospects for improving public health, we need to answer two questions: (1) Which approach to health and nutrition is the right approach? and (2) Which approach currently enjoys widespread acceptance? If we get two… Read more »

David Brown
Guest

I should add, this is an excellent summary analysis of the diet/heart debate. It just doesn’t get much better than this. Thank you for posting this article.

Meghann
Guest

I read this post with interest — even looking hopefully for some explanation of the notion why it would not be recommended that your patients stay in ketosis for long periods of time. I do apologize if this comes across as rude — but I am growing frustrated with the number of times I see such statements without explanation of WHY long term ketosis is or would be a problem. I have been in stable ketosis since May of last year (approx 10months) and the difference in the weight loss pattern (MUCH smoother), mood swings, sugar crashes, cravings and general… Read more »

Axel F Sigurdsson
Admin
Axel F Sigurdsson

@Meghann
Thanks for your comment Meghann. Maybe I should have spoken clearer on this issue. I don´t consider ketosis to be a problem, and in most cases I don´t tell people to avoid it. Indeed, I think it can be very helpful for many people. What I was implying is that it does not have to be a target in itself for everyone. You can get results with low carb although you don´t stay in ketosis. People have a choice on how hard they want to go.
Congratulations on those fantastic results on improving your health 🙂

Judit Victor
Guest
Judit Victor

THANK you Meghann, I concur “wholeHEARTedly”! Totally in agreement.

pronutritionist (@pronutritionist)
Guest

Our friends in Sweden have already accepted moderately low carb diet for the treatment of diabetes among other diets 🙂 See: https://www.socialstyrelsen.se/lists/artikelkatalog/attachments/18471/2011-11-7.pdf . They did approve low carb diet after comprehensive review of the literature. Also, ADA Position Statement: Standards of Medical Care -2012. ” For weight loss, either low-carbohydrate, low-fat calorie-restricted, or Mediterranean diets may be effective in the short-term (up to 2 years). (A)” ” The mix of carbohydrate, protein, and fat may be adjusted to meet the metabolic goals and individual preferences of the person with diabetes.” For me, this sounds like a cautious step forward. A… Read more »

Diane
Guest
Diane

The DASH diet looks pretty much like the Standard American Diet – high in grains and fructose and low in fat – I think it sounds like the same disastrous dietary advice that has taken us to the epidemic levels of obesity, heart-disease and diabetes that we have around the world today. I tried the low fat, high carb, high fibre, calorie restricted diet for many years and though I could lose weight on it, I was always hungry, always irritable, always thinking about food and never able to sustain it for any length of time and as soon as… Read more »

Axel F Sigurdsson
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Axel F Sigurdsson

Thanks for sharing your thoughts Diane. This is exactly what so many others have experienced. Good luck and hope you will sustain your good health.

David Brown
Guest

@ pronutritionist, I hope those vegetable oil “primary added fats” you’re consuming are very low in omega-6s. The edible oils industry seems to be at least somewhat aware that omega-6s are problematic because they have selectively bred soybeans, rape seeds, and sunflower seeds that have a high oleic acid content. https://www.prweb.com/releases/david_brown/omega-6/prweb8933501.htm

pronutritionist (@pronutritionist)
Guest

Rapeseed and canola oils are a way lower in omega-6 fats than sunflower, soy, safflor or corn oil. I recommend canola, rapeseed and extra virgin olive oil. As Mie stated, omega-6 are not proinflammatory in humans in realistic consumption scenarios.

David Brown
Guest

First, canola is rapeseed. Second, inflammation is not the only issue of concern[1]. Third, what constitutes a realistic consumption scenario? Fourth, the government and most health organizations continue to recommend that polyunsaturated seed oils replace saturated (animal) fats[2]. Fifth, the public is rarely if ever advised to reduce the absolute amount of omega-6 intake to pre-industrial levels[3].

References
1. https://evilcyber.com/nutrition/disrobing-dogma-polyunsaturated-fat-and-health/
2. https://www.hsph.harvard.edu/news/press-releases/saturated-fat-polyunsaturated-fat-cut-heart-disease-risk/
3. https://www.asbmb.org/asbmbtoday/asbmbtoday_article.aspx?id=18

Mie
Guest
Mie

“Second, inflammation is not the only issue of concern[1].” No, but neither are the issues mentioned in the article you linked. A collection of studies without statistical significance & attempts to “force out” the evils of n-6 from the data available (Ramsden 2011); selected animal studies & short term studies limited to very narrow scenarios etc. etc. With enough attempt, virtually anything can be made to seem harmful. Scare-mongering, nothing more since NONE of the meta-analyses of either prospective cohorts nor RCTs that I’m aware of has shown statistical significance in the supposed detrimental effects of pufa/n-6, Especially when consumed… Read more »

pronutritionist (@pronutritionist)
Guest

Both US and European populations get less 7 % of total energy from PUFA (NHANES 2009; FINRISK 2007 etc.) and therefore omega-6 intake is less than 6 % of total energy. This is the big picture, a realistic scenario. No harm showed at this level. Here in Nordic contries oils rich in omega-6 oils are not recommended. New Nordic recommendations endorse canola, flaxseed or olive oil. US may be different due to argicultural and food politics. Don’t know.

Mie
Guest
Mie

David, still promoting that n-6 -scare? No reason to, since adverse effects seem to occur only when the amount of pufa is SEVERAL times that of what we Westeners get now. Not very realistic.

Meghann
Guest

https://www.dailytelegraph.com.au/lifestyle/carb-cutting-a-recipe-for-disaster/story-e6frf00i-1226600134949

Thank you for your earlier response comment to me. I was wondering if you had any notions of the “18 long – term low carb studies” being referred to in this article.

Axel F Sigurdsson
Admin
Axel F Sigurdsson

@Meghann. Thanks for providing the dailytelegraph link. It appears they are referring to the meta-analysis performed by Hiroshi Noto and coworkers which I also cited in my article. This is a systematic review of studies lasting for more than one year. They did not find any randomized clinical trial that fulfilled their selection criteria. So, only observational studies were included in their meta-analysis. Such a meta-analysis is difficult to perform because of methodological differences between studies. Selection bias does also have to be taken into account. Although adjustments were made for some of the risk factors, there may be differences… Read more »

Mie
Guest
Mie

“Large studies, like the Nurse´s Health Study, which included almost 83.000 women did not show an increased risk of heart disease with low carb, higher protein and fat diets.”

Neither did the meta-analysis by Sato et al. However, there was a statistically significant increase in all-cause mortality. Cancer, anyone?

Axel F Sigurdsson
Admin
Axel F Sigurdsson

Mie. Increased cancer risk was my first thought as well. However, the risk of cancer by low carb diets was found to be non-significant in Hiroshi Noto´s meta-analysis. So, if it´s not cardiovascular disease and not cancer, what is it then?. Their study cannot really explain what causes the difference in overall mortality. Personally, I think a meta-analysis of observational studies may be problematic. There is no intervention. Moreover, there is often heterogeneity between studies, and different definitions are used. The concept of meta-analysis was initially intended for the aggregation of similar studies.

pronutritionist (@pronutritionist)
Guest

Low carb diet pattern in these kind of cohort studies reflect diet rich in red and processed meat and marginally lower in carbohydrates. Red and processed meat is the biggest source of animal protein and fat in western diets. In Finland we consume more than 1 kilo red and processed per week (compared 300 grams fish and 400 grams poultry). So, I suspect that what we really see in the meta-analysis of Noto is the effect of high red meat consumption. This notion is supported by multiple meta-analyses on red and processed meat in many devastating diseases. Those who are… Read more »

Axel F Sigurdsson
Admin
Axel F Sigurdsson

Thanks Reijo. I definitively agree and I think you make a very important point here. Red meat might indeed play an important role here. A low carb diet is not just a low carb diet. There are both unhealthy and healthy ones. So, if you chose low carb, you should really strive to make it as healthy as possible, for example by being careful with processed meat products etc.

PhilT
Guest
PhilT

“However, there was a statistically significant increase in all-cause mortality. ” – as this could be traffic accidents or a myriad other things I don’t think it sheds any light at all.

David Brown
Guest

@ Mie, I’m not promoting a scare. But it’s scary that almost the entire world is now consuming excessive amounts of omega-6. What one consumes in terms of fat intake gets incorporated into cell membranes and fat stores. One of the most frightening aspects of the matter is that during the third trimester of a pregnancy, fatty acids stored in fat tissues are used to construct brain tissue. Excerpt: Because the first neurons evolved in an environment high in the n−3 (omega-3) fatty acid docosahexaenoic acid (DHA), this fatty acid became a major component of neural structure and function and… Read more »

Mie
Guest
Mie

“Mie, I’m not promoting a scare. But it’s scary that almost the entire world is now consuming excessive amounts of omega-6.” Err, try and put that into less subjective terms. I’ll quote myself from an earlier post concerning the issue of n-6 and CVD: “According to NHANES 2009-10, a regular American gets about 6,5% of total energy intake from n-6 fatty acids. If we compare this to e.g. Sydney Diet Heart (which, according to some, offered further proof of the detrimental effects of n-6 fatty acids) where the amount of n-6 was about 12+ % of total energy intake, you’ll… Read more »

David Brown
Guest

It’s, “try to put that into less subjective terms.” Excerpts from a September 2003 article by global obesity expert Barry Popkin: “The world’s nutrition problems have changed dramatically in recent years in a way most Americans probably have difficulty fathoming: In most of the developing world, obesity is now a larger problem than malnutrition. Here’s why. If you lived in a village or urban-slum area in China or Mexico or Egypt 25 years ago, you were unlikely to have electricity or pumped water. You certainly did not know what television was; you walked to work or rode a cart linked… Read more »

Mie
Guest
Mie

David

“It’s, “try to put that into less subjective terms.””

Oh my God! The fact that I used a colloquial expression typical of American English totally demolished all the points I had. Dave, you rule! 🙂

Seriously, Dave. By “less subjective” I didn’t mean “copypaste parts of an article & capitalize whatever you think might be relevant”. No, no and no. You need to define “excessive amounts” by providing evidence from research literature.

Please try. For once, I’d like to believe that this isn’t just another case of silly low carb/paleo dogmas that have spread like wildfire.

David Brown
Guest

I try to say exactly what I mean when I write about nutritional issues and controversies. When someone responds with sarcasm or exaggeration (totally demolished all the points…Dave, you rule), or ridicules my attempts to communicate information about the omega-6 hazard(silly..dogmas), I don’t know what to think. I don’t take it personally because, if someone wants to use that style of communication to defend a belief, that is the person’s prerogative. Mie wrote, “…a regular American gets about 6,5% of total energy intake from n-6 fatty acids.” An estimate, is it not? But what of those who consume far more… Read more »

Judit Victor
Guest
Judit Victor

Here in South Africa we have a Dr. Tim Noakes – a sports scientist and he has just written a recipe book called “the real meal revolution”. It’s what people like Dr. Peter Attia, Dr. Michael Eades, Dr Donald Miller (thoracic surgeon), and others suggest. It’s definitely NOT high protein – one of the major newspapers here, had to publish an apology last Sunday for calling Tim Noakes’ book a high protein diet. It is Low Carb, HIGH fat and moderate protein (I eat duck, goose, eggs, a tablespoon of extra virg cold pressed coconut oil everyday (must admit ygh… Read more »

Sue
Guest
Sue

I have been on the Atkins diet for one year now. I lots 35 lbs. in the first 6 mo. and have been maintaining since. I have increased my good carbs since the induction stage and figured out about how many I can have without gaining. I have an egg and sausage for breakfst every morning but for the most part have mono and polyunsaturated fats in the rest of my daily routine and do not eat white flour, pasta, root vegetables or refined foods. My cholesterol has been elevated but my ratio is excellent.. The AMA has it all… Read more »

Marika
Guest

Without a doubt my best research is my body…and I encourage others to listen to what theirs is telling them especially when it comes to food choices. By choice my diet is very clean…gluten, dairy, sugar & yeast free. I don’t eat any grains, processed or packaged food or those awful refined vegetable oils…just coconut, olive & sesame oil for me. So its mainly carbs & protein from vegetables, salads, lamb, fish, chicken, nuts…you know like we used to eat years ago. For the last 6 weeks I have cut out all fruit as my body felt better without it…and… Read more »

Mie
Guest
Mie

“l this mumbo jumbo about low carb diets being dangerous is just silly…anybody can come up with research to confirm whatever it is they have decided is truth for them!”

But in that case the research won’t stand up to scrutiny.

tedhutchinson
Guest
tedhutchinson

But the question is who has the guts to challenge consensus opinions?

If you look at the paper I’ve linked to below you can see just how long it’s taken before someone has taken the trouble to go back to the original research concerning saturated fats and check on the original classification of those saturated fats and the courage to state the obvious.

How many researchers actually are prepared to put their jobs, careers and financial security on the line to support research that is contrary to the consensus?

Axel F Sigurdsson
Admin
Axel F Sigurdsson

Yes Ted. It´s admirable. I found the paper extremely interesting. The whole thing is a bit scary. If the initial definitions from the SCS were wrong, the whole conclusion is out of order. I was thinking about writing a blog post focusing on the paper. Hope I can find a time to do it soon. Again, thanks for drawing my attention to it.

Mie
Guest
Mie

What is this “conclusion” that you referring to? The role of safa in nutrition? The current scientific opinion on the issue has virtually nothing to do whatsoever with SCS: yes, it was a starting point, but its value nowadays is purely historical. You might as well argue that the fact that Newtonian physics is outdated would somehow indicate that our current knowledge of e.g. the universe is inherently false.

Mie
Guest
Mie

Ted, I’m not too enthusiastic about this “who dares challenge the consensus” thing which I consider to be one-sided and mostly irrelevant. Once again, let’s take the safa issue as an example: during the past 3+ years, we’ve seen a number of meta-analyses challenging the role of safa in CVD. I fail to see any “scare” or “blacklisting” in the scientific community in connection with these issues. In addition, about the consensus: you do know that one well-known example of publication bias is the fact the studies reporting outcomes different to the current opinion are more LIKELY to get published… Read more »

tedhutchinson
Guest
tedhutchinson

Zoe Harcombe’s new peer reviewed paper explains how we got into this mess
“The Seven Countries study classified processed foods, primarily carbohydrates, as saturated fats.”
see
Food for Thought: Have We Been Giving the Wrong Dietary Advice? link downloads pdf.

Axel F Sigurdsson
Admin
Axel F Sigurdsson

Ted. Thanks for providing this interesting paper.

Mie
Guest
Mie

Dave: “But what of those who consume far more than 6.5%?” Well yes, what of those? Dave, please try to understand that copypastying something you’ve come across on the Internet does not constitute a proper argument. None of the studies you referenced actually demonstrates the dangers of this alleged “excessive” intake of n-6. What you have listed is, at best, SUGGESTIVE. There is virtually no evidence from studies looking at e.g. cancer of CVD endpoints that would prove that current intakes of n-6 are are problem. The best we’ve got on e.g. the latter is Ramsden et al, and there… Read more »

David Brown
Guest

“There is virtually no evidence from studies looking at e.g. cancer of CVD endpoints that would prove that current intakes of n-6 are are problem.” Isn’t that backwards? Studies do not PROVE anything. Studies are the sort of science that is only suggestive. It’s experimental biochemical research that furnishes confirmation. Currently, that sort of research involving omega-6s is being ignored. Sometimes scientists even have trouble getting it published. For example: “Our hypothesis is that levels of omega 6 are so high in our bodies that any more unsaturated fatty acid — even omega 3, despite its health benefits — will… Read more »

Mie
Guest
Mie

Dave: “Isn’t that backwards? Studies do not PROVE anything. Studies are the sort of science that is only suggestive.” And here I was, thinking that the whole idea behind a randomized controlled trial was to confirm causal relationships. Oh well, I guess someone better notify e.g. the “Big Pharma” … C’mon Dave, seriously! “It’s experimental biochemical research that furnishes confirmation.” Errr, not really. Here’s the fundamental problem with biochemists vs nutritionists: the former can’t often see the forest for the trees. The fact that there’s a mechanism doesn’t tell whether that mechanism will actually a have perceivable, meaningful effect in… Read more »

David Brown
Guest

“So, back to n-6: the evidence from RCTs tells us that the potential inflammatory effects of n-6 fatty acids really don’t constitute that much of a problem in real life setting.” RCTs wherein n-6 is increased above average levels of intake to study it’s inflammatory effects tell us nothing about what happens when n-6 is decreased below pre industrial levels. It’s sort of like forcing someone, drowning in eight feet of water, into 12 feet of water to see what happens in terms of distress level. The World is currently drowning in industrial seed oils. “If you wish to challenge… Read more »

Mie
Guest
Mie

“RCTs wherein n-6 is increased above average levels of intake to study it’s inflammatory effects tell us nothing about what happens when n-6 is decreased below pre industrial levels.” Well then, show me some RCTs where such a reduction is achieved. But darn it, you can’t! Such trials don’t exist! So instead of this, form a SOLID argument why such a thing would be beneficial – with reference to trials indicating this. But darn it, again! You can’t because the evidence from trials doesn’t support this either! “The only long-term trial that reduced n-6 LA intake to resemble a traditional… Read more »

David Brown
Guest

“Well then, show me some RCTs where such a reduction is achieved.” I thought I made it clear that there aren’t any RTCs in which n-6 was deliberately reduced. That being the case, how can health authorities be certain that increasing omega-6 intake, which is already overly high, will reduce heart attack risk? “So instead of this, form a SOLID argument why such a thing would be beneficial – with reference to trials indicating this.” RCTs, it would seem, are the only kind of science you seem willing to pay attention to. Too bad because there’s this: “In 1938, a… Read more »

Mie
Guest
Mie

“RCTs, it would seem, are the only kind of science you seem willing to pay attention to.”

Err, no. However, they are the BEST kind of science to offer insight into matters like this.

“Too bad because there’s this:”

N = 1? And a website which claims that pufa is toxic despite the fact that we just established that there is NO evidence to back up such a ridiculous claim?

Dave, are you trying to terminate our discussion by constantly reaching for new lows? 🙂

SLS, RD, LDN, CNSC
Guest
SLS, RD, LDN, CNSC

I’m going to play devils advocate on this one and think with my R.D. brain. The problem with most of these studies is that they are not defining “Low Carb” or “High FatProtein” they are saying lower carb and higher fat/protein. You lose weight by cutting calories we all know calories in vs. calories out. The DASH and TLC are essentially this diet. If you are truly on a low carb, high fat diet you would essentially be eating only meat, nuts, and vegetables. However, since most of the said diets above also include sweet potatoes, milk, beans, peanuts, fruit—… Read more »

David Brown
Guest

“If you want to follow your Atkins diet and eat 4,000 kcals of meat, butter, and veggies all day long then go ahead but you will not lose weight permanently based on macronutrient distribution– it has been studied over and over.” It’s well established that “calories count.” It’s also true that metabolism counts, hormone balance counts, and appetite counts. The point of carbohydrate restriction is that, if done properly, it heals the metabolism, balances hormonal action, and normalizes appetite. However, if a carbohydrate restricted diet is high in omega-6, among other deleterious effects there can be problems with chronic pain… Read more »

anglosvizzera
Guest

There’s a lot of evidence that the ‘calories in equals calories out’ is not the case. The theory holds in a closed system but human beings aren’t a closed system. This article in the BMJ might be of interest – https://www.bmj.com/content/346/bmj.f1050

Patience Merriman
Guest

Agreed. I wish more cardiologists and nutritionists would read Gary Taubes’ excellent book,”Why We Get Fat.” It’s a clear, scientific, logical look at the past 100 years of research into obesity and nutrition.

Patience Merriman
Guest

“If you are truly on a low carb, high fat diet you would essentially be eating only meat, nuts, and vegetables. ” That’s not true — not at all. If you are TRULY on a low-carb diet such as Atkins, you are eating meat, sure — but you are also eating also turkey, salmon, shrimp, chicken, tuna salad, pork, eggs, bacon, shrimp, scallops, lamb, lobster, and cheese. And of course salad, green peppers, asparagus, zucchini, mushrooms, broccoli, cauliflower and other low-carb veggies. Even blueberries and strawberries occasionally. Doesn’t that sound like a really, really healthy diet? People who have never… Read more »

David Brown
Guest

RCTs “are the BEST kind of science to offer insight into matters like this.” From Wickipedia: “RCTs are considered by most to be the most reliable form of scientific evidence in the hierarchy of evidence that influences healthcare policy and practice because RCTs reduce spurious causality and bias.” https://en.wikipedia.org/wiki/Randomized_controlled_trial There’s that consensus of opinion again. I’m not clear on what is meant by the phrase “matters like this.” You’re talking about the efficacy of medical or nutritional interventions, right? One would think that five decades of public health policy based on the notion that saturated fats clog arteries along with… Read more »

Mie
Guest
Mie

“There’s that consensus of opinion again.” And once again (for the last time, though, since this conversation isn’t really worth continuing): so what? If you had any REAL criticism against the validity of a randomized controlled trial setting in investigating causality – apart from that “boohoo,consensus” stuff – shouldn’t you have shown it already? “In other words, if the actual cause of heart disease could be verified by RCTs, one would think that public health policy would have reduced the incidence of heart disease by now.” Dave, please. We do know of several risk factors, but mere knowledge doesn’t really… Read more »

David Brown
Guest

“But evidently your goal isn’t to learn from information presented to you nor from criticism which you’ve been unable to counter.” What criticism? Ridicule isn’t criticism. And sarcasm adds nothing of value to any serious discussion. I long ago familiarized myself with the arguments you presented. And like South African physician Timothy Noakes, I don’t think the mainstream view that saturated fats are bad and omega-6 are good has any merit whatsoever. Excerpt: “I concluded that the cause of the global epidemic of obesity and diabetes is simple; both conditions occur in those who are genetically carbohydrate-resistant but who persist… Read more »

David Brown
Guest

I’ve got to include this: https://www.thehealthyhomeeconomist.com/new-study-lowfat-and-skim-milk-drinking-kids-are-fattest/
Excerpt:
Dr Mark DeBoer said in an email to NPR that he and his co-author Dr. Rebecca Scharf, both of the University of Virginia, were “quite surpised” by the findings as they had hypothesized just the opposite.

Mie
Guest
Mie

So merely switching from full-fat milk to skim milk doesn’t help to fight weight gain. Sounds … well, obvious. Doesn’t it?

David Brown
Guest

Apparently, it didn’t seem obvious to the researchers or the U.S. Department of Agriculture’s Center for Nutrition Policy and Promotion.

PhilT
Guest
PhilT

I wonder if US and Canadian authorities would have an easier time if they didn’t include Fiber (sic) in their Carbohydrates figure on nutritional labels. In the UK / EU we measure carbohydrates, rather than calculating by difference, and do not include fibre in the figure – it’s a separate line.

So in the UK you can eat 15g of carbohydrates and 25g of fibre per day which makes it less controversial than over the pond where “reducing carbs” can be taken to mean inadequate fibre intake.

Miranda
Guest
Miranda

Thank you for an unbiased, well-researched and documented article. I have 100 pounds to lose and tried the Atkins Diet, which, in my opinion, was the healthiest I’ve eaten in a long time: lean meats, veggies, fruits, fish, nuts, etc. I also never felt better in my life, with increased energy levels and elevated moods. I quit the diet, though, after reading negative reviews. Now, after reading this article, I think I’ll resume the diet and listen to what my body told me while I was on it – that I felt great and was never hungry. My mother has… Read more »

Kajal
Guest
Kajal

Thanx for a very interesting article. My wife & I got quite a bit motivated by the LCHF diet recently. We are 50+, I am on Statin to control high Cholesterol and my wife is on medication to control her Hypertension. We are not obese but would be keen on getting rid of about 5-6 kgs. We have been on low fat moderate Carb high fibre diet for long time, but still we have been slowly getting heavier, bigger around the waist. Our concern is with HF part of the LCHF diet. What do you think?

PhilT
Guest
PhilT

Well Fat + Protein + Carbs + Alcohol = 100% so low carb tends to mean more fat. If you’re really low carb you have to be high fat, but you’re using that fat to fuel muscles and organs all the time – apparently the saturated fat is preferentially used as fuel – so it’s a different scenario to the carb _ fat mix that has the lipophobic cardiologists in a sweat. After 2.5 yrs of low carb my total cholesterol is under 5 mmol/litre and HDL nearly 2, so the ratio total/HDL is such that I am off the… Read more »

wendy
Guest
wendy

Judit, my 55 yr. old husband has heart disease. It hurts to type that. He had a heart attack 2 weeks ago; 99% blockage in one main artery, and 50% blockage in the other. A stent in the almost totally blocked one was placed, and while no damage to the heart was done, we are obviously not out of the woods. I am devastated. His father and all of his brothers have high cholesterol; particularly high LDL. I am learning that there is more testing we could do, but it doesn’t seem to be easily had. Caridologists here follow the… Read more »

Patience Merriman
Guest

I am so grateful whenever I see a serious, thoughtful physician taking the time to really analyze the pros and cons of low-fat and low-carb regimes. I’ve been on a low-carb regime for three years now and my test results are (to quote my doctor, who has no clue about how I eat) “terrific.” Meanwhile I have lost weight, increased muscle, and improved my athletic capacity. Living without sugar, flour, grains, corn, and sweet fruits is a way of life for me now. But since I get to eat eggs, cheese, steak, salads, shrimp, chicken, veggies and whipped cream with… Read more »

John Rees, D.C., C.F.M.P.
Guest

Doc, I am a Functional Medicine Certified Provider and a Chiropractor. I re-post many of your articles on a regular basis and am not a big fan of statin drugs. In the US, it is difficult. The docs have tremendous time constraints and are not able to spend the time necessary to start producing behavioral changes. Secondly, standard of care requires that they prescribe statin drugs, regardless of their best instincts. Litigation in the US is a tremendous burden on the health care system. But the population of the US has a tremendous hunger for Dr.s offering alternative approaches like… Read more »

Miranda
Guest
Miranda

I just want to follow up and say that since my preschooler has begun the ketogenic diet for epilepsy, we have noticed HUGE gains in speech and cognition. Seizure control is moderate, but we are encouraged to continue the diet based on his improvements alone. Granted, the ketogenic diet is extremely low carb and is a medical diet, but I cannot dispute the positive correlation we have observed.

anglosvizzera
Guest

“If you add to that, the time lag between research results and changes in standard of care, reliance on continuing education produced by pharmaceutical corporations, and the ego’s inability to admit error, we end up with the present system. Like many things in the world these days, we need a revival of a desire to do what is right, and not what is popular.” This is a huge problem with the NHS in the UK. I have a relative who is in hospital with depression, and who would undoubtedly benefit from dietary supplements but the tests aren’t done and nobody… Read more »

Siobhan
Guest
Siobhan

I found this article very interesting. My husband and I have followed a low carb diet for a while and both lost some weight and felt better. However my husband this week has had a mild heart attack. He has had an angioplasty and been recommended to follow a low fat diet. We are at a loss,I don’t want to go against medical advice, but we both feel strongly that low carb, rather than low fat is the way to go, but on the other hand we keep reading how fruits,oats and legumes are heart healthy. We really don’t know… Read more »

Axel F Sigurdsson
Admin
Axel F Sigurdsson

Hi Siobhan Of course your husband should follow his doctors’ advice. It would be irresponsible of anyone commenting here to recommend anything else. Just to add to the general discussion I can say that following a heart attack most patients are put on statin therapy. This usually takes care of their LDL cholesterol (it drops) and likely has some other beneficial effects. There is very little evidence (maybe none) that a low-fat diet will provide further benefit. However, there’s evidence that a Mediterranean type diet is of benefit for those who already have cardiovascular disease or are at high risk.… Read more »

Anglo Svizzera
Guest
Anglo Svizzera

Trouble with statins is that there is still no evidence that cholesterol or even controlling LDL helps prevent heart attacks. From what I’ve read, the overall mortality is the same with more people having strokes as a result than heart attacks. Cardiologists also say that cholesterol levels of their heart attack patients are all over the place, high, low, normal…

Dr Malcolm Kendrick’s blog on ‘what causes heart disease’ (which has now run into 40-something instalments) is very enlightening and well worth reading because it isn’t what we’ve been led to believe…

Elise Wormuth
Guest

I was happy to find your informative article this morning. My husband and I started a LCHF diet on January 2nd, and as of February 1st, I’ve lost 15.5 lb. (gotta mention that extra .5), I feel more energetic already, have had no sugar cravings to speak of, and am very happy with our progress. I did visit my doctor when we embarked on this plan, and to my great surprise, she was 100% in favor of it, knew the research, and said “go for it.” So I feel great having that support. And the food is excellent and very… Read more »

Axel F Sigurdsson
Admin
Axel F Sigurdsson

Thanks Elise

Great to hear about your results with LCHF. Hope the good results continue 🙂

blakutukendy
Guest

hi Doc, I am khendy from indonesia, I am on LCHF diet for 2 months and loss my weight over 12 kg , I am strict in carb and almost very low carb. 2 day ago I checked my lipid profile and the result was cholesterol total = 251, Trygliceride = 111, LDL Cholesterol =181, HDL Cholesterol=47 all in mg/dL please could you help me is it good or bad for me to continue my diet on LCHF?, honestly I really happy I can loss my weight 12 kg and I can control my appetite not feel hungry everytime. thank… Read more »

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