Why Low Carb? Why high fat?


Supporting Literature


Carbohydrate restriction as first response for obesity and diabetes:

  • Feinman | Nutrition | 2015

The AHA permits 6 tsp of added sugar for women and 9 for men; yet, it is discussed that sugar consumption is

associated with perpetuation of metabolic disease

  • Johnson et al | Circulation | 2009 | 120:1011-1020

The WHO argues obesity must be addressed through correcting behavior: patients need to eat fewer calories

and exercise more

  • WHO| 2004 | Global Strategy on Diet, Physical Activity and Health | Geneva | Retrieved from

http://www.who.int/dietphysicalactivity/strategy/eb11344/strategy_english_web.pdf on November 1, 2017.

The American College of Sports Medicine reports that regular (30 minutes/day) moderate intensity physical

activity provides only modest weight loss.

Donnelly | Med Sci Sports Exerc. | 2009


1. A low carbohydrate, high fat dietary pattern compares favorably to low calorie for amelioration of:

Cardiovascular risk markers:

  • Mayer | Diabetes Obes Metab. | 2015
  • Volek | Metabolism | 2009
  • McKenzie | JMIR Diabetes | 2017
  • Other references being collated...

Renal health markers:

  • Tirosh | Diabetes Care | 2013

2. The “nutritional ketosis” induced by a low carbohydrate dietary pattern suppress appetite, facilitating

decreased caloric intake and weight loss:

  • Gibson | Obes Rev | 2015
  • Ratliff | Nutr Res | 2010

3. “The lower limit of dietary carbohydrate compatible with life apparently is zero, provided that adequate

amounts of protein and fat are consumed.”

  • Institute of Medicine | Dietary Reference Intakes...Macronutrients (Pg. 275) | 2005

4. Nutritional ketosis not the same as ketoacidosis:

  • Manninen | J Int Soc Sports Nutr | 2004

5. Regardless of degree of glycemic control, insulin resistance is associated with cardiovascular disease:

  • Book: Armstrong | Oxidative Stress and Antioxidant Protection (Chapter 20) | Wiley | 2014

6. The evidence for sugar, not salt as etiological in hypertension and cardiometabolic disease; we are worried

about “The wrong white crystals”

  • DiNicolantonio | BMJ | 2014
  • O’Donnell et al | NEJM | 2014
  • The WHO disagrees arguing with should restrict sodium. WHO. Guideline: Sodium intake for adults and children, 2012


1. Dietary fat restriction has not been proven to reduce cardiovascular risk

  • Howard | JAMA | 2006

2. Saturated fat consumption has not be proven to cause cardiovascular disease

  • de Souza | BMJ | 2015
  • Dehghan | Lancet | 2017
  • The AHA disagrees. They conclude saturated fat intake must be minimized to reduce CVD based on a

meta-analysis of 4 RCTs, the most recent of which was published in 1983 and was conducted in a Finish

hospital for patients with psychiatric illness. Sacks | Circulation | 2017

3. Replacing dietary fat calories with carbohydrate calories is associated with lower HDL, and higher serum

triglycerides and small-dense LDL subfraction; this triad is called atherogenic dyslipidemia and is associated with

increased cardiovascular risk

  • Siri-Tarino | Annu Rev Nutr | 2015

4. Carbohydrates, not dietary fat, increase serum triglycerides:

  • Volk et al | Plos One | 2014

5. Serum triglycerides, HDL and small-dense LDL subfraction predict 5 year myocardial infarction risk but LDL

does not; on the other hand, decreased LDL is a marker of treatment response to statin therapy and predicts

myocardial infarction risk reduction

  • Mora | Circulation | 2015

6. It is “oxidized small-dense LDL”, that is pathogenic for atherosclerosis, not LDL-C:

  • Book: Griffin | Textbook of Endocrine Physiology | Fourth Edition (Pg. 404) | 2000


In this section, useful books for further reading will be proposed.

Online Support

Comorbidities and Keto - UNDER CONSTRUCTION - MORE TO COME

1. Is a low carb dietary pattern safe in the setting of chronic renal failure?

  • My experience is that a low carb dietary pattern is safe provided that adequate time is spent counselling the patient NOT to over-consume protein. With strict advice not to consume more than 3 oz of meat up to 3 times per day, patients with chronic renal failure can achieve amelioration of makers of chronic renal failure including serum creatinine and urine microablumin:creatinine ratio.