In this slide deck, I describe the up-to-date evidence on Low Carbs and heart health. The evidence is based mainly on two recent meta-analyses (Hession et al. & Kodama et al.) and prospective cohort studies. Limited evidence on renal aspects is also demonstrated.

1. Low Carb Diet for heart and kidneys,
what is the evidence?
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Reijo Laatikainen, Authorized Nutritionist, MBA
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2. Effect of Low Carb and Low Fat diets on
cardiovascular risk factors (RCT trials)
Better* Comment
LDL cholesterol Low Fat Hession et al. Δ 0,2-0,4 mmol/l
HDL cholesterol Low Carb Hession et al. Δ 0,05 mmol/l
Triglycerides Low Carb Hession et al. Δ 0,2 mmol/l
f-glucose Equal Kodama et al. + Hession et al.
2 h glucose Low Carb Kodama et al. 10 % lower
f-insulin Low Carb Kodama et al. 8 % lower
2 h insulin Low Carb Kodama et al. 13 % lower
Blood pressure Low Carb Hession et al. Δ in systolic 2 mmHg
Insulin sensitivity ? Shai et al. +Samaha et al: Low Carb better
Endothelial function ? In favour of Low Fat (2 vs 1 study) (Phillips et al. &
Wyscherley vs Volek)
21/12/14
References on the last page
2
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3. Effect of Low Carb and Low Fat diets on
mortality and morbidity (cohort studies)
Better* Comment
All cause mortality Low Fat Trichopoulou, Lagiou and Fung et al.
Cardiovascular mortality Low Fat Lagiou & Trichopoulou et al.
Coronary Heart Disease Equal or Low
Carb
Halton et al. (Low Carb better if
plant-based)
CV event (any) Low Fat Sjögren et al.
Strokes Equal No difference or N/A
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Additional points
• Fung et al. showed in line with Halton et al. that plant-based Low Carb Diet is linked to reduced risk
of cardiac death.
References on the last page
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4. Effect of Low Carb and Low Fat diets on renal
function (RCT trials)
Better Comment
Progression to ESRD* ? No studies
Microalbuminuria Equal Brinkworth et al
GFR Equal Brinkworth et al
S-Creatinine Equal Brinkworth et al
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Additional points
• In addition, Skov et al. & Noakes et al. have shown in short term trials (<6 months) equal effects of
high & low protein diets on key parameters of renal function (normal kidney function at baseline)
• Some cohort studies have linked the high intake of saturated fat to impaired renal function (Lin et al.
2010)
• In renal failure, low protein diets delay progression to dialysis (Robertson et al. 2007)
*) End Stage Renal Disease
References on the last page
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5. References
Cardiovascular risk
factors
Mortality & CV
morbidity
Kidney function
Hession E et al. Systematic review of randomized
controlled trials of low-carbohydrate vs. low-fat/low-
calorie diets in the management of obesity and its
comorbidities. Obesity reviews (2009) 10, 36–50
Fung T et al. Low-Carbohydrate Diets and All-Cause
and Cause-Specific Mortality Two Cohort Studies. Ann
Intern Med 2010;153:289-298
Brinkworth et la. Renal function following long-term
weight loss in individuals with abdominal obesity on a
very low carbohydrate diet vs. high carbohydrate diet.
Journal of the American Dietetic Association 110:633-
638, 2010.
Kodama S et al. Influence of Fat and Carbohydrate
Proportions on the Metabolic Profile in Patients With
Type 2 Diabetes: A Meta-Analysis. Diabetes Care. 2009
May; 32(5): 959–965
Halton TL et al. Low-carbohydrate-diet score and the
risk of coronary heart disease in women. N Engl J Med.
2006;355:1991-200
Skov et al. Changes in renal function during weight loss
induced by high vs low-protein low-fat diets in
overweight subjects. Int J Obes Relat Metab Disord.
1999 Nov;23(11):1170-7.Smaha
Samaha et al. A Low-Carbohydrate as Compared with a
Low-Fat Diet in Severe ObesityN Engl J Med
2003;348:2074-81
Lagiou P et al. Low carbohydrate-high protein diet and
mortality in a cohort of Swedish women. J Intern Med.
2007;261:366-74
Noakes et al. Effect of an energy-restricted, high-protein,
low-fat diet relative to a conventional high-carbohydrate,
low-fat diet on weight loss, body composition, nutritional
status, and markers of cardiovascular health in obese
women. Am J Clin Nutr June 2005vol. 81 no. 6 1298-
1306
Shai et al. Weight Loss with a Low-Carbohydrate,
Mediterranean, or Low-Fat Diet. NEJM 2008: 359(3);
229-41
Sjögren P et al. Mediterranean and carbohydrate-
restricted diets and mortality among elderly men: a
cohort study in Sweden. Am J Clin Nutr 2010; Sept 8,E-
pub ahead of print
Lin J et al. Associations of dietary fat with albuminuria
and kidney dysfunction. Am J Clin Nutr. 2010
Oct;92(4):897-904. Epub 2010 Aug 11.
Phillips et al. Benefit of low-fat over low-carbohydrate
diet on endothelial health in obesity.Hypertension. 2008
Feb;51(2):376-82
Trichopoulou A et al. Low-carbohydrate-high-protein diet
and long-term survival in a general population cohort.
Eur J Clin Nutr. 2007;61:575-81
Lin J et al. Associations of diet with albuminuria and
kidney function decline. Clin J Am Soc Nephrol. 2010
May;5(5):836-43. Epub 2010 Mar 18.
Volet E et al.Effects of dietary carbohydrate restriction
versus low-fat diet on flow-mediated dilation.Metabolism.
2009 Dec;58(12):1769-77.
Robertson et al. Protein restriction for diabetic renal
disease. Cochrane Database of Systematic
Reviews. 2007, Issue 4. Art. No.: CD002181. DOI:
10.1002/14651858.CD002181.pub2
Wycherley TP et al. Long-term effects of weight loss
with a very low carbohydrate and low fat diet on vascular
function in overweight and obese patients.J Intern Med.
2010 May;267(5):452-61. Epub 2009 Oct 6.
21.12.145
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6. References
Cardiovascular risk
factors
Mortality & CV
morbidity
Kidney function
Hession E et al. Systematic review of randomized
controlled trials of low-carbohydrate vs. low-fat/low-
calorie diets in the management of obesity and its
comorbidities. Obesity reviews (2009) 10, 36–50
Fung T et al. Low-Carbohydrate Diets and All-Cause
and Cause-Specific Mortality Two Cohort Studies. Ann
Intern Med 2010;153:289-298
Brinkworth et la. Renal function following long-term
weight loss in individuals with abdominal obesity on a
very low carbohydrate diet vs. high carbohydrate diet.
Journal of the American Dietetic Association 110:633-
638, 2010.
Kodama S et al. Influence of Fat and Carbohydrate
Proportions on the Metabolic Profile in Patients With
Type 2 Diabetes: A Meta-Analysis. Diabetes Care. 2009
May; 32(5): 959–965
Halton TL et al. Low-carbohydrate-diet score and the
risk of coronary heart disease in women. N Engl J Med.
2006;355:1991-200
Skov et al. Changes in renal function during weight loss
induced by high vs low-protein low-fat diets in
overweight subjects. Int J Obes Relat Metab Disord.
1999 Nov;23(11):1170-7.Smaha
Samaha et al. A Low-Carbohydrate as Compared with a
Low-Fat Diet in Severe ObesityN Engl J Med
2003;348:2074-81
Lagiou P et al. Low carbohydrate-high protein diet and
mortality in a cohort of Swedish women. J Intern Med.
2007;261:366-74
Noakes et al. Effect of an energy-restricted, high-protein,
low-fat diet relative to a conventional high-carbohydrate,
low-fat diet on weight loss, body composition, nutritional
status, and markers of cardiovascular health in obese
women. Am J Clin Nutr June 2005vol. 81 no. 6 1298-
1306
Shai et al. Weight Loss with a Low-Carbohydrate,
Mediterranean, or Low-Fat Diet. NEJM 2008: 359(3);
229-41
Sjögren P et al. Mediterranean and carbohydrate-
restricted diets and mortality among elderly men: a
cohort study in Sweden. Am J Clin Nutr 2010; Sept 8,E-
pub ahead of print
Lin J et al. Associations of dietary fat with albuminuria
and kidney dysfunction. Am J Clin Nutr. 2010
Oct;92(4):897-904. Epub 2010 Aug 11.
Phillips et al. Benefit of low-fat over low-carbohydrate
diet on endothelial health in obesity.Hypertension. 2008
Feb;51(2):376-82
Trichopoulou A et al. Low-carbohydrate-high-protein diet
and long-term survival in a general population cohort.
Eur J Clin Nutr. 2007;61:575-81
Lin J et al. Associations of diet with albuminuria and
kidney function decline. Clin J Am Soc Nephrol. 2010
May;5(5):836-43. Epub 2010 Mar 18.
Volet E et al.Effects of dietary carbohydrate restriction
versus low-fat diet on flow-mediated dilation.Metabolism.
2009 Dec;58(12):1769-77.
Robertson et al. Protein restriction for diabetic renal
disease. Cochrane Database of Systematic
Reviews. 2007, Issue 4. Art. No.: CD002181. DOI:
10.1002/14651858.CD002181.pub2
Wycherley TP et al. Long-term effects of weight loss
with a very low carbohydrate and low fat diet on vascular
function in overweight and obese patients.J Intern Med.
2010 May;267(5):452-61. Epub 2009 Oct 6.
21.12.145
http://twitter.com/pronutritionist