The document reviews evidence regarding low carbohydrate and low fat diets, focusing on their effects on cardiovascular risk factors, mortality, and renal function. Studies indicate low fat diets may be associated with lower mortality and cardiovascular events, while low carb diets improve certain metabolic parameters. The impact on renal function remains unclear, with some studies suggesting equal effects between high and low protein diets.

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
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