“Evaluate LCHF as a treatment for diabetes”


Science journalist Ann Fernholm wrote an excellent opinion piece in one of Sweden’s major newspapers, Aftonbladet.

Any evaluation of LCHF for diabetes will no doubt show the same thing as SBU (The Swedish Council on Technology Assessment) concluded in their review in 2010: a better outcome for blood sugar and weight than with today’s dietary advice. It’s what previous studies have shown, it’s what all logic tells us and it’s what I see in my patients daily.

That diabetics are still given the advice to eat a lot of carbs is a disgrace for the healthcare system.

Here’s the full article by Ann Fernholm, translated to English:

Evaluate LCHF As a Treatment for Diabetes

Letter to the Editor: Nutrition researchers’ dogmatic defensiveness prevents progress and costs the taxpayers many billions of dollars.


OPINION The dietary advice that many diabetics receive from healthcare professionals is outdated and useless. Dogmatic defensiveness in the world of academic science prevents progress and this costs the taxpayers many billions each year.

Results from a scientific study that should have created big headline news all around Sweden were published last summer. The study, Look AHEAD, is the biggest longitudinal evaluation that’s ever been done, following lifestyle recommendations for diabetics through the past decades. Thousands of people were closely monitored to follow a low-calorie, low-fat diet and to exercise. They lost weight and during all the years of the study, weighed less than the control group.

BUT. After nine years the researchers terminated the study prematurely. The weight loss had no significant impact on morbidity and mortality from cardiovascular disease. The results clearly showed that the lifestyle consultations that diabetics had been given as part of their health care regime had been a waste of time and money.

In my book “A Sweeter Blood” I examined the scientific foundation for low-fat diets. The belief that a low-fat diet would be heart-protective, rests on an assumption that scientists made in the 1950’s: that the total cholesterol level is the most important measure of health. The decision was never scientifically based, but has since the 1970’s completely dominated all types of dietary guidelines. Even type 1 diabetics (juvenile diabetes) have been advised first and foremost to avoid fat, despite the fact that high cholesterol isn’t even part of their medical problems. According to dietitians, even type 1 diabetics should fill their plates with carbohydrates, even though the science clearly shows that high blood sugar causes cardiovascular disease.

Diabetics, regardless of type, run a 2-3 times greater risk of suffering cardiovascular disease compared to a healthy person. A major European study from 2004 showed that almost seven out of ten people affected by cardiovascular disease had either diabetes or were pre-diabetic. Molecular-biology research also has shown that high blood sugar levels drive inflammation in the arteries, which leads to atherosclerosis. That the Look AHEAD intervention failed may therefore be most easily explained by the fact that a low-fat diet, which is per definition a diet rich in blood sugar-raising carbohydrates, makes the diabetic’s blood sugar fluctuate too much.

The fear of fat that was born in the 1970’s seems to have made many physicians completely forget that diabetes was once called “sugar disease”. If the diabetics of the 1920’s had received today’s dietary advice they would soon have died. The fact is that the current dietary guidelines for diabetics require that physicians prescribe drugs that inhibit the effect that the carbohydrates have on blood sugar.

Unfortunately, today’s heated diet debate shows us that many researchers and physicians will continue to shun calories, fat and cholesterol more than anything else. Hundreds of diabetics on an LCHF diet testify that a strict low-carbohydrate diet has a dramatic effect on their blood sugar and health. Many lose a lot of weight and are able to discontinue medications. But leading nutritional researchers dismiss their stories as anecdotal. Their dogmatic defensiveness is an obstacle to progress.

Type 2 diabetes is one of the major diseases of our time. Aside from all the suffering, the costs in Sweden alone amount to 0.5-1 % of Sweden’s gross national product. A mind-boggling amount of money. In order to resolve the diet debate the government needs to invest in high quality studies. We need funding of high quality scientific studies that without preconceived notions will evaluate what lifestyle guidelines best protect diabetics’ hearts. Allocating $15,000,000 would be a drop in the bucket in comparison with what health care costs. For Sweden’s 365,000 diabetics, on the other hand, this could mean the difference between a life in health and a premature death.

Ann Fernholm 

Aftonbladet: Evaluate LCHF As a Treatment for Diabetes  (Original article in Swedish, by science journalist Dr. Ann Fernholm, Sweden.) 



 One Year on an LCHF Diet with Type 1 Diabetes

“I am proof that LCHF makes you thin and cures diabetes”

“Hello LCHF – Goodbye Type 2 Diabetes”

How to Cure Type 2 Diabetes

The Doctor Asked: “What Have You Done?”

LCHF Wins Another Diabetes Study

Low-Carb to Manage Type 1 Diabetes

Ann Fernholm’s blog (In Swedish)


  1. Jay Wortman MD
    Sensible article. I am sure there will be a reply from defenders of the status quo, most likely from somebody with lots of medical credentials, saying "we know best, listen to us, keep eating carbs even though you cannot tolerate them and be sure to take lots of drugs, too". At least, in Sweden, you have elevated the discussion to a point where articles like this are being published in the mainstream media.
  2. Paul the rat
    Have a double portion of your rolled oats eddy!

    Nutrition. 2013 Nov 18. pii: S0899-9007(13)00377-8. doi: 10.1016/j.nut.2013.07.024. [Epub ahead of print]

    Tumor cell culture survival following glucose and glutamine deprivation at typical physiological concentrations.

    Mathews EH, Stander BA, Joubert AM, Liebenberg L.
    Centre for Research and Continued Engineering Development, North-West University, Lynnwood Ridge, South Africa.
    Most glucose (and glutamine)-deprivation studies of cancer cell cultures focus on total depletion, and are conducted over at least 24 h. It is difficult to extrapolate findings from such experiments to practical anti-glycolytic treatments, such as with insulin-inhibiting diets (with 10%-50% carbohydrate dietary restriction) or with isolated limb perfusion therapy (which usually lasts about 90 min). The aim of this study was to obtain experimental data on the effect of partial deprivation of d-glucose and l-glutamine (to typical physiological concentrations) during 0 to 6-h exposures of HeLa cells.
    HeLa cells were treated for 0 to 6 h with 6 mM d-glucose and 1 mM l-glutamine (normal in vivo conditions), 3 mM d-glucose and 0.5 mM l-glutamine (severe hypoglycemic conditions), and 0 mM d-glucose and 0 mM l-glutamine ("starvation"). Polarization-optical differential interference contrast and phase-contrast light microscopy were employed to investigate morphologic changes.
    Reduction of glucose levels from 6 to 3 mM (and glutamine levels from 1 to 0.5 mM) brings about cancer cell survival of 73% after 2-h exposure and 63% after 4-h exposure. Reducing glucose levels from 6 to 0 mM (and glutamine levels from 1 to 0 mM) for 4 h resulted in 53% cell survival.

    These data reveal that glucose (and glutamine) deprivation to typical physiological concentrations result in significant cancer cell killing after as little as 2 h. This supports the possibility of combining anti-glycolytic treatment, such as a carbohydrate-restricted diet, with chemotherapeutics for enhanced cancer cell killing.

  3. François
    I wholly agree with my colleague Dr Wortman. And also with Science journalist Ann Fernholm about dogmatism. The best example of this phenomenom is the new cholesterol-lowering guidelines that now state "Anyone between the ages of 40 and 75 who has diabetes should be on moderate-intensity statin treatment." Before even treating diabetes. And because diabetes is a risk factor for heart disease, it may sound scientific and reasonable, but treating adequately the underlying problem would be a more intelligent approach than adding yet another medication onto the problem, especially when the medication is primarily addressing cholesterol, whatever its level! Physicians have such a short memory! The AURORA study group demonstrated the following: “We found no effect of rosuvastatin on the primary end point of nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes. Analyses of individual components of the primary end point and of several secondary end points were consistent with the main finding. Rosuvastatin had no benefit in any subgroup examined, including patients with diabetes.” (Fellström BC et al., 2009). On top of it, it is clear that “… statins actually augment cardiovascular risk in women, patients with Diabetes Mellitus and in the young. Furthermore statins are associated with triple the risk of coronary artery and aortic artery calcification”… (Sultan S, Hynes N, 2013).

    "Statin therapy was associated with a 9% increased risk for incident diabetes (odds ratio [OR] 1.09; 95% CI 1.02-1.17), with little heterogeneity (I(2)=11%) between trials. Meta-regression showed that risk of development of diabetes with statins was highest in trials with older participants, but neither baseline body-mass index nor change in LDL-cholesterol concentrations accounted for residual variation in risk. Treatment of 255 (95% CI 150-852) patients with statins for 4 years resulted in one extra case of diabetes." (Sattar N, et al.,. Statins and risk of incident diabetes: A collaborative meta-analysis of randomised statin trials. Lancet. 2010; 375(9716): 735-742.)
    But who cares. Doctors paid by the industry will state that they are the experts and they set the law.

    And speaking of true diabetes treatment, any treatment that increases insulin production (medication) is worse in terms of cardiovascular risk as it increases a severely elevated chronic inflammation. The much more intelligent (and efficacious) method is to use a LCHF diet that will drive down insulin and inflammation.

    I think it is Dr Wortman who rightly pointed out in a previous comment a study by Jarrett and al. (Jarrett SG, Milder JB, Liang LP, Patel M. The ketogenic diet increases mitochondrial glutathione levels. Journal of neurochemistry, 2008. 106. 1044-1051) that suggested the underlying mechanism by which a ketogenic diet makes resistant epilepsy so much better: because ketone bodies are a better source of energy than glucose, a "cleaner" source and thus, they reduce oxidative stress and inflammation, which makes sense not only in resistant epilepsy and diabetes - either type 1 or 2 but also in any chronic and degenerative disease, which are all inflammation-driven.

    Go LCHF!

  4. Paul the rat
  5. Anna
    I was thinking the same thing lately. How can a drug with the recognized side effect of potentially causing diabetes be recommended across the board to … diabetics??
  6. Logan
    So if each of Sweden's 365,000 diabetics donated $42 to the study, they'd have well over the $15 million needed for it. No need to bring the government into it.

    You can sit around waiting for the government to do something, or you can do some fund-raising from the people who have the most to gain from figuring this stuff out once and for all.

    Complain about it or do something about it.

    I mean if money is the only thing standing in the way, I'd be more than happy to donate $42 to the cause and I'm not even Swedish or diabetic.

  7. Jo tB
    Logan, great idea. I'm a diabetic in Holland, but I would contribute towards the research as I am sure lots of diabetics outside Sweden would help. In the USA every diabetic would only need to contribute 1 Dollar.....
  8. Zepp
    They have alredy don a small study.. at a hospital in sweden!


    One flaw of this study is that those in the control goup did swith goup when they saw the differens!

  9. Keith Runyan, MD
    As a physician with type 1 diabetes since 1998, I still find it difficult to believe how gullible I was to follow the expert recommendations for diet particularly from the American Diabetes Association (ADA). I wrongly assumed that the ADA physicians were both true experts in the field and were patient advocates, neither of which I believe today. Now I believe their recommendations are based not only on “dogmatic defensiveness” as pointed out Ann Fernholm but also on pharmaceutical influence and blind ignorance of the known benefits of the LCHF diet for diabetes which dates to 1797 when Dr. John Rollo, surgeon-general in the British Royal Arterillery, was the first to prescribe a low-carbohydrate diet for diabetes consisting of “blood pudding and old rancid meats as pork.” In my clinical experience, when type 2 diabetes is treated early in its course with the LCHF diet, the disease is placed in remission without the need for lifelong pharmaceuticals and the normal glucose levels which result would most likely prevent all the complications and increased risks concurrently associated with diabetes. Similarly, when type 1 diabetes is treated with the LCHF diet, blood glucose normalizes and symptomatic hypoglycemic episodes stop, while insulin doses needed to accomplish that are markedly reduced. I have personally reaped the benefits of this approach over the past 2 years with LCHF. Insulin dose 54 to 17 units/day, HbA1c 6.5 to 5.0%, HDL-C 60 to 91 mg/dl, hsCRP 3.2 to 0.9 mg/L, etc. It is difficult to describe how liberating this has been. I no longer worry about if a hypoglycemic episode will occur nor do I worry about whether a stroke or heart attack or other complication will end or debilitate my life prematurely. I am confident that the ADA can find a way to change their recommendations to LCHF while perhaps calling it something different and not admitting any error on their part. That would be a win win from my point of view.



    In agreement with François, it is sad that the basic assumption about diabetes is that it is universally poorly controlled such that statins are recommended for all. The LCHF diet corrects both inflammation and dyslipidemia in the majority of those who follow it correctly, thus making statins of no benefit in my opinion.

  10. Rob
    I am a type 2 diabetic. After 2 weeks I had to stop one of my meds as it was driving my blood sugar too low. After 4 weeks I cut metformin in half, my blood sugar remains low, and now I have stopped taking it and my blood sugars are pretty flat.

    I have has steady eyesight (it used to fluctuate with blood sugar) and less pain. It may seem odd but I did try some carbs a few weeks back and the chronic back pain that flared up most days hit me in 30 minutes of my carb binge. It was enough to have me take pain meds and lay down as sitting was too painful. Since then I am at very few carbs and back to lower pain and level blood sugar and weight loss.

    I was up at 310 pounds, now down to 287. The weight loss was my goal, but the pain relief has been what keeps me on track, plus..tasty things that used to be 'bad' are actually good for me.

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