“LCHF challenging health care’s poor dietary guidelines”


How is the health care system going to manage advice on LCHF, now that SBU’s expert inquiry has shown that such advice provides more weight loss and better health markers?

I was asked to write an opinion piece about this to the Swedish Television’s opinion website, and below is the result:

LCHF Challenging Health Care’s Poor Dietary Guidelines

DIETARY GUIDELINES. The question of how we should eat to lose weight has been discussed for years, often quite passionately. Now an expert inquiry gives us the answer. Low-carbohydrate diets, such as LCHF, will produce faster weight loss and improved health markers. The report challenges the Swedish health care system, which still maintains that you should avoid fat and calories. It’s time for updated and more efficient dietary guidelines, writes Andreas Eenfeldt, physician and health blogger. 

What should you eat to lose weight? Which dietary advice should health care give overweight patients?

This question has been debated for years, often in affect. But now the expert inquiry from SBU, the Swedish Council on Technology Assessment, has come with the answer in the report Dietary Treatment for Obesity. It’s the result of an inquiry over more than two years, in which several leading Swedish experts participated, reviewing 16,000 studies on the subject.

In conclusion, the inquiry finds that advice on a strict low-carbohydrate diet, such as LCHF, produces faster weight loss in obese individuals. Moreover, health markers will generally improve when obese people eat an LCHF-like diet. No signs of problems with unfavorable cholesterol profiles have been observed in the studies performed.

In the long term (one year or more) it’s difficult to really see any differences at all in weight studies, something that SBU suggests is due to lack of compliance. Most people in the studies will simply sooner or later fall back into their old habits, like a relapsing smoker.

To help patients more efficiently to make long-term changes in lifestyle will be a great challenge for the future. But first we need to know which lifestyle change works best for obese people. The conclusions from the new SBU report provide our best basis for updated guidelines today.

This report represents a major challenge for Swedish health care. Presently, the advice most often given is about avoiding fat and calories. But according to this new report it’s the still-controversial advice on low-carbohydrate diets that’s the most effective.

Should our health care system continue to provide advice, that’s been proven worst in tests, to individuals seeking help for their weight problems? No, of course this isn’t acceptable. Licensed health care professionals have to follow good clinical practice, and therefore this new report needs to be taken very seriously.

The project manager for the SBU report, Jonas Lindblom, for example tells media that the health care system should now offer low-carbohydrate diets as an option for obese patients. And in the Swedish morning paper Svenska Dagbladet science writer Henrik Ennart writes that this report “sweeps aside the last major concerns about [a low-carbohydrate diet], and opens the doors wide open to the country’s hospitals”.

Obesity is a growing problem throughout the industrialized world. In Sweden, the proportion of obese people since the late 80’s has more than doubled to 14 percent. Add the overweight and close to half the population has a weight problem. As the problem only has grown worse with each passing year, past efforts have clearly not been enough.

The new SBU report clearly shows that there are more efficient dietary recommendations. To transfer these to new guidelines and educating health care professionals in more efficient dietary counseling will now become a giant task for the health care system.

The hope is that the advice on low-carb diets, which are the most effective in studies, will also provide better outcomes for people with weight problems, even in real life.

Then only one difficulty remains: long-term changes in lifestyle.

Andreas Eenfeldt, physician, author and health blogger at DietDoctor.com


My title suggestion was “New Advice on LCHF a Challenge for Health Care”. But the change was quite good, many people do unfortunately receive bad dietary advice within today’s health care system. The potential for better results is enormous.

SVT Opinion: LCHF Challenges Our Health Care’s Poor Dietary Guidelines (original article in Swedish)


  1. FrankG
    Great to see the momentum is continuing Dr Andreas... it may take a great effort for the establishment monolith to start rolling, or perhaps it will crack into pieces first :-)

    I'm assuming what you have posted above is a (Goggle?) translation of the article as published?

    Many thanks!

  2. Emma
    I don't see that the result that LCHF is the fastest and most effective will be taken in medical advise or in the public consciousness any time soon. That's because LCHF is still set in the context of "miracle diets" that no sane person can keep. Because people *will* lapse, because it's impossible in the long rung to live without pasta, rice, bread, potatoes and candy, right? (right...)

    But what is the most important is the result of LCHF lacking any ill effects what so ever when done right. That's pretty hard evidence against the "studies" for example about how the statistically true raised overall cholesterol level in populace in Finland *must* be a result of grown amount of LCHF dieters. (ergo, LCHF is causing heart decease and should be banned!!)

    Food industry will try to smother this to death, or they'll put out some "options", like fast food restaurants sell salads without any thought on making their food generally healthier. Healthy food is damn hard to turn processed low-cost staple without the end result ending up looking like Atkins candy bars. But what is great that even when official guidelines only change so much, they are the first stepping stone. Without that, the change would never come.

  3. Galina L.
    Actually, LCHF way of eating is much easier to keep than any starvation regiment, according to countless testimonials of LCarbers and my own experience. Being constantly hungry drives people insane, eating tasty fat foods to satiation doesn't contradict human instincts, so requires less will-power, but could be socially challenging on occasion. I stopped thinking about LCarbing as a diet a while ago, it is a way to eat for me since November 2007. Yes, I eat sometimes something like a birthday cake or pasta when I visit people and doing overwise would be socially awkward. Most of the time I can avoid stupid cookies and other garbage.
    Such eating is bad for business and economy, though. No need to snack and to eat often, no use for cheap ingredients like grains and sugar, to which it is super easy to add value. I remember watching an episode of a chief Ramsey show, where he explained to the owner of an Italian restaurant how to generate more income - first thing - to drop a lamb from the menu (expensive ingredient), introduce hand-made tortellini (ingredients cost very little, easy to make, very impressive).
  4. Randal L. Schwartz
    Any diet where I can walk in to the nearest Wendy's and order "a double baconator with cheese, and please hold the artery-clogging bun", succeeds in my way of eating. Stats: 6 months losing 45 pounds, 8 months at goal weight.
  5. Glen0
    As an Australian I would like the thank every Swedish person that pressured for the SBU report to be produced (what does SBU stand for?). Although I have no belief that our dietary guidelines in Australia will be changed within the next decade (Rolled oats are still being advertised as a super food because they have been shown to lower cholesterol) but it is really helpful to have information that has a perceived authority to it because its from an official organisation.
    Reply: #7
  6. Michelle
    @Glen0 I agree and add that here in the UK there will be no chance of this happening anytime soon. We are proud of our wheat crops and rape seed crops. I can't live near or drive near the country when rape seed is in flower as the mass of flowers gives off a pungent smell that triggers a migraine. The food industry will not give up without a fight, so the next few years are going to be very interesting.
  7. Zepp
    SBU is State Board of medical Evaluation!

    It sorts under healt department and have to evaluate whats best sciens and practise in healt care system!

    Soo.. SBU papers are nearly law for healt care!

  8. WereBear
    The true challenge is the additive nature of grains and sugar! But an essential first step is realizing they are not harmless "treats."

    There's no real difference between a meal of tortellini and a meal of chocolate cake; to someone's blood sugar.

    Reply: #9
  9. robert

    Sidenote: the chocolate cake has the potential of being healthier than the pasta. Replace the wheat flour with almond meal, add the eggs, use real butter and ripe bananas for sweetness (or maybe pure Stevia). You can make a tasty cake without too many carbs, just using real ingredients. Conventional pasta on the other hand simply doesn't work without the wheat.

  10. Martin Levac
    Dr Eenfeldt, I think I have a solution for you. Right now, it looks like we're all trying to change the dominating paradigm directly, but forget a much deeper problem. The way I summarize it is that the dominating paradigm also dictates which other paradigms are allowed to co-exist or not. So, low-fat is king, and disallows low-carb to co-exist, because it directly opposes low-fat's kingdom. It's a dietary dictatorship.

    My solution is to prevent any particular minor paradigm from dictating which other minor paradigm can co-exist, by allowing all minor paradigms to co-exist, and allowing any one paradigm to compete with the current dominating paradigm. Instead of a dictatorship, we get a democracy where whichever paradigm is best will become the dominating paradigm through merit alone. Though even at this point, the dominating paradigm is not allowed to dictate which other paradigm is allowed to co-exist, even if the dominating paradigm is the best and most obviously correct one.

    I explain it in better detail in my blog post. http://wannagitmyball.blogspot.ca/2013/09/paradigm-vii-medical-paradi...

  11. Terry Rayburn
    I love the stuff you write and promote, Dr. Eenfeldt. What a great service you are doing.

    One of the nagging things that work against successfully promoting LCHF diets is that so many thousands of people have gone on an Atkins-type low carb diet, then fallen back into their old habits.

    In fact, I used the Atkins diet for many years, lost lots of weight, then rapidly gained it back. Moreover, I never met a single person who lost weight on Atkins and kept it off (I have read of some, but it's very rare).

    Atkins is a great pioneer, but here's the problem with his diet:

    If you cut down on carbs, but keep eating grains and sugars -- especially wheat -- ("just a little"), it's like trying to stop a cocaine addiction by having "just a little" cocaine a day, or stopping cigarettes by only smoking a few a day.

    Statistically, you WILL fail, because the addiction short-circuits your brain after awhile, and you make excuses, and fall back into full-blown addictive eating.

    The solution: you simply must stop eating grains and sugars (especially wheat - read "Wheat Belly" for why). Then the addictions go away, and you can enjoy your LCHF foods to you heart's content.

    This made all the difference for me. Wheat and sugar now are like "rat poison" in my thinking. Atkins hadn't caught on to that key, reasoning, "As long as you stay under so-many grams of carbs, you're okay".

    True for temporary weight loss, disastrous for a long-term lifestyle.

  12. peter
    I love this report,I've been trying to convince loved ones about the benefits of the low carb high fat and real food option and it's great to get this info from a professional respected government department. But I wonder why I haven't seen this reported in the national news though? or anywhere else come to think of it.Can't help thinking "Big Food" with all their power and control have a hand in the lack of reporting of this important scientific "discovery".I've been expecting all hell to break loose on the diet/nutrition front but nothing-zilch-zero reporting, except from the Diet Doctor of course. Anyone got any thoughts ??
    Reply: #13
  13. Zepp
    Swedish is a very small language.. wait for the hell when its translated to English!
  14. augustine sebastian
    I walk a lot restrict my diet to wholegrain cereals, lentils and veggies my weight hovers around 59 kg to 62 kg at 55 and 5' 10" I still scamper like a kid never use the lift look like as if I'm 45 daily have 150 ml of whiskey, wake up at 5.30 in the morning walk 10 km every day ,have chicken , mutton (goatmeat) or fish only twice a week eat eggs (2 only) twice a week, keep happy no tension work hard drink lime juice avoid carbonated drinks, skip a lunch or breakfast twice a week, joke a lot, write, listen to music, play guitar go to church every sunday without fail, whats app, face book and too much TV I avoid, carry my groceries two Km's till home avoid driving, use public transport consume nearly 10 cups of tea still going strong and ever fresh any time of the day, your life style counts for your weight which counts for your physical & mental health.

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