LCHF deadly in the long run… or not?

Will cholesterol levels, and thereby heart health, suffer when you eat a high-fat low-carbohydrate diet? That’s what people used to believe – even I thought so once – but science proves that this is wrong.

Studies on diets similar to LCHF usually show that the participants on average not only lose weight but also improve their health markers, including cholesterol. This is also what a Swedish expert investigation concluded last year. And this study from the other week was no exception.

Even the harshest critics have had to concede. Now, they’re sometimes claiming that LCHF will probably cause very poor health markers some time in the future, some time long after the studies have been completed. After, for example, five years – or after you’re weight is stable – LCHF will turn around magically and have the opposite effect.

However, once again reality shows something different. Here are some excellent newly published numbers after five years, from Sweden’s perhaps most rigorous LCHF person, Tommy Runesson. He cut his weight in half in the first couple of years and has since then been practically weight stable for three years:

In mg/dl

Numbers in mg/dl

In mmol/l

Numbers in mmol/l

Cholesterol Numbers After Five Years on LCHF

Perhaps LCHF will magically instead have the opposite effect after six, seven years? Although this doesn’t appear to be the case:

My Health Markers After Eight Years on LCHF


  1. Sheryl
    What should we do when the levels keep rising? My dh now has to of 310, HDL 94, ratio of 3.3, LDL 57 and trig of 205, he was always low carb, but this past year has given up grains, lowered his carbs and upped his fat. This is so confusing, and of course, the doctor wants statins, which dh is refusing, but, we are getting afraid.
    Replies: #3, #7
  2. 1 comment removed
  3. Filip Cakl
    Total cholesterol is irrelevant. What matters is LDL-P (number of LDL particles which carry cholesterol).

    In people eating LCHF diet, maybe even elevated levels of LDL-P may be misleading due to lower levels of inflammation.

    Statins are... well, please read this before you start taking them (they can have some serious side-effects).

    BTW, when you talk to your doctor, ask him about coenzyme Q10 and statins. If the doctor doesn't know anything about those two, RUN!

  4. Lari
    Sheryl, as long as he is strict in his no grains, LCHF eating, they should eventually lower (unless there is a history of familial hypercholestemia. Mine spiked briefly after a year of no grains, no starches, but went down after the 2 year mark. I eat just meats, veg, cheese, occasional berries and some 88% chocolate. And lots of butter. I eat butter on everything. But no potatoes, no rice, once in a great while, I have a banana or some winter squash, but those are a 3 - 4 times a year treat.
  5. Sheryl
    We both know how healthy we feel now that we've changed our diets, he's always been in excellent physical shape, muscular and fit, I've been heavy, just lost 40 pounds, but neither of us can lose our belly fat. His high cholesterol is concerning, and no, we won't be doing statins, seriously, we have never had this much energy, no need to ever go back to our horrible diets. We've not had diet anything in one year, not one packaged food, ever. Now we eat homemade salad dressings with olive or Mct oils, bacon, salads, tomatoes, zucchini, cauliflower, such great foods. But, this belly fat is frustrating, and his cholesterol is as well. Thanks all, for your encouragement.
  6. William
    I am just finishing my second year on LC diet. The only Lipid particles that has me concerned is my LDL-P. From the end of year one, till now, it has increased from 1088 to 2450. In both cases, the small LDL was about 23%. But I can't figure out why the LDL-P has increased so much on the same diet. Any thoughts?

    My CRP level is .4, and my HDL/TRI ratios is about 1.

    Replies: #8, #10
  7. Zepp
    310/94=3,3, soo that not a problem.. and HDL is very high!

    But Triglycerids are not that good!

    Mayby he is a cholesterole hyperresponder?

    For moste people.. if one eat a lot of cholesterole.. the liver dont produce anything.. and then its selfregulated.

    For some it doesent goes that smoth.. ones liver still produce cholesterole despite one is eating a lot.

    So for some there is need to reduce cholesterole containing food.

    It doesnt seems to be unhealty.. but the triglycerids are still not that good.

  8. murray
    William, perhaps you are taking up way too much dietary fat. Try cutting back on fat a bit, especially coconut oil (due to the lauric acid) if you are having a lot of coconut oil.

    Dr. Fred Kummerow's new book (Cholesterol is not the Culprit) makes the point that excess fatty acids from dietary triglycerides can get reassembled into triglycerides by the liver and put into VLDL/LDL particles. (Triglycerides direct from the gut are transported in chylomicrons, not VLDL/LDL.) I forget now the details of the biochemistry, but the gist was that absorption of too much dietary fat beyond energy needs can elevate the count of lipoprotein particles (and total cholesterol). It is curious that eating a lot of surplus fat does not seem to elevate fat storage for many people, such as Sam Feltham and me (based on self-experiments). Perhaps the lipoprotein particle count goes up and once it gets high from surplus dietary fat the liver stops producing bile to absorb fat. In other words, if the liver is reconstructing triglycerides from fat it signals an override to the production of bile. So the particle count could elevate without gaining weight. Just a hypothesis.

  9. JJ
    About the eaten cholesterol sensitive people, here is my own experience as example. After couple of years of low carb my total cholesterol was over 10 mmol/l and of course, the statins were written. But I didn't take the pills, isntead I changed my coffee from presso pan coffee to filtered one and decreased the daily breakfast egg to one egg in week. As a result my tot col decreased to about 7 mmol/l. HDL and Triglys were exellent in both measurements.
  10. Boundless
    > But I can't figure out why the LDL-P has increased
    > so much on the same diet. Any thoughts?

    Get your genotype tested, specifically for the apolipoprotein E4 allele. Finding an ideal diet is apparently a challenge for ApoE4/E4 people in particular.

  11. FrankG
    Or maybe look a your overall health: how you look, how you feel.. eyes, skin, teeth, hair, lean tiissue. fat tissue, blood pressure, bllod glucose, activity levels, motivation, clarity foi thought, energy levels etc... etc...

    If these are all good, then do you really need to let your lipid numbers rule your choices?

    What is the risk vs. benefits ratio. And are the risks really what we have been told repeatedly that they are? Ultimately it is your decision.

    I've recall a gardner.. fit, lean, healthy, active, always outdoors and yet I met him when he was a patient in a Coronary Care Unit following an MI. There are studies showing over 50% of patients admitted with confirmed CVD while having "normal" lipid levels... others showing that HIGHER lipids are associated with longevity.

  12. FrankG

    I like that I wrote "clarity foi thought" when I meant "clarity of thought" :-P

    Please don't draw any conclusions about my meaning, based on my less than perfect eyesight and stubby fingers :-)

  13. NS
    Well, regarding the question of the value of different diets, for those interested, and who may not have seen this yet, I've come upon a rather surprising, intellectually honest, courageous talk by Denise Minger, AHS 2014, who admittedly was already among the more open-minded people in paleo and low carb-circles.

    You may not believe your ears listening as she concedes the medical benefits of HCLF regimens, as I and others have often pointed to in so many posts. In fact, many of the issues she mentions mirror those that have been argued over on the threads of this blog many times over - 1) that there are many routes to ketosis and therefore weight loss; that LCHF is not an exclusive pre-requisite to induce it; 2) that long-term outcomes especially as it relates to heart disease are far superior with HCLF, given the current evidence (just to note, WHO minimum recommended daily intake for saturated fat is zero); 3) that HFLC results not just in diabetes management, but, ostensibly, in diabetes reversal, eradication. I have posted more than a few times about the Ma-Pi macrobiotic diet studies - if they are eating high carb (north of 80%) and they have no blood glucose issues, then there is no reason to withhold "cure" from describing their newly found non-diabetic states; 4) that HCLF regimens have long ago been proven to reverse many end-stage complications such as kidney disease, retinopathy, CVD, heart failure, etc (pubmed: Walter Kempner); 5) that, as cited by Ornish, and others, one of the apparent mechanisms involved in the healing process of CVD patients on these regimens is the significant amounts of nitric oxide and the superior blood flow that results, Minger mentions, "cell apoxia" from too much fat; 6) that despite eating up to 400 grams a day of plain old refined white SUGAR, patients still were able to improve their diabetes numbers and ultimately arrest their diseased states - by, read carefully, re-sensitizing their insulin; 7) that - and this is extremely relevant to the current thread - that despite having higher triglycerides and lower HDL, patients still fared better in - actual outcomes - as opposed to simple biomarkers. LCHF constantly talks about the a priori need for RCTs to make any scientific claims about anything yet it poo-poos the value of simple observation, where anyone can see that on the whole the healthiest, leanest people on earth eat highly plant strong diets with moderate or low consumption of animal foods. None of the regulars on these forums have ever posted any literature on the longevity of the Masai or Inuits or any other high-fat eating societies; 8) that, and acknowledgement to Wade Henderson, individuals currently suffering with CVD issues need solutions.... What advice should be given to them? Advice that has already been proven successful or advice to eat according to LCHF regimens whose long term outcome is not yet known even among people currently free of CVD?

    So here is the question: Now that on an honest, critical, wholistic assessment of the other side has been done by someone from your side, will any of the regulars here admit to, acknowledge the issues raised, admit that there may be better or at least other successful ways than LCHF, admit to these inconsistencies in all that has been outlined by Minger? Or will the religion-like, glorification continue and the feeble, shallow criticism of anyone who questions LCHF go on unabated? Is it really better truths that your after? Or is it confirmation of what you have decided is currently comfortable for you?

    Replies: #14, #24
  14. murray
    "... Or will the religion-like, glorification continue and the feeble, shallow criticism of anyone who questions LCHF go on unabated? Is it really better truths that your after? Or is it confirmation of what you have decided is currently comfortable for you?"

    Mercy. Spare us the judgmental melodrama.

    Most people here are here because they have done poorly on HCLF and have had excellent results on LCHF or are exploring whether they can achieve excellent results on LCHF. All of us are exploring the potential refinements, benefits and trade-offs of LCHF. Some of us (I use the term "us" figuratively) are sanctimonious agenda-driven blowhards who derive some perverse thrill from bating others with denigrating rhetorical questions unsupported by premises.

    Again, acknowledging one approach may work for some others does not prove or disprove another approach is efficacious for others. How many amylase alleles are in one population versus another. Would a study of Norwegians getting systemic inflammation from a diet with more than 40% calories from carbs apply to a culture that has been rice-eating for thousands of years and likely have 10 to 15 times as many amylase alleles for example. Each body is different to a degree. The fact a population of random people may on average slightly favour one approach over the other is immaterial to the individual, who has to experiment to see which approach works better for her or him.

    It reminds me of the joke about the two scientists and the epidemiologist who went deer hunting. The trio came upon a deer 100 yards ahead and the scientists raised their rifles and shot. The first scientist shot 5 feet left and the second scientist shot 5 feet right. The epidemiologist shouted, "We got him!"

    Replies: #19, #20
  15. tw
    I find it interesting that you site a video, the premise of which is to explore an open-minded approach; and then proceed to do the opposite.

    Having watched the video, and retread your comment, I am wondering if perhaps your penchant for confirmation bias colored your interpretation of what she said.

    What financial benefit do you derive from all of your musings? If no benefit then why the endless sales pitches?

    Reply: #17
  16. Howard Lee Harkness
    In the long run, we are all dead.

    However, somewhere along the way, quality of life really does count. In the 15 years that I have been low-carbbing, I have experienced significantly improved quality of life over what I had prior to 1999, even though I never did achieve my weight goal, and my VAMC quack insists that 210 total cholesterol is "dangerously high."

    And, should I live into my 90's before I croak, I expect her to gleefully point out that my high-fat diet killed me. Nevermind that I would not even be here today if I hadn't lost over 100 lbs.

    Reply: #18
  17. bill

    Sorry, but I'm confused as to whom you are responding to.
    If you hover your mouse over the poster's name, you will
    see an arrow appear. If you click that arrow there will be
    no doubt as to whom you are directing your comments to.

  18. FrankG
    "...quality of life really does count."

    Indeed it does! Even if there were another diet that could give similar health results but that diet required extreme motivation to stick at it -- probably because it was bland, tasteless and boring.... to me that woud not be "living".

    Some of the studies we discuss talk about adding years to your life... remember that those years are not added now but rather AT THE END! Given a choice between a full, rich life now -- even with the chance of a sudden death... I'd pick that any day, over a long, slow, drawn-out demise, in a nursing home, where I barely (if at all) recognise my loved ones :-P


    and bill... what exactly are you "sorry" about? There's only an handful of comments here and so far as I can see (having read them all) only one of them links to a video... and the rest of the context makes it very clear where tw's comment was aimed :-)

  19. NS
    How about addressing the plethora of findings, issues mentioned insteading of wasting space on nonsense...

    The inflammation study you mention is important.

    There is no mention of the sources of carbohydrate used. If the sources are limited to or coming mostly from fruits and vegetables, and perhaps some other very high fiber whole food sources, there may be very different inflammatory outcomes. You may have noticed the interest in "resistant starch" in paleo and low carb circles these days. RS - and other forms of fiber - have significant anti-inflammatory properties and other magic effects on metabolism, glucose control, gut microbiota, etc. This in fact is probably a big part of the answer to the Asian paradox - how it is they stay thin while eating high carb.

    Further, just as LCHF proponents never fail to to highlight the significance between moderate low carb and very low carb in terms of outcomes, the same seems to be true for moderate carb and very high carb. Kempners results are profound. Your observation that "bodies are different" only goes so far. Kempner's patients were massivley obese and inflamed as well, as seen in the clip. Yet they reversed their obesity, as well as kidney, heart, eye disease, etc..

  20. NS
    I would suggest you revisit the points mentioned and watch the Minger talk, once more.
  21. Galina L.
    I watched the video not long time ago, and I got the impression that the message of DM was not that very LFHC diet was the best diet choice,(she started to have health problems herself on the raw vegan diet) but rather that short applications of very low fat diet were not without benefits. Probably, the main summary from that video - moderation and balance diets are not particularly helpful for very health-challenged people.
  22. NS
    From the above Minger clip:

    "Low carb diets are only band-aid treatments for diabetes, essentially. The benefits only last as long as people stay on the diet, assuming they can."

    "But in the case of this diet (Kempner's rice diet), there's actually [long term] reversal of the disease itself and the ability to regenerate normal glucose metabolism."

    Imagine that. Regeneration of normal glucose metabolism from white rice, fruit, and refined white sugar.

    Not to mention, normalization/reversal of obesity, blood pressure, advanced heart disease, heart failure, kidney, eye disease, etc...

  23. FrankG
    Denise Minger also made it quite clear in that presentation that she was playing devils' advocate in this case and already had arguments to refute all of the points she had raised in favour of LFHC.

    I know you want it to be a big win for LFHC but you're really making it out to be something that it is not. The only one who sees "sides" and a contest here is YOU.

    At best it shows that LCHF is not the only way to be healthy... shock horror.. did I just say that?!? OMG :-P

    Read the comments here NS and you'll frequently see folks openly accepting that there is no one-size-fits-all solution. This is not a dogmatic religion.. in fact I recently replied to you by saying that I don't care what you eat, I'm not trying to pressure you to change and you should respect the same in others.

    BUT this IS an LCHF blog.... I'll give you three guesses as to which approach is promoted here... why do you act surprised? Is it your life's mission to force us to see the errors of our ways?

    Perhaps you have a site where you post and swap LFHC stories with raw vegans? Would you like me to come and hang out there, or do you perhaps think I'd be wasting my breath?

    You know, it's fine to come here and voice a differing opinion but get the message when it is clear that you cannot coerce others to your way of thinking.

  24. Victor

    I do not think you have seen all of Denise's youtube video. She concedes that some very high carb and very low fat diets seem to produce what she called magical effects, but these diets are so severe that it is extremely difficult to follow. To get the desired effect, the person has to be on < 10% calories from fat, no oils or other visible fats, and very low protein. One of the researchers had to resort to whipping his patients to keep them in compliance. How effective is this type of diet for real-world issues? It is bad enough that the world is full of junk foods, CAFO meats, and HFCS additives to virtually all processed foods. LCHF diets seem the easier and more practical alternative to using nutritional health care interventions. But I will concede the patients with severe heart disease may do better by getting locked in a fat-clinic and put on this ultra-low fat diet for a few months. Will it work? yes. Is it practical? you be the judge.

  25. Galina L.
    BTW, I had a personal experience with a rice diet in 70-s, my mom's version was rice + compote made with dry prunes and dried apricots, also raw apples and carrots. Yes,a weight loss occurred each time. It required a lot of will-power to follow - it is difficult for me to try to imagine somebody has to follow it long-term, unless absolutely desperate. I was not really fat back then , just plump. I don't remember that such diet was calming for my eczema and it definitely didn't reverse my excessive appetite. It happened only on a LC diet. I lost my food obsession now.
  26. tw
    I think one of the main takeaways from the video is the difference between a diet and a way of living.

    The fact that a HCLF required a very narrow window of adherence and therefore was extremely difficult to follow makes this a diet in my opinion. It also means long term success for many May be beyond reach. Some research on willpower would assist here.

    That fact that eating a LCHF "diet" is relatively easy and has a much wider potential sweet spot makes adherence more likely and to me that means a lifestyle rather than a diet.

    Frankly rather than the ongoing diatribes of NS, I would much rather hear from actual people who have had success with a HCLF regime. Demonstrate their results and tell us what they did.

    That would be fodder for an interesting and educational debate.

  27. Galina L.
    I have a remarkable health improvement on a LC diet,and it is recorded in my medical history. I started to follow that diet to control migraines. I was surprised how all autoimmune conditions got better, it is possible it may be attributed to not eating grains, especially wheat any longer, and not everybody is concerned with issues like asthma or eczema.However, the remarkable resistance to all sorts of infections came as a big surprise. I used to be very prone to urinary tract infections, gums inflammation, yeast infection. All that is gone, gone, gone, plus the probability to catch seasonal flu is close to zero. I have been observing that effect since November 2007, and it brought up memories about an old family anecdote how a relative cured himself from tuberculosis during world war second eating liberal amounts of butter, eggs, salted pork fat which he was buying from a black market after selling all his material possessions. He didn't have an access to antibiotics back then.
    Lets say somebody is gravely concerned at the moment not with infections , migraines, mental problems and hot flashes, but with diabetes or ischemia.I guess such person may try rice diet as a short intervention when presented with both options, people have to decide for themselves, but they should monitor their condition, however I can't imagine keeping somebody eating mostly white rice, sugar and fruits long term and being healthy. There is a person who conducted an experiment eating a Twinkies diet and improving his health. There must be something therapeutic in surprising your body with totally different way of eating, but when it stopped being a surprise and starts being the part of a life-style, it easily could have quite different cumulative effect.
    Reply: #31
  28. tony
    One year ago, after trying numerous HCLF, CICO, eat less/move more diets, I stood at 5'10" weighting 250 lb. and feeling miserable.

    Today, on a liberal LCHF way of eating (liberal because sometimes I don't follow it in social situations) I weight 190 lb. And the journey has been nothing but pleasant, eating delicious food.

    Not only I am feeling great, my health markers show it: TC 202, HDL 80, BG 90,Trig 65 and BP 119/68.

    With this, do you think I'm going to pay any attention to the spurious diatribes of NS (nonsense s**t?).

    Hell no!

  29. Nate
    Well, actually, I did not mind NS's comments so much, even though I pretty much did not agree with them. One benefit of his post was the comments that followed - especially murray's.comment 14. Second, if our way of eating is truly beneficial, we should not be afraid of some criticism, no matter how strident. In fact, our review of those comments will be beneficial to the newbies who are trying to learn and decide what to do. As far as the strident part goes, for me, strident arguments undermine their points by relying on drama and not facts to make their arguments. Lastly, I would encourage and not discourage all people to read and comment on this site as it is one of the best.
  30. Nate
    Going in the opposite direction, Dr. Gardner's A to Z diet trial showed the most positive results for a LCHF diet even though Dr. Gardner is a twenty plus year vegetarian. See:

    But like Minger's talk and the HCLF diet, you must be careful about wholesale advocating for the LCHF based on the A to Z study. Dr. Gardner was basically sorely disappointed in the results, which to his credit he published and actively disseminated anyway. But his disappointment motivated him to parse the data in more detail and found that a few people did better on the HCLF diets. (I believe these were the ones most sensitive to their insulin.) Metabolism and nutrition are complex and should be discussed with some careful language with the appropriate caveats.

  31. erdoke
    I asked Wade in another topic to think about what happens when someone starts following a sub 10 % fat, HC diet, but have not seen an answer. This way I have to reveal that there are 2 options:
    1. If the dieter is overweight the fat stores will be utilized.
    2. If the dieter is lean, a big part of the high carb intake will directly be converted to triglycerides by the liver.
    Guess what, in both cases the intervention results in elevated (and mostly saturated) fat metabolism. And then again it boils down to the magic word: ADHERENCE
  32. Galina L.
    Denise Minger always finds something interesting to say. NS is right - it is stupid to complitely ignore everything what doesn't fit into our personal points of view, but on another hand, we cant dismiss our experiences.
    Could we find valuable points in that presentation which make us think harder about own diet regiments we follow?
    DM's presentation does make the popular in a paleo blogosphere advice to eat as much fat as one can consume questionable. I do think so called "real food" could be over-consumed. Foe example, I can eat liver every day because I love it, but I do it only once a week.

    I wonder, is it possible to consider a rice diet which consists mainly of refined carbohydrates to be the form of starvation ?

    Really, does listening Denise Minger 's presentation cause somebody to think that consuming rice/a lot of sugar/a lot of orange juice and basically nothing else is the healthiest way to eat even if it is exchanged on real food and vegetables? For me it looks like a severe deprivation from important nutrients which may force body to change the mood of functioning. Most modern deceases are caused by overloading body with nutrition, so consuming very little necessary proteins and fats and getting health improvement makes sense . Everybody admits that the rice diet is a short intervention, and declaring very low-fat diet to be the best way in a such situation is similar to admitting benefits of intermittent fasting and declaring afterwards that prolonged food abstinence is the best healthy regiment.

    Reply: #33
  33. erdoke
    I tend to believe that the starting point and caloric deficiency matters a lot in this case. As the diet used by Kempner focuses on diabetics who also usually happen to be overweight or obese, a hypocaloric very low fat and high carb diet could indeed work by initiating fat burning in the body. Most of the glucose coming from carbs is then used for immediate energy demand of the muscles while there is still room remaining for utilization of fat storage for fat need and additional energy demand, especially by the heart.
    Overall a hypocaloric VLFHC diet indeed works very similarly to starvation/fasting. One issue is adherence, the other one is nutritional starvation on the long run, because this diet is lacking in essential fatty acids, fat soluble vitamins and probably also in several minerals.

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