New analysis: LCHF best for long-term weight and health markers

goldencup2 Which diet works best long-term for weight loss and improved health markers? Some say: eat fewer calories and go hungry. Others say: eat fewer carbohydrates.

Many 21st Century studies have compared the effect of these two popular pieces of advice. At least 18 studies of the highest quality have clearly shown a better weight loss result from a low-carb diet. Low-fat and low-cal diets have not won in any comparison.

Now, a new analysis selecting 13 of the most well-designed and reliable long-term studies, summarizes the results. The winner? You probably guessed right. The same as usual.

Reality now becomes increasingly difficult for opponents to explain away.

The Comparison

The analysis summarizes the results from all long-term (at least 1 year long) studies that compared the following advice:

  • LCHF-like food (up to 50 g carbohydrates per day) or
  • Low-fat and low-calorie food

Participants must also have been randomized to their groups for a fairer comparison and a more reliable result. A total of 13 long-term studies met the requirements. The analysis is based on the results from these studies.

Results for Weight

Advice on a low-carbohydrate diet resulted on average in statistically significant more weight loss in the long run. The winning margin was 0.91 kg more weight lost than in the group that received advice on low-fat and low-calorie food.

Three comments on the size of the winning margin:

1. The number only shows the advantage as compared to the other group, that also lost weight. The total weight loss was of course more. It is not mentioned here, but in another new review of studies on LCHF-like food, one found on average more than seven kilos of weight loss in a time-period during which advice on a low-carbohydrate diet was provided.

2. People in the studies lived at home and shopped, cooked and ate the food on their own during a year or more. In the study, only advice on following different diets are given. Adherence to dietary advice (regardless of type) is usually terrible in long-term studies – most people soon revert to old habits. This obviously greatly reduces the effect.

For example, the weight loss of 7 kilos (15 lbs) is the average for all, including people who didn’t follow the advice. How much weight was lost by those who followed the advice is not obvious, but it has to be more. The same may apply to the difference between the groups.

3. In the majority of studies the LCHF-group was allowed to eat until satisfied. The fact that they still clearly lost MORE weight than those that were to count calories and go hungry is impressive.

Results on Health Markers

The LCHF groups on average improved blood lipid numbers in the form of lower triglycerides and more of the good HDL cholesterol, two positive changes that are seen more or less clearly in all the 13 included studies.

They also showed a slightly higher LDL cholesterol (which the article mentions can be offset by the LDL particles becoming larger and fluffier on a low-carbohydrate diet).

The LCHF groups on average improved their blood pressure, and this was statistically significant for the diastolic pressure.


Advice to overweight people on an LCHF-like diet will, even in the long run, produce more weight loss and better health markers than advice on low-fat and low-calorie foods.

Time for the health care system to wake up?

Interestingly enough, a Swedish expert review on diet for obesity will soon be released. I have already read the preliminary work that is not yet official. However, I can reveal that the investigation is looking at more or less the same studies on low-carbohydrate diets that this analysis does, and they will, not surprisingly, reach similar conclusions.

Towards the Future

Of course, opponents will try to find excuses for ignoring this study too. But it doesn’t matter. It is only a matter of time until reality catches up with them.

There are now at least 18 RCT studies and several meta analyses (both short-term and long-term) finding better weight and health markers with advice on LCHF. It is becoming more and more unlikely that future studies will point in an entirely different direction. It is more likely that for every year there will be more and more studies showing the same thing, with increasing certainty.

Like constantly dripping water wears away a stone, the opposition will be worn away. To speed up the inevitable we can send the doubters the link to the new analysis (below). Then more overweight people may dare to eat themselves thin and satisfied with real food.

The Study

The new analysis (the abstract is free): 

Bueno NB, et al. Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials. Br J Nutr. 2013 May 7:1-10. [Epub ahead of print]


“I Was Wrong, You Were Right”

A Low-Carb Diet Superior for Overweight Children Once Again

Warnings Against the Atkins Diet “Outdated”

LCHF Seems to be Healthful in All Ways

The Science of Low-Carb

Vegetarian: Atkins Best for Weight Control (Google translated from Swedish)

18 studies: A Low-Carbohydrate Diet Best for Weight Loss


  1. Ari
    Andreas, this sentence is not clear (at least not to me): "they will not surprisingly reach similar conclusions". They are not going to reach similar conclusions, which is surprising? or They are going to reach similar conclusions, which is not surprising? Which?

    Otherwise, I'm also impatiently waiting, when the tide will turn... and it will.

  2. moreporkplease

    "not surprisingly"

    We all know that English is like, Andreas's 5th language or something. And considering that he speaks it pretty well.

    As a native English speaker I immediately understand the sentence as:

    "...they will, not surprisingly, reach similar conclusions."

    The "not surprisingly" is what we in English sometimes call an "appositive phrase." As such under the stricter rules of English grammar, it requires a pair of commas - exactly to prevent the confusion you describe.

    All Andreas did was follow present informal usage, which is heading more and more to eliminating commas. :D

  3. Dr. Andreas Eenfeldt, MD Team Diet Doctor
    My bad. Fixed it.
  4. Andreas! The cardiology community has not been totally asleep, see
  5. Low carb has always worked for me. But the carbs I eliminate in my diet are the processed ones.
  6. Ondrej
    Gary Taubes and his theory brilliantly and easily destroyed by a professional. Again. Will he ever be honest?
    Reply: #7
  7. FrankG
    'funny 'cos I was just thinking we haven't heard from our resident troll lately... right on cue On-dredge!

    Quite apart from the fact that this post says nothing about Gary Taubes or that you have offered no refutation of the study presented here by Dr Eenfeldt... but please excuse me if if find it a little hard to take your so-called "professional" seriously when he describes himself as "Weightologist"!

    Then when I see that he has your man-crush Alana Arrogant and even the shrieking harpy Evil-Lyn (AKA Carb-Insane) in his cheering section, you'll have to forgive me if I continue to disregard your pathetic attempts at getting me to mend my ways.

    BTW.. and I hesitate to correct someone who claims to be a medical student but I think you meant Gary Taubes' Hypothesis not theory :-)

    Reply: #14
  8. Eric Anderson
    Hmm! Good thing I am not average.
    Anecdotal evidence maybe but losing 50 or 100 pounds or more and keeping it off for years speaks for itself. As more people register on the national register for people who lose more than 50 ponds and keep it off over 1 year and more clinical studies are done the advantages will become more visable.

    Beyond the results is the ability to adhear to the diet. Also the results of the SAD or pritikin diet speak for themselves. Pretkin killing himself is sad. The tie in to low fat is the take a way message not the sad result of someone killing themselves that might in part be related to the low fat vegan diet they promoted. Vegans, specifically low animal fat kills.

  9. Great info! I have to admit that I'm guilty of doing nothing but cutting calories and it hasn't always worked in the long run. Think it's time to regroup.
  10. Heather Hansen
    Really? Only a .91 kg (roughly 2 pounds) difference in weight loss between the two diets? I lost 4 pounds in water weight in the first week that I started low-carbing. Although I find LCHF diet to work well for me, this study is sadly lacking. It only demonstrates that low carbers don't hold onto as much water. Hardly groundbreaking stuff here, Andreas.
    Reply: #12
  11. FrankG
    Let's see.. better average weight loss than restricting calories, better lipid profile, better blood pressure and all without hunger, while using a way of eating that, in my experience, if far more easily maintained over the long haul. I'd say those were all highly significant findings

    BUT I don't think that any one study was the point of this blog post, rather that increasingly, many more studies are saying the same things and inevitably the tide will turn; such that even old-school CICO dogmatists like Ondrej might finally wake up to reality.

    Did you ever try a calorie-restricted diet. If so I expect that you did lose some weight -- water, fat AND muscle if you want to break it down... I know I did in the past but it didn't stay off and it was highly unpleasant to starve myself (I know... I'm a wimp with no "will-power" LOL). It is NOT sustainable in the long-term to live with a calorie deficit. How many of the "biggest losers" are back to their starting weights or higher? Probably struggling with a lowered metabolic rate and worse health markers than ever.

  12. Jenessa
    Not only does it not work as well but who has time to count calories? Basically, If I were on a calorie counting diet I would just have to stop before I began. I'm naturally thin (I know, don't hate me) but my sister struggles and I've watched her go on all kinds of silly diets that are extremely time consuming and eventually she gives up because she doesn't always have time to weigh her food or write down her calories. Finally I convinced her to at least do LCHF till she gets to a comfortable weight. I'm hoping by the time she gets there that she'll realize the benefits so keep your fingers crossed!
  13. Ondrej
    Ok, I should have used "theory".

    James Krieger is the founder of Weightology, LLC. He has a Master’s degree in Nutrition from the University of Florida and a second Master’s degree in Exercise Science from Washington State University. He is the former research director for a corporate weight management program that treated over 400 people per year, with an average weight loss of 40 pounds in 3 months. His former weight loss clients include the founder of Sylvan Learning Centers and The Little Gym, the vice president of Costco, and a former vice president of MSN. He has given over 75 lectures on weight loss-related topics to physicians, dietitians, and other professionals.

    In addition to helping people achieve their weight loss goals, James is a published scientist and author. He has published weight loss and nutrition-related research in prestigious scientific journals, including the American Journal of Clinical Nutrition and the Journal of Applied Physiology. James is the former editor for Journal of Pure Power, an online magazine which delivers scientific, but lay-friendly, information on training and nutrition to athletes and coaches. In fact, James has been involved in the health, nutrition, and fitness field for over 10 years, and has written over 250 articles on these topics. He is a strong believer in an evidence-based approach to health and well-being.

    James is a licensed nutritionist with the state of Washington and a certified coach with Fowler Wainwright International. For more information on James’s background and experience, view his curriculum vita.

    Yeah, journalists know better, sure:P

    Reply: #16
  14. I think batter diet is sufficient for a fit body, you should know how to burn your extra fat which can be occurred from diet food also. So that regular exercise with proper diet is complete health key.
  15. Harj
    Hi Ondrej,
    If you have people in a controlled environment it should not be very hard to lose weight at all with any diet.
    Has James Krieger ever lost any significant weight himself?

    Did the participants have to cope with feeling hungry all the time?

    Have the participants managed to keep the average 40 pounds off?

    Once we know the answers to these questions maybe we should take a closer look, until then I will stick with my tried and tested lchf thank you very much.

  16. Natalia Correia
    Dear Sir,

    This is not a comment, but a question if possible.

    In this diet can we have mixed salad like: lettuce, onions, tomatoes, feta cheese, watercress,
    cucumber, etc...?
    I want to start the diet and make sure I can have my salad.

    Thank you very much for your attention.


    Reply: #18
  17. Zepp
    Well Im not Doc.. and you can have your sallad!

    Often when peopel goes LCHF they start to eat more veggies!

    And I say.. dont bother about sallad greens.. eat them freely.. its moste tubers one have to reduce.

    "Low Carb Dieters Eat More Veggies"

  18. Steve Bergman
    Yet another paper that shows LCHF blowing away LFHC for weight loss and all measured health markers... which ends by saying that LCHF might be a viable niche alternative to LFHC for some people. Every single one of the LFHC subjects could have died of heart attacks by the ends of the studies, and the conclusion would have been the same. Even when we win we lose.
  19. Harry
    What is important is fat loss not weight loss!
  20. Bill
    Speak as you find, nearly four years of LCHF and I feel great, weight has remained constant (after losing a lot of weight) and my bloods are great, been tested four times.

    I have attempted low fat,complex carbs in the past and failed miserably.

    I entered into the change with an open rather skeptical mind but it has been very beneficial in many respects.

    Was wondering what you eat?

  21. Susanne
    Hello Dr Andreas and team

    Just like Natalia above, I also have a question please?

    I have been LCHF now for 5 weeks - have lost 5 kg's and the cm's are coming down each week.
    However, 2 things:
    1) I seem to not be losing the kg's any more as fast, but yes! the cm are coming off, and
    2) I am never really hungry! Is this OK? I do IF every a.m. as I have no appetite at all in the morning, and tend to have a really small lunch as I just feel that I should be eating something at least.
    I am fully aware that the last 5 weeks have been absolutely wonderful i.t.o the weightloss, and I am by no means expecting to maintain a kg per week. For me, the cm's coming down are far more important.
    I have unbelievable amounts of energy now - no mid-afternoon slumps like I used to get and having the need to eat to keep up the energy I just have energy deluxe with eating literally 1/3 of what I used to.

    I would be grateful for some guidance as to this loss of appetite please? A bit worried that I'm never really hungry.

    Thanks so much for a most informative and helpful site.
    Kind regards

Leave a reply

Reply to comment #0 by

Older posts