Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
18 Jun

Is It Time to Retire the Low-Carb Diet “Fad”?

This is another special guest post from our favorite study-dismantler, Denise Minger. Read all of her previous Mark’s Daily Apple articles here, here, here, here and here, and pay her website a visit. Thanks, Denise, for clearing up the confusion once again!

Sweden is a land of many wonders – most of which put the USA to shame. They’ve got fjords, ABBA, and caviar in a tube. And while Americans get arrested for things like DUIs and stealing socks from Walmart, Swedes get arrested for the more admirable feat of smuggling butter.

Such a delicious felony doesn’t reflect a life of crime so much as a life of fat – the edible kind. For nearly a decade, Sweden has been the unofficial headquarters of the Low Carb High Fat (LCHF) movement, churning out an unprecedented number of lipid lovers. In 2011, a whopping 25% of Sweden’s population was trying to eat more fat and curb their carbohydrate intake, with 5% of Swedes identifying as hardcore LCHF adherents. And those numbers only seem to be growing.

But a new study claims to cast doubt on the safety of Sweden’s fatward trend. In a paper published in Nutrition Journal last week (PDF available here), researchers linked the Swedish low-carb boom to rising cholesterol levels, increased heart disease risk, and failure to maintain long-term weight loss. A cascade of predictable headlines ensued, ranging from “Atkins diet found to be bad for the heart” to the brazen “Time to retire the low-carb diet fad.” The latter article – a well-circulated piece from The Atlantic – gave low-carb fans a particularly snarky flogging:

Low carbohydrate evangelists will almost certainly attack today’s announcement – and perhaps this post – with biblical fury. They’ll make their usual claim: that this is yet another conspiracy of scientists who just don’t get it, scientists who don’t understand nutrition, scientists who somehow made it through their PhD’s and MD’s without knowing the first thing about how the human body works. But let’s face it – most of us know in our hearts that eschewing a breakfast of whole grains and fruit crowned with a dab of yogurt for a greasy pile of sausage, bacon, and eggs is not the road to health.

Ouch! Time to whip out the granola and Yoplait?

If something seems fishy about this study, it’s not just the lutfisk: as usual, there’s more going on (or in this case, less going on) than the alarmist media would suggest. Here’s the real scoop.

No Low Carb, No Heart Disease

First and foremost, this study has nothing to do with low carbers, or even heart disease: it’s an observational study of Swedes Not Further Specified (SNFS). Researchers pulled 25 years’ worth of data from 140,000 folks in the North Sweden Diet Database, averaged everyone’s food intake, averaged everyone’s total cholesterol, and made some pretty graphs.

The findings? Sweden’s fat consumption (as a percent of total energy) dropped between 1986 and 1991, held steady until about 2004, and then started rising; the inverse happened with carbs:

(In those early years, fat kerplunked due to the Vasterbotten Intervention Programme – a project launched in the mid ‘80s to encourage more physical activity, scoot Swedes towards a low-fat Mediterranean diet, improve food labeling, and hopefully knock heart disease off its tyrannous throne.)

And like an ant frantically evading the smoosh of a human thumb, average body mass index skittered wherever the heck it wanted (usually up):

And average total cholesterol – not among low carbers, but among north Sweden’s general populationfollowed a roller-coaster-esque trajectory of its own. It plummeted between 1986 and 1992, crept back up until 1994, rolled downhill again until 2000, stabilized between 2002 and 2008, and then began yet another upward jog until the study ended. A visual for your viewing pleasure:

That’s it. No distinction between HDL and LDL, no reported triglycerides, and – most notably – no mention of how diet or cholesterol changes corresponded with actual heart disease rates. In fact, there’s nary a morbidity or mortality statistic to be found in the whole paper.

So how did the doom-and-gloom warnings about low carbing enter the scene?

Simple: the researchers think Sweden’s recent cholesterol hike might be a result of the LCHF boom – although the design of this study, with dieters of all persuasions stirred together in a giant pot of data-soup, makes it impossible to tell if that’s actually the case. Although the media apparently didn’t get the memo, the researchers even stated in their paper that “our study design does not allow a causal evaluation of the relationship between the increased fat intake since 2004 and the increased cholesterol values after 2007.” Likewise, the media thinks Sweden’s ever-increasing BMI, despite being an average of the general population, means that low-carb adherents fail to maintain their weight loss. (Yeah, I’m scratching my head over that logic too.)

Although it’s possible that saturated-fat-loving, low-carbing Swedes singlehandedly raised the nation’s average cholesterol in 2008, this seems iffy for a few reasons. For one, fat intake and blood cholesterol were hardly mirroring each other for the study’s previous 22 years: cholesterol levels continued to drop even when fat intake remained steady (though this could also be confounded by use of statins and ratios of specific fatty acids). Even more suspiciously, there was a four-to-six-year lag between the rise in fat consumption and the 2008 cholesterol jump – implying that Sweden’s fat-feasting took half a decade to affect blood values. (Usually cholesterol reflects diet changes in a matter of weeks.) And although this particular study tells us nada beyond “total cholesterol,” another paper published just a few months ago – drawing from the same pool of data – shows that after 2008, north Sweden’s triglycerides were frolicking uphill with cholesterol:

If that graph convinces anyone that the Low Carb High Fat movement is spiking triglycerides, I’ve got some oceanfront property in Arizona to sell ‘em, too: the evidence is pretty consistent that low carbing makes triglycerides sink. It seems more likely that other factors are lurking behind Sweden’s shifting blood lipid patterns, especially during the past few years.

Lo and behold, the fine print of our study-du-jour suggests the same. According to the researchers, foods associated with a high fat intake in Sweden were not just the predictable oils and meats, but also pizza, French fries, potato chips, corn chips, cheese-flavored puffed products, and popcorn, as well as “fats used for spreading on bread.” Unless Sweden has a very different definition of “low carb” than the rest of the world, it sounds like their fat intake isn’t coming solely from LCHF-approved fare, but from what most of us affectionately refer to as bona fide junk.

Even when it comes to foods directly associated with high cholesterol, Sweden’s low-carb movement still can’t shoulder all the blame. According to a supplementary table kindly included with the paper (available as a Word document here), boiled potatoes and coffee made bigger statistical contributions to blood cholesterol than saturated fat did! Other foods associated with high cholesterol included not just high-fat foods, but also low-carb no-gos like sweet buns, crisp bread, white bread, and sweet fruit soups.

Dairied Alive

Although this study doesn’t reveal anything very useful about what food does to us (particularly where fat is concerned), fear not: the diet-disease data for northern Sweden is a many splendored thing, and other studies have mined it with much more fruitful results. Or in some cases, milkful.

In 2010, the American Journal of Clinical Nutrition published a paper looking directly at dairy fat and myocardial infarction among some of the same northern Swedes used in last week’s study. The results? Women with high intakes of dairy fat – confirmed both by food-frequency questionnaires and ruminant-milk-fat biomarkers – were less likely to suffer from a first heart attack than their milk-minimizing counterparts. (Cheese and fermented dairy products looked particularly heart-protective.) And just in case you think that one was a fluke, a 2004 study examining the same Swedish population found dairy fat to be negatively associated with cardiovascular risk factors, with zero indication that full-fat milk products contribute to heart attacks. Want more? Yet another study (PDF), again based on those fat-loving northern Swedes, found dairy fat to be beautifully protective against strokes – especially in women.

So much for all that “artery clogging” hoopla!

Are Low Carbers in the Clear?

It’s a mystery why our current study tried to glean anything about low-carb diets from such tight-lipped data – especially since it’d be easy enough to actually untangle those low carbers from the rest of the population and follow them, up close and personal, like the stalkers we all secretly yearn to be. In fact, another north Sweden study published in February attempted that very feat (sans creepiness), and failed to find any increased mortality among the folks it deemed “low carb.” (Unfortunately, that study also used an invariably terrible diet-score design, but that’s a story for another day.)

As for Sweden’s recent cholesterol uppage? Without more detailed data and a look-see at disease rates, it’s virtually meaningless. But even if there’s no legitimate evidence dooming Swedish low carbers to an early grave, it’s possible that the LCHF movement is having some unhappy consequences in the Land of the Midnight Sun. The health climate there is clearly whipping fat-phobia into remission – which, despite the admirable triumph over bad science, could also breed a new species of half-hearted dieters like Low Carb Weekend Warriors, Low Carb As Long as There’s Not a Cookie in Front of Me, and Why Don’t I Just Put Butter on Everything Edible and Buy New Pants When They Get Too Tight. Folks who jump on the “high fat” bandwagon while still living in high-carb land may indeed find themselves gaining weight and frightening their doctors with ominous lipid panels. Whether or not this is happening in Sweden right now remains to be known, but it is a possibility.

Personally, though, I have other theories:

I’m not saying correlation equals causation. I’m just saying maybe we should think about switching to Google Plus.

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. Ok that was awesome, now let’s discuss why the Swedish government would try to prove such nonsense? It’s yet another case (as Tom Naughton has pointed out) of where the government and their “studies” are becoming completely irrelevant, and we should just ignore them!

    Kevin wrote on June 18th, 2012
  2. At a friends house a few weeks ago, I met a girl who was a bit chubby and she was all “carbs make you fat. I’m low carb” and I’m like “yeh totally I’m low carb high fat too!” and she was like “that’s why youre so skinny” then I offered her a teaspoon of coconut butter because she hadn’t tried it before and she grabbed the jar to read the label it said something like 16g carbs per 100g and she was appalled “oh my god that has so much sugar. I would never even touch that.” but then 5 minutes later she ate 2 MASSIVE slices of a banana cake that my friend made IN FRONT OF US with like 2 cups of sugar and heaps of milk chocolate and white flour and I was like *jaw drop*


    SophieE wrote on June 18th, 2012
    • That’s astounding! And terrifying.

      Nicole wrote on June 18th, 2012
  3. You could be describing my folks. My parents have watched me go from a 30/32 to a 0-2 eating LCHF. I was hoping to have inspired them to do the same. Instead, my father is Mr. I’ll Stick Butter On Everything Edible And Buy New Trews When They Rip. He’s now a 44/46″ waist. When mine was 53″, his was 32/34. He won’t quit HC because he’s on statins. So I told him to quit the statins (even buying him a copy of ‘The Great Cholesterol Con’. He’s not even taken it out of the Amazon packaging!). He’s just lost a close friend to complications caused by type 2 diabetes; I had hoped this would be the kick up the arse he needed. Instead he switched from 1% milk to non-fat – but he STILL has a whole whole meal baguette with butter and blue cheese at lunchtime!

    They’ve had: –

    Why We Get Fat
    Primal Blueprint
    Wheat Belly
    Jimmy Moore’s book

    I. Give. Up! If they won’t believe me because – in their words – I’m not a doctor (think the fact I’m not makes me infinitely better qualified to give advice…) then I’ll just have to watch them – particularly my dad – kill themselves… I don’t see what else I can do… Any help folks…?

    Sarah wrote on June 18th, 2012
    • Here’s a little Dad Gone Primal Success Story:

      My father is 64. He went Primal at the end of March and just had his physical last week. His glucose number dropped to 93 (normal is 65-139, before he was pre-diabetic). His HDL was 102 (good is 40) and his triglycerides were an astounding 38 (good is below 150). His doctor printed out his lab work as a door prize.

      He dropped the 10 lbs he’s been trying to lose for the past 15 years in less than 6 weeks and has never felt better. Just wishes he did it 30 years ago.

      Dad started taking all his medication (including statins) every other day about 2 weeks into being Primal. Doc told him, “Whatever you are doing, keep it up, you even look younger.”

      I hope his story may be a good example and some help to you. But I have to admit that my mother, despite seeing my Dad, me, my husband, and both of his parents, succeed with PB, utterly refuses to even consider going Primal (and smokes). So, as happy as I am for my dad, I feel your pain. You can lead a horse to water, and comfort yourself in the fact that you tried your best, but free will is tricky.

      Nicole wrote on June 18th, 2012
      • I wish my Dad would listen! I am not going to give up, but he is so firmly entrenched in CW and dutifully taking his statins. Thanks for posting!

        Lady Grok wrote on June 18th, 2012
      • Have you ever heard of the ‘Just world’ theory? It’s the idea that the world is the way it is because things work out the way they should. The rich are rich because they were virtuous and worked hard and the poor are poor because they’re lazy and morally bankrupt. What does this have to do with food? Well… the just world thinker is biased to believe that doctors are doctors because they know things, people are in authority because they deserve it and if you’re not an authority then you shouldn’t be listened to.

        Now obviously in reality things are far more complicated than a simple ‘just world’. Sometimes people get into authority because they worked hard, sometimes they were just lucky and sometimes they were actively colluding with and subverting others to advance. (we could argue about the relative numbers of those, but it doesn’t matter for this post) Because of this variation we can’t assume that an authority knows what they’re talking about. We have to check on them and what they’re telling us to do and to do that we have to think, which is hard.

        A combination of being biased toward authorities due to a ‘just world’ view and intellectual laziness is a dangerous thing. One essentially becomes a human lemming. Though honestly it only takes one of those sometimes. My mother is very rigorous in her investigations and research, no intellectual laziness there, yet her basic belief in the infallibility of the authorities she trusts means that her research is only pointed toward bolstering them and disproving me and my low carb Tim foolery. Yet she accuses me of intellectual dishonestly, even though I was a raw vegan for nearly a year in my previous pursuit of heath (it didn’t end well).


        Tim wrote on June 19th, 2012
        • Maybe I’m cynical, but how one could be a ‘Just Worlder’ in this day and age boggles the mind.

          Your mom will come around eventually. One problem is that unless one is a Ph.D. statistician (and with a good understanding of biological experimental design), it is sometimes very difficult to tease out the fallacies in some of the bad studies, even if they were done honestly.

          BillP wrote on June 19th, 2012
        • It boggles my mind too Bill but I work with quite a few people who think this way. You might say I’m surrounded by them.

          Honestly, I’m not here because the paleo community convinced me with evidence pointing to this or that study. I’m sick of reading studies laboriously dissecting this or than infinitesimally small piece of the whole picture. I’m here because I tried everything else, and this was the first thing that made me feel better and not just me, my whole family. I don’t like arguing with others, I find it pointless (and I have zero interesting in proving I’m better or know more, about anything, let others do that). Those who want to learn, will. Those who don’t won’t.


          Tim wrote on June 19th, 2012
        • Jeffrey of Troy wrote on June 19th, 2012
    • Sympathies. Convincing someone to change their way of doing things is a tough sell under any circumstances, unless they come to you begging for advice. THEY have to see the problem, THEY have to want a solution.

      Also, you have a strike against you: you’re the offspring! No one listens to their kids.

      Be low-key, try to set an example, hope some of it sinks in. The hard sell or the evangelical pitch doesn’t work.

      BillP wrote on June 18th, 2012
      • +1

        PrimalGrandma wrote on June 18th, 2012
      • Offspring I may very well be – a kid I ain’t! Turned 39 a month ago. And there was a lass a few responses back who said she’d converted her mum.

        My dad’s not THAT much older than Mark – but looking at them, you’d be convinced the difference was 25 years, not 5!

        I did think that my losing 15 sizes – and him losing one of his golf buddies to complications caused by type 2 diabetes (he was also on statins – it seems that guys over 50 here are put on them routinely (now the dept of health is recommending them for ANYONE over 45; I’d like to see a doc attempt to force them on me! They’d not dare…).

        Mike Eades blogged a couple of months back of the correlation between statins and type 2. That’s always been a no-brainer for me; doc puts you on statins and a very low fat/high carb diet, then the result is going to be insulin resistance, obesity and, eventually, diabetes, right…? What other outcome could there POSSIBLY be…?!

        Think it’s the Aspie in me which makes me frustrated. I’m half thinking they fully expect me to wake up one morning bigger than I was 4 years ago – ain’t gonna happen!

        Sarah wrote on June 19th, 2012
  4. What researchers think they will prove, they will then proceed to prove!

    Mary in FL wrote on June 18th, 2012
    • Absolutely true! And when there are trillions of dollars to be made on pharmaceuticals to keep us “healthy,” there is no way a good, healthy truth would be published and promoted, eliminating the need for big pharma. A little conspiracy theory-ish, I know, but when so much money is concerned, people are capable of anything.

      Nicole wrote on June 19th, 2012
  5. Another fine example of how the media are completely retarded when it comes to statistics.

    I think a fine way to stick it to the media is to live LCHF until we’re all old and still fit and ridiculously good looking.
    They can make up all the stats they want til the organically raised cows come home, it won’t change the fact that I’m more likely now to die from being hit by a bus than by a heart attack.

    And the (hopefully many) intervening years will be filled with bacon, heavy lifting, sprinting and sex.

    Cledbo wrote on June 18th, 2012
    • Maybe we just need to sort of outlive the self-righteous sugar burners. And then it will be nice and quieter.

      “…crowned with a dab of yogurt.”

      A dab. How pathetic and soul-crushing is THAT? Even in my pre-primal days, I understood that you don’t “dab” yogurt on food.

      Joy Beer wrote on June 19th, 2012
      • I’ll be curious to see 10-20+ years from now how the diet landscape has changed. If today’s trends keep continuing people will HAVE start clueing in when we’re the only people who aren’t obese, diabetic and dropping dead from heart attacks.

        A.Stev wrote on June 19th, 2012
  6. It is true that one of the biggest problems of Paleo/LCHF/etc diets is a lack of self-criticism. However, it is also a fact that every single negative report/review of these diets is dishonest.

    Txomin wrote on June 18th, 2012
    • I don’t really see that… like, at all.

      Maybe I’m insulated, but all of the people I follow in the Paleo-Primal community have been willing to modify their positions in light of new, contradictory evidence.

      At the very least people like Mat Lalonde keep us honest and despite being Paleo-friendly, are more than willing to make serious criticisms of certain claims.

      A.Stev wrote on June 19th, 2012
  7. Denise, I would love to see your take on the recent reports of a study in the journal, Circulation, confirming a positive correlation between sodium intake and blood pressure. Spoiler alert: if you haven’t seen it, it’s pretty weak. There are plenty of great articles from the 1980’s and early 1990’s which do a great job showing a much stronger correlation between insulin and blood pressure. I’d love to hear both your opinion as well as Mark’s on this!

    Geomike wrote on June 18th, 2012
    • Most Americans are not getting “too much” sodium; they are deficient in potassium and/or magnesium.

      Jeffrey of Troy wrote on June 19th, 2012
  8. I <3 u Minger!

    Ancient wrote on June 18th, 2012
  9. As a type 1 diabetic and a new paleo eater 3 months. I have to say, I don’t care about the studies. I can tell you the facts. 1. My daily insulin usage has dropped from over 40 units a day to less than 17 units a day. I don’t need any extra insulin when I eat a meal. That means I am using the energy that I am eating. And I eat a lot. 2. If I am not using insulin to get carbs out of the blood I am not storing fat. At 6’2″ and 214lbs, I did not think I was fat. But, now at a comfortable 185, I look and feel great. The one thing I am working towards is figuring out how much exercising I need to eliminate all my insulin needs.

    Marc wrote on June 18th, 2012
    • I have a family history of adult onset Type 1. ‘m going primal , in part, to avoid it! It’s great to here how well you’re doing!!

      mntnmom wrote on June 19th, 2012
    • How long ago were you diagnosed? even 40 units per day is quite a small amount. My son was diagnosed as a type 1 when he was three. He’s now 12, 5’5″ and 120lbs. When we went primal/paleo two years ago (from previously being raw vegan) his insulin needs went down by a lot, from more than 80 units a day to around 40 to thirty (depending on the fruit intake), but 17? That’s a huge stretch, and I don’t know if he’ll ever accomplish that. You might have some remaining insulin response from your pancreas. Some recent research I’ve seen out of the Faustman lab has shown that islet cells remain active far longer than anyone thought, they’re just present in very small quantities because they’re constantly under immune attack. I guess I’m saying, good for you, I’m glad your insulin is so low, but don’t think you can eliminate it entirely and never look back. Right now, until someone comes up with a reliable way to turn off that immune response, once a type 1, always a type 1 and you insulin needs are likely to change with time and further pancreatic degradation.

      Tim wrote on June 19th, 2012
  10. Love that last graph!

    Luce wrote on June 19th, 2012
  11. That last graph is true science!!!! LOL. I’ll reactive my myspace page.

    Interesting article by the way!

    Daniel wrote on June 19th, 2012
  12. <<Another Swedish opinion here. LCHF is indeed pretty mainstream here, plus we have a pretty good standrad of treatment for livestock, happy days! Exercise and physical work are a part of life (we are a nation that loves DIY). We also rely less on our doctors here (I last saw a doctor 2 years ago) and more on our own judgement, so we have a few things doing in our favour.
    Buuuuut…we have a secret curse called "Fredagsmys". Loosly translated as "cosy Friday" it is the act of loading up on junk food (chips and dips and loose pick and mix candy being the most popular choices) and crashing in front of the TV. This used to just happen on a Friday but nowadays it last the whole weekend with people buying half their body weight in sugar and carbs once a week. We also have the "Fika" or coffee break, which always revolves around some sort of sticky sweet concoction. Heck, we even have pastries which are specifically called "Fika breads" Could Sweden have invented a faster way to undo a weeks worth of healthy eating?
    I know plently of LCHF people who eat really good meals yet undo all that good work with their Fikas and Fredagsmys

    Liadora wrote on June 19th, 2012
  13. Fad or otherwise, I have lost considerable fat while maintaining muscle and seeing my success, my wife just started last Sunday being as primal as she can be and has lost 7 pounds in her first week. With almost zero exercise.

    Joshua wrote on June 19th, 2012
  14. That last graph doesn’t state when Justin Bieber’s music career started, so how can we say facebook had anything to do the new rise cholesterol? I still firmly believe Bieber is the cause, and something must be done.

    Casey wrote on June 19th, 2012
  15. The author of the Atlantic piece cited above has a new article today on the same topic. . I posted asking why any reader should believe her articles in the future given that she asserted causality in her previous article despite the specific comments by the study authors discounting the ability of the study itself to demonstrate causality.

    Pierce wrote on June 19th, 2012
  16. I wish people would learn how to use the Scientific Method CORRECTLY not JUST when it suits their argument, but ALL THE TIME. The Geek Manifesto would call this blog a combination of Fixing the Evidence and Mishandling the Evidence. Something our politicians are great at. You will never read a scientfic journal artcle that is completely conclusive with no limitations mentioned. We HAVE to rip our work to shreds and admit our mistakes or our peers will do it for us and we will lose a lost of respect. No limitations, no publication. This article would have been reviewed by multiple indepedent researchers with a fine tooth comb before it was published.
    This is a non-equivalent comparison group study. The purpose is to GENERATE a hypothesis which will be tested under more controlled circumstances multiple times (pending some poor researcher with no social life). This study provides empirical observations for further study. That is all

    On that note a massive flaw in the results section is Johansson et al. didn’t say what was being eaten wth the plant products (ie spreads, toppings, fillings) that induce hgh colesterol. Because based on that table we need to spend another ten years disproving the findings of food chemistry in the lab and then another ten years developing new findings. Sorry but animal products have cholesterol. Plant products do NOT. (why I always laugh when I see my supermarket advertisng cholesterol free avocado)

    Kendal wrote on June 19th, 2012
    • Just relised. I picked up something that a bunch of senior researchers did not. Science is for everyone.

      Kendal wrote on June 19th, 2012
    • @Kendal, not sure what your point is here. “Animal products have cholesterol”? This is true, but what of it? Perhaps we’re on the same page, but I cannot quite figure out what you’re getting at.

      We are animals, we produce cholesterol and it is necessary for life in too many ways to list here. I’m sure you’re aware of them. The amount of cholesterol in our bodies is barely affected by how much of it we eat because we produce as much as is needed. Vegans have cholesterol, too, or else they’d be dead.

      The graphs provided by the study show that intake of nearly everything rose during the study period, EXCEPT animal products (butter and protein were flat on the graphs). However, butter was on the rise for cooking although it wasn’t much, really, because it didn’t elevate the overall butter use. More important was the rise in use of other oils (i.e., inflammatory vegetable and seed oils), non-sugary snacks, and beer and wine. Yet, somehow animal products continue being fingered as the culprits. Where’s the scientific method in all of that? Spreads, toppings, and fillings to go along with those non-sugary snacks are typically made of sugary and/or oily (read: inflammatory) concoctions, not animal products.

      Juan wrote on June 22nd, 2012
  17. According to my most recent reading about the relationship between carb intake and LDL vs fat intake and LDL, the LCHF folks should see and increase in the LDL level over the carb eaters. However, it should also be noted that the LDL level is almost meaningless compared to the granule size of the LDL. Carbs cause the creation of small dense LDL granules, which increase artery disease. Fat intake (especially saturated (read animal) fat) cause LDL granules to swell up and get fluffy, eliminating them from the artery disease process. The best indicator of whether or not your LDL puts you at risk of heart disease is to have your blood subjected to an NMR (Nuclear Magnetic Resonance Scan) to determine grain size. If they are large grains, you are in the clear no matter how high the LDL level is. If they are small, cut out the carbs.

    Scott Birnbaum wrote on June 19th, 2012
  18. Received a public reply from the atlantic author in that article’s comment thread. I am not sure whether she is being disingenuous or does not understand the scientific method. Regardless, she is doing her readers a disservice. She continues to defend her assertion that the study concluded something its authors said it could not conclude.

    It will be interesting to see if our debate goes anywhere.

    Pierce wrote on June 19th, 2012
  19. Thank you Thank you. My family is Swedish and I enjoy the fare extensively. We always have plenty of herring and dairy in the fridge.

    There has even been some scholarly work done suggesting that one reason the Vikings were such successful warriors was that the ancestral Scandinavian diet is not the grains or rural France, but the dairy and animal fats and proteins.

    Anders wrote on June 19th, 2012
  20. How about that Lutefisk she refers to? I think it is Paleo, no?

    Steve wrote on June 19th, 2012
  21. Kalles Kaviar is inedible. If you want a great Swedish tube food try RenOst. It’s a soft cheese with bits of smoked reindeer in it. Unfortunately I can’t read the carb count on the label and it costs an insane amount to ship anything from Sweden.

    Jake wrote on June 20th, 2012
  22. I have a new assignment for Denise – just to keep her busy – vegan linguistic manipulation.
    Look at this nonsense at the NYT.
    I can’t imagine a situation when experts who gather to discuss history of China, talk about history of Chile instead, but

    anna5 wrote on June 20th, 2012
  23. According to official Swedish statistics, vascular mortality and hospital admissions for myocardial infarctions, have decereased greatly in these counties in northern Sweden (as well as the rest of Sweden) from 1986 until 2010. Now, the researchers are concerned that these trends may be reversed in the near future due to the increases in total-C.

    I think knowledge of trends in the tot-C:hdl-C ratio would have been helpful in assessing this claim, because tot-C is a rough measure, as noted by Minger. In 1986, the most common type av cooking fat was, according to the report, margarine (which was based on partially hydrogenated oils), and the use of oils in cooking seems to have been non-existent. The decrease in tot-C until 2002 may have been partially due to changes in these factors, and may have been accompanied by a decerase in tot-C:hdl-C, which may have contributed to the decreased burden of vascular disease. Since 2002, it seeems that people have replaced carbohydrates with animal fats, and this may have led to a plateau and then increase in tot-C, which may be benign, and not accompanied by rising tot-C:hdl-C.

    Use of C-lowering drugs has influenced the trends very little, as noted in the report, because relatively few people are using these. As for the correlation between vegetable foods and high tot-C noted, the association with potato is perhaps due to confounding. However, the special kind of unfiltered coffee still common in northern Sweden, may actually increase tot-C.

    Karl wrote on June 20th, 2012
  24. Thanks for once again pointing out the rubbish that passes as science. I especially liked the graph at the end!

    CMHFFEMT wrote on June 20th, 2012
  25. Great post, but you mixed up Norway and Sweden several times!

    Andrew wrote on June 24th, 2012
  26. There is a new, similar study. Would be great to get comments on this one as well:

    RobB wrote on June 29th, 2012
  27. Great article! I just wrote a blog last week about being a skeptic for these exact reasons. Thank you for doing the research and putting it all out there!

    Angela @ The Chicken Scoop wrote on June 29th, 2012
  28. The graph are impressive. And convincing.

    tim wrote on July 14th, 2012
  29. What annoys me is that Mark eats COFEE with SUGAR in the morning (not paleo), eats potatoes, chocolate and wine (not paleo) and drinks his protein shake (not paleo), but STILL talks about this lifestyle as if he is following it.

    Liz wrote on September 22nd, 2012
  30. A New and Very Important Statement from the American Heart Association.
    If all the contradictory information about what you should or should not eat to avoid heart disease has you wondering what you should do to guard your health, a statement released by the American Medical Association October 12, 1962, is very important to you.

    The statement is a result of the deliberations of America’s top nutrition and health authorities who have analyzed carefully all of the information available at this time.

    Before you consider any changes in your diet, read this statement, the full text of which follows:



    The food fad the AMA was citing was the low-fat, low-cholesterol diet.

    Ed wrote on September 26th, 2012
  31. excellent! but just have to say, sweden doesnt have fjords, norway do. im married with a norwegian girl thats way i know. but still, a lot of good information!!!

    Federico wrote on November 13th, 2012
  32. Does anyone know what the difference between the LCHF diet and The Liberation Diet is?

    Missy wrote on March 26th, 2013
  33. Clearly Obama increased Swedes’ cholesterol levels.

    Evie wrote on June 12th, 2013
  34. Nice to know my chowing through 1/2 pound of cheese a week and two pints of full fat yoghurt when low carbing won’t mess with me.

    I’m a ‘fat metabolizer’. Feel great on low carb, boundless energy, no hunger etc. Makes me laugh my ass off when people tell me it’s unhealthy while eating white bread and putting sugar in their coffee.

    I have noticed a tendency to leap on examples from high carb diets and apply them to low carb, and to include trans fats in ‘fats’ in studies. They aren’t natural, we didn’t evolve to eat them. I’m sure it’s the inclusion of crappy margarine and similar fats from previous studies that made fats read as ‘bad’.

    Heretique wrote on July 17th, 2013
  35. Having done a little digging into this study, I thinks it’s a safe bet that they didn’t bother to separate processed meats like sausage, ham and bacon from the other protein sources. The Swedes are well known for their love of bacon and ham, and processed meats are well known as causal factors in heart disease and cancer due to the crap used to preserve them.

    I’ve sen a similar thing happen in pro vegetarian studies where processed meat is shunted in with all other animal protein to ‘prove’ meat causes cancer/ whatever. However, some educated digging shows that white meat has zero association with CVD and cancer and fish appears to protect against both. One can infer from this that the apparent carcinogen seems to specifically be processed red meat.

    It’s the same thing that happened in the older dietary fat studies where trans fats were lumped in all the others.

    Mathilda wrote on July 24th, 2013
    • Thank you for this comment. I get so frustrated when people (especially scientist and physicians) try and present data like that showing that meat consumption is associated with cancer and heart disease.

      Steven wrote on October 18th, 2013
  36. If you look at the dietary approaches to extending lifespan and more importantly, healthspan, caloric restriction is by far the most potent intervention that has been shown to work in every organism studied. Recent data on monkeys is somewhat conflicting but is really difficult to execute given their long lifespans.

    Then, if you look at the gene expression array data, serum biomarker data, cancer incidence rates then you will find that restriction of dietary carbohydrates most closely resembles caloric restriction and possibly exceeds the beneficial effect of calorie restriction.

    Perhaps the most compelling argument in support of carb restriction being far superior for health is the lowering of insulin/glucose spikes and perhaps even basal insulin/glucose levels.

    Insulin and Insulin-like growth factor IGF-1 have been shown to play an important role in driving aging.

    “Contribution to aging

    It is now widely accepted that signaling through the insulin/IGF-1-like receptor pathway is a significant contributor to the biological aging process in many organisms. This avenue of research first achieved prominence with the work of Cynthia Kenyon, who showed that mutations in the daf-2 gene double the lifespan of the roundworm, C. elegans.[11] Daf-2 encodes the worm’s unified insulin/IGF-1-like receptor. Despite the impact of IGF1-like on C. elegans longevity, direct application to mammalian aging is not as clear as mammals do not form dauer like developmental stages.

    Insulin/IGF-1-like signaling is conserved from worms to humans. In vitro experiments show that mutations that reduce insulin/IGF-1 signaling have been shown to decelerate the degenerative aging process and extend lifespan in a wide range of organisms, including Drosophila melanogaster, mice,[12] and possibly humans.[13][14][15][16] Reduced IGF-1 signaling is also thought to contribute to the “anti-aging” effects of Calorie restriction.[17] ”

    I’m not trying to say that a diet based on heavily processed meats (which are full of nitrite preservatives which are positively associated with cardio vascular disease.

    A low carb diet does not have to be high in red meat. In fact there are low carb vegetarian diet, however they are far more restrictive. There are plenty of low carb vegetables and nuts and even some fruit that can make up a significant part of your diet.

    A few last comments
    1, the argument that saturated fat is being harmful is really only applicable to people eating a high carb diet. A low carb diet induces and very unique metabolic state that may even benefit from an increase in saturated fat intake.

    2, ketone bodies, which are produced on a low carb diet to feed the brain with the lower glucose availability have been shown to be beneficial in most neurodegenerative diseases and even after a traumatic brain injury or stroke.

    3. Dietary carbohydrates are the only macro \-nutrient that we can absolutely live without. I’m sure many people have heard of “Essential Amino Acids” which are protein building blocks that we must get in our diet since we can not make them ourselves. It is not as well known that there are also “Essential Fatty Acids (essential fats)” that we must take in through our diet. However, there are NO “Essentail Carbohydrates”, that’s just something to think about.

    Steven wrote on October 18th, 2013
  37. Cholesterol and heart disease are not linked as strongly as everyone makes out. The original study was flawed, the scientist eliminated the majority of countries from his study to give cholesterol and heart disease perfect correlation, using only 6 countries in the end when he originally studied over 20. After being featured on Time Magazine, he then became a hero with his terrible science. High fat diets are good, and grains/high carb consumption is bad. Sugar is what is driving the health epidemics we are currently having. A ketogenic diet has been used for a long time as a treatment for certain ailments and there are even studies suggesting that ketogenic diets hinder the development and spread of cancer.

    Dan wrote on October 29th, 2013
  38. I just wanted to add our family’s story to the low carb success list. We all went on the GAPS diet about 10 months ago. My son has some issues we thought might be helped by it, and as he’s only 7, it was too hard to have him watch us at a ‘normal’ diet while he was on such a strict one – so we all got on the diet together. We all went through the adjustment period pretty quickly, but the most drastic improvement was for my husband. He lost 12kg in the first month, and to date has lost about 26 kg (about 57 pounds). He ate waaaaay too many processed and quick carbs, and cutting them has made a huge difference not only to his weight, but also to his health, energy levels, and clarity of thought….not to mention his sleep apnoea is all but gone. I found that 3 months in, I was so sluggish and tired, I decided to reintroduce some carbs, and boy what a difference!! Since I had no health issues to speak of before the diet, I went back to my usual eating patterns (which sadly does include some junk, though not much). Low carb is a great idea and works well for many, but it is good to listen to your own body and know when it’s telling you that you are lacking something.

    My son, until now has done very well on the diet, though we are seeing he is now constantly ‘pecking’ where initially the food was satisfying and he wasn’t asking for snacks between meals. As a result we are going to reintroduce a small amount of starchy (but unprocessed) carbs every couple of days to see if that helps. He is eating fruits, but they aren’t enough. He is after all our son, so he’s bound to have some of both our genetic traits. He may need that little more carb input as I did. In any case, he is still going to be low carb in comparison to the standard western diet. The best way to know is try it for the individual, we aren’t all clones and variations are needed. Listening to our body is key

    Vera wrote on January 24th, 2014
  39. I have Heterozygous Familial Hypercholesterolemia. I am 58 for the first time in my entire life (ON statins and fibrates included) my cholesterol was 13 and on the pills 8.8 always. No lower. On LCHF it very very quickly went down to 6. Something very strange happened here. I will stay on it forever – I think it’s a lifeliine for me. The blood results told me so.

    Chloe wrote on May 4th, 2014
  40. My great uncle has always been a healthy and strong person. About 15 years ago, my great aunt told me that doctors said nonsense about how many eggs a week we should eat, because “he [my great uncle] has been eating two fried eggs for breakfast for all his life, and look how strong he is…”. Curiously, some days ago I watched a very old woman (about 110 years old) on TV saying that one of her secrets was eating 2 eggs everyday.

    José wrote on December 16th, 2014

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