Low-Carbohydrate Diets as Compared with Low-Fat Diets

to the editor: The studies by Samaha et al. 1 and Foster et al. 2 (May 22 issue) are intended to expand our knowledge about low-carbohydrate diets. One potential long-term concern about the low-carbohydrate diet is its relatively high protein load and the effect this has on kidneys. This issue is especially important in persons with diabetes, who are more likely than others to have an underlying nephropathy. As a matter of fact, the population studied by Samaha et al. 1 consisted of obese patients and among whom the prevalence of diabetes was high. For this reason, we are very interested in the data on the serum creatinine level at the conclusion of the study. Unfortunately, the study had a high dropout rate; nevertheless, data on renal function from the subjects who completed the study might shed light on this important issue. In addition, the death of one subject with diabetes in the low-carbohydrate group (whose death was thought to be due to poor compliance with drug therapy) should be kept in mind when the results of this study are interpreted.