LCHF: look at the full picture.

To the Editor: The article 'Low-carbohydrate and high-fat intake can manage obesity and associated conditions: Occasional survey' [1] by T D Noakes refers. When discussing the health benefits of their diet, low-carbohydrate, high-fat (LCHF) advocates, from Atkins to the acolytes after him, give all the credit to LCHF eating. In their conclusions, they could very well be confusing cause and correlation. When obese people lose weight, their cardiovascular risk parameters improve irrespective of the mode of weight loss, whether it was LCHF, high-carbohydrate, low-fat (HCLF), calorie restriction, or even cocaine abuse or contracting tuberculosis. The weight loss itself is the main contributor to improved health, through a decreased pro-inflammatory state, and although this is a well-established fact in the medical literature, it never gets mentioned in the conclusions of a LCHF article. As medical professionals, we would welcome a magic cure for obesity, even if it is LCHF. This diet certainly performs well over the short term (months), but there are no data on its long-term safety (decades). This short-term/long-term dichotomy never finds its way into the conclusions of the LCHF article. Long-term efficacy is questionable. The attrition rate is very high, much higher than with other diets. LCHF is easy and simple enough, until a plate of cookies is put in front of you. And it is expensive, well outside the budget of the lower socioeconomic classes, which is the population group where obesity prevalence is the highest. To be fair to his readers and science, Noakes should have mentioned this in his discussion. Where LCHF is right is in agreeing that we eat and drink too many processed and refined carbohydrates, e.g. white flour, breakfast cereals, sweets, desserts, cool drinks. Our current sugar consumption is four times higher than a century ago. To illustrate that LCHF's success is about more than LCHF eating, I refer to the second case study (obese man lost 75 kg). He was one of the patients in our bariatric (weight loss) surgery programme, but scared of the operation. At the end of one of my motivational talks to the bariatric surgery support group, he asked me if what I had presented could be an alternative to the surgery. He then voluntarily withdrew from the bariatric work-up (contrary to what Noakes writes, the anaesthesia had never been deemed too dangerous for him – I know, because I am anaesthetist on this programme) and had …