LCHF (Low Carb Healthy Fat) dietary patterns have been shown to be a treatment for obesity and Type 2 diabetes in numerous randomized, controlled trials. If diets were required to be “FDA-approved,” like drugs are, so much research has been accumulating that LCHF would be “FDA-approved” as “safe and effective.” (There is no requirement for FDA approval for diets, which is one of the reasons for the dietary confusion and wild claims that some diet promoters make.)

Like most health care providers, we were given very little nutrition education while in training. We were taught that “eating fat was fattening” and “eating saturated fat caused diabetes,” “consuming salt caused high blood pressure,” and that it would be better to eat air-popped popcorn or a piece of fruit than to eat bacon or a steak. We were taught that “ketosis was harmful,” and that “high blood cholesterol was bad.” The “low-fat diet” reigned supreme. We were all taught that the low-fat diet was the “one-size-fits-all” prescription for health. As a result of this teaching, the largest epidemic of diabetes and obesity ever seen occurred, and people were blamed because they just “weren’t following the guidelines” well enough.

The first version of LCHF was described in 1863 by Englishman William Banting, and for the next 100 years, if you wanted to lose weight, doctors in the UK advised you to do the “Banting Diet.” It was common knowledge that “sugar and starches were fattening.” LCHF was lost from the medical/nutritional world from about 1950 to 2000, as the fear of eating fat was instilled in all of us. Since 2000, the new science of clinical trials has evaluated LCHF, and it has been found to be as safe and effective as it had been from 1863 to 1950.

Over the last ten years, the Duke Lifestyle Medicine Clinic has used the LCHF lifestyle as the first-line treatment for diabetes and obesity, and the following conditions improve as well: hypertension, heartburn, arthritis, and others. WVU’s Jefferson Medical Center has been using LCHF in select patients for five years. People are taught that, on the LCHF lifestyle, the “rules of the road” are different than what they’ve been taught.

On a low-carb diet, it’s okay to eat fat—including saturated fat. It’s okay to not explicitly limit salt or require low-sodium foods (as you were taught for a low-fat diet). On a low-carb diet, there is no need to count calories, because the appetite goes down and you eat less, so you eat fewer calories without counting them. Nutritional ketosis is not harmful, it just means that your body is burning fat (it is not the dangerous ketoacidosis).

One of the last vestiges of the old “one-size-fits-all, low-fat-diet-fixes-everything” paradigm is the question of but what about the blood cholesterol on a low-carb diet? Well, LCHF lifestyles lower the cardiometabolic risk by reducing inflammation, lowering small LDL and triglycerides, and increasing the good HDL cholesterol. It’s not wrong—it’s just different!

Most physicians and dietitians are not taught about LCHF in school, and most have not read or been informed of the recent studies about the scientific basis of LCHF. So, as long as medical and nutritional societies stay uninformed about the new LCHF science, or you take advice from those who don’t want you to try LCHF for other reasons than your health, there will be “controversy” about LCHF.

— Dr. Mark is a Professor of Family Medicine at West Virginia University School of Medicine, and owner of Two Rivers Treads in Ranson (WV), the nation’s first minimalist footwear store. Follow him at

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