Six months ago I wrote a blog post named “Low Carb Diets and Heart Disease. What Are We Afraid of?“ One of the concluding remarks of my article was: “I look forward to the day when low-carb, high-fat diets are accepted by public health representatives and medical associations for the treatment of obesity, metabolic syndrome and type 2 diabetes“.

Well, this day may actually have arrived sooner than I expected because today Swedish health authorities published a report (Dietary Approach for Obesity. A Systematic Review of the Literature) concluding that carbohydrate restriction is the best short term dietary approach to lose weight for people with obesity. Furthermore, they concluded that the current scientific literature does not indicate that such an approach has any harmful effects on health as so many have suggested.

SBU (Swedish Council on Health Technology Assessment) is a group of experts appointed by Swedish authorities, whose role is to update health care professionals on the best available diagnostic and treatment options for diverse medical conditions. SBU’s reports are based on systematic reviews of the available medical literature. Their approach is standardized and well tested. SBU has been performing systematic reviews since 1987, and they consider themselves to be one of the oldest and best established Health Technology Assessment Organization in the world.

Today SBU published their systematic analysis of currently available scientific studies on different dietary approaches for the treatment of obesity. Their review deals with studies on individuals with a BMI higher than 30 kg/m, generally defined as obesity. A total of 16.000 published scientific papers were analyzed.

Low carb diet best for obesity

SBU concludes that during short term (less than 6 months), dietary advice emphasizing moderate or strict carbohydrate restriction is more effective in terms of weight loss, than advice emphasizing a low fat diet. During long term, there are no differences in weight loss between moderate or strict carbohydrate restriction, low fat diets, high protein diets, a Mediterranean diet, a low GI-diet, or a diet rich in monounsaturated fatty acids. Advice to increase the consumption of dairy products (milk in particular) or reduce the amount of sugary beverages may induce weight loss as well.

The Swedish experts conclude that available scientific evidence does not support that advising moderate or strict carbohydrate restriction will increase the risk of heart disease. Even low carb diets containing high amounts of saturated fat have not been shown to increase risk. However, they emphasize that because of the lack of reliable studies, it would be rational to limit the amount of saturated fat under these circumstances : “…it’s not possible to draw any conclusions about the relationship between a low-carbohydrate diet – regardless of fat content – and cardiovascular disease. Here we could apply the precautionary principle, and advise some restraint on saturated fat intake, as long as the documentation of the long-term effects are inadequate.”

Jonas Lindblom, who lead the group of experts that wrote the report says that the results should encourage health professionals to inform individuals with obesity about the efficacy of carbohydrate restriction. “We did not find any scientific support for the conclusion that carbohydrate restriction may increase the risk of heart disease or increase mortality”, he said.

The SBU report also contains data indicating that low carb diets lead to better blood sugar levels than low fat diets among individuals with obesity and diabetes.

D-Day for LCHF

In my blog post six months ago I wrote: “I find it extraordinary how carbohydrate restriction is repeatedly rejected by the medical community as an alternative approach for obesity, the metabolic syndrome and type 2 diabetes. Obesity has reached epidemic proportions in many countries around the world. Diabetes and other obesity related disorders have become increasingly common. Public health organizations and medical societies usually advocate a low-fat, high-carbohydrate, energy-deficient diet to manage weight. Nonetheless, clinical experience and scientific studies indicate that other approaches may be more effective”.

By their systematic review, health authorities in the Sweden are among the first in the world to acknowledge the huge potential of carbohydrate restriction to treat conditions such as obesity, metabolic syndrome and type 2 diabetes. I do hope this is only the beginning and that health authorities elsewhere will follow in their footsteps. There is very much at stake because obesity and its metabolic and cardiovascular consequences are becoming very serious health issues of pandemic proportions. We should not accept that effective weapons to fight these disorders are left unused.