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Evidence that supports the prescription of low-carbohydrate high-fat diets: a narrative review
  1. Timothy David Noakes1,
  2. Johann Windt2,3
  1. 1Department of Human Biology, University of Cape Town, Sports Science Institute of South Africa, Newlands, Cape Town, South Africa
  2. 2Department of Experimental Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  3. 3Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
  1. Correspondence to Professor Timothy David Noakes, Department of Human Biology, Division of Exercise Science and Sports Medicine, University of Cape Town, Sports Science Institute of South Africa, Boundary Road, Newlands, Cape Town 7700, South Africa; timothy.noakes{at}


Low-carbohydrate high-fat (LCHF) diets are a highly contentious current topic in nutrition. This narrative review aims to provide clinicians with a broad overview of the effects of LCHF diets on body weight, glycaemic control and cardiovascular risk factors while addressing some common concerns and misconceptions. Blood total cholesterol and LDL-cholesterol concentrations show a variable, highly individual response to LCHF diets, and should be monitored in patients adhering to this diet. In contrast, available evidence from clinical and preclinical studies indicates that LCHF diets consistently improve all other markers of cardiovascular risk—lowering elevated blood glucose, insulin, triglyceride, ApoB and saturated fat (especially palmitoleic acid) concentrations, reducing small dense LDL particle numbers, glycated haemoglobin (HbA1c) levels, blood pressure and body weight while increasing low HDL-cholesterol concentrations and reversing non-alcoholic fatty liver disease (NAFLD). This particular combination of favourable modifications to all these risk factors is a benefit unique to LCHF diets. These effects are likely due in part to reduced hunger and decreased ad libitum calorie intake common to low-carbohydrate diets, allied to a reduction in hyperinsulinaemia, and reversal of NAFLD. Although LCHF diets may not be suitable for everyone, available evidence shows this eating plan to be a safe and efficacious dietary option to be considered. LCHF diets may also be particularly beneficial in patients with atherogenic dyslipidaemia, insulin resistance, and the frequently associated NAFLD.

  • Low carbohydrate high fat
  • Weight loss
  • Cardiovascular
  • Glucose metabolism
  • Cholesterol

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  • Twitter Follow Tim Noakes @ProfTimNoakes

  • Funding JW was funded through a graduate award by the Canadian Institutes of Health Research, as well as through the Michael Smith Foreign Study Supplement.

  • Competing interests TDN is the author of the books Lore of Running and Waterlogged and coauthor of Challenging Beliefs, The Real Meal Revolution and Raising Superheroes. TDN has donated the rights to the royalties from the sale of Real Meal Revolution and Raising Superheroes to The Noakes Foundation of which he is the Chairman and which funds research of insulin resistance, diabetes and nutrition as directed by its Board of Directors. Money from the sale of other books is donated to the Tim and Marilyn Noakes Sports Science Research Trust which funds the salary of a senior researcher at the University of Cape Town, South Africa (research focuses on the study of skeletal muscle in African mammals with some overlap to the study of type 2 diabetes in carnivorous mammals and the effects of (scavenged) sugar consumption on free-living (wild) baboons).

  • Provenance and peer review Not commissioned, externally peer reviewed.

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