Carbohydrate (CHO)-restricted diets have been recommended for weight loss and to prevent obesity, but their long-term effects have not been fully elucidated. This study was designed to evaluate the effect of long-term (>1 year) consumption of a low-CHO high-fat diet ("The optimal diet," developed by Dr Kwaśniewski referenced herein) on lipid profile, glycemic control, and cardiovascular disease risk factors in healthy subjects. Of 31 "optimal" dieters enrolled in the study (17 women and 14 men, aged 51.7+/-16.6 years), 22 declared adherence to the diet for more than 3 years. Average energy intake and principal nutrients consumed were assessed from 6-day dietary records provided by the participants. In most dieters, concentrations of beta-hydroxybutyrate, free fatty acids, total cholesterol, and low-density lipoprotein cholesterol exceeded the upper limits of the reference ranges for nonstarved subjects. The metabolic profiles of most subjects were positive for several indicators, including relatively low concentrations of triacylglycerols, high levels of high-density lipoprotein cholesterol (HDL-C), and normal ratios of low-density lipoprotein cholesterol/HDL-C and total cholesterol/HDL-C. In most subjects, plasma concentrations of glucose, insulin, glucagon, cortisol, homocysteine, glycerol, and C-reactive protein were within reference ranges. Notably, in all but one subject, the homeostasis model assessment index of insulin resistance remained below the threshold for diagnosis of insulin resistance. These results indicate that long-term (>1 year) compliance with a low-CHO high-fat "optimal diet" does not induce deleterious metabolic effects and does not increase the risk for cardiovascular disease, as evidenced by maintenance of adequate glycemic control and relatively low values for conventional cardiovascular risk factors.