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VIEWPOINT AND COMMENTARY

Low-carbohydrate–high-protein diets

Is there a place for them in clinical cardiology?

C. Tissa Kappagoda, MBBS, PhD, FACC^*,*, Dianne A. Hyson, RD, MS, PhD and Ezra A. Amsterdam, MD, FACC^*

^* Division of Cardiovascular Medicine, University of California, Davis, Davis, California, California, USA
Department of Family and Consumer Sciences, California State University of Sacramento, Sacramento, California, USA

Manuscript received March 24, 2003; revised manuscript received May 25, 2003, accepted June 18, 2003.

^* Reprint requests and correspondence: Dr. C. Tissa Kappagoda, Division of Cardiovascular Medicine, One Shield's Avenue, TB 172, University of California, Davis, California 95616, USA.
ctkappagoda{at}ucdavis.edu

Since the last meeting of the American Heart Association, a great deal of media attention has been focused on low-carbohydrate–high-protein diets (LC-HP) and their potential impact on the practice of cardiology. It has been suggested that these diets, which were introduced originally as weight-loss regimens, also have a significantly beneficial effect on a variety of cardiovascular risk factors. It is clear that people who consume such diets have a reduced intake of calories, resulting in a predictable degree of weight loss. These diets induce a moderate level of ketosis and, in some studies, have been shown to improve the lipid profile overall. There is also a reduction in the number of low-density lipoprotein particles. However, these trends also have been observed over periods of 24 weeks or less with low-calorie diets that already have an established record of safety and efficacy. Although there is a public perception that LC-HP diets have a near-perfect "success rate," the attrition rate on these diets varies from 20% to 43%, which is similar to other conventional weight-loss regimens. Additionally, from a nutritional standpoint, these diets are seriously deficient in several micronutrients and dietary fiber, thus creating a need for nutritional supplements. In contrast, the conventional weight-loss regimens have a favorable impact on serum lipids without the accompanying ketosis and have the potential to provide a nutritionally balanced diet without the need for supplements. Because of the nutritional deficiencies inherent in LC-HP diets and the absence of long-term data on their efficacy and safety, they cannot be recommended in place of currently advocated low-fat, low-calorie diets that have an established record of safety and efficacy.

Abbreviations and Acronyms   AHA = American Heart Association   BMI = body mass index   GFR = glomerular filtration rate   LC-HP = low-carbohydrate–high-protein   LDL = low-density lipoprotein

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