A principal concern about low-carbohydrate approaches is that the high-fat content of the diet may adversely affect serum lipids and increase the risk for cardiovascular disease. As discussed in a review by Volek et al. (31), preliminary findings challenge this argument. In studies that compared low-carbohydrate and low-fat diets over the course of 6 to 12 mo, there were no differences in total cholesterol or low-density lipoprotein (LDL) cholesterol concentrations between groups (8-12,21). One study reported that the low-carbohydrate diet was less effective than the low-fat diet in reducing total cholesterol and LDL cholesterol at 1 yr (13). Only one study reported a small, transient increase in total cholesterol and LDL cholesterol during the third month of a 1-yr treatment (8). Furthermore, compared with the conventional group, those in the low-carbohydrate group experienced greater improvements in high-density lipoprotein (HDL) cholesterol (8,12) and triglycerides (8-10,12). Only one study reported decreases in HDL cholesterol in participants following a low-carbohydrate diet, but the decrease was less than the decrease in the low-fat group (11). Findings of these studies are summarized in Table 1. A meta-analysis of these data suggests that whereas the low-carbohydrate diet produced more favorable changes in triglycerides and HDL cholesterol concentrations, the low-fat diet produced more favorable changes in total cholesterol and LDL cholesterol concentrations (32). As such, further research is needed to understand whether the improvements in triglycerides and HDL concentrations outweigh the relatively smaller effects low-carbohydrate diets have on total and LDL cholesterol as compared with low-fat diets.
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