**11.6. Sustainability**

[94, 95]. It is also recognised that cardiovascular disease is the leading cause of death in NAFLD [96]. It has been shown that NAFLD with insulin resistance is the cause of atherosclerotic disease characterised by many of these features [97]. Since NAFLD is caused by excessive carbohydrate, especially fructose intake [98–100], it is postulated that a carbohydrate-restricted

Thus, LCHF diet is likely to benefit patients with high TG to HDL-C ratios and NAFLD, all of which are common in the insulin-resistant individual. A recent lifestyle intervention trial reduced the prevalence of metabolic syndrome from 58 to 19% among obese and overweight patients treated with LCHF for 3–8 months, showing how quickly carbohydrate restriction

As with any dietary approach, there are some caveats to following a LCHF approach. The concept of LCHF is relatively new and not everyone is fully familiar with it. The following are

Some people experience increased hunger on a LCHF diet. However, if they eat fat to true fullness, hunger should not be an issue. Lowering insulin levels and reducing insulin resistance can reduce hunger, and also protein and high-fibre green leafy vegetables can reduce

It is assumed that eating the same thing all the time following a LCHF diet will reduce variety and enjoyment. This can be circumvented as there are a wide variety of meals and foods in

It has also been suggested that following a LCHF approach can lead to deficiencies of certain vitamins and minerals. However, there is no evidence of this from trials [60]. An LCHF diet based on meat, seeds/nuts and dairy should provide a diet rich in all the essential nutrients. An online survey found that most people using LCHF diet substituted carbohydrates like bread, rice and pasta with green leafy vegetables, thus reducing likelihood of nutritional deficiencies [102].

These are potential side effects of LCHF diets at the start of dieting. This is simply because the body is used to using glucose as a primary fuel source and needs some time to adapt to

LCHF diet can reverse NAFLD.

some of the common concerns.

this sense of hunger [101].

the LCHF diet to choose from.

**11.3. Nutritional deficiencies**

**11.2. Lack of variety**

**11.1. Hunger**

80 Diabetes Food Plan

can improve health in those with metabolic syndrome [37].

**11.4. 'Low carb flu': headache, fatigue and muscle cramping**

**11. What are the drawbacks of LCHF diet?**

Trials show that adherence to LCHF and LFHC diets are similar [13, 72, 105]. On the other hand, a recent systematic review found a higher attrition rate from LFHC than from LCHF diets [106]. Therefore, sticking to a LCHF diet is perhaps as convenient as any other dietary plan and thus may be more sustainable as it tends to reduce hunger without need for specific calorie restriction. In fact, studies of long-term adherence of up to a year [38, 39] on the LCHF have not identified any evidence of harm.
