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

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 of the common concerns.

## **11.1. Hunger**

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 this sense of hunger [101].

### **11.2. Lack of variety**

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 the LCHF diet to choose from.

#### **11.3. Nutritional deficiencies**

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].

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

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 using fats. However, these symptoms may be especially prevalent only in the period of adaptation to the diet, after which most subside. Some suggest additional sodium (especially for cramping) and fluid intake to minimise side effects, since excretion of water and sodium are increased on these diets as a result of reduction in insulin levels with LCHF diet [103].

#### **11.5. Weight loss on LCHF diets is due to increased water loss**

Some have suggested that weight loss on LCHF diets is the result mainly of water loss. This increased diuresis may be true in the first weeks of carbohydrate restriction [104]. However, body composition by DEXA analysis indicates that long-term weight loss on the LCHF diet is predominantly the result of the loss of fat mass with some loss of fat-free mass [3].
