Editor - I read with interest the article in the December issue of studentBMJ on low carbohydrate diets.¹ There seems to be two problems with assessing the effectiveness and safety of low carbohydrate diets: the absence of long term research, and the difficulty of sifting the facts from the rhetoric. This article, like so many others, has acknowledged the former problem but unfortunately also fell foul of the latter.

First of all the authors say, “Atkins diet improved markers of coronary artery disease by increasing high density lipoprotein cholesterol concentrations and decreasing triglyceride concentrations.” This was supported by references to the relevant published research papers which have shown this. However, they then go on to say, “Obese people predisposed to hypertension and hypercholesterolaemia are far more likely to experience ill effects on the cardiovascular system . . . if they choose to follow this diet.” The latter statement clearly contradicting the first does not have any published data to support it. Why then was this statement made?

If we are to properly assess the risks and benefits of low carbohydrate diets, and whether or not we should be recommending them to patients in the future, then we must concentrate on the evidence base and not on hearsay or inference from unrelated studies. Low carbohydrate diets are controversial, and yet as the article says, more than three million people in the United Kingdom are estimated to have tried them. If we, as future clinicians, repeat the unsupported rhetoric to our patients, then they will still go on these diets, they just won't tell us about it. In the midst of controversy, the evidence base for what we say becomes more important than ever.

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