Since the dawn of civilization, carbohydrate has comprised the largest source of energy in the diet for most populations. The source of the carbohydrate has been from plants in the form of complex carbohydrate high in fiber. Only in affluent cultures has sugar contributed so much of the total energy. When carbohydrate is consumed as a major component of a plant-based diet, a high-carbohydrate, low-fat diet is associated with low plasma levels of total and low-density lipoprotein cholesterol, less coronary heart disease, less diabetes, and less obesity. Very low-carbohydrate (ketogenic) diets may provide short-term solutions but do not lead to a long-term solution for most people.