Low-Carbohydrate Diet Beats Others for Weight Loss

Low-carbohydrate food pyramid.

Low-carbohydrate food pyramid.

Weight loss and the myth of saturated fat

 

What’s the best diet for weight loss? Much controversy swirls around this question because although diets like the low-carb Atkins diet have had great success, we don’t know whether they’re more effective, and besides we’ve been told for years that too much saturated fat in the diet may be bad for our health.

The “fact” that saturated fat may cause heart disease and be bad for our health generally has finally, and I believe definitively, been shown to be a myth. A meta-analysis from a few years ago, one of whose co-authors was Dr. Ronald Krauss, than whom it would be impossible to be more mainstream, showed that “there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD [coronary heart disease] or CVD [cardiovascular disease].” The myth of dietary fat and health risks has been expounded upon at length in the recent book by Nina Teicholz, The Big Fat Surprise, which I highly recommend.

As the myth of saturated fat has been debunked, we’re left with which diets are better for weight loss. One factor in that analysis is compliance, that is, to what extent dieters will stay on a diet. In compliance, there are basically two things to consider: 1) whether the food taste good; and 2) whether hunger can be kept under control.

Diets must control hunger

 

Food doesn’t just supply us with nutrients; it’s pleasant and the occasion for social interaction, and a diet depriving people of these will generally make them unhappy and unwilling to continue.

And if dieters are hungry, they are much more likely to break their diets and revert to their old, weight-gaining ways. A major theme of my book, Top Ten Reasons We’re Fat, is that any diet with a reasonable chance of success must control hunger, since hunger always wins in the end.

Low-fat diets, the kind prescribed over the past few decades, generally deprive dieters of foods that humans find naturally satisfying and that taste good, fatty foods like steak and all kinds of meats, butter, cream, cheese, eggs, even olive oil. Many or most people find that they feel deprived on such a diet – I would anyway.

On the other hand, low-carbohydrate diets deprive dieters of or severely limit sugar, bread, rolls, pasta, tortillas, candy, pastries, and any number of other things. However, on a calorically restricted low-fat diet, you can’t really eat your fill of these foods either.

So, as far as taste goes, a low-carbohydrate diet would seem to offer a better choice, being able to eat one’s fill of “main meal” type, satisfying foods, while limiting anything made with flour or sugar. Low-fat diets, if calorically restricted, limit these foods anyway.

What about hunger? Most people report less hunger on a low-carbohydrate diet, so they’re more likely to stay on it. But the kicker is that most low-carbohydrate diets do not restrict calories, while low-fat or conventional diets do. So even if low-carbohydrate, high-fat foods didn’t satisfy hunger more, the fact that one can just eat more of them would seem to make up for it. But all the evidence points to low-carb, high-fat foods as better able to eliminate hunger – in fact, that’s part of the mechanism that makes them work.

 

A head-to-head comparison of low-carbohydrate, low-fat, and Mediterranean diets

 

A study from a few years ago directly compared three different diets for weight loss: Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet. (New England Journal of Medicine.)

The low-fat diet was calorically restricted, with a target 1800 calories a day for men, 1500 for women. (Editorial comment: I’d be hungry on that amount of calories.) It was 30% of calories from fat, and “participants were counseled to consume low-fat grains, vegetables, fruits, and legumes and to limit their consumption of additional fats, sweets, and high-fat snacks”. (Editorial comment: even on this diet, sweets are limited.)

The Mediterranean diet’s target calorie intake was the same as for the low-fat, but with a goal of 35% calories from fat, “the main sources of added fat were 30 to 45 g of olive oil and a handful of nuts (five to seven nuts, that’s it).

The low-carbohydrate diet was not restricted in calories; it was all you can eat. (Now we’re talking.) It provided “20 g of carbohydrates per day for the 2-month induction phase…, with a gradual increase to a maximum of 120 g per day to maintain the weight loss. The intakes of total calories, protein, and fat were not limited. However, the participants were counseled to choose vegetarian sources of fat and protein and to avoid trans fat. The diet was based on the Atkins diet.” Unfortunately, we see the fear of saturated fat loom here, with “vegetarian sources of fat and protein”. At the beginning, the diet amounts to a ketogenic diet; it’s unclear why they felt the need to increase carbohydrates from the original to 120 grams. Possibly they think better compliance would result.

The study lasted for 2 years; all participants were either overweight (BMI ≥27), or with diabetes or coronary heart disease.

So, what happened? Drum roll, please…

Weight loss on low-carbohydrate, low-fat, and Mediterranean diets. Low-carb for the win.

Weight loss on low-carbohydrate, low-fat, and Mediterranean diets. Low-carb for the win.

 

Low-carbohydrate diet resulted in more weight loss

 

For participants who completed the entire 24-month program, weight loss was 3.3 kg (7.3 lbs.) on low-fat, 4.6 kg (10.1 lbs.) on the Mediterranean diet, and 5.5 kg (12.1 lbs.) on the low-carbohydrate diet. Low-carb was the clear winner.

Note from the above graph that with all diets, most weight loss occurred in the first 6 months, with either a plateau (Mediterranean) or a gradual weight regain. This pattern is often seen in diet studies and, no doubt, in real-world dieters.

The reasons for that are at least two or three. One is that dieters lose their initial enthusiasm and start to cheat. Another is a decrease in metabolism that follows weight loss; although this occurs with all weight loss, the low-carbohydrate diet appears to have a better record of maintaining metabolism, one reason being that it’s not calorically restricted. Finally, the low-carb diet had “cheating” built into it, with a beginning carbohydrate allocation of 20 grams a day, but rising to 120 grams a day later. That alone could easily account for weight regain.

The low-carbohydrate diet reduced disease risk more

 

The researchers wanted to know how each of these diets affected heart disease risk, and thus looked at lipid profiles. Results below.

The low-carbohydrate diet had the best lipid profile results.

The low-carbohydrate diet had the best lipid profile results.

We know that in lipid profiles, triglycerides (lower is better), HDL cholesterol (higher is better), and the ratio between the two have the most significance for heart disease risk. The low-carbohydrate diet trounced the others in this category.

Fasting glucose (chart not shown) remained about the same for all groups, although in diabetics, the Mediterranean diet group showed the greatest improvement.

Also in non-diabetics, the low-carbohydrate group showed the greatest decrease in fasting insulin levels. Since insulin is a pro-growth, anabolic hormone, and is implicated in aging, this gives further backing to the fact that a low-carbohydrate diet is an anti-aging diet. Of great interest, the level of C-reactive protein, which is a measure of inflammation, dropped the most on the low-carb diet. Again, since increasing inflammation is associated with aging, the low-carb diet can potentially slow the aging process.

The results show that the low-carbohydrate diet was the clear winner for weight loss. (Diabetics had somewhat better results with the Mediterranean diet, although not for weight loss.)

The better results on low-carb were likely due to two things, in my opinion. One is that insulin levels dropped. Insulin helps drive fat into cells, and lower insulin levels allow fat cells to release fat to be burned. The other reason is probably better compliance. This low-carbohydrate diet was unrestricted in calories, i.e. all-you-can-eat, therefore the participants on this diet were unlikely to get hungry and grab the nearest food available. The participants on the other, calorically restricted diets may have been much more likely to get hungry and cheat.

If weight loss is your goal, the choice seems clear enough. The addition of weight training and adequate protein intake to a low-carb diet will make the retention and even gaining of muscle possible, even while losing fat. (Annals of Nutrition and Metabolism.)

A couple of books that I like that thoroughly explain the low-carbohydrate diet, both by the same authors, Jeff Volek and Stephen Phinney, are The Art and Science of Low Carbohydrate Living, and for athletes, The Art and Science of Low Carbohydrate Performance.

If you have any questions, please let me know in the comments.

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19 comments
Max says August 4, 2015

I love this blog and the great anti-aging info, specifically weight training, fasting, and supplements. However, I’m skeptical about this diet advice…

I think a person keenly interested in maximizing healthspan/lifespan might first just look around the world – which cultures are enjoying the longest and healthiest lives? The so-called Blue Zones might be a good place to start. Their diets are remarkably similar: basically 80% carbohydrate, 10% protein, 10% fat. The carbs are not pastries and wonder bread, of course, but whole grains, fruits, veg, and beans. The low protein likely keeps their IGF-1 nicely low, and the low-fat percentage is a by-product of unprocessed whole plant foods – the diets are 90-95% plant-based in terms of calories. So definitely not vegan, but heck of a lot closer to Dean Ornish than Robert Atkins.

In the studies you cite, what they are calling “low-fat” is less than 30% fat, quite different than 10-15% fat, which what the Ornish/Esselstyn studies prescribe. I find this offensively misleading, as often the “low-fat” cohort are eating basically a Standard American Diet!

There is also significant research strongly suggesting that animal protein (not saturated fat) is carcinogenic – especially but not only casein. As a person interested in avoiding cancer, I want to contend with this evidence:

http://nutritionstudies.org/search/animal+protein+cancer

If animal protein is carcinogenic, one would expect those following low-carb/high-animal protein diets to die sooner, and at least one study has shown that:

http://www.ncbi.nlm.nih.gov/pubmed/23372809

In this study looking at around 275,000 people, the risk of all-cause mortality amongst those following low-carb diets increased 31% (if I’m reading the numbers correctly)

“Low-carbohydrate diets were associated with a significantly higher risk of all-cause mortality and they were not significantly associated with a risk of CVD mortality and incidence. ”

I know the “diet-wars” are fraught with controversy/ideology etc. Just to add that personally I’m an omnivore but with a strong plant-based tilt based on my reading of the science.

Thanks again for all of your great work here.

Reply
    P. D. Mangan says August 5, 2015

    Max, thanks for the compliment and the input. There’s a lot to discuss re your comment, and I don’t know if I can do it justice.

    The people living in the so-called Blue Zones also are physically active, in my understanding much more so than American seniors. They are also tightly integrated into family and community, which as seen in the case of the Roseto effect, could be quite important for health. Another thing, have there actually been any science looking at a) how old do they really live, b) what do they really eat c) how old do the rest of the people in the country live. As far as I know, this is all journalism, not that I completely disbelieve, but I’d like to see more evidence.

    I agree that eating fruits and vegetables is healthy. I have a hard time believing that they eat 10% fat, as that would require NO added fats. They really don’t use butter, cream, olive oil, eat nuts? hard to believe. Until now, fat has been considered unhealthy and I suspect that there’s a lot of confirmation bias going on with journalists who write about it as well as for readers.

    I do agree that having a lower level of IGF-1 could be important for longer life, but it seems to be more important for reaching a grand old age, like 90 or 100, so I wonder again how old are the Blue Zone people.

    That study you cited looked familiar, and I see that my friend Dr. Steve Parker has tackled it: Are Low-Carb Diets Lethal? He gives lots of good reasons for doubting this study.

    The observational studies estimated carb consumption at the outset, but few ever re-checked to see if participants changed their diets. That alone is a problem. I don’t know about you, but I’ve had significant changes in my diet depending on when I was in college and med school, when I was a bachelor versus married, when my income was higher or lower, and when I had young children versus teenagers. But maybe that’s just me.

    The researchers looked at all-cause mortality, deaths from cardiovascular disease, and incidence of cardiovascular disease. They don’t bother to define cardiovascular disease. I assume heart attack, strokes, and peripheral vascular disease. (But aren’t aneurysms, deep vein thrombosis, and pulmonary embolism vascular diseases, too?) Wouldn’t you think they’d carefully define their end-points? I would. Since they were going to all this trouble, why not look at cancer deaths, too?

    Problem is, no one has ever linked low-carb diets to higher risk of death from any specific disease, whether or not in the top ten. Our researchers don’t mention that. That’s one reason I’m very skeptical about their conclusion. If you’re telling me low-carb diets cause premature death, tell me the cause of death.

    Another major frustration of mine with this report is that they never specify how many carbohydrates are in this lethal low-carb diet. Is it 20 grams, 100, 150? The typical American eats 250-300 grams of carb a day. If you’re going to sound the alarm against low-carb diets, you need to specify the lowest safe daily carb intake.

    For most of my career—like most physicians—I’ve been wary of low-carb diets causing cardiovascular disease. That’s because they can be relatively high in total fat and saturated fat. In 2009, however, I did my own review of the scientific literature and found little evidence of fats causing cardiovascular disease.

    If you’re looking for a reason to avoid carbohydrate-restricted diets, you can cite this study and its finding of premature death. I’m not convinced. I’ll turn it around on you and note this study found no evidence that low-carb diets cause cardiovascular disease. The risk of cardiovascular disease had been the traditional reason for physicians to recommend against low-carb diets.

    I couldn’t put it any better.

    Anyway, thanks for reading and commenting.

    Reply
      Max says August 5, 2015

      PD, thanks a lot for your response.

      It’s certainly true that there are a number of factors cited in the longevity success of the Blue Zones – definitely physical activity, close communities, elders being valued by society, and so on. Given the geographic diversity (Okinawa, Sardinia, Costa Rica, etc) one would think they might eat radically different foods, yet it seems that their diets have some important features in common. I was particularly interested to note that none of the BZ’s seem to consume dairy. I believe the Sardinians take goat milk sometimes. Fortunately, these are not austere puritans – they eat traditional foods they enjoy, drink lots of wine (Sardinians), eat a whole pig once a year (Okinawans) etc. But their day-in-day-out diet is overwhelmingly plant-based (and therefore quite high in carbohydrate).

      As I understand it, similar “blue zones” (Uganda, Kenya, rural China, Japan) in the mid-20th century were the epidemiological source of WFPB (whole food plant based) diet for disease reversal (Pritikin, Ornish, Esselstyn, McDougall, Fuhrman, etc). Those societies simply didn’t really get our #1 and #2 killers, heart disease and cancer.

      I don’t know of any “lifestyle-disease”-free cultures that ate animal-based high fat diets. The Masai and Innuit are sometimes cited as examples, but a closer look might debunk that:

      http://nutritionstudies.org/masai-and-inuit-high-protein-diets-a-closer-look/

      One intriguing possibility is that the main issue is not really the ratio of carbs:fat:protein but the ratio of animal:plant, a thesis that would follow from the research that suggests animal protein rather than fat is the main problem.

      For example, this Harvard study of 85,000 looked at mortality and low-carb diets, and compared animal-based LC to a so-called “eco-Atkins” plant-based yet low-carb (I guess a lot of plant-based fat from nuts, avocados, and plant-based protein from beans and tofu and greens?)

      http://www.ncbi.nlm.nih.gov/pubmed/20820038

      RESULTS: The overall low-carbohydrate score was associated with a modest increase in overall mortality in a pooled analysis (hazard ratio [HR] comparing extreme deciles, 1.12 [95% CI, 1.01 to 1.24]; P for trend = 0.136). The animal low-carbohydrate score was associated with higher all-cause mortality (pooled HR comparing extreme deciles, 1.23 [CI, 1.11 to 1.37]; P for trend = 0.051), cardiovascular mortality (corresponding HR, 1.14 [CI, 1.01 to 1.29]; P for trend = 0.029), and cancer mortality (corresponding HR, 1.28 [CI, 1.02 to 1.60]; P for trend = 0.089). In contrast, a higher vegetable low-carbohydrate score was associated with lower all-cause mortality (HR, 0.80 [CI, 0.75 to 0.85]; P for trend </= 0.001) and cardiovascular mortality (HR, 0.77 [CI, 0.68 to 0.87]; P for trend < 0.001).

      CONCLUSION: A low-carbohydrate diet based on animal sources was associated with higher all-cause mortality in both men and women, whereas a vegetable-based low-carbohydrate diet was associated with lower all-cause and cardiovascular disease mortality rates.

      Anyway, thanks for hosting and letting me share my current thinking. it's a fascinating topic and I hope to refine my dietary choices as I learn more.

      Reply
        Joshua says August 10, 2015

        One factor that occurs to me with mostly plant-based diets is that most plant foods are simply lower in calories than most animal foods. Thus, perhaps a diet that is more constituted of plants than animal sources ends up being a lower-calorie diet overall. We know that calorie restriction seems to prolong life (even if we don’t know for sure why). Perhaps this is the reason that, in population cohort studies, plant-based diets seem to lower mortality.
        Those of us who read this blog try to cheat the odds by fasting, maintaining good body composition, and then enjoying some steak and eggs after lifting weights. 😉

        Reply
        P. D. Mangan says August 12, 2015

        Max, I just came across this, which is relevant to your comment about no dairy foods in Blue Zones: High intakes of milk, but not meat, increase s-insulin and insulin resistance in 8-year-old boys. In this study, large extra amounts of protein were eaten daily, but IGF-1 went up only with milk. For anti-aging purposes, this supports the idea of no dairy, but doesn’t support no meat. That also assumes, and I think at this point it’s somewhat speculative, that IGF-1 promotes aging. For the record, I think it does.

        Edit: this may be the study I want, same experiment, different measurements: http://www.ncbi.nlm.nih.gov/pubmed/15054433

        Reply
          Joshua says August 12, 2015

          That’s pretty interesting. This would seem to suggest that milk is indeed an ideal food for building strength/muscle, no? I believe IGF-1 is helpful for that. In the book Starting Strength (by Mark Rippetoe, co-authored by Kilgore), he suggests this is one reason that milk is an ideal muscle-building food….perhaps he was right.

          Of course, this would need to be balanced against its possible pro-aging properties….

          Reply
sanmurali says August 4, 2015

Do you want get healthier and leaner, just by eating real food, with no hunger? Then LCHF

An LCHF diet means you eat fewer carbohydrates and a higher proportion of fat. Most importantly you minimize your intake of sugar and starches. You can eat other delicious foods until you are satisfied – and still lose weight.

Reply
BigFatGuy says August 9, 2015

I see how low carbs and fasting go hand in hand. With my blood sugar stabilized, I can go a long time without eating. So far I have lost 65 pounds or about a pound every 1-2 weeks. That’s the good news. The bad news is I am still fat. Nothing like the people I see at Walmart though.

Still take my supplements, magnesium citrate, etc. Been looking for a bench press on Craigslist. Have not been to a doctor in 15 years, so could be dying of cancer for all I know — but I sure feel healthy. I am 63.

No doubt about it, Rogue Health has had a big impact on my life.

Reply
    P. D. Mangan says August 10, 2015

    That’s good to hear, and congratulations on your weight loss. Are you finding your weight loss difficult? I think you had said before that low-carb alone wasn’t giving you much weight loss, so I take it that the fasting must be doing most of it.

    Reply
      BigFatGuy says August 15, 2015

      I do not remember saying low carb diets did not work. If I said that, I misspoke because it is the only thing that does work.

      A couple years ago I was in bad shape. Even my face was swollen. I tried counting calories, but I could no more lose weight by calorie restriction than I could stop the flood of illegal immigrants by voting Republican. I had watched my poor old mom die from this very thing, and here I was going down the same path.

      When my daughter came to visit, she cried when she saw me. She dumped a bunch of canned vegetables into a colander and told me to eat that. That was around the time you started your health blog, and I sent away for the supplements you recommended. I also started riding a bicycle. I could not ride very far of course and every time I stopped to rest someone would say, “Sir, are you alright?” It was so embarrassing. I wanted to punch them in the mouth, but I was too fat.

      If there is one suggestion I might give someone contemplating a low carb diet, it would be not to get discouraged if you cannot go cold turkey on carbohydrates/sugar right away. 90% of the crap they sell in supermarkets is both toxic and addicting. (My stomach would not shut up about CHEEZ-ITS for the longest time.) It takes a while to wean yourself off that garbage. Don’t give up. If I can do it, anyone can do it.

      These days losing weight is easy. I still have a long way to go, but I have the low carb thing down to a science. I exist entirely on canned vegetables and hamburger patties, which is fine by me. Some people eat whatever they want and never gain weight. I am not a member of that club. But I have found a solution I can live with, and I am so grateful for that.

      Do I fast? Well, I do that thing you suggested about going to bed hungry and putting off eating the next day as long as possible. It doesn’t really feel like fasting since I don’t get all that hungry. Not hungry like I used to get.

      After you posted your picture, I decided I wanted biceps too, so I am looking for weights and a the bench press on Craigslist.

      Someday, when I become thin, I will burn all the old pictures of myself and deny that I was ever fat. Then I will smite mine enemies and seek vengeance on them.

      But first I have to do something about these spaghetti arms.

      Reply
        P. D. Mangan says August 15, 2015

        That is so great to hear. I’m glad that I’ve something however small to do with your progress. Keep up the good work and let us know about how you’re getting on.

        Reply
Dr.Garry Lee says August 15, 2015

Anything you ever read by vegans, remember this. They are literally and metaphorically total cherry-pickers. They deliberately brush under the carpet anything which does not suit their purposes. This is an unscientific attitude.
I’m 65. When I was 28 I lost 42lb on a low-fat diet. I regained every ounce within one year of starting. I was famished.
Even though I exercised my ass off all my adult life, and still do, I could only get my weight down, temporarily, by going hungry.
In mid-2012, I gave up sweet things, but kept eating starch. I lost 20lb, but after a year and a half, still off sweet things, I’d regained 7lb. In Jan 2014, I went LCHF and had lost 28lb, for a total loss of about 40lb, by June 2014. I’ve kept this weight off by LCHF with max carbs 50g per day. I’ve learnt to make it really interesting and eat all sorts of delicious stuff.
Whatever about everybody, I can swear that for me LCHF is an entirely different diet to low-fat. I’m on it for life.
What did I find difficult? I gave up sweeteners. I’d used them for 30 years. For about 9m, I didn’t enjoy coffee without them, but I’ve broken that one now.

Reply
    P. D. Mangan says August 16, 2015

    Thanks for your comment, Dr. Lee. This blog is written with men like you (age, wanting to be in shape) in mind, so I hope you’ll become a regular reader.

    Reply
    Joshua says August 17, 2015

    Vegans are “*literally*…total cherry-pickers”….hahahaha. Had a good laugh about that one.

    Reply
José Carlos Barbosa says August 27, 2015

This is a great blog, even for people living outside America. I’m in Brazil. I’m 63. I’m quite interested in starting a low-carb diet, but since I’m already thin, I’m afraid I may get even thinner. I usually have only two meals a day – no breakfast, sometimes a snack of fresh fruit in between. Could you provide me with a brief and simple low-carb eating plan for someone who wants to start but has no clue? For example: what can I have for lunch and dinner? How much cooked and how much raw? Can I have two proteins (eggs and meat) in the same meal? etc Thanks in advance.

Reply
    P. D. Mangan says August 27, 2015

    José, if you’re thin already, make sure to eat enough calories even on low-carb, and if you don’t already, lift some weights to retain and build muscle. I think for anti-aging purposes, avoiding large amounts of refined carbs is the key, so no sugar, no pasta, avoid bread and pastries, and the like. To make up the calories, emphasize fatty cuts of meat, and don’t hesitate to use butter and olive oil liberally, put real cream in your coffee, etc. There’s no problem with two kinds of protein at one meal. What you’d be eating is meat, eggs, cheese, cream and butter, yogurt, fruits, vegetables, salads, throw in some wine and occasional cocktail.

    If you’re thin and you also exercise, your insulin sensitivity is probably good, so small amounts of carbohydrates are not going to hurt you. So a few potatoes once in a while, that sort of thing.

    Reply
      José Carlos Barbosa says August 29, 2015

      Ok, thanks, P. D. Here’s a sketch of my current diet.
      Breakfast: one or two cups of coffee with some rice milk (half coffee, half rice milk), a pinch of brown sugar.

      Lunch (1 PM): Rice or pasta (just one portion), beef or fish (two portions), steamed veggies, soaked nuts (a small portion), a whole avocado, maybe a small piece of cheese or homemade tart.

      Snack (optional, 5 PM): some fresh fruit (usually an apple, a pear, a slice of watermellon or a couple of figs)

      Dinner (8 PM): eggs (soft boiled or scrambled), a slice or two of non-gluten bread or one medium-sized sweet potato, avocado, a salad of greens.

      Yes, I do exercise, three times in the week, weight lifting and stretching.

      Reply
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