One of the best studies on diet effectiveness ever published (in my opinion at least) came out in 2008 in the New England Journal of Medicine. It was conducted on moderately obese individuals (BMI of 31), not individuals with a diagnosed metabolic disorder (e.g.
The fact that the study ran 2-years eliminated one of the most common problems with diet studies: that most participants are quite compliant when followed closely by a researcher.
The 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. Incidentally, the nutrition principles being taught in medical schools and to dietitians in North America are basically an extension of the low-fat diet principles.
The participants were counseled to decrease their intake of red meat and increase their intake of poultry and fish.
Protein, fat and calories were not restricted, participants were counseled to avoid trans fats.
I really like that these researchers applied a fairly strict carbohydrate criteria for their low-carb group.
Verdict: Once again, low-carb was most effectively, with the Mediterranean diet also providing stellar results. Looking at these results, we see that both the low-carb and the Mediterranean diets were very effective at improving blood chemistry readings, whereas the low-fat diet improved HDL, a good thing, but had little to no effect on either triglycerides or LDL cholesterol. Not only were differences found in cardiac risk factors, but significant differences in weight loss were also observed. Of course, while the really low carbohydrate diets are dramatically more effective for weight loss, they aren't necessarily the easiest to maintain.
What this suggests is that if you give an individual sufficient protein and fat, they will self-select a lower amount of calories (obviously not being able to eat carbohydrates helps in this regard) and ultimately control body weight. For whatever reason, women seem to more readily settle into a higher vegetable, higher chicken and fish diet than do males. Isn't it telling that the people whose livelihoods depend on looking good, physique athletes, have figured out long ago that strategically reducing their carbohydrates is the best way to get and stay lean?
But what is even more important, carbohydrate reduction also dramatically improves your cardiovascular risk profile.
The latest study, published in the Annals of Internal Medicine in September 2014, involved 148 middle-aged obese people who had no history of cardiovascular disease, diabetes, or kidney disease.
Participants received individual and group counseling, including sample menus and recipes, but no specific calorie goals.


After a year, average weight loss was about 12 pounds for the low-carb group and 4 pounds for the low-fat group. But there are some lingering questions: What would have happened if the study had continued? A week after this study came out, an analysis of 48 studies of popular diets (including Atkins, Zone, Weight Watchers, Jenny Craig, Ornish, and South Beach) was published in the Journal of the American Medical Association. Find a way of eating that works best for you, something you can stick to for years, since keeping off the lost pounds is the hardest part.
But what I love even more are intelligently designed research studies that are carried out long enough to provide us serious insight into human health and performance. This study1, which followed 322 obese adults for 2 years, looked at the impact of a low-fat diet vs. However as time goes on, excitement and compliance wane, making a 2-year investigation quite telling at the end of the day. One of the biggest problems with a lot of the low-carbohydrate literature is that the diets being studied are not actually low-carb at all.
Judging from these numbers, they actually experienced the greatest positive change in their cardiovascular health. We evolved off of a diet with ample amounts of both saturated fat and cholesterol, so why it would suddenly start to kill us beginning in the 20th Century is beyond me… but I digress. For the average Joe or Josephine, both a low-carb or Mediterranean diets are substantially more effective for weight-loss than is a low-fat diet. Although weight does trends back up over time on a low-carb diet, this is less a reflection of low-carb diets losing effectiveness and more a reflection that few people are willing to maintain a strict low-carb lifestyle. In my opinion, that's startlingly simple diet advice and as we know, the fewer rules or complicated counting schemes required of a dieter, the greater likelihood of success. Conversely, males seem to have little problem cutting out grains and most fruits from their diet (which makes Atkins possible), as long as they still get their red meat. Thankfully, we are now coupling this mass of observational data with an emerging body of literature to support that carbohydrate reduction is the most effective strategy for weight loss and long-term weight control. Which kinda begs the question: if lower carbohydrate diets are more effective for weight loss and are good for your heart, do our supposed health organizations (ahem, I am looking at you American Heart Association) really know what they are talking about?
For a year they followed either a moderately low-carb diet (similar to the maintenance phase of the Atkins diet) or a modestly low-fat diet (similar to American Heart Association guidelines). Those are small losses for people who weighed 210 pounds on average, especially in light of the fact that they reported cutting their daily calorie intake by 500 to 750 calories a day for a year.


They cut the proportion of carbs in their diet dramatically, while the low-fat group cut their proportion of dietary fat only modestly (to just under 30 percent of daily calories, which is not very low for fat).
Would participants have done as well if they had not been given fairly intensive counseling? Some people do better by cutting carbs, others by cutting fat—and by eating more protein. They might be lower than before, but if you are still eating 200+ grams of carbohydrate a day, that's not low. Remember, the other two groups were expected to limit calories at either 1500 kcal or 1800 kcal. Full disclosure, this wasn't my observation but one made by the study authors, however it still bears repeating.
And this guy is not some internet huckster, but rather someone who has coached thousands of clients through body transformations. However, both groups seem to benefit from swapping carbohydrate energy in favour of either more fat, more protein or both.
Still, the two diets keep slugging it out in studies, and low-carb seems to be winning more rounds.
The low-carb diet led to greater calorie reduction, so of course it resulted in greater weight loss.
Would the low-fat diet have been more effective if it required people to make bigger changes in the way they ate? Not at all, but if you are currently overweight and looking to drop some pounds, you should adopt a low-carb or Mediterranean diet until proven otherwise. Not only are low-carb diets more effective for weight loss, but they are also quite safe, if we accept that improvements in blood chemistry are a desired outcome. How would the diets affect the risk of heart attacks and strokes, as well as kidney disease, cancer, and bone density? In fact, this pattern of rapid weight loss shows up in virtually every single legitimate low-carb study ever conducted. And would low-carb diets be safe and effective in people who have cardiovascular or kidney disease (they were excluded from this study)?



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