I’m having a debate in a Norwegian paper with some official “nutrition experts”. They claimed that weight loss studies do not show any advantage for low carb diets. Unbelievably enough, that is what many so called experts still believe.
It’s either ignorance or science denial.
There are at least thirteen [updated:16] modern high quality trials that have shown significantly better weight loss with low carb diets. Here they are:
Randomized controlled trials showing significantly more weight loss with low carb diets
- Brehm BJ, et al. A Randomized Trial Comparing a Very Low Carbohydrate Diet and a Calorie-Restricted Low Fat Diet on Body Weight and Cardiovascular Risk Factors in Healthy Women. J Clin Endocrinol Metab 2003;88:1617–1623.
- Samaha FF, et al. A Low-Carbohydrate as Compared with a Low-Fat Diet in Severe Obesity. N Engl J Med 2003;348:2074–81.
- Sondike SB, et al. Effects of a low-carbohydrate diet on weight loss and cardiovascular risk factor in overweight adolescents. J Pediatr. 2003 Mar;142(3):253–8.
- Aude YW, et al. The National Cholesterol Education Program Diet vs a Diet Lower in Carbohydrates and Higher in Protein and Monounsaturated Fat. A Randomized Trial. Arch Intern Med. 2004;164:2141–2146.
- Volek JS, et al. Comparison of energy-restricted very low-carbohydrate and low-fat diets on weight loss and body composition in overweight men and women. Nutrition & Metabolism 2004, 1:13.
- Yancy WS Jr, et al. A Low-Carbohydrate, Ketogenic Diet versus a Low-Fat Diet To Treat Obesity and Hyperlipidemia. A Randomized, Controlled Trial. Ann Intern Med. 2004;140:769–777.
- Nichols-Richardsson SM, et al. Perceived Hunger Is Lower and Weight Loss Is Greater in Overweight Premenopausal Women Consuming a Low-Carbohydrate/High- Protein vs High-Carbohydrate/Low-Fat Diet. J Am Diet Assoc. 2005;105:1433–1437.
- Gardner CD, et al. Comparison of the Atkins, Zone, Ornish, and learn Diets for Change in Weight and Related Risk Factors Among Overweight Premenopausal Women. The a to z Weight Loss Study: A Randomized Trial. JAMA. 2007;297:969–977.
- Shai I, et al. Weight loss with a low-carbohydrate, mediterranean, or low-fat diet. N Engl J Med 2008;359(3);229–41.
- Krebs NF, et al. Efficacy and Safety of a High Protein, Low Carbohydrate Diet for Weight Loss in Severely Obese Adolescents. J Pediatr 2010;157:252-8.
- Summer SS, et al. Adiponectin Changes in Relation to the Macronutrient Composition of a Weight-Loss Diet. Obesity (Silver Spring). 2011 Mar 31. [Epub ahead of print]
- Daly ME, et al. Short-term effects of severe dietary carbohydrate-restriction advice in Type 2 diabetes–a randomized controlled trial. Diabet Med. 2006 Jan;23(1):15–20.
- Westman EC, et al. The effect of a low-carbohydrate, ketogenic diet versus a low- glycemic index diet on glycemic control in type 2 diabetes mellitus. Nutr. Metab (Lond.)2008 Dec 19;5:36.
13-0
The first eleven studies in the list are weight loss trials, the last two are studies on type 2-diabetics (usually overweight) showing the same effect. Many of the studies are of six months or one year duration, one of them (Shai et al) is two years long.
All of these studies show significantly more weight loss for the group that were adviced to eat a low carb diet (Atkins, in most cases).
As far as I know the opposite has never been shown: low carb has never lost a weight loss trial significantly. This means that low carb is winning versus the failed low fat/low calorie advice by 13-0!
Feel free to let me know of any exceptions (or more examples) in the comments.
Update an expert
It’s not OK for “experts” to keep denying all these modern trials. It’s time for them to take the science seriously.
Feel free to copy or link to this list, if you encounter an expert who needs an update.
Update Jul 25, 2011
Another one, making it 14 – 0:
- Dyson PA, et al. A low-carbohydrate diet is more effective in reducing body weight than healthy eating in both diabetic and non-diabetic subjects. Diabet Med. 2007 Dec;24(12):1430-5.
Update Dec 4, 2011
Two more, making it 16 – 0:
- Keogh JB, et al. Effects of weight loss from a very-low-carbohydrate diet on endothelial function and markers of cardiovascular disease risk in subjects with abdominal obesity. Am J Clin Nutr 2008;87:567–76.
- Halyburton AK, et al. Low- and high-carbohydrate weight-loss diets have similar effects on mood but not cognitive performance. Am J Clin Nutr 2007;86:580–7.
More
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Thanks Dr. Eenfeldt.
I'm revising/updating one of my books and planned to compile a similar list. You just saved me an hour.
-Steve
Glad you liked it!
"In all cases, individuals on high-fat, low carbohydrate diets lose weight because they consume fewer calories.”
“No magic ingredients, strange food combinations or pseudoscientific formulas will alter this metabolic fact”
Popular Diets: A Scientific Review: A Scientific Review.” Obesity Research 9(2001):1S
This study went through 107 weight-loss studies that have utilized LCHF-scams. Same message.
Bravata DM, Sanders L, Huang J, et al. Efficacy and safety of low-carbohydrate diets: a systematic review. JAMA 2003;289:1837-1850.
Here's two pearls as well,
“..a recent study by Foo and colleagues shows that HPLC diets may accelerate atherosclerosis through mechanisms that are unrelated to the classic cardiovascular risk factors”.
Clinical Implications of Basic Research. A Look at the Low-Carbohydrate Diet (2009)
http://www.nejm.org/doi/full/10.1056/NEJMcibr0908756
Might want to check this one as well.
Abstract 3610: Comparative Effects of 3 Popular Diets on Lipids, Endothelial Function and Biomarkers of Atherothrombosis in the Absence of Weight Loss
Don't be ridiculous, and skip the scientific cherry-picking.
Dansinger ML, Gleason JA, Griffith JL, Selker HP, Schaefer EJ. Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial. JAMA. 2005 Jan 5;293:43-53.
http://www.youtube.com/watch?v=eREuZEdMAVo
In this lecture, he also presents additional data analysis that was not included in the original paper, which shows that the low carb diet is even better for women tending towards metabolic syndrome.
Ridiculous? Did you read the word "significantly"? All the 13 studies in my list show statistically significantly better weight loss with low carb.
Correct me if I'm mistaken but the Dansinger study did not have any statistically significant differences between the groups when it came to weight. Only trends.
I have ten more studies showing non-significant trends toward more weight loss with low carb. That would make it 23 studies in favor of low carb (and 3 against that I know of). However, those results may be due to chance (like the Dansinger study) so I only count the ones with significant findings.
Still 13-0 in favor of low carb when it comes to significant findings, as far as I can see. Do you know of any exceptions?
And your'e not cherry-picking in #8?
And yet, inspite eating low fat, high carb, the americans has the most obese and metabolically sick people in the world. Why is that if low fat is so darn healthy?
Doc. Can you give me a list of the stuff you typically eat during a typical day together with portion sizes. I'll break down your calories and macronutrient ratio's of the meals. I bet you are something like 194cm tall, 92kgs?
Wouldn't that be a factor in favor of such a diet?
Spontaneously eating fewer calories, without hunger... That actually sounds like the perfect weight loss diet. Too bad that some people do not realize it yet.
I couldn't help but notice (probably because I was looking for it) that many of these studies also showed marked improvements in blood lipid levels, especially triglycerides. I especially liked the language in Samaha, et. al.: "The amount of weight lost (P<0.001) and assignment to the low-carbohydrate diet (P=0.01) were independent predictors of improvement in triglyceride levels and insulin sensitivity."
It seems to me that there are three things that would be interesting to have "study count" summaries of:
1) the weight loss effectiveness of diets (this post, 13-0 in favor of LC or LCHF);
2) the improvement of blood lipids (my count of these studies: 4 showed more improvement from LC, 3 showed similar effects from all diets investigated, 0 showed more improvement from LF, and 6 didn't make mention of lipids);
3) insulin sensitivity or fasting insulin (2 study mentioned it that I saw, and LC showed more improvement in both studies).
I include the third category since it seems likely to me that insulin resistance is the primary cause of metabolic syndrome.
Do you know, of the top of your head, any further studies showing statistically significant benefits or penalties to LC or LCHF vs. LF in these categories? It might be nice to have some lists handy for doctors here in the US that instinctively say "that's not healthy" as opposed to "that's not going to help you lose weight."
Additionally, I am quite interested in the difference between LCHF and LC. Are you aware of any studies examining the effects of one vs. the other?
I ask because I was on strict LC for about five years, and, for the last two years of that period, my weight started to creep up as I got cravings for starches or sugars. I then started dating a woman who likes to bake; cookies, cakes, that sort of thing--and she didn't believe that LC was healthy. I fell off the diet, and for five years have carried 50 extra pounds again.
I've now been following your LCHF diet for nearly a month and have had zero carbohydrate cravings. I am especially enjoying the 10% milkfat/cream/nut breakfast muesli, and have even learned to take it without artificial sweetener, since my sugar cravings are gone. My blood pressure has plummeted, falling from 148/92 to 118/78 in four weeks. I have yet to take lipid panels, but will do so in the next few weeks.
Anyway, thank you very much for your blog. I very much appreciate it, and look forward to reading more.
Cheers,
-Jason
I have a nice Excel file with all the 30+ RCTs comparing LCHF and LFLC (low fat low calorie) and the findings when it comes to other risk factors as well.
A very clear pattern emerges.
I'll try to put it into a more visually pleasing and clear design, for publishing here (with links to all the studies). I'm sure a lot of people will find it interesting.
I have not seen any studies comparing LCHF to LC. The thing is that LC has to be HF if it's not calorie restricted. LCHF is probably the only truly LC way that works long term to avoid hunger and feeling miserable. The main source of energy has to come from either carbs or fat.
I'm in my 5th month of eating LCHF. I eat fewer calories than I used to, but I'm not hungry doing it. So, strictly based on personal experience, I can't say whether weight loss is due to eating fewer carbs or fewer calories. But I've tried and failed to stay on a conventional HCLF diet. Therefore, I can say that eating fewer carbs (lots fewer) and more fat is what enables me to eat fewer calories over a sustained period.
I don't know if you can share that excel file with me, but I'm a NASA engineer and have often worked on data visualization. I might be able to whip something up easily.
I'd prefer it if you could send the data to the email I used in Jason #16 post, I used my work email to make this post.
Come to think of it, you might not be able to see my email address? I don't know. I will simply email you.
Thanks again for your blog. It is making a difference.
I can see your email and I got your mail.
I sent the file a minute ago. Let me know if you need help to make sense of it, it's a bit cluttered.
2."Dyson PA, et al. A low-carbohydrate diet is more effective in reducing body weight than healthy eating in both diabetic and non-diabetic subjects. Diabet Med. 2007 Dec;24(12):1430-5."
How sad that this title implies that "healthy eating" is not low-carbohydrate.
3. Eric is correct in pointing out that in the vast majority of studies that are cited as showing that a low-carbohydrate is either ineffective for weight loss or is "associated" with some dire outcome, the "low-carbohydrate" diet is still way to high in carbs to be ketogenic and there is no emphasis on the high fat component of the most effective low-carb diets. Nor should a diet that is labeled "high protein" be a part of this debate.
1) The studies that are often cited to disparage LCHF are usually poorly executed effectiveness trials. Typically a LCHF diet is compared to a "healthy" weight loss diet. Subjects are randomized after exclusion criteria are applied which often eliminate the people who benefit most from LCHF like type 2 diabetics. The results are subjected to an "intention to treat" analysis which includes the results of people who dropped out or who did not necessarily comply with their assigned diet. This will dilute the benefits of LCHF if there is attrition in that arm. More importantly, attrition can be affected if the administration of the LCHF diet itself is done poorly, which is usually the case. A good example is the recent Foster et al study where they excluded T2D, restricted salt and encouraged water consumption, advised increasing carbs after 12 weeks and promoted high omega-6 vegetable oils. All of these errors skewed the study in favour of the control diet. Yet, the findings which found that weight loss at 24 months was the same, are reported as evidence that LCHF offers no advantage.
2) Yes, people on LCHF eat less. That is the whole point, FCS! They eat less because they have normalized their appetite homeostatic systems by reversing their hyperinsulinemia and leptin resistance by cutting carbs. People on a low-calorie diet struggle with this because the high carb content attenuates the diet's effect on those important regulatory factors. This is why on LCHF people spontaneously cut calories without feeling hungry all the time. Yet, instead of recognizing this as a desired feature of LCHF over low-cal the critics cite this as evidence against LCHF. Truly a Bizarro World response!
Thankfully there are some researchers who know what they are doing. The best studies at the moment are being done by Jeff Volek et al at UConn. Unfortunately, he struggles to get funding and can't get published in the high impact journals, the ones that love to publish the other poorly done effectiveness studies. Go figure!
Two primary causes have been debated. The first is our mental weakness. We do not have the willpower to say no to DQ Banana Splits and mega-sized Cokes. So American armed forces personnel have no willpower. Their type-2 epidemic is because the people protecting the USA are all gluttons and sloths Six month olds have no willpower to avoid those Happy Meals. Obese single mothers are stealing food from their malnurished children. Definately take those kids away.
When you have 50% obesity rates across whole populations, it makes much more sense to look at systems, not individuals. The person who cannot put down that donut probably does exist. Personally I ate that diabetes diet and rarely partook in junk food.
The other cause is hyperinsulinemia. The science says insulin stores food and keeps it there. Mice constantly fed insulin will get obese and starve to death. This is not opinion; it's science. It's in medical textbooks. You will not find a doctor who doesn't agree with it. They may not agree that hoovering carbs raises insulin to such extremes that our bodies become imbalanced, but they will all agree on the mechanism of insulin.
The fence pusher is cholesterol. The belief that saturated fat and cholesterol cause heart disease is prevalent. After all the science clearly shows it does, right? Never mind I can't find ANY science or well conducted studies supporting either as bad. I can't find studies that convince me saturated fat raises cholesterol. The NHLBI makes an interesting statement about atherosclerosis. The NHLBI sets cholesterol treatment policy for the world. They say about the cause: "The exact cause of atherosclerosis isn't known." So we have a panel of scientists (ATP) almost all funded by Big Pharma pushing the ideas of low cholesterol and saturated fat, but they don't know the caus of atherosclerosis. Oh joy!
Have a nice day.
http://wp.me/p16vK0-5t
I am concerned that a preoccupation with ketosis as a mechanism for perferred fat metabolism masks the significance of learning the role of insulin in regulating glucose and fat metabolism. There is not one significant cut point of carbohydrate intake that is necessary for everyone to burn fat for fuel.
From over 25 years of observing clients and studying the literature it seems to me that each person has their own unique level of carbohydrate intake whereas they shift from preferential fat metabolism to glucose metabolism. Relative insulin sensitivity/resistance seems to be more of a spectrum phenomena.
I am waiting for the studies that identify relative insulin sensitivity in the population and assess how people respond to different carbohydrate intake. Chris Gardner's work provokes the discussion, but there are more than 2 cut points that are significant. By studying the extremes it is easier to get better data-but my guess is that it is just this kind of study design that serves to polarize our thinking and the discussion.
http://www.mattmetzgar.com/matt_metzgar/2011/09/why-is-empirical-evid...
A Good trial, the LCHF performed better than the low fat and didn't have to control calories.
http://www.ncbi.nlm.nih.gov/pubmed/17823420
http://www.ajcn.org/content/87/3/567.long
Yes, they should. Thanks.
That would make it 16-0. Can anybody find a single study pointing in the other direction?
If one eat to little, one can get to little nutrishon, and in the long run, one can lower the basal metabolism.
Most pepople dont need to count calories, but it give you a hint about if you eat to little or to much.. notting more!
Try to eat some more crunchy vetegabels to your meals or some small amounts starchy foods, to test if this gonna get you more hungry?
The 2005 Boden study shows that low-carb folks spontaneously eat fewer calories - in the study, they ate 1,000 calories less!
So, yes, it is possible that you might fall too low to get adequate nutrition, I suppose, if you were eating 2100 calories before and then had a Boden-type result! 
I think generally low-carb women should try to eat a threshold of at least 1400-1500 calories a day to ensure adequate nutrition. But of course some women are extra-petite and may need less. If you are under 5'2", you may be ok with fewer. You have to find what works for you.
If you are eating 25% protein, 65% fat, 10% good carbs (brightly colored and green veggies, eggs, etc.), and about 1400-1500 calories a day, you should be on a good path toward weight loss. You may want to consider adding some weight-lifting. A lot of women find adding a little more resistance exercise helps them break through.
However, some Peri-menopausal women, women with PCOS, or insulin resistant/T2D women will still struggle. If that's the case, you may want to look into your medical issues - some may still need a bit of metformin or Januvia, some may need thyroid help, some may need to have their hormones balanced.
As Dr. Mary Vernon said in Andreas' recent video, if strict low-carb isn't working for you, you may need to have your incretin hormones checked too - I have read on the low-carb blogs about some people taking Januvia for this, iirc - but obviously I'm not an expert, you should see your doctor.
http://farm8.staticflickr.com/7143/6456227775_cc4cba5703.jpg
You seeme to have lost some veight in a very short time. If you want to loose moore you prophobly will if you are young. But you must be patient because the last kilos are often the hardest.
You absolutly do not look like you need a doctor
Doesn't that just go against what you are trying to say? If people are losing weight they are doing it because they eat less that they need. Therefor it is just greed and gluttony that is the reason they were fat in the first place. If high fat, low carb made them eat less, it just means they are becoming like the rest of us who allready have the will-power to stop eating.
Why care about why they ate less, the point is if they had willpower to stop eating on a regular diet, they would reduce weight as well.
John, there's a lot of info out there about this. The thing is, on a high fat diet you naturally eat less calories because you are satisfied. This is a huge difference compared to fighting against your hunger all the time.
Furthermore, if you consume enough fat to meet your needs and there is no deficit, your body will not bother to consume its own fat stores. So it does appear that a calorie deficit is needed to lose weight.
The weird thing is what happens where there's a calorie excess. People either do not gain weight or they gain far less than the calorie excess should have caused. The other weird thing is with studies where they've tried to keep weight stable on a low carb diet, they have a really hard time doing it. The low carb people either lose weight no matter what or else they have to eat way more calories than a control group eating a high carb diet. I read this somewhere on Dr. Eades' blog, but can't remember where.
Why care about willpower at all when the change of diet (what I eat) seems to have had the desired magical effect?
Willpower must be great for feeling morally superior to others, but I don't see it having much use for anything else
Not at all John; rather we argue that we eat less because we are losing weight. Crucial difference. Eating ess is merely a symptom - it is not at all the cause.
There is also a similar page on, dietary cholesterol and saturated fats.
It is part of the Ancestral Weight Loss Registry I recently created, which hopes to gather and publish data on the best ways to lose weight on a paleo and/or carb-restricted diet.
http://www.lowcarbdietitian.com/1/post/2011/08/is-a-low-carb-high-fat...
I needed something _exactly_ like this to show my wife. I love Diet Doctor, but needed something focused on the HF part, short (so she'll read it), in lay terms, but with impressive-sounding studies (again, on just the HF/health aspect).
She's doing calorie-restriction (esp. fat) + exercise; I'm doing LCHF. We're both doing great (I'm down 12 lbs/5.5kg in 14 days!), but she's hungry and tempted, I'm not. >;-) She can't argue with the empirical evidence of my weight loss, but is SURE I'm going to stroke out, have a heart attack, or need a kidney transplant. (You gotta admit, it's counterintuitive after all the food-pyramid, calories-in minus calories-burned, "if you want to lose fat you shouldn't be putting more into your body" common "wisdom" we've been (ahem) fed for decades.)
She sees me making a 2-egg omelet in butter with cheese and sausage and taking a pound of salami to work, and damn near calls our life insurance carrier to double my policy. >;-) I'm sure none of you know what I'm talking about -
- but it sure is fun converting skeptics, every time they see you a belt-notch tighter...
Citations:
1. Tay, J., et al. Metabolic effects of weight loss on a very-low-carbohydrate diet compared with an isocaloric high-carbohydrate diet in abdominally obese subjects. J Am Coll Cardiol, 2008. 51:59-6
2. Volek, J.S., et al. Dietary carbohydrate restriction induces a unique metabolic state positively affecting atherogenic dyslipidemia, fatty acid partitioning, and metabolic syndrome. Prog Lipid Res, 2008, doi: 10.1016/j.plipres.2008.02.0033.
3. Hayek, T, et al. Dietary fat increases high density lipoprotein (HDL) levels both by increasing the transport rates and decreasing the fractional catabolic rates of HDL cholesterol ester and apolipoprotein (Apo) A-I. J Clin Invest, 1993; 91(4);1665-16714.
4. Siri-Tarino, P.W., et al. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. Am J Clin Nutr doi: 10.3945/ajcn.2009.27725
JAMA. 2005 Jan 5;293(1):43-53
In this study by Dansinger et al, we find that Atkins did worse for weight loss. However, I still like it because when I compare it with A-TO-Z, I find several interesting things. Adherence here is number of study finishers vs study starters.
When adherence is higher with Atkins, results are better.
Atkins: 53% = 2.1kg vs 88% = 4.7kg
When adherence is higher with Ornish and ZONE, results are worse.
ZONE: 65% = 3.2kg vs 77% = 1.6kg
Ornish: 50% = 3.3kg vs 78% = 2.2kg
This seems to refute the idea that adherence is positively associated with results. It only proves true for Atkins, not for Ornish or ZONE. If we formulate it in reverse (lower adherence vs results), we also refute the accepted idea that study quitters tend to make their group look better. It proves true for Ornish and ZONE, but not for Atkins.
Furthermore, compared to the A-TO-Z study, the Dansinger et al study didn't actually test the Atkins diet but something similar that included the Atkins cookbook. In fact, it didn't test any of the actual diets, only their cookbooks. This means that adherence also means following the instructions, not just completing the study. Accordingly, we can also conclude that when following the instructions more closely, we get better results with Atkins, but worse results with Ornish and ZONE. This seems to further refute the general idea that better adherence is universally associated with better results. It only proves true for Atkins.
Like I said, we shouldn't ignore any of it, especially when it contradicts our beliefs, because who knows what gems we'll find in there. Isn't that cool?
I know the Dansinger study. The difference between low carb and the other diets isn't statistically significant, i.e. it may very well be due to pure chance.
All the 16 studies above has statistically significantly better results for low carb.
If you want to count non-significant results too there are far more than 16 studies showing such an advantage for low carb.
http://www.ncbi.nlm.nih.gov/pubmed/22673594
Weight loss depended on insulin sensitivity. Some women lost more on a higher carb diet, some on a lower carb diet. This was a crossover study.
Context matters. I frequently (I'm a nutritionist) find some people do better on moderate carb, moderate fat diets, after struggling on very low carb, high fat diets (lose energy, fat loss stalls, sleep suffers)
Check the details of that study. The low-carb (their words) diet isn't low-carb, it's 40% carbs. Nor is it high-fat, it's 40% fat. Nor is it a typical low-carb diet by virtue of being hypocaloric, i.e. calorie restricted. A typical low-carb diet is at most 100g/carbs/day, or something around 20% carbs for 2,000 kcals. It's also at least 60% fat, or around 130g/fat/day for 2,000 kcals. It's also ad libitum, i.e. not calorie restricted.
The study was probably designed to show a difference where this difference can be found.
They found thirteen publications describing experiments that met these criteria, performed between 2000 and 2007. Most of these experiments showed a statistically-significant difference between the low-carb subjects and the other subjects, with the low-carb subjects benefiting with greater weight loss. Summing up the statistics from all of the studies showed an average (weighted mean difference) of 4 kg more weight loss among the low-carbers than among the low-fat/high-carbers at six months.
here and i am really impressed to read everthing at single place.
There are even vegan studies, and they put peopel on a vegan diet, but real food.. and they altso improve there healt!
And for me Dr Gardner's cred goes way up in that his personal agenda was to prove low fat better (hes a long time vegetarian) but had to accept that his results did not match his preconceived notions.