New major study: a low-carb diet yet again best for both weight and health markers!

Midsection Of Woman Smiling While Adjusting Weight Scale

Is it harmful to eat a low-carbohydrate diet for weight loss? Or is it even HEALTHIER than the current low-fat dietary advice?

A major new study published today further fuels the debate and has already made major headlines. In the study 148 people were told to eat either a low-carb diet (under 40 g of carbs per day) or a low-fat diet, for one year.

The results are similar to those in previous studies. Once again, those on a low-carb diet lost significantly more weight, in this case three times more:


Dashed line = the low-carb group

Those who ate a low-carbohydrate diet also lost more fat mass.

The low-carb group also got better cholesterol levels than those in the low-fat group! As usual, they got more HDL cholesterol, lower triglycerides, and an improved cholesterol profile (total/HDL). As if this wasn’t enough, the fat eaters in the low-carb group received a significantly lower risk assessment for heart disease according to the 10-year Framingham risk score!

In addition, the low-carb group got significantly less inflammation in the body (measured as CRP).

This study was funded by American tax dollars (through the National Institutes of Health). None of the authors have any financial ties to the food industry.

Even before this study, the results were impressive that a low-carb diet provides a better weight and better health markers than today’s low-fat advice:

Swedish Expert Committee: A Low-Carb Diet Most Effective for Weight Loss

After today’s study, the truth becomes even clearer. It becomes even harder for people to ignore the potential health benefits of low-carb diets.

When are people with weight problems going to receive scientifically sound dietary advice from most health care professionals? Hopefully soon.

The study

Annals of Internal Medicine: Effects of Low-Carbohydrate and Low-Fat Diets: A Randomized Trial

Big headlines:

TIME: For Weight Loss, Low-Carb Diet Beats Low-Fat
New York Times: A Call for a Low-Carb Diet
Reuters: Low-carb diets may beat low-fat options for weight loss, heart health
Washington Post: Low carb diets more than low fat ones may help protect against heart disease
USNews: Low-Carb Beats Low-Fat for Weight Loss, Heart Health: Study

Try it yourself

A low-carb diet for beginners

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  1. Wade Henderson
    "They must choose prudently given the weight of all available evidence."
    Which is exactly why Dr Eenfeldt made this blog post, regarding yet more available evidence demonstrating that not only is LCHF an effective way to manage excess fat mass but that it also does so safely, with improved health markers, even better when compared to a low-fat diet.

    I agree, we must all weigh the evidence in light of our own particular physical condition.
    Equally intelligent people may come to different decisions.

    I agree with Dr. Eenfeldt, that LCHF is a effective way to manage excess fat.
    However doing it "safely, with improved health markers....EVEN when compared to a "low-fat" diet is where I would take some exception.

    The exception is as follows. All the discussion above keeps throwing in the likes the Ornish and Esselstyn diets. Those two diets bear no relationship with the "low-fat" diet used in this study.

    Now, it may be if they had used the Ornish style diet, the "markers" may have come out equal.
    We don't know. All we know is that the low-fat diet they used was not what most in this discussion term as the truly low-fat diet.

    BTW, has ANYONE, other than perhaps Dr. Eenfeldt actually had the opportunity to read the darn study?
    That would clear up much of the controversy regarding what each side actually ate.
    We have only a few clues. The carbs ended up at 127 grams, not 40 grams, and we know teh low-carb side ended up eating 79 calories per day less,, but we know very few other facts, including what the low-fat group ended up eating. 25%? 30%? 33%? we just don't know.

    Surely someone must have gotten a peek.... Anyone?

    My somewhat narrow look was mostly at what those 10 million current cardiovascular heart disease patients, with angina (70% or greater blockage).... should do with the data in this study.
    I don't think it offers them any real confidence that low-carb would be their optimal route compared to a "very" low fat diet such as Ornish and Co. recommend.

    For the millions of others needing weight loss, it might be fine compared to what they are now doing.

    Please, anyone, a link to a site that lets us see the real details of the study....

    PS, Nice to see so many folks have "waded" through the prior posts ( I feel the love :-) )

  2. Z.M.
    Link to full study -
    Reply: #104
  3. murray
    I try to explore rather than negate or convince. Personally, I still lean to keto as a preferred strategy for cardiovascular issues, but this discussion reminds me of the common ground, namely, eat plenty of low-glycemic vegetables and avoiding refined starch and sugar. (I'm in a good mood today. It's Friday and I just had lunch at my favorite workday restaurant--calf's liver and bacon (both rare) with Bordelaise sauce, steamed greens and non-starchy vegetables, and loads of beautiful summer-pasteured, deep-yellow, artisan butter from Quebec. Glory. The Quebecois produce some amazing dairy.)

    Another possible common factor in the apparent rival successes of low-fat and low-carb is caloric restriction, possibly stimulating autophagy that cannibalizes plaque in arterial lining. Based on what I have read and experienced, if I developed any signs of cardiovascular issues (actual signs, not debatable risk factors), the first thing I would do is reduce calories to induce autophagy.

    After my father had a stent put in, he tried to follow the Ornish diet and, apart from rampant flatulence, he was continually hungry. This suggests that with the effects of abundant fibre, gut bacteria and low fat, that many of the calories down the gullet do not get absorbed through the gut, with a good portion being consumed by bacteria and a good portion being excreted in feces. So this might result what is in effect unwitting caloric restriction, which could provide the beneficial effects of autophagy.

    Such caloric restriction is often common to ketogenic, especially as recommended by researchers such as Dr. Thomas Seyfried who argues in favour of a calorically restricted ketogeneic diet (CR-KD) for its cancer-suppressing effects. I do periodic CR-KD specifically for the anti-cancer effects, as well as the presumptive autophagy--to get rid of time-worn, cross-linked proteins and manufacture some pristine replacements.

    Anyway, this is obviously all hypothesis, albeit projected from experience and reading. But it's done with a view to finding explanations that account for observations on both sides of the low-carb, low-fat divide. The success of one does not negate the possibility of success of the other. My constructivist/intuitionist leaning in computational theory math (and chaos theory) always steers me away from the law of the excluded middle. As Professor Robert Constable continually emphasized in our graduate computational logic class, the inference (not-(not-p) implies p) equals "magic", namely, it is a fantasy from a computational/operational perspective. It is an amusing sport to see how often it is brandished as a sword in defence of confirmation biases.

    Reply: #108
  4. Wade Henderson
    Z.M..... Link to full study -

    Looks interesting but I get nothing when I click on that link

    What am I doing wrong?

  5. Z.M.
    Wade Henderson: "Looks interesting but I get nothing when I click on that link"

    Try removing the "s26." from your link.

    Or try here -

    Reply: #107
  6. Wade Henderson
    Article from the NY Times with a bit more detail but still leaving out the crucial detail of what the low-fat arm actually ended up eating.

    Instead, all it says is the following

    " In the study, the low-carb group "BEGAN" eating a diet that averaged 34 percent carbs and 41 percent fat. By comparison, the low fat group ate 54 percent carbs and less than 30 percent fat."

    Those two sentences, use "began".... then it says "the low fat group "ATE"....

    When, did they "ate"... in the proposal? in the study design? in the beginning? in the middle?
    or in the end?

    And what does "less 30% fat" mean? 29.9%, or 26%.... or did they even meet the "less than 30%" goal?

    Without such details, how can you compare a low-carb diet with a low-fat diet.... not knowing what the participants actually ate?

  7. Wade Henderson
    Z.M. Got it , thanks. Now I'll digest the details or the 15 pages....

  8. Paul the rat

    "...I do periodic CR-KD specifically for the anti-cancer effects, as well as the presumptive autophagy--to get rid of time-worn, cross-linked proteins and manufacture some pristine replacements…."

    That is wise murray, I do it too.
    (suggestion: make sure you drink more water than usual during such a period)

  9. Wade Henderson
    Nice to see the real numbers.
    I had only a few minutes to do a cursory review.

    The "low-fat" diet, ended up eating 29.8% of their calories as fat. At baseline they were 34.7%
    Compare that to the "under" 10% used in all the Ornish and Esselstyn studies.

    Regarding the better cholesterol scores

    At 12 months the LDL of the low-fat went from about 3.20 mml to about 3.15, while the low-carb went from about 3.20 to about 3.12
    There is a little confusion in the numbers, but for LDL in mg/dl it means the low fat went from about 123.5 to about 121.6, while the low-carb went from about 123.5 to about 120.5

    In the Total Cholesterol, the low-carb arm actually went up in total cholesterol at 12 months a bit more than the low-fat arm.
    In neither case were the movements significant.

    Forgive me, if I have some mistakes, but I had only a few moments at this time to review the many detailed numbers.

    All in all the comparison of the "low-carb" diet and this version of the "low-fat" diet is almost absurd.... if what you are really trying to do is compare it to the Ornish or Esselstyn type of serious "low fat" diet.

    Now, it may be a good comparison for the "low-fat" diet that was foisted upon the American public for 30 years. The "Snackwell" version of "low-fat" dieting.

    I'll take a longer look when I have time for more numbers and more accuracy.

    Replies: #110, #117
  10. Paul the rat
    Well done Wade, I will write to NIH and suggest that their funding body retrieve money awarded for this research
    can you really not see that even such a small shift in macronutrient composition brings about change in e.g. health markers?
    Reply: #111
  11. Wade Henderson
    Paul, I can see everything that is in the study. (now that we have it)

    I have no problem with the facts as they are. I only point out that this is not a comparison of the Low-carb high fat diet with a low-fat version that is promoted by those names who are often being thrown into the discussion. The Ornish and Esselstyn types.

    As I'm made clear from the start, I'm looking at studies as to how they may help those millions and millions already diagnosed with coronary artery disease... and how they might go forward in such as way as to halt or reverse their condition of narrowed arteries.

    They have to choose a way to go. I thought this study might offer them something, but it does not. It wasn't designed to do such, but I thought it might offer some clues.
    However since it doesn't make a comparison with a truly "low fat" diet, there is not much to say.
    Though after reading more of the details, I'll no doubt make some other assessments about its over all nature.

    BTW, I've long believed that a low-carb higher fat diet was superior to the general commonly practiced "low fat" diet for weight loss. Perhaps even better than the extremely low fat diets for that purpose, over a 12 months, sometimes even longer..

    Replies: #112, #113, #119, #121, #122
  12. Paul the rat
    Point taken. It is my understanding that this study was design with weight management as the leading question, using diet compositions, which can be, let say, easily followed by general population. Researchers did not ask "let's compare two diets and see which one is heart-healthy"
  13. Paul the rat
    I am sorry about #112 I am reading (and discussing) a different paper at the moment and got confused !!
  14. Cindy C
    There was a comment made saying some experts say there is no need for any saturated fat in the diet. Our bodies can make fat, and cholesterol. However, there are larger amounts of cholesterol and saturated fat in human breast milk than man puts in formula. This study says we cannot really say that breast feeding beyond one year will cause heart disease. Why is cholesterol in the yolk to nourish the chick, in fish eggs to feed the fish, and in mammals milk to feed the young?

  15. Galina L.
    Initially I came to a low-carbing through my attempts to manage migraines, even though most of my life I was dealing more or less successfully with a tendency to fatness. Limitation of carbohydrates produced a miracle result for all aspects of my health (no need for asthma medications any longer, migraines stopped being a problem, tremendous resistance to infections and viruses now and much more), but when people ask me about how I have got there, my answer often scares them -"O, no, is not it the terrible Atkins diet? Don't you know how dangerous is it?". OK, let people think that LC and LF are equally good, such view will remove the unnecessary fear of fats and animal products which are amazingly healthy when not consumed with carbohydrates. It is how CNN presented the story. Mass opinion can't turn 180 degrees on a short notice.

    "People should choose diets that they can stick to, rather than fret over low-fat versus low-carb, says study author Bradley Johnston, assistant professor of clinical epidemiology at McMaster University in Hamilton, Ontario.""/health/low-carb-low-fat-diets/index.html?hpt=he_c2

  16. Eric
    For me the combination of hflc aka ketogenic and 36 hour fast followed by 12 hour feeding repeated 365 days a year makes eating great. The ketones keep a flow to the brain and control insulin and glucose. Half tends to blunt hunger and making sure ketones are good make the fast easy.
  17. Matt

    The low-fat diet is the typical low-fat diet recommended by AHA, USDA, FDA, etc, and also low fat compared to standard diets. This was not a comparison to Ornish. It's certainly not absurd to compare it to the standard issue low fat diets as this is what almost everyone is attempting, as opposed to Ornish as very few people attempt (or could maintain) an Ornish Diet. That's probably why it's failed miserably in all real-world tests.

  18. FrankG
    "...those names who are often being thrown into the discussion. The Ornish and Esselstyn types."

    You are trying to be funny right? YOU threw those names in to the discussion!

    YOU also decided that any discussion or trial comparison of low-fat should be based on their versions of that diet... you not only moved the goalposts, you brought your own!

    Show me the Ornish trial where the ONLY variable was the diet.

  19. FrankG

    Show me the Ornish trial where the ONLY variable was the diet. Then show me an independent repeat of the trial with the same outcomes. The trail mentioned in this blog post is NOT the only one when LCHF has not only been better at managing excess fat mass but also does it with improved health markers over the compared diet(s).

  20. FrankG
    "Though after reading more of the details, I'll no doubt make some other assessments about its over all nature."

    Please.. do spare us. I don't need you interpreting this, or any other study for me

    If you think your opinion has such weight, then by all means start your own blog, instead of hijacking others. Then we can all chose whether to visit you or not.

    Reply: #124
  21. Murray
    Wade, I agree entirely that this does not show low fat diets perform worse than low carb. What it does show is that low fat is no guarantee of better performance, and that high fat is no guarantee of poor performance. Indeed, the Ornish diet is in many ways closer to the high fat diet in this study than to the low fat in the study.

    How so? Both avoid high glycemic refined sugar and starch. The low fat protocol subjects in the study presumably (from the limited data) did not. Second, the high fibre, low-glycemic Ornish diet would result in loads of fermentation (hence the flatulence so often reported). I expect there is a lot of short chain saturated fatty acids produced, which elevates the effective macronutrient ratio of nutrients absorbed (rather than food eaten) much more into the higher fat end of the spectrums likewise, the high fibre would decrease average transit time, decreasing the amount of low glycemic carbs that would be absorbed even further. So what would appear to be say 2000 calories in the bomb calorimeter would likely be much less in absorption and effectively result in a calorically reduced diet, and one with plenty of anti-inflammatory short chain saturated fat and with no blood sugar peaks. This would in fact be not all that far from a keto diet where people are instructed to eat plenty of greens and non-starchy vegetables. And in this study the keto apparently got more fibre than the common low fat diet. The keto diet and Ornish plainly differ in the amount of fat eaten and the nature of the protein sources, but they are closer than might seem in important respects.

    Reply: #123
  22. erdoke
    The amount of bacterial fermentation of plant food going on in human large intestines seems to be overestimated and by not a small margin. Even chimps that have a very different ratio in the length between small and large intestines, do not mainly live on fermentation of cellulosic and hemicellulosic feed. You need to go as far as the gorilla, a real herbivore to find ~62 % of daily energy as fermented fatty acids being absorbed from their large intestines. Humans' ability to use bacteria for similar fermentation is very limited.
    We simply don't have the fermentation volume to be able to utilize substantial amounts of SCFAs produced from our plant diet. It is a nice addition when happening, but nobody should build a diet on bacterial fermentation occuring in one's colon. This is actually one of the solid anatomical facts often overlooked by vegans when claiming that humans are closer to herbivores than to typical omnivores.
    Reply: #126
  23. Paul the rat
    this is why I just said 'point taken' - simply, no point.
  24. 1 comment removed
  25. Paul the rat
    @ erdoke
    100% agreed
  26. Cindy C
    An example of mans domestication of fruit from wild stock, done over time.

    Reply: #129
  27. Galina L.
    I do think that whole year availability of fruits is more a problem than just size, sweetness or a flavor. The idea that fruits in all forms are the best thing you may put into your mouth because it is a super-food which is absolutely essential for one's health is one of several reasons our society is fat. We would be better-off thinking of fruits as being just natural candies.
  28. John
    I have a diet where 40 percent of my calories are protein, 40 percent carbohydrate, and 20 percent is fat. This is basically a low fat diet, but high in protein and carbohydrates. Most doctors in America recommend a low fat and high carbohydrate diet, with low to moderate protein. I think that everyone is different and many people in Western countries react badly to carbohydrates, mostly because we are not as active and tend to be more sedentary than people in developing countries. A factory worker who is on his feet has different nutritional needs than an office worker.

    I also exercise regularly and focus primarily on weight lifting with moderate cardiovascular exercise, and it has worked out very well.

    Not all carbohydrates are the same. Fresh fruit, sprouted grain bread, brown rice, quinoa are not the same as chocolates, cheap sweet breakfast cereals, sodas, etc. In the US, many foods are made with high fructose corn syrup which is particularly bad, its also found hidden in many foods that are not sweet such as bread and salad dressings. The only fructose I consume come from fresh fruit.

    I have tried low carb dieting in the past which was fairly successful, I also tried a diet known as HCG which was even more effective. I found that carbohydrates cannot be all put into one boat they are different, and also the times of the day that you consume them are relevant. Eating carbohydrates early in the day tend to better than in the evening.

  29. 1 comment removed
  30. Galina L.
    Rebecca gave a link to absolutely mediocre and not helpful web-site with recommendations to eat baked potatoes instead of fried ones and value exercise over sleep.
    Most likely she is a clicks-hungry troll.
  31. Rafael
    Nice, so why my LDL cholesterol sky rockted after this diet while it was very low my entire life?
  32. Roy Walker
    I think Wade Henderson, is against low carb in general, he is complaining because they didn't use a strict Dean Ornish diet, well I'm complaining because they didn't use a strict ketogenic low carb high fat diet. The silly man, doesn't his common sense tell him, they made it a real world study, and in the real world, each diet came a little closer to the other. I sometimes wonder if it is compulsory to have your common sense removed, if you receive, a university degree. cheers
  33. Sharon
    I wonder if they took into consideration the fact that products which are labeled "low fat" by and large contain more sugar than products with a regular fat content. Marketers do this to make the food taste better.

    Low carb diets simply restrict certain foods. Low fat diets that are not specified or do not require label reading to remove excess sugar can put a new variable into the experiment, thus making it far less reliable.

  34. Annette Dahl
    I understand what bad carbs can do to us, however, I do not have a gallbladder. And, FATS cause me great difficulty. I try to avoid all cheese, dairy, and oils because they cause me bodily harm. Not sure how to do a low carb diet without a gallbladder.
  35. Susan R.
    I've been on LCHF for the past 18 months and at my yearly physical (+ full panel lab results) my PCP told me to keep doing what I've been doing. I bragged about Diet Doctor!!! The reason I found LCHF was because I wanted to solve my blood sugar issues myself...not out of a prescription bottle. When I started my blood sugar was 300 and my Total Cholesterol was 217. Today my blood sugar is 90 (type II diabetes was reversed and has been removed from my medical profile) and my Total Cholesterol is 101. I have lost over 75 lbs...slow but sure. I try to stay between 20-30 carbs per day. I just changed my lifestyle to under 20 carbs and 18/6 7 day fasting...can't wait to see what happens. Good luck to everyone...change your life for the better!!!!!
  36. Stephanie Conner
    I have been on a food combining diet plan and even with 3 snacks a day am tired and hungry! I am trying LCHF as a last resort to weight loss surgery!
    Reply: #139
  37. Kristie Sullivan, PhD Team Diet Doctor
    You might want to try our free 2 Week Challenge to help you get started! The biggest feedback we get is that folks are no longer hungry, which makes you much more likely to be successful. If you're already a Diet Doctor member, you can do the 5 Weeks of Keto with Kristie program which gives you 5 weeks of support, including daily emails to help you every step of the way.
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