Short study on obese people finds low-fat better than low-carb - or does it?

[MeSci]

From Physician's First Watch:

Cutting Dietary Fat Leads to Greater Body Fat Loss Than Cutting Carbs, Small Study Suggests

By Amy Orciari Herman
Edited by
- Andre Sofair, MD, MPH

Patients may ask about a study suggesting that a reduced-fat diet leads to greater loss of body fat than a reduced-carbohydrate diet. The findings appear in Cell Metabolism.

Nineteen obese adults were admitted to the metabolic unit of the NIH Clinical Center for the study. Participants consumed an energy-balanced diet for 5 days, after which they were randomized to follow a reduced-fat or reduced-carbohydrate diet for 6 days. After a washout period, participants were readmitted and crossed over to the other diet. The two diets had similar caloric content, and participants maintained similar levels of activity.

Overall, the reduced fat diet was associated with significantly greater body fat loss than the reduced-carb diet (89 vs. 53 g/day of body fat). A mathematical model suggested, however, that differences in body fat loss between the diets would diminish over time.

The lead investigator noted in an NIH news release: "The real world is more complicated than a research lab ... it may be more important to consider which type of diet you'll be most likely to stick to over time."

Link(s):
Cell Metabolism article (Free PDF) http://click.jwatch.org/cts/click?q=227;68206589;5zaWxWZM+xOQQciuHf1s1CsIi4BopBog6c/z0qALzy8=
NIH news release (Free) http://click.jwatch.org/cts/click?q=227;68206589;5zaWxWZM+xOQQciuHf1s1A5EMl47/MkG6c/z0qALzy8=
Background: NEJM Journal Watch General Medicine coverage of commercial diets and weight loss (Your NEJM Journal Watch subscription required) http://click.jwatch.org/cts/click?q=227;68206589;5zaWxWZM+xOQQciuHf1s1P+Zpbo87rhF6c/z0qALzy8=

I only had a quick look but noted that it didn't seem to differentiate between loss of subcutaneous fat (relatively harmless) and loss of visceral fat (the harmful type).

The low-carb diet was better for insulin reduction - or was it? There seems to be a contradiction. On page 4 it says:

Both RC and RF diets appeared to significantly decrease plasma C-peptide, insulin...

but on page 5 it says:

only the carbohydrate-restricted diet led to decreased insulin secretion

and on the first page it seems to argue against decreased insulin having some significance that is claimed for it.

I don't have time or brainpower to analyse it further but would be interested in what others make of it.

 

[panckage]

I tried the "low fat" diet for years. All it made me do was binge eat. I would slowly gain weight for a few weeks (months?) gain 5-10 pounds and then have to diet a few weeks to get back to normal. My weight became a yoyo.

OTOH both before I tried low fat and after I've had no problems with my weight. I eat a fair bit of fatty stuff and almost never binge eat. This has worked perfectly for me and I don't need to keep track of my weight. I wouldn't say I'm low card now, but if possible I try to find an alternative for carbs if easy and possible. Hot dogs, hamburgers, all that good stuff is fine! I just make sure to have a varied diet and not overeat. I've found exercise has no bearing on my weight as well

 

[whodathunkit]

One of the biggest problems I can see with the cell-metabolism study is that they don't make a distinction between the types of carbs or the types of fat. Based on my fairly extensive experience with different eating styles (Zone, Adkins, Pritikin, macrobiotic, gluten-free, dairy-free, blah blah blah.) while fighting the Battle of the Bulge, I can say with certainty the types of carbs and the types of fat makes a HUGE difference in how your body processes what you eat (and thus your insulin levels and weight). I think we've all been hearing about the best types of carbs and fats, but I'm living it. I'm in the process of losing a significant amount of weight, and am 2/3 of the way to my goal. And most importantly, for the first time ever since I got fat, I know I will reach that goal and stay there.

Saturated fats and starchy carbs help me lose weight. I can eat very satisfying, large plates of healthy carbs with lots of fat (beef tallow/fat, butter, coconut oil, etc.) and still lose at a decent clip, indefinitely (as long as I'm not taking in a lot of omega-6 fats or sugary carbs at the same time).

If I eat saturated fat and starchy carbs but consciously cut the exogenous fat (leave the butter off the potatoes, etc.), I lose even more quickly.

Worth noting is that I've currently lost most of my belly fat (definitely the visceral kind) eating this way even though I haven't reached my goal weight yet. Even when I was younger and was slender I still seemed to have more "deep padding" in my belly than I do right now. I've also brought my blood sugar down to almost normal with the starchy carbs and saturated fat. So, contra the main conclusion of the study, high carb/low fat works. And it can work quickly. But food quality has everything to do with results.

My inference from my experience is that I've brought my insulin secretion way down and brought my insulin sensitivity up by eating this way. I believe my blood sugar will normalize over time. It's been quite deranged for quite a number of years, so expecting normalization within a short period of time (since January) probably isn't realistic.

OTOH, if I eat a bunch of omega-6 fats combined with high-carb (even if it's good carbs like fruits and veggies without starch) I lose weight more slowly, and develop cravings after a few months. This is true even if I'm using "good" unrefined omega-6 oils and eating a lot of fresh fruits and veggies. Weight loss just stalls, and after a few months I start wanting to barbecue my own hands because I'm hungry all the time. Blood sugar is controlled when eating this way (I think because calorie intake and portion sizes cut by virtue of food choices) but my belly fat is not nearly as reduced in the same time span. Because of the effect on belly fat I take away that this approach is not as beneficial on insulin secretion, but it's hard to say. Last time I tried it my blood sugar was unstable but nowhere near as bad as it has been in the last few years. My top weight (i.e., starting point before beginning weight loss) was also not as high.

Eating low-carb with whatever kinds of fat will net me quick initial weight loss, including visceral fat, but then it just stalls and the cravings come on. And then the rebound weight gain with the inevitable boost in carb intake is terrible. Plus, I've read that sustained ketosis eventually wrecks insulin sensitivity and insulin secretion. I definitely think my last dalliance with Adkins utterly wrecked my already unstable insulin sensitivity. Blood sugar control hasn't been the same since, and I rebound-gained more weight than I ever had before, and more around the middle. Plus had a tougher time getting weight loss started next time I tried, no matter what approach or where the fat or what kind.

So my take on the study is that it's kind of misleading because it's incomplete; it doesn't control for macronutrient quality or what that can do for metabolism both in short and long term.

IME both low carb and low fat work if all you're after is quick weight loss. For really quick weight loss of not a lot of weight (say, < 20lbs), if your metabolism isn't already a big mess, low-carb is probably better. But regardless, the types of fat and the types of carbs matter for the long term results, as does the long-term effects of each approach. Both approaches can mess up your metabolism if done too long, and both carry the risk of rebound weight loss, especially if done with "bad" types of macronutrients.

But the study doesn't even begin to address nutritional or quality factors, which should probably be taken into account for a really well-rounded discussion and relevant conclusions.

My $0.02.

In case anyone's interested in just the weight loss angle (rather than insulin levels or visceral v. body fat, etc.) , I will also say that unpredictably staggering calorie intake is also a very effective strategy for achieving sustained weight loss. If you overeat a bit some days and under-eat on other days, your body never thinks it's starving so you wind up with higher overall metabolism even though your overall calorie intake is low enough to burn off the weight. And the best thing is it's healthily sustainable over time (unlike daily, predictable calorie restriction). We've been reading about this but it's absolutely true. Intermittent fasting is great to achieve this.

P.S. I also found the paper to be kind of meandering and thus hard to read. I wondered a time or two if they got paid by the word or if their grant required a certain number of words in the results, or what.

 

[Scarecrow]

I haven't read this all the way through yet but I have a problem with the approach.

Each inpatient visit included a 5-day baseline and a 6-day calorie-restricted dietary intervention. Subjects were fed an energy-balanced diet (50% carbohydrate, 35% fat, 15% protein) for 5 days followed by random assignment to isocaloric removal of 30% of total energy, either by a 60% reduction of dietary carbohydrate (RC) or 85% reduction of dietary fat (RF) for 6 days.

There was two to four week washout period then they repeated the protocol but the alternate reduction diet was followed.


The mean macro composition of the diets were:

Baseline: 101g protein (14.5% of total calories), 109g fat (35.3%), 350g carbohydrate (50.2%)

Reduced Carb: 101g protein (20.9% of total calories), 108g fat (50.1%), 140g carbohydrate (29%)

Reduced Fat: 105g protein (21.1% of total calories), 17g fat (7.7%), 352g carbohydrate (71.2%)

The authors state (my bold):

In contrast to previous claims about a metabolic advantage of carbohydrate restriction for enhancing body fat loss (Ludwig and Friedman, 2014; Taubes, 2007, 2011; Westman et al., 2007), our data and model simulations support the opposite conclusion when comparing the RF and RC diets. Furthermore, we can definitively reject the claim that carbohydrate restriction is required for body fat loss (Taubes, 2011).

The problem I have with this statement is that their Reduced Fat diet was a low fat diet (7.7% of total calorie intake) but the Reduced Carb diet was not a low carbohydrate diet (29% of total calorie intake) as proponents of low carb diets understand the term. From memory, Taubes recommends restricting carbs to around 80g per day, although I will need to check that. This study only restricted carbs to 140g.

I can't decide whether the authors are dishonest or incompetent but if their aim is to disprove what Taubes and others claim about low carb diets and weight loss, they might want to consider using a diet that actually qualifies as low carb.

 

[MeSci]

My own experience has been that reducing certain carbs did the trick and has kept my weight stable. Cutting out gluten alone started off the rapid weight loss, and it continued when I increased fat and further reduced grains and sugar.

Before that, I struggled with weight for much of my life, apart from about 3 periods, one when I lost much too much weight due to amphetamines, one where I just seemed to be able to eat - and drink (alcohol) - as much as I wanted and stayed slim, and one when I couldn't eat or keep food down - at the start of ME. Otherwise I tended to gain weight, ate a lot of carbs and was always hungry.

 

[Scarecrow]

Otherwise I tended to gain weight, ate a lot of carbs and was always hungry.

That's been my experience too, pretty much.

I find it impossible to lose weight by restricting calories. I need to take carbs down to below 60g per day to lose weight. This means very little in the way of fruit, root veg, bread, pastry, pasta and rice. I desperately need to get back to this way of eating.

 

[whodathunkit]

@Scarecrow, & @MeSci, that's been me for almost my entire life.

FWIW, the first thing that helped me get rid of cravings was getting methylation going properly. Didn't take me all the way, though...I still wasn't eating that good and I would sometimes still go completely "off the reservation" with binges of my old stand-bys (fast food cheeseburger & fries, pints of ice cream at a time, too much chocolate, etc.). I didn't really lose any weight with methylation. I may have lost some and then gained it back. I can't remember now. But my starting weight this time (from this January to now) was as high as it's ever been.

Anyway, after about a year of ups and downs but ultimately successful methylation therapy, I came down with this horrible gastro flu that I still think was some kind of detox or "clean out" (due to the ramping up of cellular processes and metabolism from methylation). Can't prove it was detox but it was a kind of weird experience. I was sick at both ends (sorry for TMI), had a fever, and didn't eat for 4 days. By the end of that my blood sugar had come down significantly, and my appetite was altered. I just didn't want as much junk, plus the amount I wanted to eat was very much diminished. Portion sizes have always been a problem for me, but after this flu, no more. The blood sugar changes as well as appetite changes have endured since then. I still get hungry but I have control.

That experience was what got me into seriously looking at resistant starches and a wide variety of probiotics. Improving my gut health is what really made me feel like a normal person with food for the first time ever in my life. I realize now my gut was badly out of whack (leaky gut, bad flora balance, etc.) and getting that together was a big deal.

THEN using the Perfect Health Diet plus intermittent fasting seems to have taken me the rest of the way into weight loss and normalcy with food. I'm happy with what I eat, can eat as much as I want (which is a normal amount of food these days) and can tolerate some hunger (the intermittent fasting) without wanting to drive through the front window of a McDonald's to get at the fries and without binging later to compensate for the hunger...all while still losing weight. I attribute this to having healthy gut flora and being well-nourished in macro- and micronutrients.

Before January, restricting carbs (a la Adkins or Zone or hard-core Paleo) was the only way I could lose weight. Low cal / low fat never really did it for me until recently.

Scare, have you given the PHD a thorough look? It's got enough good starches and fibers to keep your gut in good shape and also keep you satisfied. Do you have food intolerances that would prohibit it?

Sorry if PHD is old news to you, BTW. I'm so thrilled with the weight loss and feeling better and being satisfied while losing that I'm kind of going through an evangelical phase with it right now. It will pass. Hopefully, anyway.

 

[ahmo]

Mine as well. And, as @whodathunkit notes, I've been eating a lot of omega-6 the last months, and weight which had been stable since eating GAPS diet (hi fat, mod carb)has been creeping up. As I can't increase my exercise, I was growing anxious. Now, anxious no more. I've just begun the 5:2 diet. It makes sense and it's easy. It creates a structured approach to whodathunkit's strategy of unpredictably staggering calorie intake.
Eat what you want 5 days, and 400-500 calories on 2 days. I'm getting on a Monday/Friday fast schedule.
http://thefastdiet.co.uk/

 

[ahmo]

I also spent a long time looking at probiotics that enhance fat metabolism. This was my fallback position, because my first choice was to find a healthy poo donor. But I quickly found how difficult that was going to be and researched probiotics. There aren't many choices commercially. And the one I've chosen is not the same strain as the ones mentioned in studies. But, still, it's advertised as doing the job. We shall see.

Lactobacillus Gasseri has earned a reputation as “the fitness probiotic” because it helps the body regulate levels of leptin, a hormone that plays a crucial role in energy metabolism and fat storage.
http://www.swansonvitamins.com/swanson-probiotics-lactobacillus-gasseri-3-billon-cfu-60-veg-drcaps

 

[whodathunkit]

@ahmo, I didn't go after probiotics strictly for weight loss. IMO the overall health of the gut is IMO what helps with weight loss, not just seeking out specific probiotics that address specific symptoms or conditions, so I just went after a wide variety for health. Specifically I went after the bifidos, some soil-based, and c.butyricum, which I think is supposed to help indirectly with weight loss because it helps manufacture butyrate. But I didn't use it for that reason; weight loss was incidental to me using any single one of them. But due to all of them. If that makes sense. I think they all worked in synergy along with the good fiber/starches to regulate the leptin and ghrelin. I do think regulating those hormones is a big part of why my appetite has normalized, but the posts above were kind of lengthy already so didn't go into that.

Worth noting is that in the past, when I tried upping probiotic intake with predominately lactobacilli, I got an itchy bum. Turns out that can be a side effect with too much of those. Didn't have that problem with the bifidos.

That said, thanks for the tip about l.gasseri. I might try it, just for kicks.

 

[Scarecrow]

@whodathunkit I've seen a lot of mentions of the PHD recently - and not all of them by you! - so I've just got my hands on a Kindle version.

My only real problem food is wheat, with which I have a love hate relationship. I rarely have wheat bread in the house but I do eat it elsewhere.

I've got to admit that the left hand side of the PHD apple is a bit intimidating. Nothing that would bother my gut to eat. But 1lb of starchy food? Every day? Seems a lot. Aside from that, it looks superficially very similar to my 60g of carb way of eating.

The other diet that I am considering at the moment is Grain Brain. I think that there may be a lot of overlap with that and the PHD, too.

 

[whodathunkit]

@Scarecrow: LUV Kindle! How did any of us exist before the instant gratification of Amazon? Seriously.

As far as applying the PHD: my advice is go as strictly as you can, and don't sweat what you can't. It gets easier with time to accept the change in paradigm (I hate that pretentious, overused word but it does have its uses).

I did a modified kind of PHD for some months and then as I started feeling better still, it was easier to apply it more "strictly". Although a diet that lets you eat that many potatoes and starches and still lose weight isn't what I'd call strict. LOL

What I mean by modified is that, for example, the PHD books says pork is not really ideal and shouldn't be eaten in large quantities because pigs are raised on grains which means the meat typically has more omega-6 fat than is good. But bacon has traditionally been a big jones of mine, and I've always tended to crave it. I could go through a whole pound of it on Sunday morning. So I did what I could of the PHD and simply gave in to that bacon craving at least once a week for the first few months. I didn't torture myself about it. Then suddenly my bacon jones was gone. I now can eat a sane three pieces like a normal person, once a week if that often, and I don't feel compelled to eat or cook the whole package. I don't WANT more than three pieces. Which is a minor miracle.

I also ate hot baked potatoes instead of boiled potatoes for the first few months. Modifications like that. Now I make time to boil the potatoes and I like them with just a little bit of coconut oil. I eat that now instead of baked potatoes slathered (and I do mean slathered) in butter.

Point is, do what you can. If you like PHD and can stick with it, it's quite likely you'll modify your behavior as it helps you get better.

I also eat oats fairly frequently because I think they're good for the gut, and will do bread once in a while. But honestly, with all the good starches you get, you just don't miss the grains. Really.

I truly believe getting enough of the right kind of starch is a key to not having food cravings, and that our gut bugs starving for starch is probably what drives us. PHD is the only thing I've ever tried that not only allows enough starch but specifically tells you to go after large amounts of it.

 

[ahmo]

I didn't go after probiotics strictly for weight loss.

I understand that. I've added gasseri to my current broad-spectrum probie approach, due to the repeated reports of transfer of gut bacteria from skinny into fat subjects brings benefits. I'm not fat, am considered appropriate BMI. But as I'm unable to exercise, need to get on top of the upward tendency.

 

[alex3619]

hey might want to consider using a diet that actually qualifies as low carb

This is a big issue in science designed to support a conclusion rather than test an hypothesis. The PACE trial does this too with adaptive pacing, which is a form of pacing nobody uses and almost the opposite of what patients do.

 

[alex3619]

I have been, for years, on very strict low fat high carb (vegetarian) medical diet. I did lose some weight. However my health also declined.

One thing we did find was that when my saturated fat intake dropped below 2.2g per day I got severe headaches.

I was on the diet to try to treat ME, and even trialed (in 1993) prolonged use of omega 3 fats.

My health declined eventually until I ate some junk food one day, as I was too ill to cook at all. I had a rapid surge of energy. I think it was a meat pie.

Its known that the fasted way to burn fat is to shift calories toward fat and away from carbs. The worst combo is fat and carbs together in quantity without much protein. High fat low carb is very successful, but there was considerable debate about safety. This is very old research though, I have not followed modern research on this. One of the reasons high carbs got promoted though is that its far too easy to overconsume fats.

If you want to shift to burning fat, you need to shift away from burning carbs. This will not happen instantly. One diet that was tried and I think fizzled out because I do not hear about it now, is to ramp up fat intake over two weeks, then move to very low fat. The body gears to burn fat then finds itself starving and raids fat stores. I am not sure this is safe though. Low calorie diets do this too, over time, but body metabolism will fight this.

When arctic explorers want to shift to fat burning, so they can eat lots of fat to keep energy up in the cold, they preadjust by eating more and more fat for several weeks.

 

[MeSci]

@ahmo, I didn't go after probiotics strictly for weight loss. IMO the overall health of the gut is IMO what helps with weight loss, not just seeking out specific probiotics that address specific symptoms or conditions, so I just went after a wide variety for health. Specifically I went after the bifidos, some soil-based, and c.butyricum, which I think is supposed to help indirectly with weight loss because it helps manufacture butyrate. But I didn't use it for that reason; weight loss was incidental to me using any single one of them. But due to all of them. If that makes sense. I think they all worked in synergy along with the good fiber/starches to regulate the leptin and ghrelin. I do think regulating those hormones is a big part of why my appetite has normalized, but the posts above were kind of lengthy already so didn't go into that.

My dietary change wasn't for weight loss either, but the weight loss was a delightful surprise and has made me feel so much better about myself.

IIRC, I initially cut out gluten due to suspecting an intolerance after developing a rash that looked like dermatitis herpetiformis, although a blood test for coeliac disease was negative. I wasn't prepared to endure an endoscopy, even though a positive result would have entitled me to free gluten-free food on prescription.

Then I read about gut acidosis, including the d-lactic type, and adopted a gut alkalising diet which also coincided with a leaky-gut diet. This was to treat ME, and many symptoms did improve.

I think it was the alkalising/leaky-gut diet that was also low-grain/low-sugar. It was 3 years ago so my reasons are hazy now!

I have noticed that if I accidentally stray, my gut gets messed up (diarrhoea) and other symptoms start returning, such as anxiety, insomnia, dermatitis and sinus congestion.

Gut flora are key to many things - hormone, cytokine and neurotransmitter balance included.

 

[MeSci]

Then suddenly my bacon jones was gone. I now can eat a sane three pieces like a normal person

Goodness - American 'normal' really is different from UK normal!

Not that I eat meat but, from when I did, I seem to recall that one rasher was normal, maybe two.

BTW - 'jones' for craving is a new word on me so I have posted it in my Translations thread.

 

[Valentijn]

Seriously, 6 days? No one diets for only 6 days. And that's the honeymoon period for starting any new diet, where water loss is a pretty significant confounding factor.

And yeah, that is totally not a low-carb diet. There should be more protein and a lot less carbs.

 

[whodathunkit]

Not that I eat meat but, from when I did, I seem to recall that one rasher was normal, maybe two.

Hmmm. Two rashers is quite a bit, although not as much as the whole pound. Now I don't feel so bad about my "gluttony". My mother had (actually, still has ) a big hang-up about everyone eating too much of certain things (especially things she likes) when I was growing up, so maybe I just never got a realistic grasp of what normal portions really are. Dunno. Do Brits eat all that bacon along with the full breakfast complement of eggs, oatmeal (porridge), fruit, etc...? One thing is that my overall "volume capacity" has gone down quite a bit. I just can't eat as much.

BTW - 'jones' for craving is a new word on me

It's actually is term for anything you just gotta have regardless of the consequences, not just food cravings. Can be material things that put you over your budget, drugs, or whatever. Comes loosely from the saying "Keeping up with the Joneses". There's a great song from the '70's by Boz Scaggs called "Lowdown" that kinda helps explain it, if you can get ahold of it.

 

[MeSci]

Hmmm. Two rashers is quite a bit, although not as much as the whole pound. Now I don't feel so bad about my "gluttony". My mother had (actually, still has ) a big hang-up about everyone eating too much of certain things (especially things she likes) when I was growing up, so maybe I just never got a realistic grasp of what normal portions really are. Dunno. Do Brits eat all that bacon along with the full breakfast complement of eggs, oatmeal (porridge), fruit, etc...?

I don't think most Brits have a 'full English' breakfast as well as porridge and fruit. Some don't have anything, some just have toast, some just have cereal. I don't think that a cooked breakfast is the norm now. That said, I have a cooked breakfast, albeit a vegan one.

When I was a child in the 60s we had a 3-course breakfast (cereal, toast and something cooked) and hotels still provide that sort of thing, I think, as did the university summer school I went to. Too much starch IMO, but we were more active in those days!