Low-Carb, Low-Fat and High-Protein Diets Equally Useless

by | Feb 27, 2009

A widely publicized study out this week in the New England Journal of Medicine shows that there is virtually no difference between low-carb, low-fat, high-carb or high-protein diets when it comes to weight loss. I don’t often like to toot my own horn, but if you read my post on Monday about the Top 10 Food Facts Everyone Should Know (see point #10), then this was not news to you.

For several years now data has been accumulating that the relative composition of different macronutrients (fat, carbs, protein) in your diet has little to no effect on long-term weight loss. What makes this study stand out from the pack is how well it was designed.

The Study

This was the largest, longest run study of this kind ever conducted, including nearly 650 over weight individuals of diverse racial, socioeconomic, geographic and education backgrounds. The participants were highly motivated to lose weight and were given detailed instructions on why their assigned diet was considered an effective weight loss strategy (this was to remove bias caused by the media about popular diets).

For you carbophobes out there, the importance of dietary carbohydrates was addressed directly. The amount of carbohydrates in the different diets varied from 35% (very low) to 65% (very high). All participants, including those on the high-carb diet, were instructed to choose foods that had lower glycemic index. Carbohydrate composition had no significant effect on long-term weight loss.

All subjects received substantial behavioral therapy to help them meet their goals, and detailed measurements of health and weight loss were collected from each individual throughout the study. The participants were told to keep food journals and use online support provided, as well as weekly dietary counseling.

Importantly, all the diets resulted in similar calorie deficiencies to promote weight loss. Not surprisingly, after 6 months all the participants had lost a substantial amount of weight, but after 1 year had gained about half of it back. During the final year the subjects had more difficulty sticking to their assigned diets, particularly those assigned the most extreme regimens (very low-fat or high-protein).

Conclusions

Regardless of diet, all participants experienced similar, modest (5% body weight reduction), but clinically relevant weight loss that is mainly attributed to a reduction in calories.

Interestingly, the measure that best correlated with weight loss success was attendance at the dietary counseling sessions.

Since the study is over can we now assume that many of these participants have gone back to their old eating habits? I would bet yes.

What can we take away from this study?

You can lose weight on any diet, but for most people it is very difficult and not sustained. This is because cutting calories is very tough for most people.

This study also suggests that losing weight with standard diets is very difficult and, in most cases, only moderately helpful. It seems future research should focus on how to increase adherence to a lower calorie diet. Gaming the system by manipulating macronutrient composition doesn’t seem to be working.

Why you should focus on whole foods, not nutrients

Another thing we can take from this study is that if weight loss is your goal, calories are what count. (Some of my friends responded to this finding brilliantly: “DUH.”) The nice thing about a diet based primarily on vegetables is that lowering caloric intake is relatively easy. As long as some effort is made to achieve a balanced diet (enough plant protein and fats), satisfaction after a meal can be attained with far fewer calories.

Vegetables are very bulky, highly nutritious and have very few calories. It’s not easy to gain weight when you eat kale, beans and brown rice for dinner.

Like I explained a few weeks ago, since I have focused on health (rather than weight) and a vegetable-based (rather than macronutrient-based) diet, I have lost weight effortlessly. I am also less stressed about food in general, and have completely lost my old cravings for sugar and fat.

Best of all, I do not feel like I have given up anything whatsoever. In fact I would argue I have gained the freedom to eat what I want, whenever I want it. And the food I eat is much more satisfying and delicious. I guarantee you this tagine tasted better than any Atkins bar, rice cake or BigMac.

My life now is much more delicious.

Are you ready to give up diets and focus on health?

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16 Responses to “Low-Carb, Low-Fat and High-Protein Diets Equally Useless”

  1. Greg says:

    It sounds like this study just takes the UCLA (?) study to a new level, showing not only that weight loss from a diet is ineffective over the long term, but also that it doesn’t even really matter what diet you’re on. I think the focus just has to be on obtaining healthy vitamins and minerals from natural stuff that comes from the earth, not the factory. Great post by the way!

  2. Lee says:

    Phenomenal summary and critique of this study.

    • Guy says:

      Actually, this critique was absolutely horrible. It’s obvious this author has ZERO training whatsoever in statistical analysis and even skewed the results to her benefit. What was ACTUALLY found was that there is no statistical difference between the groups because of non-compliance with the regimens prescribed. Each group ended up eating approximately the same percentages of each macro-nutrient regardless of which group they were in. The end points reached were NOT statistically significant with a regard to an alpha of 0.5. Therefore, we can NOT conclude from this study that there is no difference in weight loss dependent on macro-nutrient intake.

      Moral of this lesson is not to believe everything that you read. Such as this article. She’s pumping her own beliefs, not following the actual results of this study.

      • Darya Pino says:

        Actually Guy, I am a scientist and have had extensive training in statistics. I do not entirely disagree with your points, however I see no reason for you to be so impolite. I read the article again and deleted a couple sentences that in retrospect I agree over-stated some conclusions. Thank you for forcing me to revisit this topic.

        In the future, please take a more personable approach to comments here or they will be deleted. Disagreement is welcome on this blog, but rudeness is not.

      • Jag says:

        So what you’re saying is, after years and years of medical research your conclusion is that if we taken in less than we burn then we loose weight. Doesn’t take a genius to figure that out.

        What I would like to know is what is the best ratio of carbs, protein and fat that we should eat in order to reduce weight the healthy way and to maintain as much muscle mass at the same time. Does your study answer this? Also what is the minimum percentage of calorie intake we should reduce to if we do want to loose weight the healthy way? Obviously if I reduce it to 500 calories a day then I know that’s dangerously low so what would you recommend?

      • Darya Pino says:

        This is a really old post, but since you’re curious there is little data that macronutrient ratios matter much for weight loss. My personal experience and the anecdotal stories of many others suggests that higher protein consumption is necessary to maintain muscles while losing fat. But obviously you need to exercise for this to work. About 10% caloric reduction should produce slow but steady weight gain. Basically the best thing you can do is cut out refined grains and sugar and replace them with real foods like vegetables, meats, beans and intact grains.

      • jo hardy says:

        I understand from the news/articles etc that eating lots of whole grains and fruit and vegetables and eschewing red meat and saturated fats will lead to weight loss and good long health. Well what can I say ? at the ripe old age of 64 I know I cannot get what my body needs from whole grains and fruit & veg. I am not diabetic but I have known for many years that a diet of full cream dairy, eggs, fish and all meats is the only way for me to survive without ill health. most bread and fruits are not so good for me [cause digestive discomfort and /or insulin spikes] but- protein, most vegetables, and some fruits like berries -in moderation and with fat [eg. cream/yogurt] are ok. I am slim and fit and healthy and good for my age -we walk in the local park most days and look after the garden in summer. I see other people -older than me -buying fruit & bread etc in the supermarket but I cannot eat them without causing problems. If a heart attack’s going to get me because I eat saturated fat or the number 10 bus does it on the way to buy all that fat -sobeit- I gotta die sometime!
        [I believe an attitude of ‘no strain’ helps!]
        we are not all the same but individual and whatever works for you …..bon voyage in your journey finding out..

  3. Michelle says:

    Sometimes I feel guilty saying this, but I’ve never “been on a diet.” I’ve tried different diet theories but I’ve never put myself on a strict regimen in order to lose weight. Well, now maybe I don’t feel so bad after reading your post!

  4. Steve Parker, M.D. says:

    Great analysis, Darya. The Atkins advocates will not accept the results of this study, saying that it did not include a true Atkins program. But the studied diets varied from 35 to 65% of total calories form carbohydrates. That’s a pretty big difference.So why didn’t the researchers include a radically low carb option such as Atkins Phase 1, or even later phases? A quote from the article:”In addition, trials of low-carbohydrate diets have reported a very low incidence of urinary ketosis after 6 months, suggesting that in most overweight people, it is futile to sustain a low intake of carbohydrates.”-Steve

  5. Mike of Tustin says:

    For at least 30 years I have told anyone who cared to listen that calories are the only things that count in weight loss/gain. The response has always been carbohydrates, protein, fat, blah, blah, blah. The cool thing about a calorie restricted diet is that you can eat whatever you want as long as you stay below your calorie limit. That includes my favorite food, M&Ms. I once lost weight on a pure CornNuts diet. I love those things.

  6. Make Money Online says:

    Are you ready to give up diets and focus on health?Well not yet, but I guess i need to get healthy and be fit. Sigh all the good things in life come at a cost.

  7. Matt Shook says:

    The best diet is no diet at all… ;)I believe a lot people end up in a vicious cycle…they over-eat and then get depressed (because they are out of shape), or they over-eat because they are already depressed (from some other factor). I’m trying to figure out how to help someone break out of this…it can be very difficult.

  8. Paul G says:

    Wow, dumb and dumber eh?

    It’s simple, there are different body types, and each responds differently to carbs, fat, and protein. Anyone who tells you otherwise is a moron.

    Especially Mike, who said “..cool thing about a calorie restricted diet is you can eat whatever you want”. OK mike, eat 2000 calories of McDonalds and let me know how that works out.

    If you are an endomorph, reducing carbs is a huge help (I’m speaking from experience). I was on diet and exercise for 2 months, with no loss until my friend pointed out I was eating almost entirely carbs. Switched to mostly protein and the weight melted off.

    For the naysayers, explain how my roomate and I (who would cook food or just buy junk food) were different sizes (I was huge, he was a stick) despite eating the same food and roughly the same portion sizes?

  9. Steve says:

    @ Paul G, mike is right, so long as he’s in negative energy balance he can eat only mcd’s and lose weight.
    read this for more info: http://www.bodyrecomposition.com/research-review/hormonal-responses-to-a-fast-food-meal-compared-with-nutritionally-comparable-meals-of-different-composition-research-review.html

    My response to the whole article: you should differentiate between weight lost and fat lost. Keeping high, or at least sufficient protein(depending on activity levels etc), will spare lean body mass which then means that of the weight lost the majority will be fat rather than a mix of fat and lean mass. Also it has the greatest effect on satiation of the macronutrients so its win-win.

  10. Elin says:

    Gary Taubes. Read. Learn.

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