The media was all over it. “A Call for a Low-Carb Diet That Embraces Fat” announced Anahad O’Connor in the New York Times (9-1-14) . Even Medscape Medical News responded to a study published in the Archives of Internal Medicine on September 2 with the headline ” Heart Disease Risk: Low-Carb Diet Trumps Low-Fat Option.”
Do the headlines tell the whole story? Should we swap our brown rice for steak?
Not so fast. The devil, as usual, is in the details. In the study in question, researchers Lydia Bazzano and colleagues followed 148 men and women for 1 year after placing them in groups and instructing them to eat either a low carbohydrate or low fat diet. In both groups, all of the individuals were obese but none had cardiovascular disease or diabetes. The low fat group received nutrition guidance aimed at keeping fat to less than 30% of total calories. The low carbohydrate group also received nutrition guidance, and was advised to keep total carbohydrate under 40 grams per day.
The results were interesting in several ways. After 12 months, those in the low carb group had lost on average about 7 1/2 pounds less than those in the low fat group. BUT, an analysis of the diets based on food logs found that compliance in the low carb group was poor. Rather than limiting carbohydrates to 40 grams or less, this group averaged 97 grams of carbohydrate each day after 3 months and by 12 months they were eating 127 grams daily. The low fat group did a good job at keeping total fat to under 30% of calories, but this didn’t represent a big change as their normal diets at the beginning of the study averaged about 35% of calories of total calories from fat. Another interesting observation was that the amount of fiber consumed by each group was similar. All subjects had less fiber in their diets during the study than before, well below recommended amounts.
What does this tell us?
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First, calories count. The group consuming the fewest calories (low carb) lost the most weight. This occurred even though they were eating 3x the amount of carbohydrate prescribed.
Second, quality counts. The similar amounts of fiber consumed by each group suggest that rather than getting their carbs from minimally processed grains, fruits, vegetables and beans as is generally recommended, they were likely getting them from highly processed sources, possibly white breads and pastas, chips and pretzels, and perhaps even sweets. The portion of carbohydrates obtained from sugar was not specified.
This study does not shed any new light on the question of whether it is healthier to eat more or less carbohydrate. The best advice remains to eat plenty of fruits and vegetables, include mostly whole grains, and reach for healthier sources of fats including olive oil, avocado and nuts. Above all, calories must be reduced to promote weight loss in obese people.