Low Carb and Mediterranean Diets Beat Low Fat on the Scale

July 23, 2008

Low-Carb and Mediterranean Diets Beat Low-Fat on the Scales    

Number 224 Competency # 2 The Best Diet: DASH and OMNI Heart.        Reference: New England Journal of Medicine, July 17, 2008 Shai et al  Results of the DIRECT Trial 

 We’ve been teaching low-fat diets for years.  “If you want to lose weight, eat a low-fat diet.”  Well, get over it.  It was wrong.   Sorry.  We made a mistake.  It’s time to put that one to bed and move on.  This article is the funeral dirge.  Let’s just put low fat into the ground and stop obsessing about it.  We’ve all done it.  We’ve all tried.  It didn’t work.  In fact, on the 1978 standard food pyramid that advocated for low-fat diets, the average American gained some 15 pounds and we went from 14% obese to over 30% obese in some states.  Avoiding fat seems so reasonable.  After all, there are 9 calories in a gram of fat and only 4 in a gram of carbohydrate.  And it was fat around our bellies and on our hips that seemed to collect so easily.   Oops. 

 What Dr. Shai and company did was offer three diets in a randomized fashion to 322 folks for 2 years.  About 52 years old.  BMI about 31.  Sounds like me and you.  The low fat was calorie restricted.  The Mediterranean arm was calorie restricted.  The low carb was UNRESTRICTED.  Eat as much as you want.  Just no white carbs or sugar (well, 20 grams a day for the first two months, then up to 120 a day later – sort of like the Atkins diet). 

 Guess what happened?  They all lost weight, yes.  But the low carb and the Mediterranean lost about twice as much and didn’t regain it.  In fact, the low-fat women didn’t lose anything (but small numbers).  The Mediterranean folks had better control of their blood sugar.  The low-carb folks did better on their lipids.  And the two together did better on markers of inflammation (C-reactive protein).  Now, the participants were 85% male and there weren’t enough diabetics in the study to really tell what happens with diabetes. 

 There are those who will say, “You can’t lose weight when you stimulate insulin”.  White carbs and sugars drive insulin up.  Insulin drives fat into your cells.  Your fat cells will not release fat when there is insulin in your blood.  Carbs make you release insulin.  Low-fat diets are, by definition, higher carbs.  You can’t lose weight by eating carbs.  Now, remember.  It's the RIGHT fats that count.  Not saturated animal fats.  Eat olive oil, nuts, fish oil, and flax seeds. The study was done in an ideal setting.  All the participants could come to a place where their lunch could be prepared.  They all met with dieticians for multiple sessions of teaching, support, monitoring, and all the community and relationship that brings.  But we know that counseling, connecting, and relating is half the battle.  Care providers talking to their patients works.  In fact, it works twice as well as anything else.  And this study shows you can make it work for two years.  Not just one.  And keep it off. 

 WWW:  What will work for me.  Well, I weigh myself daily, usually with a sigh of resignation.  “Oh well” I say.  This gives me renewed hope.  First step, less white sugar.  Second step, no white bread.   Third step, small snacks with some almonds thrown in.  Beautiful cherries are in season.  Splurge.

The column was written by Dr. John E. Whitcomb, MD, Brookfield Longevity, Brookfield, WI. (262-784-5300)