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Low-carb trumps low-fat for weight loss and cardiovascular risk: study
By Rita Jane Gabbett on 9/2/2014
A new clinical trial funded by the National Institutes of Health bucks decades of nutritional advice, finding a low-carbohydrate diet is more effective for weight loss and reducing cardiovascular risk factors than a low-fat diet, according to an article published in Annals of Internal Medicine.
The results challenge the perception that low-fat diets are always better for the heart, according to lead author Dr. Lydia Bazzano, professor in nutrition research at Tulane University School of Public Health and Tropical Medicine.
"Over the years, the message has always been to go low-fat," Bazzano said in a statement. "Yet we found those on a low-carb diet had significantly greater decreases in estimated 10-year risk for heart disease after six and 12 months than the low-fat group."
After a year, the low-carb group lost an average of 7.7 pounds more than the low-fat group. The blood levels of certain fats that are predictors of heart disease risk also improved more in the low-carb group. While low-density lipoprotein cholesterol for both groups were about the same, the low-carb group saw a spike in so-called "good" HDL cholesterol and a decline in the ratio of bad to good cholesterol.
While the low-carb dieters got 41 percent of their calories from fat, most were healthy monounsaturated and polyunsaturated fats like olive or canola oil. The group only got 13 percent of calories from saturated fats like butter.
"It's not a license to go back to the butter, but it does show that even high-fat diets — if they are high in the right fats — can be healthy and help you lose weight," Bazzano said.
Clinical trial
A clinical trial differs from epidemiological studies (many of which have been used to support a low-fat diet recommendation) because only a clinical trial can establish causation between a diet and a health outcome. Epidemiological studies can only show an association, a point driven home in Nina Teicholz's new book, "The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet."
To compare the effects of a low-carbohydrate versus a low-fat diet on body weight and cardiovascular risk factors, researchers in this most recent clinical trial randomly assigned 148 men and women without clinical cardiovascular disease and diabetes to follow a low-carbohydrate (less than 40g a day) or low-fat diet (less than 30 percent of daily calories from fat).
All participants were classified as obese based on body mass index and just over half of the participants were black. Both the low-carbohydrate and the low-fat groups received dietary counseling at regular intervals but had no specific calorie or energy goals.
Results
At one year, both black and white participants on the low-carbohydrate diet had greater decreases in weight, fat mass, and other cardiovascular risk factors than those on the low-fat diet.
Overall, blood levels of certain fats that are predictors of risk for cardiovascular disease also decreased more in the low-carbohydrate group.
Physical activity was similar in the groups throughout the study, suggesting that the greater weight loss among participants in the low-carbohydrate group was not because they exercised more. When the researchers evaluated the black and white participants separately, the results were similar.
Even without additional exercise, the trial showed that "compared with participants on the low-fat diet, those on the low-carbohydrate diet had significantly greater proportional increases in lean mass."
Limitations
The study lasted 12 months, and whether the participants will maintain the weight loss is not known. In addition, because the study lasted only 12 months, it is not known whether the reductions in blood markers of risk for cardiovascular disease will be accompanied by reductions in the development of coronary artery disease, heart attacks, strokes, and other cardiovascular problems.
Conclusion:
"The low-carbohydrate diet was more effective for weight loss and cardiovascular risk factor reduction than the low-fat diet. Restricting carbohydrate may be an option for persons seeking to lose weight and reduce cardiovascular risk factors," according to the study summary in the Annals of Internal Medicine.
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