Remembering Kevin Moore

NIH-Funded RCT Study Finds Low-Carb Tops Low-Fat For Weight Loss, Heart Health

One of the things I’ve been hammering in my message over the past couple of years is the need for a whole lot more randomized, controlled clinical trials being conducted on a genuinely low-carb, high-fat, ketogenic diet with less than 50 grams of carbohydrates consumed daily (as opposed to the so-called “low-carb” diet studies that have been done where the participants eat upwards of 40-50% of their calories from carbohydrates!). Furthermore, I have been calling for the National Institutes of Health (NIH) to take this nutritional approach seriously by granting research dollars toward examining it much more closely to see if there are beneficial health effects that are desirable for people pursuing weight loss and optimized health. With the release of monumental new study this week, I got both with the publication of “Effects of Low-Carbohydrate and Low-Fat Diets: A Randomized Trial” in the September 2, 2014 issue of the scientific journal Annals of Internal Medicine. THIS…IS…HUGE!

Lead researcher Dr. Lydia Bazzano, MD, PhD (pictured right), Associate Professor of Epidemiology and Clinical Assistant Professor of Medicine in the Department of Epidemiology at the Tulane University School of Public Health and Tropical Medicine in New Orleans, Louisiana, wanted to examine the impact of low-carb, high-fat, ketogenic diets for weight loss and cardiovascular health since they have seen a resurgence in popularity in recent years (as evidenced by the fact that it was the #5 most Googled diet search term in 2013). Despite books like my 2013 bestseller Cholesterol Clarity explaining why low-carb diets improve all the relevant cardiovascular health markers, there are still concerns about whether this way of eating can be used as a preventative measure for optimal heart health. So Dr. Bazzano and her research team submitted a funding request to do this ClinicalTrials.gov study to conduct what is widely consider the “gold standard” in research (something we discussed at length at the beginning of Chapter 16 in my book Keto Clarity) to find out: A randomized, controlled parallel-group clinical trial pitting the low-carbohydrate diet vs. the low-fat diet to see which would produce the best outcomes in weight and cardiovascular risk factors.

A racially-diverse total of 148 men and women ages 22-75 without any sign of clinical cardiovascular disease or diabetes were randomly selected to be placed in one of two diet groups with no restrictions on calories or any changes in their physical activity for this study:

LOW-CARB GROUP: Defined as less than 40 grams net carbohydrates daily with mostly unsaturated fats and up to 13% of calories from saturated fat.

LOW-FAT GROUP: Defined as less than 30% of calories from total fat along with less than 7% saturated fat and no more than 55% of calories from carbohydrate sources such as grains, cereals and starches.

Both groups received dietary counseling on their specified plan from a registered dietitian at regular periods throughout the study and the weight of the participants, cardiovascular risk factors such as triglycerides and HDL cholesterol, and a diet assessment took place at baseline, three months, six months, and twelve months. A total of 60 people (82%) in the low-fat group and 59 people (79%) in the low-carb group finished the one-year study.

So what were the results at the end of 12 months? Check it out:

  • LOW-CARB beat LOW-FAT in weight loss: 12 pounds vs. 3 pounds
  • LOW-CARB beat LOW-FAT in fat mass lost: -2.6% vs. -0.4%
  • LOW-CARB beat LOW-FAT in HDL cholesterol increases
  • LOW-CARB beat LOW-FAT in triglyceride reduction
  • (I would have LOVED it if they had measured for LDL particle number and LDL particle size since these advanced lipoprotein panels like the NMR Lipoprofile test tell you so much more about your risk for heart disease…but the improvements in HDL and triglycerides serve as a good proxy for the quality of the LDL particles being the mostly large, fluffy kind in the LOW-CARB group and much less of the small, dense kind.)

    Dr. Bazzano and her fellow researchers concluded that “the low-carbohydrate diet was more effective for weight loss and cardiovascular risk factor reduction than the low-fat diet” and they explain that “restricting carbohydrate may be an option for persons seeking to lose weight and reduce cardiovascular risk factors.” SHAZAM! With 27 million Americans dealing with heart disease right now, this new research could be life-changing for so many of them who think they have to eat a low-fat, high-carb diet to deal with their condition. I fully expect the boo-birds to come out in force and exclaim that nothing should change about the way people should eat for heart health because this was “only” a one-year study. But this is VERY GOOD evidence that there is efficacy in the low-carb, ketogenic diet approach that warrants even longer studies to show the effectiveness goes beyond one year. Hopefully the NIH continues to give research money to fund the studies that provide the evidence in the scientific literature that anecdotal stories over the past decade or two have already proven to be valid.

    As someone who has been blogging and podcasting about this very subject for nearly a decade, it is so gratifying to see quality clinical research coming to the conclusion that low-carb is a safe and effective alternative to the low-fat lie that’s been shoved down our throats for four decades as the one-size-fits-all way to get healthy and lose weight. But that gig is up! We’ve already had 23 other randomized controlled trials (RCTs) conducted showing low-carb beats low-fat–and now we have #24! How much more compelling a case do we need to make to the USDA’s Dietary Guidelines Committee, the American Heart Association, the American Diabetes Association and all the other leading nutritional health groups in the United States before they wake up to smell the bacon? It’s going to be much more difficult for them to keep ignoring all this compelling data from the research world in the coming years.

    This study got some great major media exposure, including:
    The New York Times: A Call for a Low-Carb Diet
    National Public Radio: Cutting Back On Carbs, Not Fat, May Lead To More Weight Loss
    Time Magazine: For Weight Loss, Low-Carb Diet Beats Low-Fat
    CBS News: ​Low-carb versus low-fat: Best diet for weight loss, heart health
    Washington Post: Low carb diets more than low fat ones may help protect against heart disease

    What a year 2014 has been for low-carb, high-fat, ketogenic diets! Between the work of Nina Teicholz and her New York Times bestselling book The Big Fat Surprise, Time Magazine putting butter on its front cover, one of the world’s most recognizable professional athletes Lebron James famously losing weight on a low-carb diet, and the fortuitous timing of the release of my new book with Dr. Eric Westman that’s been so well-received called Keto Clarity, this way of eating is making a HUGE comeback in our culture–and I believe the very best is still yet to come! We’re on the cutting edge of the future of healthy nutrition and we’ll continue to chronicle these historical moments as they unfold before our very eyes.

    I’ve contacted Dr. Bazzano requesting an interview on “The Livin’ La Vida Low-Carb Show” podcast about the results of her study. You can share your appreciation to her for this stunning new low-carb diet research by e-mailing her directly at lbazzano@tulane.edu. And the ketogenic diet research will continue to pour in as there are currently 65 ketogenic diet research studies at ClinicalTrials.gov going through the process of funding from the NIH. The low-carb, ketogenic diet revolution is here to stay, so spread the word to friends, coworkers, family and anyone else who could stand to benefit in their health by choosing to eat this way!

    • This Old Housewife

      So when are they gonna stop wussing out on the fats, and start testing using more SATURATED fats? Also, I believe they didn’t do an NMR because they didn’t really want to know how the lipid profiles change so dramatically after consumption of fat–that would lead to massive unemployment in the health care sector.

      It seems like they’re willing to give a little, but nit enough to change the national food guidelines, and CERTAINLY not in the public school lunch programs (so heavily supported by subsidized foods).

    • The good low carb high fat news gets better by the day ! Those carboholics are running out of steam.

      Kind regards Eddie

    • gardenofwheaton

      Awesome, I agree. But one thing made me worried: Although the low-carb group was “defined as less than 40 grams net carbohydrates daily with mostly unsaturated fats and up to 13% of calories from saturated fat,” that wasn’t exactly what they actually ate. The low-carb group actually averaged between 93 and 127 grams of carbs per day (Table 2). At least it was still lower than the low fat group, who averaged 200 grams per day. And it’s still a nifty study that has healthy (not sick) people and a racially diverse group of men AND women. Nice! Thanks for the summary!

      • LLVLCBlog

        That is the flaw in these kind of studies. But I think this further emboldens our position–even when they didn’t do it perfectly, they STILL saw superior results compared with low-fat. Just once I want to see an intellectually honest study that has them on the stated diet exactly. THAT would be interesting.

    • RIchard Feinman

      The NIH has twenty years of not funding quality research. Volek and Westman and others have consistently been turned down and when they get whatever funding is possible from Atkins or whoever they dismiss this. Now they’ve got somebody to do poorly what Volek has done well. And the paper is full of disclaimers like “Prospective cohort studies have produced conflicting results regarding the association between low-carbohydrate patterns and risk for CVD (2,3)” Have you read references 2 and 3? This group does not have your interests at heart.

    • shotofhealth

      This research actually shows nothing of any significance at all. Both diets were not healthy and very poorly controlled. A study of any diet that allows refined and processed grains to be included is poor science!

      It is noticeable that neither group showed improvements in overall cholesterol, LDL or blood pressure.

      You guys are really clutching at the proverbial straws if you you highlight this study as anything to latch on to.

      Here are three questions for you advocates of extreme diets:

      1. If the human being was not supposed to eat any form of carbohydrate why is human breast milk (of the three macro ingredients after water) approximately 60% carbohydrate (mostly lactose) compared to 33% fat and 7% protein?
      2. Which culture/nation/population in the world eats the way you advocate and has healthy longevity for generations? Please don’t cite the tired old argument of the Inuits and Masai – they might not get heart disease but they don’t live very long lives and never have. Plus they live in conditions that don’t apply to most of the world, plus they are (or were) so physically active that they burn off what they ingest.
      3. If carbohydrates per se are so BAD for you, why do several billion people on this planet eat diets high in UNREFINED complex carbohydrates and have long and healthy lives? Indians, Chinese, Africans, South Americans, the Blue Zones – the list goes on and on and on and on.

      One last comment: just because someone on “low-carb” experiences short-term health benefits, it doesn’t prove long-term health. One can get the same “benefits” using chemotherapy (losing weight, lower blood sugars and lowered cholesterol) but it doesn’t make it healthy.

      • LLVLCBlog

        Ahhhh, I wondered when a vegan with an agenda was going to pop their head in here. Welcome, my friend, and please look around and stay a while. We aren’t about anything but showing people how a real foods-based nutritional plan like a low-carb, high-fat, ketogenic diet can be a powerful way to optimize your health. All of your questions have been addressed in this forum and others like mine again and again, so I encourage you to do the research and find the answers. I’m happy to see you are seeking because it indicates you have questions about the very things you believe. I wish you well on your journey to the truth.

    • Really good post! Hope there will be more good post here!Thanks for sharing valuable information.