Low-Fat Versus Low Carb Dieting:
In Relation to Weight Loss and Health Effects

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Low Carb Weight Loss Diet Trial (4)

The Samaha Low Carb Study

A Comparison of Low-Fat Versus Low Carb Dieting in Relation to Weight Loss and Health Effects

Low Carb Study Conclusions:

Obese patients on a low-carbohydrate diet for six months lost more weight and fared better on certain cardiovascular and diabetes measures than patients on a low-fat, calorie-restricted diet. The study is one of several in recent years to suggest that low-carbohydrate diets may offer some advantages over the low-fat regimen pushed by doctors and nutritionists since the 1970s.

In the study, 132 men and women were randomly put on either a low-fat or low-carbohydrate diet for six months. The low-carbohydrate group was told to limit carbohydrate intake to 30 grams per day. They received counseling on healthy types of fat, such as omega-3 fatty acids, but had no limit on total fat intake. The low-fat group was put on a calorie-restricted diet, with no more than 30 percent of total caloric intake from fat.

Overall, volunteers assigned to a low-carbohydrate diet lost an average of about 13 pounds, compared to 4 pounds for the low-fat group. The low-carbohydrate dieters reduced their levels of triglycerides - blood fats that, like cholesterol, may contribute to clogged arteries - by an average of 20 percent, versus 4 percent for the low-fat group. There were no significant changes in cholesterol or blood pressure levels in either group.

Among non-diabetic people in the study, insulin sensitivity improved for the low-carbohydrate group, but worsened somewhat for the low-fat group, possibly raising their risk of diabetes. Among diabetic participants, the low-carbohydrate dieters reduced their fasting blood-sugar levels by about 9 percent, versus only 2 percent for the low-fat dieters. Over the six-month study, seven diabetic patients in the low-carbohydrate group were able to reduce their dose of insulin or other medication to control blood sugar. In the low-fat group, one diabetic patient lowered his insulin dose and one had to begin therapy.

According to lead researcher, Dr Samaha, even though all the study participants remained extremely overweight, those in the low-carbohydrate group significantly reduced risk factors for diabetes and heart disease: Their triglycerides dropped to normal range, and their glycemic, or blood sugar levels approached normal. "The metabolic effects were fairly impressive," said Samaha.

According to co-author Dr Stern, eating fewer carbohydrates and more protein and fat makes people feel fuller and less likely to consume extra calories. It avoids blood sugar fluctuations and the constant insulin spikes that lead to the development of insulin resistance, which sets the stage for diabetes.

The ideal approach, said the authors, may be to focus less on the proportions of fat and carbohydrate in the diet and more on the quality of foods. One reason for the apparent failure of low-fat diets, they said, is that people tend to make up for lower fat intake by eating more junk food. "People shouldn't get the message that as long they lower their fat intake they can eat all kinds of carbohydrates--candy, cookies, sugar-coated cereals, and other foods that may not be that healthful," said Samaha. He cited vegetables with a high fiber-to-carbohydrate ratio as an example of the "good" carbohydrates that should play a greater role in either low-fat or low-carbohydrate eating plans.

Lead author Frederick F. Samaha, MD cautioned against discarding the low-fat approach, which has been shown to cut the risk of heart attack, but he also said more attention needs to be paid to the harmful effects on body chemistry of carbohydrate-rich diets. "There are important metabolic effects to a high-carbohydrate diet in a person who tends to overeat, and we need to take a close look at that," said Samaha.

Philadelphia VA Medical Center. Researchers, Dr FF. Samaha and Dr L. Stern, Dr. Nayyar Iqbal, VA and UPSM; Dr. Prakash Seshardi, UPSM; Kathryn L. Chicano, Denise A. Daily, Joyce McGrory, Terrence Williams and Monica Williams, VA; and Dr. Edward J. Gracely, Drexel University College of Medicine. Published New England Journal of Medicine, May 22, 2003.

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