
Effect of Low-Fat vs. Low-Carb Diet on 12-Month Weight Loss in Overweight Adults - nradov
https://jamanetwork.com/journals/jama/article-abstract/2673150
======
gwern
Fulltext:
[https://www.dropbox.com/s/cbpt3bw8ql310kr/2018-gardner.pdf?d...](https://www.dropbox.com/s/cbpt3bw8ql310kr/2018-gardner.pdf?dl=0)

Worth noting that the genetics here was just 3 SNPs based on a 2010 candidate-
gene study of apparently n=133 (it was never published, it's just a conference
talk, based on the citation & description of the work in
[https://www.wsj.com/articles/SB10001424052748703862704575099...](https://www.wsj.com/articles/SB10001424052748703862704575099742545274032)
), which made the absolutely crazy claim that "those with a genetic
predisposition to benefit from a low-carbohydrate diet lost 2 1/2 times as
much weight as those on the same diet without the predisposition". So
unfortunately, their total failure is exactly what you would predict from a
non-GWAS-derived set of SNPs and the result is meaningless. This tells you
nothing about whether SNPs can predict or cause more/less weight loss, be used
to optimize diet choice, or have any cross-racial differences, despite people
apparently interpreting it that way.

~~~
jobu
The key thing for these diets is the ratios of Carb/Fat/Protien :

 _In the HLF vs HLC diets, respectively, the mean 12-month macronutrient
distributions were 48% vs 30% for carbohydrates, 29% vs 45% for fat, and 21%
vs 23% for protein._

Both of those diets seem fairly balanced. A typical ketogenic diet (high-fat,
low-carb) is usually < 10% calories from carbohydrates, 20-30% from protein
(depending on exercise) and 60-75% fat calories. It seems unlikely any of the
HLC participants would have gotten into ketosis, so I don't see this study as
being relevant to the current debate over the efficacy of ketogenic diets.

------
firasd
Low-Carb proponents don't necessarily disagree that 'a calorie is a calorie'
in the physics sense. We just feel there's no need to be hungry when you can
eat to satiation and still lose weight, and that unnecessarily high glucose in
the bloodstream is not good for you anyway.

~~~
cageface
Complex carbs like potatoes are some of the most satiating and nutritious
foods you can eat:

[https://scottabelfitness.com/potato-and-the-satiety-
index/](https://scottabelfitness.com/potato-and-the-satiety-index/)

High fat diets can also be satiating but there are a lot of downsides to
eating saturated fats, which make up most of the fats in the typical
keto/paleo high fat diet.

[https://nutritionfacts.org/video/the-saturated-fat-
studies-s...](https://nutritionfacts.org/video/the-saturated-fat-studies-set-
up-to-fail/)

~~~
firasd
I guess it depends on how a potato is prepared. The guy in the link eats baked
potatoes which I suppose would be pretty filling. Personally I've found most
'filling' foods I eat when (trying to get back to) low-carbing are:
cauliflower, eggs, paneer (a type of Desi cheese), coconut, and beans/legumes.

~~~
cageface
Boiling potatoes provides the best glycemic profile. Letting them cool before
you eat them increases the amount of resistant starch further:

[https://yurielkaim.com/resistant-starch/](https://yurielkaim.com/resistant-
starch/)

Legumes are a very healthy food on a lot of counts.

------
dieterrams
Missing from the title is the qualifier "healthy", as in "healthy low-fat"
diet vs "healthy low-carb" diet. What does "healthy" mean, here? It's not
defined in the abstract.

~~~
fredrik-j
The closest I got to definition of "healthy low X" was a general description
of the approach in the paper:

"Briefly, the main goals were to achieve maximal differentiation in intake of
fats and carbohydrates between the 2 diet groups while otherwise maintaining
equal treatment intensity and an emphasis on high-quality foods and beverages.

Thus, participants were instructed to reduce intake of total fat or digestible
carbohydrates to 20 g/d during the first 8 weeks. Higher priorities for
reduction were given to specific foods and food groups that derived their
energy content pri- marily from fats or carbohydrates. For example, the
reduction of edible oils, fatty meats, whole-fat dairy, and nuts was
prioritized for the healthy low-fat group, whereas the reduction of cereals,
grains, rice, starchy vegetables, and legumes was prioritized for the healthy
low-carbohydrate group.

Then individuals slowly added fats or carbohydrates back to their diets in
increments of 5 to 15 g/d per week until they reached the lowest level of
intake they believed could be maintained indefinitely. No explicit
instructions for energy (kilocalories) restriction were given. Both diet
groups were instructed to (1) maximize vegetable intake; (2) minimize intake
of added sugars, refined flours, and trans fats; and (3) focus on whole foods
that were minimally processed, nutrient dense, and prepared at home whenever
possible."

I find the last sentence interesting, reminds me of Michael Pollan's quip:
"Eat food. Not too much. Mostly plants."

------
jewei
Conclusions: In this 12-month weight loss diet study, there was no significant
difference in weight change between a healthy low-fat diet vs a healthy low-
carbohydrate diet, and neither genotype pattern nor baseline insulin secretion
was associated with the dietary effects on weight loss. In the context of
these 2 common weight loss diet approaches, neither of the 2 hypothesized
predisposing factors was helpful in identifying which diet was better for
whom.

------
lokopodium
I wonder which of the two is easier to keep. Feeling hungry most of the time
is little joy and leads to relapses.

~~~
Pokepokalypse
Oh but. . . "weak willpower", and "immorality", and "fat people deserve their
misery and shame". . . we really need to maintain our comfortable mindset.

------
markdown
I'm not sharing this because it doesn't confirm my self-tested and proven
beliefs. #NoCarbsForLife

------
lucidguppy
29% cal from fat isn't really low fat. It would be interesting to see a study
on lower fat diets.

~~~
testuser312
Also, 30% of calories from carbs (on the so-called low-carb diet) is not
really low-carb. As mentioned in another comment, for a 2,000 calorie diet,
that's 600 calories from carbs! Most low-carb diets aim way lower than that
because they aim at reaching a state of ketosis, where your body is
essentially burning fat instead of sugar for energy. This might be something
like 20-50 grams per day, depending on a lot of factors like specific carbs
consumed, etc. This is the stage where a lot of the health benefits including
increased energy, no afternoon crash, weight loss, etc. come in.

I realized recently that I was getting fat (4 inches of waist size increase in
just a couple years), so for the past couple months, I've tried restricting my
calories. At first, I tried cutting out things that are just ridiculous like
beer and bread. In the past week or so, I've gotten more 'restrictive' and
have been trying to eat almost exclusively meat. I'm not counting calories or
anything like that, I just eat until I'm full and then I stop. I have lost 20
lbs in the past two months, and I feel much better overall. I have way more
energy than I did before and I fart a lot less.

I can understand if it sounds extreme, but look at the standard American diet.
Since the food pyramid was introduced, with a base of grains, people have
gotten nothing but fatter, more diabetic, more heart attacks and stokes, etc.
While there are essential fats and proteins, there are NO essential
carbohydrates. I'm not sure if I'm going to stay on this diet forever, but it
doesn't seem like the mainstream diet is very healthy, so I'm going to listen
to what my body tells me and use reason to try to get out of this mess.

~~~
lucidguppy
I've done both keto and whole-foods-plant-based diets.

Both lose weight - but I feel a lot more energy on a starch based diet. Whole
plant foods contain the right amount of fat (10%). Who cares about farts when
I never get constipated. With a little exercise and a starch based diet I was
able to lose 80lbs. When I started introducing fats and added refined sugars -
the weight came back. The fat you eat is the fat you wear.

Long term ketosis is not optimal health.

[https://www.ncbi.nlm.nih.gov/pubmed/22850317](https://www.ncbi.nlm.nih.gov/pubmed/22850317)

[https://www.ncbi.nlm.nih.gov/pubmed/11108325](https://www.ncbi.nlm.nih.gov/pubmed/11108325)

Look at cheese consumption and it tracks national weight gain. We're taking in
way more fat today than long ago.

[http://www.pcrm.org/images/media/blog/cheese_consumption.jpg](http://www.pcrm.org/images/media/blog/cheese_consumption.jpg)

But we're taking more calories overall - so people get to blame whatever they
want.

Starches powered all civilizations up to the 20th century. Only when we
started consuming lots of meat and purified sugars and white flour did we
really gain weight.

------
forkLding
I'm guessing they used a random sample to study the diets hopefully and also
this would generally mean I believe that any general diet low in fat or carbs
can lose weight because they listed that participants still lost 5 to 6 kg no
matter the diet?

------
euler_
Ketosis can apparently lead to more weight loss because ketones are less
efficient vehicles of energy in general. Additionally, unused ketones can be
eliminated through sweat, urine, and breath.

~~~
kasey_junk
Apparent to what evidence?

~~~
will_brown
The Krebs Cycle I am guessing.

------
enraged_camel
>>In the HLF vs HLC diets, respectively, the mean 12-month macronutrient
distributions were 48% vs 30% for carbohydrates, 29% vs 45% for fat, and 21%
vs 23% for protein.

30% carbs is hardly "low-carb".

Indeed, most low-carb diets suggest 50g or less carbs per day - 200 calories
or less.

[https://www.dietdoctor.com/how-low-carb-is-low-
carb](https://www.dietdoctor.com/how-low-carb-is-low-carb)

edit: why am I being downvoted?

~~~
lowdest
30% of a 2000-calorie diet is going to be 150g of carbohydrates per day. Not
very low carb at all.

~~~
aYsY4dDQ2NrcNzA
> 30% of a 2000-calorie diet is going to be 150g of carbohydrates per day.

600g

~~~
nraf
There are 4 calories per gram of carbohydrate.

------
adadad3442
Unsurprising results- calories intake & expenditure defines weight loss/gain,
not other nutrition information like fat, carbs, vitamins, etc.

~~~
20180201
calorie intake and expenditure is a _description_ not a _prescription_. this
is about as useful as saying "make more money than you spend" in order to
become wealthy. sure, that's true, but it won't help you make $10 million. how
do you eliminate the desire to waste time and money on useless pursuits?
_that_ is the analogy we need to use to reframe this discussion. yes, there is
a certain level of maturity and self-control involved, but you need to know
what _NOT_ to do first.

what is causing people the intense desire to overeat, and the intense lethargy
that follows? probably insulin-spiking processed carbs and sugar. have you
seen anyone in the throes of a carb addiction/crash cycle? it's damn near
supernatural the amount of power these foods have over people.

at this point i consider them about the same level as cigarettes or alcohol.
cheap, widely availabe, intensely addictive, and people who don't have a
problem just telling you to "use less", "it's so easy". okay. sure.

"how do i graduate college?" "take more credits than it requires to graduate."

try telling this to the person who got sucked into the for-profit university
and is $50k in debt.

the world is not as cut and dry as it seems, especially if you are burdened
with a low IQ like the people who most easily fall for these schemes.

~~~
_red
Good points, but there is something else going on.

If you travel alot you start to see that every culture is heavy on carbs:
Rice, pasta, potatoes, noodles, bread. They are ubiquitous.

Find a frenchmen that isn't eating bread from first meal to last...or an asian
with rice / noodles. Or an Italian with pasta / bread, etc.

There is something else wrong here. I don't pretend to know what it is, but it
seems like its almost a "food culture" problem. The most immediate things you
notice are: (a) Americans portion size is double the rest of the world, and
(b) Americans eat very very fast.

~~~
cageface
Exactly. The idea that carbohydrates, which have been the staple of most human
diets for millennia, are somehow suddenly toxic makes no sense. Complex
carbohydrates are fine. What's gone wrong in the US is that we are eating more
processed carbohydrates along with way more chicken and cheese and our portion
sizes and overall calorie intake have gone up significantly:

[http://geeksta.net/visualizations/calories-
us/](http://geeksta.net/visualizations/calories-us/)

Excess consumption leads to obesity, which correlates strongly with just about
every major chronic illness. Portion sizes are a big part of the problem.
Every time I come back to the US after living in Asia I'm shocked at how
ridiculously large restaurant serving sizes are.

