10 ms·

Effect of Low-Carb, High-Fat Diet versus High-Carb, Low-Fat Diet

45 points by mikequinlan 4y ago

mikequinlan 4y ago
Effect of Calorie-Unrestricted Low-Carbohydrate, High-Fat Diet Versus High-Carbohydrate, Low-Fat Diet on Type 2 Diabetes and Nonalcoholic Fatty Liver Disease Result: The mean age was 56 years (SD, 10), and 58% were women. Compared with the HCLF diet, participants on the LCHF diet had greater improvements in hemoglobin A1c (mean difference in change, −6.1 mmol/mol [95% CI, −9.2 to −3.0 mmol/mol] or −0.59% [CI, −0.87% to −0.30%]) and lost more weight (mean difference in change, −3.8 kg [CI, −6.2 to −1.4 kg]). Both groups had higher high-density lipoprotein cholesterol and lower triglycerides at 6 months. Changes in low-density lipoprotein cholesterol were less favorable in the LCHF diet group than in the HCLF diet group (mean difference in change, 0.37 mmol/L [CI, 0.17 to 0.58 mmol/L] or 14.3 mg/dL [CI, 6.6 to 22.4 mg/dL]). No statistically significant between-group changes were detected in the assessment of NAFLD. Changes were not sustained at the 9-month follow-up.
- altairprime 4y ago
  n=165
- chrisco255 4y ago
  Meaning the diets were not maintained (on avg) after the trial? Can't imagine how difficult it must be to run a properly controlled dietary study. Even if you feed the participants, how can you be sure they're not ingesting additional food outside of the experiment for months on end?
  - AnEro 4y ago
    Exactly why it is normal that nutritional science is taken with a grain of salt, not cause researchers are slacking or producing bad studies. Just the fact they have data sources with a giant astrix attached. Imho i think this also plays into the misinformation in the space. It's hard to prove anything and I find I mostly wait for a good meta analysis before putting my eggs in that basket
    - BLKNSLVR 4y ago
      Aside: "astrix"? If intended to be funny, it certainly is. If not, I believe "asterisk" is the word you're looking for. However, I could see astrix becoming the word of 2023. Related: https://www.asterix.com https://www.asterix.com
  - chasebank 4y ago
    Why not run these trials in a prison?
    - chrisco255 4y ago
      Ha, probably ethics reasons. Plus prisons aren't representative of general population.
  - cableshaft 4y ago
    I did a Keto diet for 4 months and lost 45lbs. Those pounds started coming back quick after I eased off of it (my triglycerides and cholesterol numbers were getting worryingly high). I also found it incredibly difficult to jump back into Keto for any sustained period of time afterwards. Tried and failed within a couple of weeks multiple times, kind of like whenever I try to go off of caffeine. Been finding just eating lower-carb (not as low as keto, and some days where there have been carb binges) and focusing more on whole foods and not eating high-fat foods and my triglycerides and cholesterol numbers are back to normal levels, and I'm back to losing weight again, albeit a lot slower (down 25 lbs this year). I know another guy who lost 107lbs off Keto (he was my initial inspiration to try it, in fact) and he eventually went off it and he had regained about half of that when I saw him last (according to him). I'm sure there are people who have been able to keep the weight off, but it was difficult for me.
hirundo 4y ago
> It remains unclear if a low-carbohydrate, high-fat (LCHF) diet is a possible treatment strategy for type 2 diabetes mellitus (T2DM) N=1 personal non-random uncontrolled experiment: 4+ years of drug-free diabetes control to below pre-diabetic levels via an LCHF diet, regularly measured with continuous glucose monitoring. I suspect that the success rate among self-selected followers is higher than among the randomly assigned.
- hollerith 4y ago
  What food or foods have been your main source of fat while on this LCHF diet?
  - hirundo 4y ago
    Beef, butter, eggs.
  - anonymousab 4y ago
    I'm not OP, but I also adhered to an LCHF diet for ~8 months a few years ago. I found that, early on, maintaining a consistently high ratio of fats was hard, but over time, it simply became a natural aspect of things like e.g. eating normal/non-extra-lean beef. For the first while I found that using coconut oil or olive oil was a trivial way of adding just pure fat to my daily numbers. Both of them are relatively cheap (though high cal) and can be added to any heated drink like coffee or tea with minimal impact on for flavor. Over time, this just became unnecessary, but it was helpful early on as it was trivial to prep a small container with n grams of oil every morning. There are also nutrient bars that are explicitly higher on fat and protein and lower on carbs for this very purpose, e.g. 'good fats' bars. Unlike what others report, while I felt generally good and had energy for day to day things, I simply could not ever work up enough energy for more rigorous cardio or weightlifting, compared to when I'm on a normal/carb-rich diet.
- readthenotes1 4y ago
  I have also met adults who control their diabetes with hclf (high complex carbs, 0 to no simple carbs) I believe that the common denominator is nearly zero sugar.
ablatt89 4y ago
I think this is not so surprising, given that the calories are not restricted in the study. High carb, low fat foods I think are not satiating relative to low carb, high fat foods. As an example: https://pubmed.ncbi.nlm.nih.gov/36051903/ https://pubmed.ncbi.nlm.nih.gov/36051903/ Any type of caloric restriction will improve health outcomes.
- user3939382 4y ago
  Weight isn't the product of calories in vs out, that's an overly simplistic model that doesn't account for the effect of hormones on how we metabolize different compounds and nutrients. This area of nutrition science is nascent and unsettled, and fraught with research funded by parties with conflicts of interest, but here's for example a pretty good talk that discusses some of the research https://www.youtube.com/watch?v=ZKC3hiyLeRc&t=159s https://www.youtube.com/watch?v=ZKC3hiyLeRc&t=159s
  - algoatecorn 4y ago
    It's simple enough to be useful and applied. If you continue to reduce your calorie intake, you will lose weight. This is a fact. Build a model to explain weight gain/loss and calorie intake will always be the most influential variable full stop
    - rhinoceraptor 4y ago
      This is like saying the way to become financially successful, is to simply earn more money than you spend. These two explanations are correct, but not particularly helpful, because they are tautologies.
      - soco 4y ago
        True they're not particularly helpful, but the commenter was arguing against their truthfulness.
    - maerF0x0 4y ago
raajg 4y ago
The conclusion is in line with Tim Ferris's 'Slow Carb Diet'
smcleod 4y ago
Note: Very small sample size (165 participants) of primarily older aged people (mean 56 years), all located in the same geographic region.
atlgator 4y ago
Funded by Novo Nordisk, an insulin manufacturer.
peter_retief 4y ago
Still so much resistance to the high fat diet. It works and it seems to be way healthier than any high carb diet
- Kairinz 4y ago
  It is not surprising to see resistance. The food industry will collapse if people pivot to low carb diets :)
  - peter_retief 4y ago
    I think you are right, it is about money.
algoatecorn 4y ago
Every time I see some study anchored in dietary impositions, I can't help but wonder: How have we managed to complicate diet and health so much? We are humans. We are supposed to move. A lot. Eat mostly whole food and move. Walk. Walk uphill. Lift if you can. Run if you can. Buy food in the produce section. Buy food in the meat section (if you eat meat). Buy whole grains. It's not expensive. Maybe it takes time to prepare. Try to find value in that time. Do it with family and friends. There's no food product, diet, or gimmick that's going provide a greater marginal benefit
- fedeb95 4y ago
  This should be the diet. Let's eat less junk food and we'll be better
- hnuser123456 4y ago
  And in my case, don't speedrun 100% grubhub for all the 100+ restaurants in the college town
  - pushedx 4y ago
    I’m an All Tacos% runner myself
- _0w8t 4y ago
  Coach potatoes spend approximately the same amount of calories as modern-day hunter-gatherers. The current thinking is that a body has an energy budget to spend. If one does not move, that energy is spent on other things like hormone synthesis. Conversely walking or even running for 5 miles each day will not decrease the weight. So been overweight is really about eating too much. This does not mean that one should not move. That has a lot of benefits, it is just loosing wright is not one of them.
  - wizofaus 4y ago
    Except those that regularly take part in physically strenuous activities are often very much aware that excess weight makes those activities much harder (particularly if you're at all competitive), which provides extra motivation for being concerned with what and how much you eat. Anecdata, yes, but everyone I know that was overweight in the past and has now lost it and kept it off has done so by taking up some sort of sport/regular physical activity (mostly cycling). I don't know anyone who's done so just by dieting alone.
_0w8t 4y ago
The so-called Low-Fat diet still allowed for 20%-30% of calories to come from fat. There are a lot of indications that this is not really low to make a meaningful conclusion. One needs to target max 10%-15% of calories from fat to make a difference.
Beaver117 4y ago
Yet another useless study clouding peoples minds. Stop eating ultra processed foods, meat is okay, rice is okay, most bread from the store isnt (look at the ingredients). Potatoes are possibly the most nutritious vegetable provided you dont deep fry them in seed oil. Stay away from cheap oils like canola, corn, soybean, safflower. Stick to olive oil, coconut oil, tallow, lard, ghee, etc BUT KEEP IT LIMITED. No need to go on a restrictive keto or carnivore diet, it does have some benefits yes but you're missing out on variety.
- idlehand 4y ago
  Potatoes are a brilliant food. They're filling, contain an appropriate amount of calories, a lot of nutrients and a lot of potassium which helps balance out all that salt we're eating.
  - StephenSmith 4y ago
    https://www.healthcanal.com/nutrition/potato-diet https://www.healthcanal.com/nutrition/potato-diet
- CabSauce 4y ago
  Do you have any studies to support your recommendations?
  - Beaver117 4y ago
    No, I learned these myself through trial and error
    - SketchySeaBeast 4y ago
      I sincerely hope you spent time on a 100% ghee diet to justify saying you figured this out through trial and error.
      - Beaver117 4y ago
JesseMReeves 4y ago
Maybe ancient nomadic humans ate low-carb / keto in winter (which is why it seems good for using up fat resources efficiently) and high-carb in summer (which is why it seems good for filling up fat storages)?
nonameiguess 4y ago
Many comments so far responding with a reader's personal feelings on how all people should eat. This was a study of the effect of these diets on diabetics. As such, it's not a huge surprise that low-carbohydrate, high-fat would come out ahead, given diabetes is a disease that prevents your body from properly processing carbohydrates. The authors here have made no claim whatsoever that anyone who is not diabetic would see any of these same effects and would even want to see these same effects (note that the only thing that might matter here to a non-diabetic is the LDL change, which was worse for the high fat diet). It's just too bad the participants that saw improvement still didn't stick with it and all benefits disappeared 3 months after the intervention was complete.
maerF0x0 4y ago
Note that many of the beneficial effects to blood markers are identical so long as weight is lost. Yes, ad libitum consumption maybe lower on HFLC, but both diets when equated for deficit off TDEE, protein grams, and fiber grams will result in improved blood markers.
- sph 4y ago
  You need to prove that first, it is not a given. Because a n=1 counter argument is seeing my triglycerides, blood pressure and heart rate drop significantly in 2 weeks, while still being overweight on a very low carb diet and having lost a negligible amount of weight (can't do much in two weeks). It is possible that some markers improve as a function of weight, but it is not necessarily so.
beej71 4y ago
I think there are a lot of different types of people who react in a lot of different ways to various diets, and you can't just say this or that is the best without specifying which person you're talking about. Doctor said my cholesterol was getting high, so I radically cut saturated fats. Suddenly I was losing weight at a pound a week, eating as much as I wanted. Shed 25+ lbs that way. Would that work for everyone? I sincerely doubt it. Find what works for you, I say, and to heck with the naysayers.
- edanm 4y ago
  Agreed. And it's not just what works for people in the biological sense (since any diet that's restricting calories will make you lose weight.) It's really what diet works for you psychologically or situationally. If eating in a time-restricted way (Intermittent fasting) causes you to lower total calories, and is easy for you, great. If cutting out carbs is easier for you, great. If counting calories and eating only a certain amount of calories works for you, great - that's what I personally prefer cause it's the most flexible, though counting is a pain at first.

45 points by mikequinlan 4y ago

Effect of Calorie-Unrestricted Low-Carbohydrate, High-Fat Diet Versus High-Carbohydrate, Low-Fat Diet on Type 2 Diabetes and Nonalcoholic Fatty Liver Disease Result: The mean age was 56 years (SD, 10), and 58% were women. Compared with the HCLF diet, participants on the LCHF diet had greater improvements in hemoglobin A1c (mean difference in change, −6.1 mmol/mol [95% CI, −9.2 to −3.0 mmol/mol] or −0.59% [CI, −0.87% to −0.30%]) and lost more weight (mean difference in change, −3.8 kg [CI, −6.2 to −1.4 kg]). Both groups had higher high-density lipoprotein cholesterol and lower triglycerides at 6 months. Changes in low-density lipoprotein cholesterol were less favorable in the LCHF diet group than in the HCLF diet group (mean difference in change, 0.37 mmol/L [CI, 0.17 to 0.58 mmol/L] or 14.3 mg/dL [CI, 6.6 to 22.4 mg/dL]). No statistically significant between-group changes were detected in the assessment of NAFLD. Changes were not sustained at the 9-month follow-up.

altairprime 4y ago
n=165
chrisco255 4y ago
Meaning the diets were not maintained (on avg) after the trial? Can't imagine how difficult it must be to run a properly controlled dietary study. Even if you feed the participants, how can you be sure they're not ingesting additional food outside of the experiment for months on end?
- AnEro 4y ago
  Exactly why it is normal that nutritional science is taken with a grain of salt, not cause researchers are slacking or producing bad studies. Just the fact they have data sources with a giant astrix attached. Imho i think this also plays into the misinformation in the space. It's hard to prove anything and I find I mostly wait for a good meta analysis before putting my eggs in that basket
  - BLKNSLVR 4y ago
    Aside: "astrix"? If intended to be funny, it certainly is. If not, I believe "asterisk" is the word you're looking for. However, I could see astrix becoming the word of 2023. Related: https://www.asterix.com https://www.asterix.com
- chasebank 4y ago
  Why not run these trials in a prison?
  - chrisco255 4y ago
    Ha, probably ethics reasons. Plus prisons aren't representative of general population.
- cableshaft 4y ago
  I did a Keto diet for 4 months and lost 45lbs. Those pounds started coming back quick after I eased off of it (my triglycerides and cholesterol numbers were getting worryingly high). I also found it incredibly difficult to jump back into Keto for any sustained period of time afterwards. Tried and failed within a couple of weeks multiple times, kind of like whenever I try to go off of caffeine. Been finding just eating lower-carb (not as low as keto, and some days where there have been carb binges) and focusing more on whole foods and not eating high-fat foods and my triglycerides and cholesterol numbers are back to normal levels, and I'm back to losing weight again, albeit a lot slower (down 25 lbs this year). I know another guy who lost 107lbs off Keto (he was my initial inspiration to try it, in fact) and he eventually went off it and he had regained about half of that when I saw him last (according to him). I'm sure there are people who have been able to keep the weight off, but it was difficult for me.

hirundo 4y ago

> It remains unclear if a low-carbohydrate, high-fat (LCHF) diet is a possible treatment strategy for type 2 diabetes mellitus (T2DM) N=1 personal non-random uncontrolled experiment: 4+ years of drug-free diabetes control to below pre-diabetic levels via an LCHF diet, regularly measured with continuous glucose monitoring. I suspect that the success rate among self-selected followers is higher than among the randomly assigned.

hollerith 4y ago
What food or foods have been your main source of fat while on this LCHF diet?
- hirundo 4y ago
  Beef, butter, eggs.
- anonymousab 4y ago
  I'm not OP, but I also adhered to an LCHF diet for ~8 months a few years ago. I found that, early on, maintaining a consistently high ratio of fats was hard, but over time, it simply became a natural aspect of things like e.g. eating normal/non-extra-lean beef. For the first while I found that using coconut oil or olive oil was a trivial way of adding just pure fat to my daily numbers. Both of them are relatively cheap (though high cal) and can be added to any heated drink like coffee or tea with minimal impact on for flavor. Over time, this just became unnecessary, but it was helpful early on as it was trivial to prep a small container with n grams of oil every morning. There are also nutrient bars that are explicitly higher on fat and protein and lower on carbs for this very purpose, e.g. 'good fats' bars. Unlike what others report, while I felt generally good and had energy for day to day things, I simply could not ever work up enough energy for more rigorous cardio or weightlifting, compared to when I'm on a normal/carb-rich diet.
readthenotes1 4y ago
I have also met adults who control their diabetes with hclf (high complex carbs, 0 to no simple carbs) I believe that the common denominator is nearly zero sugar.

ablatt89 4y ago

I think this is not so surprising, given that the calories are not restricted in the study. High carb, low fat foods I think are not satiating relative to low carb, high fat foods. As an example: https://pubmed.ncbi.nlm.nih.gov/36051903/ https://pubmed.ncbi.nlm.nih.gov/36051903/ Any type of caloric restriction will improve health outcomes.

user3939382 4y ago
Weight isn't the product of calories in vs out, that's an overly simplistic model that doesn't account for the effect of hormones on how we metabolize different compounds and nutrients. This area of nutrition science is nascent and unsettled, and fraught with research funded by parties with conflicts of interest, but here's for example a pretty good talk that discusses some of the research https://www.youtube.com/watch?v=ZKC3hiyLeRc&t=159s https://www.youtube.com/watch?v=ZKC3hiyLeRc&t=159s
- algoatecorn 4y ago
  It's simple enough to be useful and applied. If you continue to reduce your calorie intake, you will lose weight. This is a fact. Build a model to explain weight gain/loss and calorie intake will always be the most influential variable full stop
  - rhinoceraptor 4y ago
    This is like saying the way to become financially successful, is to simply earn more money than you spend. These two explanations are correct, but not particularly helpful, because they are tautologies.
    - soco 4y ago
      True they're not particularly helpful, but the commenter was arguing against their truthfulness.
  - maerF0x0 4y ago

raajg 4y ago

The conclusion is in line with Tim Ferris's 'Slow Carb Diet'

smcleod 4y ago

Note: Very small sample size (165 participants) of primarily older aged people (mean 56 years), all located in the same geographic region.

atlgator 4y ago

Funded by Novo Nordisk, an insulin manufacturer.

peter_retief 4y ago

Still so much resistance to the high fat diet. It works and it seems to be way healthier than any high carb diet

Kairinz 4y ago
It is not surprising to see resistance. The food industry will collapse if people pivot to low carb diets :)
- peter_retief 4y ago
  I think you are right, it is about money.

algoatecorn 4y ago

Every time I see some study anchored in dietary impositions, I can't help but wonder: How have we managed to complicate diet and health so much? We are humans. We are supposed to move. A lot. Eat mostly whole food and move. Walk. Walk uphill. Lift if you can. Run if you can. Buy food in the produce section. Buy food in the meat section (if you eat meat). Buy whole grains. It's not expensive. Maybe it takes time to prepare. Try to find value in that time. Do it with family and friends. There's no food product, diet, or gimmick that's going provide a greater marginal benefit

fedeb95 4y ago
This should be the diet. Let's eat less junk food and we'll be better
hnuser123456 4y ago
And in my case, don't speedrun 100% grubhub for all the 100+ restaurants in the college town
- pushedx 4y ago
  I’m an All Tacos% runner myself
_0w8t 4y ago
Coach potatoes spend approximately the same amount of calories as modern-day hunter-gatherers. The current thinking is that a body has an energy budget to spend. If one does not move, that energy is spent on other things like hormone synthesis. Conversely walking or even running for 5 miles each day will not decrease the weight. So been overweight is really about eating too much. This does not mean that one should not move. That has a lot of benefits, it is just loosing wright is not one of them.
- wizofaus 4y ago
  Except those that regularly take part in physically strenuous activities are often very much aware that excess weight makes those activities much harder (particularly if you're at all competitive), which provides extra motivation for being concerned with what and how much you eat. Anecdata, yes, but everyone I know that was overweight in the past and has now lost it and kept it off has done so by taking up some sort of sport/regular physical activity (mostly cycling). I don't know anyone who's done so just by dieting alone.

_0w8t 4y ago

The so-called Low-Fat diet still allowed for 20%-30% of calories to come from fat. There are a lot of indications that this is not really low to make a meaningful conclusion. One needs to target max 10%-15% of calories from fat to make a difference.

Beaver117 4y ago

Yet another useless study clouding peoples minds. Stop eating ultra processed foods, meat is okay, rice is okay, most bread from the store isnt (look at the ingredients). Potatoes are possibly the most nutritious vegetable provided you dont deep fry them in seed oil. Stay away from cheap oils like canola, corn, soybean, safflower. Stick to olive oil, coconut oil, tallow, lard, ghee, etc BUT KEEP IT LIMITED. No need to go on a restrictive keto or carnivore diet, it does have some benefits yes but you're missing out on variety.

idlehand 4y ago
Potatoes are a brilliant food. They're filling, contain an appropriate amount of calories, a lot of nutrients and a lot of potassium which helps balance out all that salt we're eating.
- StephenSmith 4y ago
  https://www.healthcanal.com/nutrition/potato-diet https://www.healthcanal.com/nutrition/potato-diet
CabSauce 4y ago
Do you have any studies to support your recommendations?
- Beaver117 4y ago
  No, I learned these myself through trial and error
  - SketchySeaBeast 4y ago
    I sincerely hope you spent time on a 100% ghee diet to justify saying you figured this out through trial and error.
    - Beaver117 4y ago

JesseMReeves 4y ago

Maybe ancient nomadic humans ate low-carb / keto in winter (which is why it seems good for using up fat resources efficiently) and high-carb in summer (which is why it seems good for filling up fat storages)?

nonameiguess 4y ago

Many comments so far responding with a reader's personal feelings on how all people should eat. This was a study of the effect of these diets on diabetics. As such, it's not a huge surprise that low-carbohydrate, high-fat would come out ahead, given diabetes is a disease that prevents your body from properly processing carbohydrates. The authors here have made no claim whatsoever that anyone who is not diabetic would see any of these same effects and would even want to see these same effects (note that the only thing that might matter here to a non-diabetic is the LDL change, which was worse for the high fat diet). It's just too bad the participants that saw improvement still didn't stick with it and all benefits disappeared 3 months after the intervention was complete.

maerF0x0 4y ago

Note that many of the beneficial effects to blood markers are identical so long as weight is lost. Yes, ad libitum consumption maybe lower on HFLC, but both diets when equated for deficit off TDEE, protein grams, and fiber grams will result in improved blood markers.

sph 4y ago
You need to prove that first, it is not a given. Because a n=1 counter argument is seeing my triglycerides, blood pressure and heart rate drop significantly in 2 weeks, while still being overweight on a very low carb diet and having lost a negligible amount of weight (can't do much in two weeks). It is possible that some markers improve as a function of weight, but it is not necessarily so.

beej71 4y ago

I think there are a lot of different types of people who react in a lot of different ways to various diets, and you can't just say this or that is the best without specifying which person you're talking about. Doctor said my cholesterol was getting high, so I radically cut saturated fats. Suddenly I was losing weight at a pound a week, eating as much as I wanted. Shed 25+ lbs that way. Would that work for everyone? I sincerely doubt it. Find what works for you, I say, and to heck with the naysayers.

edanm 4y ago
Agreed. And it's not just what works for people in the biological sense (since any diet that's restricting calories will make you lose weight.) It's really what diet works for you psychologically or situationally. If eating in a time-restricted way (Intermittent fasting) causes you to lower total calories, and is easy for you, great. If cutting out carbs is easier for you, great. If counting calories and eating only a certain amount of calories works for you, great - that's what I personally prefer cause it's the most flexible, though counting is a pain at first.