A Question about the latest diet study ...

As you may have heard there's a new LC vs. LF diet RCT out there.  I'll have more to say about that when some time frees up, but I have had a chance to look at the full text and it is quite the horribly conducted study -- at least by the description put forth in a fairly highly regarded peer review journal.  (disturbing ....)  

In any case, the LC group was instructed to keep carbs under 40g per day.  If you arm a person with some tables of carb content or links to online databases, etc., this is a pretty straight forward and "simple" task.  By that I mean, disregarding any issues with compliance, the task remains an easy and straightforward one.

The LF group was instructed to reduce total fat to a maximum of 30% of calories and sat fat to a maximum of 7%.  We are then told that no calorie goals were specified (for either group).

Pray tell,  how does the LF group accomplish their goal?


Greta Carbo said…
Well, it's sure easier on the LC group in showing compliance: count carbs - you only need one other person to have the digits to get to forty. The LF group has to count each macro plus saturated fat and do some math. That is not so easy, the last meal of the day might require calculation just to see if you can sit at the table.

But why the saturated fat restriction? Meat restriction is already guaranteed by the low fat requirement. I suspect another vegetarian sponsored study which means more than usual scrutiny for dirty tricks.

Does the study show what was actually chosen for the menu? Many fish including some shellfish are low fat. and it would interesting to see if that is a food choice. For either group.

When or where can we read about this study? 40 grams of carbs is a true low carb diet but I wonder if 70-100 grams in the LC is more in keeping in spirit with 30% fat for the LF group. 30% per cent fat is in the range of popularly accepted healhy fat ranges while 40 grams is considered by many as being too low for health (in the long run). In other words, it looks like a moderate LF diet vs an extreme LC diet. So the question is, what is exactly being tested?
David Pete said…
Oh it can be done, you just need a graphing calculator
MacSmiley said…
Actually, perhaps one can figure out macro %'s by adding up the macros of each individual food one eats during the day? Pain in the posterior, I know.
LWC said…
How is 30% fat considered low fat? I thought (per Denise Minger) that <15% is the "magic zone."

I don't think animal protein had to be restricted much to get to 30% fat. It's at the truly low fat levels that you have to forgo at least some animal protein. To get to 30% you probably have to cut back on deep fried foods and processed packaged foods.
carbsane said…
When I blog on it I'll try and share the full text on Google Drive. There is no indication of the foods eaten by either group. Interestingly they give rather detailed avg. intake info -- except for the absolute grams of protein. That you have to figure out for yourself from the percents and calories! Unfortunately since the grams of fat and carb don't agree with the percents and calories, one can't be sure of the accuracy.
carbsane said…
You couldn't even do that without some sort of app as unless you had 100 cal allotments or something it would be a nightmare. I think they tried too hard to eliminate the calorie factor?
carbsane said…
LULZ at only needing one more person to make the digits to count 40g carb :-)
carbsane said…
They have to at least go 20% if it's going to be a "fair fight" for drastic reductions of a macro.
charles grashow said…

"At 12 months, mean total energy intake on the low carbohydrate diet was 1,448 kcal/day with 23.6% from protein, 40.7% from fats, and 34.0% from carbohydrate versus 1,527 kcal/day with 18.6% from protein, 29.8% from fats, and 50.0% from carbohydrate on the low fat diet."

Guess it was the calorie restriction that caused the weight loss.
Lighthouse Keeper said…
That's right, it's deja vu all over again. The much vaunted PREDIMED study had the low fat diet at around 2% less fat than the Mediterranean Diet, both being thirty odd percent. No wonder Dean Ornish gets his knickers in a twist over this.
fatsane said…
I regularly consume under 20 grams of carbs a day and have done so for 2+ years - oddly whenever I open a nutrition textbook I can't find anything about "essential carbohydrates" (I'm 6'2" and 170 lbs - used to be 213)

How many studies have shown a negative effect from a long-term low carb diet?

Not one... there are no long-term controlled studies of a low carb diet - so when people talk about this issue as if they know what "healthy" is, they are really talking out their ass.
fatsane said…
34% carb is hardly low carb either - if the outcome of the study had been the other way round - low carb people would be screaming this.

Shouldn't we focus on the important issue here - the LOWER carb diet beat the LOWER fat diet in basically every heart disease correlate/risk marker (kinda shocking given both diets seem heavily calorie restrictive - even though they didn't restrict either group)

(1450 and 1527 are both very low)
fatsane said…
I eat 70-75% fat and try to eat over 3000 kc a day - if I had 30% fat I'd be worried for my health.
fatsane said…
It's simple carbsane. You read the labels and make sure your fat does not exceed 30% of the total calories you consume each day. So, for instance since I eat roughly 3000 calories a day (a bit more some days) I would not want my fat calories to be above 900 - meaning I could consume roughly 100 grams of total fat. My saturated fat should compose no more than 210 of those 900 calories.

I would also point out that the carbs actually consumed were well above a low carb diet at 35% per commenter below.

It also sounds like you are asserting the lead researcher had some goal to reach this conclusion - read her CV - it's full of papers on cholesterol and fat's role in heart disease as well as quite a few on fruits and vegetables role in preventing it. (Standard lipid hypothesis CV)
fatsane said…

^The person who ran the study talking about the study (lowish fat vs. lowish carb).
fatsane said…
Also you should quit deleting comments - very undemocratic - shows how weak you find your own arguments to be.
fatsane said…
charles grashow said…
care to give us an average day's menus?
StellaBarbone said…
The lower carb people were directed to choose lean protein and cook in olive and canola oil. We already knew that polyunsaturated oils will improve lipid markers.
Wuchtamsel said…
Don't feed the troll. (With fat or carbs doesn't matter...)
carbsane said…
>>> It's simple carbsane. You read the labels and make sure your fat does not exceed 30% of the total calories you consume each day. So, for instance since I eat roughly 3000 calories a day ... <<<

OK, now try again without the total calories ... which was the point of the question.

I haven't even commented on the research yet. I have hinted that I think the journal write up is poor. I'll expand on that when I discuss the study/article, but for now I'll say that the raw data is hopelessly obscured.
carbsane said…
>>> How many studies have shown a negative effect from a long-term low carb diet?

Not one... there are no long-term controlled studies of a low carb diet - so when people talk about this issue as if they know what "healthy" is, they are really talking out their ass

(1) If there are such studies, why is Nina Teicholz going on any program that will have her claiming that such diets have unequivocally been proven to be healthier? The answer is that she is being dishonest in portraying the Shai diet trial as a test of any sort of low carb diet.

(2) Not only have there been no long term studies on this diet, but statistically zero human beings have ever eaten it. Ever. Meanwhile, there are billions of humans who have consumed upwards of 80% of their diets as carbohydrate, and many of the longest living cultures on the planet eat a higher percentage than we do. The LCHF diet is NOT the diet of the Inuit or the Masai.

Therefore it is those who are talking about LCHF as "healthy" who are really talking out of their asses. The burden of proof is on them to demonstrate that it is a healthy diet for the long term, not the other way around.
carbsane said…
I do not delete comments. If Disqus sent them to spam there is usually a reason. I will check.
carbsane said…
Thank you for finding this. Butter in moderation. Someone needs to inform Jimmy that this RCT wasn't for his keto diet or anything even close.
David Pete said…
Why? There are probably billions of healthy people who eat that or less. Why do you feel it would damage your health?
MacSmiley said…
The fiber content of both diets were similar, which means the low fat cohort was eating mostly refned carbohydrates, not whole plant foods which are naturally low in fat and high in fiber which DO improve CV markers better than LC.
Kitty said…
The essential carbohydrate argument is very, very stupid. Please tell me you can do better. Yes, you can survive without carbohydrates. Most of us would like to function at a level somewhere above merely surviving.

A VLC diet will leave you lethargic, constipated, sleep-deprived, insulin-resistant and unable to do any strenuous activity, along with screwing up your thyroid function... but you'll live. Keto advantage!
carbsane said…
John Smith said…
You can cure the sleep deprivation aspect of VLC by taking approximately 9 over-the-counter supplements each night at carefully timed intervals. Through this method you will enjoy excellent sleep on every fifth night.
fatsane said…
There are billions of people in very poor health - I was one. No longer the transformation that followed me adopting a high fat diet (this was after years of low calorie misery and vehement belief in the thermodynamic hypothesis of weight gain) has been nothing short of remarkable - many of my friends and coworkers have seen similar results following my example. (Some of the lipid panel changes I've seen from them have shocked even me)

I look around and I see oceans of fat people suffering from chronic diseases resulting from chronically high sugar and insulin levels which in turn result from low-fat, low calorie diets they try to follow and the inherent substitution towards sugar and refined grain they cause.

It may be that a plant based diet is healthier - but the fact that everyone seems to "know this" and doesn't follow it, seems to indicate alternate messages need to be put forward.

" If the rule you followed brought you to this, of what use was the rule?"

-Cormac McCarthy
fatsane said…
I'm aware you'll argue nobody followed the rules - but my counterargument to this is that the rules CAN'T be followed by the most people, either due to will or some as of yet unproven biological factor - after all who hasn't endlessly tried a calorie restrictive diet, they almost invariably fail after just a few years.
fatsane said…
Oh man,

I always ate ridiculous amounts of food prior to high fat. (I would often eat an entire deep dish Giordano's pizza after work in college)

(If you've been to Chicago you know how much food that is)

I still do eat a lot:

1 cup heavy whipping cream a day. (Spread throughout - in coffee and drunk straight - love the taste)
2-4 table spoons coconut oil.
6-8 eggs yolks, 2-3 egg whites, boursin cheese (half pack) and shredded cheese on top with hot sauce.
2-3 pieces of bacon
Half a rotisserie chicken for lunch (split with coworker) - some days.

1 pound ribeye (costco) for dinner with a half stick of garlic butter and sparing amounts of boursin.
Occasionally small amounts of almonds (not daily)

The other thing I noticed was how easy it was to put on muscle - nobody apart from my girlfriend (who sees me workout) can believe I only workout 5 minutes or less a day - not sure if my results are due to higher testosterone from all the cholesterol in my diet but I'll sure take em' whatever it is.
fatsane said…
I work at a very high level in analytical finance - ketosis has saved me from the mental fatigue I used to experience on the 12-16 hour days we occasionally had to work.

People really shouldn't talk bad about ketosis until they've tried it for a few weeks. It's just like a runner hitting the wall - the more times you've gone through it and the longer you stay in it - the easier it becomes.

Odd Aside:

(runners hitting the wall is actually switching from glucose to FFA's and Ketones - so its the same process - indeed you hear the long-term runners talk about how much shorter the wall lasts the more you go through it)
fatsane said…
Sleep deprivation? I've never heard this argument - I can say the one thing I didn't notice going from low-calorie diets to a low carb one was any difference in sleep. (though it was occasionally hard to sleep hungry on a low calorie diet).
fatsane said…
See, you are making unscientific claims "statistically zero humans have ever eaten it"

A. You don't know that. (you don't know what all humans throughout history have eaten)
B. Native Americans in the plains often ate only Pemmican for vast periods of time (buffalo protein with tallow dripped into it) for months (particularly in the winter) - they were nomads so the only time in the northern midwest that food could be obtained from plants was what they could scrounge from the prairie when it was available. (Buffalo always were).
C. Inuits - even more-so.
D. I eat like that.

(I can't speak for Nina since I haven't read her book but I'd imagine her argument is more along the lines that we don't know, and that the evidence points to the low-fat diet as wrong and the high fat one as healthier - far from unequivocal - I assume like Taubes she urges us to do more science.
charles grashow said…
Have you had a recent NMR or VAP test done?
carbsane said…
If you can eat like that and maintain a lean physique, more power to you. For me, it would not be worth the risk if I could even stand the gross amounts of fat (sorry, everything you mention is appealing in reasonable amounts, but not all together in those amounts). As someone who has worked with human blood from countless people, the cloudy plasma from a fatty meal is quite stark and the metabolic repercussions of this unknown and generally unmeasured by fasting lipids. Given the unnatural nature of such a diet compared with what humans have ever consumed, I cannot see it being recommended save for therapeutic purposes.

On Twitter, Thomas Dayspring stated that roughly 20-25% of people he's seen go on keto diets exhibit the hypercholesterolemia that Jimmy does -- at times TC > 400 , LDL-P > 3000, LDL-C > 300. NOBODY can say that this is not associated with increased risk just because fasting trigs and HDL are good.

This is my big problem with the promoters of this wholly untested diet, which the current trial doesn't even come close to resembling. For all the nonsense about how a low fat diet is untested, it remains nonsense. The vast majority of cultures favor a much lower fat intake than we even consider "low" (30% is a joke to call low fat). The advice is potentially dangerous.
carbsane said…
In the 80's cocaine was popular for much the same reasons. Would you say that people shouldn't talk bad about cocaine until they've tried it for a few weeks?

You are also making assumptions that folks like myself have never been in ketosis and that would be highly erroneous. I don't experience any elevated mental function, rather the opposite as it is difficult to function on only 4 hours of interrupted sleep.
carbsane said…
Yeah, been reading bits about it over at the Little Pharma blog with it's Non-Prescription Pad.
carbsane said…
You haven't been around much then.
carbsane said…
D - You are statistically zero. I have no way of verifying your results and if I do in 30 years it will be too late for me.

C -- The Inuit diet is roughly 45% protein, 55% fat on average and involved seasonal "starvation" with very low fat intakes. They were rarely in ketosis.

B -- Still statistically zero as you'll find most of the northern central plains Indians also consumed a lot of wild rice and potatoes that were preserved for the winter. There were many many more tribes besides the one that is highlighted in low carb lore, including tribes for whom maple sugare was a major dietary component. Let's not forget the rest of the continent either.

A -- No, it is not wildly unscientific. If you say that we can't know what humans ate in the paleolithic, I'd agree. Which is why you cannot *GUESS* that they were keto and claim this supports your diet. Of the cultures whose dietary traditions have been documented, there are isolated pockets that get up to perhaps 60% fat. Such diets were not keto.

So, like I said, it is irresponsible to recommend such a diet to others without expressing the necessary reservations. It is fraudulent to pass off short term trials that don't even test anywhere near the diet as support for the keto extreme.
carbsane said…
Oh and Teicholz claims the high fat has beaten low fat unequivocally. Based almost entirely on the Shai trial while dismissing several others favorable to a moderate fat Mediterranean diet. Her science is awful, but the LC dogmatists are lapping it up.
Kitty said…
I was on a ketogenic diet for a couple of months once. I had the energy of a corpse, and that wasn't even the worst of it.

If you haven't heard of ketosis-induced insomnia and lethargy, then you must have a black belt in confirmation bias. Google "ketosis insomnia." Thousands of threads about it (MDA, paleohacks, lowcarbfriends, myfitnesspal, etc., etc., etc.).
carbsane said…
If you truly believe that people are suffering from chronic diseases due to high sugar and insulin levels and that those arose fro following low fat/low calorie diets, you are deluding yourself. Nowhere on any such diet plan does it say to "replace fat with sugar" ... or refined grain for that matter, though what qualifies as "whole grains" is hardly much more than highly refined powder with a bit of ground up whole mixed in.
carbsane said…
Atkins has been around over 40 years now. Why aren't we all lean? Oh that's right. Too much lean protein.
Glenn Dixon said…
That would be an interesting poll - "Have you ever peed on a ketostix?" The fatsane troll might not believe the numbers.

On a related note, this reminds me of when I left Christianity. So many Christians would talk to me as if I had never believed. I had to constantly remind them that I was a fundamentalist Christian for 40 years. So much polarity in religion, politics, sports and now, it appears, in friggin' diet! So tiring...
Greta Carbo said…
Ha ha, that makes my day! I got so tired of 'splaining (over and over, and often to the same people too!) that it wasn't Atkins I was doing that I stopped self-describing myself as Paleo.

Now I self-appellate as an omnivore and have to explain that I am not a carnivore. I am going nameless soon.
Glenn Dixon said…
Curse of omnivore. CAN eat anything - so vegans and zero carbs are all good, yet yell at each other about which is correct. I eat everything, just not too much. And no pickles *ick*
fatsane said…
People can't eat a low fat - low glycemic load diet long term - the hunger will get them eventually.

I've tried both diets extensively (I once lost 30 pounds on 1000 calories a day and swimming 1000 meters each day) but eventually the hunger won over. (like I said - I have an incredible capacity to eat)

Low-carb is the only one that seems to regulate appetite effectively, this may lead to restriction and ultimate weight loss - but I'm not so sure since I saw my weight loss accelerate pretty massively when I kept eating what I was and turned the fat way up (more butter and coconut oil)
fatsane said…
Variants of Atkins diet go back far past Atkins - Atkins didn't invent low carb but was rather just one of many people/physicians throughout history who brought the diet forward.

In the cases of the people who've seen my example (friends and coworkers) and did what I did, the number one reason was always fear of health risks (due to the perceived heart risk) as well as a firm belief in calories.

All who did it for more than a 2 months lost very significant weight and seem to have kept it off - even as they exempt whole days from the restrictions of the diet.

So the real answer to your question is that most people don't try it - and the ones who do invariably lose weight - this does not however mean that all stay on it.
Glenn Dixon said…
that's just not true

" Among this sample of successful weight loss maintainers, maintenance of weight loss is associated with continued consumption of a healthy low-energy, low-fat diet."

fatsane said…
I really never understood the cholesterol hypothesis - I know people can go on for days about this - but the thickening and stiffening of arterial walls (both of which seem to be influenced heavily by age) seem more likely to have to do with the process of glycation which also ages and stiffens the skin and increases with age.

The other massive issue that is overlooked is how the bacteria they find in the arterial macrophages along with the LDL of bypass patients is the same kind of bacteria that causes periodontal disease.

One thing I have noticed (along with my dentist) was how my teeth stopped developing plaque entirely on this diet. This of course is due to oral bacteria being unable to maintain numbers sufficient to quorum signal and form colonies using biofilm... perhaps the periodontal bacteria (different from the plaque bacteria) are somehow affected by the same process using simple sugars in the blood - I really wish they'd look at this more instead of perpetually treating people with statin drugs that show minimal efficacy and have skewed results due to the multiple interventions people engage in when they are prescribed. (i.e. lifestyle changes often accompany a diagnosis of heart disease as well)
fatsane said…
No, and I never really got why high blood cholesterol would stiffen and thicken arteries, I think heart disease is mostly caused by white sugar and fructose creating glycation in the arteries - indeed this is what much of the current research is focused on.

I believe the only reasons that low fat diets ever show an improvement in heart disease mortality (its usually very small in real terms) is that they remove some of the things sugar can oxidize, but they only slow the process.

A simpler means may just be to get the sugar under some as of yet unknown threshold where the body can enzymatically manage glycation.

charles grashow said…

My goodness! If a new healthy looking, normal weight patient showed up with an LDL-C ~ 230 mg/dL, we are all presuming that familial hypercholesterolemia is present. At the age of 54 we would be searching for arcus senilis, a sternotomy scar or xanthomata. Although there is no premature CHD, there are certainly cholesterol issues in her family. Although we do not have a baseline LDL-P or apoB, how can one go from a perfect lipid profile to a seeming very high risk one in a very short period of time? Can CV lipid/lipoprotein-related risk be worsened by the weight loss? Or perhaps the question is – does it matter what one consumes to lose weight? Is there a danger too low carbs/high fat in some people? Or how about this absurd question – can an LDL-P of ~2600 nmol/L not be associated with atherothrombotic risk? It has been reported for years that diets high in saturated fat raise TC and LDL-C and diets with reduced saturated fat lowers them (Evidence Level IA in NCEP ATP-III). MUFA and PUFA can be neutral or lower LDL-C. MUFA may raise HDL-C. Of course we now know what any therapy does to CV outcomes likely has little if any relationship to what that therapy does to HDL-C but the story that raising LDL-C is associated with or causal of atherosclerosis is widely accepted. I, other lipidologists, and many patients themselves, are starting to see that the above lipid response to a high fat diet as not being very rare response in people who abandon carbs and replace it with saturated fat, especially in those doing extreme carb restriction to achieve nutritional ketosis.

“Let’s get rid of the nonsense seen all over the internet that atherosclerosis is an inflammatory disease, not a cholesterol disease. That is baloney-with the reality being that it is both. One cannot have atherosclerosis without sterols, predominantly cholesterol being in the artery wall: No cholesterol in arteries – no atherosclerosis. Plenty of folks have no systemic vascular inflammation and have atherosclerotic plaque. However clinicians have no test that measures cholesterol within the plaque – it is measured in the plasma. It is assumed, that if total or LDL-C or non-HDL-C levels are elevated the odds are good that some of that cholesterol will find its way into the arteries, and for sure there, are many studies correlating those measurements with CHD risk. Yet, we have lots of patients with very low TC and LDL-C who get horrific atherosclerosis. We now recognize that the cholesterol usually gains arterial entry as a passenger inside of an apoB-containing lipoprotein (the vast majority of which are LDLs) and the primary factor driving LDL entry into the artery is particle number (LDL-P), not particle cholesterol content (LDL-C). Because the core lipid content of each and every LDL differs (how many cholesterol molecules it traffics) it takes different numbers of LDLs to traffic a given number of cholesterol molecules: the more depleted an LDL is of cholesterol, the more particles (LDL-P) it will take to carry a given cholesterol mass (LDL-C). The usual causes of cholesterol depleted particles are that the particles are small or they are TG-rich and thus have less room to carry cholesterol molecules. Who has small LDLs or TG-rich LDL’s? – insulin resistant patients! After particle number endothelial integrity is certainly related to atherogenic particle entry: inflamed endothelia have inter-cellular gaps and express receptors that facilitate apoB-particle entry. So the worse scenario is to have both high apoB andan inflamed dysfunctional endothelium. Is it better to have no inflammation in the endothelium – of course! But make no mistake the driving force of atherogenesis is entry of apoB particles and that force is driven primarily by particle number not arterial wall inflammation.”
charles grashow said…
Have you told this to people like Jimmy Moore as well??
charles grashow said…
Long-term weight loss maintenance

Results of random digit dial surveys indicate that ≈20% of people in the general population are successful at long-term weight loss maintenance. These data, along with findings from the National Weight Control Registry, underscore the fact that it is possible to achieve and maintain significant amounts of weight loss.

Findings from the registry suggest six key strategies for long-term success at weight loss: 1) engaging in high levels of physical activity; 2) eating a diet that is low in calories and fat; 3) eating breakfast; 4) self-monitoring weight on a regular basis; 5) maintaining a consistent eating pattern; and 6) catching “slips” before they turn into larger regains. Initiating weight loss after a medical event may also help facilitate long-term weight control.

Additional studies are needed to determine the factors responsible for registry participants' apparent ability to adhere to these strategies for a long period of time in the context of a “toxic” environment that strongly encourages passive overeating and sedentary lifestyles.

Persons successful at long-term weight loss and maintenance continue to consume a low-energy, low-fat diet

Successful maintainers of weight loss reported continued consumption of a low-energy and low-fat diet. Women in the registry reported eating an average of 1,306 kcal/day (24.3% of energy from fat); men reported consuming 1,685 kcal (23.5% of energy from fat). Subjects in the registry reported consuming less energy and a lower percentage of energy from fat than NHANES III subjects did. Subjects who lost weight on their own did not differ from those who lost weight with assistance in regards to energy intake, percent of energy from fat, or intake of selected nutrients (iron; calcium; and vitamins C, A, and E). In addition, subjects who lost weight on their own and those who lost weight with assistance met the RDAs for calcium and vitamins C, A, and E for persons aged 25 years or older.


Because continued consumption of a low-fat, low-energy diet may be necessary for long-term weight control, persons who have successfully lost weight should be encouraged to maintain such a diet.
charles grashow said…
"some as of yet unproven biological factor"

Any thoughts as to what that might be??
charles grashow said…

Merio said…
maybe it's time for you to check this site:


or this site also:

charles grashow said…
charles grashow said…
Maybe you should - just for science
Angelo Coppola said…
A potentially big problem with the 30% fat guideline for the low-fat group is this: if they tallied their calories and macronutrients at the end of the day and discovered that they had eaten, say, 35% fat instead of 30% -- how would they fix that? The only way is by eating more carbs & protein; i.e. ensuring that they consumed additional non-fat calories, which would lower the percentage of calories from fat.

So, with a 2,000-calorie intake and 35% of calories from fat -- participants would actually have to eat an additional 300 calories of carb & protein (whether they were hungry or not) in order to transform that 35% into 30%. It's a lower percentage, but still the same amount of fat & an extra 300 calories, to boot.

Obviously, I don't know for sure if this happened, but it seems plausible, and if it did, the methodology itself could have led the low-fat group to overeat. Not good.
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