New England Journal of Medicine - Low Carb Study Revisited
July 22, 2008
My previous entry started a discussion on the new carbohydrate restriction study that was published in the New England Journal of Medicine. Since then there has been a lot of buzz in the media and across the web about this study - what is really is saying, how is is flawed, and how low carb diets have been finally vindicated.
Initially I was going to tear through the paper for you guys and analyze each section pulling out points from the research worth noting. But after thinking about it over the weekend (I didn’t post on Friday as I wasn’t sure how I wanted to present things to you) I realized that an analysis of this paper in that fashion would be boring.
I have to go through those mechanical breakdowns of scientific studies everyday with my PhD work - but just because I do them doesn’t mean I like reading them.
So instead today I’m going to talk about some of the comments that people made on the blog regarding my post and this study and throughout I will give you some practical information that you can take away from the study to improve your weight loss and health.
Sound like a deal?
Onto the comments. Lara correctly pointed out out that the Low Carb diet group wasn’t really low carb as they ate 40% of their calories from carbohydrates. This is right on the money and is one of the things that annoyed me about the buzz surrounding this study. Terms like ‘low carb’, ‘low fat’, etc are very vague and mean different things to different people. If you are normally eating 70% of your calories from carbs then eating 40% of your calories from carbs will be low carb but for the most part eating 40% of your calories from carbs is not a low carb diet but a ‘carb restricted diet’ (I tried to use the term ‘carb restricted’ in the previous post when discussing the diet for clarity although I did slip up a couple times and call it low carb).
This brings us to our first big take home point - The carb restricted group received a lot of health benefits without going on a ‘true’ low carb diet. This drives home the point that you don’t necessarily need to cut carbs completely out of your diet but instead if you just cut back on them you will reap great benefits.
Sean brings up another good point in stating that “the low-carb dieters didn’t have to count calories while the others were on restricted calorie diets.” Not having to count calories is a hallmark trait of carb restricted diets and it drives ‘high carb diet people’ nuts! Because saying that “you don’t have to count calories” is very different from saying “you don’t have to be in a caloric deficit.” but many people don’t seem to realize that.
Many very low carbohydrate diet studies are conducted so that the subjects are not instructed to count calories and the subjects lose weight with great success. I believe that in the very low carbohydrate diet studies run by Dr. Jeff Volek at UCONN they NEVER have subjects count calories and achieve +20lbs of weight loss in a 12 week time period.
Here is big take home point number two. You don’t have to count calories to lose weight. Modifying how you pick your foods (i.e. avoiding starchy carbohdyrates and opting for green vegetables) will automatically help you reduce your calorie intake without the root canal type pain associated with counting calories (for more about losing weight without counting calories check out Your Naked Nutrition Guide).
P.J (who wins longest comment of all time prize 
) brings up a good question in regards to the study design “Why was the LC group counseled to choose vegetarian sources of fat and avoid trans fats?”
I can understand why the carb restricted diet group was instructed to avoid trans fat but I’m not sure why the Atkins Foundation (whom provided funding for the project) didn’t request that they follow the Atkins diet guidelines better (or at all really). The authors in the paper refer to the Supplementary Appendix also provided that explains more about the diets but at the moment there is a glitch in the NEJM site and I haven’t been able to download that (I’ll post an update once I do with take home points).
VN asked for my input on Tom Venuto’s take on the study. In the end Tom and I have a similar opinion on what it takes to lose weight and how this study doesn’t necessarily effect how we approach fat loss. He nicely summarizes the keys to fat loss at the end of his post as:
- Personalization
- Adherence
- Long term maintenance
- Accountability
- Social Support
- Calories
A colleague and fellow nutritionist Jayson Hunter makes 2 very good points that I will highlight to close out this post.
1. “…modifications in overall carb intake and other social support tools people can lose weight.” As I mentioned above you don’t need to reduce your carbohydrate intake A LOT to make a huge impact on your weight loss and health.
2. “Just imagine if these participants were really counseled and given plenty of guidance to be strict with their respective programs.” Amen brother. You need to follow the stinkin’ program! Most people don’t follow their laid out diet plan. If the subject in this study would have been able to do exactly as they were told their results would have been even better.
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3 Responses to “New England Journal of Medicine - Low Carb Study Revisited”
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40/40/20 at 2400 calories and exercising 5X a week has kept me ab friendly and in maintenance for over 3 years now. Whole grains and veggies make up a big part of my diet. Like Venuto says personalize. I think Fiber is my personal fit. Oh well, just sharing. Hope y’all find the personal fit. Happy lifting.
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[...] Low Carb Diet Study [...]
Thanks for your dedication to prompting us on evidenced based practice.
It just makes me laugh a little with the world of research being so relatively bias.
Heres another recent paper that has a different bias, but affectively contradicts your previously considered paper. Although I must admit I haven’t read the actual article as yet, only a report.
Shai I, Schwarzfuchs D, Henkin Y, et al. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med. 2008;359:229-241.
Thanks again for criticing and filtering all the good information to us.
Really appreciate your enthusiasm.
Cheers
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