{"id":489,"date":"2014-12-10T13:43:12","date_gmt":"2014-12-10T13:43:12","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/?p=489"},"modified":"2017-08-21T12:08:22","modified_gmt":"2017-08-21T12:08:22","slug":"primary-care-corner-with-geoffrey-modest-md-low-carb-vs-low-fat-diet","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2014\/12\/10\/primary-care-corner-with-geoffrey-modest-md-low-carb-vs-low-fat-diet\/","title":{"rendered":"Primary Care Corner with Geoffrey Modest MD: Low Carb Vs. Low Fat Diet"},"content":{"rendered":"

By: Dr. Geoffrey Modest<\/strong><\/p>\n

T<\/span>he annals of int med published a small randomized controlled trial\u00a0of a low-carb vs low-fat diet for weight loss in September (see\u00a0<\/span>doi:10.7326<\/span><\/span><\/strong>\/M14<\/span>-0180<\/strong>). 148 people 22-75 yo with BMI 30-45 but free of\u00a0cardiovascular disease, diabetes, or kidney disease were recruited at Tulane University,\u00a0with mean age 46.8\u00a0yo, 88% female, 51% African-American and 45% white. Average cholesterol 202, HDL 55 and LDL 123. only 30% on antihypertensives, 14% on lipid lowering agents, and median\u00a010-yr Framingham risk score of 4%. Followed 12 months.\u00a0<\/span><\/p>\n

\"Untitled\"Details:<\/span><\/p>\n

\u00a0<\/span>–73 in low-fat diet group (<30% of daily energy intake from fats, <7% from saturated fats,\u00a0and 55% from\u00a0carbs). 75 in low-carb group (digestible carbs – total carbs minus total fiber– less than 40g\/d). Neither diet had a reduced-calorie goal and all patients\u00a0were told to continue the same\u00a0exercise they had been doing. \u00a0All were given a handbook with\u00a0recipes, sample menus, food lists, meal planners, as well as 1 meal replacement (bar or shake) per day. Weekly 1 hr individual\u00a0visits to\u00a0dietitian\u00a0for 4 weeks, then small group counseling sessions every two weeks\u00a0for next five months, then monthly\u00a0for last 6 months. dietary recall questionnaires provided every 3 months. 80% completed the 12 month intervention.<\/p>\n

–Total energy intake similar between groups (1527 kcal in low-fat, 1448 in low carb)\u00a0with significant differences in food composition\u00a0(but well above the targets)\u00a0\u200bin\u00a0carbs (198g in low-fat and 127\u00a0in low-carb) and fat (52g in low-fat and\u00a069 in low-carb). Similar physical activity in the 2 groups.<\/span><\/p>\n

–At 6 months (comparing\u00a0low-fat to low-carb):<\/p>\n

–Body wt dec 2.3 vs 5.6\u00a0kg, with diff of 3.2 kg (signif at <.001 level)<\/span><\/p>\n

–Waist circumference\u00a0dec 4 vs 5.9 cm (signif)<\/span><\/p>\n

\u200b–HDL no change vs inc 0.10 mmol\/L (3.86 mg\/dl); chol\/HDL ratio inc 0.07 vs dec 0.25; triglycerides\u00a0dec 0.01 mmol\/L (0.9 mg\/dl)\u00a0vs dec 0.22 (19.5 mg\/dl). No signif change in total chol, LDL (though all trended to be better with low-carb diet)<\/span><\/p>\n

–Framingham risk score inc 0.4 vs dec of 0.7 (signif)<\/span><\/p>\n

–CRP (C-reactive protein)\u00a0level inc 6.7 vs dec 4.8 (signif)<\/span><\/p>\n

–At 12 months (comparing\u00a0low-fat to low-carb):<\/span><\/p>\n

–Body wt dec 1.8 vs 5.3\u00a0kg, with diff of 3.5 kg (signif)<\/span><\/p>\n

–Waist circumf dec 5 vs 6.7 cm (nonsignif)<\/span><\/p>\n

–HDL inc 0.06 mmol\/L\u00a0(2.31 mg\/dl) vs inc 0.24 (9.27 mg\/dl); chol\/HDL ratio dec 0.05\u00a0vs dec 0.49; TG dec 0.07 mmol\/L\u00a0(6.2 mg\/dl)\u00a0vs dec 0.23 (20.4 mg\/dl). No\u00a0signif change in total chol, LDL (though all trended to be better with low-carb diet)<\/span><\/span><\/p>\n

–Framingham risk score inc 0.4 vs dec 1.0 (signif)<\/p>\n

–CRP level inc 8.6 vs dec 6.7 (signif)<\/span><\/p>\n

–Only difference\u00a0in adverse events was increase of headaches at 3 months in the low-fat group<\/span><\/p>\n

S<\/span>o, pretty unusually healthy group to start with (given their exclusions, which limit generalizability), in one center in Louisiana (generalizable to people eating different, and probably less tasty\u00a0foods in other geographical areas).\u00a0 Pluses of the study include that there was significant representation of African-Americans (unusual in these studies),\u00a0the results were impressive\u00a0after 12 months (most studies show decrease in efficacy of diet after first 6 months or so), the dietary changes actually made\u00a0were hardly extreme (which may go along with the better adherence), the intervention was pretty easy\/cheap,\u00a0and the results are consistent with several other studies finding that low-carb (or low glycemic index diets) are associated with decreased appetite\/less food intake than low-fat diets (even without calorie restriction), more profound weight loss (esp early on, related to the finding that low glycemic index\u00a0diets depress resting and total energy expenditure less than low fat diets), decreased CRP levels,\u00a0and improvement in chol\/HDL ratio and TG. also more improvement\u00a0in A1c in diabetics.<\/p>\n

\u00a0<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

Low Carb Vs. Low Fat Diet […]<\/p>\n

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