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Category: Nutrition

Weight Loss – Mixed Messages from the American Medical Association

In this report, Canadian and American researchers performed a comprehensive analysis of 48 randomized trials that encompassed over 7,000 individuals. They looked at the weight loss achieved by either a low-fat diet or a low-carbohydrate diet at both 6 and 12 months. They were able to determine that both of these approaches did lead to weight loss but that the “largest weight loss was associated with low-carbohydrate diets.”

There were no significant side effects of either diet, but the most frequent mild side effect, constipation, was seen to occur more frequently in the low-carbohydrate diet compared to the low-fat diet. 

In this study, a diet deriving less than 40% of total calories from carbohydrate was considered low carbohydrate, high-fat. On the other hand, low-fat diets, found to be less effective in terms of weight loss, derived 20% or less calories from fat and had about 60% of calories derived from carbohydrate. 

Interestingly, in the very same journal, In the JAMA Patient Page, a section of the journal that doctors are encouraged to copy and distribute to their patients, this weeks topic was “Healthy Weight Loss.” The specific recommendation that doctors are then told to transmit to their patients stated:

However, most health experts recommend a balanced diet that provides approximately 15% to 20% of calories from protein, 20% to 35% of calories from fat, and the rest from complex carbohydrates.

In other words while the journal is presenting an extensive study demonstrating the effectiveness of a higher-fat, low-carb diet, the actual recommendation made to doctors, and what doctors are told they should communicate to their patients, is exactly the opposite. Again both of these articles appear in the exact same issue of the exact same journal. 

The science tells us to eat less carbs and more fat and the recommendation that we should take to our patients tells us to do just the opposite. In fact, for more information, the JAMA Patient Page then refers us to the US Department of Agriculture. 

It is certainly going to continue to take time for mainstream medicine to embrace the notion that dietary fat plays a critical role in human health end will actually enhance weight-loss. Over the past several decades dietary fat has been virtually castigated, despite excellent science indicating that even as it relates to weight-loss, more dietary fat with reduction of carbohydrates is clearly the most effective approach, as once again confirmed by this recent study appearing in the highly respected and influential Journal of the American Medical Association. Old habits die hard, and clearly people tend to be down on what they are not up on.

  • Lynn Dell

    It’s good news travels fast nowadays. The public can be made aware of these advances in proving a high good fat, low carb diet is best for a lot of issues. There’s pressure in public opinion, and hopefully that will help anybody who is in the pocket of the old school lobby to make a break and follow where the solid science is leading.

  • Boundless

    re: people tend to be down on what they are not up on.

    As I understand it, the average medical student gets less than 20 classroom hours on the role of nutrition in health. This only serves to teach them that diet doesn’t matter. To drive the point home, their medical Boards include exactly zero questions on that topic.

    And almost all of what they were taught was, to put it charitably, mistaken. If they advocate it to their patients, the patients never get better as a result, further confirming what they “learned” in school.

    The American Affliction Associations also tend to get substantial funding from both sources selling the “foods” making every SAD eater sick, and providers of patented potions that pretend to treat the needless ailments.

    So we have an army of the blind, getting counsel from parties who like things just the way they are.

  • Lloyd Stewart

    Excellent post Dr P.

    • David Perlmutter

      Thanks Lloyd. I’m glad to know you find this valuable.

      • Emmalee

        Hi Dr. P. – an important question for those of us with familial high cholesterol. Will the cholesterol-containing foods help us if we stay on a statin?

  • Antoinette Marie

    How do you keep weight on while on this life style change? What’s the highest amount of carbs one can consume and still stay in Ketosis and yet not get skinny as a rail?

  • Lori Weeder

    This also goes for Statin Drugs for elevated cholesterol. After reading several articles about the negatives of Statin Drugs and how the body needs cholesterol, I decided to stop taking my statin drug for a couple months or so before my next scheduled fasting blood work. I was taking one fish oil capsule once a day. When I had my blood work done, my triglycerides were elevated to 323 and my cholesterol was 215.

    • Emmalee

      Hi Lori – do you have high cholesterol due to inheriting it? I do and often wonder if there would be a difference for those with familial cholesterol vs. those who did not.
      I have taken 20 mg Zocor for over ten years. When I added fish oil to that, my LDL dropped to 70. This was post-physical labs and results.

      • Lori Weeder

        I believe I inherited it. A cardiologist I saw once for a screening prior to a surgery told me that those numbers on my cholesterol were what I got from my great grandparents. My LDL was 60 while on statin drugs. This last time it was 94. My HDL went from 53 to 57. Prior to the most recent blood work my Cholesterol was 146 and my triglycerides were 163. When I told my PC doctor about stopping the statin drug and why, he said studies show that the good of taking statins outweigh the possible bad. But what about what I have read about our body and brain needing cholesterol?

        • Emmalee

          That is a good question! We have lots of good cholesterol from foods but will the liver kick them out as well? I am going to see my MD next week and will inquire.

  • Attracta

    Those of us in the celiac world have members who actually give a detailed presentation of disease to medical students. We have seen great improvement of knowledge and being willing to f/u.

  • Lori Weeder

    Hit enter too soon. The nurse called and said the doctor said to tell me that I needed to remain on the Statin drug and increase my fish oil to 4000 mg or units ? per day. Shortly after that I started getting an itchy rash on my neck and chest. I looked up side effects of the statin drug and the fish oil and both listed rash. Also, I had just had a flu shot. I could not get in to my doctor so I saw a NP and she said she thought it might be poison ivy. I have not had that for over 50 years when I had a horrible case as a 12 year old and thought I had developed an immunity. She gave me a cortisone shot and prednisone pills. I continued to itch though not quite as badly as before. My husband and I decided to stop the statin drug and cut the fish oil to 1 per day and the rash disappeared and itching stopped. I have no definite answers, but if I am on a low carb diet, no gluten, no dairy and low to no sugar and as little of corn or soy as possible is it bad for me to have elevated cholesterol and triglycerides? Or is it better for me to take Statin drugs? It is like getting conflicting medical advice.

    • Deirdre

      pfyzer have just paid a big settlement, lipitor causing calcium deposits in arteries, leading to Heart Disease! Cholesterol got the blame for a crime it did not commit, high triglycerides would indicate to me a liver issue, try nettle or dandoline tea, whwt you need to know are you LDL and HDL levels, Hdl is the good one, try avocado and coconut oil, poison Ivy! that one made me laugh! Best of luck to you Lori Weeder.

    • LibbyMe

      there is no proof that statin drugs lower cholesterol or help with heart disease. These are actually caused by inflammation..address that and it will go away. Statin drugs “do” cause diabetes and cause the liver not to function properly. I refuse to take them…told my NP that as well and she’s not liking it.

  • Deirdre

    The sad thing about this low fat fad is that so many young people are Vitamin D defficient.

    • Yvonne Forsman

      If only that was the o-n-l-y negative result!

  • Z

    I think it was a clerical error… or at least I hope it was…

  • Dr P I read the meta-analysis and I’m afraid I cannot find any evidence that the study supports a low carbohydrate diet. On the contrary the excerpts from the study copied below make it clear that they specifically conclude that low carb and low fat diets are equally efficacious. In fact at 12 months the low fat diet seems to outperform the low carb diet. I am a proponent of the LCHF regime but as a scientist I have to be objective in how I read and report research studies.

    “At 12-month follow-up … the diet classes of low fat (7.27 kg [95% CI, 5.26-9.34 kg]) and low carbohydrate (7.25 kg [95% CI, 5.33-9.25 kg) continued to have the largest estimated treatment effects. At 6-month follow-up, the low-carbohydrate diet class had the highest estimated probability of being superior to all other diet classes at 83%; however, at 12-month follow-up, the low-fat diet demonstrated the highest probability at 50%.

    Low-carbohydrate and low-fat dietary programs were associated with more weight loss than no dietary intervention over a 12-month period; behavioral support and exercise enhanced weight loss. The weight loss differences between indivdual named diets were small with likely little importance to those seeking weight loss. This supports the practice of recommending any diet that a patient will adhere to in order to lose weight.”

    • Bob P

      Interesting that the weight loss accelerates during the first six months for the low-carb group but then achieves parity with the low-fat group at the 12 month point.

      All things being equal, though, it would seem the low-carb is much more beneficial for diabetic patients and others who need to restrict their carb intake.

      Thanks for the “devil’s (scientists?) advocate” position.

      • The problem with putting forward such publications is that not everyone can read them critically. The study concludes clearly that there is no difference (in weight loss) between the two diets but I take issue with the original RCTs included in the meta-analysis and the level of control they had in their methodology. The devil is in the detail! Thanks for your reply!

    • Rebecca Young

      Thank you for reading the original study and pulling out these quotes. I’ve now read the study and agree. It certainly does not support a low-carbohydate diet over a low-fat diet. Dr. Perlmutter, your work has strongly affected my thinking and my actual diet, even though I was quite healthy before learning of your work. I have recommended Grain Brain to others. I am especially interested in the implications of your work as I am a mental health attorney, representing many elderly clients in nursing homes who are given dangerous antipsychotic medications to address “behaviors” associated with dementia. I have come to trust you, and I want to be able to continue to do so. Please respond to Mr. Tsakirides’ comments regarding your interpretation of the study. Thank you.

      • Dear Rebecca
        Thanks for taking the time to read my comment. It is quite possibly an oversight on Dr P’s part caused by being so prolific. I have found his writings and videos very helpful and always try to follow up the studies he quotes – it’s a professional habit.

    • LisaM

      Costas, you should read this interview with Gary Taubes. http://blogs.scientificamerican.com/cross-check/2014/10/07/gary-why-we-get-fat-taubes-speaks-out-on-diet-studies-including-his-own/ The JAMA study is discussed. He goes over the flaws and methodological problems with many of these diet studies.

      For example one big problem is that with most of the studies that compare low carb to low fat, the group that is low fat group is calorie restricted, whereas the group that is low carb is allowed to eat as much as they want. So, the one group is hungry and the other group isn’t. From the link:

      “The catch is that when the investigators report the results, they typically ignore the fact that one diet was prescribed calorie-restricted (the low-fat diet) and one wasn’t (the low-carb). This study published in 2010 is a good example. It was funded by the NIH and was the largest such trial ever done up until then. The investigators mention in the intervention section that the low-fat diet consisted of a “limited energy intake” and the low-carb diet did not, but that’s effectively the only time they mention it. So what they’re doing is comparing a low-fat diet that is calorie-restricted and, as I said, carbohydrate-restricted, to a low-carb diet that is neither fat or calorie-restricted, but you’d never know it from reading the rest of the paper.”

  • Yvonne Forsman

    The body stores toxins in the fat tissue. Detox and lose weight! Google Dr Usman Detox Protocol.

  • Dr. Z

    I received my BS in Nutrition/Dietetics at a large University and then went to a 4 year Naturopathic Medical school. My personal diet for the last 15 years has been low carb high fat and I remember being told at University that my fat content was too high (even though it was from nuts, seeds, avocados, olive oil, coconut oils, fatty fish etc.) At Naturopathic school, I learned more about clinical nutrition. It is the basis of Naturopathic medicine and many hours are spent in biochemistry classes, and specific nutrition classes. Research at our Naturopathic school is not funded by the Dairy Counsel or the US Dept of Agriculture, or a large food/beverage company, so we do not have to “massage” the stats in order to continue to get funded. Instead we focus on the science/ breakdown of Proteins, Fats, and Carbs, and what we see and learn clinically.
    I’ve been in private practice for 4 years and I educate my patients that healthy fats are not evil and do not put weight on but help take it off. That not all carbs are created equal and we have a long discussion just about carbs, and then we discuss protein and its many sources. Depending on their health history, family history, stress levels, exercise history etc. I help them see how their diet plays the lead role in their health.
    I also tell them to read Grain Brain.

    • Maggiemae

      I wish there were more doctors in every area like you. I’m a diabetic and would love nothing more than to just sit down and talk to a doctor about what I eat and how I should change my diet. I keep my carbs under control. I’m still overweight, my A1C is 7 and I would like it to be lower and I’d like to be healther. I’m 69 yrs. old and have yet to find anyone that has helped me with foods. I just got the Grain Brain cookbook.

      • Eli

        Read the book Blood Sugar 101 to help you with very specific instructions to get your blood sugar down. Author is Jenny Ruhl.

        • Maggiemae

          Thank you. I’ll get on Amazon and Ebay and get it ordered.

    • Interesting Dr Z. Is Naturopathic medicine officially in support of LCHF diets? I was under the impression they promoted more plant-based and fruit-based diets. Maybe that’s ‘old school’?

  • Katie

    Thank you for raising awareness! I have increased my health 10 fold by going high protein/fat, low carb and the only carbs consumed are veggies, minimal fruit. This allowed me to lose 40 pounds and keep it off for years, never felt better getting rid of grains, sugar and high carb food. Keep pressing on Dr. P! You’re changing many many lives. Kudos!

    • David Perlmutter

      Wonderful to hear that you are a success story Katie.

  • cpark

    Went low-carb (under 30 grams a day) several months ago and have lost 31 pounds so far. I feel so much better! More energy, clearer thinking. Diet is meat, non-starchy vegetables, full-fat dairy and the occasional handful of almonds, along with lots of water.

    • David Perlmutter

      Thanks for sharing this with me CPark. It’s good to know there are success stories like yours out there.

    • adriana

      hi cpark. what kind of meals you put together?
      I’m overweight and ready to try Dr Perlmutter suggestion

      • cpark

        Any kind of non-starchy vegetables and lean meats. I have full-fat cottage cheese and a small handful (8-10) almonds for lunch. Dessert is a half-cup of full-fat greek yogurt with a squirt of sugar-free vanilla syrup.
        Snacks include veggies dipped in salad dressing, the occasional piece of sugar-free candy, nuts or lean meats.

  • wfindley

    All I have to say is, Thank GOD, someone is finally putting the truth out!!

    • David Perlmutter

      Hopefully we can continue to spread the word.

      • wfindley

        Thanx for your reply, here at NaturesSpaTreatment.com we’re trying to help this by showing people how to get the Purest Water they can!!

  • J B

    About a year ago I read “Grain Brain”. I am a 78 year old heart patient and knew my “beer belly” had to go. I am 5’8″ and weighed 175 # at that time. With out much pain at all I lost about 27# and had all my pants taken in to 32″ from 36-38″. I’m back to my weight when I started college in 1954.
    I work out 3 times a week, like before, and the low carb approach worked wonders. My blood sugar is normal for the first time since 1982. I had always been pre-diabetic and the advice was to “cut the sweets”. It’s carbs my friends.

    • David Perlmutter

      Wonderful results JB. Congrats on taking back control of your health.

    • Suzy Fauria

      Congrats, JB! I’m sure your family is thankful you made the changes 🙂

  • Sandra

    After 6 months on the high fat, low carb, moderate protein, gluten free diet, I just got great news at my very surprised Doctor’s appointment. She had suggested cholesterol lowering drugs at my last appointment, but I told her I was expecting to see “magic” in my latest lipid profile. That’s what it showed–MAGIC! Total cholesterol 247 (down 51), triglyceride 130 (down 42), HDL 53 (up 13), calc LDL down 50 to 168, chol/HDL ratio went from 6.48 to 4.66. I had also lost 15 lbs, and would like to lose 20 lbs more by the next six month lab check.

    I’m going to keep doing what I was doing, and pay even closer attention to equalizing the omega 3’s & 6’s. The only fats in my diet are coconut oil, flax seed oil, krill oil, 2 eggs a week, and 1 salmon filet a week. I generally eat lots of raw nuts and small amounts of home cultured tempeh, mushrooms, and beans for protein, along with large amounts of greens, moderate veggies, and daily citrus. For the next six months I’ll exercise more, walk twice as far each day, and cut back on carbs even more. I’m considering cutting back on the 4-6 tablespoons of fat I consume each day, but I’m not sure if I should since I got such good results in the first 6 months on the plan.

  • apt

    For those of us who are not so science “minded” can you please give some examples of 50-80/g carbs. like bread, rice, beer, etc. thx.

  • sandy bikus

    nutrition question:
    when a label lists “protein” does that mean “complete” protein??

  • Caringpa

    The conflict arises because in a higher fat diet there is evidence showing that there is significantly more atherosclerosis, even if patients are loosing weight due to lower carbs. Check out Ornish.com for a medically researched and accepted approach to healthy living.

  • Jess

    I believe there is a false notion that a low-carb, high fat diet means gulping down lard (e.g. bacon) and cream, coupled with a high intake of protein (I noticed I myself had such a picture etched to my brain). However, if I now understand this diet correctly (I’m a newcomer), the idea is to have 20% of the calorie intake from protein (not 5 steaks a day), and fat MAINLY from healthy vegetable sources (olive oil, avocados, nuts, seeds) coupled with a more moderate amount of animal fat. The notion of a 60% calorie intake in the form of fat may conjure up images of piles of fat on one’s plate, but if we consider that fat is very energy dense, one may not need to consume very large volumes of it in order to reach 60% of one’s daily calorie intake. Or am I at all thinking along the correct lines here? Since cholesterol is mostly derived from animal fat, I would assume it is good to ensure a proper intake of it by eating eggs and meat products in addition to vegetable fats (BTW where do vegans get their cholesterol or do they just produce all they need themselve?) One thing I am not completely clear on is what my approach to animal fat should be. Is it better to chose a more lean variant, e.g. filet over bacon, or does this not make any difference? What would you say should be the %-distribution between vegetable fat and animal fat? 60/40, 80/20? Or is this relevant at all? And as we are talking fats, how much coco butter is it ok to consume? And what makes butter (dairy fat) healthy, while dairy products in general should be avoided (due to their tendency to induce inflammation, I would think)? So many questions…

  • Wheat-Free Wonderer

    Hi Dr. Perlmutter
    I started following your Grain Brain diet a year ago and lost 20 pounds. The only problem was, I was already extremely skinny and I got to the point where I was almost anorexic. I went back on wheat (and gained it all back!), then became an insomniac and started getting terrible headaches. I want to go back on the Grain Brain diet to help with my sleep/headaches, but how can I make sure that I won’t become overly skinny without going on the wheat?

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