Diets That Reduce Calories Lead to Weight Loss, Regardless of Carbohydrate, Protein or Fat Content


February 26, 2009
Health, Uncategorized

Many popular diets emphasize either carbohydrate, protein or fat as the best way to lose weight. However, there have been few studies lasting more than a year that evaluate the effect on weight loss of diets with different compositions of those nutrients.

In a randomized clinical trial led by researchers at the Harvard School of Public Health (HSPH) and Pennington Biomedical Research Center of the Louisiana State University System, a comparison of overweight participants assigned to four different diets over a two-year period showed that reducing calories achieved weight loss regardless of which of the three nutrients was emphasized. The study, which was funded by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health, appears in the February 26, 2009 issue of The New England Journal of Medicine.

“This is important information for physicians, dieticians and adults, who should focus weight loss approaches on reducing calorie intake,” said Frank Sacks, professor of cardiovascular disease prevention at HSPH and lead author of the study.

The NEJM issue includes an accompanying editorial on the study’s findings.

The trial included 811 men and women who were randomly divided into four diet groups with different target nutrient compositions:

* Low-fat, average protein: 20% of calories from fat, 15% of calories from protein, 65% of calories from carbohydrate

* Low-fat, high-protein: 20% fat, 25% protein, 55% carbohydrate

* High-fat, average protein: 40% fat, 15% protein, 45% carbohydrate

* High-fat, high-protein: 40% fat, 25% protein, 35% carbohydrate

The participants were diverse in age, sex (62% women, 38% men), geography and income. The diets followed heart-healthy principles, replacing saturated with unsaturated fat and were high in whole cereal grains, fruits and vegetables. Each participant received a diet prescription that encouraged a 750-calorie reduction per day, however none were less than 1,200 total calories per day. Participants were asked to do 90 minutes of moderate exercise each week. They recorded their daily food and drink intake in a food diary and in a web-based program that provided information on how closely they were meeting their dieting goals. Individual counseling was provided every eight weeks over two years and group sessions were held three out of four weeks during the first six months and two out of four weeks from six months to two years.

The results showed that, regardless of diet, weight loss and reduction in waist circumference were similar. Participants lost an average of 13 pounds at six months and maintained a 9-pound loss at two years. Weight loss primarily took place in the first 6 months; after 12 months, all groups began to slowly regain weight, a finding consistent with other diet studies. However, the extent of weight regain was much less, about 20%, of the average regain in previous studies. Waistlines were reduced by an average of two inches at the end of the two-year period.

Most risk factors for cardiovascular disease improved for dieters at six months and two years. HDL (“good”) cholesterol increased and LDL (“bad”) cholesterol, triglycerides, blood pressure and insulin decreased. The metabolic syndrome, a group of coronary heart disease risk factors including high blood pressure, insulin resistance and abdominal obesity, also decreased.

The main finding from the trial was that diets with varying emphases on carbohydrate, fat and protein levels all achieved clinically meaningful weight loss and maintenance of weight loss over a two-year period. “These results show that, as long as people follow a heart-healthy, reduced-calorie diet, there is more than one nutritional approach to achieving and maintaining a healthy weight,” said Elizabeth G. Nabel, M.D., Director, NHLBI.

Another important finding was that participants who regularly attended counseling sessions lost more weight than those who didn’t. Dieters who attended two thirds of sessions over two years lost about 22 pounds of weight as compared to the average weight loss of 9 pounds. “These findings suggest that continued contact with participants to help them achieve their goals may be more important than the macronutrient composition of their diets,” said Sacks.

Support for this study was provided by the National Heart, Lung, and Blood Institute, National Institutes of Health and NIH General Clinical Research Center.

“Randomized Trial Comparing Fat, Protein, and Carbohydrate Composition of Diets for Weight Loss for Two Years,” Frank M. Sacks, George A. Bray, Vincent J. Carey, Steven R. Smith, Donna H. Ryan, Stephen D. Anton, Katherine McManus, Catherine M. Champagne, Louise M. Bishop, Nancy Laranjo, Meryl S. Leboff, Jennifer C. Rood, Lilian de Jonge, Catherine M. Loria, Evan Obarzanek, Donald A. Williamson, NEJM, February 26, 2009, vol. 360, no. 9.




Diets That Reduce Calories Lead to Weight Loss, Regardless of Carbohydrate, Protein or Fat Content

21 Responses to Diets That Reduce Calories Lead to Weight Loss, Regardless of Carbohydrate, Protein or Fat Content

  1. mary900009 March 18, 2010 at 12:32 pm #

    Great study!I decided to try a calorie reduced diet before my lap band procedure and I lost 20 pounds!

  2. Anonymous March 4, 2010 at 4:48 pm #

    I enjoyed reading this post. Thanks for a wonderful job!

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  4. Anonymous October 23, 2009 at 2:21 am #

    Hey / Hello,
    I read article its good and also informative which is based on Diets That Reduce Calories. Keep it up Dietary Fibre plays an important role in keeping our body healthy and processing of food looses almost 40% of fibre content.
    more detail will available on this link ….http://www.medimanage.com/my-diet/articles/fibre-the-essential-stuffing-in-your-diet.aspx

  5. Anonymous August 13, 2009 at 6:38 am #

    I agree with madler… any conscious restriction is.. well.. restriction. Although there’s nothing inherently wrong with that from a mental point of view and there indeed is some merit to that… but it is still fighting against the body – and is a deprivation strategy in itself… on some level anyway… understanding how the body decides what it needs (as well as “wants” and those are clearly different) and what affects that mechanism would certainly bring a lot more value from a practical perspective… I strongly believe that new, more “intuitive” approaches to dieting (as well as exercise) will emerge soon based on that understanding…

  6. Anonymous July 5, 2009 at 2:01 pm #

    Great article

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  7. Anonymous April 4, 2009 at 12:02 pm #

    Great Article!! Another good tip would be to eat 7 A.M., 10 A.M., 1 P.M., 4 P.M., and 7 P.M…

    small portions = higher metabolism.

    Claire, Trainer
    http://5waystodietandbehealthy.blogspot.com/ (more tips)

  8. Anonymous February 27, 2009 at 1:34 pm #

    What a great response! Thank you!

    P.S. Taaaake oooon me, take on me! ;)

  9. Anonymous February 27, 2009 at 1:33 pm #

    Gary Taubes is a science writer. I am a nutritionist with a masters degree and four years of training. This is the problem with Americans, when they do want their easy fix, they turn to pop culture rather than trained professionals.

  10. Anonymous February 27, 2009 at 12:09 pm #

    1. I’m more of an independent observer when it comes to the various types of diets, and that’s mainly because I’ve found what’s good for me through trial and error. That includes how much I need to eat and how frequently, as well as whatever ratio of the food groups that ends up being. Frankly, I have no idea what that ratio is, and it won’t be helpful for me know what your ratio is … our bodies aren’t equivalent.

    2. The idea of ketosis as a form of sustainable energy seems rather ridiculous to me. I’d equate it to pedaling a bicycle with your hands instead of your feet, forever. Human metabolism is a tuned machine from a biochemical standpoint. The Krebs/TCA/Dark Cycle nets 36 ATP, whereas anaerobic metabolism nets 2 ATP. When it comes to ketosis, you’re not limiting the oxygen to force the switch fermentation, but ultimately achieving the same end result through another much less efficient pathway of lipolysis. If you’re a sedentary being that only needs his/her body to work extra hard just to support the brain and liver, that’s fine. If you want to have an active lifestyle and maintain muscle density, it just doesn’t make sense as a sustainable diet.

    3. Not to be picky, because perhaps you were completing it mentally, but some of your logic is flawed. You say “Indeed, people on low carb diets have seen the LDL lower and HDL raise” … but it’s not the carbohydrates that are impacting the levels, it’s the increased fiber and reduction in saturated fats that give better HDL/LDL levels. And yes, you can have a low-carb diet that’s high in fiber and low in saturated fat. And the rest of your arguments follow the same (1) here’s my point (2) evidence that sounds good but doesn’t directly support and/or isn’t specific of my point (3) [insert contemptuous comment about the AHA]. Yes, you can get vitamins from other sources than fruits/vegetables … at what sacrifice to caloric intake or health (e.g. you may have to eat 5 lbs of red meat to get the equivalent amount of vitamins in a cup of veggies)? Yes, Jack La Lanne ate meat, but he also consumed thousands of calories of carbohydrates to sustain the strenuous workouts … no active person/athlete/body builder could do it otherwise.

    4. I thought AHA was a band from the 80s …

  11. Anonymous February 27, 2009 at 8:54 am #

    > However, this is not a healthy way to lose weight in the long term.
    > Diets which allow unlimited fat, saturated fat, and cholesterol (as
    > nearly all low carb diets do) may lead to any one of many
    > cardiovascular diseases. Dr. Atkins himself experienced cardiac arrest
    > in 2002. Further, the body requires complex carbohydrates, simple
    > carbohydrates and vitamins and minerals to function effectively
    > and sustain life

    Go read “Good Calories Bad Calories”. There is there is little evidence to link low-carb (not no carb diets) any of the diseases of western excess. Indeed, people on low carb diets have seen the LDL lower and HDL raise which is counter to the bankrupt recommendations of the AHA from the 50’s onwards.

    Dr Atkins outlined a way of using ketosis to lose weight some decades ago. He was kinda resting, defeated almost by the Surgeon General and the AHA up to the turn of the millennia. Gary Taubes, in a precursor to his ultimate tome on the entire history of science/health in the west, penned the an article for the New York Times – “What if it had all been a big fat lie”. Atkins’ diet got a second life. Dr Atkins himself may not have been on the diet when he died, or indeed even in the intervening years.

    Gary Taubes back filled the objective history of the carbs in the American diet. From memory, it was 10 grams per American per day in 1910, and is now in excess of 100 grams.

    There is a particularly interesting section of his book that details a previous study on calorie restriction, and the measurement of the hunger claims and the thoughts of those under the study. Some suffered long term effects of calorie restriction. I’ll follow up with an excerpt.

    Vitamins? It turns out that the Scurvy allegations that the sailors on English galleons experienced all of a sudden, were because of a switch from salted meat (in barels) to processed starches (in barrels). This was effected to allow for longer more effective sea campaigns. The kicker ? Red meat has lashings of vitamin C. Lemons/Oranges as supplies for such sea farers was to allow the continued use of starches as the primary food source. Unfortunately we have a myth that lasts today suggesting that fruit/veg are the only ways to get Vitamin C.

    Thus we have many college educated people engaged in long-term low carb (not no carb) diets now, as a life choice. They are maintaining their weight, or losing it if they need to. None of their diets are represented in the study cited in this page, they are all off the bottom of the scale.

    Lastly, and by no means a study of appropriate size, check out the finger-tip pushups of Jack La Lanne in his 90’s – a celebrated meat eater. Contrast to the hobbled form of a 100 year old Ancel Keys the architect of the food pyramid (carbs good, fat/protein bad) from the 1950’s and extinguisher of any counter studies that were commissioned during his decades in effective power.

    Just because low/slow carbs is new to you, does not mean you have to do the knee-jerk AHA sponsored response that and entire generation has been conditioned to give. Educate yourself. Start with Good Calories Bad Calories.

  12. Anonymous February 27, 2009 at 7:55 am #

    To those without knowledge of the macronutrients and their function in the body, it would seem as if a low carb diet provides quick, healthy and sustainable weight loss without cutting calories. First, low carbohydrate diets are a form of calorie restriction, that is why they work in the short term. Almost any time an entire food group is eliminated from or severely restricted in the diet, calories are cut and weight loss occurs. Diets without carbohydrates emphasize protein and fat, both of which contribute to feeling full. Thus, the dieter can eat less without feeling hungry.

    However, this is not a healthy way to lose weight in the long term. Diets which allow unlimited fat, saturated fat, and cholesterol (as nearly all low carb diets do) may lead to any one of many cardiovascular diseases. Dr. Atkins himself experienced cardiac arrest in 2002. Further, the body requires complex carbohydrates, simple carbohydrates and vitamins and minerals to function effectively and sustain life. The main source of vitamins and minerals is fruits and vegetables. These contain….AHHHHHH…..carbs. This leads many ignorant low carb patrons to severely restrict these items in their diet, paving the way for vitamin deficiencies including impaired vision, rupture of blood cells, nerve damage, impaired bone mineralization, prolonged blood coagulation, anorexia, muscle weakness, beriberi, photophobia, peripheral neuropathy, indigestion, fatigue, insomnia, etc etc. And no, vitamin supplements cannot replace the levels lost from the diet or provide enough for health benefits in a restricted diet. All kids know that fruits and vegetables are food for you. But Americans will look for any reason to avoid eating them….especially if they think they doing so will help them lose weight without actually changing their diet habits or working out.

    Glucose is the form of sugar that travels in your bloodstream to fuel the brain. Glucose is the ONLY fuel used by brain cells. Because neurons cannot store glucose, they depend on the bloodstream to deliver a constant supply of this precious fuel. If glucose is not provided by the diet for prolonged periods of time the brain cannot function and will shut down.

    Finally, one must consider fiber. Most Americans do not consume the recommended amount of fiber each day. This is why we have significant problems with bowel movements and/or constipation. Fiber is the indigestible portion of plant foods that move food through the digestive system, absorbing water and easing defecation. Since plants contain carbohydrates and little fat or protein, these are the items removed from the low carb diet. Without fiber and with high amounts of animal foods, bowel movements will inevitably be infrequent, dry, hard, and painful.

    Yes, many Americans do eat too many highly refined carbohydrates such as sugary cereals, white breads and snack foods containing added sugar. It is true that these items should be limited. However, fruits, vegetables, whole grains, beans and legumes should be consumed every day to avoid adverse health effects and to promote a long and healthy life. (Note, these foods are naturally low in fat and calories, which aids in weight loss.)

    Before you attempt to discredit the AHA or other organizations designed to promote health and wellness using evidenced based recommendations, I suggest you put down the paperback fad diet book and pick up a basic nutrition or physiology text.

  13. Anonymous February 27, 2009 at 7:54 am #

    To those without knowledge of the macronutrients and their function in the body, it would seem as if a low carb diet provides quick, healthy and sustainable weight loss without cutting calories. First, low carbohydrate diets are a form of calorie restriction, that is why they work in the short term. Almost any time an entire food group is eliminated from or severely restricted in the diet, calories are cut and weight loss occurs. Diets without carbohydrates emphasize protein and fat, both of which contribute to feeling full. Thus, the dieter can eat less without feeling hungry.

    However, this is not a healthy way to lose weight in the long term. Diets which allow unlimited fat, saturated fat, and cholesterol (as nearly all low carb diets do) may lead to any one of many cardiovascular diseases. Dr. Atkins himself experienced cardiac arrest in 2002. Further, the body requires complex carbohydrates, simple carbohydrates and vitamins and minerals to function effectively and sustain life. The main source of vitamins and minerals is fruits and vegetables. These contain….AHHHHHH…..carbs. This leads many ignorant low carb patrons to severely restrict these items in their diet, paving the way for vitamin deficiencies including impaired vision, rupture of blood cells, nerve damage, impaired bone mineralization, prolonged blood coagulation, anorexia, muscle weakness, beriberi, photophobia, peripheral neuropathy, indigestion, fatigue, insomnia, etc etc. And no, vitamin supplements cannot replace the levels lost from the diet or provide enough for health benefits in a restricted diet. All kids know that fruits and vegetables are food for you. But Americans will look for any reason to avoid eating them….especially if they think they doing so will help them lose weight without actually changing their diet habits or working out.

    Glucose is the form of sugar that travels in your bloodstream to fuel the brain. Glucose is the ONLY fuel used by brain cells. Because neurons cannot store glucose, they depend on the bloodstream to deliver a constant supply of this precious fuel. If glucose is not provided by the diet for prolonged periods of time the brain cannot function and will shut down.

    Finally, one must consider fiber. Most Americans do not consume the recommended amount of fiber each day. This is why we have significant problems with bowel movements and/or constipation. Fiber is the indigestible portion of plant foods that move food through the digestive system, absorbing water and easing defecation. Since plants contain carbohydrates and little fat or protein, these are the items removed from the low carb diet. Without fiber and with high amounts of animal foods, bowel movements will inevitably be infrequent, dry, hard, and painful.

    Yes, many Americans do eat too many highly refined carbohydrates such as sugary cereals, white breads and snack foods containing added sugar. It is true that these items should be limited. However, fruits, vegetables, whole grains, beans and legumes should be consumed every day to avoid adverse health effects and to promote a long and healthy life. (Note, these foods are naturally low in fat and calories, which aids in weight loss.)

    Before you attempt to discredit the AHA or other organizations designed to promote health and wellness using evidenced based recommendations, I suggest you put down the paperback fad diet book and pick up a basic nutrition or physiology text.

  14. Anonymous February 27, 2009 at 2:25 am #

    Please please please go do you’re research again cause what you are saying here is totally and utterly useless.

    The findings in this study are already well known and was a waste of money and research resources. The only time in which the atkins or any other fad diets work is when you totally cut out the other food groups and any sane Nutritionist will tell you that’s insane. You will never get the complete vitamins etc that you need.

    What people must remember is that the human body is a very well tuned scale. What you have to do it spend more energy than you are taking in. My best advice from Tom Venuto is to firstly measure your BMR. Then restrict your diet by approximately 100 Calories a day while maintaining a well balanced and nutritious diet. Then do exercise spending approximately 150 calories per day. This is a 250 calorie deficit and would equate to losing 1 pound of fat in 2 weeks (14 days).

    By starving yourself (crash dieting) more than the given amount will place your body into starvation mode. This means your body slows down your metabolism (BMR) and thus you have to eat less to get under that 100 calories. This starts a vicious cycle with you eating less and less and your body continuously decreasing the metabolism. You just can’t win this battle.

  15. Anonymous February 26, 2009 at 6:58 pm #

    The conclusion of the title of this page is way off.

    Where is the elements of the study with 10% carbs, or 5% carbs, or less ?

    Weight loss (Atkins, Taubes, Montingnac, Banting, Mendosa) over the last 150 years is known to be easier and faster with carb restriction. Particularly high GI carbs.

    The conclusion, and perhaps the skew in favor of “no difference” is designed to support the bankrupt AHA-lead hypothesis of of a carb heavy food pyramid, and the suggestion that cutting calories is the way to go.

  16. madler February 26, 2009 at 5:45 pm #

    The point was made quite clear: “The main finding from the trial was that diets with varying emphases on carbohydrate, fat and protein levels all achieved clinically meaningful weight loss and maintenance of weight loss over a two-year period.” The study was to show that several different diets with the same caloric intake, but different ratios of carbs, fat, and protein all produced the same weight loss. How you get that they were comparing the caloric input of varying diets, I have no idea. The objective was to have the same caloric input for all of the diets, and only vary ratios of food types. One variable at a time, like any good study.

  17. Anonymous February 26, 2009 at 5:24 pm #

    madler, you seem to miss the entire point of the study. It wasn’t done to see if they could lose weight, it was done to see which diet, if any, would provide the most weight loss compared to the other diets. The study wasn’t to help them eat fewer calories, it was to compare the caloric input of varying diets and attempt to discern the different in weight loss between them.

  18. Anonymous February 26, 2009 at 2:15 pm #

    Dude, that is some pretty cool stuff man! Well done!

    RT

  19. Anonymous February 26, 2009 at 1:07 pm #

    Couldnt agree more with the comment before mine. I’ve lost 45lbs this year after quitting smoking and focusing on my own health — I’ve learned a lot.

    One of the most important things ive learned is that starving myself of calories is not going to help me lose weight. it’s going to do the opposite — my body resists the ability to lose fat when i am starving myself.

    I agree with the article, that calorie deficits are the most important part (instead of focusing on say carbs or fat content)– however, just like anything else in life, its easy to take this too far.

  20. Anonymous February 26, 2009 at 11:52 am #

    See the term “overweight” adults. Try doing a study with fit individuals and then we will talk about what diets work best in reducing andipose tissue and not water weight and muscle loss that occurs with all diets including ketogenic ones. You take an overweight junk eating adult and give them whole grains and ditch the junk OF COURSE they will lose weight duh!

    There is some truth in weight loss is due to caloies in vs calories out but…. what information is there about their excercise routine, off days if any and cheat meals? None. This news is dangerous because uniformed adults will think slim fast will work for them and they will eat far less food and their bodies will suffer reprocussions.

    Gotta get back to class

  21. madler February 26, 2009 at 10:05 am #

    It’s just conservation of energy. However this misses the point.

    Sure, at the same level of exercise, if you reduce you caloric input, you will lose weight, regardless of the nature of the calories. If you don’t, you won’t. (This is because the calories listed on food labels take into account the energy that is actually usable by the body, and so for example doesn’t count dietary fiber in the calories, which a simple bomb calorimeter measurement would count.)

    However this is relevant only if you assume that humans are able to consciously control their caloric input. It has been proven time and time again that they can’t. Not in the long run anyway, if they have a ready supply of food (which all of us who are not well below the poverty level do). Most humans can consciously control their caloric input for weeks, maybe a few months, but then fall back to a baser, subconscious control system for caloric input that relatively little is known about. Eating fewer calories is like trying to hold your breath, just over much longer time scales. A few people have the self-control to do this, but most don’t.

    The claim of some of these diets is that they manipulate this unknown control system in a way that permits lowering the set point of the caloric input in a way that can be maintained, without the human having to consciously consume fewer calories than the control system is requesting. It requires a different sort of conscious control of the food consumed, usually with regard to consuming some types over other types.

    I suspect that most, probably all of the claims of these diets are bogus. However the basic idea has merit. If we understood the subconscious control system for caloric input, it would be far more effective to manipulate that system than to attempt, usually in futility, to override the subconscious demands with conscious control.

    When we do learn about this control system, I’m sure it will be more complicated than just responding to total caloric input, so it may also be difficult to consciously control certain types of foods. (Do some “cravings” come from that system?) But however that system works, I bet that we can find a way to fool it into lowering the caloric input set point without drugs.

    So while this study is correct, it proves nothing whatsoever about the possibility of diets that could in and of themselves help you reduce caloric input without having to count calories and force yourself to eat fewer of them. This study simply helped the participants to eat fewer of them with guidance and counseling over long time periods, with entirely predictable results. Also entirely predictable is that once the study is over, most of the participants will gain back the lost weight within a year.

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