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Low Carbohydrate or Low Fat?

Posted on September 8, 2019 | No Comments on Low Carbohydrate or Low Fat?

Woe is the obese individual. Not only is he surrounded with deliciously unhealthy and delectably fattening food, he is also, ironically, bombarded with fad diet programs, back-breaking exercise machines, and costly weight loss medications. The lightest on the pocket but most mind-twisting would probably be diet management. Zone? Atkins? South Beach? Confused? Well, so am I. The evolution of fad diets is as fast as the rise in my blood pressure when another new diet is introduced into the market!

Being in the field of clinical nutrition, I need to be up-to-date with the latest. I finally gave up and went back to the basics. I realized that whatever name they may give to the diet, it all boils down to differences in macronutrient breakdown: carbohydrates, proteins, and fats.

Carbohydrates are the primary energy providers that come in the form of starches. Examples are rice, bread, pasta, corn, and potatoes. Proteins are meant for tissue building and repair. Good sources are meats, fish, chicken, seafood, tofu, beans, cheese, and eggs. Finally, fats give us the highest amount of calories per gram. Together with carbohydrates, they provide our body with energy. Examples are natural oils, seeds and nuts, avocado, animal fat, and butter.

The confusion lies in which macronutrient breakdown is the most effective in eliciting weight loss. If you think about things, it really is simple to lose excess weight.

Starve yourself, cut down on your usual intake, or stick to just one kind of food for several days and you may feel lighter and smaller. It’s simple mathematics. To lose weight or be in negative energy balance, you need to decrease what you put in and put out more (by exercising if you are into that sort of thing). But you also feel severe hunger pangs, undergo the “crash and crave” phenomenon and then binge. You find yourself gaining back the weight and then some. This is called the yoyo effect.

You must understand that your body is an engine that still needs fuel or energy in the form of calories from food to be able to function properly. As a doctor and a nutrition consultant, I always teach my patients that although the basic tenet in weight loss is cutting down on calories, overall health is always the priority. Weight loss may be the name of the game but this must be done safely and effectively.

So going back to diets. I was asked to explain the difference between low carbohydrate and low fat diets and perhaps offshoot to high protein diets that have been in the forefront of modern weight loss methods. In doing this, I’ve decided to use a more evidence-based approach (which is how medicine is supposed to be practiced, so I’m told) and depend less on testimonials. Don’t worry. This will be harmless, I promise.

Although there is no strict definition for low carbohydrate, to simplify matters, any diet that promotes carbohydrate content less than the standard recommended value (250 to 300g/day) can be considered as such. Atkins allows only 20g, Schwarzbein 60g, and Zone 100 to 150g. Low fat diets comprise less than 30 percent fat. High protein diets contain > 30 percent protein as opposed to the standard 10 to 15 percent.

In a study on the comparison between the effects of a lowcarbohydrate diet (Atkins, beginning with 20g) and those of a conventional low fat diet (60 percent carbohydrates, 15 percent protein, 25 percent fat) on 63 obese individuals, it was noted that subjects placed on the Atkins diet lost more weight within six months.

They also experienced earlier satiety and reduced appetite. However, the weight loss difference between the two groups was no longer statistically significant after 12 months. Apart from this, they also noted that subjects on the Atkins diet had decreased blood triglycerides (bad kind of lipid or fat) and increased HDL (good cholesterol) levels. This may seem quite favorable. However, because of the higher fat content of this diet (to make up for the low carbohydrate), undesirable lipids such as LDL and total cholesterol shot up, increasing the risk for cardiovascular disease.

In a paper analyzing five separate studies on the differences in the metabolic effects between low carbohydrate diets and low fat diets, the following observationswere made: (1) After six months, subjects on the low-carbohydrate diets were more likely to complete their diets than those on the low fat regimen; however, after 12 months, the differences were not statistically significant; (2) After six months, there was a trend towards lower blood pressure values among low carbohydrate diet followers but after 12 months, the trend was no longer significantly different from the other diet; (3) Values of total cholesterol and LDL were consistently lower among subjects on the low fat diet during the six- and 12-month determination; (4) After six and 12 months, subjects on the low-carbohydrate diets had higher HDL and lower triglyceride levels; (5) Weight loss after 12 months was not significantly different between the two groups; and (6) There was no significant difference in blood sugar levels between the two study groups.

In the A TO Z Weight Loss Study, Gardner et al. compared four popular weight loss diets. By order of increasing carbohydrate, decreasing fat, and decreasing protein contents, the diets studied were Atkins, Zone, LEARN (traditional), and Ornish. It showed that the diet with the greatest weight loss at the end of 12 months was the Atkins diet but the weight loss was a modest 4.7kg. Zone diet performed the worst, having the least weight loss. Insulin and glucose measurements were not significantly different across the diets. It was not certain whether this weight loss, though small, was due to the low carbohydrate or the high protein component.

Many have been skeptical about high protein diets. Although in another weight loss paper, it was shown that early satiety, weight loss, and body fat reduction were more pronounced in subjects on high protein diets, we question the safety of such diets. Yet another paper proved that calcium balance and bone density were not affected by high protein consumption. However, we warn converts to be cautious. Prior to commencing any diet, be sure to consult your doctor. There have been cases of followers of these diets ending up in the ICU for kidney malfunction. Be careful.

It seems that the traditional low fat diet (with consequent low calorie content) is still the safer and possibly easier regimen to follow. To reiterate, our aim is weight loss but weight loss that is safe and effective, the kind of weight loss that can answer the multitude of medical problems obese patients have. Remember that obesity isn’t just about being fat—it is having increased risk for diabetes, cardiovascular disease, and serious joint pains to name a few.

The key to true weight loss success is sustainability. To achieve this, you must be willing to make changes not only in the way you eat but the way you live. Food choices, restaurant options, food portion decisions are all based on behavior and lifestyle modifications. Eating is a matter of proper quality and quantity of foods. You need motivation and to learn to divert the food obsession to good obsession. Maybe replace eating in times of emotional stress with exercise or reading a book.

But you must remember that the total weight loss program is not just nutrition. There is no easy way out. There is no quick fix to keep the weight off forever. You need to work at it constantly. Nutrition is only part of it. Exercise is tremendously essential to complete the health package. As the saying goes, no pain, no gain. In this case, no pain, no loss.

So we return to our woeful obese individual. Life does not need to be complicated, his mind muddled with confusing data. Healthy living is simple living—going back to basics. He should go for moderate amounts of his macronutrients, exercise hard enough to work up a sweat, and try his darndest to make the right choices. He loses the weight and gains back his health. He gains back his health and he gains back his life. Now that’s worth the pain!

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