It’s mind-boggling how long this acrimonious debate has been raging among various experts. I remember myself as a fat little kid first hearing the word “calorie,” but was too busy chewing my second Snickers bar to pay much attention. By 11 or 12, I was taken (or rolled) to a weight loss “specialist” and remember receiving an assortment of pills, even as my mother guesstimated the calories in our usual dinner of fried chicken, French fries, broccoli with Hollandaise sauce, and hot fudge sundaes for dessert.
Then an immense best-seller appeared, the now-forgotten Calories Don’t Count (1961), by Herman Taller, MD. His book may have been the first to suggest that in terms of weight loss, food selection trumped the calorie count of any individual food. Teller was, as Atkins would be some decades later, a pro-fat/low-carb advocate, and since many people really do prefer a breakfast of bacon and eggs to a bowl of granola, the dozens of low-carb diets that rode the book’s wake have remained quite popular.
Ornish vs Atkins
Dean Ornish, MD, the famous cardiologist, put the brakes on our steaks with his book Reversing Heart Disease. Fat, he felt (and does to this day), was the enemy in our midst. In an acrimonious debate between two diet gurus, Ornish called the Atkins Program the ultimate in nutritional irresponsibility. But people themselves preferred Atkins. To many men, a steak, salad, and martini are a semi-orgiastic pleasure, far removed from the concept of dieting, and many who followed Atkins did lose weight.
Women, who need some carbs to produce enough of the stress-buffering neurotransmitter serotonin (men have more to begin with) liked the weight loss, but found themselves with a serotonin deficit-induced snarkiness that nutritionists dubbed “Atkins Attitude.”
Ornish countered all this weight loss success with a fuss-budgety approach of ends not justifying the means. Although weight loss might have occurred, he maintained that in the process your arteries got clogged with fat. As you’ll see, this didn’t turn out to be the case.
The last diet you’ll ever need?
If you type “diet books” into the Amazon search bar, you’ll be rewarded with 142,278 selections. You can trim (pardon the pun) this down to a mere 1,598 titles if you choose “top selling diet books of 2014,” keeping in mind 2014 isn’t over yet and there are likely more to come.
But today, I’m going to report on a study that should save you the bother of ever buying another diet book in your life. The researchers are physicians from Tulane University School of Medicine in New Orleans. I thought this was a good location for such a study, since Louisiana is the fourth most obese state in the US, with nearly one in three Louisianians officially classified as obese. (Good food, though. I feel for them.)
The researchers’ goal was simple: if you take as diet goals both weight loss and preventing heart disease, which of the two major diets—low-carb or low-fat–gives you the most bang for your buck?
For the study, they selected 148 men and women of all races between the ages of 22 and 75. None had evidence of cardiovascular disease or diabetes. Their BMIs (a measure of relative weight to height) ranged from 30 to 45. Keep in mind that all values above 29.9 are officially categorized as obese.
The volunteers were randomly assigned to one of two groups, either the low-carbohydrate (fewer than 40 grams of carbs daily) or the low-fat (less than 30% of calories from fat, with less than 7% from saturated fat). Both groups received counseling at frequent intervals.
Approximately 80% in both groups completed the year-long study, which is a very good result for studies like these. The important conclusions were published as the lead article in this month’s Annals of Internal Medicine. In comparison to a low-fat diet, those following the low-carb diet:
- Lost significantly more weight.
- Had greater improvement in body composition (lean body mass, as opposed to fat).
- Increased their HDL (good cholesterol) levels.
- Improved their total cholesterol/HDL ratios.
- Lowered their CRP (a marker of inflammation).
- Improved their estimated ten-year coronary heart disease risk.
So that you don’t agonize over what to eat and what to avoid, here are the basics:
Meat, fish, eggs, vegetables, fruits, nuts, seeds, high-fat dairy, healthy oils (see below). Allow yourself some potatoes (not a lot) and some non-gluten grains (ditto).
Sugar, high fructose corn syrup, seed oils, trans fats, artificial sweeteners, “diet” products, processed foods.
Sugar Soft drinks, fruit juices, candy, ice cream, cakes, cookies.
Gluten grains Wheat, spelt, barley, and rye. Includes breads, pastries, pasta.
Trans fats Includes hydrogenated or partially hydrogenated oils.
High omega-6 seed and vegetable oils Soybean, sunflower, cottonseed, etc.
“Diet” and “low-fat” products Just walk away from this junk.
Processed foods If it came off an assembly line, don’t eat it.
Enjoy these low-carb foods
Meat Beef, lamb, pork, chicken. Grass-fed is best.
Fish Salmon, trout, haddock, many others. Wild-caught is ideal.
Eggs Omega-3 enriched, pasteurized, or from a free-ranging flock.
Vegetables Virtually any and all.
Fruit Apples, pears, blueberries, plums, strawberries, melon.
Fats and oils Coconut oil, butter, lard, olive oil, avocado.
Enjoy in moderation
Tubers Potatoes, sweet potatoes.
Non-gluten grains Rice, quinoa, oats, many others.
Legumes Lentils, black beans, pinto beans.
Dark chocolate Organic with 70% cocoa or higher.
Wine and spirits Dry wines with no added sugar, spirits like vodka, gin, or bourbon without sugared mixers (use soda water and citrus instead).
Snacks A piece of fruit and cheese, full-fat yogurt, two hard-boiled eggs, baby carrots, a handful of nuts, last-night’s leftovers.
Reject the bread basket. Order a meat or fish-based dish. If fried, request that it be fried in real butter. Ask for a double portion of vegetables or salad (dressed with vinegar and oil) instead of bread, potatoes, or rice.
Prepared food from grocery stores
Personally, I wouldn’t bother, simply because you have no information on the ingredients or source (organic, wild-caught), or even how long it’s been sitting on the steam table.
If all this sounds onerous, don’t despair. Our friends at The World’s Healthiest Foods offer 100 recipes made with real food to get you started.
And if you need help with limiting carbs, knowing which fats are good, or the basics of sensible shopping, schedule an appointment with one of our nutritionists, Marla Feingold, Seanna Tully, or Marcy Kirshenbaum. Health insurance companies seem a bit more oriented toward prevention than in the past. This means nutritional counseling is now a covered benefit of many policies.
David Edelberg, MD