Low-Carb vs Low-Fat: The Debate Is Over!

Health Tips / Low-Carb vs Low-Fat: The Debate Is Over!

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.

Low-carb basics

So that you don’t agonize over what to eat and what to avoid, here are the basics:

Eat more 
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).

Don’t eat 
Sugar, high fructose corn syrup, seed oils, trans fats, artificial sweeteners, “diet” products, processed foods.

Diligently avoid
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.

In restaurants 
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, check out this link from Positive Health Wellness.

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.

Be well,
David Edelberg, MD

14 thoughts on “Low-Carb vs Low-Fat: The Debate Is Over!

    As has already been pointed out, this wasn’t a ‘low fat’ versus ‘low carb’ study at all.
    30% of calories from fat is a very fatty diet. Take a look at the thousands of people on genuinely low fat diets; 10%-12%, and you’ll see that they are slim, fit and very healthy.

    Posted January 15, 2024 at 6:37 pm

    throughout history, every civilization has eaten a diet of starches (grains, potatoes, paste, etc) along with fruits, veggies, nuts, seeds, and some animal foods, except for the Eskimos.People who eat a high unrefined carb diet with lots of veggies are lean, fit adn healthy. Ask Dr, Mc Doughall, Dr. Ornish, Dr, Esselstyn, Dr, Barnard, and many others. I met these guys. They are all fit, and many in their 70s now.

    John A Mooter
    Posted January 15, 2019 at 8:23 pm

    Dr E – Just curious about some of the items that seem to show up on the “Eat More” and “Eat Less” lists. Specifically: seeds are good for you (i.e. sunflower seeds), but seed oils should be avoided (sunflower seed oil). Other are good in both seed and oil form (flax seed). How should we think about this?

    Matt Kelley
    Posted December 26, 2014 at 5:02 pm

    Hi Sue
    If you look at the Pritikin Diet, it’s actually both low fat and low carb (in terms of quality carbs). It works because its very similar to the Mediterranean Diet and if you read their “go” foods and “no” foods, they’re similar to the lists above
    Dr E

    Dr E
    Posted November 25, 2014 at 4:40 pm

    Why is it that the Pritikin Diet, which stresses low fat, has helped so many people suffering from heart disease and angina?

    Sue Wise
    Posted November 22, 2014 at 12:46 pm

    I am very curious, how does this single study on 119 people (that’s how many completed the study) officially end the diet debate? Especially when on one side, people are supposed to limit carbs to under a certain number (easy!) while on the other side, rather than limit fats to a certain number, they are instead told to keep them under a certain percentage. That seems far more complicated to follow. I know that no one fully followed either diet, but still, keeping track of macronutrient ratios is a struggle for most people.

    And who is most likely to stick to the diet, and keep off weight/keep cholesterol lowered in the long term?

    Posted October 24, 2014 at 4:03 pm

    Hi Dr E, Thought provoking article indeed. I see an issue here with the study design, specifically how they chose to define their terms. In this case, “low-fat” is defined as you say “less than 30% of calories from fat, with less than 7% from saturated fat.” At first glance, a third of your diet as fat seems like a ton to me. Are people really eating 50%+ fat besides paleo/atkins followers? Then I remembered that the low fat proponents like Dr Esselstyn and many others have a very low recommended fat intake so I figured Ornish recommends around the same. A simple google search of his name and fat grams came up with 10%. I’d like to see an actual low fat diet compared to the paleo diet. From other research I’ve read, the results aren’t the same as this study but rather the opposite when you have a real low-fat diet in the study.

    Posted October 3, 2014 at 3:40 pm

    Where do you stand on corn products? I love corn SO much, and have the most difficult time eliminating corn meal, masa and popcorn! I use non-GMO organic. Is there a place in this diet for moderate consumption if there are no allergies present?

    Julie Lyman
    Posted October 3, 2014 at 7:52 am

    Loved this article. You not only stated the obvious in such a direct way, but also provided the details for how to go about eating a healthy diet in a very concise way. Thank you Dr. E. I appreciate you sharing your vast knowledge with us, cause I’m too lazy to research it all myself.

    Mery Krause
    Posted September 30, 2014 at 4:42 pm

    I enjoyed reading your article, very informative. Send me more information on good eating habits. Thank you!

    Teresa Ruiz
    Posted September 30, 2014 at 11:07 am

    I found this article very helpful as I have been reading a lot on the paleo diet and wondering if some of the items (like coconut oil) are really safe to eat on a regular basis. Heart disease is in my family, so it is a concern for me. I am gluten free and do eat gluten free food made with brown rice. Since those are to be enjoyed in moderation, the question that lingers in my mind is what is considered healthy moderation? I have always struggled with knowing what is true moderation versus no longer being in moderation. Any insight on healthy moderation would be appreciated.

    Linda Cullison
    Posted September 30, 2014 at 10:31 am

    Thanks for this timely article, Dr. E. Having followed the Ornish and Atkins diets many years ago, I am now experimenting with gluten free while my partner is eating paleo, so this has been a dinner table discussion. The research findings confirm my intuition that some legumes and non-gluten grains are fine in moderation.

    Deborah Zera
    Posted September 30, 2014 at 9:14 am

    I can personally attest to this way of eating. One comment – fruits can be a significant source of sugar, and not just fruit juices.

    People who are not used to eating this way sometimes “discover” fruit and overdo it, thereby negating some of the benefits of eating lo carb. Because fruit is natural, they think you can eat it to excess.

    You do not need to publish this, but I would love to see it addressed in a future issue.

    Keep up the good work!!!

    Roy Strauss
    Posted September 30, 2014 at 8:47 am

    Just as an interesting post script. Dr. Taller’s 1961 “Calories Don’t Count” was greeted by the medical profession with such fury that the FDA came down hard on him because he had promoted taking safflower oil capsules as part of a weight loss program in case a reader had a difficult time finding “good” fats. Olive oil would certainly have been a better choice but this was fifty years ago. At any rate, because he had financial interest in a safflower oil firm, and conventional medicine was firm in its stance that calories counted for everything, Taller was indicted for mail fraud, found guilty, fined $7,000 and received a two year suspended sentence. By that time, the book had sold two million copies and many people, following Taller’s low-carb program were delighted with their weight loss.

    Dr E
    Posted September 30, 2014 at 7:08 am

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