What The New "Low Carb"
Study REALLY Says
By Tom Venuto, CPT, CSCS
A news media feeding frenzy
erupted earlier this week when a new diet study
broke in the New England Journal of Medicine (NEJM)
on Thursday, July 17th. Almost all the reporters got
it wrong, wrong WRONG! So did most of the gloating
low carb forumites and bloggers.
Come to think of, almost everyone interpreted this
study wrong. Some valuable insights came out of this
study, but almost everyone missed them because they
were too busy believing what the news said or
defending their own cherished belief systems...
The new study, titled, "Weight Loss With a
Low-Carbohydrate, Mediterranean, or Low-Fat Diet"
was published in The New England Journal of Medicine
(NEJM) in issue 359, number 3.
I quickly read the full text of the research paper
the day it was published. Then, I shook my head in
dismay as I scanned the news headlines.
I found it amusing that the media turned this into a
three ring circus, putting a misleading "low carb
versus high carb," "Atkins vindicated" or "Diet
wars" spin on the story. But that's mainstream
journalism for you, right? Gotta sell those papers!
Just look at some of these headlines:
"Study Tips Scales in Atkins Diets Favor: Low
Carb Regimen Better Than Low Fat Diet For Weight And
Cholesterol, Major Study Shows. "
"Low-Carb and Low-Fat Diets Face Off "
"The Never-Ending Diet Wars"
"Low Carb Beats Low Fat in Diet Duel."
"Atkins Diet is Safe and Far More Effective Than a
Low-Fat One, Study Says"
"Unrestricted Low-Carb Diet Wins Hands Down"
Some of these headlines are hilarious! I wonder if
any of these reporters actually read the whole
study. Geez. Is it too much trouble to read 13 pages
before you write a story that will be read by
millions of already confused people suffering the
pain and frustration of obesity?
Here's a quick look at the study design.
The low fat restricted calorie diet was based on
American Heart Association guidelines. Calorie
intake was set at 1500 for women, 1800 a day for men
with 30% of calories from fat, and only 10% from
saturated fat. Participants were instructed to eat
low fat grains, vegetables, fruits and legumes and
to limit their consumption of additional fats,
sweets and high fat snacks.
The Mediterranean diet group was placed on a
moderate fat, restricted calorie program rich in
vegetables and low in red meat, with poultry and
fish replacing beef and lamb. Energy intake was
restricted to 1500 calories per day for women and
1800 calories per day for men with a goal of no more
than 35% of calorie from fat. Added fat came mostly
from nuts and olive oil.
The low carb diet was a
non-restricted calorie plan aimed at providing 20 grams
of carbs per day for the 2 month induction phase with a
gradual increase to 120 grams per day to maintain the
Intakes of total calories, protein and fat were not
limited. However, the participants were counseled to
choose vegetarian sources of protein (more on that
The study subjects were mostly
male (86%), overweight (BMI 31) and middle age (mean
Here were the study results:
There were some health improvements in cholesterol,
blood pressure and other parameters in the
Mediterranean and low carb group that bested the
high carb group. That was the focus of many articles
and discussions that appeared on the net this week.
However, I'd like to focus on the weight loss aspect
as I'm not a medical doctor and fat loss is the
primary subject matter of this website.
All three groups lost weight. The low carb group
lost 5.5 kilos, the Mediterranean group lost 4.6
kilos and the low fat group lost 3.3 kilograms…. IN
TWO YEARS! Whoopee! :-)
My conclusion would be that the results were similar
and that none of the diets worked very well over the
Amanda Gardner of the US News and World Report
Health Day was one of the few reporters who got it
"Diet plans produce similar results: Study finds
Mediterranean and low-carb diets work just as well
as low fat ones."
Tara Parker-Pope of the New York Times also came
close with her headline:
"Long term diet study suggests success is hard to
come by: In a tightly controlled experiment, obese
people lost an average of just 6 to 10 pounds over
Ironically, even this headline wasn't 100% accurate.
The study was HARDLY tightly controlled. Tightly
controlled means metabolic ward studies where the
researchers actually count and control the calorie
The problem is, you can't lock people in a hospital
or research center ward for two years. So in this
study, they used a food frequency questionnaire.
Sure, like we believe what people report about their
eating habits at restaurants and at home behind
closed doors! BWAHAHAHAHAHAHAHAHA!
"No! I swear Dr. Schwarzfuchs! I swear didn't eat
those donuts over the weekend! I stayed on my
Mediterranean diet. Honest!"
One of the most firmly established facts in
dietetics research is that almost everyone
underreports their food intake BADLY, sometimes by
as much as 50%. I'm not saying everyone "lies," they
just forget or don't know. In fact, this
underreporting of calorie intake is such a huge
problem that it makes obesity research very
difficult to do and conclusions difficult to draw
from free-living studies.
Another blunder in the news reports is that this
study didn't really follow Atkins diet parameters OR
even the traditional low fat diet for that matter,
so it's not an "Atkin's versus Ornish" showdown at
If you actually take the time to read the full text
of the research paper it doesn't say ANYTHING like,
"Atkins is the best after all." That's the spin that
some of the news media cooked up (and what the
Atkins foundation was hoping for).
It says, "The diet was based on the Atkins diet."
However, the sentence right before that says, "The
participants were counseled to choose vegetarian
sources of fat and protein." Vegetarian Atkins?
The chart on page 236 says the low carb diet
provided 40% of calories from carbs at 6, 12 and 24
months. If I'm reading that data properly, then the
only low carb period was a brief induction phase in
the very beginning.
Does that sound like Atkins? 40% carb sounds more
like the Zone diet or my own Burn The Fat program to
The Atkins Foundation, which partially supported
this study, told reporters, "We feel vindicated."
HA! They should have paid the reporters and told the
researchers they felt ripped off and they wanted a
refund for misuse of their research grant!
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After carefully reading the full
text of this study, there are many interesting
findings we could talk about, from the differences
in results between men and women to the improvements
in health markers. Here's what the study really says
that stood out to me. It's what I would have talked
about if the newspapers or TV stations had called
1. "Mediterranean and low carb diets may be
effective alternatives to low-fat diets."
I can agree completely with that statement. All
three diets created a calorie deficit. All three
groups lost weight. Low carb lost a little more,
which is the usual finding because low carb diets
often control appetite and calorie intake
automatically (you eat less even if you don't count
calories). Also, if body composition is not
indicated, there's an initial water weight loss that
makes low carb diets look more effective in the very
2. "Personal preferences and metabolic
considerations might inform individualized tailoring
of dietary interventions."
Absolutely! Nutrition should be individualized based
on goals, health status, body type, activity level
and numerous other factors. Different people have
different phenotypes. Some people are more
predisposed to thrive on a low carb approach. Others
feel like crap on low carbs and do better with more
carbs or a middle of the road approach. Those who
dogmatically follow and defend one type of diet or
the other are only handcuffing themselves by
limiting their options. Iris Shai, a researcher in
the study said, "We can't rely on one diet fits
all." Hmm, far cry from "Atkins wins hands down,"
wouldn't you say?
3. "The rate of adherence to a study diet was
95.4% at 1 year and 84.6% at 2 years."
THIS was the part of most interest to me. When I
read this, immediately I could have cared less about
the silly low carb versus high carb wars that the
news reporters were jumping on.
I wanted to know WHY the subjects were able to stick
with it so well. Of course, that's boring stuff to
journalists… adherence? What does that word mean
anyway? Yawn - not interesting enough for prime
time, I guess.
But it was interesting to me, and I hope YOU pay
attention to what I found. The authors of the study
"This trial suggests a model that might be applied
more broadly in the workplace. Using the employer as
a health coach could be an effective way to improve
health. The model of group intervention with the use
of dietary group sessions, spousal support, food
labels, and monthly weighing in the workplace within
the framework of a health promotion campaign might
yield weight reduction and long term health
Hmmmmm, lets see:
* Dietician coaching * Group meetings * Motivational
phone calls * Spousal support * Workplace monitoring
(corporate health program) * Food labels - calorie
monitoring * Weigh ins (required and monitored)
Wow, everything helpful to long term fat loss that
sticks. Can you say, ACCOUNTABILITY? These factors
help explain the better adherence.
By the way, the adherence rate for the low carb
group was the lowest.
90.4% in low fat group 85.3% in the Mediterranean
group 78% in the low carb group
Here's the bottom line, the way I see it:
First, please, please, please learn how to find and
read primary research and take the news media
stories with a grain of salt. If you want to know
who died, what burned down or what hurricane is
coming, tune in to the news -- they do a GREAT job
at that. If you want to know how to lose weight or
improve your health, look up the original research
papers instead of taking second hand information at
Second, those who prefer a low carb approach; more
power to them. Most studies, this one included, show
at the very least that low carb is an option and
it's not necessarily an unhealthy one if done
intelligently. I also have no qualms with someone
claiming that low carb diets are slightly more
effective for weight loss, especially in the short
term, free living situations. Is low carb superior
for fat loss in the long haul? That's STILL highly
debatable. It's probably is superior for some
people, but not for others.
Third, low carb people, Listen up! Even if low carb
is superior, that doesn't mean calories don't count.
Deny this at your own peril. In fact, this study
shows the reverse. The low carb group was in a
larger negative energy balance than the high carb
and Mediterranean group (according to the data
published in this paper), which easily explains the
greater weight loss. Posting the calories contained
in foods in the cafeteria may have improved the
results and helped with compliance in all groups.
When energy intake is matched calorie for calorie,
the advantage of a low carb diet shrinks or
disappears. For most people, low carb is a hunger
management or calorie control weight loss advantage,
not metabolic magic (sorry, no magic folks!)
Fourth, choose the nutrition program that's most
appropriate for your personal preferences, your
current health condition, your genetics (or
phenotype) and most important of all… the one you
can stick with. Then tend your own garden instead of
wasting time criticizing how the other guy is
eating. Your results will speak for themselves in
the end. Take your shirt off and show us.
If I were forced to choose only one approach (and
thank god I'm not), I would recommend avoiding the
extremes of very low carb or very low fat or very
high fat or very high carbs. Balance makes the most
sense to me, and the research suggests that this
helps produce the highest compliance rate. That's
not rocket science either, it's common sense. If you
have a serious fat loss goal, as when I compete in
bodybuilding, then a further reduction in carbs and
increase in protein makes perfect sense to me as a
If an extremely low or extremely high carb diet
worked for you, great. But generalizing your
experience to the entire rest of the world is dumb.
Arguments from exceptions are the weakest form of
The reason I have THREE nutrition plans (three
phases) in my own fat loss programis because
programs with flexibility and room for
individualization beat the others hands down in the
long term. In fact, I wrote an entire chapter in my
e-book about unique body types, how to determine
yours and how to individualize your nutrition --
it's THAT important.
If you have more choices, you have more power. The
people who are shackled by dogma and narrow thinking
are stuck. They also risk missing what's really
important. Things like:
Personalization Adherence Long term maintenance
Accountability Social Support
Train hard and expect success,
PS. If you want to learn more about a
balanced, flexible and proven approach, which
teaches nutritional individuality and which can
produce similar weight loss in one month, month
after month that the subjects of this study produced
in TWO YEARS, (if you ADHERE to it!), then visit my
fat loss website.
If you're interested in leveraging the power of
accountability and social support to help you stick
with your program better and get leaner, faster,
then check out what the Inner Circle has to offer by
About Tom Venuto
Tom Venuto is a natural bodybuilder,
certified strength and conditioning specialist (CSCS) and a
certified personal trainer (CPT). Tom is the author of "Burn the
Fat, Feed The Muscle,” which teaches you how to get lean without
drugs or supplements using methods of the world's best
bodybuilders and fitness models. Learn how to get rid of
stubborn fat and increase your metabolism by visiting: