Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet

S. Daniel Abraham Center for Health and Nutrition, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
New England Journal of Medicine (Impact Factor: 55.87). 07/2008; 359(3):229-41. DOI: 10.1056/NEJMoa0708681
Source: PubMed


Trials comparing the effectiveness and safety of weight-loss diets are frequently limited by short follow-up times and high dropout rates.
In this 2-year trial, we randomly assigned 322 moderately obese subjects (mean age, 52 years; mean body-mass index [the weight in kilograms divided by the square of the height in meters], 31; male sex, 86%) to one of three diets: low-fat, restricted-calorie; Mediterranean, restricted-calorie; or low-carbohydrate, non-restricted-calorie.
The rate of adherence to a study diet was 95.4% at 1 year and 84.6% at 2 years. The Mediterranean-diet group consumed the largest amounts of dietary fiber and had the highest ratio of monounsaturated to saturated fat (P<0.05 for all comparisons among treatment groups). The low-carbohydrate group consumed the smallest amount of carbohydrates and the largest amounts of fat, protein, and cholesterol and had the highest percentage of participants with detectable urinary ketones (P<0.05 for all comparisons among treatment groups). The mean weight loss was 2.9 kg for the low-fat group, 4.4 kg for the Mediterranean-diet group, and 4.7 kg for the low-carbohydrate group (P<0.001 for the interaction between diet group and time); among the 272 participants who completed the intervention, the mean weight losses were 3.3 kg, 4.6 kg, and 5.5 kg, respectively. The relative reduction in the ratio of total cholesterol to high-density lipoprotein cholesterol was 20% in the low-carbohydrate group and 12% in the low-fat group (P=0.01). Among the 36 subjects with diabetes, changes in fasting plasma glucose and insulin levels were more favorable among those assigned to the Mediterranean diet than among those assigned to the low-fat diet (P<0.001 for the interaction among diabetes and Mediterranean diet and time with respect to fasting glucose levels).
Mediterranean and low-carbohydrate diets may be effective alternatives to low-fat diets. The more favorable effects on lipids (with the low-carbohydrate diet) and on glycemic control (with the Mediterranean diet) suggest that personal preferences and metabolic considerations might inform individualized tailoring of dietary interventions. ( number, NCT00160108.)

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    • "disease compared to a control low-fat diet.(Estruch et al., 2013) MedD improves fasting plasma glucose and insulin resistance compared to a low-fat, restricted-calorie diet in diabetic patients.(Shai et al., 2008) However, it is not associated with significant improvements of fasting plasma glucose and insulin sensitivity in non-diabetic subjects.(Shai et al., 2008) Complementary lifestyle interventions, such as exercise training, should thus be encouraged to address the improvement of glycemic parameters in non-diabetic patients , in the objective of reducing coronary events.(Pai et al., 2013) In the last decade, growing evidence has made HIIT to be considered as a safe and effective alternative "
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    ABSTRACT: Objectives: To analyze the effects of a long-term intensive lifestyle intervention including high-intensity interval training (HIIT) and Mediterranean diet (MedD) counseling on glycemic control parameters, insulin resistance and β-cell function in obese subjects. Methods: The glycemic control parameters (fasting plasma glucose, glycated hemoglobin), insulin resistance, and β-cell function of 72 obese subjects (54 women; mean age = 53 ± 9 years) were assessed at baseline and upon completion of a 9-month intensive lifestyle intervention program conducted at the cardiovascular prevention and rehabilitation center of the Montreal Heart Institute, from 2009 to 2012. The program included 2-3 weekly supervised exercise training sessions (HIIT and resistance exercise), combined to MedD counseling. Results: Fasting plasma glucose (FPG) (mmol/L) (before: 5.5 ± 0.9; after: 5.2 ± 0.6; P < 0.0001), fasting insulin (pmol/L) (before: 98 ± 57; after: 82 ± 43; P = 0.003), and insulin resistance, as assessed by the HOMA-IR score (before: 3.6 ± 2.5; after: 2.8 ± 1.6; P = 0.0008) significantly improved, but not HbA1c (%) (before: 5.72 ± 0.55; after: 5.69 ± 0.39; P = 0.448), nor β-cell function (HOMA-β, %) (before: 149 ± 78; after: 144 ± 75; P = 0.58). Conclusion: Following a 9-month intensive lifestyle intervention combining HIIT and MedD counseling, obese subjects experienced significant improvements of FPG and insulin resistance. This is the first study to expose the effects of a long-term program combining HIIT and MedD on glycemic control parameters among obese subjects.
    04/2015; 2. DOI:10.1016/j.pmedr.2015.04.015
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    • "Specifically, we explore whether Internet searches for the term " diet " by the general population increase following temporal landmarks. Maintaining a healthy diet is considered one of the most effective methods for maintaining an optimal body weight (Shai et al. 2008), and about two-thirds of adult Americans are currently classified as overweight or obese (Centers for Disease Control and Prevention 2013), making dieting an important goal for most Americans. Indeed, dieting, losing weight, and eating more healthfully are among the most popular New Year's resolutions listed on the U.S. government's website ( "
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    ABSTRACT: The popularity of New Year's resolutions suggests that people are more likely to tackle their goals immediately following salient temporal landmarks. If true, this little-researched phenomenon has the potential to help people overcome important willpower problems that often limit goal attainment. Across three archival field studies, we provide evidence of a "fresh start effect." We show that Google searches for the term "diet" (Study 1), gym visits (Study 2), and commitments to pursue goals (Study 3) all increase following temporal landmarks (e. g., the outset of a new week, month, year, or semester; a birthday; a holiday). We propose that these landmarks demarcate the passage of time, creating many new mental accounting periods each year, which relegate past imperfections to a previous period, induce people to take a big-picture view of their lives, and thus motivate aspirational behaviors. Data, as supplemental material, are available at
    Management Science 10/2014; 60(10):2563-2582. DOI:10.1287/mnsc.2014.1901 · 2.48 Impact Factor
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    • "More recent clinical trials of low-carbohydrate diets have supported the effectiveness of this dietary approach as well (Foster et al., 2003; Gardner et al., 2007; Samaha et al., 2003; Shai et al., 2008). Thus, multiple effective dietary approaches are available for weight loss, leading some experts to suggest that individuals beginning weight loss programs should be provided a choice between empirically supported dietary approaches, consistent with patient-centered care (Sacks et al., 2009; Shai et al., 2008). Little is currently known about how individuals choose between different dietary approaches to weight loss. "
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    ABSTRACT: Individuals undertaking a weight loss effort have a choice among proven dietary approaches. Factors contributing to choice of either a low-fat/low-calorie diet or a low-carbohydrate diet, two of the most studied and popular dietary approaches, are unknown. The current study used data from participants randomized to the 'choice' arm of a trial examining whether being able to choose a diet regimen yields higher weight loss than being randomly assigned to a diet. At study entry, participants attended a group session during which they were provided tailored feedback indicating which diet was most consistent with their food preferences using the Geiselman Food Preference Questionnaire (FPQ), information about both diets, and example meals for each diet. One week later, they indicated which diet they chose to follow during the 48-week study, with the option of switching diets after 12 weeks. Of 105 choice arm participants, 44 (42%) chose the low-fat/low-calorie diet and 61 (58%) chose the low-carbohydrate diet. In bivariate analyses, diet choice was not associated with age, race, sex, education, BMI, or diabetes (all p>0.05). Low-carbohydrate diet choice was associated with baseline higher percent fat intake (p=0.007), lower percent carbohydrate intake (p=0.02), and food preferences consistent with a low-carbohydrate diet according to FPQ (p< 0.0001). In a multivariable logistic regression model, only FPQ diet preference was associated with diet choice (p=0.001). Reported reasons for diet choice were generally similar for those choosing either diet; however, concerns about negative health effects of the unselected diet was rated as more influential among participants selecting the low-fat diet. Only three low-carbohydrate and two low-fat diet participants switched diets at 12 weeks. Results suggest that when provided a choice between two popular weight loss dietary approaches, an individual's selection is likely influenced by baseline dietary intake pattern, and especially by his or her dietary preferences. Research is needed to determine if congruency between food preferences and dietary approach is associated with weight loss.
    Appetite 08/2014; 83. DOI:10.1016/j.appet.2014.08.023 · 2.69 Impact Factor
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