Open Future Health

The Science Behind Banting

It's been known for 500 years that if epileptic people were maintained on short rations (semi-starvation) that their seizures were infrequent or might stop altogether. 100 years ago it was discovered that if carbohydrates were removed from the diet the same effect on the seizures occurred without starvation.

It now known that a ketogenic diet, produces ketones that the brain can use for energy, conserving glucose. This might be particularly important in any brain condition where glucose metabolism is compromised.

Sixty-Nine Randomised Controlled Trials

All these trials test Banting principles.

NOTE: In many of these trials the researchers could not research very low carbohydrate diets with high saturated fats, even if they thought that would be a good idea. There were constraints because a high fat diet was thought to be dangerous, potentially causing heart disease.

Twenty-One Randomised trials about Type II Diabetes

Seven Randomised Trials with Adverse or Mixed Results

Forty-One Randomised Trials About Weight Loss (This Page)

Forty Studies where Weight Loss was a Key Finding


A randomized controlled trial of low carbohydrate and low fat/high fiber diets for weight loss (1986)

J A Baron, A Schori, B Crow, R Carter, and J I Mann

Conclusions: We found no support for particular effectiveness of dietary fibre in weight loss, however the low fat diet (higher carbohydrate) dieters were happier about their diet.


A randomized trial of a low-carbohydrate diet for obesity. (2003)

Gary D Foster, Holly R Wyatt, James O Hill, Brian G McGuckin, Carrie Brill, B Selma Mohammed, Philippe O Szapary, Daniel J Rader, Joel S Edman, Samuel Klein

Cochrane Logo A one-year, multicenter, controlled trial involving 63 obese men and women who were randomly assigned to either a low-carbohydrate, high-protein, high-fat diet or a low-calorie, high-carbohydrate, low-fat (conventional) diet.
The increase in high‐density lipoprotein cholesterol concentrations and the decrease in triglyceride concentrations were greater among subjects on the low‐carbohydrate diet than among those on the conventional diet throughout most of the study.

Conclusions: The low-carbohydrate diet produced a greater weight loss (absolute difference, approximately 4 percent) than did the conventional diet for the first six months, but the differences were not significant at one year.

NOTE:  HCLF diet; approximately 60 percent of calories from carbohydrate, 25 percent from fat, and 15 percent from protein. LCHF diet; 20 gm of carbohydrate for the first two weeks. Each subject was given a copy of Dr. Atkins' New Diet Revolution, 10 which details the Atkins diet program, and asked to follow that.


A Low-Carbohydrate as Compared with a Low-Fat Diet in Severe Obesity (2003)

Frederick F. Samaha, M.D., Nayyar Iqbal, M.D., Prakash Seshadri, M.D., Kathryn L. Chicano, C.R.N.P., Denise A. Daily, R.D., Joyce McGrory, C.R.N.P., Terrence Williams, B.S., Monica Williams, B.S., Edward J. Gracely, Ph.D., and Linda Stern, M.D.

Conclusions: Taken together, our findings demonstrate that severely obese subjects with a high prevalence of diabetes and the metabolic syndrome lost more weight during six months on a carbohydrate-restricted diet than on a calorie- and fat-restricted diet. The carbohydrate-restricted diet led to greater improvements in insulin sensitivity that were independent of weight loss and a greater reduction in triglyceride levels in subjects who lost more than 5 percent of their base-line weight.


Comparison of energy-restricted very low-carbohydrate and low-fat diets on weight loss and body composition in overweight men and women (2004)

JS Volek, MJ Sharman, AL Gómez, DA Judelson, MR Rubin, G Watson, B Sokmen, R Silvestre, DN French, and WJ Kraemer

Conclusions: This study shows a clear benefit of a VLCK over LF diet for short-term body weight and fat loss, especially in men. A preferential loss of fat in the trunk region with a VLCK diet is novel and potentially clinically significant but requires further validation. These data provide additional support for the concept of metabolic advantage with diets representing extremes in macronutrient distribution.


Comparison of high-fat and high-protein diets with a high-carbohydrate diet in insulin-resistant obese women (2004)

K. A. McAuley, C. M. Hopkins, K. J. Smith, R. T. McLay, S. M. Williams, R. W. Taylor & J. I. Mann

Conclusions: During the first 8 weeks of the study all three diets produced a decrease in fasting insulin levels that was maintained throughout the study period. The observed improvement in key indicators of insulin resistance (central adiposity, hyperinsulinaemia and hypertriglyceridaemia) confirms that insulin sensitivity was improved by all three dietary regimens. The greater reductions in waist circumference and triglycerides observed in the HF and HP groups indicate that insulin sensitivity may have been improved to a greater extent by the alternative diets than by the HC diet. However, given that the aim in insulin-resistant individuals is to reduce the cardiovascular risk as well as to reduce the risk of developing diabetes, the observed effect of the HF approach on LDL levels suggests that the HP diet offers a distinct advantage.


Comparison of a low-fat diet to a low-carbohydrate diet on weight loss, body composition, and risk factors for diabetes and cardiovascular disease in free-living, overweight men and women (2004)

Kelly A Meckling, Caitriona O'Sullivan, Dayna Saari

Conclusions: Both groups of subjects had significant weight loss over the 10 wk of diet intervention and nearly identical improvements in body weight and fat mass. LF subjects lost an average of 6.8 kg and had a decrease in body mass index of 2.2 kg/m2, compared with a loss of 7.0 kg and decrease in body mass index of 2.1 kg/m2 in the LC subjects.


The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: one-year follow-up of a randomized trial (2004)

Linda Stern, Nayyar Iqbal, Prakash Seshadri, Kathryn L Chicano, Denise A Daily, Joyce McGrory, Monica Williams, Edward J Gracely, Frederick F Samaha

Cochrane Logo 132 obese adults with a body mass index of 35 kg/m2 or greater; 83% had diabetes or the metabolic syndrome.
Option: Either restrict carbohydrate intake to less than 30 g per day (low‐carbohydrate diet) or to restrict caloric intake by 500 calories per day with less than 30% of calories from fat (conventional diet).

Conclusions: Participants on a low-carbohydrate diet had more favorable overall outcomes at 1 year than did those on a conventional diet. Weight loss was similar between groups, but effects on atherogenic dyslipidemia and glycemic control were still more favorable with a low-carbohydrate diet after adjustment for differences in weight loss.

NOTE: These findings are limited by a high dropout rate (34%) and by suboptimal dietary adherence of the enrolled persons.


Diet-induced weight loss is associated with decreases in plasma serum amyloid a and C-reactive protein independent of dietary macronutrient composition in obese subjects (2005)

Kevin D O'Brien, Bonnie J Brehm, Randy J Seeley, Judy Bean, Mark H Wener, Stephen Daniels, David A D'Alessio

Conclusions: In otherwise healthy, obese women, weight loss was associated with significant decreases in both SAA and CRP. These effects were proportional to the amount of weight lost but independent of dietary macronutrient composition.


The role of energy expenditure in the differential weight loss in obese women on low-fat and low-carbohydrate diets (2005)

Bonnie J Brehm, Suzanne E Spang, Barbara L Lattin, Randy J Seeley, Stephen R Daniels, David A D'Alessio

Cochrane Logo 50 healthy, moderately obese (body mass index, 33.2 +/- 0.28 kg/m(2)) women were randomized to 4 months of an ad libitum low-carbohydrate diet or an energy-restricted, low-fat diet. Forty women completed the trial.
There were no differences in energy intake between the diet groups as reported on 3-d food records at the conclusion of the study

Conclusions: These results confirm that short-term weight loss is greater in obese women on a low-carbohydrate diet than in those on a low-fat diet even when reported food intake is similar. The differential weight loss is not explained by differences in resting energy expenditure, the thermic effect of food, or physical activity and likely reflects under reporting of food consumption by the low-fat dieters.


The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus (2008)

Eric C Westman, William S Yancy Jr, John C Mavropoulos, Megan Marquart, and Jennifer R McDuffie

Conclusions: In summary, lifestyle modification using two diets that reduce carbohydrate intake led to improvement in glycemic control, diabetic medication elimination/reduction, and weight loss in overweight and obese individuals with type 2 diabetes over a 24-week period in the outpatient setting. The diet containing fewer carbohydrates, the low-carbohydrate, ketogenic diet, was more effective for improving glycemic control than the low glycemic diet. Lifestyle modification using low-carbohydrate diet interventions are effective for improving obesity and type 2 diabetes, and may play an important role in reversing the current epidemic of 'diabesity.'


Low-Fat Versus Low-Carbohydrate Weight Reduction Diets: Effects on Weight Loss, Insulin Resistance, and Cardiovascular Risk: A Randomized Control Trial (2009)

Una Bradley; Michelle Spence; C. Hamish Courtney; Michelle C. McKinley; Cieran N. Ennis; David R. McCance; Jane McEneny; Patrick M. Bell; Ian S. Young; Steven J. Hunter

Cochrane Logo We investigated a low‐fat (20% fat, 60% carbohydrate) versus a low‐carbohydrate (60% fat, 20% carbohydrate) weight reduction diet in 24 overweight/obese subjects.
A change in overall systemic arterial stiffness was, however, significantly different between diets, with a significant decrease in augmentation index following the low‐fat diet.

Conclusions: This study demonstrates comparable effects on insulin resistance of low-fat and low-carbohydrate diets independent of macronutrient content. The difference in augmentation index may imply a negative effect of low-carbohydrate diets on vascular risk.

NOTE: Low Carb 20% double what Banting calls Low Carb 10% or less than 50gm a day.
The augmentation index (AI) is an indicator of arterial stiffness that has been shown to be higher in those with hypercholesterolemia. (High Cholesterol)


Comparative Study of the Effects of a 1-Year Dietary Intervention of a Low-Carbohydrate Diet Versus a Low-Fat Diet on Weight and Glycemic Control in Type 2 Diabetes (2009)

Nichola J. Davis, MD, MS; Nora Tomuta, MD; Clyde Schechter, MD; Carmen R. Isasi, MD, PHD; C.J. Segal-Isaacson, EDD, RD; Daniel Stein, MD; Joel Zonszein, MD; Judith Wylie-Rosett, EDD, RD

Conclusions: Among patients with type 2 diabetes, after 1 year a low-carbohydrate diet had effects on weight and HbA1c similar to those seen with a low-fat diet. There was no significant effect on blood pressure, but the low-carbohydrate diet produced a greater increase in HDL cholesterol.


Evaluation of weight loss and adipocytokines levels after two hypocaloric diets with different macronutrient distribution in obese subjects with rs9939609 gene variant (2012)

Daniel Antonio de Luis, Rocío Aller, Olatz Izaola, Beatriz de la Fuente, Rosa Conde, Manuel Gonzalez Sagrado, David Primo

Conclusions: Metabolic improvement secondary to weight loss was better in A carriers with a low fat hypocaloric diet.


In type 2 diabetes, randomisation to advice to follow a low-carbohydrate diet transiently improves glycaemic control compared with advice to follow a low-fat diet producing a similar weight loss (2012)

H. Guldbrand, B. Dizdar, B. Bunjaku, T. Lindström, M. Bachrach-Lindström, M. Fredrikson, C. J. Östgren & F. H. Nystrom

Conclusions: Weight changes did not differ between the diet groups, while insulin doses were reduced significantly more with the LCD at 6 months, when compliance was good. Thus, aiming for 20% of energy intake from carbohydrates is safe with respect to cardiovascular risk compared with the traditional LFD and this approach could constitute a treatment alternative.

NOTE: 20% energy from carbohydrates is not yet Low Carb.


A Randomized Pilot Trial of a Moderate Carbohydrate Diet Compared to a Very Low Carbohydrate Diet in Overweight or Obese Individuals with Type 2 Diabetes Mellitus or Prediabetes (2014)

Laura R. Saslow, Sarah Kim, Jennifer J. Daubenmier, Judith T. Moskowitz, Stephen D. Phinney, Veronica Goldman, Elizabeth J. Murphy, Rachel M. Cox, Patricia Moran, Fredrick M. Hecht

Conclusions: Our data suggest that, in overweight and obese individuals with type 2 diabetes, a very low carbohydrate, high fat, non calorie-restricted diet may be more effective at improving blood glucose control than a medium carbohydrate, low fat, calorie-restricted, carbohydrate counting diet that remains the standard for most diabetes education efforts.


Weight Loss + Lower Cardio-Vascular Disease Risk


A randomized trial comparing a very low carbohydrate diet and a calorie-restricted low fat diet on body weight and cardiovascular risk factors in healthy women (2003)

Bonnie J Brehm, Randy J Seeley, Stephen R Daniels, David A D'Alessio

Conclusions: Based on these data, a very low carbohydrate diet is more effective than a low fat diet for short-term weight loss and, over 6 months, is not associated with deleterious effects on important cardiovascular risk factors in healthy women.


Very Low-Carbohydrate and Low-Fat Diets Affect Fasting Lipids and Postprandial Lipemia Differently in Overweight Men (2004)

Matthew J. Sharman, Ana L. Gómez, William J. Kraemer, Jeff S. Volek

Conclusions: Both the low-fat and very low-carbohydrate hypoenergetic diets resulted in significant and similar decreases in serum total cholesterol and no change in serum HDL-C or the TC/HDL-C ratio, indicating a similar effect on CVD risk. The greater weight loss during the very low-carbohydrate vs. the low-fat diet period would be expected to decrease serum LDL-C to a greater extent (20); however, in this study, only the low-fat diet significantly decreased serum LDL-C.

NOTE:  This was a Low Carb diet, and ketones were measured.


Comparison of isocaloric very low carbohydrate/high saturated fat and high carbohydrate/low saturated fat diets on body composition and cardiovascular risk (2006)

Manny Noakes, Paul R Foster, Jennifer B Keogh, Anthony P James, John C Mamo, and Peter M Clifton

Conclusions: Isocaloric VLCARB results in similar fat loss than diets low in saturated fat, but are more effective in improving triglycerols, HDL-C, fasting and post prandial glucose and insulin concentrations. VLCARB may be useful in the short-term management of subjects with insulin resistance and hypertriglycerolemia.


Metabolic Effects of Weight Loss on a Very-Low-Carbohydrate Diet Compared With an Isocaloric High-Carbohydrate Diet in Abdominally Obese Subjects (2007)

Jeannie Tay BNutrDiet (Hons), Grant D.Brinkworth PhD, Manny Noakes PhD, Jennifer Keogh MSc, Peter M.Clifton PhD

Conclusions: Under isocaloric conditions, VLCHF and HCLF diets result in similar weight loss. Overall, although both diets had similar improvements for a number of metabolic risk markers, an HCLF diet had more favorable effects on the blood lipid profile. This suggests that the potential long-term effects of the VLCHF diet for CVD risk remain a concern and that blood lipid levels should be monitored.


Effects of weight loss from a very-low-carbohydrate diet on endothelial function and markers of cardiovascular disease risk in subjects with abdominal obesity (2008)

Jennifer B Keogh, Grant D Brinkworth, Manny Noakes, Damien P Belobrajdic, Jonathan D Buckley, Peter M Clifton

Conclusions: In conclusion, short-term weight loss with the LC did not impair FMD. We observed beneficial effects on most of the traditional and new CVD disease risk factors measured with both dietary patterns. The overall risk of CVD does not seem to be different for these 2 types of diet. However, this was a short-term study; the long-term effects of this dietary pattern on vascular function and CVD require investigation.


Systematic review of randomized controlled trials of low-carbohydrate vs. low-fat/low-calorie diets in the management of obesity and its comorbidities (2008)

M. Hession, C. Rolland, U. Kulkarni, A. Wise, J. Broom

Conclusions: Evidence from this systematic review demonstrates that LC/HP diets are more effective at 6 months and are as effective, if not more, as LF diets in reducing weight and cardiovascular disease risk up to 1 year.


The effect of a plant-based low-carbohydrate ("Eco-Atkins") diet on body weight and blood lipid concentrations in hyperlipidemic subjects (2009)

Jenkins DJ, Wong JM, Kendall CW, Esfahani A, Ng VW, Leong TC, Faulkner DA, Vidgen E, Greaves KA, Paul G, Singer W

Cochrane Logo 47 overweight hyperlipidemic men and women. Two diets. (1) Low Carb; carbohydrates 26%, only vegetable protein 36%, and vegetable oils 43%. (2) High Carb; carbohydrates 58%, vegetable protein 16%, and vegetable oils 25%)
The study food was provided at 60% of calorie requirements.

Conclusions: A low‐carbohydrate plant‐based diet has lipid‐lowering advantages over a high‐carbohydrate, low‐fat weight‐loss diet in improving heart disease risk factors not seen with conventional low‐fat diets with animal products.

NOTE: Carbohydrates more than twice the normal definition of "Low Carb". Both diets supplied 60% of calories needed for maintenance of weight.


Long-term effects of a low carbohydrate, low fat or high unsaturated fat diet compared to a no-intervention control (2009)

S.S. Lim, M. Noakes, J.B. Keogh, P.M. Clifton

Conclusions: Significant cardiometabolic risk factor reduction was observed equally with VLC, VLF and HUF diets after 15 months, compared to an exacerbation of risk factors in the control group. At a modest level of adherence, 3 months of intensive support on these dietary patterns confer an improvement in cardiometabolic profile compared to no dietary intervention after 15 months.


Weight and Metabolic Outcomes After 2 Years on a Low-Carbohydrate Versus Low-Fat Diet (2010)

Gary D. Foster, PhD, Holly R. Wyatt, MD, James O. Hill, PhD, Angela P. Makris, PhD, RD

Cochrane Logo 307 participants with a mean age of 45.5 years (SD, 9.7 years) and mean body mass index of 36.1 kg/m(2) (SD, 3.5 kg/m(2)). Two diets: LC and LF.
A low‐carbohydrate diet; carbohydrate 20 g/d for 3 months in the form of low‐glycemic index vegetables with unrestricted consumption of fat and protein. After 3 months, participants in the low‐carbohydrate diet group increased their carbohydrate intake (5 g/d per wk) until a stable and desired weight was achieved.
A low‐fat diet consisted of limited energy intake (1200 to 1800 kcal/d; Less than 30% calories from fat). Both diets were combined with comprehensive behavioral treatment.

Conclusions: Successful weight loss can be achieved with either a low-fat or low-carbohydrate diet when coupled with behavioral treatment. A low-carbohydrate diet is associated with favorable changes in cardiovascular disease risk factors at 2 years.


Consuming a hypocaloric high fat low carbohydrate diet for 12 weeks lowers C-reactive protein, and raises serum adiponectin and high density lipoprotein-cholesterol in obese subjects (2013)

Megan R. Ruth, Ava M. Port, Mitali Shah, Ashley C. Bourland, Nawfal W. Istfan, Kerrie P. Nelson, Noyan Gokce, Caroline M. Apovian

Conclusions: Relative to the LFHC group, the HFLC group had greater improvements in blood lipids and systemic inflammation with similar changes in body weight and composition. This small-scale study suggests that HFLC diets may be more beneficial to cardiovascular health and inflammation in free-living obese adults compared to LFHC diets.


Effects of Low-Carbohydrate and Low-Fat Diets (2014)

Lydia A. Bazzano, MD, PhD, MPH*, Tian Hu, MD, MS*, Kristi Reynolds, PhD, Lu Yao, MD, MS, Calynn Bunol, MS, RD, LDN, Yanxi Liu, MS, Chung-Shiuan Chen, MS, Michael J. Klag, MD, MPH, Paul K. Whelton, MD, MSc, MB, Jiang He, MD, PhD

Cochrane Logo 148 men and women without clinical cardiovascular disease and diabetes.
A low‐carbohydrate (Less than 40 g/d) or low‐fat (Less than 30% of daily energy intake from total fat [Less than 7% saturated fat]) diet. Both groups received dietary counseling at regular intervals throughout the trial.

Conclusions: The low-carbohydrate diet was more effective for weight loss and cardiovascular risk factor reduction than the low-fat diet. Restricting carbohydrate may be an option for persons seeking to lose weight and reduce cardiovascular risk factors.


Weight Loss + Lower HbA1c and Lower Cardio-Vascular Disease Risk

Low-carbohydrate dietary pattern on glycemic outcomes trial (ADEPT) among individuals with elevated hemoglobin A1c (2021)

Kirsten S. Dorans, Lydia A. Bazzano, Lu Qi, Hua He, Lawrence J. Appel, Jonathan M. Samet, Jing Chen, Katherine T. Mills, Bernadette T. Nguyen, Matthew J. O’Brien, Gabriel I. Uwaifo & Jiang He

Conclusions: We expect the results from this study have the potential to lead to new horizons for developing and implementing dietary approaches (other than the most frequently used reduced fat diet) that will substantially reduce risk of cardiometabolic disease among adults with or at high risk of T2DM.


Weight Loss + Suitable for Young People


Effects of a low-carbohydrate diet on weight loss and cardiovascular risk factor in overweight adolescents (2003)

Stephen B. Sondike MD. Nancy Copperman MS RD, Marc S.Jacobson MD

Conclusions: The LC diet appears to be an effective method for short-term weight loss in overweight adolescents and does not harm the lipid profile.


Efficacy and Safety of a High Protein, Low Carbohydrate Diet for Weight Loss in Severely Obese Adolescents (2010)

Nancy F. Krebs, MD, MS, Dexiang Gao, PhD, Jane Gralla, PhD, Juliet S. Collins, MD, and Susan L. Johnson, PhD

Conclusions: The HPLC diet is a safe and effective option for medically supervised weight loss in severely obese adolescents.


Metabolic impact of a ketogenic diet compared to a hypocaloric diet in obese children and adolescents (2012)

Ioanna Partsalaki, Alexia Karvela, Bessie E Spiliotis

Conclusions: The ketogenic diet revealed more pronounced improvements in weight loss and metabolic parameters than the hypocaloric diet and may be a feasible and safe alternative for children's weight loss.


Weight Loss + Decreased Hunger Perception


Perceived Hunger Is Lower and Weight Loss Is Greater in Overweight Premenopausal Women Consuming a Low-Carbohydrate/High-Protein vs High-Carbohydrate/Low-Fat Diet (2005)

Sharon M.Nickols-Richardson PhD, RD, Mary Dean Coleman PhD, RD, Joanne J.Volpe, Kathy W.Hosig PhD, MPH, RD

Conclusions: Based on Eating Inventory scores, self-rated hunger decreased in women in the low-carbohydrate/high-protein but not in the high-carbohydrate/low-fat group from baseline to week 6. In both groups, self-rated cognitive eating restraint increased from baseline to week 1 and remained constant to week 6. Both diet groups reported increased cognitive eating restraint, facilitating short-term weight loss; however, the decrease in hunger perception in the low-carbohydrate/high-protein group may have contributed to a greater percentage of BW loss.


Weight Loss on Popular Diets


Comparison of the Atkins, Ornish, Weight Watchers, and Zone Diets for Weight Loss and Heart Disease Risk Reduction (2005)

Michael L. Dansinger, MD; Joi Augustin Gleason, MS, RD; John L. Griffith, PhD;

Conclusions: Although some popular diets are based on long-standing medical advice and recommend restriction of portion sizes and calories (eg, Weight Watchers), a broad spectrum of alternatives has evolved. Some plans minimize carbohydrate intake without fat restriction (eg, Atkins diet), many modulate macronutrient balance and glycemic load (eg, Zone diet), and others restrict fat (eg, Ornish diet). Given the growing obesity epidemic, many patients and clinicians are interested in using popular diets as individualized eating strategies for disease prevention. Unfortunately, data regarding the relative benefits, risks, effectiveness, and sustainability of popular diets have been limited.


Randomised controlled trial of four commercial weight loss programmes in the UK: initial findings from the BBC “diet trials” (2006)

Helen Truby, Sue Baic, Anne deLooy, Kenneth R Fox, M Barbara E Livingstone, Catherine M Logan, Ian A Macdonald, Linda M Morgan, Moira A Taylor, D Joe Millward

Conclusions: Clinically useful weight loss and fat loss can be achieved in adults who are motivated to follow commercial diets for a substantial period. Given the limited resources for weight management in the NHS, healthcare practitioners should discuss with their patients programmes known to be effective.

Comparison of the Atkins, Zone, Ornish, and LEARN Diets for Change in Weight and Related Risk Factors Among Overweight Premenopausal Women (2007)

Christopher D. Gardner, PhD; Alexandre Kiazand, MD; Sofiya Alhassan, PhD; et al Soowon Kim, PhD; Randall S. Stafford, MD, PhD; Raymond R. Balise, PhD; Helena C. Kraemer, PhD; Abby C. King, PhD

Conclusions: In this study, premenopausal overweight and obese women assigned to follow the Atkins diet, which had the lowest carbohydrate intake, lost more weight and experienced more favorable overall metabolic effects at 12 months than women assigned to follow the Zone, Ornish, or LEARN diets. While questions remain about long-term effects and mechanisms, a low-carbohydrate, high-protein, high-fat diet may be considered a feasible alternative recommendation for weight loss.

NOTE: The Atkins group aimed for 20 g/d or less of carbohydrate for “induction” (usually 2-3 months) and 50 g/d or less of carbohydrate for the subsequent “ongoing weight loss” phase. so it was Low Carb. Concerns about adverse metabolic effects of the Atkins diet were not substantiated within the 12-month study period.


Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet (2008)

Iris Shai, R.D., Ph.D., Dan Schwarzfuchs, M.D., Yaakov Henkin, M.D., Danit R. Shahar, R.D., Ph.D., Shula Witkow, R.D., M.P.H., Ilana Greenberg, R.D., M.P.H., Rachel Golan, R.D., M.P.H., Drora Fraser, Ph.D., Arkady Bolotin, Ph.D., Hilel Vardi, M.Sc., Osnat Tangi-Rozental, B.A., Rachel Zuk-Ramot, R.N.

Cochrane Logo 2-year trial, we randomly assigned 322 moderately obese subjects (mean age, 52 years)
Randomly assigned to one of three diets: low-fat, restricted-calorie; Mediterranean, restricted-calorie; or low-carbohydrate, non–restricted-calorie. Dropout rate over 2 years 16%. The four diets are carefully explained in the report.

Conclusions: 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.

NOTE: The low-carbohydrate, non–restricted-calorie diet aimed to provide 20 g of carbohydrates per day for the 2-month induction phase and immediately after religious holidays, with a gradual increase to a maximum of 120 g per day to maintain the weight loss. They were advised to use vegetable fat sources.
They tested the participants for detectable urinary ketones at the end of the study. (With poor results of course.) I think this set-up was stacked against the Low Carb diet.


Weight Loss + Improved Mood and Cognitive Function


Low- and high-carbohydrate weight-loss diets have similar effects on mood but not cognitive performance (2007)

Angela K Halyburton, Grant D Brinkworth, Carlene J Wilson, Manny Noakes, Jonathan D Buckley, Jennifer B Keogh, Peter M Clifton

Conclusions: Both dietary patterns significantly reduced body weight and were associated with improvements in mood. There was some evidence for a smaller improvement in cognitive functioning with the LCHF diet with respect to speed of processing, but further studies are required to determine the replicability of this finding.


Weight Loss + Lower Insulin Resistance - Metabolic Syndrome


A randomized study comparing the effects of a low-carbohydrate diet and a conventional diet on lipoprotein subfractions and C-reactive protein levels in patients with severe obesity (2004)

Prakash Seshadri, MD, Nayyar Iqbal, MD, Linda Stern, MD, Monica Williams, Kathryn L. Chicano, CRNP, Denise A. Daily, RD, Joyce McGrory, CRNP, Edward J. Gracely, PhD, Daniel J. Rader, MD, Frederick F. Samaha, MD

Conclusions: In this 6-month study involving severely obese subjects, we found an overall favorable effect of a low-carbohydrate diet on lipoprotein subfractions, and on inflammation in high-risk subjects. Both diets had similar effects on LDL and HDL subfractions.


Carbohydrate Restriction has a More Favorable Impact on the Metabolic Syndrome than a Low Fat Diet (2009)

Jeff S. Volek, Stephen D. Phinney, Cassandra E. Forsythe, Erin E. Quann, Richard J. Wood, Michael J. Puglisi, William J. Kraemer, Doug M. Bibus, Maria Luz Fernandez & Richard D. Feinman

Conclusions: The findings provide support for unifying the disparate markers of Metabolic Syndrome and for the proposed intimate connection with dietary carbohydrate. The results support the use of dietary carbohydrate restriction as an effective approach to improve features of Metabolic Syndrome and cardiovascular risk.


Long-term effects of a very-low-carbohydrate weight loss diet compared with an isocaloric low-fat diet after 12 months (2009)

Grant D Brinkworth, Manny Noakes, Jonathan D Buckley, Jennifer B Keogh, Peter M Clifton

Conclusions: Under planned isoenergetic conditions, as expected, both dietary patterns resulted in similar weight loss and changes in body composition. The LC diet may offer clinical benefits to obese persons with insulin resistance. However, the increase in LDL cholesterol with the LC diet suggests that this measure should be monitored.


Enhanced weight loss with protein-enriched meal replacements in subjects with the metabolic syndrome (2010)

Marion Flechtner-Mors, Bernhard O Boehm, Regina Wittmann, Ulrike Thoma, Herwig H Ditschuneit

Conclusions: Individuals with the metabolic syndrome achieved significant weight loss while preserving fat-free mass when treated with an energy-restricted, high-protein diet that included nutrient-dense meal replacements, as compared with the results for conventional protein intake. An intervention with a protein-enriched diet may have advantages for the management of the metabolic syndrome.


Visceral adiposity and metabolic syndrome after very high–fat and low-fat isocaloric diets (2016)

Vivian L Veum, Johnny Laupsa-Borge, Øyvin Eng, Espen Rostrup, Terje H Larsen, Jan Erik Nordrehaug, Ottar K Nygård, Jørn V Sagen, Oddrun A Gudbrandsen, Simon N Dankel, Gunnar Mellgren

Conclusions: Consuming energy primarily as carbohydrate or fat for 3 months did not differentially influence visceral fat and metabolic syndrome in a low-processed, lower-glycemic dietary context. Our data do not support the idea that dietary fat per se promotes ectopic adiposity and cardiometabolic syndrome in humans.


Exercise Capacity and Tolerance


Effects of a Low Carbohydrate Weight Loss Diet on Exercise Capacity and Tolerance in Obese Subjects (2012)

Grant D. Brinkworth, Manny Noakes, Peter M. Clifton, Jonathan D. Buckley

Conclusions: The current data suggest that in untrained, overweight individuals, the consumption of an LC weight loss diet for 8 weeks, does not adversely affect physical function or exercise tolerance compared with an HC diet. This suggests that, at least over the short-term, an LC weight loss diet is unlikely to limit an individual's ability or desire to participate in concomitant exercise which is unequivocally recognized as an important adjunct to diet for obesity treatment.

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