Carbs, Fat, or Quality. What should I do???
Okay, so everybody wants to know should I do low fat, low carb, high-protein, something in between? there is certainly a lot of hyper regarding different diets over the last several years. However, does the data actually support any of these on larger scale studies? Perhaps it is not the actual specific macro nutrient that we take in but rather the quality of the food taken.
I just listened to an interesting talk regarding research related to what is most important in weight loss. The eternal question and answer to life, the universe, and everything. What is most important in weight loss: Carbs, Fat, or Calories?
Summary:
None of the above…dangit
Although this article hails from 2009 I feel that it encompasses this eternal question quite well (1). In summary, “Reduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize.”
There is a lot going on in this graph from the study but essentially it demonstrates that at the end of the 2 year intervention there is no statistically significant difference between high fat, low carb, high-protein, low-fat diets.
Although there does appear to be changes in other significant markers for health and well-being regarding macro-nutrient interventions/restrictions. For example, the intensity of a blood glucose spike is decreased in a low-carbohydrate diet. Furthermore there is evidence that insulin levels and insulin sensitivity is also improved in low-carbohydrate diets. This leads many people to state a low-carbohydrate diet, read ketogenic diet, is far superior. However, there does not appear to be actual high-quality human evidence to support these larger claims.
Furthermore, in a large Cochrane systematic review of the available literature, the authors conclude “There is probably little to no difference in weight reduction and changes in cardiovascular risk factors up to two years' follow-up, when overweight and obese participants without and with T2DM are randomised to either low-carbohydrate or balanced-carbohydrate weightreducing diets.” (4)
Perhaps it is not the actual macro-nutrient profile that matters as much as it is the quality of the food we are taking in. There is a very interesting study (2) that compared a ultra processed food diet to a minimally processed diet. There was a strong association to increase calorie intake with the ultra processed food diet. Now, one might say that the ultra processed foods such as potato chips, cheeseburgers, etc. might be more satisfying and familiar to the subject in the study. However, they also looked at this and the familiarity and satisfaction between the 2 arms was also similar.
All meals were matched for calories, sugar, fat, fiber, and macronutrients. The only difference was the processing of the foods. Participants were allowed to eat as much as desired.
Personally, I think this makes sense in both anecdotal and personal experience. What appears to be most important is that one is cognizant of the food they take in. When we are more present during the act of eating we tend to enjoy what we are eating more and therefore require less to feel satisfied.
Furthermore, there is certainly concern and pathophysiologic mechanisms to consider when it comes to eating highly processed foods and the effects on the human body. Theoretically, our bodies were not made to ingest artificial dyes, flavorings and the multitude of other chemicals that end up in ultraprocessed foods. I think these studies can provide a frame work for healthy eating. Once again I feel Michael Pollan hit the nail on the head. "Eat food, not too much, mostly plants." (3)
References
Sacks FM, Bray GA, Carey VJ, Smith SR, Ryan DH, Anton SD, McManus K, Champagne CM, Bishop LM, Laranjo N, Leboff MS, Rood JC, de Jonge L, Greenway FL, Loria CM, Obarzanek E, Williamson DA. Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med. 2009 Feb 26;360(9):859-73. doi: 10.1056/NEJMoa0804748. PMID: 19246357; PMCID: PMC2763382.
Hall KD, Ayuketah A, Brychta R, Cai H, Cassimatis T, Chen KY, Chung ST, Costa E, Courville A, Darcey V, Fletcher LA, Forde CG, Gharib AM, Guo J, Howard R, Joseph PV, McGehee S, Ouwerkerk R, Raisinger K, Rozga I, Stagliano M, Walter M, Walter PJ, Yang S, Zhou M. Ultra-Processed Diets Cause Excess Calorie Intake and Weight Gain: An Inpatient Randomized Controlled Trial of Ad Libitum Food Intake. Cell Metab. 2019 Jul 2;30(1):67-77.e3. doi: 10.1016/j.cmet.2019.05.008. Epub 2019 May 16. Erratum in: Cell Metab. 2019 Jul 2;30(1):226. Erratum in: Cell Metab. 2020 Oct 6;32(4):690. PMID: 31105044; PMCID: PMC7946062.
Pollan, Michael. The Omnivore's Dilemma : a Natural History of Four Meals. New York :Penguin, 2007.
Naude, Celeste E., Amanda Brand, Anel Schoonees, Kim A. Nguyen, Marty Chaplin, and Jimmy Volmink. “Low‐carbohydrate versus Balanced‐carbohydrate Diets for Reducing Weight and Cardiovascular Risk.” Cochrane Database of Systematic Reviews 2022, no. 1 (2022). https://doi.org/10.1002/14651858.cd013334.pub2.
