In English: following weight loss, people on lower carbohydrate diets were able to eat more food to keep their weight stable than people on high carb low-fat diets, putting another nail in the coffin of low fat diets and “calories-in/calories-out” – weight may be more dependent on hormonal interaction with food (insulin/ghrelin/leptin) than on simple number of calories eaten.
“Change in total energy expenditure, the primary outcome, in intention-to-treat (top) and per protocol (bottom) analyses. Data are shown as mean change from start of test phase, with whiskers representing 1 standard error above and below the mean. P tests uniformity across diet groups for average of changes at midpoint and end of test phase.”Ebbeling CB, Feldman HA, Klein GL, Wong JMW, Bielak L, Steltz SK, et al. Effects of a low carbohydrate diet on energy expenditure during weight loss maintenance: randomized trial. BMJ [Internet]. 2018;363:4583. Available from: dx.doi.org/10.1136/bmj.k4583
Since this paper has been published, there’s been a lot of back and forth, first on social media, and now nicely organized in the response section on bmj.com, so best to learn about the different points of view.
In addition to the energy expenditure differences it’s worth noting two additional findings:
- People with higher insulin secretion at the beginning of the study (a sign of greater insulin resistance) had even greater differences (more energy expenditure) on lower carbohydrate diets.
- Lipid changes were more favorable on the lower carbohydrate diet groups, as has been the case in studies including DIETFITS (see my analysis here: Just Read: DIETFITS and Effect of Low-Fat vs Low-Carbohydrate Diet, real food is better, is the low fat diet worse for metabolic health?) – lower triglycerides, higher HDL. Lower triglycerides indicates less excess energy in the bloodstream, a marker for better metabolic health.
Helpful reminder from study authors
This is not a study of plant-based or plant-free nutrition.
Toward Common Ground in Nutrition
Scientific argument often aligns with personal ethics.
👉Vegans cite studies on benefits of low-fat.
👉Low-carb dieters highlight benefits of meat.
But these biases don't reflect modern realities, as we argue in BMJhttps://t.co/JryK0syiTW— Dr. David Ludwig (@davidludwigmd) November 26, 2018
Reference
Ebbeling CB, Feldman HA, Klein GL, Wong JMW, Bielak L, Steltz SK, et al. Effects of a low carbohydrate diet on energy expenditure during weight loss maintenance: randomized trial. BMJ [Internet]. 2018;363:4583. Available from: dx.doi.org/10.1136/bmj.k4583
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