Monday, December 16, 2013

Low Carb No Better Than High Protein For Weight Loss

sharma-obesity-chronic-kidney-diseaseWhen I finished medical school in 1986, restricting protein intake in patients with reduced kidney function was still part of standard practice. This practice, has since been long abandoned (having probably done more harm than good), but notions about higher protein intake somehow being harmful to kidneys lingers on.

Thus, I was interested by a recent study by Pedersen and colleagues from the University of Adelaide, Australia, published in Nutrition, Metabolism and Cardiovascular Disease, which examined the effect of of a high-protein calorie restricted diet on overweight individuals with type 2 diabetes, albuminuria and reduced kidney function (estimated GFR of >40 ml/min/1.73m2).

Subjects were randomised to 12 months of a standard-protein diet (protien:fat:carbohydrate ratio 20:30:50 % of energy) and one where energy from carbohydrates was reduced and replaced by protein (30:30:40 % of energy).

Both groups lost a significant amount of weight over 12 months (6.6 Kg on the standard-protein diet, 9.7 Kg on the high-protein diet).

The diets had no impact on kidney function despite improvements in diabetes control.

Of note, only 45 of the 76 volunteers completed the study – a drop-out rate of over 40%

Overall, the study shows that differences in carb to protein ratios matter neither in terms of weight loss nor in their impact on kidney function.

Perhaps, even more importantly, the study shows that trying to keep people on diets – even in clinical trials – is challenging, with almost half the subjects abandoning their diet within 12 months.

As I have noted before, diets only work when you stick with them. Rather than obsessing about the exact composition of your diet, it may be best to chose the one you like best and can actually stay on.

@DrSharma
Edmonton, AB

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10 Responses to “Low Carb No Better Than High Protein For Weight Loss”

  1. Willi says:

    Thanks for the info. Your advice is very sound, as usual!

  2. Anonymous says:

    True, the best diet is the one you stay on.

    Losing weight is in itself a motivating factor to stay on a diet, and the high protein diet makes you lose significantly more weight.
    The standard-protein dieters lost only 68% of the weight the high-protein dieters lost.
    If you have a lot of weight to lose, that difference will add up over the years. After 5 years, standard protein dieters lose 33 kg/73lb, high-protein dieters lose 48 kg/105 lbs. Of course over 5 years many other factors come into play, but if you’re going to be in it for the long haul, you might as well go with the diet that will make the biggest difference. If, of course, you stick with it, which is most important.)
    So, if effectiveness of a diet is important to you, high protein has the advantage.

  3. fredt says:

    protien:fat:carbohydrate ratio of 30:30:40 is not low carb, nor a good weight loss ratio.
    Low carb is more like 20:70:10 for a fat/carb ration of 7. It is the fat that controls satiety, but what do the exobese know?

  4. Katharine de Baun says:

    The higher-protein group lost more than 3kg more than the other group. Wouldn’t this be significant?

  5. Sukie Crandall says:

    Were the diets designed to reduce phosphorous intake? That was part of the basis for reduced protein intake, but careful diet selection can do it, too.

  6. Kim says:

    Sorry, I highly disagree with the entire premise of this study. It is not a true representation of high protein vs low carb at all. This study only exchanged 10% protein and carbs for either group, so how on earth is that an accurate basis? Low carb programs are not set up to operate this way. The most successful of all low carb systems divides calories up almost exactly between protein and fat, and greatly reduces the carb allotment to 10% total carb intake. The added fat creates a feeling of fullness that allows the participants to eat less and still feel satisfied. The ratios used in this study would have people dropping out because they would always be hungry. They consumed too many carbs to not still suffer from the carb cravings. Bogus study! Bogus reporting! And this is from a woman who is living proof Low Carb works! I have lost 120 lbs in 9 months without ever being hungry and not feeling the need to ‘cheat’ on a regular basis. I’ve lived first hand the benefits of low carb as I watched my waist line, blood sugar levels, cholesterol, and triglycerides go from HIGH to healthy levels. If you are going to do studies, then take real information……. not try to get your flawed studies to match what you want them to say.

  7. MikeS says:

    I agree with Fred. 30:30:40 is not low carb. I am on currently on a ketogenic diet and try to keep my carb intake below 50 grams per day. In practice that means no sugar, no bread, wheat or other grains, no seeds, no legumes, no starches. Low GMI vegetables, some fermented, in whatever quantity I want to go along with the meat, fish, eggs, cheese, butter, and a few nuts. I saute, never fry foods in ghee, butter/olive oil, duck fat, or coconut oil, which I also consume with cocoa.

    Because I wish to avoid neoglucogenesis, I try to keep my protein relatively low, and aim to eat about .6 gms per lb of lean body weight — that comes to about 30 gms. I err on the high side, so I’m probably closer to 50 gms of protein.

    Prior to going on this diet, I have long eschewed most carbs, particularly wheat and sugar. Since July, I have lost 10 lbs. and 4 inches in the waist. I’ve dropped from 25% to 22% (Takata scale, admittedly both inaccurate and imprecise). More to the point, I feel great. No great hunger, and no food cravings. Blood work — if even relevant– is acceptable even to my conservative cardiologist. TC 200, HDL 60, Triglcerides 30. Fasting blood sugar 90. HbA1C, 5.0

    I don’t believe this is really about willpower except in the early stages — similar to quitting smoking — 30 years after my last and final time to quit, I have no desire now for a cigarette.

    Oh yes. A glass of white wine on most days. Food is not a preoccupation anymore. Definitely eating to live, not living to eat.

    Sadly, none of this has helped my blood pressure, which remains at about 135/80 in spite of 100 mg beta blocker, and 10 mg of CCB and ARB for 13 years. At my current 160, I’m 40 lbs lower than my heaviest. Losing weight didn’t help in my case, nor did avoiding salt. Very frustrating because I hate being on drugs — except caffeine.

    I know I’m my own N1 experiment, but I believe fats, saturated fats particularly, have been demonized. My nomination for demon is carbohydrates — an all forms, but especially sugar.

    I also believe that those will to adopt a diet consisting of high saturated fat (abut 50% sat), truly low carb, modest protein, supplemented by MDR of EFAs where necessary, would find excess weight wouldn’t be a problem, not to mention possible amelioration or solution of other “neolithic” diseases, such as diabetes, GERD, IBS, SIBO, and yes, maybe CVD.

    Here’s an intriguing link outlining many of these ideas at mid-20th century BK, that is Before Keys:

    http://hopefulgeranium.blogspot.com/2013/11/dr-richard-mackarness-meets-low-carb.html

  8. Kindke says:

    Carbs should be measured not as a % of the energy intake but in absolute grams. Sorry but this is fail.

  9. tamilnet online says:

    trying to lose weight suddenly is really very dangerous.

  10. Rod says:

    This is interesting, I suffer from kidney issues as a result of having amphro B many years ago during a cocci episode (1 year). The protein topic has come up often during my annual visits, but I tend to eat a protein less to no carb diet and I’m doing fine regardless..that is at least for now. ;)

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