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You certainly would have had to look far and wide to find a “no-spin” reporting zone a couple of weeks ago when the New England Journal of Medicine¹ published a headline-grabbing study comparing weight loss on one of three diets: (1) Mediterranean, (2) Low-Carb, or (3) Low-Fat.

I doubt if many headline writers or reporters bothered to read the entire 13-page study — they were too busy writing dramatic headlines.  But God is in the details, and in this case, the details were pretty important. So let’s take a look at this fairly important study and talk about what it actually showed (and, also important, what it didn’t show).

Israeli researchers recruited 322 moderately obese subjects and randomly assigned them to one of three dietary groups.

Group one followed a low-carb diet without any restriction on calories. For the first two months they limited their carbohydrate intake to 20 grams a day (the exact amount on the Induction Phase of Atkins).  They were then encouraged to increase their intake of carbs up to a maximum of 120 grams a day of carbs. (Sharp-eyed readers might note that 120 grams of carbs hardly constitutes an Atkins diet, even during the most generous “maintenance” phase.

For someone eating 1500-1800 calories a day diet, that would be between 25-40% of calories from carbs, closer to “The Zone” than to Atkins. But I digress.)

In contrast, both the Mediterranean and the low-fat groups were calorie limited: 1500 calories a day for women and 1800 for men. The low-fat group followed the standard American Heart Association guidelines (30% of calories from fat). The Mediterranean group were allowed up to 35% fat, mostly from olive oil and nuts, and were counseled to substitute beef and lamb with poultry and fish.

Interestingly, all three groups lowered their calories significantly from where they started, even though the low-carb group wasn’t told to do so, meaning the low-carb group “naturally” ate fewer calories without even trying. (This is an important point, since I’ve long maintained that a low-carb diet is easier to follow for many people — especially those with sugar addictions — because it doesn’t stimulate the appetite like high-carb diets frequently do.)

Fast forward two years: the low-carb group lost the most amount of weight, the low-fat diet brought up the rear and the Mediterranean group was in the middle. It’s important to remember that the actual amount of weight loss we’re talking about was pretty pathetic — an average of about 12 pounds for the low-carb group, 10 for the Mediterranean group, and 7 for the low-fat group — but I’ll get to that in a minute.

The weight loss results, however, were only part of the picture. The low-carb group had the highest increase in HDL (”good, protective cholesterol”), the most improvement in cholesterol ratio, and the greatest reduction in triglycerides — an important risk factor for heart disease that many say is more important than cholesterol. (Triglycerides didn’t budge in the low fat group.)

It gets better. As readers of THB know, inflammation is a silent killer and a component of every known degenerative disease — from heart disease to obesity. One of the best markers for inflammation is a blood component called C-Reactive Protein (CRP). Low-carb dieters saw their CRP go down the most — it barely budged in the low-fat group.

So what’s the take home?

Well, first of all, diets are tough. The amount of weight lost by all three groups was pretty dismal, but those numbers were averages — some people lost a lot more (the highest number of pounds lost was lost on the low-carb approach, by the way).

Second, although this study was pretty rigorous about checking “compliance,” we all know that it’s just about impossible to truly monitor “compliance” in a free-living situation — so exactly how well the subjects followed the test diets is open to question.

Third, though the “low-carb” group did the best, I can’t help wonder how much better they would have done if they had actually kept carbohydrate levels down to a more reasonable level of under 100 grams a day (or even less) — a level that seems to work the best for people who have problems with sugar, insulin, and carbohydrates in general. (I’m guessing they would have lost a lot more weight.)

Fourth — and maybe most important — the study shows that there are health benefits to a low-carb approach that go beyond weight loss. Lowered CRP, lowered triglycerides, and increased HDL are nothing to sneeze at — and a nice slap in the face to the establishment that keeps telling us how “unhealthy” low-carb diets are!

I think many of the “distinctions” between the three diets — especially between the low-carb and Mediterranean approach — were somewhat artificial. You could easily follow low-carb and eat more olive oil and nuts, and you could easily follow Mediterranean and eat low carb.

Both programs emphasize a ton of vegetables (yes, even low-carb diets do!), healthy protein, and good fat. In this study, even the low-fat approach sounded dangerously close to the Mediterranean diet (30% of fat vs. 35%).

The best we can say about this important study is that it got a lot of attention (after all this was the New England Journal of Medicine) and gave credibility to the researchers stated conclusion that there are other ways to go besides low-fat. It also gave credibility to the unstated conclusion that no one program works for everyone — and that some people may be more metabolically suited to low-carb (just as some may thrive on vegetarian or raw food diets).

And as far as the dismal weight loss results, let’s just remember that weight loss remains a tough nut to crack.  But with the right match between program and person, the right social support system, a level of determination and commitment, it can be done.

And it frequently is — often with much more dramatic results than were seen in this study.

Reference

1. Shai, I et al. New England Journal of Medicine, 359(3), 229-241, 2008.

[Ed. note: Dr. Bowden is a nationally known expert on weight loss, nutrition and health. He's a board certified nutrition specialist with a Master's degree in psychology and the author of five books including The 150 Healthiest Foods on Earth. His latest book is The Most Effective Cures on Earth.  For more information, click here.]