Here’s a really nice study on the effect of Low Carb diet on Diabetics (Guenther Boden; Effect of a Low-Carbohydrate Diet on Appetite, Blood Glucose Levels, and Insulin Resistance in Obese Patients with Type 2 Diabetes; Ann Intern Med. 2005; 142(6):403-411. DOI: 10.7326/ 0003-4819-142-6-200503150-00006). This study was funded by grants from the National Institutes of Health and the American Diabetes Association.
All of the results were positive for the Low Carb diet for treating diabetics. The objective of the study was:
To determine effects of a strict low-carbohydrate diet on body weight, body water, energy intake and expenditure, glycemic control, insulin sensitivity, and lipid levels in obese patients with type 2 diabetes.
One thing in the conclusions was particularly noteworthy:
On the low-carbohydrate diet, mean energy intake decreased from 3111 kcal/d to 2164 kcal/d. The mean energy deficit of 1027 kcal/d (median, 737 kcal/d) completely accounted for the weight loss of 1.65 kg in 14 days (median, 1.34 kg in 14 days).
This does contradict some of the magical thinking in the Low Carb community. Calories do count in this sense. You lose weight on a Low Carb diet because you are eating less calories. The Second Law of Thermodynamics is rescued.
However, this point goes against the other side in that the people on this study ate as much as they wanted, they were just limited to Low Carb foods. And when eating Low Carb foods, their calorie consumption dropped to their actual healthy caloric needs levels. As the conclusions noted:
In a small group of obese patients with type 2 diabetes, a low-carbohydrate diet followed for 2 weeks resulted in spontaneous reduction in energy intake to a level appropriate to their height
And of course all of their Blood Glucose numbers improved greatly.
The question that is begging to be asked in the article is why a Low Carb diet dropped these people to a “level of energy intake appropriate to their height”. The article stated:
Thus, our data did not support the concept that the weight loss induced by the low-carbohydrate diet was due to different metabolic utilization of macronutrients
True, the calories in and calories out did balance but the reason that the calories in was reduced was because of the macronutrients. In particular, the lowering of Insulin levels results in less weight. In fact, for many of the participants their insulin injections were reduced. The reduction in Serum Insulin provides the most compelling explanation for why this diet worked.
Mean 24-hour serum insulin and leptin levels profiles were statistically significantly lower at the end of the low-carbohydrate diet than before this diet, while ghrelin profiles increased marginally.
This brings up a novel idea for stalls. Perhaps the reason that people stall is that they are now eating the calories to maintain their appropriate body weight. Even under Low Carb the same laws apply. Calories out and calories in match. And yes, when the calories come from carbs our bodies treat them different than our bodies treat calories of protein or fat which is the key insight of the Low Carb community.
So the only way to break stalls is to actually reduce calories.
And this is where Protein Sparing Modified Fasting comes into play. Eat low carbs to keep Insulin Levels low. Eat enough Protein to preserve Lean Body Mass but not too much which stimulates Insulin. Eat enough fat from the body to meet daily calories out. And for what your body can’t provide from fat stores eat it as fat in your diet.
High Fat or High Protein
The participants in this study were allowed to eat fat and protein in whatever proportions they preferred. And in the end most ate fat and protein pretty much at the rates that they ate them before the diet.
That’s not what the Low Carb High Fat folks are telling us we need to do. Some are telling us with this same magical thinking that if we are stalled we need to eat more fat. And this isn’t working for a lot of people. In fact, I don’t know of anyone that it has worked for. Maybe it has some effect to shake things up momentarily but not to reach goal weights.
And everyone lived happily ever after – as long as they stayed Low Carb.