In a study published this week in the New England Journal of Medicine, people on low-carbohydrate and Mediterranean diets lost more weight and had more favorable metabolic changes than people on low-fat diets - but the degree of weight loss after 2 years was not impressive for any group.

In the DIRECT study, 322 middle-aged individuals (mainly men) who had an average body mass index of 31 (anything over 29 is considered obese), were randomized to one of three diets: a low-calorie low-fat diet, a low-calorie Mediterranean diet, or a low-carb diet patterned after the Atkins diet and without calorie restrictions. The study was conducted among employees of an Israeli nuclear research center, and their meals were tightly controlled, so that compliance with the assigned diets was high.

After 2 years, those on the low-fat and Mediterranean diets lost an average of 10 pounds, and those on the low-carb diet lost an average of 14 pounds. Improvements in LDL cholesterol, HDL cholesterol and triglycerides were seen with all 3 diets, but the improvements were greatest among the low-carb and Mediterranean dieters.

DrRich Comments:

We can reach 2 reasonable conclusions from this study.

First, the decades-long bias within revered medical organizations such as the American Heart Association in favor of low-fat diets and against alternative diets (especially low-carb diets) is being systematically worn away by hard data from head-to-head trials like this one. While we wait for the bureaucratic wheels to engage in their ponderous rotation, to the point where such organizations will formally recognize the legitimacy (if not the superiority) of non-low-fat diets not only for weight loss, but also for improvement of cardiac risk factors, there seems now to be plenty of evidence to say: Low-carb and Mediterranean diets are just fine. Go ahead and try them.

Second, if you are obese, to achieve really substantial weight loss it looks like diet alone - no matter what type - will likely not do the trick. You're going to have to work on the other end of the weight loss equation also, and increase the number of calories you're burning. There's no way to avoid the conclusion that it's going to take exercise as well.

Sorry.

_{Read more about low fat vs. low carb diets here.}

Sources:

Shai I, Schwarzfuchs D, Henkin Y, et al. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med 2008; 359:229-41.

In the past few years, numerous studies have shown an association between drinking moderate amounts of alcohol (no more than 2 standard-sized drinks per day) and a reduction in cardiac risk. In fact, complete abstention from alcohol has been identified as one of the 9 major risk factors for heart disease.

But doctors have been reluctant to recommend alcohol consumption to their patients, because of its well-known propensity to cause addiction, and also because consuming more than 2 drinks per day INCREASES one's risk of death. This increased risk of death has generally been attributed to the increase in accidents, liver disease, neurological disease, and heart failure that alcohol is known to cause.

A new study out of Japan this week shows that heavy alcohol consumption (the equivalent of 4 or more drinks per day) is associated with a 50% increased risk of death from stroke in men.

But in women, heavy alcohol consumption was associated with a doubling of the risk of death from stroke, and a quadrupling of the risk of death from heart attack. Also, the benefits of light alcohol consumption in women was less than for men.

The most striking finding in this study, therefore, was that not only are the benefits of light alcohol consumption less in women, but also that the risk of heavy alcohol consumption appear much worse in women. In both women and in men, however, this study confirms once again that consuming any more than one or two drinks per day causes a net increase in mortality.

_Sources:

Ikehara S, Hiroyasu I, Toyoshima H et al. Alcohol consumption and mortality from stroke and coronary heart disease among Japanese men and women. The Japan collaborative cohort study. Stroke 2008; DOI: 10.1161/strokeaha.108.520288.