Low-carb, low-fat, Mediterranean diet. Which works best for you?

steakby James Hubbard, M.D., M.P.H.

I must admit that I have a bias against the low-carb Atkins diet. It just doesn’t make sense to me and I don’t want to try it. I have written off past studies that conclude these diets do, in fact, lower cholesterol and weight by reasoning that the study is too short, or some other flaw. However, I am being worn down with facts.

Still, the devil is in the details.

The latest is a two-year study in the July 17 New England Journal of Medicine pitting the low-carbohydrate, non-restricted-calorie diet against the Mediterranean-style and low-fat diets, both restricted-calorie. Who won? It depends on how you look at it–and there are lots of numbers.


The low-fat diet consisted of 30 percent fat (10 percent saturated) and 300 mg of cholesterol per day. Women got 1,500 calories and men 1,800.

The Mediterranean diet was popularized when researchers found that the Europeans who ate this way had a lower risk of heart disease. It’s rich in vegetables, poultry, fish, nuts and olive oil. Calories were limited the same as the low-fat diet.

The low-carb diet was based on the Atkins diet. This group gradually built up to 120 grams of protein per day with unlimited calories and fat. They were counseled on using vegetarian sources of fat and protein.

Overall, for those who finished the whole two years, the group in the low-fat diet lost an average of 2.9 kg (6.4 lbs), Mediterranean 4.4 kg (9.7 lbs) and low-carb 4.7 kg (10.3 lbs).

So the low-carb was the best, right?

Well there were many more men than women so let’s break it down a bit further.

Men’s average weight loss:

  • Low-fat: 3.4 kg (7.5 lbs)
  • Mediterranian: 4.0 kg (8.8 lbs)
  • Low-Carb: 4.9 kg (10.8 lbs) (WINNER!)

Women’s average weight loss:

  • Low-Fat: 0.1 kg (0.2 lbs)
  • Mediterranian: 6.2 kg (13.6 lbs) (WINNER!)
  • Low-Carb: 2.4 kg (5.3 lbs)

Percentage of people who stuck with the diet for two years:

  • Low-fat: 90.4 percent (WINNER!)
  • Mediterranian: 85.3 percent
  • Low-Carb: 78 percent

A different diet wins in each category! The Mediterranean diet gets women; low-carb gets men; and low-fat wins for sustainability. (I think that’s important because you want a long-term rather than quick fix.)

Other notables:

  • Total cholesterol and triglycerides dropped in all three groups.
  • HDL (good cholesterol) rose in all, but more in the low-carb group.
  • Blood pressure and waist size decreased in all three groups.
  • The only decrease in glucose levels came with the Mediterranean diet.

Weaknesses in the study could be in the small size (322). Certainly, researchers need to study a larger group of women. Also, the project was partly funded by the Veronica Atkins Research Foundation (wife of the Atkins diet founder).

Bottom Line: It is becoming clear that, among these major diet plans, whatever works for you is best. All appear to be safe. Just find the one that gives you results and that you can stick with long-term. (and don’t forget to eat your vegetables)

Maybe I will try that low-carb diet after all. What have you found that works for you?

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15 Responses to “Low-carb, low-fat, Mediterranean diet. Which works best for you?”

  1. DR Says:

    I have a few problems with this study.

    Since when did Atkins recommend vegetable based fats and protein? It may be low-carb, but it’s not Atkins

    The low carb diet looks less like an Atkins plan and more like a Paleoplithic / Caveman type diet – http://healthhabits.wordpress.com/2008/05/10/news-flash-caveman-diet-goodyour-diet-bad/

    Atkins partially funded the study – I am not questioning the integrity of the researchers, but when you go looking for a specific outcome, you often find what you were looking for.

    How is 30% of calories from fat low-fat? Pritikin recommends 10% of calories come from fat – http://www.webmd.com/diet/pritikin-principle-what-it-is

    Thank you for taking a critical look at the research. Most media coverage of this study has simply been parroting the conclusions of the lead researcher

    DRs last blog post..Scientists discover the Couch Potato gene

  2. Diana Young Says:

    I agree with your bottom line 100%. That’s our philosophy at Iowa Avenue.

    Diana Youngs last blog post..Elisa left a comment for cathy

  3. jhubbard Says:

    Thanks Diana,

    I agree. The http://www.iowaavenue.com website is full of helpful nutritional advice and delicious, healthy recipes.

  4. jhubbard Says:


    Great insight. Thanks for the valuable comments.

  5. Mark Salinas Says:

    I don’t believe in diets period….. Eat smart, appropriate portions and stay active. I can see how they could benefit one though. Thanks!

    Mark Salinass last blog post..Gadgets – again

  6. James Hubbard, M.D., M.P.H Says:

    Mark, you’re right. I’ve seen so many people who go from diet to diet trying whatever is new but not sticking with anything. You have to find something healthy that you can stick with and add exercise to the mix.

  7. Diana Young Says:

    I should clarify: We believe one size doesn’t fit all and the difference between success and failure has more to do with people feeling in control, and having the ability to customize their respective programs.

  8. Jill Weisenberger, M.S., R.D., C.D.E. Says:

    I think that there a few important things to consider about this study. It was conducted in Israel where beans, nuts and vegetables are more frequently eaten than they are here. Vegetables are even served at breakfast. We don’t know exactly what they ate, but the lower carb group was advised to choose vegetable sources of protein and fat. That suggests that they were eating more beans and nuts than bacon and burgers.

    Overall, the weight loss was modest in all three groups. Though modest weight loss can have huge benefits, many of my patients are left frustrated with just a 10 pound loss. I, however, am celebrating their losses and thinking about the improvement in their overall health.

    As a registered dietitian, I want all of my patients to eat a balanced diet regardless of their weight. Thousands of studies over decades have linked a diet high in fruits, vegetables and whole grains to lower cancer risk. The rates of heart disease is also reduced with this type of diet. So to me it doesn’t matter so much about the absolute number of grams of fat or grams of carbohydrate a person eats. I just care that the diet is rich in phytochemicals and other nutrients to prevent disease and that means lots of colorful fruits and vegetables and a few servings of whole grains each day. For my weight loss patients, I want to see a healthy reduction in calories as well.

    The biggest problem in many diets is the number of highly refined products. It doesn’t matter if your brownie is reduced in carbohydrates or reduced in fat. It’s still a brownie and shouldn’t be a major part of the diet. If the diet is low in calories, a person will lose weight. In this study, the lower carb diet was reduced by about 560 calories per day in the first 6 months. That accounts for the weight loss at 6 months. Each group lost weight by the 6 month period, but regained some after that.

    It’s also important to note that women didn’t really do so well on the carb-restricted plan. They lost more weight on the Mediterranean plan. Also among people with diabetes, only the Mediterranean plan improved fasting blood glucose levels.

    There is one other important thing to consider. Weight loss is one thing, but maintenance of that loss is another. My experience tells me that successful maintenance stems from a healthy attitude. It’s not about dieting. Instead it’s about not dieting. It’s understanding that you can eat anything (remember the word moderation), but you cannot eat everything. It’s about making choices. I base my own choices on overall nutrition, calories, taste, cost and convenience (often in that order, but certainly not always).

    This is one more study in the mix. What it shows is that people can lose weight in a variety of ways when the calories are lowered. Each group (not each individual) reduced their average calorie intake by 255 to 560 calories per day.

  9. James Hubbard, M.D., M.P.H Says:

    Well said Diana

  10. James Hubbard, M.D., M.P.H Says:

    Thanks for the discerning comments.
    I agree completely

  11. Judy Rodman Says:

    Wow… this is the one of the best and most intellegent, non-biased discussions I’ve read about weight loss strategies. Personally, I’m glad the Mediterranean diet did well with women… my Turkish restaurant is my favorite dining out experience!

    I also agree that weight issues are much more than counting calories. Bodies and minds are different, as are the issues leading to the weight issues. I know people who have benefited from participating in OverEaters Annon to keep weight in perspective and to deal with obesity as well as it’s opposite problem…anorexia.

    In the music business, appearance is important. When I notice personality disorders in my vocal students, they are often accompanied by career-affecting weight issues and obsession with weight issues. I’ve noticed that when their minds become more healthy and balanced, the lifestyle diet changes they need for their health become easier to stick to, and … they sing better, as well!

    Judy Rodmans last blog post..Vocal contests… how to "win"

  12. James Hubbard, M.D., M.P.H Says:

    Great insight from the entertainer perspective. I just did a short video we will have on our website soon, and I decided I need multiple cosmetic surgeries (lol).
    Seriously, the body and the mind are so interconnected. The mindset should come first.

  13. Bonnie Modugno, MS, RD Says:

    I find the preoccupation with weight loss in this study to be bewildering. The real significant impact was the decrease in CV, DM and inflammatory risk factors–especially for the “atkins” type diet. I am wondering why the researchers continued to identify the diet plan as “atkins” like. When the average intake of CHO is 40% at 6 mos, 12 mos, and 24 mos of the study, it is hardly “atkins like”. Still, helping participants decrease insulin resistance by limiting CHO to 20 grams a day for the first two months, and then again after holidays was a brilliant part of the design. That is a phenomenal way to quiet those carbohydrate cravings after a period of over indulging.

    One phenomenal feature was the access to RD support–18 ninety minute presentations over the two years plus individual motivational phone calls by an RD for those who needed it. How does that rank with most client’s access to nutritional support?

    Lastly, I agree that whatever works is what works. The question is not which diet is best, but which approach to food works best for any one individual. And how come we never hear about the participants’ experience during these studies? I think it would be fascinating to hear their perspective. It’s not all in the numbers.

  14. James Hubbard, M.D., M.P.H Says:

    Thanks for the post, Bonnie. You bring up some great points.

  15. James Hubbard’s My Family Doctor Blog » Blog Archive » Good Fats for Life! Mediterranean diet leads to less risk of chronic disease and death. Says:

    [...] We already knew the diet could lower glucose, but the BMJ study looked at the bottom line of bottom lines–death–and found good news, as well as pleasant surprises. [...]

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