From Lowering the Bar on the Low-Fat Diet, Dr. David Ludwig MD PhD, Journal of the American Medical Association
[N]utrition-related public policy underwent a rapid change in the late 20th century. The US government advised the public to increase intake of carbohydrates (including 6 to 11 servings of grain products and additional potatoes) and consume all fats (including full-fat dairy, olive oil, nuts, avocado, and fatty fish) sparingly, as exemplified by the Food Guide Pyramid of 1992. To facilitate this change, the Healthy People 2000 goals included a call to the food industry to increase from 2500 items “to at least 5000 brand items the availability of processed food products that are reduced in fat.” The food industry followed suit, systematically replacing fat in food products with starch and sugar.
As a result of these efforts, dietary fat decreased to near the recommended limit of 30% total energy. But contrary to prediction, total calorie intake increased substantially, the prevalence of obesity tripled, the incidence of type 2 diabetes increased many-fold, and the decades-long decrease in cardiovascular disease plateaued and may reverse, despite greater use of preventive drugs and surgical procedures. However, other changes in diet (such as meals away from home) and lifestyle (such as physical activity level) may have influenced these trends.
Recent research suggests that the focus on dietary fat reduction has directly contributed to this growing burden of chronic disease. (Read more)
1) MY LOW-CARB HIGH-FAT JOURNEY
By almost any measure I've enjoyed exceedingly good health during my five decades on the planet, thanks primarily to my parents. My mom was a fantastic cook who showed us that meals at home could be healthful, delicious, and fun; my dad turned me on to running when I was in elementary school, sparking a passion for physical activity that's still with me today; and they both passed on a set of genes that, at least to date, have been essentially trouble-free.
But over the last decade three shifts caused me to take a more deliberate approach to health and fitness. First, in 2008 (a few months after turning 40), I realized that my "yo-yo" approach to physical activity (i.e. a few weeks on, then a few weeks off, or even a few months on, then a few months off) was increasing my risk of injury, and I needed to prioritize daily exercise and get control of my schedule to make that possible. I've maintained that goal for the last 9 years, and today I typically exercise 5 or 6 times a week.
More gradually, over the course of the past decade I realized that even though I was relatively active and a generally "healthy" eater (according to conventional nutritional guidance), I was slowly but surely gaining weight. I took some steps to address this--working out harder, or eating and drinking more moderately--but these efforts were either unsustainable or ineffective. Working out harder led to chronic injuries, and greater moderation when I already felt like a prudent eater seemed wearisome and joyless. I realized that simply "doing more" or 'doing better" wasn't going to work, and I began looking into alternatives.
Finally, as an executive coach and in my work with MBAs at Stanford I came to see what a crucial role health and fitness play in our professional lives. I believe that our effectiveness at work is directly related to our ability to focus our attention and manage our emotions, and these capabilities are significantly influenced by four basic practices: mindfulness, exercise, sleep, and stress reduction. Given the complex relationships among these practices and our overall well-being, it was inevitable that my coaching practice and my research on self-coaching would also lead me to explore health and fitness in greater depth.
Over the past few years I began to see articles suggesting that the conventional nutritional wisdom wasn't as infallible as we'd been led to believe. The ideas that seemed most intriguing were that fat--and specifically saturated fat from animal sources--may not be as bad for us as we'd been told, and that sugar may be quite bad for us, even when it comes in "healthful" low-fat foods. I wasn't ready to overturn my "healthy" low-fat diet, but I began eating more meat, eggs, and cheese, fewer processed foods, and less sugar.
This past year I decided to review those articles more thoroughly and to take an in-depth look at the research behind them. I learned that there's a Low-Carb High-Fat (LCHF) movement that's been gaining momentum for several decades, albeit slowly and against resistance from the institutions and organizations that remain committed to the conventional Low-Fat High-Carb approach to dietary health. After exploring the resources below thoroughly and having committed myself to a rigorous LCHF diet over the course of this summer, I've concluded that this approach is absolutely right for me and I'm prepared to recommend it to others who find themselves, as I was, reasonably active and eating "right" (according to the conventional wisdom), but still gaining weight in middle-age.
To be clear, I'm not taking the position that everyone should adopt an LCHF diet, particularly with regard to my clients and students. First, it's clear that a substantial percentage of the population can consume a high-carb diet with minimal ill effects--I'd put myself in that category. More personally, though, that's not my role as an executive coach. But I am prepared to take the same approach that I take regarding the other practices I mention above--mindfulness, exercise, sleep, and stress reduction.
I believe there's sufficient evidence to warrant investing meaningful time and effort in 1) consistent meditation (or other activities that promote mindfulness), 2) regular physical exercise, 3) more and higher-quality sleep, and 4) reducing or eliminating chronic stressors. I don't prescribe specific regimens or routines in these domains to my clients and students--it's up to my them to determine what works best--but I do raise these issues and am happy to discuss what I've learned from the research, my personal experience, and my work with others. Similarly, I'm confident that my clients and students will benefit from better nutrition, and while I won't prescribe specific diets, I'm very open to discussing what I've learned about LCHF (and other approaches) through this process.
2) LCHF IN BRIEF
The model of healthy nutrition embedded in the conventional wisdom of the last 50+ years (referred to in the passage from Dr. David Ludwig above) is often referred to as Calories In, Calories Out, or CICO. This model rests on a number of assumptions:
- All calories are essentially equivalent in their impact on the human body (and, more specifically, in their contribution to weight gain), whether they're derived from carbohydrates, protein, or fat.
- Carbohydrates and protein contain 4 calories per gram, while fat contains 9 calories per gram, so keeping the amount of fat in our diets relatively low should minimize the risk of weight gain and other health issues associated with obesity.
- Consumption of dietary fat can be expected to increase the amount of fat in our circulatory system, which is associated with atherosclerosis (i.e. "clogged arteries") and other forms of heart disease, so, again, keeping the amount of fat in our diets relatively low should minimize the risk of these health issues.
- As a result, our diets should be composed primarily of low-fat, carbohydrate-rich foods such as fruits and vegetables, bread, rice, pasta, and other grain-based products. And our protein should be derived from low-fat sources such lean meat and fish, soybeans and other legumes, and fat-reduced dairy products.
- Dietary fat is necessary only as a source of "essential fatty acids," compounds that the human body can't create or derive from other sources, but because fat is generally unhealthy (as a result of its high caloric load and its contribution to obesity and heart disease), fat consumption should be minimal.
Unfortunately, all of these assumptions are essentially wrong. If you've been a health-conscious eater at any point over the last 50+ years, that assertion may seem astonishing, but that's the conclusion I've drawn after thoroughly reviewing the resources below.
The primary alternative to CICO that has emerged in recent years (although there are others) is what I'm calling LCHF. So what is it?
First, from the introduction to Gary Taubes' Why We Get Fat (discussed below), the problem:
[T]wo factors will essentially determine how much fat we accumulate, both having to do with the hormone insulin. First, when insulin levels are elevated, we accumulate fat in our fat tissue; when these levels fall, we liberate fat from the fat tissue and burn it for fuel. This has been known since the early 1960s and has never been controversial. Second, our insulin levels are effectively determined by the carbohydrates we eat--not entirely, but for all intents and purposes. The more carbohydrates we eat, and the easier they are to digest and the sweeter they are, the more insulin we will ultimately secrete, meaning that the level of it in our bloodstream is greater and so is the fat we retain in our fat cells...
In other words, the science itself makes clear that hormones, enzymes and growth factors regulate our fat tissue, just as they do everything else in the human body, and that we do not get fat because we overeat; we get fat because the carbohydrates in our diet make us fat. The science tells us that obesity is ultimately the result of a hormonal imbalance, not a caloric one--specifically, the stimulation of insulin secretion caused by eating easily digestible, carbohydrate-rich foods: refined carbohydrates, including flour and cereal grains, starchy vegetables such as potatoes, and sugars, like sucrose (table sugar) and high-fructose corn syrup. These carbohydrates make us fat, and by driving us to accumulate fat, they make us hungrier and they make us sedentary. (pages 9-10)
And then, from the conclusion of Nina Teicholz's The Big Fat Surprise (also discussed below), the solution:
Eat butter; drink milk whole, and feed it to the whole family. Stock up on creamy cheeses, offal, and sausage, and, yes, bacon. None of these foods have been demonstrated to cause obesity, diabetes, or heart disease. A large and growing body of recent research now points strongly to the idea that these conditions are caused instead by carbohydrates. Sugar, white flour, and other refined carbohydrates are almost certainly the main drivers of these diseases. Recent scientific research and the historical record all lead to the conclusion that the consumption of refined carbohydrates leads to a higher risk of obesity, heart disease, and obesity...
I acknowledge that these conclusions seem counterintuitive. They were counterintuitive to me when I started the research for this book. And the implications seem almost impossible to believe, even though they are supported by the best available science: that a beet salad with a fruit smoothie for lunch is ultimately less healthy for your waistline and your heart than a plate of eggs fried in butter. Steak salad is preferable to a plate of hummus and crackers. And a snack of full-fat cheese is better than fruit. (page 335)
Three additional points on carbohydrates, protein, and fat:
- Many of the foods we've been trained to think of as "good carbohydrates," from whole-wheat bread and pasta to butterless popcorn to almost all cultivated fruits are readily converted to forms of sugar in the body, contributing directly to the increase in insulin levels and the corresponding accumulation of fat described by Taubes above. The low-carb aspect of LCHF is much more comprehensive than cutting out candy and ice cream.
- While LCHF generally involves significant consumption of animal products (as Teicholz makes clear), this does not imply increasing the amount of protein in our diets. As bad as carbohydrates can be, too much protein can be just as bad for us, and most people eat more than sufficient protein already. The lean animal products that we've been trained to think of as "healthy" actually play almost no role in my LCHF diet.
- LCHF is really all about the F--the fat. There are plenty of unhealthy fats that must be avoided--not only hydrogenated oils and trans-fats, but also most vegetable-based oils (including those that have now replaced trans-fats in most commercial kitchens.) But the biggest change in an LCHF diet is increasing the amount of saturated fat from animal products, coconut, and palm oil, and (to a lesser extent) unsaturated fat from olive oil and certain nut and seed oils.
One final point: In addition to the macro-nutrient content of our diets--what we eat--the issue of timing and when we eat can have a significant influence on our weight and overall health. Dr. Jason Fung's The Obesity Code (cited below) discusses the importance of occasional fasting and avoiding snacks between meals in order to keep blood glucose levels low and minimize the risk of insulin resistance (which appears to play a critical role in weight gain and can be triggered by eating patterns that keep blood glucose levels high for sustained periods of time.)
The changes in when I eat that I'm finding helpful are 1) skipping breakfast, except for black coffee and occasionally a handful of nuts--the old line about it being "the most important meal of the day" appears to be more marketing bullshit, like so much of the nutritional advice we've been given, 2) eliminating almost all snacks between meals, and 3) generally eating only between Noon and 8pm.
All of the above is, to be sure, an oversimplification of the extraordinarily complex processes involved in human health and nutrition, but it's accurate to the best of my ability to represent the resources below.
3) OPPOSITION TO LCHF
The Low-Carb High-Fat approach continues to face strong opposition from many nutritionists, physicians, and other reputable experts, largely because it goes against decades of accepted research. I'm not someone who reflexively distrusts official authorities, but the historical record laid out in the books I recommend below (particularly Why We Get Fat by Gary Taubes and The Big Fat Surprise by Nina Teicholz) is sufficiently compelling for me to conclude that the conventional wisdom's "accepted research" is fundamentally flawed and cannot be viewed as scientifically sound. As Teicholz wrote in 2014:
It now appears that since 1961 the entire American population has, indeed, been subjected to a mass experiment, and the results have clearly been a failure. Every reliable indicator of good health is worsened by a low-fat diet. Whereas diets high in fat have been shown, again and again, in a large body of clinical trials, to lead to improved measures for heart disease, blood pressure, and diabetes, and are better for weight loss. Moreover, it's clear that the original case against saturated fats was based on faulty evidence and has, over the last decade, fallen apart. Despite more than two billion dollars in public money spent trying to prove that lowering saturated fat will prevent heart attacks, the diet-heart hypothesis has not held up.
In the end, what we believe to be true--our conventional wisdom--is really nothing more than sixty years of misconceived nutrition research. (page 330)
How is it possible that so many esteemed authorities could have made such an error? The story is long and complex, but it is, like so many other tragic human stories, one of personal ambition and money. This book is full of evidence attesting to these human flaws at work. Yet the misguided nutrition story has another, more noble element behind it: the passionate desire among high-minded researchers to cure heart disease in America. They wanted to save the nation. It's just that, roughly speaking, they jumped the gun, making official pronouncements before proper trials had been conducted and disregarding those who cautioned that medical interventions should, according to the Hippocratic oath, "first, do no harm."
This original mistake by low-fat diet proponents has been compounded over the years in a number of ways: by billions of dollars spent trying to prove the hypothesis, by vested interests lining up behind it, by research careers coming to depend on it. Biases developed and hardened. Researchers quoted inadequate studies back and forth to each other, confirming their biases, as if in a hall of mirrors. Critics were sidelined and silenced. And eventually, a universe of nutrition experts came to believe that meat, dairy, and eggs were dangerously unhealthy foods, forgetting that their ancestors ever milked a cow. (pages 332-333)
Above and beyond the errors of the health science establishment, though, I believe that opposition to LCHF is also rooted in larger cultural dynamics that made CICO such an appealing model during the last half-century. To take just one example, the just-world fallacy is a powerful psychological bias that leads us to believe that our actions lead to moral and fair outcomes. This fits nicely with the idea that obesity and heart disease are the result of a failure of willpower, and that they can be avoided by redoubled efforts to decrease our caloric intake (banning fatty foods) and increase our caloric output (exercising religiously.) The idea that eating fat won't make us fat and that exercise won't make us thin seems somehow "wrong."
4) RELATED TERMS
The Low-Fat High-Carb approach is associated with several terms (and affiliated communities) that are worth noting, in part because each of these terms has some problematic aspects:
- Atkins, after Dr. Robert Atkins, who made millions from his LCHF-based diet books and products in the 1970s but was rebuffed by the nutrition science establishment. In addition to the books cited below, Jeff Volek and Stephen Phinney co-wrote with physician Eric Westman a diet book based on Atkins principles in 2010, and today Atkins' reputation seems to be undergoing a reassessment. I was under the impression that Atkins was just another shady diet-book salesman when I began this research, and while it's unfortunate that he wasn't a more effective advocate for his theories against the conventional wisdom, it appears that he was both right and more principled than the authorities who rejected him.
- Keto, short for "ketosis," the biological state that's triggered when we eat insufficient carbohydrates to generate glucose, causing our bodies to burn more fat for fuel and resulting in the generation of molecules called ketones. Ketosis appears to be an important aspect of the science underlying LCHF principles, and all of the books I cite below discuss it as a physiological process, some in great detail. That said, "keto" as a label seems to have attracted a mixed group of LCHF proponents. While some of the "keto"-oriented resources I've encountered are practical and helpful, others seem to make spurious claims with a particular appeal to hard-core bodybuilders and others who care deeply about the state of their abs, or alternatively, try to translate LCHF concepts into recipes that will allow people to keep eating sugary sweets without the sugar.
- Paleo, after the work of a number of researchers, most notably Dr. Loren Cordain, whose 2002 book The Paleo Diet (which I haven't read) proposed that humans are best-suited to eat the foods that existed during our evolution as a species (i.e. during the bulk of the paleolithic era, beginning some 2.6 million years ago), and that we are fundamentally ill-suited to eat many if not most of the foods that have resulted from the development of agriculture some 10,000 years ago. More accurately, the low-cost, high-output plant foods that agriculture has made possible are (obviously) edible, but, according to paleo proponents, they don't result in optimal health and nutrition because they were developed hundreds of thousands of years after the development of human beings, and we haven't yet fully adapted to them (and may never.) The paleo movement (and it's certainly a movement that transcends diet and nutrition) seems to be fascinated by the issue of whether certain foods or practices are technically "paleo." (By definition almost all paleo foods are LCHF, but many LCHF foods are not, strictly speaking, "paleo.") These discussions get very boring very quickly.
- Primal, apparently coined by Mark Sisson, dicussed below, and seemingly a more flexible and expansive (and trademarked?) version of "paleo."
These are the most helpful resources I've encountered in this process, and I'm deeply indebted to the authors named here:
Why We Get Fat: And What to Do About It, Gary Taubes
- This is the single-most compelling LCHF resource I've encountered, discussing both nutrition science and its critically-important history since the mid-twentieth century in detail. It's the follow-up to science journalist Taubes' Good Calories, Bad Calories: Fats, Carbs and the Controversial Science of Diet and Health, which is apparently exhaustively-researched but densely-written (and which I haven't yet read.) Note that while I find Taubes' primary arguments convincing (particularly with regard to his deconstruction of the conventional Calories In, Calories Out model), years of LCHF research has emerged since Why We Get Fat was first published in 2010, and today some sources find Taubes' focus on insulin inadequate or insufficient (for example, see Jason Fung and Stephen Guyenet below.)
- Science journalist Teicholz goes even deeper on the history of nutrition science, interviewing many of the principal figures who played a role in the development of today's conventional wisdom and its emphasis on avoiding saturated fat, and providing a compelling explanation for why efforts to combat heart disease have actually hurt our health.
The Art and Science of Low-Carbohydrate Performance, Dr. Jeff Volek and Dr. Stephen Phinney
- Research physician Phinney and dietitian Volek have collaborated extensively, and this book provides both an accessible explanation of the physiological processes underlying LCHF as well as a practical set of guidelines to implement it.
The Art and Science of Low-Carbohydrate Living, Dr. Jeff Volek and Dr. Stephen Phinney
- Despite the title, this previous book by Volek and Phinney goes into greater depth on the technical and historical aspects of LCHF and offers less practical advice.
Eat Bacon, Don't Jog: Get Strong. Get Lean. No Bullshit., Grant Petersen
- Bicycle entrepreneur Petersen wraps serious advice on LCHF eating and "primal" fitness in a very funny, readable book composed of 100+ short chapters. He concludes with a list of additional resources that led me to many of the works listed here. While this book served as an easy-to-grasp introduction to a number of LCHF-related topics, I find myself returning to it as a reference because of its organizational structure (and Petersen's snappy, engaging writing.)
The Obesity Code, Dr. Jason Fung
- Physician Fung specializes in diabetes and kidney disease, and his research on obesity grew out of a determination to address the underlying causes of these diseases rather than the symptoms. His readable book strikes an admirable balance among a history of the misguided Calories In, Calories Out model, the science underlying the alternative LCHF model, and practical guidelines for readers. While I continue to find Gary Taubes' discussion of the science most useful, I think Fung's work is nearly as compelling, and he offers a wider range of practical LCHF advice than Taubes. He puts a significant emphasis on occasional fasting (a topic addressed in a number of other LCHF resources), and while I questioned this practice at first, I've come to adopt aspects of it--see my comment near the end of Section 1 above. A further advantage is that writing in 2016 Fung has the benefit of the latest research, and he provides some updates to the basic LCHF model articulated by Taubes in 2010.
Always Hungry? Conquer Cravings, Retrain Your Fat Cells, and Lose Weight, Dr. David Ludwig
- Boston physician and Harvard Med prof Ludwig is a researcher who also maintains an extensive clinical practice, like Jason Fung above. Ludwig's practice is specifically focused on weight loss, and his accessible book provides a very straightforward and highly structured program to help people adopt an LCHF diet. I had already made most of the changes in my diet discussed above when I read about Ludwig's program, so I didn't feel the need to follow it, but this would be a particularly useful book for anyone who finds the other resources insufficient.
While there are a seemingly endless number of online resources dedicated to LCHF (or keto or paleo), I've generally found them far less informative and useful than the books cited above. Many of these online resources are a good way to quickly familiarize yourself with basic LCHF concepts or to translate those concepts into practical daily eating routines. But almost all of them seem to be lacking in one way or another. Some are effective at addressing nutritional science but provide fewer (or no) practical guidelines, while others offer straightforward dietary advice, but without much reassurance that their advice is thoroughly grounded in current science. Still others are highly technical and difficult for the lay reader to fully grasp. And, of course, there are a vast number of sites that make seemingly spurious claims in order to promote their diet books, supplements and other products.
- "MDA," as its users refer to it, is far and away the best online LCHF resource I've encountered (and it still has its flaws.) Former competitive athlete Sisson has turned "primal" (a near-synonym for "paleo," as far as I can tell) into a lifestyle brand that extends beyond LCHF eating to exercise and other activities. While I'm turned off by the site's efforts to convert readers into Primal customers, and the dietary fanaticism of many of the users on their forums is a bit over the top, overall I've found the site a very helpful resource. And while Sisson is clearly a skillful marketer, at least he's up-front about it, and he also has a good sense of humor about himself. (T.J. Murphy's article on Sisson in Outside provides a candid, engaging introduction to Sisson and LCHF in general.)
The Big Fat Surprise, Nina Teicholz
- Teicholz blogs only rarely, but her posts allow her to respond to critics (which she does quite effectively), an opportunity that she's often denied in established journals and media outlets.
Nutrition Science Initiative (NuSI)
- A nonprofit co-founded by Gary Taubes and dedicated to researching the causes of obesity and related diseases and improving the quality of nutrition research. They strike me as an important, ambitious effort and are worth noting for that reason (and Taubes' involvement), but I haven't explored their resources at length.
The Eating Academy, Dr. Peter Attia
- The personal site of physician Attia, whose medical practice apparently focuses on longevity and optimal health, and who directed NuSI for a number of years.
Protein Power, Dr. Michael Eades
- The name is somewhat misleading--physician Eades is an LCHF proponent and doesn't seem to be promoting protein consumption per se. He and his wife Mary Dan, also a physician, have written a number of LCHF-related books, none of which I've read.
Intensive Dietary Management, Dr. Jason Fung
- Physician Fung is the author of The Obesity Code, cited above
- Ludwig, a physician and researcher, is also the author of Always Hungry? (which I haven't yet read.)
Whole Health Source, Dr. Stephan Guyenet
- I'm not very familiar with Guyenet's work, but I include him here because of his belief that the emerging LCHF consensus (which he refers to as the "insulin model") is itself an insufficient explanation of the causes of obesity and related diseases. I'm in the process of learning more, but this post on what he calls the "leptin model" is intriguing. (Note that Guyenet's post is a response to a previous post by Ludwig.)
Keto Diet Blog, Martina Slajerova
- This site by keto enthusiast Slajerova embodies some of the strengths and weaknesses of various keto-oriented resources, and I've added it here as an example of the type. To its credit, it's practical and hands-on--for example, this list of foods to eat and avoid is more detailed than the similar lists found in the books I cite above and highly relevant to anyone on an LCHF diet. But it doesn't discuss the underlying science in much detail, leaving me unclear on Slajerova's expertise, and many of her recipes go to great lengths to create "keto" versions of profoundly unhealthy foods, particularly sweets, which seems to miss one of the fundamental points of the entire LCHF approach.
FoodMed, Marika Sbouros
- This site covers a range of health-related topics (not all of which I take an interest in), but journalist Sbouros offers a number of interesting LCHF posts as well.
7) TWITTER ACCOUNTS
This is an alphabetical list of Twitter accounts I currently follow who post regularly on LCHF topics. Don't assume that the guys who like to show off their abs are knuckleheads--that's what I thought at first, but I've been proven wrong.
|Aseem Malhotra||Nina Teicholz|
|David Ludwig||Robert Lustig|
|Mark Sisson||Shawn Baker|
|Marika Sbouros||Ted Naiman|
|Michael Eades||Tim Noakes|
8) ACADEMIC AND PROFESSIONAL JOURNAL PAPERS
I include these last here because I assume most people will be unlikely to take the time to actually read them--that's what nerds like me are for. But I actually read these papers before I encountered almost all of the resources above, and they're what motivated me to dive more deeply into the books and actively experiment with my own diet. If you only have the patience for one academic paper, read this one, in which a group of Stanford physicians compared the effects of four different diets.
A Low-Carbohydrate as Compared with a Low-Fat Diet in Severe Obesity (New England Journal of Medicine, 2003)
A Randomized Trial Comparing a Very Low Carbohydrate Diet and a Calorie-Restricted Low Fat Diet on Body Weight and Cardiovascular Risk Factors in Healthy Women (Journal of Clinical Endocrinology and Metabolism, 2003)
Biomarkers of dairy intake and the risk of heart disease (Nutrition, Metabolism and Cardiovascular Diseases, 2012)
Carbohydrate Restriction has a More Favorable Impact on the Metabolic Syndrome than a Low Fat Diet (Journal of the American Oil Chemists Society, 2008)
Changes in lipoprotein(a), oxidized phospholipids, and LDL subclasses with a low-fat high-carbohydrate diet (Journal of Lipid Research, 2010)
Comparison of the Atkins, Zone, Ornish, and LEARN Diets for Change in Weight and Related Risk Factors Among Overweight Premenopausal Women: The A TO Z Weight Loss Study: A Randomized Trial (Journal of the American Medical Association, 2007)
Effect of a low-carbohydrate, ketogenic diet program compared to a low-fat diet on fasting lipoprotein subclasses (International Journal of Cardiology, 2006)
Effects of a high-protein ketogenic diet on hunger, appetite, and weight loss in obese men feeding ad libitum (American Journal of Clinical Nutrition, 2008)
Perceived Hunger Is Lower and Weight Loss Is Greater in Overweight Premenopausal Women Consuming a Low-Carbohydrate/High-Protein vs High-Carbohydrate/Low-Fat Diet (Journal of the American Dietetic Association, 2005)
The effects of a low-carbohydrate diet on appetite: A randomized controlled trial (Nutrition, Metabolism and Cardiovascular Diseases, 2016)
Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials (British Journal of Nutrition, 2013)
Weight and Metabolic Outcomes After 2 Years on a Low-Carbohydrate Versus Low-Fat Diet (Annals of Internal Medicine, 2010)
Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet (New England Journal of Medicine, 2008)