Do low-fat diets really work?

For many decades, health authorities have recommended a diet low in fat.

This recommendation has been widely accepted in the general medical community.

Although recent studies have raised some questions about the validity of these guidelines, most health authorities have not changed their position.

The issue remains controversial and the guidelines remain virtually unchanged, although their scientific basis has been weakened (1, 2).

So, are low-fat diets really effective in preventing heart disease or promoting weight loss? This article summarizes the evidence.

What is a low-fat diet?

Do low-fat diets work?

The standard low fat diet recommended by the health authorities contains less than 30% of the daily calories from fat.

Very low fat diets generally provide 10 to 15% (or less) of the total calories from fat.

In addition, many health guidelines recommend that the daily calorie contribution of saturated fats should not exceed 7-10%.

Most studies investigating low-fat diets seem to follow these definitions.

Summary The low-fat diet usually provides less than 30% of the total calories from fat, while very low-fat diets provide less than 10-15%.

Are low-fat diets good for losing weight?

Low-fat diets are often recommended for people who need to lose weight.

The main reason behind this recommendation is that fat provides a greater amount of calories per gram compared to the other main nutrients, proteins and carbohydrates.

Fat provides approximately 9 calories per gram, while proteins and carbohydrates provide only 4 calories per gram.

Studies show that people who reduce their calorie intake by eating less fat lose weight. Although weight loss is small, on average, it is considered relevant to health (3).

But how effective is a low-fat diet compared to a low-carb diet?

Low in fat vs low in carbohydrates

Low-carbohydrate diets are usually high in protein and fat.

When food intake is closely controlled and controlled, low-fat diets seem to be as effective at losing weight as low-carb diets.

At least, these were the results of a small study in 19 obese adults who spent two weeks in a metabolic room, which is a highly controlled laboratory environment (4).

However, the study period was short and the environment did not reflect a real-life situation.

Studies in free-living people generally agree that low-fat diets are not as effective as low-carbohydrate diets (5, 6, 7).

The reason for this inconsistency is not clear, but the most likely explanation is that low-carb diets are generally associated with a higher quality of diet.

They tend to focus on whole foods, such as vegetables, eggs, meat and fish. They also encourage skipping most junk foods, which are usually high in refined carbohydrates or added sugar.

In addition, low-carbohydrate diets based on whole foods tend to be higher in fiber and protein than in low-fat diets.

A successful low carb diet can promote weight loss in the following ways:

  • Reduce your calorie intake: A high protein intake decreases calorie intake by suppressing appetite and increasing the amount of calories burned (8).

  • Increase the fullness: A high intake of certain types of fiber can reduce caloric intake by increasing fullness (9).

  • Fight the cravings: Low-carbohydrate diets can suppress carbohydrate and sugar cravings (10).

In short, low-carb diets work because they promote a healthier diet.

In contrast, following a low-fat diet without emphasizing the quality of food can lead to an increase in the intake of junk foods with high sugar content and refined carbohydrates.

Summary Low-fat and low-carbohydrate diets are equally effective in losing weight in highly controlled situations. However, in free-living obese people, low-fat diets tend to be less effective than low-carbohydrate diets.

The low-fat guidelines and the obesity epidemic

The low-fat guidelines were first published in 1977. Since then, many of the leading health organizations have not changed their position.

The introduction of low-fat guidelines seems to have marked the beginning of the obesity epidemic. The following image speaks more than a thousand words:

Of course, many things were changing in society at that time and this chart does not prove that the patterns caused the obesity epidemic.

However, I personally find it plausible that demonizing fat and giving refined carbohydrates and green light sugar may have contributed to that.

When consumers began to believe that fat was the root of all evil, all kinds of low-fat junk food flooded the market.

Many of these foods were loaded with refined carbohydrates, sugar and trans fat, which are associated with heart disease, diabetes, obesity and all those diseases that the low-fat diet had to treat (11, 12, 13).

Summary The low-fat guidelines were first published in 1977. The obesity epidemic began almost at the same time, but it is not clear whether the two are connected.

Do low-fat diets reduce the risk of heart disease?

When the low-fat guidelines were conceived, scientists believed that saturated fat was a major cause of heart disease.

This idea shaped the dietary recommendations of the following decades. It explains why health organizations began to dissuade people from eating foods high in saturated fats, such as eggs, fatty meat and full-fat dairy products.

The guidelines were based on weak evidence at the time and not all scientists agreed. They warned that advocating a low-fat diet could have unintended consequences.

Today, high-quality research suggests that saturated fat is not the villain it was designed to be. Several recent studies indicate that there is no significant relationship between saturated fat and heart disease (14, 15).

However, replacing saturated fats with polyunsaturated fats can have benefits for heart health, probably due to its anti-inflammatory effects (16).

But the standard low fat diet does not just recommend reducing the intake of saturated fats. The guidelines also advise people to restrict their fat intake to less than 30% of their total calorie intake.

Several studies show that reducing total fat intake does not improve heart health (1, 17, 18, 19).

Eating too little fat can even adversely affect risk factors for heart disease.

LDL cholesterol is often referred to as the "bad" cholesterol. However, this is only half true. The size of the LDL particles is also important.

The more small particles you have, the higher your risk of heart disease. If the particles are mostly large, then your risk of heart disease is low (20, 21, 22, 23, 24).

What happens with low-fat diets is that they can really change the LDL of large, harmless particles to the small, dense, damaging LDL that clogs the arteries (24, 25, 26).

Some studies also show that low-fat diets can reduce "good" HDL cholesterol and increase triglycerides in the blood, another important risk factor (27, 28, 29).

Summary Low-fat diets can adversely affect levels of blood lipids, LDL, HDL and triglycerides, potentially increasing the risk of heart disease.

The bottom line

The low fat guidelines introduced in 1977 were not based on solid evidence.

While recent studies have further weakened their scientific basis, the debate continues.

One thing is clear. Eating less fat is not always the best way to lose weight. Low-carbohydrate diets tend to be more effective for most people.

The association of fat with heart disease is more controversial and complex. In general, reducing your fat intake is not likely to reduce your risk of heart disease.

Instead of worrying about your total fat intake, focus on improving the quality of your diet. Eating more whole foods and healthy fats is a good way to start.

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