Nutritional Pearls: Low-Carb vs High-Carb—Who's Less Hungry?

  • Answer: A diet that you can stick with is better than any fad diet that demonizes a whole food group or macronutrient.

    The fad diet wars continue, with more and more variations of a low carbohydrate diet being invented every few months, it seems. There's Atkins, South Beach, keto, paleo, and a host of other diets that essentially direct you to stop eating grains in favor of protein (most often in the form of meats) and fat.

    In terms of weight loss, it does appear that for the short term a low-carbohydrate diet may help you lose weight faster than a more moderate or high-carb diet. The problem, however, is maintaining that weight loss. Losing weight is great, but if you can't keep it off, what good does it really do you? That's even more important if you have been diagnosed with diabetes.

    The Research

    Researchers based primarily in Australia randomly assigned 84 clinically overweight or obese individuals who had previously been diagnosed with type 2 diabetes to one of two different diets.

    The diets were matched in the number of calories consumed in the sense that all of the participants cut their usual caloric intake by about 30%. The difference between the diets was that one was considered a very low carbohydrate (VLC) diet, with less than 14% of calories from carbohydrates (less than 50 grams of carbohydrate per day); and the other was a high carbohydrate (HC) diet, with 53% of calories from carbohydrates. All of the participants attended professionally led exercise classes 3 days per week throughout the study.

    The participants followed their assigned diets for 2 years, while the researchers monitored not only their weight but also their appetite. Using a visual scale of 1 to 100 (least to most), for a 7-day period at weeks 0, 4, and 16, the authors asked the participants to rate their feelings of hunger, fullness, desire to eat, and how much they felt they could eat (prospective consumption) at regular intervals before and after each meal of their day.

    The Results

    Somewhat unsurprisingly, the groups lost about the same amount of weight over the 2 years of the study: It didn't seem to matter which diet the participants followed.

    While they lost the same amount of weight (statistically speaking), the participants didn't experience the reduction in overall calories in quite the same way: those following the HC diet reported feeling "greater daily overall fullness” than those on the VLC diet as well as feeling greater "reduced prospective consumption."
    In short, those on the HC diet felt fuller on a day-to-day basis and were less hungry than those on a LC diet.

    What’s the Take Home?

    On the one hand, this research suggests that if you are looking to lose weight, your overall caloric intake is more important than what you eat in terms of macronutrients like protein, fat, or carbohydrate.

    That said, it does appear that a high-carb diet, one with plenty of quality carbohydrates like whole grain breads and pastas as well as legumes, fruits, and vegetables, will help you stick to your diet better because you're more satisfied over the long haul.
    Once again: a diet that you can stick with that's delicious and satisfying is better than any fad diet that demonizes a whole food group or macronutrient. And your long-term health is all about what you can stick with for (surprise!) the long term.

    Struik NA, Brinkworth GD, Thompson CH, et al. Very low and higher carbohydrate diets promote differential appetite responses in adults with type 2 diabetes: a randomized trial. J Nutr. doi: 10.1093/jn/nxz344

    Dr. Gourmet is the definitive health and nutrition web resource for both physicians and patients with evidence-based resources including special diets for coumadin users, patients with GERD/acid reflux, celiac disease, type 2 diabetes, low sodium diets (1500 mg/d), and lactose intolerance.

    Timothy S. Harlan, MD, is a board-certified internist and professional chef who translates the Mediterranean diet for the American kitchen with familiar, healthy recipes. He is an assistant dean for clinical services, executive director of The Goldring Center for Culinary Medicine, and associate professor of medicine at Tulane University in New Orleans.