Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet
Open accessAbstract
BACKGROUND: Trials comparing the effectiveness and safety of weight-loss diets are frequently limited by short follow-up times and high dropout rates. METHODS: In this 2-year trial, we randomly assigned 322 moderately obese subjects (mean age, 52 years; mean body-mass index [the weight in kilograms divided by the square of the height in meters], 31; male sex, 86%) to one of three diets: low-fat, restricted-calorie; Mediterranean, restricted-calorie; or low-carbohydrate, non-restricted-calorie. RESULTS: The rate of adherence to a study diet was 95.4% at 1 year and 84.6% at 2 years. The Mediterranean-diet group consumed the largest amounts of dietary fiber and had the highest ratio of monounsaturated to saturated fat (P<0.05 for all comparisons among treatment groups). The low-carbohydrate group consumed the smallest amount of carbohydrates and the largest amounts of fat, protein, and cholesterol and had the highest percentage of participants with detectable urinary ketones (P<0.05 for all comparisons among treatment groups). The mean weight loss was 2.9 kg for the low-fat group, 4.4 kg for the Mediterranean-diet group, and 4.7 kg for the low-carbohydrate group (P<0.001 for the interaction between diet group and time); among the 272 participants who completed the intervention, the mean weight losses were 3.3 kg, 4.6 kg, and 5.5 kg, respectively. The relative reduction in the ratio of total cholesterol to high-density lipoprotein cholesterol was 20% in the low-carbohydrate group and 12% in the low-fat group (P=0.01). Among the 36 subjects with diabetes, changes in fasting plasma glucose and insulin levels were more favorable among those assigned to the Mediterranean diet than among those assigned to the low-fat diet (P<0.001 for the interaction among diabetes and Mediterranean diet and time with respect to fasting glucose levels). CONCLUSIONS: Mediterranean and low-carbohydrate diets may be effective alternatives to low-fat diets. The more favorable effects on lipids (with the low-carbohydrate diet) and on glycemic control (with the Mediterranean diet) suggest that personal preferences and metabolic considerations might inform individualized tailoring of dietary interventions. (ClinicalTrials.gov number, NCT00160108.)
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Low-carbohydrate diet trials have reported very low urinary ketosis after six months, suggesting that sustaining low carbohydrate intake is futile for most overweight people.
“In addition, trials of low-carbohydrate diets have reported a very low incidence of urinary ketosis after 6 months,6,8,12 suggesting that in most overweight people, it is futile to sustain a low intake of carbohydrates.”
From Comparison of Weight-Loss Diets with Different Compositions of Fat, Protein, and Carbohydrates (2009) · cites this paper as [12]
The Dietary Intake, Energy Expenditure, and Urinary Ketones section reports low detectable urinary ketones at 24 months (8.3% in the low-carbohydrate group), not at six months. Contrary to the claimed futility of sustaining low carbohydrate intake, it reports lower carbohydrate intake in that group, and the Discussion describes the diet as an effective alternative after two years. (LLM, conf=0.84)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredThe most important feature for diet modification is a reduced-calorie meal plan, which is essential for effective weight loss.
“The most important feature for diet modification is a reduced-calorie meal plan, which is essential for effective weight loss.687–690”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [690]
The Low-Carbohydrate Diet section describes a plan with no limit on total calories. The Results report weight loss on that plan, and the Discussion calls it an effective alternative for people who will not follow a restricted-calorie regimen. Although participants in all groups achieved a caloric deficit, the paper does not support the claim that a reduced-calorie meal plan is essential. (LLM, conf=0.88)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredIntensive lifestyle intervention in the Look AHEAD trial resulted in 1-year weight loss of 8.6% and 4-year weight loss of 4.7%, compared with 1.1% in the standard group.
“Intensive lifestyle intervention resulted in 1-year weight loss of 8.6%, and 4-year weight loss of 4.7% compared with 1.1% in the standard group, and was accompanied by lower A1C with less need for DM medications, DM remission in ~10% of persons, lower diastolic and systolic BP, improved lipids (higher HDL-C, lower triglycerides), improvements in OSA as reflected by lower apnea hypopnea index sc”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [690]
The Abstract and Weight Loss section describe a two-year trial comparing three diets, not the Look AHEAD trial. The Weight Loss section reports weight changes in kilograms at 24 months; it does not report the claimed one- and four-year percentages or a standard-group comparison. Page numbers are unavailable in our copy. (LLM, conf=0.88)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredShort-term trials comparing low-carbohydrate, high-protein diets with conventional high-carbohydrate, low-fat diets have yielded inconsistent results.
“Several trials showed that low-carbohydrate, high-protein diets resulted in more weight loss over the course of 3 to 6 months than conventional high-carbohydrate, low-fat diets,4–12 but other studies did not show this effect.13–17”
From Comparison of Weight-Loss Diets with Different Compositions of Fat, Protein, and Carbohydrates (2009) · cites this paper as [12]
The Weight Loss section reports that weight loss was greatest during months 1–6 and was greater in the low-carbohydrate group than in the low-fat group. This supports one outcome described in the citing sentence, but this paper does not establish that short-term trials yielded inconsistent results or that its own trial failed to show the effect. Page numbers are unavailable in our copy. (LLM, conf=0.76)
Experimental — accuracy not yet measuredThe trial did not confirm earlier findings that low-carbohydrate or high-protein diets caused greater weight loss at six months and that this advantage eroded by twelve months.
“We did not confirm previous findings that low-carbohydrate or high-protein diets caused increased weight loss at 6 months3–12 and that the advantage of these diets usually eroded by 12 months, with weight loss that was nearly or fully equivalent to that with low-fat diets6,11,18 or other diets.12”
From Comparison of Weight-Loss Diets with Different Compositions of Fat, Protein, and Carbohydrates (2009) · cites this paper as [12]
The Weight Loss section reports greater weight loss with the low-carbohydrate diet than with the low-fat diet, consistent with an early advantage. It does not establish that this advantage eroded to near-equivalence by 12 months; it reports greater low-carbohydrate weight loss at 24 months. The citing authors’ statement that they ‘did not confirm’ earlier findings describes their own trial, not Shai et al.’s. (LLM, conf=0.84)
Experimental — accuracy not yet measured
At six months, the mean differences among diet groups in fat, carbohydrate, or protein intake were often larger than those in several earlier weight-loss trials.
“The mean differences among the groups in fat, carbohydrate, or protein intake at 6 months were nevertheless often greater than those in several previous trials comparing diets for weight loss.11,12,19,21,26”
From Comparison of Weight-Loss Diets with Different Compositions of Fat, Protein, and Carbohydrates (2009) · cites this paper as [12]
Table 2 reports six-month differences among the diet groups in fat, carbohydrate, and protein intake. The Dietary Intake section also describes these differences, but our copy does not establish that they were often greater than those in several previous weight-loss trials. (LLM, conf=0.84)
Experimental — accuracy not yet measuredSeveral recent trials have shown that continued contact with participants after weight loss is associated with less regain.
“Several recent trials have also shown that continued contact with participants after weight loss is associated with less regain.12,24,37,38”
From Comparison of Weight-Loss Diets with Different Compositions of Fat, Protein, and Carbohydrates (2009) · cites this paper as [12]
The Eligibility and Study Design section describes dietitian-led sessions continuing throughout the two-year trial. The Weight Loss and Discussion sections report an initial weight-loss phase followed by partial regain, but they do not compare regain by amount of contact or establish that continued contact was associated with less regain. (LLM, conf=0.82)
Experimental — accuracy not yet measuredIntensive lifestyle intervention in Look AHEAD was accompanied by lower A1C with less need for diabetes medications, diabetes remission in about 10% of people, lower diastolic and systolic blood pressure, improved lipids, improvements in obstructive sleep apnea, increased mobility, slower progression of nephropathy, and improved quality of life.
“Intensive lifestyle intervention resulted in 1-year weight loss of 8.6%, and 4-year weight loss of 4.7% compared with 1.1% in the standard group, and was accompanied by lower A1C with less need for DM medications, DM remission in ~10% of persons, lower diastolic and systolic BP, improved lipids (higher HDL-C, lower triglycerides), improvements in OSA as reflected by lower apnea hypopnea index sc”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [690]
The Weight Loss section (page unavailable) reports lower systolic and diastolic blood pressure in all three diet groups, and the glycated-hemoglobin results report decreases among participants with diabetes. But this paper studies a two-year comparison of diets, not Look AHEAD; it does not support the attributed diabetes-remission rate or the claims about sleep apnea, mobility, nephropathy, and quality of life. Its Characteristics of the Participants section also reports little change in medication use, not less need for diabetes medication. (LLM, conf=0.87)
Experimental — accuracy not yet measuredLifestyle programs that include behavioral interventions are effective for promoting adherence to meal and physical activity prescriptions.
“Clinical trials have demonstrated the efficacy of lifestyle programs that include behavioral interventions and have underscored particular practices that are most likely to be associated with success.690,811”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [690]
The Eligibility and Study Design section (page unavailable) describes dietitian-led sessions and motivational calls for participants struggling to follow their diets; the Discussion reports weight loss and suggests benefits from behavioral approaches. The paper assesses physical activity but does not establish that the program promoted adherence to physical-activity prescriptions or identify which practices were most associated with success. (LLM, conf=0.83)
Experimental — accuracy not yet measuredStructured lifestyle interventions that include reduced-calorie low-fat diets in people with overweight or obesity prevent progression from prediabetes to diabetes and lower A1C, blood pressure, and triglycerides in people with type 2 diabetes.
“Structured lifestyle interventions that include reduced-calorie low-fat diets in persons with overweight or obesity have been shown to prevent progression from prediabetes to DM,690,811,827 and to lower A1C, BP, and triglycerides in persons with T2D.678,690,702–704,927,928”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [690]
Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredThe 0.9% absolute (12% relative) HbA1c reduction observed at 2 years is consistent with low carbohydrate studies reporting HbA1c reductions of 8-15% at 2 to 3.5 years with medication reduction.
“The 0.9% absolute (12% relative) HbA1c reduction observed at 2 years is consistent with low carbohydrate studies reporting HbA1c reductions of 8–15% at 2 to 3.5 years (52, 55–57) with medication reduction.”
From Long-Term Effects of a Novel Continuous Remote Care Intervention Including Nutritional Ketosis for the Management of Type 2 Diabetes: A 2-Year Non-randomized Clinical Trial (2019) · cites this paper as [52]
The Fasting Plasma Glucose, HOMA-IR, and Glycated Hemoglobin section (page unavailable) reports a 0.9-percentage-point HbA1c decrease at 24 months among participants with diabetes on the low-carbohydrate diet, consistent with the claimed range. The Characteristics of the Participants section (page unavailable) does not support a general claim of medication reduction: only one participant reduced a glycemic-control medication dosage, while five started medication. This two-year trial also does not establish a result at 3.5 years. (LLM, conf=0.87)
Experimental — accuracy not yet measuredStudies comparing dietary composition have generally demonstrated modest effects on weight maintenance, with differences between diets attenuating over time, particularly beyond one year.
“studies comparing dietary composition (e.g., variations in protein content, carbohydrate restriction, or glycemic index) have generally demonstrated modest effects on weight maintenance, with differences between diets attenuating over time, particularly beyond one year”
From Weight maintenance after discontinuation of GLP-1 therapies (2026) · cites this paper as [63]
The Discussion (page not provided) describes weight maintenance after six months, with partial rebound and a plateau. The Weight Loss section (page not provided) reports relatively small differences between diets at 24 months, but it does not establish that those differences attenuated particularly after one year. This trial also did not compare diets by glycemic index. (LLM, conf=0.83)
Experimental — accuracy not yet measuredIn the DIRECT trial, A1C was lowest in the low-carbohydrate group after 2 years among obese adults with type 2 diabetes.
“A1C was lowest in the lowcarbohydrate group after 2 years”
From Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report (2019) · cites this paper as [90]
The “Fasting Plasma Glucose, HOMA-IR, and Glycated Hemoglobin” section reports that, among participants with diabetes, glycated hemoglobin fell most in the low-carbohydrate group at 24 months. It reports changes from baseline, however, not the groups’ absolute A1C levels at two years, so it does not establish that A1C was lowest in that group. (LLM, conf=0.84)
Experimental — accuracy not yet measuredIn the DIRECT trial, fasting plasma glucose was lower in the Mediterranean-style group than in the lower-fat group.
“fasting plasma glucose was lower in the Mediterranean-style group than in the lower-fat group (90).”
From Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report (2019) · cites this paper as [90]
The Fasting Plasma Glucose, HOMA-IR, and Glycated Hemoglobin section reports a greater reduction with the Mediterranean diet than with the low-fat diet among the 36 participants with diabetes. The claim omits that restriction: the paper reports no significant glucose change among participants without diabetes. Page numbers were not supplied in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredOnly two trials have reported dietary intake beyond one year, and one of them provided food to participants.
“Only two trials have reported dietary intake beyond 1 year,12,26 and one of them provided foods to the participants.12”
From Comparison of Weight-Loss Diets with Different Compositions of Fat, Protein, and Carbohydrates (2009) · cites this paper as [12]
Other studies have shown greater weight loss at one to two years with diets high in unsaturated fat or with low-fat, high-carbohydrate vegetarian diets.
“Other studies showed increased weight loss at 1 to 2 years with diets that were high in unsaturated fat12,21,26 or with low-fat, high-carbohydrate vegetarian diets.22,24”
From Comparison of Weight-Loss Diets with Different Compositions of Fat, Protein, and Carbohydrates (2009) · cites this paper as [12]
Other interventions using carbohydrate restriction reported variable long-term glycemic improvement outcomes.
“Other interventions using carbohydrate restriction reported variable long-term glycemic improvement outcomes (52–57).”
The Mediterranean-style eating pattern has demonstrated a mixed effect on A1C, weight, and lipids in a number of randomized controlled trials.
“The Mediterranean-style pattern has demonstrated a mixed effect on A1C, weight, and lipids in a number of RCTs (85 -90).”
From Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report (2019) · cites this paper as [90]
The principal outcome measure in Look AHEAD was cardiovascular disease events, and the study was discontinued prematurely when an interim analysis showed no difference between treatment groups after 9.6 years median follow-up.
“The principal outcome measure in Look AHEAD was CVD events, and the study was discontinued prematurely when an interim analysis showed no difference between treatment groups after 9.6 years median follow-up.”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [690]
The Statistical Analysis section identifies change in weight over 24 months as this paper’s primary aim, but it does not describe Look AHEAD. Searches for Look AHEAD, cardiovascular events, premature discontinuation, and 9.6 years of follow-up found no passage addressing the claim. (LLM, conf=0.78)
Experimental — accuracy not yet measuredPeople who track their weight, food intake, or physical activity are more likely to meet weight management goals.
“For example, persons who self-monitor and record weight, food intake, or physical activity are more likely to achieve weight management goals.”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [690]
The Outcomes and Electronic Questionnaires sections describe monthly weighing and questionnaires about diet and physical activity. Neither reports whether people who self-monitor and record those behaviors are more likely to meet weight-management goals; searches for that relationship found no supporting passage. (LLM, conf=0.76)
Experimental — accuracy not yet measuredTrials of weight loss usually recruit people who are obese or overweight and aim for large short-term loss with special diets, so their results may not apply to nonobese groups or to gradual long-term gain.
“Weight-loss trials1–3 have typically enrolled obese or overweight persons who attempted substantial short-term weight loss on specialized diets, thus limiting the generalizability of the findings to nonobese populations and to the factors that determine long-term, gradual weight gain.”
From Changes in diet and lifestyle and long-term weight gain in women and men (2011) · cites this paper as [2]
Strategies such as the Mediterranean diet and the DASH diet appear to be more sustainable in the long term and have fewer gastrointestinal side effects that often lead to malnutrition.
“Strategies such as the MD and the DASH diet appear to be more sustainable [77] in the long term and have fewer gastrointestinal side effects that often lead to malnutrition.”
From Nutrition and Physical Activity in Optimizing Weight Loss and Lean Mass Preservation in the Incretin-Based Medications Era: A Narrative Review (2025) · cites this paper as [77]
In the DIRECT trial, greater weight loss occurred with an ad libitum low-carbohydrate diet than with a calorie-restricted low-fat diet, persisting at 2 years.
“The DIRECT trial (Dietary Intervention Randomized Controlled Trial), in which participants received prepared meals to enhance adherence, reported greater weight loss with an ad libitum low-carbohydrate diet than with a calorie-restricted low-fat diet, which persisted at 2 y (158).”
From The carbohydrate-insulin model: A physiological perspective on the obesity pandemic (2021) · cites this paper as [158]
Our results with regard to body weight are consistent with other trials and a recent meta-analysis.
“Our results with regard to body weight are consistent with those of other trials (23, 24) and a recent meta-analysis (25).”
From Effects of Low-Carbohydrate and Low-Fat Diets: A Randomized Trial (2014) · cites this paper as [23]
Previous studies had small sample sizes or low completion rates, did not assess a typical low-carbohydrate diet for weight loss, or did not include diverse populations.
“Previous studies have examined the effects of low-carbohydrate diets on CVD risk factors, but most of these trials had small sample sizes or low completion rates, did not assess a typical low-carbohydrate diet for weight loss, or did not include diverse populations (19–24).”
From Effects of Low-Carbohydrate and Low-Fat Diets: A Randomized Trial (2014) · cites this paper as [23]
Other intervention trials using the Mediterranean diet have also shown some beneficial effects in the treatment of obesity, the metabolic syndrome, and arthritis.
“Other intervention trials using the Mediterranean diet have also shown some beneficial effects in the treatment of obesity, the metabolic syndrome, and arthritis (28–30).”
From Health Benefits of the Mediterranean Diet: Metabolic and Molecular Mechanisms (2018) · cites this paper as [28]
High dietary salt consumption was estimated to be responsible for 102,000 annual deaths in the United States.
“High dietary salt consumption was estimated to be responsible for 102 000 annual deaths”
From Heart Disease and Stroke Statistics—2013 Update: A Report From the American Heart Association (2013) · cites this paper as [110]
Low dietary omega-3 fatty acid consumption was estimated to be responsible for 84,000 annual deaths in the United States.
“low dietary omega-3 fatty acids for 84 000 annual deaths”
From Heart Disease and Stroke Statistics—2013 Update: A Report From the American Heart Association (2013) · cites this paper as [110]
Low consumption of fruits and vegetables was estimated to be responsible for 55,000 annual deaths in the United States.
“and low consumption of fruits and vegetables for 55 000 annual deaths.110”
From Heart Disease and Stroke Statistics—2013 Update: A Report From the American Heart Association (2013) · cites this paper as [110]
High dietary trans fatty acid consumption was estimated to be responsible for 82,000 annual deaths in the United States.
“high dietary trans fatty acids for 82 000 annual deaths”
From Heart Disease and Stroke Statistics—2013 Update: A Report From the American Heart Association (2013) · cites this paper as [110]
When randomized controlled trials of weight loss used equal-intensity interventions in each diet arm, the mix of macronutrients had little independent influence on weight loss.
“However, RCTs designed to investigate weight loss and having equal-intensity interventions in each dietary arm have demonstrated that macronutrient composition has little independent effect on weight loss.169–172”
From Components of a Cardioprotective Diet: New Insights (2011) · cites this paper as [171]
For any weight loss diet, regardless of macronutrient mix, adherence was the strongest predictor of success.
“Adherence to any weight loss diet, regardless of its macronutrient composition, was the best determinant of success.169–172”
From Components of a Cardioprotective Diet: New Insights (2011) · cites this paper as [171]
Mediterranean diets have higher palatability and acceptance than low-fat diets.
“and the higher palatability and acceptance of MeDiets in comparison with low-fat diets 17,18 lend support to our hypothesis.”
From Cohort Profile: Design and methods of the PREDIMED study (2012) · cites this paper as [17]
In the DIRECT trial, subjects in the ketogenic diet group started with carbohydrate intake of 20 g/day and ended at 12 months with 40% of total energy intake from carbohydrate.
“In the DIRECT trial, subjects in the KD group started with carbohydrate intake of 20 g/day and ended at 12 months with 40% of TEI from carbohydrate intake [68].”
From Effects of ketogenic diet on health outcomes: an umbrella review of meta-analyses of randomized clinical trials (2023) · cites this paper as [68]
In DIRECT, HbA1c was lowest in the low carbohydrate group after 2 years, whereas fasting plasma glucose was lower in the Mediterranean-style group than in the lower-fat group.
“Results from the Dietary Intervention Randomized Controlled Trial (DIRECT) assigning obese adults with T2DM to a calorie-restricted Mediterranean-style, a calorie-restricted lower-fat, or a low carbohydrate eating pattern (28% of calories from carbohydrate), showed that HbA1c was lowest in the low carbohydrate group after 2 years, whereas fasting plasma glucose was lower in the Mediterranean-style”
From Effects of diet, lifestyle, Chrononutrition and alternative dietary interventions on postprandial Glycemia and insulin resistance (2022) · cites this paper as [105]
The reduction in insulin levels and the homeostatic model assessment index triggered by the Mediterranean diet are precocious and sustainable over time.
“Also, the reduction in insulin levels and other measures of IR, i.e., the homeostatic model assessment (HOMA) index, triggered by this dietary approach, are precocious and sustainable over time [17,18].”
From Mediterranean diet nutrients to turn the tide against insulin resistance and related diseases (2020) · cites this paper as [17]
The Mediterranean diet is associated with greater improvement of insulin resistance in obese individuals compared with other nutritional interventions.
“The Mediterranean diet (MedDiet), characterized by high consumption of extra-virgin olive oil (EVOO), nuts, red wine, vegetables and other polyphenol-rich elements, has proved to be associated with greater improvement of IR in obese individuals, when compared to other nutritional interventions.”
From Mediterranean diet nutrients to turn the tide against insulin resistance and related diseases (2020) · cites this paper as [17]
The glyco-metabolic benefits of the Mediterranean diet appear sustainable over time, independent of body weight change, as they do not occur with other successful nutritional interventions for weight loss.
“These glyco-metabolic benefits appear to be sustainable over time, independent of body weight change, as they do not occur with other successful nutritional interventions for weight loss [17].”
From Mediterranean diet nutrients to turn the tide against insulin resistance and related diseases (2020) · cites this paper as [17]
Monounsaturated fatty acids and polyunsaturated fatty acids, in forms of olive oil, nuts and seeds in plant-based dietary regimens, may function as the driving force for amelioration of glucose metabolism, insulin sensitivity, blood lipids, and cardiovascular disease risk in diabetic individuals or the general population.
“Monounsaturated fatty acids (MUFAs) and polyunsaturated fatty acids (PUFAs), in forms of olive oil, nuts and seeds in plant-based dietary regimens, may function as the driving force for the amelioration of glucose metabolism, insulin sensitivity, blood lipids and CVD risk, observed either in diabetic individuals [17,40,41] or in the general population [42].”
From Mediterranean diet nutrients to turn the tide against insulin resistance and related diseases (2020) · cites this paper as [17]
The Mediterranean eating pattern can considerably improve fasting glucose, glycated hemoglobin, and insulin levels in obese diabetic patients when compared with low-fat diets.
“In particular, important health benefits have been demonstrated for the Mediterranean eating pattern, which can considerably improve fasting glucose, glycated hemoglobin (HbA1c) and insulin levels in obese diabetic patients, when compared to low-fat diets [17].”
From Mediterranean diet nutrients to turn the tide against insulin resistance and related diseases (2020) · cites this paper as [17]
Previous studies have focused on comparing low-carbohydrate to low-fat eating patterns.
“Instead, previous studies have focused on comparing low-carb to low-fat eating patterns (3–10).”
Mediterranean-style diets tend to be relatively high in unsaturated fat, particularly from extra-virgin olive oil.
“They tend to be relatively high in unsaturated fat, particularly from extravirgin olive oil.”
From Popular dietary patterns: alignment with American Heart Association 2021 dietary guidance: a scientific statement from the American Heart Association. (2023) · cites this paper as [20]
Low-carbohydrate patterns generally refer to patterns with total carbohydrate targets between 20% and 40% of kilocalories.
“Low-carbohydrate patterns generally refer to patterns with total carbohydrate targets between 20% and 40% of kilocalaroies.20,[29][30][31][32][33][34][35][36]”
From Popular dietary patterns: alignment with American Heart Association 2021 dietary guidance: a scientific statement from the American Heart Association. (2023) · cites this paper as [20]
Low-fat patterns generally target total fat intake between 20% and 30% of kilocalories alongside other healthy dietary guidelines.
“Low-fat patterns generally target total fat intake between 20% and 30% of kilocalories alongside other healthy dietary guidelines.20,[29][30][31][32][33][34][35][36]”
From Popular dietary patterns: alignment with American Heart Association 2021 dietary guidance: a scientific statement from the American Heart Association. (2023) · cites this paper as [20]
Multiple RCTs including people with type 2 diabetes have reported that a Mediterranean eating pattern can improve both glycemic management and blood lipids.
“Multiple RCTs including people with type 2 diabetes have reported that a Mediterranean eating pattern (120,203-208) can improve both glycemic management and blood lipids.”
From 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:<i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [204]
Longer-term studies (52 weeks) showed mixed effects on A1C in adults with type 2 diabetes, and results were confounded by pharmacologic weight loss therapy.
“longer-term studies (52 weeks) showed mixed effects on A1C in adults with type 2 diabetes (82–85), and results were confounded by pharmacologic weight loss therapy.”
From Standards of Medical Care in Diabetes—2009 (2009) · cites this paper as [85]
In a 2-year dietary intervention study, Mediterranean and low-carbohydrate diets were found to be effective and safe alternatives to a low-fat diet for weight reduction in moderately obese participants.
“In a 2-year dietary intervention study, Mediterranean and low-carbohydrate diets were found to be effective and safe alternatives to a low-fat diet for weight reduction in moderately obese participants (85).”
From Standards of Medical Care in Diabetes—2009 (2009) · cites this paper as [85]
In Dansinger et al, significant reductions in triglycerides occurred after 2 months on the Atkins and Zone diets, but these effects were no longer significant after 12 months.
“Although significant reductions in triglycerides occurred after 2 months on the Atkins and Zone diets, these effects were no longer significant after 12 months.”
From Triglycerides and Cardiovascular Disease: A Scientific Statement From the American Heart Association (2011) · cites this paper as [440]
In Dansinger et al, weight loss was similar after 12 months (4.8 to 7.3 kg) for the Atkins, Zone, Weight Watchers, and Ornish diets.
“Weight loss was similar after 12 months (4.8 to 7.3 kg) for all 4 diets.”
From Triglycerides and Cardiovascular Disease: A Scientific Statement From the American Heart Association (2011) · cites this paper as [440]
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- Authors
- Shai, I., Schwarzfuchs, D., Henkin, Y., Shahar, D. R., Witkow, S., Greenberg, I., Golan, R., Fraser, D., Bolotin, A., Vardi, H., Tangi-Rozental, O., Zuk-Ramot, R., Sarusi, B., Brickner, D., Schwartz, Z., Sheiner, E., Marko, R., Katorza, E., Thiery, J., Fiedler, G. M., Blüher, M., Stumvoll, M., & Stampfer, M. J.
- Affiliations
- Ben-Gurion University of the Negev (IL)
- Shimon Peres Negev Nuclear Research Center (IL)
- Soroka Medical Center (IL)
- University Hospital Leipzig (DE)
- Leipzig University (DE)
- Harvard University (US)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2008-07-17
- Volume
- 359
- Issue
- 3
- Pages
- 229-241
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2146463166
- Semantic Scholar
- 77344a3328e9620b32871d25bb734173c95c6354
- Cited by
- 2,143
- References
- 43
- Citations by year
- 2026: 54 · 2025: 68 · 2024: 79 · 2023: 119 · 2022: 126 · 2021: 125 · 2020: 191 · 2019: 115 · 2018: 123 · 2017: 112 · 2016: 115 · 2015: 106 · 2014: 121 · 2013: 136 · 2012: 127
- FWCI
- 95.74
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- IRIS eCampus Telematic University (Università degli Studi eCampus) (submittedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Diet and metabolism studies
- Health Sciences › Medicine › Physiology › Dietary Effects on Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Keywords
- weight loss, Mediterranean diet, low-carbohydrate diet, low-fat diet, obesity, dietary adherence, dietary fiber, urinary ketones, TC/HDL-C ratio, glycemic control, fasting blood glucose, insulin, type 2 diabetes, dietary intervention
- MeSH terms
- Blood Glucose, Energy Intake, Female, Follow-Up Studies, Glycated Hemoglobin, Humans, Ketones, Lipids, Male, Middle Aged, Obesity, Surveys and Questionnaires, Biomarkers, Weight Loss, Body Mass Index, Diet, Fat-Restricted, Diet, Mediterranean, Diet, Carbohydrate-Restricted
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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