Atkins vs. Low-Fat

Low-carbohydrate diets have long been a matter of contention within the diabetes community. Nowhere is this truer than here at Our very first week of Diabetes Flashpoints featured opposing essays on low-carb diets, and the wisdom of restricting carbohydrate intake has been debated in The Diabetes Self-Management Blog since much earlier. Advocates of carbohydrate restriction often argue that it can aid in weight loss as well as in blood glucose control, and therefore potentially reduce the risk of long-term diabetes complications.


Now, a new study comparing a low-carb Atkins-style diet with a calorie-restricted low-fat diet has entered the debate. Published in the journal Annals of Internal Medicine on August 3, the study’s goal was primarily to compare the effects of the two diets on weight loss. But it also looked at blood triglyceride and cholesterol levels, blood pressure, ketones in the urine, bone mineral density, body composition (ratio of muscle to fat), and any potential side effects. Members of both groups were also given identical “intensive behavioral treatment” to aid in weight loss.

After one year, researchers found that both groups experienced an identical pattern of weight loss, averaging 11 kilograms (24 pounds), or 11% of body weight. After two years, participants in both groups had gained back some weight, for an average of 7 kilograms (15 pounds) of weight loss since the start of the study, or 7% of body weight. There were also no differences between the two groups in body composition or bone mineral density. However, the low-carb group saw a greater increase in HDL (high-density lipoprotein, or “good”) cholesterol than the low-fat group did throughout the study, with its average level climbing by 23% over the two-year study period. During the first six months of the study, the low-carb group also had greater reductions in diastolic blood pressure and triglycerides than the low-fat group did. However, according to an article on the study in The New York Times, the low-carb group also had greater side effects during this period, which included bad breath, constipation, dry mouth, and hair loss. The low-fat group also experienced a greater reduction in LDL (low-density lipoprotein, or “bad”) cholesterol during the first six months.

People with diabetes or abnormal lipid levels were excluded from this study, and the effect of the two diets on blood glucose levels was not measured. For many people with diabetes, this means the absence of information crucial to their decision about what type of diet to follow. The study’s focus on weight loss mirrors the American Diabetes Association’s position on low-carb diets, which touts their potential to aid in weight loss but not their impact on blood glucose levels, and declines to endorse the low-carb approach over other weight-loss options.

What to do you think — have you tried either a low-carb or a low-fat diet for weight loss? Did you find it to be effective and/or satisfactory? In your experience, are there reasons besides weight loss to follow either a low-carb or a low-fat diet? Have you found any other special diet — such as one focusing on foods with a low glycemic index — to be helpful in managing your diabetes? Leave a comment below!

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  • Vivian

    I’ve been following a lower carb paleo type diet since being diagnosed with T2 diabetes 4 years ago. Following that diet has easily allowed me to drop 75 pounds and keep it off without effort. It also provided me with enough additional energy to get me up off the couch and exercising religiously.

    My A1c reduced from 6.7 to 4.9 and my morning fasting numbers and 1 and 2 hours after eating numbers remain in the normal range as long as I continue to eat this way. If I slip and eat too many carbs (too much fruit), up goes the blood sugar. However, I don’t feel deprived in the least – I feel healthy and energetic.

    I’m off BP meds, and don’t take any diabetes meds now. My lipids are all good, with high HDL and low trigs and a list of minor complaints have completely resolved.

    Prior to my diagnosis I was a low-fat veg for a dozen years – I truly believe that’s a factor in how I ended up obese and diabetic, on BP meds with increasingly bad lipid numbers.

    I truly believe, after living this, that every diabetic should be counselled as to all the nutrition options, including lower carb paleo approach – the only advice I got was low fat, high carb portion controlled eating. I already knew where that was going to get me…

  • Jeny-Lynn

    I have been a Type I diabetic for approximately 35 years. Long acting insulin did not work well for me, and I went on an insulin pump 2 years ago. I weighed approximately 100 lbs. when I became diabetic, but steadily gained weight with each increase in insulin. I went from approximately 130 units of insulin daily to now, less than 10 depending on what I need for bolus doses. By decreasing the amount of insulin I am on, being able to control my lows with this pump, and going on a low calorie diet, I was able to lose 50 lbs. By lowering my calorie intake, it automatically lowered to a great extent the amount of carbs and fats, and the kinds of carbs and fats that I have been eating. So, I guess you could say that I have been on a combination of both of these diets. All of my cholesterol/trigliceride levels have fallen to well below the normal range, my good cholesterol has risen, my kidney function is back to normal, and my A1c has gone from 7.8 to 6.1 when last taken 4 months ago. I have even been able to go off one of the cholesterol medications that I have been taking. It has also lowered my blood pressure. So, I think that by combining these 2 diets is a good way to lose weight and improve one’s health.

  • Kenneth Schmidt

    We went on the South Beach diet. During phase one it was difficult and we had to shorten the time we were on it. I felt ill and ran keytones. On to phase two, it was terrific. Wait loss was good and blood sugars were much better. Phase three was also very good. I have been a type one diabetic for 67 years. And always been very brittle. At age 66 I received a kidney transplant. I am doing well but my blood sugars are hard to control. I have been told part of that is due to the anti-rejection medication. I went off the South Beach diet when I went on dialysis. The dialysys diet has to be one of the most unhealthy diets there is. I have gained back about 10 to 15 pounds. I really need to do the South Beach diet again. Just dread that phase one!

  • Neil

    After getting diabetes T-2 four years ago, I read Dr Bernsteins book and went on a low carb diet. It just made so much sense,too much glucose in the blood causes many problems, only carbs cause glucose-so don’t eat them.Nobrainer. A1c last was 5.3, never higher than 5.8.

  • granny Pat

    Okay, I will join the others on the low carb way of eating. Nothing else works for me so why not try this……we will see what happens. Consuming low carbs makes sense to me. Just how low I supposed depends upon each individual. I am so tired of carrying excess weight.




  • Alex

    I tried Atkins for a about a year, and found my blood-sugar control was very good, but I couldn’t lose any weight. Instead I lost my weight (25 pounds) by skipping lunch, and getting yelled at by my MD. Needless to say, my bg control was poorer with the second method. Oh well.

  • Kenneth Schmidt

    It seems amazing to me that Jenny Craig doesn’t fund a study of diabetics on their (Jenny Craig) low carb diet. This should be done under close supervision, but I feel it would prove the point of yes or no for the low carb diet. Their meals are all carefull callibrated. How about it JC and ADA?

  • jmouse41

    I have been type 2 for about 5 years. At first, I was on Byetta, which greatly helped me lose weight. I could not keep my glucose numbers down, however, and I eventually went on insulin. I injected 2x per day and tried to watch my diet, but my numbers went up. I have been on an insulin pump for several years, but still have high numbers… last A1C was 7.7. I started on South Beach Diet and have lost 9 lb, but AIC was up from 7.2. I probably have not done as much cardio as I should, but do work out with a trainer 2 times per week.

    I guess everyone is different. One would think that if my weight were down the AIC would be reduced also. So far no kidney problems. Have some foot discomfort.. neuropathy I guess. I keep an eye on my feet (fortunately I can feel them and am flexible enough to inspect them regularly).

    My daughter developed type 1 diabetes after having gestational with her second child. He is now 14. She continues healthy with no kidney problems as well. Her control is brittle although she has been on a pump for quite a few years.

    I guess I was at risk for type 2 because I had a baby over 9 lb (the daughter I mentioned above). Lots of history of diabetes in my family as well.

    I am hoping that the South Beach diet will help me stay somewhat in control.

  • jim snell

    excellent comments between both. for me i find i get best bs control where i restrict carbs to 20 per cent or less. i also follow mediteranean diet – hunter gathere diet and back in some starches to be sure we have some glucose. research studies have stated that for diabetics, it is better to restrict carbs and have some fat – olive oil etc.

    every time my bs gets out of whack or requires tons of exercise to deflate, faile to accurately gauge and limit carbohydrates was the issue.


    Due to economics after my dh died, I found myself with a lot less money for food for awhile, and started buying chicken legs in store packages at discount prices and freezing them (after awhile I started taking off the skin when hand pain allowed, tuna in water, stopped eatting butter or margarine in any form-used no calorie sprays instead, eggs, and hot oatmeal-no sugar packets,no mayo or used canola mayo with frozen mixed veg, spinach-frozen. Switched from half and half to skim milk in my coffee and got used to it! After loosing 30 punds in about 4 months I thought it might be due to my diabeties 2 or some such. I was not exercising much as I also have spinal stenosis and find walking on cement painful and many exercises that help to loose weight not allowed to do.

    The nutritionist explained that protein makes the body work harder and that a study between 2 groups had shown a surprising thing. One had eatten mainly or only vegetables and lost little weight and many gained. The other group ate only or mostly low fat protein and lost weight better then the other group. I had stumbled onto a better diet for me. However, as I lost weight she wants me to slowly add fresh vegetables and fruit in season which is better health wise.

    My physical therapy exercises do no include any for belly fat so I will be going to a physical therapist who is familiar with my sort of problems to find out what I can do that is more strenuous-walking is supposed to be best for loosing weight so I will see what I learn.

    Just my comment that might help someone.

  • the gray guy

    I started my low carb diet 4 years ago after being told I had type 2. I lost 50 Lbs and kept it off. I have had many friends ask about and state that they were going on this low carb diet. My reaction is “Are you completely nuts”? I would not recommend it to anyone who doesn’t need to be on it. It is hell and I still struggle with it dally . The breads are the worst and the bar-b-que sauce is second. I found a couple of passable low carb breads but I can’t get them locally anymore. Same story on the bar-b-que sauce. I guess the manufactures/distributers don’t see a market for low carb anymore. I also found that it took about 3 weeks to get the major cravings out of my system. If you cheat, figure another 3 weeks. I have also left restaurants after consuming a 22 oz porter house stake (but nothing else) and wondering where the 2nd one was. I still felt very hungry for about an hour or 2. After digesting it awhile I felt much better. You will have to train yourself to realize that you don’t get that satisfied feeling from your food right away and that it will come sometime later.
    Good luck with your weight loss!
    the gray guy

  • Robert

    The first time I went on the Atkin’s diet it worked like a dream come true. I was on it for 1 year lost 75 pounds and built some serious muscle in the process. My HDL went up and LDL went down along wih my tri..

    The second time I wnet on Atkin’s amost tem years later I was on it for about 8 day when I found myself in the emergency room with a blood sugar count of about 790. 2 days in intensive care and 3 days in a normal room and I was a type 2 diabetic.

    Atkin’s points out time and time again, “If you are a diabetic, make sure you speak with your doctor. I didn’t know I had developed diabetes during the time between my diet attempts.

    Please check with your doctor prior to attempting a low carb diet. Although it works great, people with certain type of diabetes need constant blood monitoring and potentially radical changes in their medications during the first week or two.

    Please check with your doctor prior to starting the diet. It does positive but radical things to the way your systems work.

  • pat

    I am not sold on atkins or jenny criag (JC) too expense. Heard that atkins is not safe too much protein. Everything in moderation. I am not sold either way. Whew so much info comes out whether this one is good or not or whatever and my head is spinning.

  • Dave Skotarczyk

    It worked for me. The short story,I walk three
    miles most days.I eat four ot five meals a day
    with 30 grams of whole grain per meal. My blood
    sugar is good.

  • Diana Starr Daniels

    I am a vegetarian and find it really hard to go low carb and still maintain my vegetarian diet. My diet is high in fiber, but I am not losing weight and go on sugar binges. Not sure why that is. I am going to try a low carb substituting tofu, eggs and low fat diary. My biggest problems is sugar cravings.

  • jim snell

    I too am on low carb diet and restrict carbs. I really helps to control blood sugar and keep grief reduced.

    In am a T2 diabetic with system that has been down all night, dawn effect has nailed any available insulin and last thing you need is more glucose as body comes out of barn and you start taking pills. Remember that in am the fastest thing that can get out in blood stream in am is humolog at 45 minutes all else is snails pace. My drugs take 2 to 3 hours after ingeston to get bnlood system back rolling.

    Are type 2 diabetics more sensitive in am to carbs – hell yes till drgs back to work and body normal. Last thing yo need is more carbs/glucose in early am as you bring up body unless you prefer 2 to 5 mile walk each day in am burning off excess glucose.