Could Counting Carbohydrates Matter More Than Counting Calories?

Counting carbohydrates in your food -- a la the Atkins diet -- may actually be better than counting calories in terms of yielding weight loss and better health. But how and why? And if high calorie carb restricted diets actually work, what might that tell us about the nature of the problem of obesity and overweight?

Our two theories about what makes us fat -- Caloric Balance and Lipophilia -- both make predictions about why low carb diets work. Caloric Balance says they work because they somehow manipulate calories in and out. Lipophilia says that they work by fixing problems at the level of the fat tissue.

So can we find examples of diets that encourage counting carbohydrates (but not calories!) that nevertheless lead to weight loss? Yes. Here are a few randomly culled articles and sources that help make the case for counting carbohydrates:

1. "A randomized trial of a low carbohydrate diet for obesity."

"We conducted a one year, multicentric, controlled trial involving 63 obese men and women who were randomly assigned to either a low carbohydrate, high protein, high fat diet, or a low calorie, high carbohydrate, low fat (conventional) diet... Subjects in the low carbohydrate diet had lost more weight than subjects in the conventional diet at three months... and six months."[1]

The authors then found that these differences seemed to melt away around 12 months and there was attrition and poor adherence later on. But the fact that weight loss occurred -- even if it turned out to be evanescent -- suggests that something strange was going on, at least initially. If calories count, why did the diet in which calories were unrestricted yield better weight loss? If you believe the idea that only calories "count," this presents a paradox.

2. Here's another article: "Treatment of obesity with a low protein calorically unrestricted diet."

"A low protein but calorically unrestricted diet was used to treat 42 overweight patients. The immediate results were encouraging: 32 subjects lost 100 more grams per day, and continued to feel well."[2]

3. This is another study from A.W. Pennington, an influential low carb researcher, that emphasizes the importance of counting carbohydrates. In 1953, he published a study on "Treatment of obesity with calorically unrestricted diets."

The article begins:

"Restriction of carbohydrate, alone, appears to make possible the treatment of obesity on a calorically unrestricted diet composed chiefly of protein and fat. The limiting factor on appetite, necessary to any treatment of obesity, appears to be provided by the increased mobilization and utilization of fat, and in conjunction with homeostatic forces, which normally regulate the appetite. Ketogenesis appears to be a key factor in the increased utilization of fat. Treatment of obesity by this method appears to avoid the decline in metabolism encountered in treatment by caloric restriction."[3]

4. Gary Taubes quotes Pennington at length in Good Calories, Bad Calories and discusses an avalanche of additional evidence, which again and again shows this effect. Restrict carbohydrates and you will lose weight even if calories are unrestricted.[4]

Read Chapter 20 (pp 327-354) as well as pages 316 to 326, in which Taubes describes and deconstructs study after study after study to hammer home this point that counting carbohydrates matters more than counting calories.

Once again, this evidence yields powerful support for Lipophilia and creates problems for Caloric Balance.

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1. Gary D. Foster, Ph.D., Holly R. Wyatt, M.D., James O. Hill, Ph.D., Brian G. McGuckin, Ed.M., Carrie Brill, B.S., B. Selma Mohammed, M.D., Ph.D., Philippe O. Szapary, M.D., Daniel J. Rader, M.D., Joel S. Edman, D.Sc., and Samuel Klein, M.D "A randomized trial of a low carbohydrate diet for obesity." NEJM Volume 348:2082-2090 May 22, 2003 Number 21.

2. Vincent Pole, Irving Schwartz, Jorn Hess Thaysen, Niels Thorn, and Lawrence Silver. "Treatment of obesity with a low protein calorically unrestricted diet." American Journal of Clinical Nutrition, Vol 2, 381-391, Copyright © 1954 by The American Society for Clinical Nutrition, Inc.

3. A. W. Pennington. "Treatment of obesity with calorically unrestricted diets." American Journal of Clinical Nutrition, Vol 1, 343-348, Copyright © 1953 by The American Society for Clinical Nutrition, Inc.

4. Taubes, Gary. "Good Calories, Bad Calories." pp 327-354. New York: Knopf (2007).

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