Laura Schoenfeld: I think there’s a lot of debate out in the nutrition community about what kind of diet is most effective for weight loss. I don’t think that question has been 100 percent answered with any sort of certainty. I think there are a lot of people that would say low carb is better. Some people may even say ketogenic is better for a patient like that. Other people would say a higher carb, more Mediterranean type of diet would be a good solution for that patient. Like I said, I don’t think there’s any one right answer with weight loss, and a lot of times it’s going to come down to what the patient would prefer.
Now, obviously the heart disease piece in there can make it a little bit complicated because if someone is on a very-low-carb diet and they’re eating a lot of fat, the question is, what kind of fat is appropriate for them to be eating a lot of? On one hand, you have the philosophy that saturated fat does not affect heart disease and you shouldn’t worry about eating a lot of saturated fat. On the other hand, there is some evidence that some people are hyper-responders to saturated fat and their cholesterol will go up, and the question is, is having a high cholesterol value in someone with heart disease something that’s safe? You want to approach this with caution, and you don’t want to just say, oh, just do low carb because that’s the best way to lose weight and you don’t need carbs and all that. I think a high-carb, calorie-controlled diet can actually be a every effective weight loss diet, especially if you do it with a more Paleo approach, where you’re getting a lot of those high-fiber tubers and root vegetables and that kind of stuff that are going to be helpful for clearing out extra cholesterol if the person does have elevated cholesterol. It may also help feed their gut microbiome, which can help with things like inflammation or digestion of certain nutrients that can help with heart disease. Certainly we’re not just going to be looking at the macronutrients and the calories when it comes to someone with heart disease, and there are lots of micronutrients that are important there, especially things like K2. But if you’re just talking about the macronutrients and the calorie intake, I personally would probably go with a more high-carb, lower-fat Paleo diet with some level of attention to total calories, depending on if they actually need that attention because some people can lose weight just because they’re eating whole foods, and if you are seeing weight loss without the person paying attention to their calories, then that’s fine, but if they’re having some weight loss resistance or they have a hard time with overeating, then having them track their diet and stick to a certain calorie range can actually be helpful. Ultimately the research only supports calorie deficit as being the absolute requirement for weight loss, and the low carb versus low fat question is definitely not resolved at this point, but if somebody has heart disease and I don’t want them eating a ton of extra fat, which I don’t personally think is really appropriate for someone with heart disease or even helpful, I would rather go with higher carb, lower fat, and the fat primarily coming from things from monounsaturated or maybe some coconut oil or something like that that’s a little bit less of a cholesterol increaser potentially. Just make sure that they are losing weight consistently, and if not, then look at calories and don’t necessarily jump straight into the calorie amounts right away.