The three diet studies everyone is talking about (DiReCT, PURE, and Virta)

None of them have particularly great study designs, but that hasn't prevented the buzz. Here is a summary of the strengths and weaknesses.<figure></figure>


DiReCT (Diabetes Remission Clinical Trial): randomized. N=306, 1-year. 3-5 months ultra-low calorie weight loss diet (~850 kcal/d) followed by 2-8 weeks of guided food reintroduction and then weight maintenance counseling.

PURE (Prospective Urban Rural Epidemiology): n=135335, 7.4 years follow-up. The dreaded Food Frequency Questionnaire, although they were comparing lowest with highest quintile... I think I can accurately recall if I've had more than 5 servings of something today or none in the past month. They're not asking what I had to eat August 25th 2017 for lunch.

Virta: low carb, calorie restricted. N=262, 1 year long. They had a weight maintenance control group, which is good, but it's not hard to beat a weight maintenance control group with any diet. A low fat comparison group would've been more informative.


DiReCT: the goal was weight loss (thus the low fat, low carb approach). 24% lost > 15 kg; mean weight loss was 10 kg (~22 lbs). Big reduction in T2D meds and remission of T2D (which they defined as HbA1c < 6.5% & off T2D meds). Greatest finding: despite pretty severe food restriction, huge increase in quality of life!

PURE: the goal was finding correlations between diet and mortality. All of the hazard ratios were small, but high carb was associated with increased total mortality but not cardiovascular disease (CVD) or CVD mortality. Dietary fat was associated with reduced mortality and saturated fat was associated with reduced stroke (phew!). 

Correlations don't prove causation yadda yadda yadda.

Virta: the goal was to reduce meds, which was accomplished via weight loss. T2D meds went from 56.9% to 29.7%, body weight declined by 13.8 kg on average, and HbA1c went from 7.6% to 6.3% (which the DiReCT authors would've claimed was T2D remission). Triacylglycerols declined and HDL & LDL increased which aren't uncommon on low carb.

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