NEJM: Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet

[ReginaW]

Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet

ABSTRACT

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.

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The dramatic increase in obesity worldwide remains challenging and underscores the urgent need to test the effectiveness and safety of several widely used weight-loss diets.1,2,3 Low-carbohydrate, high-protein, high-fat diets (referred to as low-carbohydrate diets) have been compared with low-fat, energy-restricted diets.4,5,6,7,8,9 A meta-analysis of five trials with 447 participants10 and a recent 1-year trial involving 311 obese women4 suggested that a low-carbohydrate diet is a feasible alternative to a low-fat diet for producing weight loss and may have favorable metabolic effects. However, longer-term studies are lacking.4,10 A Mediterranean diet with a moderate amount of fat and a high proportion of monounsaturated fat provides cardiovascular benefits.11 A recent review citing several trials12 included a few that suggested that the Mediterranean diet was beneficial for weight loss.13,14 However, this positive effect has not been conclusively demonstrated.15
Common limitations of dietary trials include high attrition rates (15 to 50% within a year), small size, short duration, lack of assessment of adherence, and unequal intensity of intervention.10,12,15,16,17 We conducted the 2-year Dietary Intervention Randomized Controlled Trial (DIRECT) to compare the effectiveness and safety of three nutritional protocols: a low-fat, restricted-calorie diet; a Mediterranean, restricted-calorie diet; and a low-carbohydrate, non–restricted-calorie diet.

Methods

Eligibility and Study Design

We conducted the trial between July 2005 and June 2007 in Dimona, Israel, in a workplace at a research center with an on-site medical clinic. Recruitment began in December 2004. The criteria for eligibility were an age of 40 to 65 years and a body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) of at least 27, or the presence of type 2 diabetes (according to the American Diabetes Association criteria18) or coronary heart disease, regardless of age and BMI. Persons were excluded if they were pregnant or lactating, had a serum creatinine level of 2 mg per deciliter (177 µmol per liter) or more, had liver dysfunction (an increase by a factor of at least 2 above the upper limit of normal in alanine aminotransferase and aspartate aminotransferase levels), had gastrointestinal problems that would prevent them from following any of the test diets, had active cancer, or were participating in another diet trial.

The participants were randomly assigned within strata of sex, age (below or above the median), BMI (below or above the median), history of coronary heart disease (yes or no), history of type 2 diabetes (yes or no), and current use of statins (none, <1 year, or 1 year) with the use of Monte Carlo simulations. The participants received no financial compensation or gifts. The study was approved and monitored by the human subjects committee of Soroka Medical Center and Ben-Gurion University. Each participant provided written informed consent.

The members of each of the three diet groups were assigned to subgroups of 17 to 19 participants, with six subgroups for each group. Each diet group was assigned a registered dietitian who led all six subgroups of that group. The dietitians met with their groups in weeks 1, 3, 5, and 7 and thereafter at 6-week intervals, for a total of 18 sessions of 90 minutes each. We adapted the Israeli version (developed by the Maccabi Health Maintenance Organization) of the diabetes-prevention program19 and developed additional themes for each diet group (see Supplementary Appendix 1, available with the full text of this article at www.nejm.org). In order to maintain equal intensity of treatment, the workshop format and the quality of the materials were similar among the three diet groups, except for instructions and materials specific to each diet strategy. Six times during the 2-year intervention, another dietitian conducted 10-to-15-minute motivational telephone calls with participants who were having difficulty adhering to the diets and gave a summary of each call to the group dietitian. In addition, a group of spouses received education to strengthen their support of the participants (data not shown).

Low-Fat Diet

The low-fat, restricted-calorie diet was based on American Heart Association20 guidelines. We aimed at an energy intake of 1500 kcal per day for women and 1800 kcal per day for men, with 30% of calories from fat, 10% of calories from saturated fat, and an intake of 300 mg of cholesterol per day. The participants were counseled to consume low-fat grains, vegetables, fruits, and legumes and to limit their consumption of additional fats, sweets, and high-fat snacks.

Mediterranean Diet

The moderate-fat, restricted-calorie, Mediterranean diet was rich in vegetables and low in red meat, with poultry and fish replacing beef and lamb. We restricted energy intake to 1500 kcal per day for women and 1800 kcal per day for men, with a goal of no more than 35% of calories from fat; the main sources of added fat were 30 to 45 g of olive oil and a handful of nuts (five to seven nuts, <20 g) per day. The diet is based on the recommendations of Willett and Skerrett.21

Low-Carbohydrate Diet

The low-carbohydrate, non–restricted-calorie diet aimed to provide 20 g of carbohydrates per day for the 2-month induction phase and immediately after religious holidays, with a gradual increase to a maximum of 120 g per day to maintain the weight loss. The intakes of total calories, protein, and fat were not limited. However, the participants were counseled to choose vegetarian sources of fat and protein and to avoid trans fat. The diet was based on the Atkins diet (see Supplementary Appendix 2).22

Nutritional and Color Labeling of Food in the Cafeteria

Lunch is typically the main meal in Israel. The self-service cafeteria in the workplace provided a varied menu and was the exclusive source of lunch for the participants. A dietitian worked closely with the kitchen staff to adjust specific food items to specific diet groups. Each food item was provided with a label showing the number of calories and the number of grams of carbohydrates, fat, and saturated fat, according to an analysis based on the Israeli nutritional database. Each food item was also labeled with a full circle (indicating "feel free to consume") or a half circle (indicating "consume in moderation"). The labels were color-coded according to diet group and were updated daily (see Supplementary Appendix 2).23

Electronic Questionnaires at Baseline and Follow-up

Adherence to the diets was evaluated by a validated food-frequency questionnaire24 that included 127 food items and three portion-size pictures for 17 items.25 A subgroup of participants completed two repeated 24-hour dietary recalls to verify absolute intake (data not shown). We used a validated questionnaire to assess physical activity.26 At baseline and at 6, 12, and 24 months of follow-up, the questionnaires were self-administered electronically through the workplace intranet. The 15% of participants who requested aid in completing the questionnaires were assisted by the study nurse. The electronic questionnaire helped to ensure completeness of the data by prompting the participant when a question was not answered, and it permitted rapid automated reporting by the group dietitians.

Outcomes

The participants were weighed without shoes to the nearest 0.1 kg every month. With the use of a wall-mounted stadiometer, height was measured to the nearest millimeter at baseline for determination of BMI. Waist circumference was measured halfway between the last rib and the iliac crest. Blood pressure was measured every 3 months with the use of an automated system (Datascop Acutor 4) after 5 minutes of rest.

Blood samples were obtained by venipuncture at 8 a.m. after a 12-hour fast at baseline and at 6, 12, and 24 months and were stored at –80°C until an assay for lipids, inflammatory biomarkers, and insulin could be performed. Levels of fasting plasma glucose, glycated hemoglobin, and liver enzymes were measured in fresh samples. The level of glycated hemoglobin was determined with the use of Cobas Integra reagents and equipment. Serum levels of total cholesterol, high-density-lipoprotein (HDL) cholesterol, low-density-lipoprotein (LDL) cholesterol, and triglycerides were determined enzymatically with a Wako R-30 automatic analyzer, with coefficients of variation of 1.3% for cholesterol and 2.1% for triglycerides. Plasma insulin levels were measured with the use of an enzyme immunometric assay (Immulite automated analyzer, Diagnostic Products), with a coefficient of variation of 2.5%. Plasma levels of high-molecular-weight adiponectin were measured by an enzyme-linked immunosorbent assay (ELISA) (AdipoGen or Axxora), with a coefficient of variation of 4.8%. Plasma leptin levels were assessed by ELISA (Mediagnost), with a coefficient of variation of 2.4%. Plasma levels of high-sensitivity C-reactive protein were measured by ELISA (DiaMed), with a coefficient of variation of 1.9%. The clinic and laboratory staff members were unaware of the treatment assignments, and the study coordinators were unaware of all outcome data until the end of the intervention.

Statistical Analysis

For weight loss, the prespecified primary aim was the change in weight from baseline to 24 months. We used the Israeli food database23 in the analysis of the results of the dietary questionnaires. We analyzed the dietary-composition data and biomarkers with the use of raw unadjusted means, without imputation of missing data. We compared the dietary-intake values between groups at each time point with the use of an analysis of variance in which all pairwise comparisons among the three diet groups were performed with the use of Tukey's Studentized range test. We transformed physical-activity scores into metabolic equivalents per week27 according to the amount of time spent in various forms of exercise per week, with each activity weighted in terms of its level of intensity. For intention-to-treat analyses, we included all 322 participants and used the most recent values for weight and blood pressure. To evaluate the repeated measurements over time, we used generalized estimating equations for panel data analysis, also known as cross-sectional time-series analysis, with the use of the Stata software XTGEE command; this allowed us to account for the nonindependence of repeated measurements of the same bioindicator in the same participant over time. We used age, sex, time point, and diet group as explanatory variables in our models. To study changes over time and the effects of sex or the presence or absence of diabetes, we added appropriate interaction terms. We assessed the within-person changes from baseline in each diet group with the use of pairwise comparisons. We calculated the homeostasis model assessment of insulin resistance (HOMA-IR) according to the following equation28: insulin (U/ml) x fasting glucose (mmol/liter) ÷ 22.5. For a mean (±SD) difference between groups of at least 2±10 kg of weight loss, with 100 participants per group and a type I error of 5%, the power to detect significant differences in weight loss is greater than 90%. We used SPSS software, version 15, and Stata software, version 9, for the statistical analysis.

Results

Characteristics of the Participants

The baseline characteristics of the participants are shown in Table 1. The mean age was 52 years and the mean BMI was 31. Most participants (86%) were men. The overall rate of adherence (Figure 1) was 95.4% at 12 months and 84.6% at 24 months; the 24-month adherence rates were 90.4% in the low-fat group, 85.3% in the Mediterranean-diet group, and 78.0% in the low-carbohydrate group (P=0.04 for the comparison among diet groups). During the study, there was little change in usage of medications, and there were no significant differences among groups in the amount of change; four participants initiated and three stopped cholesterol-lowering therapy. Twenty participants initiated blood-pressure treatment, five initiated medications for glycemic control, and one reduced the dosage of medications for glycemic control.

Dietary Intake, Energy Expenditure, and Urinary Ketones

At baseline, there were no significant differences in the composition of the diets consumed by participants assigned to the low-fat, Mediterranean, and low-carbohydrate diets. Daily energy intake, as assessed by the food-frequency questionnaire, decreased significantly at 6, 12, and 24 months in all diet groups as compared with baseline (P<0.001); there were no significant differences among the groups in the amount of decrease (Table 2). The low-carbohydrate group had a lower intake of carbohydrates (P<0.001) and higher intakes of protein (P<0.001), total fat (P<0.001), saturated fat (P<0.001), and total cholesterol (P=0.04) than the other groups. The Mediterranean-diet group had a higher ratio of monounsaturated to saturated fat than the other groups (P<0.001) and a higher intake of dietary fiber than the low-carbohydrate group (P=0.002). The low-fat group had a lower intake of saturated fat than the low-carbohydrate group (P=0.02). The amount of physical activity increased significantly from baseline in all groups, with no significant difference among groups in the amount of increase. The proportion of participants with detectable urinary ketones at 24 months was higher in the low-carbohydrate group (8.3%) than in the low-fat group (4.8%) or the Mediterranean-diet group (2.8%) (P=0.04).

Weight Loss

A phase of maximum weight loss occurred from 1 to 6 months and a maintenance phase from 7 to 24 months. All groups lost weight, but the reductions were greater in the low-carbohydrate and the Mediterranean-diet groups (P<0.001 for the interaction between diet group and time) than in the low-fat group (Figure 2). The overall weight changes among the 322 participants at 24 months were –2.9±4.2 kg for the low-fat group, –4.4±6.0 kg for the Mediterranean-diet group, and –4.7±6.5 kg for the low-carbohydrate group. Among the 277 male participants, the mean 24-month weight changes were –3.4 kg (95% confidence interval [CI], –4.3 to –2.5) for the low-fat group, –4.0 kg (95% CI, –5.1 to –3.0) for the Mediterranean-diet group, and –4.9 kg (95% CI, –6.2 to –3.6) for the low-carbohydrate group. Among the 45 women, the mean 24-month weight changes were –0.1 kg (95% CI, –2.2 to 1.9) for the low-fat group, –6.2 kg (95% CI, –10.2 to –1.9) for the Mediterranean-diet group, and –2.4 kg (95% CI, –6.9 to 2.2) for the low-carbohydrate group (P<0.001 for the interaction between diet group and sex). The mean weight changes among the 272 participants who completed 24 months of intervention were –3.3±4.1 kg in the low-fat group, –4.6±6.0 kg in the Mediterranean-diet group, and –5.5±7.0 kg in the low-carbohydrate group (P=0.03 for the comparison between the low-fat and the low-carbohydrate groups at 24 months). The mean (±SD) changes in BMI were –1.0±1.4 in the low-fat group, –1.5±2.2 in the Mediterranean-diet group, and –1.5±2.1 in the low-carbohydrate group (P=0.05 for the comparison among groups).

All groups had significant decreases in waist circumference and blood pressure, but the differences among the groups were not significant. The waist circumference decreased by a mean of 2.8±4.3 cm in the low-fat group, 3.5±5.1 cm in the Mediterranean-diet group, and 3.8±5.2 cm in the low-carbohydrate group (P=0.33 for the comparison among groups). Systolic blood pressure fell by 4.3±11.8 mm Hg in the low-fat group, 5.5±14.3 mm Hg in the Mediterranean-diet group, and 3.9±12.8 mm Hg in the low-carbohydrate group (P=0.64 for the comparison among groups). The corresponding decreases in diastolic pressure were 0.9±8.1, 2.2±9.5, and 0.8±8.7 mm Hg (P=0.43 for the comparison among groups).

Lipid Profiles

Changes in lipid profiles during the weight-loss and maintenance phases are shown in Figure 3. HDL cholesterol (Figure 3A) increased during the weight-loss and maintenance phases in all groups, with the greatest increase in the low-carbohydrate group (8.4 mg per deciliter [0.22 mmol per liter], P<0.01 for the interaction between diet group and time), as compared with the low-fat group (6.3 mg per deciliter [0.16 mmol per liter]). Triglyceride levels (Figure 3B) decreased significantly in the low-carbohydrate group (23.7 mg per deciliter [0.27 mmol per liter], P=0.03 for the interaction between diet group and time), as compared with the low-fat group (2.7 mg per deciliter [0.03 mmol per liter]). LDL cholesterol levels (Figure 3C) did not change significantly within groups, and there were no significant differences between the groups in the amount of change. Overall, the ratio of total cholesterol to HDL cholesterol (Figure 3D) decreased during both the weight-loss and the maintenance phases. The low-carbohydrate group had the greatest improvement, with a relative decrease of 20% (P=0.01 for the interaction between diet group and time), as compared with a decrease of 12% in the low-fat group.

High-Sensitivity C-Reactive Protein, High-Molecular-Weight Adiponectin, and Leptin

The level of high-sensitivity C-reactive protein decreased significantly (P<0.05) only in the Mediterranean-diet group (21%) and the low-carbohydrate group (29%), during both the weight-loss and the maintenance phases, with no significant differences among the groups in the amount of decrease (Figure 4A). During both the weight-loss and the maintenance phases, the level of high-molecular-weight adiponectin (Figure 4B) increased significantly (P<0.05) in all diet groups, with no significant differences among the groups in the amount of increase. Circulating leptin, which reflects body-fat mass, decreased significantly (P<0.05) in all diet groups, with no significant differences among the groups in the amount of decrease; the decrease in leptin paralleled the decrease in body weight during the two phases (Figure 4C). The interaction between the effects of low-carbohydrate diet and sex on the reduction of leptin (P=0.04), as compared with the low-fat diet, reflects the greater effect of the low-carbohydrate diet among men.

Fasting Plasma Glucose, HOMA-IR, and Glycated Hemoglobin

Among the 36 participants with diabetes (Figure 4D), only those in the Mediterranean-diet group had a decrease in fasting plasma glucose levels (32.8 mg per deciliter); this change was significantly different from the increase in plasma glucose levels among participants with diabetes in the low-fat group (P<0.001 for the interaction between diet group and time). There was no significant change in plasma glucose level among the participants without diabetes (P<0.001 for the interaction among diabetes and Mediterranean diet and time). In contrast, insulin levels (Figure 4E) decreased significantly in participants with diabetes and in those without diabetes in all diet groups, with no significant differences among groups in the amount of decrease. Among the participants with diabetes, the decrease in HOMA-IR at 24 months (Figure 4F) was significantly greater in those assigned to the Mediterranean diet than in those assigned to the low-fat diet (2.3 and 0.3, respectively; P=0.02; P=0.04 for the interaction among diabetes and Mediterranean diet and time). Among the participants with diabetes, the proportion of glycated hemoglobin at 24 months decreased by 0.4±1.3% in the low-fat group, 0.5±1.1% in the Mediterranean-diet group, and 0.9±0.8% in the low-carbohydrate group. The changes were significant (P<0.05) only in the low-carbohydrate group (P=0.45 for the comparison among groups).

Liver-Function Tests

Changes in bilirubin, alkaline phosphatase, and alanine aminotransferase levels were similar among the diet groups. Alanine aminotransferase levels were significantly reduced from baseline to 24 months in the Mediterranean-diet and the low-carbohydrate groups (reductions of 3.4±11.0 and 2.6±8.6 units per liter, respectively; P<0.05 for the comparison with baseline in both groups).

Discussion

In this 2-year dietary-intervention study, we found that the Mediterranean and low-carbohydrate diets are effective alternatives to the low-fat diet for weight loss and appear to be just as safe as the low-fat diet. In addition to producing weight loss in this moderately obese group of participants, the low-carbohydrate and Mediterranean diets had some beneficial metabolic effects, a result suggesting that these dietary strategies might be considered in clinical practice and that diets might be individualized according to personal preferences and metabolic needs. The similar caloric deficit achieved in all diet groups suggests that a low-carbohydrate, non–restricted-calorie diet may be optimal for those who will not follow a restricted-calorie dietary regimen. The increasing improvement in levels of some biomarkers over time up to the 24-month point, despite the achievement of maximum weight loss by 6 months, suggests that a diet with a healthful composition has benefits beyond weight reduction.

The present study has several limitations. We enrolled few women; however, we observed a significant interaction between the effects of diet group and sex on weight loss (women tended to lose more weight on the Mediterranean diet), and this difference between men and women was also reflected in the changes in leptin levels. This possible sex-specific difference should be explored in further studies. The data from the few participants with diabetes are of interest, but we recognize that measurement of HOMA-IR is not an optimal method to assess insulin resistance among persons with diabetes. We relied on self-reported dietary intake, but we validated the dietary assessment in two different dietary-assessment tools and used electronic questionnaires to minimize the amount of missing data. Finally, one might argue that the unique nature of the workplace in this study, which permitted a closely monitored dietary intervention for a period of 2 years, makes it difficult to generalize the results to other free-living populations. However, we believe that similar strategies to maintain adherence could be applied elsewhere.

The strengths of the study include the one-phase design, in which all participants started simultaneously; the relatively long duration of the study; the large study-group size; and the high rate of adherence. The monthly measurements of weight permitted a better understanding of the weight-loss trajectory than was the case in previous studies.

We observed two phases of weight change: initial weight loss and weight maintenance. The maximum weight reduction was achieved during the first 6 months; this period was followed by the maintenance phase of partial rebound and a plateau. Among all diet groups, weight loss was greater for those who completed the 24-month study than for those who did not. Even moderate weight loss has health benefits, and our findings suggest benefits of behavioral approaches that yield weight losses similar to those obtained with pharmacotherapy.29

We distinguished between changes in levels of biomarkers (leptin, adiponectin, and high-sensitivity C-reactive protein) that are apparently related to loss of adipose tissue and changes in biomarkers (triglycerides, HDL cholesterol, glucose, and insulin) that apparently reflect, in part, the effects of specific diet composition. The changes we observed in levels of adiponectin and leptin,30 which were consistent in all groups, reflect loss of weight. Consumption of monounsaturated fats is thought to improve insulin sensitivity,14,31,32 an effect that may explain the favorable effect of the Mediterranean diet on glucose and insulin levels. The results imply that dietary composition modifies metabolic biomarkers in addition to leading to weight loss. Our results suggest that health care professionals might consider more than one dietary approach, according to individual preferences and metabolic needs, as long as the effort is sustained.

This trial also suggests a model that might be applied more broadly in the workplace. As Okie recently suggested,33 using the employer as a health coach could be a cost-effective way to improve health. The model of intervention with the use of dietary group sessions, spousal support, food labels, and monthly weighing in the workplace within the framework of a health promotion campaign might yield weight reduction and long-term health benefits.

FREE Full-Text has the tables - LINK (http://content.nejm.org/cgi/content/full/359/3/229?query=TOC)

[Judynyc]

http://www.sciencenews.org/view/generic/id/34183/title/Against_the_grains

Low-carbohydrate and Mediterranean diets outperform low-fat regimen in two-year trial

Carbohydrates have taken another hit. A new study finds that a low-carb diet results in greater weight loss and better cholesterol readings than a low-fat regimen that promotes a lot of grains and fruits. A Mediterranean diet that incorporates some of each diet yielded results that fell between the two, researchers in Israel report in the July 17 New England Journal of Medicine.



more at link above.

[alisbabe]

Yay!! Finally we're getting some decent evidence.

How long do you think it'll take the rest of the western world to catch on, do ya think?

[alisbabe]

The low-carbohydrate, non–restricted-calorie diet aimed to provide 20 g of carbohydrates per day for the 2-month induction phase and immediately after religious holidays, with a gradual increase to a maximum of 120 g per day to maintain the weight loss. The intakes of total calories, protein, and fat were not limited. However, the participants were counseled to choose vegetarian sources of fat and protein and to avoid trans fat. The diet was based on the Atkins diet (see Supplementary Appendix 2).22

Sheesh just spotted this. They're still so very scared of saturated fat and meat aren't they?

[Judynyc]

Mediterranean Diet

The moderate-fat, restricted-calorie, Mediterranean diet was rich in vegetables and low in red meat, with poultry and fish replacing beef and lamb. We restricted energy intake to 1500 kcal per day for women and 1800 kcal per day for men, with a goal of no more than 35% of calories from fat; the main sources of added fat were 30 to 45 g of olive oil and a handful of nuts (five to seven nuts, <20 g) per day. The diet is based on the recommendations of Willett and Skerrett.21
This is very beachy to me. I do admit that my fat % is higher than this. :o

Low-Carbohydrate Diet

The low-carbohydrate, non–restricted-calorie diet aimed to provide 20 g of carbohydrates per day for the 2-month induction phase and immediately after religious holidays, with a gradual increase to a maximum of 120 g per day to maintain the weight loss. The intakes of total calories, protein, and fat were not limited. However, the participants were counseled to choose vegetarian sources of fat and protein and to avoid trans fat. The diet was based on the Atkins diet (see Supplementary Appendix 2).22

Emphasis mine!! :cool:

Great study.... :thup:

[mike_d]

I just saw this on ABC news. They said the low-carb group was the clear winner in weight loss, health markers and hunger control. Could the truth have finally come out?

[Luzyanna]

I just saw this on ABC news. They said the low-carb group was the clear winner in weight loss, health markers and hunger control. Could the truth have finally come out?

But it was a vegetarian LC diet....they still won't admit to eating any type of red meat. You can "occasionally" have chicken or fish.

They admitted that "low fat diets may not be first choice anymore." :lol:

[pennink]

Yep, saw it on ABC, too.

(still the 'ate less because we're full') ya, right. Have you seen my pound of ribs on my plate, doc? :lol:

Ate less of the BAD stuff, ya!


I KNEW there was a change in the air!!!! :thup:

[LessLiz]

We enrolled few women; however, we observed a significant interaction between the effects of diet group and sex on weight loss (women tended to lose more weight on the Mediterranean diet), and this difference between men and women was also reflected in the changes in leptin levels. This possible sex-specific difference should be explored in further studies. That is a very interesting finding.

Leslie, I don't see where this is a vegetarian low carb diet. Where do you see that?

[Dodger]

A sample of headlines on the study from news sources:

Long-Term Diet Study Suggests Success Is Hard to Come By (http://www.nytimes.com/2008/07/17/health/nutrition/17diets.html)

Study: Low-carb diet best for weight, cholesterol (http://ap.google.com/article/ALeqM5g5nH6bV4fr0ofSKGT8ZjkSVjbM_AD91V64HG0)

Best Diet: Low-Fat, Low-Carb or Mediterranean? (http://abcnews.go.com/Health/Diet/story?id=5389423&page=1) Research Belies Long-Held Belief That Low-Fat Diets Are Best (http://abcnews.go.com/Health/Diet/story?id=5389423&page=1)

Diet Study:Hold the carbs, not the fats (http://www.boston.com/news/health/blog/2008/07/diet_study_hold.html)

[fuzzyturn]

Fabulous! Just saw it here, myself:

http://news.yahoo.com/s/ap/20080716/ap_on_he_me/med_dueling_diets

[Nancy LC]

LOL! Health day is reporting it that they're all equal.

Diet Plans Produce Similar Results (http://www.healthday.com/Article.asp?AID=617520)
Study finds Mediterranean and low-carb diets work just as well as low-fat ones

Fools!

[Luzyanna]

That is a very interesting finding.

Leslie, I don't see where this is a vegetarian low carb diet. Where do you see that?

It was on NBC news as well comparing these 3 diets then interviewed a doctor - he made sure to state it was a vegetarian low carb diet.


The low-carb diet was based on the Atkins plan. In this group, calories weren't restricted. These participants were told to eat about 20 grams of carbs a day (about the amount in two slices of bread) for two months, and then increase it to no more than 120 grams a day. They focused on vegetarian sources of fat and protein and avoided foods with trans fat.

Diet Debate (http://www.webmd.com/diet/news/20080716/diet-debate-3-top-plans-go-toe-to-toe)

[LessLiz]

They counseled people to make those choices, which doesn't translate into vegetarian. People are going to spin the results, but the article doesn't say or in any way indicate that this LC diet was vegetarian.

[lowcarbUgh]

Fasting Plasma Glucose, HOMA-IR, and Glycated Hemoglobin

Among the 36 participants with diabetes (Figure 4D), only those in the Mediterranean-diet group had a decrease in fasting plasma glucose levels (32.8 mg per deciliter); this change was significantly different from the increase in plasma glucose levels among participants with diabetes in the low-fat group (P<0.001 for the interaction between diet group and time). There was no significant change in plasma glucose level among the participants without diabetes (P<0.001 for the interaction among diabetes and Mediterranean diet and time). In contrast, insulin levels (Figure 4E) decreased significantly in participants with diabetes and in those without diabetes in all diet groups, with no significant differences among groups in the amount of decrease. Among the participants with diabetes, the decrease in HOMA-IR at 24 months (Figure 4F) was significantly greater in those assigned to the Mediterranean diet than in those assigned to the low-fat diet (2.3 and 0.3, respectively; P=0.02; P=0.04 for the interaction among diabetes and Mediterranean diet and time). Among the participants with diabetes, the proportion of glycated hemoglobin at 24 months decreased by 0.4±1.3% in the low-fat group, 0.5±1.1% in the Mediterranean-diet group, and 0.9±0.8% in the low-carbohydrate group. The changes were significant (P<0.05) only in the low-carbohydrate group (P=0.45 for the comparison among groups).



Great news for diabetics! It appears the higher-fiber diet reduced fasting blood glucose levels more and the LC diet produced a better A1c. I think you can do both: high-fiber veggies and low carb for the best results. :thup:

[ruthla]

Isn't it interesting how this study was done in Israel, not the USA or England? It seems to me that both of those countries are so heavily invested into the lowfat regime that it's doubtful either of them would have financed a study on alternatives- or if they did, they'd find a way to spin the results to promote LF no matter what.

[LessLiz]

Part of the funding came from the Robert and Veronica Atkins Foundation. I remember reading they were funding a long term study, but promptly forgot about it.

[valleegirl]

I was on Atkins before & lost over 20 lbs. I'm back on again, as there was a lot of negativity - this makes me feel better. This was an article I just read - copy link - http://www.msnbc.msn.com/id/25708495

[Judynyc]

They counseled people to make those choices, which doesn't translate into vegetarian. People are going to spin the results, but the article doesn't say or in any way indicate that this LC diet was vegetarian.

he made sure to state it was a vegetarian low carb diet.

Ummm...maybe spin...but I think that he just got it plain wrong!! :p :lol:

The article does say that they counseled the low carb dieters to choose fats from vegetarian sources. :idea: Maybe thats where he got it?

[fatnewmom]

http://www.cnn.com/2008/HEALTH/diet.fitness/07/16/dueling.diets.ap/index.html

today's news on cnn

ATLANTA, Georgia (AP) -- The Atkins diet may have proved itself after all.
A diet low in carbohydrates, found in bread, improved cholesterol more than two other diets.

A diet low in carbohydrates, found in bread, improved cholesterol more than two other diets.

A low-carb diet and a Mediterranean-style regimen helped people lose more weight than a traditional low-fat diet in one of the longest and largest studies to compare the dueling weight-loss techniques.

A bigger surprise: The low-carb diet improved cholesterol more than the other two. Some critics had predicted the opposite.

"It is a vindication," said Abby Bloch of the Dr. Robert C. and Veronica Atkins Foundation, a philanthropy group that honors the Atkins' diet's creator and was the study's main funder.

However, all three approaches -- the low-carb diet, a low-fat diet and a Mediterranean diet -- achieved weight loss and improved cholesterol.

The study is remarkable not only because it lasted two years, much longer than most, but because of the huge proportion of people who stuck with the diets: 85 percent.

Researchers approached the Atkins Foundation with the idea for the study. But the foundation played no role in the study's design or reporting of the results, said the lead author, Iris Shai of Ben-Gurion University of the Negev.
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Other experts said the study, being published Thursday in the New England Journal of Medicine, was highly credible.

"This is a very good group of researchers," said Kelly Brownell, director of Yale University's Rudd Center for Food Policy and Obesity.

The research was done in a controlled environment: an isolated nuclear research facility in Israel. The 322 participants got their main meal of the day, lunch, at a central cafeteria.

"The workers can't easily just go out to lunch at a nearby Subway or McDonald's," said Dr. Meir Stampfer, the study's senior author and a professor of epidemiology and nutrition at the Harvard School of Public Health.

In the cafeteria, the appropriate foods for each diet were identified with colored dots, using red for low-fat, green for Mediterranean and blue for low-carb.

As for breakfast and dinner, the dieters were counseled on how to stick to their eating plans and were asked to fill out questionnaires on what they ate, Stampfer said.
Health Library

* Fitness and Nutrition

The low-fat diet -- no more than 30 percent of calories from fat -- restricted calories and cholesterol and focused on low-fat grains, vegetables and fruits as options. The Mediterranean diet had similar calorie, fat and cholesterol restrictions, emphasizing poultry, fish, olive oil and nuts.

The low-carb diet set limits for carbohydrates but none for calories or fat. It urged dieters to choose vegetarian sources of fat and protein.

Most of the participants were men; all men and women in the study got roughly equal amounts of exercise, the study's authors said.

Average weight loss for those in the low-carb group was 10.3 pounds after two years. Those in the Mediterranean diet lost 10 pounds, and those on the low-fat regimen dropped 6.5.

More surprising were the measures of cholesterol. Critics have long acknowledged that an Atkins-style diet could help people lose weight but feared that over the long term, it may drive up cholesterol because it allows more fat.

But the low-carb approach seemed to trigger the most improvement in several cholesterol measures, including the ratio of total cholesterol to HDL, the "good" cholesterol. For example, someone with total cholesterol of 200 and an HDL of 50 would have a ratio of 4 to 1. The optimum ratio is 3.5 to 1, according to the American Heart Association.

Doctors see that ratio as a sign of a patient's risk for hardening of the arteries. "You want that low," Stampfer said.

The ratio declined by 20 percent in people on the low-carb diet, compared with 16 percent in those on the Mediterranean and 12 percent in low-fat dieters.

The study is not the first to offer a favorable comparison of an Atkins-like diet. Research published in the Journal of the American Medical Association last year found that overweight women on the Atkins plan had slightly better blood pressure and cholesterol readings than those on the low-carb Zone diet, the low-fat Ornish diet and a low-fat diet that followed U.S. government guidelines.

The heart association has long recommended low-fat diets to reduce heart risks, but some of its leaders have noted that the Mediterranean diet has also proved safe and effective.

The heart association recommends a low-fat diet even more restrictive than the one in the study, said Dr. Robert Eckel, the association's past president who is a professor of medicine at the University of Colorado-Denver.

It does not recommend the Atkins diet. However, a low-carb approach is consistent with heart association guidelines so long as there are limitations on the kinds of saturated fats often consumed by people on the Atkins diet, Eckel said.

The new study's results favored the Atkins-like approach less when subgroups such as diabetics and women were examined.

Among the 36 diabetics, only those on the Mediterranean diet lowered blood sugar levels. Among the 45 women, those on the Mediterranean diet lost the most weight.

"I think these data suggest that men may be much more responsive to a diet in which there are clear limits on what foods can be consumed," such as an Atkins-like diet, said Dr. William Dietz of the Centers for Disease Control and Prevention.

"It suggests that because women have had more experience dieting or losing weight, they're more capable of implementing a more complicated diet," said Dietz, who heads the CDC's nutrition unit.

[Sallyannie]

yep, I just saw this. It is SO EXCITING and so clear! I am just sorry DR Atkins didnt live long enough to see this. I am going to print up copies of this and carry them with me to shove in people's faces if they get snotty about what I am eating (or not eating) :wave: :agree:

[Judynyc]

Among the 45 women, those on the Mediterranean diet lost the most weight.

Interesting!! :thup:

[fatnewmom]

Oh -- just saw ReginaW actually posted the study on this forum!

[Sallyannie]

Quote:
Among the 45 women, those on the Mediterranean diet lost the most weight.


Interesting!! :thup:

yes and they had the best improvement in blood sugar readings too,

but what I found even more interesting (for me) than weight or BG was the following:

" the low-carb approach seemed to trigger the most improvement in several cholesterol measures, including the ratio of total cholesterol to HDL, the "good" cholesterol. For example, someone with total cholesterol of 200 and an HDL of 50 would have a ratio of 4 to 1. The optimum ratio is 3.5 to 1, according to the American Heart Association.

Doctors see that ratio as a sign of a patient's risk for hardening of the arteries. "You want that low," Stampfer said.

The ratio declined by 20 percent in people on the low-carb diet, compared with 16 percent in those on the Mediterranean and 12 percent in low-fat dieters.

[fatnewmom]

I wonder why Atkins folks were not able to decrease blood sugar as much as the Mediterranean group. I'd love to hear from a diabetic, why they think this is the case...

[teaser]

The low-carb diet set limits for carbohydrates but none for calories or fat. It urged dieters to choose vegetarian sources of fat and protein

Because of course animal sources of fat and protein would never have worked. :nono:


The Mediterranean Diet was the only one that encouraged any kind of meat.

[Donna7]

I wonder why Atkins folks were not able to decrease blood sugar as much as the Mediterranean group. I'd love to hear from a diabetic, why they think this is the case...

Fasting glucose was not reduced, but Hemoglobin A1c was reduced in LC, which is an overall measure, more sensitive to food intake than fasting glucose.

The MSNBC article stated incorrectly that diabetics did not lower blood sugars on low carb...as any diabetic would tell you, that's ludicrous. I see it on my glucometer three or four times a day.

I think the women/men difference can be accounted for by the prevalence of insulin resistance and body shape; for instance, I am a woman with an apple shape, meaning I tend to gain weight around the middle like a man...and I am very insulin resistant. LC is by far the best way of eating for me, although it may not necessarily be for other women who are not insulin resistant (who do not gain weight around the midsection)...although I think it can benefit anyone who may be at risk for diabetes, whether or not they are insulin resistant (yet...that comes over time!)

[PearlWhite]

Hi valleegirl :wave:

Welcome to the forum.

Rest asure there are plenty of articles out there that "prove" that low carb works as there are plenty of articles that "prove" it doesn't and it will kill you.

You just have to find out what's best for you & your body.

[RachelTN]

July 16: In addition to weight loss, low-carbohydrate, high-protein lifestyles promote lower cholesterol levels than competing diets, a Harvard School of Public Health study found. NBC Chief Medical Correspondent Robert Bazell reports.

http://www.cnn.com/2008/HEALTH/diet.fitness/07/16/dueling.diets.ap/index.html


http://www.foxnews.com/story/0,2933,384362,00.html


http://www.msnbc.msn.com/id/25708495/

We could have told em. :D

[skeeweeaka]

Yes, I saw this today...my ex called me to take a look at it :lol: He's been on me about the diet...

TJ :rheart:

[Kendogirl]

WOW, Foxnews!! I dare say that's a big breakthrough. I wonder how many shares they have reserved for when Truvia hits the stock-market... ;-)

But seriously, that's awesome! A 2 year study and again low-carb lifestyle came out a big winner. It's getting harder and harder to ignore, I really hope more people will see the "light" and dump the sugar.

[Demi]

It's good to see that this is being reported by the UK media too:



The Mail
London, UK
17 July, 2008


The controversial Atkins diet is 'safe and far more effective than a low-fat one', study shows

The controversial Atkin's diet is just as effective and safe as a conventional low-fat diet, a two year study has found.

Researchers found that overweight volunteers shed more pounds on the low carbohydrate regime than they did on an orthodox calorie-controlled diet.

A Mediterranean diet with plenty of vegetables, fibre, white meat and fish was equally effective - and just as safe, they found.

The findings come from an experiment involving 322 overweight volunteers carried out by a team of Israeli, America and German scientists.

Lead researcher Dr Iris Shai, from the department of epidemiology at Ben-Guiron University of the Negev, Israel, said: 'Clearly there is not one diet that is ideal for everyone.

'We believe that this study will open clinical medicine to considering low-carb and Mediterranean diets as safe, effective alternatives for patients, based on personal preference and the medical goals set out for such intervention.'

Atkin's was the biggest dieting phenomena in years. At its peak around 2004, an estimated three million Britons were following it.

Devised by US heart doctor Robert Atkins, it involves eating plenty of protein while virtually eliminating carbohydrates like sugar, bread, rice and pasta. Controversially, it was high in fat - attracting the ire of doctors.

The diet involves no calorie counting and at its height was particularly popular with men. However, it fell out of favour after concerns that it could increase the risk of heart disease and kidney problems.

By contrast a Mediterranean diet includes a high intake of vegetables and fruits, fish and unsaturated fats like olive oil.

The volunteers in the study, reported in the New England Journal of Medicine, were assigned to one of three diets - a low fat calorie-restricted diet; a Mediterranean calorie-restricted diet high in fibre and low in red meat, and a low-carbohydrate diet where volunteers had no limit on calories.

Those on the conventional low-fat diet lost an average of 6.5 pounds in weight over the two years - compared to 10 pounds for those on the Mediterranean diet and 10.3 pounds on the low carb diet.

Most of the weight was lost in the first six months of the trial.

The low-carb diet was best for reducing levels of bad cholesterol, while all three diets had the same beneficial effect on liver and inflammation function, the researchers said.

In the first year, just five per cent of the volunteers dropped out of the study. By the end of the second year, 85 per cent of the volunteers were still on the diet.

The experiment was carried out at the Nuclear Research Centre in Israel where the staff canteen provided suitable dishes for each of the three diets.

Lunch is typically the main meal of the day in Israel. The researchers also gave advice to the families of the volunteers on how to stick to the diets at home.

The researchers concede that the study has some flaws. Around 85 per cent of the volunteers were men - and the effects could be different for women, they say.


http://www.dailymail.co.uk/news/article-1035779/The-controversial-Atkins-diet-safe-far-effective-low-fat-study-shows.html

[steve41]

Does anyone remember a debate/interview held years ago between Atkins, Dean Ornish and a lady from the AHA?

They both ganged up and dismissed Atkins in the most egregious way. I can still see Ornishs' smarmy condescending smile when ever Atkins tried to make a point. He would trot out his trademark 'Atkins would have us all eating deep fried pork rinds' line.

Geez I hated that little jerk Ornish. I would love to have seen that interview re-visited in light of this latest study.

Fat rules, carbs suck!

[moggsy]

This study will change nothing on its own. It's not the first time a study indicated that low carb was safe and more effective for weight loss than low fat or low calorie.

I'd love to see a steady barrage in the media of "maybe Atkins was right all along" stories. I'd also like to see something that would make the tendency to temper these stories (or in this case, the study itself) with caution about meat and saturated fat. But I suppose we all would.

[steve41]

Or how about a Taubes' interview one on one with a Larry King-type? Taubes doesn't fare too well in a debate setting... he is too polite and gets over-powered sometimes. Remember the last appearance on the LK show? I was disappointed, although Andrew Weil had a nice plug.

I am guessing that he has had quite a few live interviews since GCBC came out. I sure hope he has polished up his presentation and is 'ready for primetime'.

Atkins was a too much of a bully and Taubes was too nice. Somewhere in between would be good.

[Womb]

http://content.nejm.org/cgi/content/full/359/3/229

[ReginaW]

Isn't it interesting how this study was done in Israel, not the USA or England? It seems to me that both of those countries are so heavily invested into the lowfat regime that it's doubtful either of them would have financed a study on alternatives- or if they did, they'd find a way to spin the results to promote LF no matter what.

The NIH has a five year study that's been underway for a few years now... :)

[ReginaW]

I wonder why Atkins folks were not able to decrease blood sugar as much as the Mediterranean group. I'd love to hear from a diabetic, why they think this is the case...

40% of their diet was carbs at 6, 12 and 24 months?

[ReginaW]

I just posted these on my blog....

The headlines are all over the place regarding what the results mean:

Low-Carb and Low-Fat Diets Face Off

Dr. Meir Stampfer, the study's senior author and professor of epidemiology and
nutrition at Harvard School of Public Health, told ABC News: "The low-carb diet
was the clear winner in providing the most weight loss."


The Never-Ending Diet Wars: Why Atkins Still Doesn't Beat Low-Fat Diet

"An optimal diet is one that is low in fat (because fat, whatever the type, has
9 calories per gram versus only 4 calories per gram for protein and
carbohydrates). When you eat less fat, you consume fewer calories without
having to eat less food, because the food is less dense in calories, as well as
low in refined carbohydrates."

Healthy Diets Shown to Have Benefit Despite Modest Weight Losses

In a tightly controlled dieting experiment, obese people lost an average of just
6 to 10 pounds over two years. The study, published Thursday in The New
England Journal of Medicine, was supposed to determine which of three types of
diets works best. Instead, the results highlight the difficulty of weight loss
and the fact that most diets do not work well.


More Evidence that Diets Don't Work

After two years of effort the dieters lost, on average, 6 to 10 pounds. The
study, funded in part by the Atkins Research Foundation, seemed designed to
prove that low-carb diets trump low-fat diets. But in the end, all it really
showed is that dieters can put forth tremendous effort and reap very little
benefit.


Diet Study: Hold the Carbs, Not the Fats

Low-carbohydrate and so-called Mediterranean diets may be more effective than
low-fat diets, according to a major new study published in tomorrow’s New
England Journal of Medicine.


Against the Grains

Carbohydrates have taken another hit. A new study finds that a low-carb diet
results in greater weight loss and better cholesterol readings than a low-fat
regimen that promotes a lot of grains and fruits.


Diet Plans Produce Similar Results

New research shows that Mediterranean and low-carb diets are just as good and
just as safe as the low-fat diet often prescribed by doctors, a revelation that
should give people more choices in eating well.


Unrestricted Low-Carb Diet Wins Hands Down

The similar caloric deficit achieved in all diet groups suggests that a
low-carbohydrate, non–restricted-calorie diet may be optimal for those who will
not follow a restricted-calorie dietary regimen.


Atkins Diet is Safe and Far More Effective Than a Low-Fat One, Study Says

The controversial Atkins diet is just as effective and safe as a conventional
low-fat diet, a two-year study has found. Researchers found that
overweight volunteers shed more pounds on the low carbohydrate regime than they
did on an orthodox calorie-controlled diet.


Low-Carb and Mediterranean Diets May Equal Watching Fat Intake

Explain to interested patients that the study suggested low-carbohydrate and
Mediterranean diets could be as effective as the traditionally recommended
low-fat diet for weight loss.


It's amusing that each of the above headlines are all reporting on the same study!

[Aeon]

Here's how this morning's New York Times covered the NEJM study results.

July 17, 2008
Healthy Diets Shown to Have Benefit Despite Modest Weight Losses (http://www.nytimes.com/2008/07/17/health/nutrition/17diets.html)
By TARA PARKER-POPE

In a tightly controlled dieting experiment, obese people lost an average of just 6 to 10 pounds over two years.

The study, published Thursday in The New England Journal of Medicine, was supposed to determine which of three types of diets works best. Instead, the results highlight the difficulty of weight loss and the fact that most diets do not work well.

The researchers followed 322 dieters, 277 men and 45 women. The dieters were assigned to follow one of three types of diets — a diet with about 30 percent fat, based on American Heart Association guidelines; a Mediterranean diet; and a low-carbohydrate diet based on the Atkins diet plan. The study was partly financed by the Atkins Research Foundation.

The trial was conducted at the Nuclear Research Center in Dimona, Israel, an isolated workplace that has its own medical department.

In addition to regular meetings and telephone calls with dietitians for the participants, the plan included nutrition counseling for spouses and a revamping of the food served in the center’s cafeteria.

Because the center is in an isolated area, the dieters consistently ate lunch, the largest meal of the day, in the company cafeteria, where food was color-coded to help dieters comply with their eating plan.

The biggest weight loss happened in the first five months of the diet — low-fat and Mediterranean dieters lost about 10 pounds, and low-carbohydrate dieters lost 14 pounds.

By the end of two years, all the dieters had regained some, but not all, of the lost weight. The low-fat dieters showed a net loss of six pounds, and the Mediterranean and low-carbohydrate dieters both lost about 10 pounds.

Researchers said the results sound modest, but they said the small weight loss had resulted in improvements in cholesterol and other health markers.

“In order to keep participants on the diet for long term as a way of life, we did not impose extreme diet protocols,” said Iris Shai, the study’s lead author and a registered dietitian at the S. Daniel Abraham International Center for Health and Nutrition. “More dramatic diet protocols could probably reduce more weight for the short term, but participants would have dropped out.”

There were subtle differences in the three diets studied. Men did better on the low-carbohydrate diets, losing 11 pounds compared with about 9 pounds for the Mediterranean diet.

Women fared best on the Mediterranean diet, losing about 14 pounds compared with about 5 pounds on the low-carbohydrate plan.

For all dieters, there were improvements in the ratios of good to bad cholesterol.

“This suggests that healthy diet has beneficial effects beyond weight loss,” Ms. Shai said.

[LessLiz]

Ya know, I'm feeling sorry for Jane Brody today. With the study published yesterday she lost about 95% of what harps on about. “In order to keep participants on the diet for long term as a way of life, we did not impose extreme diet protocols,” said Iris Shai, the study’s lead author and a registered dietitian at the S. Daniel Abraham International Center for Health and Nutrition. “More dramatic diet protocols could probably reduce more weight for the short term, but participants would have dropped out.” I hope people, doctors in particular, pay attention to this. One of the reasons the average weight loss was so low was the fact they were more interested in keeping people in the study than with the amount of weight those people lost. For many, perhaps most people, in real life this may be the most important consideration. One point made in the study is that even though people did not continue to lose weight on LC/Med beyond 6 months, their blood profiles *did* continue to improve over the entire 24 month period.

[Aeon]

Ya know, I'm feeling sorry for Jane Brody today. With the study published yesterday she lost about 95% of what harps on about.

No sympathy here for Jane Brody, nor for the Washington Post's Sally Squires (http://www.washingtonpost.com/wp-srv/health/lpc/index.html).

When people have dedicated entire careers to misinforming the public -- after having been put on notice for years by folks more knowledgeable than themselves -- they are not deserving of solace. (Anyway, they will continue to insist that they are right despite all the evidence to the contrary.)

[ruthla]

A couple of thoughts:

1) Even when they interpret this study to mean "all diets work equally well", it's still casting doubt on the universal low-fat guidelines

2) OK, so the groups lost 10 lbs or so on average. Did that mean any of them dropped from "obese" into "overweight" or from "overweight" into "normal weight"? I've lost 20 lbs in the past year, and after losing only 15 of them most of my obesity-related health problems were gone. If health is improved, most people lost weight, and what they lost they kept off, who cares if the results were modest?

[Wifezilla]

Bwaa haa haa!

Jane Brody is probably holding a statin bottle in her hand and sobbing as we speak.

[pamlynn]

I saw Katie Curic's interview with some Dr.(?) and was thrilled about their findings and the fact that it was on a national TV station. Maybe this will help people to take a more serious look at Low Carbing and those who have done it before, will try it again. Awesome!

I told my Doc just today that I was low carbing and she was happy about it since she noticed my weight loss.

[LessLiz]

Zilla, I picture her with a statin bottle in one hand and a blank computer screen staring her in the face as she tries to figure out what to write *now*! :D

[ReginaW]

The Never-Ending Diet Wars
A new study reports that the Atkins diet can be just as healthy as a low-fat diet. But don't start buying bacon yet. This research has some serious flaws.

Dean Ornish M.D.
Newsweek Web Exclusive

A new study comparing the Atkins diet, a Mediterranean diet and a low-fat diet published on July 17 inThe New England Journal of Medicine (NEJM), is likely to inspire headlines saying that the Atkins diet is better for your waistline and your health than a low-fat diet.

However, as a lead investigator on numerous peer-reviewed studies of low-fat diets, and the author of several books about the benefits of healthy low-fat lifestyles, I believe this study is extremely flawed. Here's why:

The NEJM study, which was funded in part by the Atkins Foundation, reported that participants who ate a low-carb (Atkins) or Mediterranean diet (restricted calorie, moderate fat intake) for two years lost more weight, and saw more of an improvement in their glucose and cholesterol levels, than those who were on a low-fat, restricted calorie diet. However, participants in the study who were on the "low-fat" diet decreased their total fat intake from 31.4 percent to 30.0 percent, hardly at all.

I'm also very skeptical of the quality of data in this study. For example, the investigators reported that those on the "low-fat" diet consumed 200 fewer calories per day—or 10,000 fewer calories per year—than those on the Mediterranean diet, yet people lost more weight on the Mediterranean diet. That's physiologically impossible.

In addition, in the "Atkins diet" that was tested, "the participants were counseled to choose vegetarian sources of fat and protein and to avoid trans fat." A vegetarian Atkins diet? Most people associate an Atkins diet with bacon, butter and brie, not a plant-based diet like the one I recommend.

Then there's the question of what constitutes a "low-fat" diet. The one used in the NEJM study was not very low in fat. It was based on the American Heart Association (AHA) guidelines, which I have long criticized as not being enough of a change in diet to show much benefit. In earlier studies, as in this one, the AHA diet did not cause much of a reduction in either blood cholesterol levels, weight or blood sugar, so it's not surprising that the new NEJM study reported that the Atkins and Mediterranean diets were more successful at reducing these levels. In the Womens Health Initiative study, the AHA diet didn't do much to prevent heart disease, colon cancer or breast cancer, either.

My colleagues and I at the nonprofit Preventive Medicine Research Institute and the University of California, San Francisco, have studied for more than three decades the effects of diets much lower in fat (10 percent) than the one used in NEJM study as well as lower in refined carbohydrates and higher in fruits, vegetables, whole grains, legumes and soy products.

We reported in a randomized, controlled clinical trial published in the Journal of the American Medical Association a 24-pound weight loss after one year and 13-pound average weight loss after five years in a group of men and women, much more than the 9.7 to 10.3 pounds lost in the new NEJM study. These findings were replicated in larger demonstration projects as well.

Using state-of-the-art measures, in a series of randomized controlled trials, we found that this low-fat diet (plus moderate exercise and stress management techniques) caused reversal of coronary heart disease after only one month, even more reversal after one year, and still more improvement after five years. We also found that it could stop or even reverse the progression of early prostate cancer. Our latest study, published in the Proceedings of the National Academy of Sciences, showed that these diet and lifestyle changes caused beneficial changes in gene expression in over 500 genes in just three months-"turning on" disease-preventing genes and "turning off" genes that promote heart disease, cancer, and other illnesses. This is why Medicare is now covering intensive lifestyle programs such as the one I recommend.

However, studies of people who go on an Atkins diet showed that their heart disease actually worsens when heart disease was actually measured rather than just risk factors.

In other words, improved health, not just weight, is important.

The current NEJM study statement that the low-carbohydrate Atkins diet has more favorable effects on HDL-cholesterol levels is based on the observation that HDL-cholesterol levels are higher on an Atkins diet than on a low-fat diet. Remember, HDL is just a risk factor for heart disease. We measured the effects of a healthy low-fat diet on actual disease states, not just on risk factors.

As I have written about before, there is tremendous confusion about what HDL does among both health professionals, as well as in the general public. There is often a simplistic view that HDL is good, so that anything that raises HDL is good for you, and anything that lowers it is bad for you. Nothing could be farther from the truth.

Your body makes HDL to remove excessive cholesterol from your blood and tissues, a process known as "reverse cholesterol transport." Think of HDL as the garbage trucks of your body. HDL transports cholesterol back to your liver where it is metabolized and removed from your body. Your body's ability to make more garbage trucks (i.e., raise your HDL) is, in part, genetically determined. Some people can make more garbage trucks than others.

Most Americans eat a diet that's relatively high in saturated fat and cholesterol—i.e., a lot of "garbage." Those people who have a lot of garbage trucks—in other words, who have high HDL levels—are more efficient at getting rid of extra fat and cholesterol in their diet. As a result, they have a lower risk of a heart attack or stroke than those who eat a high-fat, high-cholesterol diet who have lower HDL levels. However, the relationship of HDL to risk of heart disease and stroke assumes that people are not changing their diet.

Not everything that raises HDL is good for you. For example, if you increase the amount of fat and cholesterol in your diet (e.g., an Atkins diet), you may increase your HDL because your body is trying to get rid of the extra "garbage" (fat and cholesterol) by increasing the number of available garbage trucks (HDL) if you are genetically able to do so. Eating a stick of butter will raise HDL in those who are able to do so, but that does not mean that butter is good for your heart. It isn't.

Not everything that lowers HDL is bad for you. If you change from a high-fat, high-cholesterol diet to a healthy low-fat, low-cholesterol diet, your HDL levels may stay the same or even decrease because there is less need for it. When you have less garbage, you need fewer garbage trucks to remove it, so your body may make less HDL. Thus, a reduction in HDL on a low-fat diet is not harmful.

We know this is true because instead of just measuring risk factors like HDL, we measured what actually happens to the progression of coronary heart disease in people who went on diets that were very low in "garbage"—i.e., very low in cholesterol, saturated fat, total fat and refined carbohydrates and high in fruits, vegetables, whole grains, legumes and soy products.

Their HDL levels came down by 9 percent after one year, but their LDL ("bad") cholesterol levels came down even more, by an average of 40 percent. None of these patients was taking cholesterol-lowering drugs. As mentioned above, even though their HDL levels decreased, these patients showed reversal of their heart disease using state-of-the-art measures.

A low HDL in the context of a healthy low-fat diet has a very different prognostic significance than a low HDL in someone eating a high-fat, high-cholesterol diet. People living in countries such as Asia that consume a low-fat diet have low HDL levels yet among the lowest rates of heart disease in the world.

It's time to call a truce in the diet wars. Although many people feel more bewildered than ever when they hear seemingly contradictory advice about different diets, there is actually a convergence of recommendations that is evolving. While some significant differences remain, a greater consensus is emerging among nutrition experts than most people realize.

An optimal diet is one that is low in fat (because fat, whatever the type, has 9 calories per gram versus only 4 calories per gram for protein and carbohydrates). When you eat less fat, you consume fewer calories without having to eat less food, because the food is less dense in calories, as well as low in refined carbohydrates.

Also, an optimal diet is low in refined carbohydrates. When you remove fiber and bran, you turn an unrefined carbohydrate into a refined one. The fiber and bran fill you up before you consume too many calories—you can only eat so many apples without getting full—but you can consume virtually unlimited amounts of refined carbohydrates such as sugar without getting full. And because refined carbohydrates are absorbed quickly, they cause blood glucose levels to spike which, in turn, leads to repeated insulin surges and, over time, may lead to insulin resistance diabetes.

Whole grains are rich in fiber which slows the absorption of food, causing blood glucose levels to be more stable and actually reducing the incidence of diabetes. Unfortunately, many studies of "low-fat diets" are often very high in refined carbohydrates. It's low in trans fatty acids and saturated fats and with enough fish oil to provide the good fats of omega-3 fatty acids.

People have a spectrum of choices. To the degree that you eat a diet higher in fruits, vegetables, whole (unrefined) grains, legumes, soy products, some fatty fish like salmon, low in fat, low in refined carbohydrates and served with love, you're likely to look better, feel better, lose weight and gain health.

Disclaimer: I lecture and write books on the benefits of healthy low-fat diets, including my newest book, "The Spectrum," (Ballantine) but I do not endorse or receive royalties from any products other than books.

URL: http://www.newsweek.com/id/146641

[LessLiz]

Dear ole Dean is another one I'm feeling sorry for. All those researchers out there talking about what a well done study it was....

:D :D :D

[jschwab]

Did the NYT get the obese part wrong, because I haven't read anywhere else that the participants were obese. More likely overweight and maybe members of the Israeli military considering where they were stationed? Not likely to all be obese.

Janine

EDITED: I looked again - BMI had to be at least 27, so not necessarily obese.

[Judynyc]

In addition, in the "Atkins diet" that was tested, "the participants were counseled to choose vegetarian sources of fat and protein and to avoid trans fat." A vegetarian Atkins diet? Most people associate an Atkins diet with bacon, butter and brie, not a plant-based diet like the one I recommend.

Would someone please explain to me the "choose vegetarian sources of fat and protein"????

why would they tell them to do atkins vegetarian? It makes no sense to me at all!!
this has got to be wrong!! IMO, it should say "lean protein" But what do I know. :lol:

[Donna7]

This study will change nothing on its own. It's not the first time a study indicated that low carb was safe and more effective for weight loss than low fat or low calorie.

I'd love to see a steady barrage in the media of "maybe Atkins was right all along" stories. I'd also like to see something that would make the tendency to temper these stories (or in this case, the study itself) with caution about meat and saturated fat. But I suppose we all would.

*sigh* I'm afraid you're right...just reading Taubes and seeing how many other studies have been twisted to report what's PC testifies to that.

I was curious where the 40% figure came from...did you read that somewhere in the study, Regina? I didn't see it, although it sounds reasonable if 35% was fat, leaving 25% for protein. But with 1500-1800 calories, that's still only 150-180g carbs...half the 300-375 recommended in the 2000-2500 calorie American dietary guidelines.

I'd be curious to see what the blood glucose markers looked like in the diabetics at the two month point, after being on induction-levels of carbs for that time frame. Doesn't look like they checked at two months, though...in fact, the only glucose markers I can see quoted in the study are at 24 months. Wish I could see those earlier numbers!

[Wifezilla]

I'm also very skeptical of the quality of data in this study. For example, the investigators reported that those on the "low-fat" diet consumed 200 fewer calories per day—or 10,000 fewer calories per year—than those on the Mediterranean diet, yet people lost more weight on the Mediterranean diet. That's physiologically impossible.

Reason #416 Dean Ornish is a dufus.

Humans do not COMBUST food, they DIGEST IT. A calorie is a unit of energy caused by combustion. Digestion involves a lot more than lighting something on fire and seeing how much heat is given off. It is not only physically possible to lose weight with more calories, it is done every stinking day by low carbers all over the world.

[triplemom]

I saw that report on CNN yesterday. Pretty cool!

[big_loser]

doesnt seem to have made it to the UK yet. i searched bbc for low carb and its bringing up old stories such as 'low carb diet health risk fears' and 'low carb diet cuts heart energy'

tut

[ReginaW]

Did the NYT get the obese part wrong, because I haven't read anywhere else that the participants were obese. More likely overweight and maybe members of the Israeli military considering where they were stationed? Not likely to all be obese.

Janine

EDITED: I looked again - BMI had to be at least 27, so not necessarily obese.

The average BMI was 31 according to the abstract and full-text data.

[susieq0613]

I 'googled' this and found Ornish's response saying the study was flawed. (here is the snot's response)

I'm also very skeptical of the quality of data in this study. For example, the investigators reported that those on the "low-fat" diet consumed 200 fewer calories per day—or 10,000 fewer calories per year—than those on the Mediterranean diet, yet people lost more weight on the Mediterranean diet. That's physiologically impossible.

In addition, in the "Atkins diet" that was tested, "the participants were counseled to choose vegetarian sources of fat and protein and to avoid trans fat." A vegetarian Atkins diet? Most people associate an Atkins diet with bacon, butter and brie, not a plant-based diet like the one I recommend.

Then there's the question of what constitutes a "low-fat" diet. The one used in the NEJM study was not very low in fat. It was based on the American Heart Association (AHA) guidelines, which I have long criticized as not being enough of a change in diet to show much benefit. In earlier studies, as in this one, the AHA diet did not cause much of a reduction in either blood cholesterol levels, weight or blood sugar, so it's not surprising that the new NEJM study reported that the Atkins and Mediterranean diets were more successful at reducing these levels. In the Womens Health Initiative study, the AHA diet didn't do much to prevent heart disease, colon cancer or breast cancer, either.

My colleagues and I at the nonprofit Preventive Medicine Research Institute and the University of California, San Francisco, have studied for more than three decades the effects of diets much lower in fat (10 percent) than the one used in NEJM study as well as lower in refined carbohydrates and higher in fruits, vegetables, whole grains, legumes and soy products.

We reported in a randomized, controlled clinical trial published in the Journal of the American Medical Association a 24-pound weight loss after one year and 13-pound average weight loss after five years in a group of men and women, much more than the 9.7 to 10.3 pounds lost in the new NEJM study. These findings were replicated in larger demonstration projects as well.

Using state-of-the-art measures, in a series of randomized controlled trials, we found that this low-fat diet (plus moderate exercise and stress management techniques) caused reversal of coronary heart disease after only one month, even more reversal after one year, and still more improvement after five years. We also found that it could stop or even reverse the progression of early prostate cancer. Our latest study, published in the Proceedings of the National Academy of Sciences, showed that these diet and lifestyle changes caused beneficial changes in gene expression in over 500 genes in just three months-"turning on" disease-preventing genes and "turning off" genes that promote heart disease, cancer, and other illnesses. This is why Medicare is now covering intensive lifestyle programs such as the one I recommend.

However, studies of people who go on an Atkins diet showed that their heart disease actually worsens when heart disease was actually measured rather than just risk factors.

In other words, improved health, not just weight, is important.

The current NEJM study statement that the low-carbohydrate Atkins diet has more favorable effects on HDL-cholesterol levels is based on the observation that HDL-cholesterol levels are higher on an Atkins diet than on a low-fat diet. Remember, HDL is just a risk factor for heart disease. We measured the effects of a healthy low-fat diet on actual disease states, not just on risk factors. As I have written about before, there is tremendous confusion about what HDL does among both health professionals, as well as in the general public. There is often a simplistic view that HDL is good, so that anything that raises HDL is good for you, and anything that lowers it is bad for you. Nothing could be farther from the truth.

Your body makes HDL to remove excessive cholesterol from your blood and tissues, a process known as "reverse cholesterol transport." Think of HDL as the garbage trucks of your body. HDL transports cholesterol back to your liver where it is metabolized and removed from your body. Your body's ability to make more garbage trucks (i.e., raise your HDL) is, in part, genetically determined. Some people can make more garbage trucks than others.

Most Americans eat a diet that's relatively high in saturated fat and cholesterol—i.e., a lot of "garbage." Those people who have a lot of garbage trucks—in other words, who have high HDL levels—are more efficient at getting rid of extra fat and cholesterol in their diet. As a result, they have a lower risk of a heart attack or stroke than those who eat a high-fat, high-cholesterol diet who have lower HDL levels. However, the relationship of HDL to risk of heart disease and stroke assumes that people are not changing their diet.

Not everything that raises HDL is good for you. For example, if you increase the amount of fat and cholesterol in your diet (e.g., an Atkins diet), you may increase your HDL because your body is trying to get rid of the extra "garbage" (fat and cholesterol) by increasing the number of available garbage trucks (HDL) if you are genetically able to do so. Eating a stick of butter will raise HDL in those who are able to do so, but that does not mean that butter is good for your heart. It isn't.

Not everything that lowers HDL is bad for you. If you change from a high-fat, high-cholesterol diet to a healthy low-fat, low-cholesterol diet, your HDL levels may stay the same or even decrease because there is less need for it. When you have less garbage, you need fewer garbage trucks to remove it, so your body may make less HDL. Thus, a reduction in HDL on a low-fat diet is not harmful. We know this is true because instead of just measuring risk factors like HDL, we measured what actually happens to the progression of coronary heart disease in people who went on diets that were very low in "garbage"—i.e., very low in cholesterol, saturated fat, total fat and refined carbohydrates and high in fruits, vegetables, whole grains, legumes and soy products.

Their HDL levels came down by 9 percent after one year, but their LDL ("bad") cholesterol levels came down even more, by an average of 40 percent. None of these patients was taking cholesterol-lowering drugs. As mentioned above, even though their HDL levels decreased, these patients showed reversal of their heart disease using state-of-the-art measures.

A low HDL in the context of a healthy low-fat diet has a very different prognostic significance than a low HDL in someone eating a high-fat, high-cholesterol diet. People living in countries such as Asia that consume a low-fat diet have low HDL levels yet among the lowest rates of heart disease in the world.

It's time to call a truce in the diet wars. Although many people feel more bewildered than ever when they hear seemingly contradictory advice about different diets, there is actually a convergence of recommendations that is evolving. While some significant differences remain, a greater consensus is emerging among nutrition experts than most people realize.

An optimal diet is one that is low in fat (because fat, whatever the type, has 9 calories per gram versus only 4 calories per gram for protein and carbohydrates). When you eat less fat, you consume fewer calories without having to eat less food, because the food is less dense in calories, as well as low in refined carbohydrates.

Also, an optimal diet is low in refined carbohydrates. When you remove fiber and bran, you turn an unrefined carbohydrate into a refined one. The fiber and bran fill you up before you consume too many calories—you can only eat so many apples without getting full—but you can consume virtually unlimited amounts of refined carbohydrates such as sugar without getting full. And because refined carbohydrates are absorbed quickly, they cause blood glucose levels to spike which, in turn, leads to repeated insulin surges and, over time, may lead to insulin resistance diabetes.

Whole grains are rich in fiber which slows the absorption of food, causing blood glucose levels to be more stable and actually reducing the incidence of diabetes. Unfortunately, many studies of "low-fat diets" are often very high in refined carbohydrates. It's low in trans fatty acids and saturated fats and with enough fish oil to provide the good fats of omega-3 fatty acids.

People have a spectrum of choices. To the degree that you eat a diet higher in fruits, vegetables, whole (unrefined) grains, legumes, soy products, some fatty fish like salmon, low in fat, low in refined carbohydrates and served with love, you're likely to look better, feel better, lose weight and gain health.

Disclaimer: I lecture and write books on the benefits of healthy low-fat diets, including my newest book, "The Spectrum," (Ballantine) but I do not endorse or receive royalties from any products other than books.

so....that's the spiel

Sue

[Judynyc]

Low-carb and Mediterranean diets beat low-fat for weight-loss, lipid changes at two years
http://www.theheart.org/article/882281.do

Beer-Sheva, Israel - Both a low-carbohydrate diet or a Mediterranean-style diet may be "effective alternatives" to a low-fat diet, with more favorable effects on lipids and/or glycemic control, new research suggests [1]. The two-year study, which managed to keep almost 85% of the 322 study participants on one of the three diets for the entire period, offers the hope that weight-loss diets can be tailored to personal preferences, without sacrificing efficacy, researchers say.

"Several recent one-year dietary studies have led the American Diabetes Association to state in January 2008 that low-carb diets should be considered for a maximum of one year," lead author on the study, Dr Iris Shai (Ben Gurion University of the Negev, Beer-Sheva, Israel), told heartwire. "The current two-year study suggests that one low-fat diet doesn't fit all, meaning that the old paradigm should be reconsidered."

Shai and colleagues publish the results of the Dietary Intervention Randomized Controlled Trial (DIRECT) in the July 17, 2008 issue of the New England Journal of Medicine.



Diet options


At the start of the study, DIRECT subjects were middle-aged (mean age 52 years) and mildly obese (body-mass index=31). All participants were randomized to one of three diets: low-fat/restricted-calorie diet; Mediterranean/restricted-calorie diet; or low-carbohydrate diet, with no restriction on calories. After two years, adherence to their respective diets ranged from more than 90% in the low-fat group, to 85% in the Mediterranean diet group, to 78.0% in the low-carb group.

Weight loss occurred in all three groups over the 24 months but was greater in the Mediterranean and low-carb groups. In men—who made up the bulk of the study cohort—weight loss was greatest in the low-carb group, whereas women—just 45 in the study cohort—appeared to lose more weight on the Mediterranean diet. When the analysis was performed just in the 272 "completers" who adhered to the diet for the entire study period, the pattern of weight loss associated with each diet was similar.


Changes in lipid parameters were also most striking in the low-carb and Mediterranean-diet groups. HDL increases and triglyceride decreases were most pronounced in the low-carb group, while reductions in LDL cholesterol were greatest in the Mediterranean-diet group. Reductions in total cholesterol/HDL ratio were greatest in the low-carb group, closely followed by the Mediterranean-diet group.

Lipid changes

Parameter
Low-fat (mg/dL)
Low-carb (mg/dL)
Mediterranean (mg/dL)

HDL
+6.4
+8.4
+6.3

LDL
-0.05
-3.0
-5.6

Triglycerides
-2.8
-23.7
-21.8

Total cholesterol/HDL ratio
-0.6
-1.1
-0.9


In the subset of patients with diabetes—just 36 out of 322 subjects—the Mediterranean diet appeared to improve fasting plasma glucose levels. According to Shai, the results suggest that "one size doesn't fit all."

"The current results suggest that Mediterranean and low-carbohydrate diets are effective alternatives to low-fat diets," she said. "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."



An "optimal" study environment


One of the unique features of the study was its location: the DIRECT study was conducted at a nuclear research center in Israel with an on-site cafeteria and medical clinic. Participants in the trial ate their main meal of the day—lunch—in the workplace cafeteria, where food choices were carefully controlled and labeled. On-site dieticians worked regularly with participants to help them adhere to their diets. Indeed, the Nuclear Research Center Negev itself, along with the Robert C and Veronica Atkins Foundation—the low-carb diet in DIRECT was based on the Atkins diet—helped fund the study.

In the paper, Shai et al acknowledge that the setting was perfectly suited to a study of this kind, but that this doesn't mean these diets would not have worked elsewhere. "We took advantage of the isolated place, which is highly monitored by an excellent internal medical department, and a set of cafeterias [whose menus] we could modify," she told heartwire. And in fact, she said, "we do believe that this optimal model could be applied in other workplaces, once the manager prioritizes this kind of long-term health-promotion project."




Why do they work?
Asked what she thinks is behind the success of the low-carb and Mediterranean diets, Shai said that, at least in the case of the Mediterranean diet, reducing calories may be slightly easier when moderate fat consumption is permitted.

In the case of the low-carb diet, there are a number of possible explanations, she says.

"First, the advantage of this strategy is that the 'enemy'—carbohydrates—is well defined and once learning it, the [dieter] knows what to stay away from, without counting calories," Shai told heartwire. "And after the initiation phase, the dieter has less craving. Second, we assume that a relatively high-protein diet does contribute to higher satiety. Third, the immediate response of the body to weight loss may encourage the dieter."
-SW





Commenting on the study for heartwire, Dr Eric Westman (Duke Clinical Research Institute, Durham, NC), a long-time skeptic of low-fat diets, acknowledged that the low-carb diet craze of the early 21st century has died down, something he can't explain. "There is this study, and there are two additional National Institutes of Health studies in the US that are progressing well, so I don't know what the push-back was. Some have speculated that Dr [Robert C] Atkins dying or the company going bankrupt made the wind change, even though the science has just marched along. It's a mystery to me."

Like Shai, Westman thinks it might be time to "get beyond that old low-fat diet" and that, slowly but surely, this is actually starting to happen.

I'm reading my daughter's high school health textbook, and it's like a religion: 'Everyone should follow a low-fat diet' and 'Saturated fats kill you,' and that's just wrong, plain wrong. "I'm reading my daughter's high school health textbook and it's like a religion: 'Everyone should follow a low-fat diet' and 'Saturated fats kill you,' and that's just wrong, plain wrong," he told heartwire. "There are more people coming out of the closet saying they weren't part of this low-fat diet thing all along, but I guess they felt they couldn't speak up. I think that what we're soon going to find is that nobody's going to be defending the 30% fat, low-fat diet anymore."

Indeed, AHA past-president Dr Robert Eckel (University of Colorado Health Sciences Center, Denver), points out that Shai et al's study used the outdated 2000 AHA guidelines as the template for its low-fat diet.

"The AHA updated its dietary guidelines in 2005, which are quite different from the diet that's quoted here," he told heartwire. "The dietary fat restriction at 30% of calories is no longer part of the AHA guidelines, and the saturated-fat content has been reduced from 10% to 7% and the cholesterol content from 300 to 200 mg/day. I think it's a little bit unfair to kind of generalize that the AHA, number one, stands for a low-fat diet; that's no longer the case. And number two, there is some kind of mysterious benefit of being on the Mediterranean and low-carb diets over time that doesn't necessarily at this point have any explanation."

But Eckel rejects the idea that saturated fats could be embraced by any legitimate weight-loss approach. "Anything that would endorse the Atkins-type of food-intake pattern would not be something that the AHA would back," he said firmly. "Saturated fats raise LDL cholesterol—I don't think many people would disagree with that. . . . At this point limiting saturated fats is still a position the AHA would claim, and I think that's consistent with the National Cholesterol Education Program guidelines, the American Diabetes Association, the US Department of Agriculture. I don't think there is any major professional organization at this point that's willing to throw in the towel on saturated fats and say they are unimportant."

Both Westman and Eckel had some niggling questions about Shai et al's study. Westman pointed out that there were only 10 people in each diet group with diabetes and as such the effects of the Mediterranean diet in this group may have been "overstated." It's likely that both the Mediterranean and low-carb diets are beneficial in diabetics, he says, since both were higher in fat and lower in carbohydrates.

Eckel, for his part, points out that a study cohort that is 86% male is unusual in a diet study, which typically enrolls more women. "How generalizable this study is to women with obesity is not clear to me," he said.

He also pointed to the lack of emphasis on physical activity in the study—something he believes is key to keeping weight off long term.



More tools in the trunk

I don't think there is any major professional organization at this point that's willing to throw in the towel on saturated fats and say they are unimportant. What the authors, as well as Westman and Eckel, agree is on the notion of different options for different people, with different medical concerns. Eckel points to the AHA's "No Fad Diet," which offers three strategies for people to choose from, including a low-carb option. Westman stresses the need for physicians treating overweight and obese patients to stop quibbling over diets. "In the end, all of these lifestyles work," he said. "Low-fat diets work, but the low-carb and Mediterranean diets are stronger, and that's good because we need more tools. All this 'my diet is better than your diet'—we need to get beyond that. What we really want are the metabolic outcomes, and there are many ways to go about it."

Westman also points out that a decades-old bias against the possibility of higher-fat diets having any benefits to them has hampered research. "It's time to study low-fat and high-fat diets with cardiac end points and genetic markers to tailor diets for cardiac risk reduction," he says.

And until that time, Eckel remains unconvinced. "Until we have studies . . . that show me that heart attacks, cancer, or other comorbidities of obesity are reduced in terms of hard end points, I'm not going to be convinced that any diet is better, even though you may be down a few more kilograms on that one diet," Eckel told heartwire. "I'm not denying the success of [Shai et al's] study, I'm just saying that this is more hand-waving with soft outcomes, which really don't get at the question: can people lose weight for five, 10, 15, and 20 years, and what does that do to risk for heart disease, stroke, and mortality?"

[kyrasdad]

Ornish has changed his tune about refined carbs over the years. He used to dismiss it, and I think I read a Time article once where he begrudgingly credited Dr. Atkins for that realization. He is still using science to get the conclusion he wants rather than the other way around, but it's a bit of progress.

People have often said "Atkins works but it's hard to maintain." Ornish wants you to eat less than 10% fat. How hard is THAT to maintain in comparison? Especially if he now preaches reducing simple carbs.

[Wifezilla]

Maybe Jane Brody can have Dr Robert Eckel for some statins and a glass of Zima so they can whine together.

[ReginaW]

Study Fuels Low-Fat vs. Low-Carb Debate

Overweight people on low-carbohydrate and Mediterranean diets lost more weight and got greater cardiovascular benefits than people on a conventional low-fat diet, according to a study that endorses alternative diets published in a major medical journal.

The study, which tracked 322 Israelis for two years, surprisingly found that a low-carb diet, often associated in the U.S. with high levels of meat consumption -- was better than a low-fat diet in boosting blood levels of "good" cholesterol, or high-density lipoproteins associated with cardiovascular health benefits. It also determined that the Mediterranean diet, which includes wine, olive oil, whole grains and fruits, was better than the low-fat diet in controlling glucose levels.

The researchers suggested that doctors and nutritionists could use the findings to tailor diets individually to patients with heart disease or diabetes, stressing that these were alternatives to low-fat diets that many people find hard to follow. The results also indicated that worries that low-carb diets, in particular, might cause health problems, are unfounded.

"A lot of people believe a low-fat diet is the only sanctioned weight-loss diet," said Meir J. Stampfer, an epidemiology and nutrition professor at the Harvard School of Public Health who was senior author of the report, published in Thursday's edition of the New England Journal of Medicine. The study found that "there are alternatives that work better."

The study's leader, Iris Shai of Ben-Gurion University of the Negev, said, "We believe that this study will open clinical medicine to considering low-carb and Mediterranean diets as safe, effective alternatives for patients."

The study was funded with a $497,000 grant from the Jenkintown, Pa., nutritional-research foundation established by Robert Atkins, the late diet guru whose Atkins diet is controversial because it allows dieters to consume large amounts of meat and cheese, while eliminating bread and pasta. The foundation said it didn't influence the findings, and the study's authors said they didn't have any financial conflicts under the New England Journal guidelines.

Dean Ornish, a doctor and University of California at San Francisco professor who advocates extremely low-fat diets, said the Israel study shouldn't be seen as endorsement of the Atkins diet because the low-carb participants in the study were encouraged to consume vegetable fats, as opposed to the meat fats that Atkins dieters typically ingest. "A vegetarian Atkins diet is almost an oxymoron," he said. He also said the low-fat diet in the study, which was based on recommendations by the American Heart Association, doesn't cut out enough fat.

Low-carb diet advocates said they weren't surprised by the results, which they said confirm shorter, smaller, studies done over the past 20 years. Last March, Stanford University researchers reported in the Journal of the American Medical Association that over the course of a year, overweight women assigned to follow the Atkins diet lost an average of 10 pounds, exceeding losses recorded by women on other diets in the study. However, the study was criticized because many of the women didn't stick with diet guidelines and because they were paid to participate.

Stephen Phinney, professor emeritus of nutrition at University of California at Davis who has researched high-protein, low-carb diets for more than 25 years, said that with publication in the New England Journal -- which he called "the keeper of the consensus in medicine" -- he expects that "what was considered unacceptable, becomes mainstream thought."

Jimmy Moore, a 36-year-old from Spartanburg, S.C., who operates a dieter's Web site, says he lost 180 lbs. after going on the Atkins diet four years ago. He said he did it even though his doctor "thought I was nuts." He says his doctor was impressed with his diet success, and publication of the study may convince him to recommend the diet to other overweight patients.

In the Israel study, after two years, those in the group assigned to the low-carb diet lost an average of 10.3 lbs. -- 58% more than the 6.5 lbs. lost by dieters who followed the low-fat diet based on the Heart Association recommendations. Those on the Mediterranean diet, which includes lots of carbohydrates like pasta and more calories from fat in the form of olive oil than the Heart Association recommends, lost 10 lbs., nearly as much as the low-carb diet.

Excluding drop-outs, the average weight loss was 12.3 lbs. for the low-carb dieters, 10.2 lbs. for the Mediterranean dieters and 7.3 lbs. for the low-fat dieters. The subjects started out with an average body-mass index of 31, well above the top level of 24.9 considered normal weight. About 85% of those in the study were men.

The study was conducted among a group of workers at Israel's Nuclear Research Center in Dimona. Aided by support from the center, including color-coded menu information in the company cafeteria, 95% of the employees stuck with their diets for a full year and 85% were still involved at the end of the two-year study. Dr. Shai, the lead researcher, said that the "support in the workplace," helped people stay on the diets, even after weight loss plateaued at the six-month mark. She said the success suggests that workplace support for diet programs could help employers improve employee health.

The low-carb diet was also found to reduce harmful triglycerides, a precursor of heart disease, more than the low-fat diet. Levels of "bad" cholesterol, or low-density lipoprotein, which is associated with the formation of arterial blockages, didn't significantly differ among the three diets.

Low-carb diets permit people to freely eat cheese, meats and animal fats that are discouraged in traditional diets, although in the Israel study, employees were counseled to emphasize vegetable fats. The low-carb dieters weren't given any restrictions on the number of calories they could consume, although they ended up eating about the same number of calories as the other two groups, indicating that they were satiated by their fat consumption. After an initial two-month period with just 20 grams a day of carbohydrates, they were allowed to consume up to 120 grams a day, well above the Atkins-recommended levels.

The low-fat and Mediterranean dieters were restricted to 1,800 calories a day for men and 1,500 for women. The Mediterranean dieters were urged to eat poultry and fish instead of beef and lamb, and they ate a handful of tree nuts and about five tablespoons of olive oil a day, so they got 35% of calories from fat. The low-fat dieters got just 30% of calories from fat.

Dr. Shai, the study leader, said she conceived the study when she was at Harvard School of Public Health in Boston on a Fulbright scholarship. "Before I came, I had the understanding that a low-fat diet was the best. But after I came, I started to think maybe we are wrong." Dr. Shai, 39 years old, said she thought the Israel nuclear research center would be a good place to run a study because it is isolated and people seldom leave. In addition, people were all on a private computer network, making it easy to monitor employee compliance by administering electronic questionnaires. But she says, "The main effects could be achieved in any workplace."

Barbara Howard, former chairwoman of the American Heart Association's Council on Nutrition, said that the group hasn't advocated a low-fat diet in recent years. She said reducing total calories and exercise are the key to weight loss. The group also urges people to avoid saturated fats and limit "calorie dense foods" such as fats and "highly processed carbs like pastries."

http://online.wsj.com/article/SB121624140800859549.html?mod=googlenews_wsj

[LessLiz]

But Eckel rejects the idea that saturated fats could be embraced by any legitimate weight-loss approach. "Anything that would endorse the Atkins-type of food-intake pattern would not be something that the AHA would back," he said firmly. "Saturated fats raise LDL cholesterol—I don't think many people would disagree with that. . . . At this point limiting saturated fats is still a position the AHA would claim, and I think that's consistent with the National Cholesterol Education Program guidelines, the American Diabetes Association, the US Department of Agriculture. I don't think there is any major professional organization at this point that's willing to throw in the towel on saturated fats and say they are unimportant."I agree that the sheep are not going to throw in the towel on saturated fat. But if this idiot thinks everyone agrees with his statements then he should pull his head out of his ass, get a whiff of fresh air, and read some of the excellent research done by people other than his friends.

[susieq0613]

And another view....which I have been also wondering if I should go buy some beef that is grass fed and stock my freezer.

[I]* A Radical New Vision of Nutrition *

Dr. Robert Atkins died this spring from an accidental fall, but not before he changed the world of nutrition. His radical low-carb diet dared to confront conventional nutrition. His ensuing persecution exposed the medical profession's close-minded intolerance of new ideas. Now after his death, independent and accredited research has finally proved what Atkins knew for nearly his entire life.

What did Dr. Atkins say that was so different? Since the 1960's, he has been making two very contrarian claims.

? One, Americans are fat not because they eat too much fat and calories but because they eat too much carbohydrate.

? Two, the best way to lose weight was not a low fat diet but a low carb diet.

Nutritionists have always presumed that weight equaled calories consumed minus calories burned and the type of calories didn't really matter. Nutritionists still have trouble accepting Atkins' theory but new research has prompted even the staunchest critics to take notice. Here are some examples of evidence supporting Atkins' theory.

• February 2003: A landmark study that compared the American Heart Association's low fat diet to the Atkins' diet. The Atkins' diet caused greater weight loss and lowered cholesterol and triglycerides much more effectively than a low fat diet of equal calories.

• In May 2003: The prestigious New England Journal of Medicine published a study that found the Atkins approach beat out the American Heart Association's low fat approach for both weight loss and blood fats improvement.

• Nutrition Week 2003: National meetings recently reported preliminary results of a study performed by Heritage Medical Center on patients with Metabolic Syndrome. Participants ate a low-carb diet for 18 months. Their LDL (“bad” cholesterol) reduced by an average of 82%. HDL (“good” cholesterol) scores increased by an average of 30%.

Atkins was right about the problem. Excess starches like potatoes and breads made Americans fat – not too much dietary fat. But, here's where we part: I do not agree with his dietary solution.

It is true that fat is relatively inert at affecting the hormonal control of your metabolism. But I do not recommend you eat sausage, hot dogs, and spareribs for weight loss. Here's why:

The unnatural living conditions of animals in the modern food industry. This produces diseased animal fat. Modern farming techniques prevent the animals from getting normal exercise and feed a diet of grains instead of grasses. This makes for an obese animal. Not only do these products of the modern slaughterhouse have inordinate quantities of fat but it is the wrong kind of fat. It has an unnatural and unhealthy concentration of omega-6 fatty acids that cause heart disease. Additionally, all of the herbicides, pesticides, toxins and hormones that the animal has been exposed to collect in the fat.

Beyond Atkins

Manipulating macronutrients (protein, fat and carbohydrates) did not make Dr. Atkins a quack as conventional medicine insisted for decades. In fact, it is a sophisticated approach. The right balance of increased protein, decreased carbohydrate with the right healthy fats can effectively control aspects of your metabolism and weight. You can improve your energy and strength at the same time you lose body fat. It is also much easier to follow than the AHA's low-fat approach. Here are the easy rules for your new approach:

1. Eat excess protein. Quality protein is the key to good nutrition. Protein promotes muscle growth and over all health. Eating more protein than you need for daily metabolism signals to your body that “the hunting is good” and liberalizes the burning of carbs and fat for energy. Fish, lean meats, eggs, dairy, beans and nuts are all good sources of protein. Eat as much of them as you like.

2. Limit processed carbs. Processed carbs make you fat and diseased. Starches in particular are the main cause of the American obesity epidemic. Limit consumption of anything made from grains or potatoes. Get your carbs from unprocessed vegetables that grow above ground.

3. Eat natural fats. Fat is neutral as a macronutrient but most modern fat is a health nightmare. Eat unprocessed vegetable fats like avocados, nuts and virgin olive oil. Avoid corn oil, all hydrogenated oils and margarine. Get your animal fat from wild fish, free range or grass fed animals. Read Health Alert 49 for some more tips on finding quality natural meat.

Al Sears MD

[ReginaW]

I was curious where the 40% figure came from...did you read that somewhere in the study, Regina? I didn't see it, although it sounds reasonable if 35% was fat, leaving 25% for protein. But with 1500-1800 calories, that's still only 150-180g carbs...half the 300-375 recommended in the 2000-2500 calorie American dietary guidelines.

The data tables are in the free full-text of the paper....

http://content.nejm.org/cgi/content/full/359/3/229?query=TOC

In this table: http://content.nejm.org/cgi/content-nw/full/359/3/229/T2

Low-carb Groups Carb intake at:

6-months = 41.4% of calories
12-months = 41.6% of calories
24-months = 40.4% of calories

Let's see if me trying to drop the graphic works:

http://content.nejm.org/content/vol359/issue3/images/medium/04t2.gif

[Wifezilla]

Saturated fats raise LDL cholesterol—I don't think many people would disagree with that

Not many...just the smart ones! LOL

[mike_d]

ABC has put some spin on this already saying the Mediterranean is the winner and hardly mentioning Atkins at all except to mention its impossible to stick to.Researchers at Brigham and Women's Hospital in Boston, Mass., found in a study of 322 obese subjects that the so-called Mediterranean diet — a diet plan characterized by high levels of healthy fats, fruits, and vegetables — beat out the low-fat diet both in terms of how much weight patients lost, as well as how many health benefits they gained as a result of the diet... "The Mediterranean diet is the one I find patients are most likely to maintain long-term compliance with," Shekelle said, adding that the low-carb, high-protein [?] diet commonly known as the "Atkins" diet is the one that dieters have the hardest time sticking to. I've not seen anyone in my practice who is still on the [Atkins] diet two years later. Compliance past a few months is the number one problem with the Atkins diet."http://abcnews.go.com/Health/Diet/story?id=5389423&page=1

I wish the study had not muddled the waters with the "Mediterranean Diet" and at lest should have done the respective diets correctly by the book.

[Wifezilla]

I've not seen anyone in my practice who is still on the [Atkins] diet two years later

When your head is up your butt, it is hard to see the long term low carbers because of the obstructed view.

[LessLiz]

And the watering eyes from the smell...

[LC FP]

Thanks R