http://fanaticcook.blogspot.com/200...s-are-hard.html

Thursday, March 15, 2007
Diets Are Hard
Dr. Christopher Gardner is one busy researcher.

Remember my post last week about the garlic study? The one that received lots of media attention for its failure to show garlic useful in reducing cholesterol? (And as a result had a lot of statin makers snickering and high-five-ing?) The one that I flogged for using a prepared garlic mash that had been previously frozen and thawed then insinuating it could adequately substitute for fresh? (In fairness, the study would have been difficult to conduct and control without some sort of monitored dosing.)

Well, The lead author on the garlic study was Dr. Christopher D. Gardner of Stanford University. And the lead author on the study below, published a week later, this time in JAMA (March 6th issue) is none other than Dr. Christopher D. Gardner of Stanford University:

Comparison of the Atkins, Zone, Ornish, and LEARN Diets for Change in Weight and Related Risk Factors Among Overweight Premenopausal Women

________

So here we have it. A straight-up comparison of 4 of the most popular diets, representing a spectrum of carbohydrate intake.

The study lasted for a year and was conducted as sanely and scientifically as any good study would be - using hundreds of women, hours of classroom instruction, books, handouts, incentive emails and phone calls, regular blood collections, regular dietary intakes ... incentive payments! I should note that participants were recruited from the local community (near Stanford, one of the richest areas in the country) and had an average education level beyond 4 years of college. Apart from locking these women up and rationing their food, this protocol, using this group of well-educated, motivated, financially- and socially-supported women, should have spelled dietary success. (If you're reading this Mr. Gardner, I applaud your hard work.)

Here are these women's weight losses:




The average weight loss across diets was 6 lbs, in one year. Raise your hand if you think losing 1/2 pound per month spells weight loss success.1 The women selected for this study were required to be overweight or obese at baseline. So, we're not talking 6 lbs from an already-whittled frame.

Also, note that after 6 months, all groups started to regain weight lost. It would be interesting to see what their weights were a year after the study (and all those incentives) ended.

The Winner?

It looks like Atkins edged out the other 3 diets when it came to weight loss. Atkins' women lost an average of 10 lbs in 12 months, compared to a combined average of 5 lbs for the other 3 groups. I would call that only winning by a nose, especially after a year of dieting. But a nose is a nose. And had women in the Atkins group actually been eating the Atkins diet, that nose might have been a full head length (or a few more inches of midsection).

What Were Participants Actually Eating?

The following is for those of you who share my giddiness over details. I created these charts from data in the study, a chart for each macronutrient: carbohydrate, protein, and fat. Diets often differ by macronutrient content. Gardner, et al., selected these diets based on their range of carbohydrates, from Atkins (low) to Ornish (high).2

Before you run out to purchase Dr. Atkins New Diet Revolution and start restricting your carbohydrates to less than 10% of calories, take a look at what these women were actually eating at 12 months (even with all that diet instruction and prodding) compared to what they were instructed to eat (their goal) in each diet category. It may be, as Gardner concluded, that for those who "initiate a low-carbohydrate diet ... weight loss is likely to be at least as large for any dietary pattern."




There are a number of things I could say about these. I'll leave it to you to notice some stand outs. Just two things ... Atkins is not so much a high-protein diet as it is a high-fat diet. And even with all that fat, participants still lost weight and their lipids were better (more about that in a follow-up post.)

Also, notice how all the diets' carbohydrate, protein, and fat contents converged or sought a middle ground over time. If the diet's prescription was too extreme (e.g. very low fat: Ornish, or very low carb: Atkins), participants soon adjusted that to a middle ground. It's as if we naturally crave a certain proportion of carbohydrate, protein, and fat. Or at least that's what's easy, available, and tastes good.

One last thing, regardless of macronutrient content, all of the women had reduced their calorie intake by about 300 calories/day (at 12 months).

Thanks for sharing this Samuel. I hadn't seen the macronutrient breakdown, so this is quite interesting.

Over time, I believe the majority of dieters go back to their routine eating patterns with just a slight change for whatever macronutrient they think is causing the problem. So, at the end of one year, the Ornish dieters continued to cut back on their fats, but weren't low fat... The Atkins dieters continued to cut back on their carbs, but weren't low carb. In other words, they took the principle and applied it a little bit.

Personally, I think it's really hard to follow any diet for a long period of time. I know there are folks here on the forum who would disagree, especially with being able to stick with the lc lifestyle. Those of us who stick with it are plugged in here and get tons of support with this way of living. But for the majority of the population, who aren't plugged into support forums, etc, it's just hard to keep up with dieting. And it is so easy to just go back to the old way of eating.
I wonder then if a diet designed to target that middle ground might be a bit easier for people to follow.

Probably not, since glucose has an addictive quality. So it would be sort of like getting a chain smoker to just have one cigarette a day. It might work for a month or so but I would bet that within a year they would be back to chain smoking again.

Over and over again I have read posts by people saying that they cannot have anything high in sugars or they will binge. So for them, they MUST stay low-carb and have only certian vegies (low starch) as a source of carbs.

Well, that's basically what the Zone is, right? Unfortunately, "easy to follow" is not necessarily the same as "easy to lose weight on" -- and in fact, the Zone dieters lost less than the others at each time check.

The single most appealing feature of Atkins for me is how pleasant, convenient, and simple it is to sustain as a lifestyle. I've been an Atkid for four years. The longer I persist, the more dedicated I become to the principles and practices of low-carb. The best advice I ever heard along the way is: Stop thinking of it as a "diet," and simply adopt it as your normal way of life.

I'm convinced that it's possible to live happily ever after without sugar, white flour products, and starchy vegetables. Exceptions upon occasion can be made. The fact is, I don't thrive on the "normal" American diet of bread, fried foods, pizza, pasta, and Twinkies. So I've embraced a new "normal" that seems to be doing good things for my body, inside and out.

Not everyone wants to accept this enormous change of behavior. Too bad.

Wow, you might as well add a "So there! Ha!" to that.

So there! Ha!

When I first went to my GP to talk to her about having WLS, I mentioned that I'd spent a year on low carb (she knew, because I'd talked to her about it previously), and that I'd only lost a whopping 21 pounds. And, believe me, I was following it almost religiously, not just halfway, not allowing myself weekly "cheats", etc. I started gaining it back at 10 months for no obvious reason - no changes in diet, was up to 3 miles a day on the treadmill, doing crunches, etc. She said, "That's the thing about low carb, it does that to a lot of people". So it's not for everyone, and it doesn't work for everyone.

I found that, too! We have been assiduously living low-carb for three years, but I am right back where I was when I started (weight-wise). But my cholesterol is in excellent shape, and I like the other lifestyle changes that low carbing has wrought.
But it's not perfect for everyone.

There is certainly no guarantee of getting down to a "goal weight" by eating low carb. Most people will lose some weight, maybe even a significant amount, but only a small portion get to an ideal weight simply by changing to a low carb lifestyle.

So true! There's no such thing as a one-size-fits-all eating plan. Over on the South Beach board, we have a few members who stopped losing on Atkins and only started losing again when they made the switch to the higher carb levels and lower fat of South Beach. I'm sure there are members on the Atkins board that have experienced the opposite.

The key is listening to your body, and finding out what works the best for you. For example, even though I'm "allowed" to eat whole grains on South Beach phase II, I've personally found that they cause me to stall in my weight loss, so I get my phase II carbs from berries and starchy vegetables. I tweak the plan as I go along depending on how my body responds.

Since most diet books are most successfully marketed as "weight loss" schemes, it stands to reason that there's not a lot of easy reading on the subject of maintenance.

My guess is, most healthy diets wind up in about the same place. Moderate to low carbohydrates (emphasis on vegetables), medium protein, and moderate fats. Duh. How you get there as a lifestyle is an important personal choice.

In any case, there's no such thing as a "normal" American diet of pizza, Mickey D's, mac-and-cheese, and Twinkies that will support health and weight management. We're all trying to get cured of that.

I'm done being a yo-yo.

I just keep seeing the name of this thread, and thinking of that Barbie doll that said "Math is hard!"