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  #1   ^
Old Tue, Feb-20-18, 17:53
JEY100's Avatar
JEY100 JEY100 is offline
To Good Health!
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Plan: IF Fung/LC Westman/Primal
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Default Counting Calories is Not the Key to Weight Loss

Fascinating new study results by Christopher Gardner.

https://www.nytimes.com/2018/02/20/...rb-low-fat.html

Quote:
Anyone who has ever been on a diet knows that the standard prescription for weight loss is to reduce the amount of calories you consume. But a new study, published Tuesday in JAMA, may turn that advice on its head. It found that people who cut back on added sugar, refined grains and highly processed foods while concentrating on eating plenty of vegetables and whole foods — without worrying about counting calories or limiting portion sizes — lost significant amounts of weight over the course of a year.

The strategy worked for people whether they followed diets that were mostly low in fat or mostly low in carbohydrates. And their success did not appear to be influenced by their genetics or their insulin-response to carbohydrates, a finding that casts doubt on the increasingly popular idea that different diets should be recommended to people based on their DNA makeup or on their tolerance for carbs or fat. The research lends strong support to the notion that diet quality, not quantity, is what helps people lose and manage their weight most easily in the long run. It also suggests that health authorities should shift away from telling the public to obsess over calories and instead encourage Americans to avoid processed foods that are made with refined starches and added sugar, like bagels, white bread, refined flour and sugary snacks and beverages, said Dr. Dariush Mozaffarian, a cardiologist and dean of the Friedman School of Nutrition Science and Policy at Tufts University. “This is the road map to reducing the obesity epidemic in the United States,” said Dr. Mozaffarian, who was not involved in the new study. “It’s time for U.S. and other national policies to stop focusing on calories and calorie counting.”

The new research was published in JAMA and led by Christopher D. Gardner, the director of nutrition studies at the Stanford Prevention Research Center. It was a large and expensive trial, carried out on more than 600 people with $8 million in funding from the National Institutes of Health, the Nutrition Science Initiative and other groups. Dr. Gardner and his colleagues designed the study to compare how overweight and obese people would fare on low-carbohydrate and low-fat diets. But they also wanted to test the hypothesis — suggested by previous studies — that some people are predisposed to do better on one diet over the other depending on their genetics and their ability to metabolize carbs and fat. A growing number of services have capitalized on this idea by offering people personalized nutrition advice tailored to their genotypes.

The researchers recruited adults from the Bay Area and split them into two diet groups, which were called “healthy” low carb and “healthy” low fat. Members of both groups attended classes with dietitians where they were trained to eat nutrient-dense, minimally processed whole foods, cooked at home whenever possible. Soft drinks, fruit juice, muffins, white rice and white bread are technically low in fat, for example, but the low-fat group was told to avoid those things and eat foods like brown rice, barley, steel-cut oats, lentils, lean meats, low-fat dairy products, quinoa, fresh fruit and legumes. The low-carb group was trained to choose nutritious foods like olive oil, salmon, avocados, hard cheeses, vegetables, nut butters, nuts and seeds, and grass-fed and pasture-raised animal foods. .....continues. ...
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  #2   ^
Old Tue, Feb-20-18, 21:39
M Levac M Levac is offline
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Plan: VLC, mostly meat
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I like Chris, he's one of the very few serious nutrition scientists.
Quote:
In the HLF vs HLC diets, respectively, the mean 12-month macronutrient distributions were 48% vs 30% for carbohydrates, 29% vs 45% for fat, and 21% vs 23% for protein. Weight change at 12 months was −5.3 kg for the HLF diet vs −6.0 kg for the HLC diet (mean between-group difference, 0.7 kg [95% CI, −0.2 to 1.6 kg]).

Quoted from the abstract. I see a tendency here, a significant tendency that replicates pretty much all other diet experiments. The more fat, the better the results. The less carbs, the better the results. And, protein is inconsequential because it's very hard to go very high or very low, which would be needed to produce any actual significant difference.

(In further reading the full paper, there's a problem with the idea of more fat. The HLC group actually ate less fat too. Without knowing any more about the type of fat they ate (which is arguably pertinent for various reasons), I'm left with the idea of less carbs. The HLC group cut their carb intake by half. This makes the "non-significant" results even more puzzling to me.)

See, Chris concludes there's no significant difference in the results, but outside the context of the equally weak intervention difference. Once we consider the weak intervention difference, results become more significant. Of note, the tendency I mentioned was not reversed. If it had, I'd wonder how that's even possible.

One thing just struck me. If we accept Chris' conclusion of "no significant difference". It does not mirror Chris' own A-TO-Z experiment in terms of intervention-results correlation. Tendency is still there, but somehow made either weaker for the HLC group, or stronger for the HLF group, or both. In the A-TO-Z experiment, there is a clear difference in power of intervention when considering amplitude of results. Atkins was best - more powerful - simple as that. But here, if we equate HLC to Atkins, it's no longer best, it's merely equivalent.

Both groups were not advised to eat less total food, except specifically for eating less fat or eating less carbs. There was no intentional total calorie restriction. This could be a pertinent finding so that regardless of which diet we choose for weight loss, eating to satiety somehow has an effect of its own. It makes a certain sense if we consider the Minnesota semi-starvation experiment, where subjects went crazy with hunger. If this effect is true, that alone contradicts official guidelines regarding weight loss.

All in all, this latest from Chris is weaker and less reliable than the A-TO-Z experiment. In a way it makes sense. I had the impression that the idea of genotype/insulin-sensitivity was a result of the A-TO-Z results in that regard. That experiment was more powerful, more reliable, less ambiguous. This means to me that the DIETFITS experiment can't confirm nor refute this idea simply because it's too weak to do so. I feel like Chris tried to reinvent the wheel, when it looks like he just figured out how to lose a wheel. Atkins got it right the first time, stick to what works, Chris.

Here's a thought. The idea of genotype/insulin-sensitivy is that it's all about our genes, and the effect of diet on those genes. Well, if the idea includes the concept of an effect from diet, this is an environmental factor, so it invariably includes the concept of other environmental factors as well. As Taubes said, carbs is the primary cause, not the only cause. If carbs have the ability to affect genes, then other environmental factors have it too, to make carbs (or other macros or whatever) appear more or less powerful. This means that for an experiment to expose this other factor, carbs must be removed, not just cut by half. In my opinion, it explains why DIETFITS can't show what's going on with genotype/insulin-sensitivity.

Last edited by M Levac : Tue, Feb-20-18 at 21:45.
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  #3   ^
Old Wed, Feb-21-18, 04:18
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JEY100 JEY100 is offline
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Plan: IF Fung/LC Westman/Primal
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Two Gary Taubes comments via Twitter on this study:

"Indeed. The only thing not said is that calories restricted in both groups are the most fattening carbs. Both groups are carb-restricted, but one also restricts fat.
Counting Calories Is Not the Key to Weight Loss, New Study Finds"


"The debate used to be whether low-carb diets were deadly. Now it's whether low-fat diets are as good as low carb (at least, when both are restricted in sugar and high GI grains). That's progress."

A typical LFHC dieter would include fruit juice, LF muffins, white rice (at least I did) so both diets restricted carbs, or the worse of the high GI carbs.

Long article evaluating this study on DietDoctor, links to the study, Mail Online and The Telegraph articles also.

https://www.dietdoctor.com/new-stud...ior-weight-loss


From MedPage: "We made sure to tell everybody, regardless of which diet they were on, to go to the farmer's market, and don't buy processed convenience food ... Also, we advised them to diet in a way that didn't make them feel hungry or deprived -- otherwise it's hard to maintain the diet in the long run," said Gardner in a statement. "We wanted them to choose a low-fat or low-carb diet plan that they could potentially follow forever, rather than a diet they would drop when the study ended."

And

"Both diets also showed improvements in markers for body mass index, body fat percentage, waist circumference, lipids, blood pressure, and insulin and glucose levels after 12 months. However, the HLC diet showed significant improvements in HDL cholesterol and triglycerides compared with the HLF group."

Last edited by JEY100 : Wed, Feb-21-18 at 05:58.
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  #4   ^
Old Wed, Feb-21-18, 06:49
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teaser teaser is offline
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Plan: mostly milkfat
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In A to Z, there was a strong correlation of dietary adherence to weight loss. This of course throws up the hard to answer question of support and education, is a diet inherently easier to follow, or are the people teaching/supporting the dieters more effective at supporting one diet than the other? It seems to me that providing people support for something they genuinely want to do might be easier.

What does "healthy low carb" mean? Less bacon? Avocado instead of butter? What the researchers look at as healthy low carb is probably a bit different from what I'd consider healthy low carb. I don't want to jump to any conclusions here--but Gardner makes the claim that quality trumps calorie control, well, maybe. But which qualities? Did a low fat diet and a low carb diet work because the food was of higher quality--less refined this and that? Was there a control "less healthful" high carb group and a control "less healthful" low carb group? I know stressing "higher quality" low carb foods like nuts does not give me optimal weight loss, and that's a fairly common observation. Trading donuts for nuts or peanuts, I'd probably lose weight, but adding them to Atkins Induction makes it less effective. And if both groups were given "high quality" food advice, what have you controlled for? Everybody ate their veggies. I'm all for that. You haven't shown that a "low quality" low carb diet would have been less effective.

The idea that if a low carb diet works, and a low fat diet works, then it isn't fat or carbohydrate restriction that's working, is a false one, there's another possibility that a low fat diet works because it's low fat, and a low carb diet works because it's low carb.
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  #5   ^
Old Wed, Feb-21-18, 07:02
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bkloots bkloots is offline
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Plan: Atkins/LCHF
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Thanks, all, for discussion of an article I don't intend to read. May I comment anyway??

My lifelong goal as a "weight watcher" (and I've done all the diets!) has been not to count anything. Following LC guidelines as basic as "no sugar, no starch" is what it comes down to for me. In addition, I have to kick my own butt regularly about alcohol consumption. I've totally rejected fast food and processed food for decades, and I think that's a pretty good start for most people.

Finally, there's self-acceptance. I often wonder if these studies incorporate the experiences of "never fat" (or temporarily fat) persons compared to "always fat" persons--as in childhood obesity--or weight gain during early adulthood that arrives at a kind of stable obesity. The "yo-yo" experience is a universal challenge. Anyone--any diet--can produce weight loss. Maintenance? Not so clear.

Another issue I seldom see in a study is the location of body fat. Upper body--back and chest? Internal abdominal? Stomach and belly? Lower body--butt and thighs? Fat accumulation patterns do not change. Do different diets produce anything other than total fat reduction? What does that tell us about the persistence of fat cells and their relation to individual health?

I've gone way beyond the study at hand. But these are things I think about as I continue to wrestle in my 55 years of weight management. Maintenance is very, very hard, because the body has ideas of its own. No study can address all the variables.
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  #6   ^
Old Wed, Feb-21-18, 07:09
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teaser teaser is offline
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Plan: mostly milkfat
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Quote:
Soft drinks, fruit juice, muffins, white rice and white bread are technically low in fat, for example, but the low-fat group was told to avoid those things and eat foods like brown rice, barley, steel-cut oats, lentils, lean meats, low-fat dairy products, quinoa, fresh fruit and legumes. The low-carb group was trained to choose nutritious foods like olive oil, salmon, avocados, hard cheeses, vegetables, nut butters, nuts and seeds, and grass-fed and pasture-raised animal foods.


Look at the low fat intervention. For a lot of people, their grocery bill will have gone down. Low carb? Salmon, grass-fed and pasture-raised animal foods? They've been told to eat low carb, and then told to eat the most expensive versions of low carb food they can get their hands on. Have you seen the price of nut butters lately? I guess there's always peanut butter, that's always been especially problematic for me.
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  #7   ^
Old Wed, Feb-21-18, 11:24
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Dodger Dodger is offline
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Plan: Paleoish
Stats: 225/175/175 Male 71.5 inches
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I don't consider 30% carbs as low-carb, just lower-carb. I'm sure that those who support low-fat eating will say that 29% fat is not low-fat.
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  #8   ^
Old Wed, Feb-21-18, 12:26
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khrussva khrussva is offline
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Plan: My own - < 30 net carbs
Stats: 440/205/210 Male 5' 11"
BF:Energy Unleashed
Progress: 102%
Location: Central Virginia - USA
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One issue that I have with group studies is that they typically don't properly account for the outliers. In some cases the outliers are tossed out and in other cases the outlier data is just averaged into the mix. The results of a good study may be meaningful for the overall population; the average Joe. But how far is each of us as individuals from the overall "average" of all individuals? I think that it makes a lot of difference where you fall. Me? I'd be an outlier on either one of those diet plans. My data would have been tossed out for non-adherence or tossed into the average data with my weight gain having a negative impact on the overall numbers. Of that I'm fairly certain.

I have no doubt that eating more healthy whole food as well as less sugar and refined carbs would result in many people losing weight. I saw that in my own family. My change in diet had a significant impact on the quality of food in our household. Two members of my family lost weight without even trying to be on the diet. Eating better quality food, much less processed food & sugar, less dining out, etc. was enough. But if free to choose among all the food options in my household at the time, without tracking I'm not sure that I would have lost much if any weight. I would have had trouble with compliance, too. I was extremely metabolically unhealthy and I had serious issues with carb addiction and binging. Even healthy food would have set off those counterproductive behaviors.

They did mention non-compliance in that DD story. But why stop there? Why was there non-compliance? Gluttony and sloth? Weak will? Maybe. Or perhaps neither diet option as put forth was appropriate for the special needs of the non-compliant participants.

I wonder how much the non-compliant individuals affected the results of this study. Would compliance with the low carb diet have been better if at least counting carbs and keeping it "keto" had been added to the parameters?

Last edited by khrussva : Wed, Feb-21-18 at 12:38.
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  #9   ^
Old Wed, Feb-21-18, 23:15
M Levac M Levac is offline
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Plan: VLC, mostly meat
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Quote:
Originally Posted by Dodger
I don't consider 30% carbs as low-carb, just lower-carb. I'm sure that those who support low-fat eating will say that 29% fat is not low-fat.

Exactly what I think too. I remember Ornish had the same complaint about the A-TO-Z experiment. Well, the Atkins group also didn't eat exactly like the book said. In spite of that, Atkins was best. So basically, it could be why this latest experiment doesn't declare LC the winnar, but I think there's something else involved here, like Teaser cited about the cost of the foods advised to eat for example. Atkins didn't do any of that. I could conclude that whatever Chris considers "healthy" low-carb, is less effective in fact, which puts doubt on the claim that it is in any way "healthy". It's as if Chris tried to stitch in his own beliefs about a proper diet (he's a self-acknowledged vegetarian) into an otherwise proper low-carb diet. And if this is true, then it confirms the idea that it's less effective (actually the idea is that it's harder, but it amounts to the same in the end) to do low-carb the vegetarian way. Or if we prefer, Atkins beats a Mediterranean diet (whatever that is).

In a sort of irony. It seems Chris actually learned something about low-carb with his A-TO-Z experiment, then applied this new knowledge to his own beliefs, i.e. eat less carbs or at least less refined carbs. And it seems to work pretty well since the HLF group did a bit better than in the previous experiment. On the other hand, he seems to have forgot why exactly low-carb works so well, since this time the HLC group did less well than it did before.

Last edited by M Levac : Wed, Feb-21-18 at 23:21.
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  #10   ^
Old Thu, Feb-22-18, 07:31
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GRB5111 GRB5111 is offline
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Plan: Ketogenic (LCHFKD)
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Agendas and those who have a horse in the race distort what otherwise could be an educational dialog with recognition about how to refine the RCTs that are needed to provide real knowledge about nutrition. I don't for a minute doubt that some can be successful with more than one approach to a WOE. Some, who have experienced damage over the years, may be best suited for a stricter approach and need to follow LCHF or vegan without the most damaging carbs. Revelation: calorie restriction and counting isn't as important as carb elimination? Who'd have thought? Seems Gardner recognizes that one can have toxic food substances no matter the eating approach used. Interesting to see he's moving to the middle. Has the turning tide forced this? Must be frustrating for him that there is no trial that conclusively identifies whole animal protein and fats as an unhealthy dietary decision.
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  #11   ^
Old Thu, Feb-22-18, 09:04
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deirdra deirdra is offline
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Plan: HF/vLC/GF,CF,SF
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30% carbs and counting calories made me hungry every couple of hours and constantly thinking about food and craving more carbs - its all about denial. I could lose some pounds by white-knuckling it for a while, but it was not sustainable. 10% carbs kill the hunger, cravings & constant thoughts of food, giving me a lot more free time to live life and eat delicious and even decadent fatty food a couple of times a day.

Last edited by deirdra : Thu, Feb-22-18 at 09:12.
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