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  #1   ^
Old Fri, Apr-20-12, 03:49
Demi's Avatar
Demi Demi is offline
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Default Dr Briffa: Higher protein diets proven better for a range of health measures

Quote:
From Dr Briffa's blog
20 April, 2012

Higher protein diets proven better for a range of health measures

For some time now there has been debate in some nutritional circles about the relative merits of different ‘diets’. Certainly, there has been at least two factions here. One argues for a low-fat, high-carbohydrate diet which usually includes plenty of starchy carbohydrates such as bread, potato, rice, breakfast cereals and pasta. Others (including me) argue that all that carbohydrate is bad news for many people, and in general terms it helps to put more emphasis on fat and protein in the diet.

The Atkins and other similar diets have often been classed as ‘high-protein’ diets. Some believe them to be high-fat too. Actually, when individuals adopt such diet they don’t tend to eat much more in the way of protein or fat – they just eat less carbohydrate. So, while the percentage of protein and fat will generally go up, the absolute amount of these ‘macronutrients’ stays more-or-less the same.

One of the rationales for eating a diet relatively rich in protein is that it is the macronutrient which, calorie-for-calorie, sates the appetite most effectively. What appears to be true is that individuals who adopt this type of diet almost always spontaneously eat less (often, several hundred calories a day less). This may have something to do with protein, but it might also have something to do with fat (which many people find is important for sating the appetite properly). It might also have something to do with the better blood sugar stability these diets tend to afford, which will help guard against episodes of low blood sugar which can trigger ‘false hunger’ and food cravings (usually for carbohydrate).

There is also a theory that higher protein diets may assist weight loss through increased ‘thermogenesis’. After eating, the metabolism will generally enjoy a ‘boost’ – a bit like what happens when you put fuel on a fire. The thermogenic effect of protein is greater for protein then it is for carbohydrate or fat. The effect is not huge, but might help weight control (and other things) over time.

This week, the European Journal of Clinical Nutrition published a review of the impact of protein content on a range of health parameters. The study was a ‘meta-analysis’ – a pooling together of similar studies. In this case, the results of 74 studies were lumped in together. These studies varied quite a lot in design. For example, in some studies individuals were left to fend for themselves food-wise, while in others they were supplied with food. Meta-analyses seem like a good idea, but something the fact that they lump together quite-different studies can make it hard to draw firm conclusions. Also, as usual, there can be a gap between what the diet was designed to test and what it actually tested, because not all people are utterly compliant of course. Many will misreport (deliberately or unconsciously) what they ate too.

Anyway, leaving these issues aside, what did the review find.

Well, overall, the prescribed diets has these macronutrient compositions (percentage of calories contributed by each macronutrient):

Lower protein:

protein – 18 per cent
carbohydrate – 55 per cent
fat – 26 per cent

Higher protein:

protein – 27 per cent
carbohydrate – 38 per cent
fat – 32 per cent

The diets in which higher protein was prescribed led to significant improvements, compared to lower protein, in a range of parameters, including:

Weight
Waist circumference
Systolic blood pressure (the higher of the two blood pressure readings)
Diastolic blood pressure (the higher of the two blood pressure readings)
HDL cholesterol levels
Triglyceride levels
Fasting insulin levels
Satiety

No parameter measured was improved by the lower-protein diet.

Overall adverse effects was the same between groups, and there was no difference detected in terms of bone and kidney health (high-protein diets are often claimed to be ‘bad for the bones’ or kidneys though, actually, there is no evidence for this for health people).

In general terms, one would have to chalk this up as a win for higher-protein, lower-carbohydrate diets. But actually, the authors of this review were quite dismissive of the results. They tell us that: “Higher-protein diets probably improve adiposity, blood pressure and triglyceride levels, but these effects are small and need to be weighed against the potential for harms.”

First of all, why “probably”? Their own meta-analysis shows that higher-protein diets do indeed induce these changes. And the authors left some of the other benefits out too. But what’s this “potential for harms” all about? The meta-analysis actually found these diets to be as safe as lower-protein ones, overall, so what could they be referring to?

When authors’ conclusions don’t match their very own results it sometimes pays to look for potential conflicts of interest (this can help explain authors’ bias). Well it turns out that one of the study authors is an employee of Barilla – an Italian company that makes pasta. Two of the other authors received “grant support” from Barilla to conduct the review.

Now, the relative popularity of ‘high-protein’ diets has not been particularly good news for companies like Barilla, essentially because these diets are lower in carbohydrate, and specifically encourage restraint in the consumption of starchy ‘staples’ including pasta.

My suspicion (this is just speculation) is that Barilla decided to go looking for evidence which was unsupportive of higher-protein and lower-carbohydrate diets. If so, it seems Barilla’s efforts here back-fired a bit it seems, so what to do? How about pouring cold water on the clearly positive findings and refer to the “hazards” of higher-protein diets for which there is no evidence?

References:

1. Santesso N, et al. Effects of higher- versus lower-protein diets on health outcomes: a systematic review and meta-analysis. Eur J Clin Nutr Epub 18th April 2012

http://www.drbriffa.com/2012/04/20/...ealth-measures/
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  #2   ^
Old Thu, Aug-23-12, 03:04
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Demi Demi is offline
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Default Dr Briffa: Review finds low-carb eating benefits wide range of health markers

From Dr Briffa's blog:

Quote:
22 August, 2012

Review finds low-carb eating benefits wide range of health markers

I’m a long-time advocate of diets that are generally lower in carbohydrate than those encouraged by most Governments, health agencies and health professionals. I’m not very prescriptive about it, and prefer not in my talks or writings to give specific carbohydrate ‘targets’ e.g. no more than 50 g of carbohydrate a day. I do, however, advise those wanting to optimise their health and weight to avoid or limit foods with added sugar (sometimes even foods that are naturally sugary too), as well as reining in starchy carbohydrates such as bread, potatoes, rice, pasta and breakfast cereals.

Just this change in dietary tack will very often bring significant improvements in terms of weight and general wellbeing. The underlying mechanisms are probably various. But it occurs that this sort of eating regime will help to stabilise blood sugar levels, which so often seems to impact positively on things like energy levels, mood and sleep. Another thing is that many of the foods de-emphasised on this approach may have quite-toxic effects on the body. Many grains (particularly wheat), for instance, have the capacity to induce problems related to food intolerance that can cause problems such as fatigue and gastrointestinal symptoms. Grains aren’t particularly nutritious either, so losing a bunch of them is unlikely to lead to problems with nutrition status (despite what some health professionals would have us think).

Of course, not everyone is enthused by low-carb approaches, and some will publish articles or studies which are broadly critical of them. In one such study, it was claimed that the low-carb phenomenon is putting Swedish people in perilous danger. However, even a cursory glance at the design of the study reveals it’s simply not fit for purpose. It is my opinion that the authors are less motivated by a desire to get to the truth, and perhaps more motivated to produce whatever they can (however poor the science) to justify and support their biases against this dietary approach.

One of the reasons I say this is because it is widely recognised that the best judge of any approach (dietary or otherwise) is not the sort of junk ‘epidemiological’ science they churned out, but clinical studies. Studies where the approach is actually tried in real, live human beings.

My eye was caught today by a paper published yesterday which reviews the impact of low-carbohydrate eating on a range of health markers. The review amassed data from 17 studies in the form what is called a ‘meta-analysis’ [1]. This sort of review study is not necessarily ideal, at least in part because it included approaches utilising different carbohydrate intakes over different lengths in sometimes quite different demographics of people. Also, another problem is that in studies of this nature people are usually ‘free living’, and this means that adherence to the ‘diet’ is not assured and tends to drop off over time too.

Nevertheless, the broad results from this review make interesting reading in that, overall, low carbohydrate eating was found, on average to bring statistically significant benefits in several measures including:
Body weight (average loss of 7 kg)
Abdominal circumference (average reduction of 5.74 cm = 2.26 inches)
Systolic blood pressure (average reduction of 4.81 mmHg)
Diastolic blood pressure (average reduction of 3.10 mmHg)
HbA1c – also known as glycosylated haemoglobin and a measure of blood sugar control over the preceding 3 months or so (average reduction 0.21 per cent)
Reduction in blood insulin levels
C-reactive protein reduction (an inflammatory marker – inflammation being something that has the capacity to drive disease process)
Increase in levels of supposedly ‘healthy’ HDL cholesterol

No overall effect was seen on levels of supposedly ‘unhealthy’ LDL cholesterol. Though, we know from research that low carbohydrate diets tend to lead to lead to increases in the size of LDL particles and reduce the number of ‘small, dense’ LDL – changes that are believed to be desirable in terms of cardiovascular disease risk reduction [2].

Taken as a whole, these effects can only really be seen as a sign that low-carb eating has broadly beneficial effects across just about every health markers it’s been judged with.

None of this, I suspect, will come as too much of a surprise to those who employ this strategy in practice, or to many people who have used it on themselves, in that similar results to those found in the studies will often stare us in the face. What is perhaps more surprising is how often doctors and health professionals seem unaware of the evidence for low-carb eating (or perhaps just choose to ignore it).

References:

1. Santos FL, et al. Systematic review and meta-analysis of clinical trials of the effects of low carbohydrate diets on cardiovascular risk factors. Obesity Reviews epub 21 Aug 2012

2. Volek JS, et al. Modification of lipoproteins by very low-carbohydrate diets. J Nutr. 2005;135(6):1339-42
http://www.drbriffa.com/2012/08/22/...health-markers/
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  #3   ^
Old Thu, Aug-23-12, 15:49
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Ghaleon Ghaleon is offline
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Default

I already heard most of this stuff from reading low carb websites. However, it's always good to get confirmation and to hear that more studies are reaching the same conclusions. If more doctors recommend these dietary habits to their patients, it will help tremendously. Thank you for posting it, Demi.
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