Dr. Christopher Gardner says Atkins diet deserves a second look
Are you one of those people who STILL thinks the Atkins low-carb diet is just another dangerous fad that is a far inferior way to lose weight and improve overall health compared to the more highly-recommended, yet unsubstantiated traditional low-fat, low-calorie diets? If so, then you may be interested in the very latest research released in today's issue of the highly-respected Journal Of The American Medical Association which could very well change how all of us view the much-vilified, yet extremely effective Atkins diet.
Lead researcher Dr. Christopher D. Gardner, from the Stanford, CA-based Stanford Prevention Research Center and Associate Professor in the Department of Medicine at the Stanford University Medical School, and his fellow researchers conducted a one-year randomized trial they entitled "A TO Z: A Comparative Weight Loss Study."
Recognizing the severity of the obesity epidemic that has become what they describe as "the single most significant nutrition-related health issue of the new millennium," Dr. Gardner wanted to know in his study if the monopolistic low-fat dietary recommendations that have been coming directly from government and health agencies for decades really were better for weight loss and improvements in various health outcomes than some of the other popular weight loss methods to come out in recent years, including the lower-carb Zone and Atkins diets.
Observing 311 women who were overweight or obese at baseline with a body mass index of 27-40, non-diabetic, pre-menopause, and willing to participate in the 12-month study, the researchers divided up the study participants into one of four diet groups:
ATKINS (20g carbs daily for 2-3 months, 50g daily thereafter)
ZONE (40-30-30 ratio of carbs to protein to fat)
LEARN (55-60% carb intake, less than 10% saturated fat)
ORNISH (No more than 10% calories from fat)
Additional recommendations for each study group regarding exercise, supplements, and other behavioral strategies for being successful on each plan as prescribed by the various diet books used were also provided to the study participants. Dr. Gardner explained to the "Livin' La Vida Low-Carb" blog that each of the study participants were also provided with eight weeks of intensive education from a nutritionist about their respective diet plan and then left on their own for the remaining ten months of the study.
While the primary outcome studied was weight loss, the researchers were also interested in some of the secondary outcomes such as differences in cholesterol, including LDL, HDL, and triglycerides, body fat percentage, waist-to-hip ratio, fasting insulin and glucose levels, and blood pressure.
Each of the study participants were measured for their progress on their specified diet plan at the beginning of the study, after two months, after six months, and then at the end of the 12-month study.
Interestingly, although the percentage of study participants who were able to stay on their specified diet plan was not statistically different, it was the ATKINS group that led the pack for retaining the most dieters for the duration of the study among the four study groups:
ATKINS - 88 percent
ZONE - 77 percent
LEARN - 76 percent
ORNISH - 78 percent
So, what did Dr. Gardner and his team find at the end of the study?
Weight loss among the ATKINS group was statistically higher as compared with the other diet groups, including triple the weight loss of the ZONE group, nearly twice as much weight loss as the LEARN group, and more than double the weight loss of the ORNISH group. Statistically speaking, there was very little difference in the weight loss between the ZONE, LEARN, and ORNISH groups.
While most people expected the ATKINS group to produce higher weight loss (although the infamous Dansinger study indicated there was no significant difference in weight loss after 12 months between the various diet groups), the unexpected aspect of Dr. Gardner's study is what happened to the health of the individuals who followed this dietary plan as compared to the others.
One of the frequent criticisms of the low-carbohydrate approach is the assertion that it can lead to certain health complications, including the loss of muscle mass rather than body fat (contradicted by this previous study, an increase in cholesterol (again, not an issue for people following a low-carb diet), a rise in blood pressure, and other such heart health risks (despite this study which found there were none associated with low-carb diets).
But this new study confirms most of those flailing arguments are all for naught.
The body mass index of the ATKINS group at the end of the study had been reduced by more than three times as much as the ZONE group and twice as much as the ORNISH group. At the same time, the body fat percentage loss for the ATKINS group after 12 months was three times higher than the LEARN and ZONE groups as twice as high as the ORNISH group. This echoes what previous research found regarding body fat loss on a low-carb diet.
As for cholesterol, LDL remained relatively stable among all groups except for the ORNISH group which saw a noticable drop, but it was the HDL and triglycerides numbers (which this recent study confirms is a better marker for measuring heart health anyway) that were dramatically different.
The ORNISH group saw HDL remain exactly the same after 12-months while the ZONE and LEARN groups saw equally modest increases in HDL. But it was the ATKINS group's rise in HDL that was more than double that of ZONE and LEARN while their triglycerides dipped twice as much as ORNISH and LEARN groups and seven times as much as the ZONE group.
While the waist-to-hip ratio and blood glucose levels were not statistically different among all groups (although the ATKINS group again saw a greater drop in insulin levels), blood pressure among the ATKINS group was significantly lower than all the other groups, including nearly four times lower than the ORNISH group.
This groundbreaking study was published in the March 6, 2007 issue of The Journal Of The American Medical Association.
In an exclusive interview with "Livin' La Vida Low-Carb" blog, Dr. Gardner was quick to point out that this was a smaller study and that his research should not be misconstrued as an endorsement of the Atkins low-carb diet. However, he did say the previous rush to judgment about the low-carb nutritional approach was probably a bit premature.
"This [study] is more evidence for shifting to low-carbohydrate diets," he said.
He added that the average weight loss among the ATKINS group was only about 10 pounds each and that several of the groups had people who lost 30 pounds or more, which proved that there are multiple ways to lose weight. However, Dr. Gardner admitted there were limitations in his study that are impossible to measure, including whether the dietary changes are the key to permanent weight loss or if there are qualities about individuals that make them more prone to success.
"We need to find out what internal mechanisms are at work in people to make them successful and bottle it up somehow," he exclaimed.
He said there was a noticable drop in performance among all groups when they were left to do their respective diet on their own following the eight weeks with a nutritionist. Dr. Gardner believes the support the dieters received was a key to their success early on regardless of the plan they were using. This is proof that having a weight loss buddy could be a beneficial ingredient for people desiring weight loss.
Foreshadowing his future research on carbohydrates as it relates to obesity, Dr. Gardner wants to study whether there is a limit on the carbohydrate intake for people to consume for weight loss.
"Is there threshold on the continuum of carbohydrates consumed," he asked. "Is it below 40 grams carbohydrates, 30 grams? That's what I'd like to know."
Regarding his decision to conduct this study comparing the Atkins diet with three other higher-carb diet plans, Dr. Gardner said he feels the low-fat diet has been too heavily publicized and recommended without seeing the beneficial results to make a dent in the health and obesity crisis we now find ourselves facing.
"People have been asking about diets for years," he stated. "We think it's time to give them some answers."
Although there have been widespread concerns about what is allegedly lacking in the Atkins diet, the researchers concluded that this particular diet is just as good a place to start for people who are committed to losing weight and living a healthy lifestyle.
"These findings [in the study] have important implications for clinical practice and health care policy," the researchers remarked. "Physicians whose patients initiate a low-carbohydrate diet can be reassured that weight loss is likely to be at least as large as for any other dietary pattern and that the lipid effects are unlikely to be of immediate concern."
Convincing the medical community of this fact is now the real challenge. How much longer will they continue to ignore studies like this one while millions upon millions of people keep getting fatter and sicker than they've ever been before following the low-fat recommendations, hmmm? This is something low-carb practitioner Dr. Mary C. Vernon wondered in response to this study.
"The evidence in favor of carbohydrate restriction continues to accumulate," she wrote on her blog today. "Once again, this study quantifies what physicians using this technique to treat disease and return metabolic parameters to normal have reported over and over again. Wow."
She added that we need to stop being shocked every time the Atkins diet is confirmed by credible scientific research that it works as well as it has been proven to work.
"The surprise in today's Journal Of The American Medical Association is not that Atkins works and confers health benefits, the surprise is that it's still a surprise," Dr. Vernon expressed. "You can lead a mainstream doctor to water, but clearly you can't make him drink. Oh, wait, sorry, that's a horse."
Ironically, it was Dr. Vernon who said in my interview with her last year that the National Institutes of Health (NIH) needs to step up to the plate and fund more studies comparing the Atkins diet with the low-fat diets that unfairly dominate dietary recommendations.
Well, she and everyone else should be pleased to hear that this study was indeed underwritten with grants from the NIH, the Community Foundation of Southeastern Michigan, and Human Health Service. Will this funding trend for low-carb research from our health entities continue on based on the positive response Dr. Gardner found in his study about the Atkins diet? We shall see.
I have long held the belief that the future of low-carb hinges on the research proving it is everything that those of us who support it believe it is. I guess it's not enough that I lost nearly 200 pounds on the Atkins diet in 2004 and kept it off ever since.
While low-carb weight loss success stories like mine are interesting and important in communicating the message that the Atkins diet really works for people, the real difference in our culture will come when more and more research like this one today is brought to the attention of family doctors and those who work directly with overweight and obese patients. People trust their doctors and will heed their advice about diet. Now if we can only get the healthcare community to absorb this research.
If that happens (and I believe it will at some point), then it could very well bring about the much-needed paradigm shift within the world of diet, health, and nutrition that has been needlessly dominated by what has been proven in another JAMA study last year to be the high-carb, low-fat lie for far too long. Keep the low-carb research coming because sooner or later the truth will break through. Hopefully, not before it's too late.
You can e-mail Dr. Christopher D. Gardner to thank him for his outstanding research comparing the Atkins diet with the low-fat diets by writing to email@example.com.
3-7-07 UPDATE: Upon reading my blog post about his study, Dr. Christopher Gardner was not at all pleased with what I had written regarding his research. It seems his disdain for low-carb diets as a long-term solution to obesity and health problems is an ever-present concern and he did not want people to misunderstand his position about the diet despite the favorable findings in his study.
Here's what he wrote:
I did not particularly enjoy your blog. I do not endorse the Atkins as wholeheartedly as you do. I find the results interesting, and I do intend to follow up on them. However, I am disappointed that you included many of the interesting findings I discussed, but few of my concerns.
The line below, in particular, was a misunderstanding.....
"Is there threshold on the continuum of carbohydrates consumed," he asked. "Is it below 40 grams carbohydrates, 30 grams? That's what I'd like to know." I was referring to 40% of calories from carbohydrates, not 40 grams. Please do not allow that misunderstanding to remain as it is.
On 20, 30 or 40 grams a day there are several important vitamin and mineral deficiencies that can't be avoided. I don't believe it is healthy to go that low, and I don't believe many people can sustain a diet that low.
I would not be surprised to learn that you, with your iron will (that I truly would like to bottle) could go this low. But the average person cannot or would not and I believe it is fair to say should not go on that low a carbohydrate diet.
I'm glad it has worked for you. But I have numerous concerns about being on that kind of diet long-term, and our study was not able to address long-term concerns.
I wish you the best in your endeavors. I would prefer to not be included in your blog, or, if included, to be presented as being much more cautious about the findings and their interpretation than you have portrayed me.
Sincerely, and in the hopes of finding more ways for more people to lose and keep off weight,
WOW, that's a rather strong reaction to what most people have e-mailed to tell me was a well-written article. But, it is what it is and Dr. Gardner is trying to keep up the that proverbial wall that many medical researchers are scared to death of tearing down--between the reality of the effectiveness of low-carb and their fantasy that it is healthy or sustainable to eat less than 50g carbs daily.
I couldn't let his e-mail go without a response:
THANK YOU for writing and I apologize if you felt I made it appear you were endorsing the Atkins diet with your study released in JAMA on Tuesday. I spent nearly 7 hours writing this column with painstaking details reading the full text of the study and in conducting personal research for it.
It was not my intention to mislead my readers into believing you supported low-carb as a permanent and healthy lifestyle change as many of us do. If you still have questions about the long-term implications, then certainly the door is open for you and other researchers to continue looking for the answers to those questions (many of which HAVE been answered by research in the links I provided).
Very clearly your research provides a solid basis for continuing to look at the low-carbohydrate approach as it relates not just to weight loss, but also health management. When I spoke with you about your theory for a new study, it was not made clear you were referring to the percentage of the macronutrient rather than the actual grams. Again, I apologize for that.
Feel free to contact me anytime you have any questions or concerns. My blog is about providing people with education and hope for a brighter tomorrow. That's exactly what I'll keep doing sharing the good news of livin' la vida low-carb with them. Take care and THANK YOU again for your e-mail!
Do you feel Dr. Gardner overreacted a bit in response to my column? It was never my intention to put words in his mouth, but rather share what his amazing study found--that is, that for at least one year, we can say that the Atkins/low-carb nutritional approach is at the very least just as effective for managing weight and health as any other way of eating. Why is there such vitriol opposition...STILL?!