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Tuesday, March 06, 2007

Stanford Researchers Confirm Atkins Diet Best For Weight Loss, Improved Health


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 cgardner@stanford.edu.

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:

Jimmy,

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,

Christopher Gardner


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:

Dr. Gardner,

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?!

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29 Comments:

Blogger Carol Bardelli said...

This is incredible news, though most of us on low carb knew it already. Maybe the tide will turn now and researchers will explore fully the potential of controlling carbs. Nice writing Jimmy!

3/06/2007 7:47 PM  
Blogger Diane; AL said...

I'm with Dr Vernon on this---why are the people still surprised by the research.
I posted this on my WLS forum I frequent---even though we are recommended to follow a LC WOE---they still insist on the old low-fat dogma----

3/06/2007 8:03 PM  
Blogger Science4u1959 said...

Believe it or not but this study was actually reported in the mainstream media. Of course the critics had more than their say; they were quick to quote our ever-ready friend Ornish, basically stating that it "doesn't mean much" and baseless nonsense like that. But it is indeed good news, but I like most what Dr Vernon said about it: the surprise is that it's still a surprise. Indeed, how true.

Logic dictates that eventually the paradigm shift should occur, and I do hope and pray that I may see it happen in my lifetime. But even from the reporting that has been done so far, it's clear that the current bias and prejudgment, although absolutely baseless, is very deeply rooted. We can thank over 3 decades of media en Gov't lies, deceptions and propaganda for that. Nevertheless, we can always hope - for the sake of the millions upon millions of innocent victims that are killed every year by our "modern dietary wisdom". Or perhaps, in the end, the skyrocketing costs of healthcare will finally bring about the change that will end all the madness.

Excellent article, and keep up the good work, Jimmy!

3/06/2007 11:10 PM  
Blogger Jimmy Moore said...

One of my readers had trouble posting her enlightening comment, so here it is:

I think it's fantastic news, and even more ammunition to use with the naysayers (except those who refuse to hear -- I'm not sure if any study will open their minds). Here's one question I still have after reading the results:

Those on the Atkins plan lost around 10 pounds in a year, with 88% of the participants sticking with the plan. Does the 10.4-pound average loss include those who did not stick with the plan, who either did not lose weight or might have even gained weight? While of course that reflects real-life experience (if all of us could stick with the Atkins plan perfectly, now that we'd discovered it, we would all eventually be at goal weight!), that also skews the averages. Since there are statistics for those who adhered to each plan, I would like to know what the average weight loss was for those who were considered to have stuck with each plan.

The reason why that's important: if you have 10 or 20 pounds to lose, it truly may not matter how you do it, as long as you select a plan that you're likely to stick with (which was essentially Dansiger's conclusion). But if you have as much or more to lose than the study participants (BMI of 27-40), then you'll want to select the plan that allows you to lose the greatest amount of weight in the shortest time.

I'm also curious about the 20/50 gram selection. I know they have to standardize it for each participant, but I know that 50g takes me out of ketosis/weight loss range (and I'm a female who meets all the criteria for the study). I realize that even Dr. Atkins doesn't recommend staying on induction forever, but it doesn't seem the study participants could tweak their plans the way that Atkins recommends to ensure that the number of carbs they consume keeps them in weight loss mode/ketosis.

If Dr. Gardner thinks that's dangerous, then there's no surprise there, but it's another thing that perhaps got in the way of Atkins participants losing even more than the average 10 pounds. Given that virtually everyone I have known on Atkins who has stuck with the plan for an entire year (and that's many many people, since my ex-husband used to manage a low-carb store) has lost well over 10 pounds (many lose that much in the first month!), then the results might also have been even more favorable for those following Atkins -- if they had been able to follow it the way that Dr. Atkins intended and to ensure they stayed in ketosis.

3/07/2007 9:38 AM  
Blogger Invisible Blogger said...

this issue of will power Dr. Gardner brings up is an interetsting one... I've been low carbing for almost 5 years and I dont think I possess anything near "iron-like" will. What these folks dont understand is that once you eliminate sugar and starch from your diet, you stop craving it. Completely.

That's part of why I stick with low carb, in addition to the fact that I dont need to go hungry to maintain my weight loss, I feel great, I rarely catch colds (it's been almost 2 years since the last one...), my bloodwork is spectacular, CT scan shows I have zero plaque, the list goes on and on...

3/07/2007 11:28 AM  
Blogger Jimmy Moore said...

Hey IB! Dr. Gardner got that "iron will" terminology from me because he asked how I was able to lose my weight. It's not the whole picture, but you do have to be strong enough to endure.

3/07/2007 11:57 AM  
Blogger BamaGal said...

I was taken back by the update from Dr. Gardner. Who put a bee in his bonnet?? Something just doesn't jive there. As they say---"me thinks he doth protest too much"

3/07/2007 12:23 PM  
Blogger LowCarbCentralWI said...

Gee Jimmy - in comparing this comment (from your interview with Mr. Ornish) 'If you can help people get out of this adversarial mindset of low-fat versus low-carb and say "Wait a minute, what's really going on here?"' to his comment on the Stanford study "I'm concerned that this study may cause people to forgo eating a healthy diet for one that's actually harmful for them" It seems his "adversarial mindset" is preventing him from taking his own advice... But what really takes the cake is how the low fat advocates blame the study PARTICIPANTS when they don't get the results the were hoping for. Unbelievable.

3/07/2007 12:28 PM  
Blogger Science4u1959 said...

Do you feel Dr. Gardner overreacted a bit in response to my column?
He certainly did overreact - but then again, scientists are super-cautious by definition. It seems to me that he's not completely aware of the literal mountains of positive evidence that's readily available in the published literature.

Why is there such vitriol opposition...STILL?!
Well, that's the sad part, isn't it. A great scientist once said that "any scientific breakthrough starts as a blasphemy". The current low-fat mantra, after decades of pure communist-style indoctrination, is so effectively hammered down and, hence, so deeply rooted in our present belief [sic!] system that it is almost impossible to open minds - no matter how much evidence to the contrary is presented. That is very discouraging, no doubt, but it also makes abundantly clear that we have to keep exposing the truth. That's why your work is so important, Jimmy! The only way to defeat the system is to keep exposing the lies, fallacies and nonsense - backed up by hard, irrefutable scientific evidence. I am convinced that eventually, the ivory towers will fall. Don't forget that there are already some mighty cracks (very!) visible in that geometric nutritional absurdity, the USDA Food Pyramid.

3/07/2007 1:25 PM  
Blogger renegadediabetic said...

Us low carbers may think Dr. Gardner overreacted. However, I think we should give him a break. For him to make the some of the comments he did is a step in the right direction. It is difficult for the medical establishment to acknowledge a politically incorrect dietary approach. We've seen it before in other favorable studies. It will take a lot of time to overcome the inertia in the medical establishment, as other comments have noted. I know we want the medical establishment to acknowledge low carb right now, but we must be patient.

As for willpower, I didn't have the willpower to overcome the cravings from the low-fat, high-carb diet. It takes less willpower to stick with low carb.

At least THIS study is getting some media attention. The Houston Chronicle had a good, fairly positive article today. http://www.chron.com/disp/story.mpl/health/4607983.html

I also heard a quick report about the study on our local morning TV news about it. It showed someone grilling meat. They had to add that "experts" were concerned about the effects of eating "high fat and no carbs." Geeze, will these "experts" ever get a clue???

3/07/2007 4:19 PM  
Blogger Paula said...

[Thanks, Jimmy, for posting my comment above -- not sure if it was enlightening or not, but thanks for suggesting that it was...]

I think that anyone who does a rigorous scientific study doesn't want to be too closely identified with the results, so that he or she doesn't get pegged as an advocate.

Jimmy is obviously a most aggressive advocate for low-carbing; Dr. Mary Vernon is an advocate; etc. etc. If he gets pegged as one of "those Atkins doctors," then he might not get funding from mainstream sources to continue his research, so that he gets the long-term results that will match his short-term results.

The question I have for the researchers who run from their own data is: when you find increased weight loss AND improved lipid profiles in the short-term, how could that be bad in the long-term?

If I as a patient take action to lose weight and improve my cholesterol and triglycerides, and then maintain all of that at a medically appropriate level by continuing to follow a low-carb maintenance plan, what is it that could happen in the meantime that would be bad for me? If I were able to achieve that following a low-fat plan, or by taking statin drugs, I would be considered a model patient.

Yet by achieving it via low-carb, I'm supposed to believe I'm undertaking something unproven and dangerous? More so than remaining obese and having what is considered an unhealthy lipid profile?

How is it that the same way of eating that improved my cholesterol profile will suddenly mutate into something that makes me worse off?

3/08/2007 4:46 PM  
Blogger Kendra said...

No overreaction. The 40-30 thing was unclear. His response was fine. IMHO 50g carb is probably too high for most women and no educated person suggests doing Atkins without supplements.

3/10/2007 7:04 PM  
Blogger Matt Metzgar said...

The Atkins group lost 10 pounds, but how much of this was fat and how much was muscle? The study doesn't say.

Also, the Atkins group started regaining body fat from month 6 to month 12.

3/15/2007 3:10 PM  
Blogger Jimmy Moore said...

That's true, Matt, but ALL diet groups started gaining weight at that time because they basically got "off the diet." These dieters pushed their carb intake up over 150g daily after 6 months--no wonder they started gaining weight back. If they had just stuck to the plan, then their weight loss would have been FAR more impressive. MUCH MUCH MORE!

As for muscle mass loss, that's yet another myth. Google it for two studies that I've blogged about showing you DON'T lose muscle when you low-carb.

Nice try, though.

3/16/2007 12:35 AM  
Blogger Matt Metzgar said...

Don't you think there's a reason people got off the diets??? Could it be because these diets aren't sustainable in the long-term?

3/16/2007 10:31 AM  
Blogger Jimmy Moore said...

EXCELLENT question, Matt. I don't think it's the diets necessarily that don't work in the long-term, but rather the lack of support while following them that makes the difference between success and failure.

There are many ways to lose weight, but keeping it off takes an entire line of defense centered around supporting these people with continuing on their good habits long after weight loss is no longer an issue.

That's why I'm doing what I do here at my blog and will keep encouraging and educating people about what I have been able to do to keep my weight off three years and counting. :)

THANKS again for your comments!

3/16/2007 10:46 AM  
Blogger Matt Metzgar said...

Eating less calories than the body needs on a long-term basis (no matter what type of diet) is not a healthy way to lose weight in my opinion. Exercise is the only true way to reshape the body in the long-run.

Also, I am looking into your studies about low-carb and muscle mass.

3/16/2007 12:21 PM  
Blogger Matt Metzgar said...

In regards to low-carb and muscle mass, I looked at the "study" you mentioned. It was in fact not a study, but a review of other studies.

If you look at a more thorough meta-analysis, you will see that low-carb does indeed lead to muscle mass loss on average:

Am J Clin Nutr. 2006 Feb;83(2):260-74. Effects of variation in protein and carbohydrate intake on body mass and composition during energy restriction: a meta-regression.

pg. 269 - "low-carbohydrate diets were associated with a greater loss of fat-free mass than high-carbohydrate diets".

pg. 272 - "Low-carbohydrate diets were associated with a greater fat-free mass loss than were low-fat diets".

Nice try, indeed!

3/16/2007 12:53 PM  
Blogger Jimmy Moore said...

Nice try again, Matt, but you must have completely overlooked the STUDY by Dr. Donald Layman. He has looked at low-carb diets as they relate to muscle mass and concluded there is not the major loss as you are claiming.

Read my interview with Dr. Layman to learn more about his fantastic and eye-opening research (pay close attention to his answer to Question #6 and learn something, my friend).

3/16/2007 6:56 PM  
Blogger Jimmy Moore said...

While I agree exercise is an important facet of weight loss over the long term, it is not as important as you are promoting. Dr. Mary Vernon from the University of Kansas has found in her practice with the patients she puts on a low-carb diet that getting their diet in order first is most important and then they will spontaneously start moving around as a result. It's the chicken before the egg argument.

3/16/2007 7:06 PM  
Blogger Matt Metzgar said...

Nice try again. You say there are two studies that show muscle mass is not lost on low-carb.

1) The research by Manninen was not a study, but a review of other studies. It uses no quantitative technique to come to its conclusion. The American Journal of Clinical Nutrition study I referenced above was a much more comprehensive meta-review of other studies.

2) In the study by Layman, J. Nutr. 135:1903-1910, August 2005, subjects on the low-carb diet with no exercise LOST LEAN MASS (space may not be wide enough for proper formatting):

TABLE 3 Body weight and composition for adult women at baseline and after 16 wk of consuming reduced-energy diets with a carbohydrate:protein ratio >3.5 (CHO) or <1.5 (PRO) with or without a supervised exercise program (EX: 5 d/wk walking and 2 d/wk resistance training)1
Group PRO PRO + EX CHO CHO + EX P-value
D2 E3, 4

--------------------------------------------------------------------------------

kg
Body weight
Baseline 86.1 ± 4.6 93.7 ± 3.5 79.8 ± 2.7
Post-test 76.3 ± 3.9* 85.9 ± 3.5* 73.1 ± 2.8* <0.05 0.98
Fat mass
Baseline 39.0 ± 3.0 40.9 ± 3.6 40.6 ± 2.0 36.3 ± 2.2
Post-test 33.1 ± 2.4* 32.1 ± 2.9* 35.6 ± 2.1* 30.8 ± 2.3* <0.05 <0.05
Trunk fat
Baseline 19.6 ± 2.0 20.1 ± 2.2 20.1 ± 1.3 17.0 ± 1.2
Post-test 16.0 ± 1.6* 15.1 ± 1.9* 17.1 ± 1.3* 13.8 ± 1.2* <0.05 0.11
Lean mass
Baseline 50.6 ± 2.5 42.6 ± 1.4 51.7 ± 1.7 40.6 ± 0.8
Post-test 48.6 ± 2.4* 42.2 ± 1.4 49.0 ± 1.8* 39.6 ± 0.8* 0.10 <0.001



1 Values are means ± SEM; n = 12.

* Different from baseline, P < 0.05.

2 D = Test for significant main effect of diet (PRO; n = 24: CHO; n = 24).

3 E = Test for significant main effect of exercise (EX; n = 24: control; n = 24).

4 D x E was not significant for any variable.

3/17/2007 1:28 PM  
Blogger Dana said...

I am COMPLETELY unsurprised that insulin dropped more on Atkins than on the other diets, AND that BP also dropped. Dr. Atkins used to say that hyperinsulinism was a greater indicator of the potential for BP problems than even salt intake. I wonder how many other things he said are going to be proven right before the medical establishment and the media finally stop shortchanging the man's contribution to society.

3/22/2007 11:18 PM  
Blogger Tim said...

Eating less calories than the body needs on a long-term basis ... is not a healthy way to lose weight in my opinion. Exercise is the only true way to reshape the body in the long-run.

*rolls on floor laughing*.

You do understand that exercize pushes up the body's requirement for calories, and that fat loss then occurs when your daily calorie requirement has been pushed over your total intake, right?

You can tone all the muscle you want, but if you keep your metabolized calorie intake over your expenditure, you'll retain every ounce of that fat.

You've got almost no chance of actually building muscle mass if you're processing less calories than expenditure, too. That's why body builders do growth/cut cycles -- excess calories during building phases, and then insufficient calories to trim off the slight fat gains.

You are always going to lose at least some muscle mass if you take in less calories than you are expending. It's unavoidable. But the body is very slow and reluctant to remove resources it's using. Exercizing a muscle greatly reduces its wastage.

Obviously, by far the best approach for losing weight is to both restrict intake and exercize the entire muscle base. The exercize component ups your metabolic requirements so in effect you're dieting harder, helps minimize muscle wastage, and improves your mood to boot.

But don't fool yourself. The only ways we have at the moment to remove body fat are to hack it out, or to process less calories than you use -- exercize included.

This stuff really isn't rocket science.

And Matt... Why on Earth are you so desperate to convert people away from a weight-loss regime that demonstrably works, and works well? No matter how bad the (seemingly mythical) poor health implications of a low-carb diet are, they're nothing compared to the very horrifying implications of obesity. Whose mental voice are you trying to persuade or defend against?

4/29/2007 6:30 AM  
Blogger sacocella said...

Dear Jimmy and blog members -

I am posting a resent prospective, cohort study that followed and investigated nearly 33,000 subjects who were evaluated for percent of calories in their diets from protein and carbohydrates and compared their intake with morbidity and mortality for over a decade. The authors conclude that, "Prolonged consumption of diets low in carbohydrates and high in protein is associated with an increase in total mortality". This is a well designed, peer-reviewed study. I know that the low-carb approach focuses caloric intake on high-fat but we all agree by default this diet style is also low-carb and high in protein, as fatty food are often derived from high-protein foods. I know I'm in the lion's den here but Jimmy often posts opposing view and allow hearty debate. My post will hopefully inspire such discourse. I will not editorialize, but simply post the study and listen to you and you're reader’s comments. I will say that there's no reason that we need to dispute the efficacy of the study itself. Let's go from the position that the study is not flawed, let's discuss the science and findings. The conclusions of the authors are reproducible and consistent. What do you all think? If you do post this study I applaud your willingness to explore the science and not ignore nor dismiss it.

I am keen on hearing the comments.

Dr. Steven Acocella
Board Certified Dietitian
Doctor of Chiropractic Medicine
Master of Science Human Nutrition
Fellow - American College of Lifestyle Medicine
Diplomate - American Clinical Board of Nutrition


European Journal of Clinical Nutrition (2007) 61, 575–581. doi:10.1038/sj.ejcn.1602557; published online 29 November 2006



Low-carbohydrate–high-protein diet and long-term survival in a general population cohort

Guarantor: A Trichopoulou.

Contributors: AT is the principal investigator of the Greek EPIC project and has the supervising responsibility for all aspects of this project. TP is the physician directly involved in the implementation of this study. PO is the coordinator for data analysis. C-CH and DT are the epidemiology consultants.
1Department of Hygiene and Epidemiology, School of Medicine, University of Athens, Athens, Greece
2University of Massachusetts Cancer Centre, Worcester, MA, USA
3Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA Correspondence: Professor A Trichopoulou, Department of Hygiene and Epidemiology, University of Athens Medical School, 75 Mikras Asias Street, Goudi, Athens GR-11527, Greece. E-mail: antonia@nut.uoa.gr

Abstract:

Objective: We have evaluated the effects on mortality of habitual low carbohydrate–high-protein diets that are thought to contribute to weight control.

Design: Cohort investigation.

Setting: Adult Greek population.

Subjects methods: Follow-up was performed from 1993 to 2003 in the context of the Greek component of the European Prospective Investigation into Cancer and nutrition. Participants were 22 944 healthy adults, whose diet was assessed through a validated questionnaire. Participants were distributed by increasing deciles according to protein intake or carbohydrate intake, as well as by an additive score generated by increasing decile intake of protein and decreasing decile intake of carbohydrates. Proportional hazards regression was used to assess the relation between high protein, high carbohydrate and the low carbohydrate–high protein score on the one hand and mortality on the other.

Results:During 113 230 persons years of follow-up, there were 455 deaths. In models with energy adjustment, higher intake of carbohydrates was associated with significant reduction of total mortality, whereas higher intake of protein was associated with nonsignificant increase of total mortality (per decile, mortality ratios 0.94 with 95% CI 0.89 –0.99, and 1.02 with 95% CI 0.98 –1.07 respectively). Even more predictive of higher mortality were high values of the additive low carbohydrate–high protein score (per 5 units, mortality ratio 1.22 with 95% CI 1.09 –to 1.36). Positive associations of this score were noted with respect to both cardiovascular and cancer mortality.

Conclusion: Prolonged consumption of diets low in carbohydrates and high in protein is associated with an increase in total mortality.

Keywords: diet, survival, protein intake, carbohydrate intake, cohort study

5/03/2007 8:46 AM  
Blogger Valerie Jacobsen said...

Dr. Acocella, I just found this post when I was doing a Google search. I suppose I am far too late for any discussion, but....

Did you read the full study? Do you know if the authors controlled for body weight?

I'm trying to think of possible etiologies for an increased risk of death with a decreased intake of carbohydrate.

The only thing that comes quickly to mind is the inreased prevalence of obesity in the low carb community.

An association is not a cause. What do you think?

8/18/2007 12:21 AM  
Blogger Robert said...

Interesting. I am curious however. Are you familiar with the PH balance theory? Where an over acidic or over alkaline condition in the body has been shown to lead to almost every malady known to man, including obesity? As you are probably aware, meat and most dairy products, when digested by the body, are highly acidic. While I do enjoy meat from time to time, I think a balance is in order here, through the consumption of a variety of healthy foods. The main problem today is that we are "supersized" to death, stressed out, with little time for exercise. Quantity over Quality has become the montra. Just curious what your take is on this. Thank you.

10/11/2007 10:06 PM  
Blogger Jimmy Moore said...

Robert, I don't buy into the PH balance theory, although there may be a minimal causal effect. If what you believe about the acidity of consuming meat and dairy products is true, then it would run counteractive to a low-carbohydrate nutritional approach. Those participants would not lose weight and would be extremely unhealthy. But that is just not the case.

I agree that we are supersized with larger and larger portions of (mostly high-carb) food and we could stand to move and wiggle more than we do. But I'm not about to cut back on my own personal meat consumption because it got me to where I am today.

10/11/2007 10:20 PM  
Blogger Gloriana said...

There is one element to this study - and others I have seen related to low carb - which totally puzzles me. Why is there no significant weight loss? Heavens, I would say a weight loss of ten pounds during INDUCTION is not unusual. I was first attracted to Atkins when a co-worker of mine lost 120 pounds, then a friend lost 30 in two months.

I only lost a little over 60 pounds in a year, but that is not bad for a menopausal woman. I still am far from goal, but, though I've had plateau problems beyond the first year, I never had the slightest problem with gaining. I by no means have iron will power - it took eliminating starches and sugar for cravings to disappear.

As well, those in this study were hardly 'doing low carb' at all. Fifty grams of carbs is too high for most women - raising them to 150 grams is infuriating, because it guarantees weight gain - and this man's idea of 40 PERCENT intake of carbs, not forty grams, is a recipe for failure.

Yet this is not an isolated instance. Are there ANY medical studies (as opposed to our experience - which would show loss of probably a minimum of 50 pounds a year) which show significant weight loss?

11/13/2007 7:33 PM  
Blogger Jimmy Moore said...

I agree, Gloriana, which is why I wrote this blog post asking that very same question. The researchers say they don't force their study participants to remain on the diet strictly which to me proves nothing. Make them stay at 20-30g carbohydrates over a long period of time and that 10-pound weight loss easily becomes 100.

11/13/2007 11:10 PM  

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