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Monday, August 20, 2007

Why Is There Such Trivial Weight Loss In Low-Carb Diet Studies?

I am blessed to have some of the most intelligent, insightful, and introspective readers in the entire blogosphere gracing this blog with their presence each and every day. It is my distinct pleasure to have so many of you not just visit, but engage in a dialog about the ideas I present to you here.

Even if you disagree with something I have written, most of the time that simply opens the door for a better understanding by everyone so true learning can take place. I can't tell you how many times I've been personally touched with information that expanded my knowledge base even further about livin' la vida low-carb from a reader who caused me to stop and think. There's nothing wrong with that at all!

Whether you post a remark in the comments section, talk about it in my forum, or e-mail me directly, I am ALWAYS happy to hear every opinion about an issue regardless of where you stand. You may convince me to change what I think about a topic and that's okay. I'm not too proud to admit when I'm off base, so please don't hesitate to challenge me.

Okay, I'm gonna duck now since I've made myself a sitting target! :D

One of my faithful readers recently e-mailed me with an excellent, thought-provoking question about all these low-carb studies that have come out in recent years. You've seen 'em, I'm sure, and I've highlighted quite a few of them at my blog, including the Stanford study from Dr. Christopher Gardner published in JAMA earlier this year and the famous Tufts Popular Diet Trial by Dr. Michael Dansinger a few years back.

The question that intrigued me the most and merited this blog post was about the actual weight loss of the study participants who allegedly went on a low-carb diet.

Here's what she wrote in her e-mail:

Dear Jimmy,

As one who finds low-carb dieting to be close to miraculous, I naturally love reading your blog. I'm down 64 pounds so far--not bad for a menopausal woman--though I'm sorry to say I'm still severely obese and 50 pounds from goal. But it is a great pleasure to be free of the ravenous hunger, exhaustion, and weight gain of the dreadful low-fat diets.

I do have one question and thought you may have a clue. I've read various medical studies about the Atkins diet the including the ones linked to the Atkins web site. I'm totally puzzled as to why these studies keep going on about its being 'safe' (at least briefly...), but no one involved has any significant weight loss.

The latest study I saw (Gardner's JAMA study) showed a loss of only ten pounds in a year! That's about what some people I know lost during Induction. Another study showed a loss of no more than 19 pounds in a year among any subject.

Tell me something: Why do none of these studies show the significant weight loss one would expect if they observed the Atkins diet in the span of a year?


I know she's not the only one to wonder about that and I too have questioned why the weight loss is so...um, inadequate and a far cry from my own experience on this way of eating. Heck, I lost 15 pounds in the first WEEK on my Atkins diet, 30 pounds in the first month, 70 pounds in the first two months, and 100 pounds in about three months!

So what's up with celebrating a measly 10 pounds lost in a year, hmmm? Sure, it was more than the low-fat diet groups, but what's going on with these people. Are they TRYING to sabotage their efforts or what?

Here was my response back to the reader:

Thanks for writing and I appreciate your questions. I was just talking to Dr. Jonny Bowden about this in an interview recently regarding the lack of weight loss in these studies like the JAMA study from Gardner where they only lost 10 pounds in a year.

Remember, compliance on such studies is absolutely horrendous and the study participants actually end up eating about 150 grams of carbohydrate--nowhere close to ANY of the acceptable phases of the Atkins diet or any low-carb diet I'm aware of.

But the good news is there were still improvements in weight and health although not as good as it could have been. The researchers said these studies mimic the real world when people don't stick to their diet. I think they need to look into WHY people don't comply with their diet. Livin' la vida low-carb has been the easiest way for me to eat healthy EVER!

Don't lose heart...this way of eating works and we know it, don't we?! Nobody can ever take that away from us. Keep livin' la vida low-carb and let's be the example of what REAL low-carbers are like!


So, the answer to the question "Why is there such trivial weight loss in low-carb studies?" comes down to compliance with the diet itself. Sure, we can be happy that progress was made in the weight and health of the individuals for moving their carb intake in the right direction, but let's not call what they did a low-carb diet. Lower-carb, perhaps, but NOT low-carb.

Although I enjoy the positive publicity that studies like this give to low-carb diets, especially when improvements are made, the fact is they could be THAT MUCH BETTER if somehow we could get people to follow the plan they were assigned. Is forced compliance too much to ask for so we can get an accurate depiction of what people can expect if they do choose to go on a strict low-carb diet?

If I was put in charge of a group of study participants to give them direction about being on the Atkins diet, you bet your sweet bippy those people would be eating 20g carbohydrates for two weeks and probably no more than 40g carbohydrates for the entire year! I can guarantee you they'll lose more than 10 pounds in that year?! :)

This issue with compliance in the real world is not a good enough reason in my eyes to prevent the study from being strictly controlled to produce meaningful results. Let's see a study that REQUIRES study participants to eat a truly low-fat diet vs. a genuinely low-carb diet and then let's talk.

Is there a researcher willing to make this happen? I know Dr. Eric Westman at Duke University is doing some of this kind of research and he is to be applauded for being willing to get in the trenches to do this kind of research. But it's high time we FINALLY get a major published peer-reviewed study like this that presents a clear picture once and for all.

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8 Comments:

Blogger mrfritznyc said...

a big problem with a lot of these studies is that the subjects are randomly assigned to the diet. Motivation and belief in your particular diet are big factors. I'd imagine a lot of the folks assigned to low carb diet carry around the same negative notions about the diet that we in the media and hear from our less informed friends and family, so it's no suprise that they don't comply.

Imagine if you participated in a study, Jimmy, and were asked to follow Weight Watchers for 3 months, hahaaa...

Also, the study subjects are often provided diet instructions by nutritionists who actively believe the diet is dangerous, how effective is that gonna be?

Try to imagine Jimmy giving low fat instructions to a group of subjects and maybe you'll see what I mean.

8/21/2007 8:04 AM  
Blogger Jimmy Moore said...

Good points, Fritz! And that's why I think they need to describe the diet (without putting a label on it) telling the potential participants the foods they can eat ahead of time and let them CHOOSE which diet they want. That would give them ownership of the diet and would likely make them MORE successful in the end. Something for researchers to think about.

8/21/2007 9:07 AM  
Blogger Mr. LowBodyFat said...

Good post Jimmy, and you know what I'm going to say right? LOL! It's the calories, not the carbs. I honestly believe that until the LC community wraps its head around the idea that calories are more important in weight loss than carbs, then we are going to continue to have a lot of frustrated folks doing _______ (fill in the low carb diet) and wondering why they can't lose any more weight. I've been there, so have you, as well as many of your readers.

8/21/2007 10:23 AM  
Blogger Pot Kettle Black said...

The problem with studies, version 12.

To "food cop" on test subjects for an entire year is costly. Cost is a factor, especially since funding for LC research is at a premium. I don't think you can cop people too hard. On the upside, compliance in the JAMA study was a lot better than the other three diets, and they were looking more like Atkins lc dieters, hence the good results. But like in a lot of studies, they hit a 6-month wall, and then compliance/carb creep became an issue.

Mr. Low Fat: Yeah, total consumption is an issue. But at the top end of the weightloss, carb reduction is sufficient to move the scale significantly for many. It's only as you get closer to goal weight (for most people) that calories count more significantly. But also, I would suggest there are other things to factor. Calories out. Calorie quality. Insulin response. Alcohol. Digestion efficiency. Spacing for metabolic response. Cal in/Cal out is an overly simplistic model that doesn't account for a lot of factors. Our knowledge and understanding simply isn't there yet.

8/21/2007 11:08 AM  
Blogger Charles said...

Calories still do not count in weight loss, even when you reach your goal weight! I can't believe how many people continue to repeat this dogma despite the fact that there are ZERO studies confirming this. Dr. Mike Eades has a wonderful blog post on this issue that he wrote yesterday at www.proteinpower.com.

Starving your metabolism will only make your body store fat, not burn fat. Eating fat will cause your body to burn fat at twice the amount than if you ate nothing. Benoit, F.L. et al. "Changes in Body Composition During Weight Reduction in Obesity: Balance Studies Comparing Effects of Fasting and a Ketogenic Diet," Annals of Internal Medicine, 63, 1965, pp. 604-612.

8/21/2007 2:05 PM  
Blogger Mr. LowBodyFat said...

Pot Kettle Black: First of all, I love your handle. LOL! Yes, there are other factors that have to be considered; however, the energy balance equation, which includes the calorie out part you mentioned, is at the top. While I agree that there are still things we are learning about this process, the metabolic ward studies done show that the simplistic calories in/calories out equation is pretty spot on when it comes to weight gain and loss, and it's a good place for people to start.

Charles: As someone who has lost more than 130 lbs and have reduced his body fat from 44% to 7%, my goal is 5%, I'm at a lost for words that you would even suggest that calories don't count in weight loss. So, what counts? Also, the study you cite talks about "body composition" during weight loss, not simply weight loss itself. If I follow your logic, then a person eating fat would lose more weight than a person who fasts?

8/22/2007 7:24 PM  
Blogger melodiegale said...

Here's my 2 cents worth. Maybe what is considered a low carb study just isn't low carb enough. Everybody's ability to burn carbs is different. As to calories, while I think they count (and I'm not really sure of the mechanism) I don't think all calories are created equal. Carbs are the most available to the body for convertion to glucose, followed by protein, and then dietary fat. I believe dietary fat may be utilized using a different pathway. The point is, it's not as simple as calories in vs. calories out. I think it's more like regular, high octane, and diesel. Just depends on the engine.

8/22/2007 10:30 PM  
Blogger Pot Kettle Black said...

Mr. Low: First, congrats on getting to beyond where I want to go. The thing is, we know more than straight calorie in/calorie out already. We know about resting metabolism. We know about metabolic flux. We know about protein burning less efficiently that carbs. Who knows what we don't know. And we all know that lab studies are pale imitations of real life.

Last thing on calories: I think calories are only estimable, on both sides of the equation. Now, a calorie here and there is probably not a lot of fudge in our fudge factor, but I dunno that it's even that small.

As to Charles's comments, I think we (even Dr. Eades) is in agreement that at some point, calories count. It's pretty well documented that folks who eat fat lose more body fat. And really, if I had to weigh 209 forever, I'd rather shed fat and build muscle and be a more muscular 6'2" 209#. So, yes and no to Charles. Will have to review Dr. Eades posting.

8/23/2007 12:02 PM  

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