The Danger of Low Carb Diets..

[REattempt]

To keep this simple, let's take this one thing, and look at it. There are two problems with what you have said.

First, you are not understanding the meaning of "controlled." <SNIP> The experiment was controlled.

So, to say that the experiment was not controlled is incorrect.

Second, just because he didn't do the experiment you wanted to see, doesn't mean that it was damning or bad science.
<SNIP>

That's all he set out to do, and he did it following the best principles of science.

No one can do this experiment testing cardiovascular results over 20 years. That would be nice, but it's not feasible. The best we can do is look at marker that correlate with CVD.

In summary, it was a randomized, controlled experiment that looked at how different diets would affect subjects' weight and health markers in the real world. It was excellent science.

1) I Agree with you on the controlled study. I misspoke..it was a controlled study. I might even agree with you on the damning or poor science. He did, however, have poor compliance (see below).

2) I wasn't arguing with the loss of weight on Atkins. It may well be the best diet for people to lose weight "in the real world." In fact, it did demonstrate that people who reduced carb intake lost more weight. That's about all the study demonstrated.

3) I do believe that it is a mis-representation. The article published in Jama was Comparison of the Atkins, Zone, Ornish, and LEARN Diets for change in Weight and related risk factors among overweight premenopausal women. It was not a comparison of the diets. It was a comparison of a poorly executed study that got no where near the compliance of well run studies and DOES NOT REFLECT THE ACTUAL RESULTS OF THE DIETS WHEN FOLLOWED.

Ok, with that out, I understand your point about "which diet will work, given my inability to follow directions, for me?" Fair point.

It is OK science, however poorly executed...biggest mistake was in the execution:

What happened in this study that subjects weren't able to follow the basic guidelines of their diets during the period of intense teaching and support? This was an NIH funded study - so, how did a $2-million trial fail to achieve measurable compliance? Other studies note good to excellent compliance, check it out:
ScienceDirect.com - The American Journal of Cardiology - Comparison of Coronary Risk Factors and Quality of Life in Coronary Artery Disease Patients With Versus Without Diabetes Mellitus Ketogenic low-carbohydrate diets have no metabolic advantage over nonketogenic low-carbohydrate diets
Low-Fat Dietary Pattern and Risk of Cardiovascular Disease, February 8, 2006, Howard et al. 295 (6): 655
Low-Fat Dietary Pattern and Weight Change Over 7 Years, January 4, 2006, Howard et al. 295 (1): 39

One thing is clear to me: those tasked with instructing participants about their assigned diets knew the rules of the dietary approach well and were able to communicate, clearly, how to implement the necessary dietary changes to participants in the studies.

In this study (AtoZ): "[t]he same dietitian taught all classes to all groups in all 4 cohorts."
and per the video, the follow-up support was "thank you for your input, goodbye."

It's clear to me, from this study's method of instruction compared with other studies with better compliance, that it is not just knowledge of a diet that is necessary to teach someone how to follow a diet, but actual expertise of the dietary approach is critically important. The enthusiasm and understanding of the approach. Compliance is driven by the quality of the instruction and the follow-up and support.

Compliance stunk across the board...even the Atkins group had poor compliance.

These are not the best principles of Science. They are sloppy execution.

I get that they took the "public health" approach, but then name it something different..."Dietary results for AtoZ based on real world compliance....."

Finally, I agree that we need a 20 year time horizon to truly "know." However, I disagree with the assertion that looking at the markers are "the best we can do." I believe that looking at outcomes (CVD, CHD, blood flow) are better measure of cardiac impact than simply the markers.

 

[donheff]

Not sure if this study may have been mentioned above but I will toss it out as relevant in any event. I was looking for info on a different topic at the National Center for Complementary and Alternative Medicine (NCCAM) site. NCCAM is a government funded outfit that employs a lot of real scientists and has a mission to explore the efficacy of alternative health approaches. I happened to notice a link to Atkins in the index and found it contains one NCCAM funded study from 2007. The study compared four diets (including Atkins and Ornish) for 1 year with 311 women. It found Atkins resulted in the greatest weight loss (I don't think there is much argument here on Atkins being good for weight loss) but significantly it found good metabolic effects. From the summary:

The Atkins diet group reported the most weight loss at 12 months with an average loss of 4.7 kilograms, or just over 10 pounds. They also had more favorable overall metabolic effects. Average weight loss across all four groups ranged from 3.5 to 10.4 pounds. The authors note that “even modest reductions in excess weight have clinically significant effects on risk factors such as triglycerides and blood pressure.”​

This does not in any way mean that the Ornish diet couldn't be the "best" for overall wellness. But it does support the contention that LCHF may be a good alternative - and doable for many like me who could never endure Ornish. Here is NCCAM summary.

 

[REattempt]

Not sure if this study may have been mentioned above....

Donheff...yes, this is the same study that we are discussing above.

They funded him/them for $2MM.

I think we (me and T-Al) are in agreement the science is fine, but I contend the results are misleading because of the poor compliance.

Based on looking around after my "issue" with the mis-representation and the the compliance issue, come to find out, they actually did a sub-study 1 year later...specifically on my issue, compliance/adherence: Dietary adherence and weight loss success among overweight women: results from the A TO Z weight loss study.

Dietary adherence and weight loss success ... [Int J Obes (Lond). 2008] - PubMed - NCBI

Here are the actual compliance numbers from the study:

"Across all three diet groups, only one participant, in the Ornish group, met the criteria for absolute adherence at all three post-randomization time points. A total of nine participants from the three diet groups met the absolute adherence criteria for at least two of the three post-randomization time points (Atkins, n=6; Ornish, n=1; and Zone, n=2)."

"...dietary data were available at all four time points for 181 women (78%) (Atkins, n=68; Zone, n=57; and Ornish, n=56)."

So, 6 out of 68 women in the Atkins group were adherent (8.8%); 1 out of 56 in the Ornish group (1.8%), and 2 out of 57 in the Zone group (3.5%). Those are pretty poor adherence numbers. By comparison, Adherence and Success in Long-Term Weight Loss Diets: The Dietary Intervention Randomized Controlled Trial (DIRECT) got somewhere around 55-66% compliance after 2 years. Granted it is self reported, but so was AtoZ.

Either way, they found that the most compliant people lost the most weight....

Atkins
Highest compliance = 8.3kg
p = 0.0006

Zone
Highest compliance = 3.7kg
p = 0.12

Ornish
Highest compliance = 6.5kg
p = 0.06

I'm still trying to get the study itself, I'd like to see the CHD marker results for the highest compliant individuals to compare those results. My guess is that it is not in this study...unfortunately.


I guess the bottom line to this thread, from my perspective is the following:

1) If weight loss is your goal, LCHF/Atkins and LF/Plant based will work.
2) Choose your diet and stick to it, don't cheat...you will get better results.
3) Exercise.
4) Based on data/feedback from the study(ies) above and ER.org participants, adherence to LCHF/Atkins is easier. You will likely be more successful on LCHF/Atkins.
5) If you choose LF/Plant and you follow it, you will have demonstrable improvement in your CHD outcomes and potentially reversal of CHD and an improvement in prostate cancer outcomes.
6) There is no evidence that LCHF/Adkins will improve CHD outcomes or reverse CHD and there is no evidence that it will improve prostate cancer outcomes.
7) There is some evidence to suggest that LCHF/Adkins will exacerbate coronary blood flow in the short term vs. LF/Plant based.

 

[rgarling]

Sorry but your 6 and 7 are both wrong. LCHF diets have been shown to
1. reduce inflammation
2. reduce triglycerides
3. raise HDL
4. foster pattern A LDL profile
5. lower blood pressure
6. reduce arterial plaque
7. reduce body fat / weight
8. improve muscle mass
and more...

Many of these factors are felt to be risk factors for CAD, and improving one's risk factors is thought to improve one's CHD outcomes. Doesn't that count as evidence? Furthermore, the triglycerides / hdl ratio is currently believed to be the BEST indicator of coronary disease. A LCHF diet will quickly improve this ratio.

LCHF keeps blood sugar low, reducing AGE and the risk of cancer. Also, these diets reduce arterial plaque, including in the coronary arteries which generally would improve blood flow to the heart muscle.

 

[Bikerdude]

I still have to go back to Bill Clinton, (who most would agree is a pretty smart guy) who has access to the best medical advice money and fame can buy has chosen a 'Vegan' diet to treat his CAD. Looks like he also lost some weight in the process.

 

[harley]

I still have to go back to Bill Clinton, (who most would agree is a pretty smart guy) who has access to the best medical advice money and fame can buy has chosen a 'Vegan' diet to treat his CAD. Looks like he also lost some weight in the process.

He also had the best political advice that money, power, and fame could buy, and still chose to have an affair with a moderately nice looking woman that nearly derailed his presidency. I'm not basing my decisions on his judgement. Plus, I susect he has a highly paid chef and kitchen staff preparing those veggies into a delicious and non-repetitive form. Vegan or vegetarian fare in real life can be hard to keep interesting and yummy in real life, especially over a long period. Not impossible, but hard.

Regarding the comments about whether the Ornish or LCHF diet is best for dealing with CHD or not, I would just like to point out that even if the Ornish diet is better for CHD, there is a lot more to health than just CHD. As a diabetic, heart failure might be a blessing compared to the long, drawn out, and miserable advance of diabetes. Weight loss and low carb has a direct and measurable positive effect on blood sugar levels. It's easy to see and easy to track. I'll take that over a theoretical argument about which diet is best for general health anytime.

 

[REattempt]

Honestly, I truly love all you guys/gals, but I call UNCLE! I want nothing but good health, long life and happiness for everyone here....

oh, BTW...BACON!!!

Bacon Coffin lets bacon lovers die AND go to Heaven | KING5.com Seattle

 

[jclarksnakes]

Me and the dog had already decided on cremation or we would be putting deposits down on a matching set of the bacon coffins right now. The dogs new favorite word is "BACON!!!!". Anyone want me to post my Fatty recipe? It is really tasty.

 

[Nords]

The real test will take about 6 months - do I stay with it or drift back to my bad habits?

I'm just glad that protein bars come in both chocolate and peanut butter flavors.

And I'm glad that dark chocolate has been declared healthy again. Looks like I'm ahead of the science...

 

[eytonxav]

Heat Surgeon Changes his viewpoint

http://www.sott.net/articles/show/24...-Heart-Disease

The entire article is interesting and worth a read, but if your looking for studies to reference you can stop right now. In part:

"Simply stated, without inflammation being present in the body, there is no way that cholesterol would accumulate in the wall of the blood vessel and cause heart disease and strokes. Without inflammation, cholesterol would move freely throughout the body as nature intended. It is inflammation that causes cholesterol to become trapped.

Inflammation is not complicated -- it is quite simply your body's natural defence to a foreign invader such as a bacteria, toxin or virus. The cycle of inflammation is perfect in how it protects your body from these bacterial and viral invaders. However, if we chronically expose the body to injury by toxins or foods the human body was never designed to process,a condition occurs called chronic inflammation. Chronic inflammation is just as harmful as acute inflammation is beneficial.

What thoughtful person would willfully expose himself repeatedly to foods or other substances that are known to cause injury to the body? Well, smokers perhaps, but at least they made that choice willfully.

The rest of us have simply followed the recommended mainstream diet that is low in fat and high in polyunsaturated fats and carbohydrates, not knowing we were causing repeated injury to our blood vessels. This repeated injury creates chronic inflammation leading to heart disease, stroke, diabetes and obesity.

Let me repeat that: The injury and inflammation in our blood vessels is caused by the low fat diet recommended for years by mainstream medicine.

What are the biggest culprits of chronic inflammation? Quite simply, they are the overload of simple, highly processed carbohydrates (sugar, flour and all the products made from them) and the excess consumption of omega-6 vegetable oils like soybean, corn and sunflower that are found in many processed foods. "
​

 

[REattempt]

What are the biggest culprits of chronic inflammation? Quite simply, they are the overload of simple, highly processed carbohydrates (sugar, flour and all the products made from them) and the excess consumption of omega-6 vegetable oils like soybean, corn and sunflower that are found in many processed foods. "

Just to be clear, he is of the belief that inflammation is what captures/causes the accumulation of Cholesterol and causes CHD. Not high cholesterol in and of itself.

His statement, "Let me repeat that: The injury and inflammation in our blood vessels is caused by the low fat diet recommended for years by mainstream medicine." I don't think that we can or should interpret this to mean that low fat diet is wrong in his eyes. He is saying that blindly following the low-fat diet by buying and consuming highly processes low-fat foods is causing the inflammation.

To be clear, he is not advocating LCHF diet...The following quote is also from the article you referenced...[just so we don't represent his recommendations as something they are not . Emphasis mine]

"There is no escaping the fact that the more we consume prepared and processed foods, the more we trip the inflammation switch little by little each day. The human body cannot process, nor was it designed to consume, foods packed with sugars and soaked in omega-6 oils.

There is but one answer to quieting inflammation, and that is returning to foods closer to their natural state. To build muscle, eat more protein. Choose carbohydrates that are very complex such as colorful fruits and vegetables. Cut down on or eliminate inflammation- causing omega-6 fats like corn and soybean oil and the processed foods that are made from them.

What you can do is choose whole foods your grandmother served and not those your mom turned to as grocery store aisles filled with manufactured foods. By eliminating inflammatory foods and adding essential nutrients from fresh unprocessed food, you will reverse years of damage in your arteries and throughout your body from consuming the typical American diet. "

 

[REattempt]

I called uncle and that still stands.

I read Good Calories, Bad Calories this weekend. Very interesting read. I don't buy that LCHF is the solution, but it has evolved my thinking and re-directed my own research. Don't have the answers yet and may not, but thanks for pointing me at the book.

Interestingly, after reading the book, I started looking into the premise put forth. To wit: obesity is caused by a regulatory defect in fat metabolism, insulin plays a primary role in the fattening process and carb consumption drives insulin production.

As a result, you may find this interesting:

Whole Health Source: The Carbohydrate Hypothesis of Obesity: a Critical Examination

By the way, this author is a Paleo diet fan, which is very close to Atkins as I understand (without much research)...

 

[jclarksnakes]

To be clear, he is not advocating LCHF diet...The following quote is also from the article you referenced...[just so we don't represent his recommendations as something they are not . Emphasis mine]

He is in fact advocating the LCHF diet I know. His one answer to quieting inflammation by returning to real food like our grandmas made and cutting out processed foods and omega 3 fats and limiting carbs to some of the complex ones is amazingly similar to the Swedish "Dietdoctors" LCHF diet. I think you are trying to warn us about a diet that you do not know enough about.

LCHF for beginners | Dietdoctor.com (link is to the DietDoctor LCHF diet)

I am not prepared to claim that I am sure that this LCHF diet is the very best diet for weight control and cardiac health but it is a diet that actually works for those purposes. More importantly this diet works for people who have failed at other diets because people can more easily stick with this diet. For me almost entirely cutting out sugar and processed foods and omega 3 fats is easy. The decision on how much to cut back on the better natural carbs like beans and rice and fresh fruit is not quite as easy.

 

[eytonxav]

Just to be clear, he is of the belief that inflammation is what captures/causes the accumulation of Cholesterol and causes CHD. Not high cholesterol in and of itself.

His statement, "Let me repeat that: The injury and inflammation in our blood vessels is caused by the low fat diet recommended for years by mainstream medicine." I don't think that we can or should interpret this to mean that low fat diet is wrong in his eyes. He is saying that blindly following the low-fat diet by buying and consuming highly processes low-fat foods is causing the inflammation.

To be clear, he is not advocating LCHF diet...The following quote is also from the article you referenced...[just so we don't represent his recommendations as something they are not . Emphasis mine]

Just to be clear, where in my post did I claim he was advocating a LCHF diet For someone who called uncle you seem kind of defensive to me.

 

[donheff]

I called uncle and that still stands.

I read Good Calories, Bad Calories this weekend. Very interesting read. I don't buy that LCHF is the solution, but it has evolved my thinking and re-directed my own research. Don't have the answers yet and may not, but thanks for pointing me at the book.

Interestingly, after reading the book, I started looking into the premise put forth. To wit: obesity is caused by a regulatory defect in fat metabolism, insulin plays a primary role in the fattening process and carb consumption drives insulin production.

As a result, you may find this interesting:

Whole Health Source: The Carbohydrate Hypothesis of Obesity: a Critical Examination

By the way, this author is a Paleo diet fan, which is very close to Atkins as I understand (without much research)...

Don't bow completely out of the discussion. The back and forth is valuable since, lets face it, none of us know for sure what the answers are. It appears the entire medical establishment got it wrong for half a century so assuming we figured it out in a couple of evenings is the height of hubris. In any event, I am enjoying the readings and will take a look at the two books you referenced (provided they are available free from the library - I have my standards after all)

Here is another one to add to the list:

The Blood Sugar Solution, by Mark Hyman, MD. Quite interesting and, again, death on sugars and refined carbs, about which he marshals some good science. This guy seems close to the Ornish approach although he is not very clear about why the need to limit fat. He also sounds a bit more moderate in his preference for avoiding meat. And his aversion to fake sweetners doesn't cite any research IIRC just speculation that the sweetness will trigger cravings for more food (thus more calories). Anecdotaly, I haven't experienced that in my vast 1 1/2 weeks experience.

Sanjay Gupta joined the fray on 60 minutes last night with a new study that demonstrates the horrible impact of sugar. A group in CA did a highly controlled study with a group who were kept in captivity under observation to make sure they couldn't sneak out and break their diets. They were fed a low card diet for a week to get their base blood level measures and then split into high sugar and low sugar groups and measured after two weeks. The high sugar group was floating in the nasty cholesterol particles so worrisome for CHD. The study did not appear to address fat - just sugars/carbs. I suspect the fat side would be a much longer proposition and unlikely to be tested.

 

[donheff]

I read the Whole Health Source article by Dr. Guyenet. Pretty good. I also read some of Taubes' stuff on his blog. Also good. They seem to both be interested in science not self defense. I added Guyenet's and Taubes' blogs to my RSS reader so I can observe the back and forth as it develops

The only firm take away I have so far is that reducing sugar and refined carbs is definitely good. The jury seems to be out on a lot of other hypothesis (e.g. get rid of complex carbs too, get rid of fat, get rid of meat, or vice versus). In any event, I just returned from the gym and am down another pound to 175. Still sticking with relatively LCHF (not radical at all) and still not having any hunger issues.

 

[haha]

Don't bow completely out of the discussion. The back and forth is valuable since, lets face it, none of us know for sure what the answers are. It appears the entire medical establishment got it wrong for half a century so assuming we figured it out in a couple of evenings is the height of hubris.

This is where I have trouble with one aspect of internet boards. How is one person who knows a limited amount about some topic, which may or may not even be correct, going to learn anything by arguing with another person possessing the same faulty or limited knowledge?

It seems likely to me that one's time might be better spent reading papers, listening to podcasts and reading observations by experts who are actually scientists working in the field, or as in the case of the Swede, or Mary Vernon or some other practicing MDs (non-scientists) who have a great deal of clinical experience.
There will be plenty controversy right there, and plenty need to judge to what extent marketing affects their statements.

To me, getting entangled in one of these "discussions" is just proof that one doesn't have much confidence yet in any position, hence the attempt to convince oneself by convincing others.

Ha

 

[REattempt]

Just to be clear, where in my post did I claim he was advocating a LCHF diet For someone who called uncle you seem kind of defensive to me.

You didn't, the doctor did (from your post): "Let me repeat that: The injury and inflammation in our blood vessels is caused by the low fat diet recommended for years by mainstream medicine." My interpretation is that this is advocacy of a LCHF.

That is why I was careful to use "we" when I made my statement. I'm happy to jump in the boat! I'm sorry that it came out the wrong way.... wasn't my intent.

 

[donheff]

This is where I have trouble with one aspect of internet boards. How is one person who knows a limited amount about some topic, which may or may not even be correct, going to learn anything by arguing with another person possessing the same faulty or limited knowledge?

It seems likely to me that one's time might be better spent reading papers, listening to podcasts and reading observations by experts who are actually scientists working in the field, or as in the case of the Swede, or Mary Vernon or some other practicing MDs (non-scientists) who have a great deal of clinical experience.
There will be plenty controversy right there, and plenty need to judge to what extent marketing affects their statements.

To me, getting entangled in one of these "discussions" is just proof that one doesn't have much confidence yet in any position, hence the attempt to convince oneself by convincing others.

Ha

Maybe. But I like hearing what other people have to say. And it often leads me to interesting technical references as was the case with this thread. Same thing happened with investing -- I was in a bunch of managed funds when I stumbled on this site but discussion and references I read here led me to books and articles that swung me in a different direction I am very happy with.

I agree that the vociferous, defend our position, arguments are not valuable but a lot of people simply like to argue so if you can take all that lightly it is still fun. You obviously are capable of that since you follow lots of low content/high volume threads and drop in a pithy comment or two.

 

[haha]

You obviously are capable of that since you follow lots of low content/high volume threads and drop in a pithy comment or two.

Oh-oh, caught. I would like to go cold turkey on that stuff (including my comments) but I have not yet been able to pull it off. It's harder than exercising everyday, harder than taking my vitamins, harder than watching my weight.

Ha

 

[REattempt]

LCHF for beginners | Dietdoctor.com (link is to the DietDoctor LCHF diet)

For me almost entirely cutting out sugar and processed foods and omega 3 fats is easy. The decision on how much to cut back on the better natural carbs like beans and rice and fresh fruit is not quite as easy.

JC, this post threw me for a loop. Everything I'm reading is saying to cut out the Omega 6 and shift to omega 3. Even the article you quoted says reduce omega 6. Was this a typo or did you truly mean cutting out omega 3s? If so, why? Thanks.

+++1 on "The decision on how much to cut back on the better natural carbs..." This is exactly where I'm at...on the other side. I think fats (the right ones), fish and meats in the right portions, nuts, eggs etc. are good for me, I'm just not sure how much to add them back to the diet.

and Oh, BTW, I forgot...BACON!

 

[jclarksnakes]

JC, this post threw me for a loop. Everything I'm reading is saying to cut out the Omega 6 and shift to omega 3. Even the article you quoted says reduce omega 6. Was this a typo or did you truly mean cutting out omega 3s? If so, why? Thanks.

+++1 on "The decision on how much to cut back on the better natural carbs..." This is exactly where I'm at...on the other side. I think fats (the right ones), fish and meats in the right portions, nuts, eggs etc. are good for me, I'm just not sure how much to add them back to the diet.

and Oh, BTW, I forgot...BACON!

Oops, my bad, it was either a typo or a senior moment on the omega fat numbers.

 

[eytonxav]

You didn't, the doctor did (from your post): "Let me repeat that: The injury and inflammation in our blood vessels is caused by the low fat diet recommended for years by mainstream medicine." My interpretation is that this is advocacy of a LCHF.

That is why I was careful to use "we" when I made my statement. I'm happy to jump in the boat! I'm sorry that it came out the wrong way.... wasn't my intent.

OK, got ya, no problem and like the others said, the debate is good so don't bow out.

 

[FinanceDude]

Are you saying that it has laxative properties?

Uh no, but this forum is pretty opiniated, and full of those who believe that food companies are full of chemist cooking up witch doctor-like potions in a cauldron all the while counting their stock options..........

 

[eytonxav]

Uh no, but this forum is pretty opiniated, and full of those who believe that food companies are full of chemist cooking up witch doctor-like potions in a cauldron all the while counting their stock options..........

Yeah, but its those finance dudes in those food companies that are driving the chemists to do it