Today sees the publication of a study in the Journal of the American Medical Association in which the effectiveness of four diets were assessed over a year-long period [1]. Researchers at Stanford University School of Medicine ascribed women to eat either the Atkins’ diet (low carb), Zone diet (carb, protein and fat in the ratio of 40:30:30), LEARN diet (based on standard food pyramid) and the Ornish diet (low fat, high carb).
At the end of the year it was revealed that the most effective regime was the Atkins diet, with an average weight loss of 10.4 lbs. Average weight loss on the Zone, LEARN and Ornish diets were 3.5, 5.7, 4.8 lbs respectively. Note here that the effectiveness of the Atkins diet was approximately double that of higher carb diets (Ornish and LEARN).
But that’s not all, because the Atkins’ diet, compared to at least one of the other diets, brought about significant improvements in one or more health measurements such as blood triglyceride levels, ‘healthy’ high density lipoprotein (HDL) cholesterol levels and blood pressure. Taken as a whole, the Atkins’ diet beat the other ones hands down.
This result may come as a surprise to those who continue to tout the ‘benefits’ of a low fat diet. However, I can pretty sure these findings are precisely what individuals who use low and lower-carb diets in practice would expect. I, personally, have found lower-carb diets broadly beneficial not just in terms of weight loss, but in normalising physiology and biochemistry too.
Dr Chrisopher Gardner, one of the authors of this study, has speculated about how it might be that the Atkins’ diet might outperform other types of diets. He cited the fact that it was a simple message which people could easily understand and put intopratice. He also made reference to the fact that the diet is encourages water consumption and is rich in protein ” which, calorie for calorie, is more sating than either carbohydrate or fat.
All these seem like reasonable explanations for the apparent superiority of low-carb diets.
However, there is another fundamental reason why low-carb diets may be the best for us: they mirror the diet we are designed for.
Through the process of evolution, we have become best suited to the foods which we had access to. For the vast majority of our time on this planet this meant a diet based on meat, fish, vegetable matter, fruit, nuts and seeds. Analysis of primitive hunter-gatherer diets allows us a window into our evolutionary diet [2]. It turns out that compared to the primitive diet which we evolved on, the typical Western diet is significantly lower in protein and fat, while being much richer in carbohydrate.
Put another way, compared to the typical Western diet, the Atkins’ diet and other low-carb approaches are much more in keeping with the diet we, as a species, are best suited to from a genetic, metabolic, biochemical and physiological perspective. Let’s not be too surprised, then, that such as diet brings more benefits for health than higher-carb, lower-fat approaches traditionally touted as ‘healthy’.
References:
1. Gardner CD, et al. Comparison of the Atkins, Zone, Ornish, and LEARN Diets for Change in Weight and Related Risk Factors Among Overweight Premenopausal Women: The A TO Z Weight Loss Study: A Randomized Trial JAMA. 2007;297:969-977.
2. Cordain L, et al. Plant-animal subsistence ratios and macronutrient energy estimations in worldwide hunter-gatherer diets. Am J Clin Nutr 2000;71:682-92
Dr Briffa is right when he says that the findings of this trial in terms of superior weight loss and normalised biochemistry come as no surprise to experienced low carbers. Dr Briffa also embraces the concept of ‘the diet humans are designed for’. Unfortunately both concepts are lost on most medical professionals, who seem to be in denial about the benefits and safety of low carb diets, believing that the only healthy diet is a high carb/low fat one.
The irony of it is, that in refusing to accept that ‘low carb science’ may just be valid after all, and in preventing open and honest debate about it, these same medical professionals are needlessly prolonging the suffering of millions of people afflicted by or at risk of obesity, type 2 diabetes and the health problems that accompany these conditions.
Although low carb came out best of the bunch, all 4 groups were regaining weight at the end of twelve months.
Guess it shows how in real life, sticking to a long term change in eating behaviour is not easy.
Which doesn’t mean the concept of low carb is necessarily wrong, just that people are surrounded by temptation and that considerable will-power is required.!
a study being undertaken in the west country is looking at compliance of low carb diets opposed to a higher carb intake. The problem is that a low carb diet is actually rather difficult to keep to – in fact the study in question does not seem to be showing any difference in diabetic control , blood lipids – yes the low carbers have lost wt but it is mainly because the low carb diet has severly restricted the calorie intake.
in real life a very low carb diet is difficult to keep to !
Hi Chris, out of interest, where in the West Country is the study? (Its where I live)
Also, do you know how low they are trying to get the carb intake?
Thanks,
Neil
it is right acroos the devon area – their interim results have shown the same thing that low carb diet does have a greater wt loss in the short term – the problem is always compliance. They stareted with around 60g carb but patients migrated upwards because of it being so difficult. You see what winds me up with the low carb ideas is thta the foods are expensive, often inaccessable and alien – I think it is always obviuos to me that the recipes and meal ideas have been planned by people who havent a clue about reality – atkins is a prime example!
they hope to publish maybe next year but they havent found any major difference apart from the greater wt loss in bs control or lipids – intersting seeing as there are many making a fortune out a low carb existence!
i just wish there was a way as a Dietitian of reporting our findings without a study! i have a lot of patients who have lost wt with the atkins type plan but have found it so difficult to keep to long term and the lipid profiles have been different to some of these studies too!
I would agree that a low carb diet can be very difficult to keep to. But that’s because we are surrounded by high carb foods and high carb eating habits. Those of us at the ‘forefront’ have to be prepared to lead the way and suffer the inconveniences – eventually the food manufacturers and catering establishments will get the message and make it easier for us. The advent of Low GI will help.
Causing change in the amount of highly refined and processed carbs people eat is too important for us to be put off by the fact that it’s difficult.
I think there are two main aspects to the ‘it’s too difficult’ factor – ignorant attitude towards low carb diets by the medical establishment (Dr Briffa excepted!), and availability of low carb alternatives. (I don’t mean low carb ‘fake food’, I mean foods that are naturally low in carbs like fish, meat, seeds, nuts and vegetables). Hopefully with more low carb studies appearing, the attitude problem will now start to change, and low carbers will be able to follow their diets openly, with the full support of their doctors, nutritionists, weight loss clubs and magazines etc. This should then have a knock-on effect in the food manufacturing and catering world.
Meanwhile the low carber websites and forums do a good job of helping people make the change to a low or lower carb way of eating – maybe the problem with the people who ‘put the weight back on’ or ‘find it too difficult to continue’ after the study is over are not put in contact with these sites and forums and are simply unaware of the support that’s available to them? Personally as a low carber myself, I try to ‘help make it easier’ for other low carbers through my low carb website, but I can only help those who know my website exists …
i think u have missed the point here – we are not talking about refined carbs anyway . The problem with alot of these so called low carb sites is that they use american info which certainly does not fit in with my clients – some do not even use British food tables and there is a difference – the internet is littered with appaling web sites.
As a properly trained nutritionist I see the effects of these web sites quite regularly. You also fail to realise that there are alot of people out there that really do not even understand what a carb is !
The gi effect is fine – we have been using it for years long before the low carb concept but there is still alot of research to do. What we need to concentrate on is getting rid of the rubbish in our diets – if you had the number of food diaries I have then you would know the problem is the junk not carbs as a whole.- crips, sweets , fizzy drinks, pies, pies, cakes etc – that is where we need to concentrate!
Chris
I don’t think Jackie has missed the point. While the foods you single out are, i think, unhealthy, many carbohydrate sources traditionally regarded as ‘healthy’ can also pose hazards for health.
Certain wholegrain breakfast cereals and wholemeal bread, for instance, tend to have high GI’s, and may also need to be moderated in or eliminated from the diet for optimal health.
Also, can I add that, in my experience, individuals do not usually need to go to Atkins-esque extremes to get the benefit of eating a lower carb diet. I think Jackie is right to advocate a diet based on natural, unprocessed foods. In reality, I find that individuals find the sort of diet she outlines as both healthy and sustainable.
john – u jsut missed the point – I advocatae eating fresh foods but eating carbs does not mean excluding bread , potatoes and some cereals. If they eaten in conjunction with other healthy measures they are fine. One does not have to be extreme at all !
I eat them and am perfectly healthy but i stay away from the refined carbs and that is what we need to be impressing on people! Also one cannot expect people to be perfect all the time – i am sure even you are not. Taking foods in isolation is the probem – we need to look at the whole diet and that is what nutritionists do .
I don’t agree. As I just pointed out, certain unrefined carbs are about as disruptive to the body’s biochemistry as refined ones, and therefore need to be consumed with conisderable caution by certain people (especially those with abdominal obesity, metabolic syndrome or diabetes).
I’m glad you seem to be able to eat certain starchy carbs and are perfectly healthy – however there is a huge body of evidence now linking the consumption of high HI carbs (which as I’ve already pointed out, include, wholemeal bread and certain wholegrain breakfast cereals) with a range of ills including weight gain and diabetes.
You say you accept the GI diet, but that does not seem to extend for you to wholegrains of high GI. Can I ask why?
i eat wholemeal or granary bread but I believe it is the portion size and also what you have with it – there is still not enough work done on the mix of foods is there?. If I have bread and for most of my clients i rec a couple of slices and the cereals i eat are things like oats, shredded wheat etc.
I wonder what is wrong with that – I must admit I have tried less than 50 g carbs and felt dead!
I also think the practicalities of removing carbs – some of my clients are manual workers and lorry drivers who cook in the cab – they need bread etc.
Most of my diabetics are on moderate carb intakes and the overall hba results in the surgeries are very good. You see in practical terms for the vast majority of people a low carb diet relying on alien foods wont work! Ithink you deal with very different types of people
ps i guess you are saying u never eat any of these carbs!
There’s nothing ‘wrong’ with your approach – I just believe it poses significant hazards for health by virtue of the high GI (and generally high glycaemic load) foods it contains.
Shredded Wheat and wholemeal bread, as you will no doubt know, are high GI foods. So, for example, why would we be suggesting that a diabetic eat them? And what’s so ‘alien’ about naturally low GI/low GL foods such as meat, fish, eggs, vegetables and nuts?
You say the hba (do you mean HbA1c?) values in your diabetics are generally very good – could you give me what you mean by ‘very good’? Because I don’t think I’ve ever seen a diabetic eating a diet including the foods you advocate with a normal HbA1c level.
I have, however, seen diagnosed Type 1 and 2 diabetics have entirely normal HbA1c (i.e. non-diabetic) levels on a properly carb-controlled diet.
I include very little starchy carb indeed in my diet. I certainly don’t base meals on it. And if I were diabetic, I would eat even less.
‘ G.I.’ probably belongs in the dustbin, ‘G.L.’ looks like a far more useful concept, and at least recognises that portion size/ total carb intake is also important.
If I suffered from high blood sugars (how about renaming Type 2 diabetes as Chronic Carbohydrate Metabolism Dysfunction?) then i would seriously downgrade my starch consumption. At the moment, touch wood, I’m fine!
As an aside, i read in the Daily Mail in an article entitled MOST BRITONS WILL BE OBESE IN 25 YEARS (March 12th)
the following sentence,
“The number with Type 2 Diabetes, which is caused almost exclusively by fat…….”
Incredible how these basic errors survive isn’t it. The writer was in fact the Deputy Political Editor!
Must point out that my wife gets given the Mail for the Sudoku.
neil – hi . The problem here is that carbs are seen as the enemy but those of us who are working with “real” people at ground level know what the problem is! This is a typical intake from a lady I saw on wed
BF – nil
mm- crisps
Lunch – nil
ev meal – 2 ready meals , 4 packets of crisps, 2 bars of choc, 2 bowls of crunchy nut cornflakes,
3 cans of diet coke! Intotal a litre of skimmed milk. No fruit/veg/or carb from bread etc!
Now it is not difficult to see that too much fat and sugar adding up to alot of calories and no exercise adds up to a high bs and this is very typical. And it is not rocket science. Changing this may take a few months and she will make mistakes but what would be the point of a very low carb intake when the quality of her diet is poor. Web sites dont deal with this – they just make people feel worse.
What we need are more dietitians – half the graduates from last year are unemployed because of the jobs freeze. Then they can spend time with these people. Incidentally this lady was actually a nurse!
I have come to the conclusion that those advocating low carb and high fat intakes actually do not see things from real people’s point of view – maybe as they do not see any!
Chris
What do you mean when you refer to ‘real’ people that consult you? The individuals I (and other practitioners) see in practice are every bit a ‘real’ as your own clients.
I appreciate that some of your clients may have spectacularly unhealthy eating habits – so by all means advise them to get the junk out of their diets.
However, I have seen countless individuals over the years who are eating what, I suspect, you would regard as a ‘healthy’ diet, but who are suffering nonetheless. And the consumption of certain starchy carboohydrates of high GI/GL are a frequent factor here.
Common issues in these indivduals include abdominal obesity, metabolic sydrome and Type 2 diabetes.
Do you really think it’s appropriate to suggest that these individuals and their health issues are somehow not ‘real’ enough to warrant proper attention and the best dietary advice we can give?
I do not think that eating pattern is very unusual at all – and yes many present with “healthy” diet but quite often it is the portion sizes. I have encountered the lady eating 2 whole chickens at a meal or the poud of beef oh and the best one was a lady who was consuming 20 cartons (and yes this is true) of sugar free yogurt because on slimming world red days it was a free food. Peoples perception of portions is quite extradorinary at times. Dietitians are very skilled at this and taking food diaries – a major part of our training and post grad competancies. Oh and i dont think this is perculiar to south wales ! The channel 5 prog last night showed 4 very obese patients who were consuming around 15000 calories a day and thought they only ate 2 meals a day!
You still havent ans any of my questions!
i have had time to reflect over the said study and have come to the conclusion that it hasnt shown very much at all – hardly much to crow over after a year.
Chris
I’m at a loss to understand why you think your personal experience with individuals gorging on meat or sugar-free yoghurts has to do with my question about giving individuals appropriate advice carb intake, particularly when suffering from conditions such as metabolic syndrome and Type 2 diabetes.
Glad you have ‘reflected’ on the JAMA study, but I do think it is a shame you feel the need to dismiss the clearly superior results produced by the low-carb approach.
I suppose there are none so blind as those who do not want to see.
Hi Chris, not knowing what ready meals the lady tends to eat, I can’t really comment on them. Some ready meals are a lot better than others.
The rest of her typical intake, I would characterise as high carbohydrate (most of the carb being sugar) low fat and moderate protein, and frankly as junk food (or perhaps ‘pleasure food’. The best part probably the nuts on the crunchy nut cornflakes. Why have skimmed milk when you can have whole milk?
We’ve had decades of a government led low fat high carb agenda and I don’t see any evidence of its benefit. Quite the reverse in fact. As an experiment, which is exactly what it has been, it has failed, and a new direction is needed.
I do think that the food industry is highly adept at manipulating our tastes towards foods that suit them and the superstores, ie low cost high profit margin. I can’t quote any figures, but I’m positive that a ready meal or a box of cornflakes or packets of crisps have a higher profit margin than perishables like fresh veg. Hence real people are coerced into buying cheap (to produce) highly processed foods. Which translates as carbohydrate and vegetable/seed oils.
If the government is serious about 5 a day (and where is the RCT evidence that 5 a day is better than 4 a day but not as good as 6 a day??) then why are fruit and veg not subsidised?
I think the JAMA trial eschewed a more controlled scientific trial in favour of a trial that looked at what happens when people (presumably motivated, and apparently paid) try particular diets. It would have been better to let them read about all 4 diets, then choose which one they wanted to follow. For all its shortcomings, it at least lasted far longer than most trials ( and cost a lot of money)
Dietitians have a valuable role, I just think the dietary guidelines they have at their disposal are the problem.
Right, time for some fajitas!
John – what I am trying to highlight is that people do bizzare things – surely u see that with your clients ! And that focusing on one part of our diet like carbs is the wrong way – we need to be holistic!
that trial does not prove anything – and a year is not long enough. I have seen patients who have lost more than that following atkins but cannot keep to it long term and that is something that trials do not reflect.
Your approach is very idealistic i think.
i am not blind but I am a realist – and have a very down to earth approach!
Ps – did u see channel 5 last night – facts about food ! the dentist who described his atkins pateints as smelly – he should know he gets closest to them. he described it as sour apples with a stilton cheese sauce – how nice !
Chris
Individuals are usually able to maintain a low-carb diet if appropriately educated and supported.
There is now a signficant body of evidence that supports the use of low-carb eating for ills such as obesity and diabetes. You can choose to ignore this, but I choose not to (for the sake of my patients).
I don’t believe my approach is ‘idealistic’ – but it is evidence-based.
And your stance, it seems, is based anecdotes such as the one about the dentist objecting to the supposed smell of the breath of his patients who are on Atkins. Hardly what you’d call intellectually or scientifically rigorous, I reckon.
As I said, there are none so blind…
Are there any high quality dietary trials that have lasted more than a year? Anybody got any accessible links or references please?
Saw the C5 prog, quite funny in a 6th form sense ( thats a compliment) but the humour got too muddled up with the factual stuff.
I don’t ‘do Atkins’ and never have, but the item shown on C5 was just an excuse for a piss take instead of showing something more serious.
Dietitians may well have a holistic approach to diet ( careful with ‘holistic’ it’s getting strongly associated with ‘woo’ merchants like GM) rather than focussing on single aspects of diet, but the mainstream media ( as per HMG and official nutrition) is equally pretty single minded about reducing one’s Saturated fat intake.
People are often bizarre (makes the world go round), and the vast majority are simply unable to cope with a rigorous diet for any length of time. If push comes to shove, they’ll go for the easy option most times. But people’s ‘weakness’ doesn’t in itself invalidate the validity of any particular style of nutrition. Maybe with better support from the mainstream so-called fad diets would be better adhered to. Instead, these dieters are depicted as cranks and loonies rather than supported. Maybe the question to research with any diet that produces weight loss and improvement in surrogate blood markers (as does low carb for example) is why people fail to keep to it and relapse.
John – I think u have missed the point completely and not ans some points I made to you.
Diietitian do not advocate a low fat diet at all – but a normal amount . Th carb issue I do not think is easy at all – for a start u may deal with people who can grasp it but alot of people do not. I see a broader spectrum of clients and to tell a manual worker to take a salad and nuts to work is uterly unworkable.
I keep saying to you that the problem with our weight issues here is the total amount of junk we are collectively eating combined with the complete lack of understanding of how to put a meal together and alcohol. I regularly run cooking workshops for young adults – it is very alarming that they have no knowledge at all.
Trials and studies are of course important but for those of working at the coal face we are confronted with the realities of coping with life food / families/ work etc and a trial does not look at that at all.
The trial in the west country has lasted for 2 years – slightly better!
but above all one has to retain a sense of humour !
Chris
I don’t know about you, but somehow I don’t feel that the plight we face with regard to conditions such as obesity and Type 2 diabetes is anything to smile or laugh about.
neil – I think we are really in danger of turning people off – look at the studies on here alone – eat this , dont do that etc.
Nutrition is a minefield at the moment and so called self taught experts are also making it worse. I think we are in danger of people just switching off! We have t have a lead and it is right that the govt or a body does this in an unbiased way.
I think the internet is making it worse because there are some real cranks on there!
Right off for a fry up and off to see wales slaughter england!!
lol
Chris, so basically you are saying that you have to compromise on the advice you give to clients. I don’t see why a manual worker can’t take salad and nuts to work. I know it’s a big change but if you explain why, many people are not so stuck in their ways as you are suggesting. Whatever you may think of her, Gillian McKeith gets many people to change their ways in terms of their dietary habits. It needs regular and consistent follow up.
Linda
Well it wasn’t a slaughter Chris, but still a defeat for England. 🙁
I agree there are some cranks around, perhaps the fact that they exist and even prosper is partly down to the failure of what comes under the umbrella of mainstream nutrition. The govt may be leading, but there’s a wrong turning crept in.
I suppose the best ‘trial’ was the one inadvertently that began in 1940 and continued to 1954 rationing during WW2. This is sometimes used to try and support the notion that restriction of animal fat and protein is a good thing for heart health. There was a short lived decrease in heart disease (between 3 and 4 years) in the early years of the war, but after this, heart disease rates continued the previous rise even more steeply.
However the decrease actually began in 1939, well before the start of rationing.
Have you any link to anything on the West Country trial or any info on the centre conducting the trial, please Chris
Sadly, I see the point made here (as elsewhere) that there is something inherantly wrong with the low-carb approach because people gain the weight back after ending the regimen. I have personal experience with this, as I had lost 50lbs on Atkins but gained nearly half of it back a couple of years later. The reason I regained some of the weight was that I grew homesick for my high-carb lifestyle.
Exactly how does this reflect badly on low-carb? That it is unsustainable?
Our society (in the US) and yours in the UK have both fallen headlong for the low-fat mantra. The vast majority of take-out, dine-in, and convenience food still reflects this erroneous science. We are surrounded by high-carb foods and have been for decades. We have grown up eating this stuff. All of our favorite foods are high-carb. So when we eschew the carbs and lose significant weight, it’s only natural to go off the diet and attemp to go back to the former eating habits. Hence the weight gain.
I am once again on Atkins, and have gotten to within 15lbs of my goal (25lbs lost since Sept 06). This time I’ll not make the same mistake as before – processed sugars and grain products will likely never reenter my eating regimen. Moderate amounts of fruit and loads of veggies and nuts will. All the while I will continue to eat freely of the Atkins fare of meats and eggs. With regular excercise I expect to maintain 170 – 175lbs for the remainder of my life. I will be spared the ill effects of low-fat diets – poor cholesterol profile, high triglycerides and metabolic syndrome.
Don’t bother criticizing my diet because it failed me once. It’s not unlike criticizing soap because I got dirty a few hours after using it.
Being an overweight middle-aged man, I have been reading this debate with considerable interest.
The only time that I have ever been on “a diet” was 5 weeks of Atkins as a volunteer in a study at the University of Surrey &, although I lost weight, I found it to be an expensive way of feeling miserable!
Despite that, I still think that Dr Briffa’s point that a low-carbohydrate regime corresponds with the kind of diet that homo sapiens adapted to & thrived on over a few million years until the first agricultural revolution, is well made.
It surely also true that humans are adaptable. Inuits traditionally eat very little carbohydrate whereas the Japanese diet consists of 80% carbohydrate [source: The Oxford Companion to Food]. Sumo wrestlers apart, the Japanese are not known for being obese & as far as I am aware have not, historically, been plagued by widespread type 2 diabetes.
Although, as the JAMA study shows, it is possible for us as individuals to live healthily on a low-carbohydrate diet it is difficult to imagine how the same thing would be possible on a population level because this sort of diet is expensive not just in monetary terms but also in terms of its environmental impact & practicality. It is possible to argue that the modern world in which we live was only made possible by the introduction of a substantial proportion of carbohydrate into our diets because it allowed for the expansion of the population, the development of cities, culture & science. Until very recently, obesity was an indication of wealth & confined to a minority.
Some have claimed that we inhabit an obesinogenic (if that’s the correct spelling!) environment & that it is the 24/7 availability of cheap, calorie-rich foods, rather than the proportions of different food types in our diets which is responsible for the situation in which we find ourselves.
I lost three stone on the GI diet and found it remarkably simple. The most interesting thing about it was realizing what a large percentage of ‘fast food’ involves unhealthy bread, pastry, etc… Oatcakes and hummus saved my life!
I have kept it off for eighteen months and am now planning to lose another 2-3 stone.
I can’t really go back to eating the way I used to (lots of bread, pasta, potatoes, rice) nor do I really want to.
It is better (and actually cheaper) to eat low-carb and eat real, less- or unprocessed foods – not only have I benefitted from this knowledge, but so has my family.
So there.