You don’t have to wait too long before reading some statistic or other that tells us about how rates of obesity are soaring left, right and centre. As ever, though, the advice to ‘eat less and exercise more’ remains the same. That’s a shame, seeing as there is abundant evidence that neither of these approaches is effective for the purposes of weight loss in the long term.
The reasons for the failure of traditional weight loss advice are complex, but have at least something to do with the fact that when people eat less they usually feel hungrier and this is a sensation that few will be able to tolerate in the long term. Plus, when people become more active they tend to be hungrier and also are generally compelled to eat more as a result Perhaps a better approach would be one which would allow individuals to be able to lose weight without being hungry.
Of course a lot of people have already discovered that a way to achieve this is to cut back on carbs. When someone embarks on the Atkins diet, for instance, they will almost always confess to feeling less hungry then the ordinarily do. I just found myself eating less� is a common cry from low-carbers.
One of the reasons that Atkins and diets like it tend to reduce hunger and food intake has to do with the fact that these diets are rich in protein. And calorie for calorie, protein has been found to sate the appetite more than either carbohydrate or fat. The mechanism behind the appetite sating power of protein was recently investigated in a study which is due to be published in the Journal of Clinical Endocrinology and Metabolism. The study, conducted at the University of Washington in Seattle, USA, involved the giving of beverages of different nutritional make-up to a group of 16 subjects. The beverages differed in terms of the relative amounts of protein, fat and carbohydrate they contained.
Before and after consuming the drinks, the subjects had blood drawn and this was analysed for levels of a hormone called ghrelin ” higher levels of which are known to stimulate the appetite. According to reports regarding this study, protein was found to be the best suppressor of ghrelin. It also, not surprisingly, was most effective in terms of sating the appetite.
I was also interest to read about the ghrelin response to carbohydrate. The reason being is that I’ve lost count of the number of people who find that eating a carbohydrate rich diet just fails to satisfy for long. It turns out that after consuming a carb-rich drink, the ghrelin response is suppressed at first. But then, apparently, ghrelin came back with a vengeance, and actually left individuals hungrier than before they had eaten.
This finding is utterly consistent with the experience that some many people have of eating a carb-rich meal which ‘hits the spot’, but only for a relatively short period of time compared to something ‘heavier’ in terms of protein content. There may of course be other mechanisms at play here, but this study does seem to provide a legitimate explanation for many people’s experiences in the real world.
As an addendum to this, I’d also like to discuss the results of a study published this month in the American Journal of Clinical Nutrition [1]. The study involved giving a group of obese men two different diets, each for a 4-week period. Both diets were reasonably rich in protein (30 per cent of calories). The diets different, though, in that one of them low-carb (4 per cent of calories) while the other was higher in carbs (35 per cent of calories). The men were allowed to eat as much of these diets as they liked.
Compared to when eating the higher carb diet, the low-carb diet led to:
1. Reduced hunger
2. Reduced caloric intake (an average of 167 calories less each day)
3. Improved weight loss (weight loss of 6.34 kg compared to 4.35 kg)
The level of carbohydrate restriction in the ‘low-carb’ group was considerable, and might be unsustainable in the long term. However, this study demonstrated very clearly that in a diet containing a decent amount of protein, eating more carb is less satisfying.
Take these two studies together and there is, I think, quite compelling reasons to believe that if individuals are going to eat less in a sustainable way (i.e. in a way that does not just make them hungry), then a protein rich, carb-controlled diet is generally the way to go. Mind you, as I alluded to above, countless individuals will attest to that fact as a result of their experiences in the real world.
References:
1. Johnstone AM, et al. Effects of a high-protein ketogenic diet on hunger, appetite, and weight loss in obese men feeding ad libitum. Am J Clin Nutr 2008 87: 44-55
I think this also ties in with the work by Arne Astrup (I think that is his name) from Denmark who tried to discover which of the three macronutrients gave the greater satisfaction as regards hunger
Did you see this news release?
Dietary Guidelines may have a downside?
http://www.medpagetoday.com/PrimaryCare/DietNutrition/tb1/8064
I liked this quote:
The committee noted concern that “the previous priority given to a ‘low-fat intake’ may lead people to believe that, as long as fat intake is low, the diet will be entirely healthful. This belief could engender an overconsumption of total calories in the form of carbohydrates, resulting in the adverse metabolic consequences of high-carbohydrate diets,” the committee wrote, while also noting that “an increasing prevalence of obesity in the United States has corresponded roughly with an absolute increase in carbohydrate consumption.”
Chris
http://www.conditioningresearch.com
Thanks Chris – I feel a blog coming on, but I can’t seem to trace the actual article on-line . Have you tried and managed to locate it?
Did you also see the news 17/1/08 about a Swedish Medical Board recommending low-carb, high-fat diets for the overweight and type 2 diabetics?
I don’t think it was reported anywhere here in Australia, apart from Jimmy Moore’s low-carb blog.
Jimmy Moore:
The National Board of Health and Welfare have gone against their own advice concerning which diet doctors should be recommending to their diabetic patients.
A diet low in carbohydrates and high in fats and protein was found to be more beneficial than previously thought by the board.
Avoiding bread and potatoes and eating more butter and cheese has long been declared the best method for treating those with type 2 diabetes by controversial doctor Annika Dahlqvist.
http://www.sr.se/cgi-bin/International/nyhetssidor/artikel.asp?nyheter=1&ProgramID=2054&artikel=1837650
Jimmy Moore:
Speaking of good news for the low-carb lifestyle, have you heard about what is happening over in Sweden right now? Just last week, a major Swedish medical board started recommending low-carb (what they describe as LCHF–low-carb, high-fat) diets for the overweight and Type 2 diabetics to follow after deliberating about it since 2005. The hero in this is the tireless work of a very courageous physician named Dr. Annika Dahlqvist who had been castigated and ostracized for daring to promote low-carb to her patients. Now they’re saying a collective OOOPS and giving Dr. Dahlqvist the praise and adoration she deserves for following the science rather than the dogma that pervades much of the worldwide medical community.
This Swedish story as well as this single English language story from a radio station in Sweden are the only mentions of the fact that the National Board of Health and Welfare now admit that a diet low in carbohydrate and high in fat and protein was found to be more beneficial for diabetics and the overweight. Avoiding bread and potatoes and eating more butter and cheese has long been declared the best method for treating those with Type 2 diabetes by Dr. Dahlqvist. While weight loss is always acknowledged as a benefit of low-carb, the blood sugar normalization and ability to quit insulin in very short order is often missed.
Sweden is like the first country in the world to have a major medical board to officially admit that low-carb is suitable treatment for diabetes and overweight, although the decision this month to embrace low-carb by the American Diabetes Association (ADA) comes closest. I have been in contact with Dr. Dahlqvist about conducting an interview with her about this celebrated accomplishment in her home country of Sweden. Stay tuned!
What a lot of nutritionists seem to forget/ignore, is that proteins can be deaminated.After removal of the amine groups the molecules can enter the Krebs cycle and participate in carbohydrate metabolism.
I have two types of breakfast: croissant with butter and honey,
or a fry-up of two eggs, rasher of bacon, couple of slices of black pudding, 1xsliced mushroom and a couple of slices of precooked potato. Given that the bulk of the latter is greater and may well have a satiating effect of its own, nevertheless,I’m always hungrier an hour or so after the criossant than after the fry-up.
When the research on ghrelin response is published, will you be providing a link, please?
Thanks for the great work you’re doing.
Sorry John – couldn’t find any more info
Megan
Here’s a link to a pdf of the manuscript of the study:
http://jcem.endojournals.org/cgi/rapidpdf/jc.2007-2289v1
What next? Smoking has been known to reduce the appetite also. Will your next blog entry on this topic promote a combination of smoking combined with ingesting large quantities of animal products as recommended by [whoever] for the ultimate in quick weight loss fix?
What about creating a webpage/blog constructed with only 2 columns (pros and cons). Maybe start here? => http://www.webmd.com/content/article/53/60634.htm?lastselectedguid={5FE84E90-BC77-4056-A91C-9531713CA348}
Opooops … to get where you need to go you need to have the entire link underlined … (don’t shoot the messenger)
http://www.webmd.com/content/article/53/60634.htm?lastselectedguid={5FE84E90-BC77-4056-A91C-9531713CA348}
SuperSizemeSux
Relatively protein rich, carbohydrate restricted eating has been shown not just to reduce appetite and aid weight loss, but also bring improvements in surrogate markers for health including levels of blood lipids, insulin, glucose and HbA1c. The difference (if this is not already blindingly obvious to you) is that while smoking may suppress the appetite, it is, overall, an unhealthy pursuit.
It seems to me you’re simply attempting to discredit this particular dietary approach by likening it to something known to be unhealthy. Nice try, but the parallel you draw is, basically, irrelevant.
Of course, I may have this wrong, and your comments are based on a whole slew of evidence which shows that diets relatively rich in protein and low in carbohydrate have disastrous consequences for health. If you are aware of such studies, then you’re at liberty to present them here.
Best appetite suppressant I know is Norovirus, but I can’t recommend it. I speak from personal experience
Well OK, I posted some info on another page of your blog => http://www.drbriffa.com/blog/2008/01/25/scientists-claim-that-conventional-healthy-eating-messages-may-be-doing-more-harm-than-good/#comment-60531
But to be honest, I do think my [above] analogy is correct and should be “blindingly obvious to everyone” yet I must admit I “go there” clawing and scratching because 30 years ago I thoroughly enjoyed cigarettes and purchased custom grown beef hung for 28 days (served to my family daily, the mignon wrapped in bacon), cooked rare and so tender you could cut it with a fork. And my smashed white spuds with unique gravies every day were enough to make a grown man leave home. Just like everyone I knew. But then came the OA with hip (and other) spurs (ending my sports activities), my spouse with his cardio alert, high BP, Type 2 … my wonderful 45-yr old “high-protein” neighbours and friends incapacitated, unable to provide for their family. My darling son with asthma (I only recently discovered that every 4th cigarette of mine went directly into his lungs, resulting in asthma … and everyone in the home smoked). If only I’d known then what I know now.
When I recently met my spouse’s (famous) cardio (at famous heart institute) I couldn’t take my eyes off the watermelon he lugs around his belly. And his advice … my chin was bruised for 2 weeks it hit the floor so hard. Even I knew better than that. And a nurse proudly told us she weighs 250 lbs as she waddled in with the chart. A 3-D full-colour image of a beached whale spread over my internal vision. I slammed my eyelids shut so they wouldn’t see my eyeballs rolling skyward like that.
The Harvard Nurses’ Health Study alarms me also, especially now that I’m a gramma. As you are no doubt aware this huge study “tested the effect of milk on bones …
“The research team followed 77,761 women for 12 years and reported in 1997 that those who drank the most milk actually broke the most bones. Specifically, those who got the most calcium from dairy sources had nearly double the risk of hip fractures, compared to those who got little or no calcium from dairy products. When the statistics were adjusted for confounding factors … the relationship still held. Yale researchers found much the same thing.
“Green vegetables typically have calcium absorption rates of over 50% compared with only about 32% for milk.”
This info alarms the gramma in me, especially since this is what I did to my offspring (at my physician’s behest) => “Well-meaning parents often push cow’s milk on children, buying into the myths that have come from relentless advertising. A child drinking three glasses of milk in a day swallows 24 grams of fat (more than 60% of which is artery-clogging saturated fat) and 450 calories.” Refer to the pictures I’ve posted at your other blog page (link pasted above).
“The theory behind drinking milk in childhood is, of course, that is builds bone density, so that when the bone-thinning osteoporosis begins later in adulthood, the extra reserve of calcium can be drawn from. This has not been supported by good research. Over the long run, milk drinkers get no protection at all. Indeed, the Harvard Nurses’ Health Study found that those who got the greatest amount of calcium from dairy sources had approximately double the risk of hip fractures, over a 12-year follow-up period, compared to those who got little calcium from dairy products.”
Sources: Feskanish D, Willett WC, Stampfer MF, and Colditz GA, “Milk, dietary calcium, and bone fractures in women: A 12-yr prospective study,” AM J Publ Health 87 (1997): 992-97 and Barnard, MD, Neal, “Turn Off the Fat Genes.” 137-141 and 150-153
It appears to me the evidence above shows that “the parallel I draw is, basically, relevant.”
Generally I find your thinking and research to be mentally challenging … “worth the read” … and I look forward to your reasoned rebuttal or support … whatever.
Nice anecdotes, SuperSizemeSux, but it was studies I was looking for. And for the record, I don’t personally advocate milk drinking for bone health or mashed potato.
Hi SuperSizemeSux I wouldn’t worry overly about the Havard Nurses Health Study, this is basically epidemiology which provides raw material for data dredges and media headlines, but unless they come up with results that show high Relative Risk (less than 2, or less than 100%) then they aren’t significant in a scientific sense. Maybe a pointer to future research/proper science.
re the fat Cardio, lol my wife could never take the locally well known Weightwatchers guru. Not when she stood behind her and watched the rolls around her midriff!
The Harvard Nurses’ Health Study tracked 77,761 women for 12 years and reported in 1997, 11 years ago. I’m surprised you haven’t heard about it.
So, if not for bone health or smashing potatoes for what DO you recommend the ingestion of milk?
Hi Neil, thx for your comment. What appears to be happening is my Mathmetician is saying to my Muncher, “Yes, smoking will result in the loss of some lard and milk may result in your bones getting 32% of its calcium while it stores its fat where the smoking just lost it … but there’s a better way to achieve both lard-loss and calcium gain.”
So Munchie asks the inevitable and Mathie responds with, “You are too stupid for tracking calories so we’ll not go there. Munch all you want of raw greens, vegs, fruits even if you take 3 helpings you won’t ingest near the calories of fats, you’ll lose weight, and you’ll be healthy as all get out.”
The look on Munchie’s face is priceless.
SuperSizemeSux
Where did I say I haven’t heard of that Harvard Nurse’s study? And where did you get the impression I positively advocate milk on health grounds?
Dr John Briffa:
1. RN’s Study. A search for Nurse’s Study on your site gets zero hits. It appears you could have “said it” by omission when referring to similar studies. http://www.drbriffa.com/blog/2006/10/09/soft-drinks-cause-soft-bones-and-is-it-time-to-slay-the-sacred-cow/
2. The impression you give. If you do NOT advocate milk for some type of health promotion your statement would have been, “I don’t personally advocate milk drinking,” but instead you specified “for bone health or mashed potato.”
Oh, I see SuperSizemeSux, seems you’d have as guilty by virtue of the things I never said 😉
I find your weekly newsletter interesting and imformative. Thank you. It is always reasuring to have one’s feelings, views, predudices (?) confirmed!
I therefore wonder whether you know the work of Gary Taubes, “cotroversial science writer” and author of The Diet Dilusion: Challenging the Wisdom on Diet, Weight Loss and Disease. I refer to an article in Stella of 27 January 08, as part of the Sunday Telegraph.
I’d be interested in your view on his take on all this.
Please keep up the good work.
Shirley
Hi. the study on calcium is just correlational. It takes about 17 different nutrients to build bone, not just calcium. In particular magnesium is very important and if you ingest lots of Ca without enough Mg ,Ca will not be used for bone but will just get deposited in soft tissue. It may be that communities who drink lots of milk also have have other problems such as low Mg, low benefiial bacteria (needed to make vit K, involved in the bone matrix) etc etc. Hilda
Hi Shirley
I’ve not read Taubes’ books (though I bought Good Calories Bad Calories, left it at a friend’s house and it hasn’t been returned yet…) but I am familiar with his work, mainly by reading articles written by or about him.
In short: I’m a fan. I think he does a very good job of challenging conventional nutritional ‘wisdom’ in a way that is both informative and relevant. And he does go to great lengths, it seems, to scientifically reference his work, which is generally a good sign!
SuperSizemeSux…………………………. you sure do !
Dr John Briffa (and Helen?)
lol … actually, from my shoes … yes. In software engineering if something is unstated it means either it doesn’t exist or more clarification is needed. The thought voyage goes thus: if not A [this] else B [or that] get C [find something else] (or the entire system will thwack you with Murphy’s Law). So of course as soon as I saw your statement not for this [bone health] or that [mash potatoe] my fingers automatically typed the search for [else]. Too funny.
And if that’s not kooky enough I live in Quebec under the Justinian Code and work (and also live) in Ontario Canada under the same system as you. Daily life in Quebec is the reverse of yours. If [whatever] is unstated under your system you are free to do it or not, however, under the Justinian Code if it is unstated that means [whatever] actually IS stated to be specifically not permissible. lol
Hilda
Thank you for explaining the co-relationships of calcium. In my childhood my father (a physician) made me gargle with Milk of Magnesium every day. Could that have been why?
Shirley Bright
Thank you soooo much for your input, you precisely fingered my dilema! I couldn’t get the pdf links in the Taubes Wiki to work but the link to the article worked and I sat riveted to all 11 pages of “What if It’s All Been a Big Fat Lie?” – New York Times. His unguarded stand in absolute defense of Atkins appears so justified I’m going to eat eggs for breakfast from now on and will take a very close look at Atkins’ diet and reasoning.
Shirley Bright
Oh-Oh. Guess I’ll hold off on those eggs. The refutations of those that Taubes quoted are frightening. Here are a couple of the many:
“The article was incredibly misleading,” says Gerald Reaven, the pioneering Stanford University researcher, now emeritus, who coined the term “Syndrome X.” “My quote was correct, but the context suggested that I support eating saturated fat. I was
horrified.”
“Gary Taubes tricked us all into coming across as supporters of the Atkins diet.” ” John Farquhar, Stanford University
http://www.cspinet.org/nah/11_02/bigfatlies.pdf
*back to the drawing board* grrrrrrrr
Hey SupersizemeSux
Those guys that are aghast at Taubes – did any of them quote some specific and relevant science that explains their stance? Or was it the usual anti-fat/anti-Atkins/anti-low-carb rhetoric?
My advice is to listen less to opinion, and focus more on what lies behind that opinion in terms of evidence.
Dr John Briffa
Thank you for that advice. From what I’ve been discovering I think the “evidence” should first be examined from the perspective of “follow the money.”
True, theres billions being made from statinising people unecessarily and by convenience foods cereals, veg oils, soya , package and processed food