Four Diets, One Study

      16 Comments on Four Diets, One Study

Some months ago, I discovered that Stanford University has quite a few class lectures available for free on iTunes.  I enjoy listening to books and lectures during my long walks, while driving, while sitting on airplanes, and sometimes even while working on programming projects if I’m not in the middle of a real head-scratcher.  (Don’t tell my clients.) 

I’ve downloaded and listened to several lectures on subjects that interest me:  history, politics, science, economics and, of course, health and nutrition.  I had planned to transcribe portions of a couple of nutrition lectures so I could comment on them, but since I don’t like typing all that much, I kind of put that project aside.

Turns out one of the lectures I wanted to write about is also on YouTube, as I found out when I visited Mike Eades’ blog this morning.  I enjoyed it on iTunes, but it’s even better when you can see the visuals.  So in case you haven’t already seen it, here it is.  The speaker is Dr. Chris Gardner, a director of Nutrition Studies and an associate professor of medicine at Stanford:


A few things struck me as I listened to the lecture the first time, and again as I watched it today.  One is that all diets are difficult to follow to some extent — just look at the dropout rates for the other studies Gardner mentioned.  There’s no getting around that.  If your weight is going up and your health is going down, you’re on a bad diet.  To turn things around, you have to give up some foods you love.

I miss fettuccine alfredo and sourdough toast, but I’ve found it much easier to stick to a low-carb diet than any of the others I tried.  Low-fat diets, by contrast, made me feel lethargic and depressed.  I’d start cheating, then eventually give up.  (Good thing, in retrospect.)

Along those lines, notice what happened in Gardner’s study with the group assigned to the Ornish diet: on average, they began eating double the amount of fat Ornish recommends almost immediately and eventually moved up to triple what he recommends.  Ornish has complained that this wasn’t a fair test of his diet since most subjects didn’t stay within the 10% fat limit.  I think it’s more likely they couldn’t stay within the 10% limit … their bodies rebelled.

(Here’s how someone once described the Ornish diet:  put food in your mouth. If it tastes good, spit it out.)

To be fair, the Atkins group drifted back towards a higher carbohydrate intake as well.  If you do the math, it appears that by the end of a year, most of the women in the Atkins group were consuming something in the neighborhood of 150 carbohydrates per day.  They ended up on a restricted carbohydrate diet, but not exactly a low- carbohydrate diet.

But that actually makes their weight loss more impressive.  Remember, they weren’t told to count calories, as two other groups were.  And yet the Atkins group lost the most weight, even though they ate more carbohydrates than Atkins recommended.  And as their carbohydrate intake went up over time, so did their weight — again, they weren’t counting calories.  This would seem to confirm what Atkins said all along:  carbohydrates make you hungry.  You have to find the level of carbohydrate intake that keeps your insulin in check and your appetite stable, then stay there.

I also noticed that the Atkins group had the lowest dropout rate.  Once again, I’m not surprised.  Yes, you may miss your sugars and starches on a low-carb diet, but at least fat is satiating.  I never felt satiated on a low-fat diet, unless I ate huge meals.

What really perked up my ears the first time I heard the lecture was the comparison of the health parameters.  The Atkins group showed the most improvement in weight, blood pressure, triglycerides and cholesterol levels.  No other diet out-performed Atkins on any health parameter.  So much for the notion that a low-carb, high-fat diet will kill you.

Gardner even explains, in response to a question, that low-fat, high-carb diets tend to make triglycerides go up, HDL go down, and produce a higher proportion of small, dense LDL.  And remember, we’re hearing this from a guy who’s been a vegetarian for 25 years — not exactly a shill for the meat industry.

I also found it interesting the relative success of one diet versus another seems to depend on the dieter’s level of insulin resistance.  Now and then, I hear from people who swear they lost a lot of weight on a low-fat diet and felt fine doing it.  I believe them.  But I’m guessing those are people who aren’t insulin-resistant.  They can eat plenty of carbohydrates and lose weight by restricting fat and calories because they don’t end up with high insulin levels that command their bodies to continue storing fat.  Good for them. 

The problem is, the rest of us are told that if it works for them, it should work for us, too — assuming we just had the proper discipline. But it doesn’t work for us.  We produce too much insulin in response to sugar and starch.   We have to give up the carbs, or we’re setting ourselves up to fail.  And given the steep rise in metabolic syndrome and type II diabetes, I think most overweight Americans are probably insulin-resistant. 

This lecture — recounting a study conducted by a committed vegetarian — confirms what I already knew:  the usual dietary advice given to overweight people who are developing metabolic syndrome is a load of bologna.  Hats off to Dr. Gardner for reporting his results with no apparent attempt to manipulate them.  We could use a few more researchers like him.

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16 thoughts on “Four Diets, One Study

  1. Carl Nelson

    While he didn’t manipulate the data, he sure saw the need to manipulate his presentation to fit in his own agenda several times. I guess that is going to happen with any human, and we should be glad that he didn’t tamper with the data to get it to suit him. But I wish he didn’t see the need to vilify saturated fats at every opportunity.

    He even assumed that his Atkins test subjects didn’t follow Atkins strictly, as no one in their right mind would eat steak and cream! How does he know this? Maybe the successful ones DID eat steak and cream and cheese all the time, and maybe the ones who didn’t were the ones who didn’t lose as much fat?

    Even in a good study and a good presentation like this, even smart vegetarians find ways to irritate me.

  2. Deb Jordan

    The aspect of the Atkins group drifting back to about 30% carbs is what the Atkins book has the dieter do. He didn’t seem to realize that in the lecture. He spoke of it as the participants failing to stay on the diet.

    Atkins allows each dieter to find the proper maintenance level, which could be 30 percent for some but lower for others, depending on insulin response. I seem to do okay even if my carbs drift up to around 100-130 (which is where I was during the fast-food diet), but I usually keep it lower than that because I feel better if I avoid sugar and starch entirely.

  3. Jenny Ruhl

    The LC diet has been shown several times to be more effective for people with insulin resistance. But there are many other causes of overweight, and in some cases people who are insulin resistant are insulin resistant because of a primary cause where the IR is only one of many problems that fight weight loss.

    Thyroid problems, PCOS, pituitary tumors, and high blood sugar unassociated with underlying IR (I.e. from slow autoimmune diabetes or MODY) will also cause weight gain, and though LC will help to some extent, people can stall out pretty fast with these conditions.

    My polling of people with Type 2 diabetes who use low carb diets show them to stall out too–at around 20% lost off starting weight.

    In my observation, people tend to stick with the LC diet until they stall, but after a few months of stall they lose their motivation and the difficulty of adhering to the diet combined when faced with emotional challenges derails them.

    Many of the comparison studies show a worse adherence rate for Atkins than some more moderate diets. In the diabetes field people who eat a more relaxed lower carb diet rather than a stringent one persist much longer than those who attempt to remain at ketogenic levels.

    In the early phases of a low carb diet people become evangelical–as you are now. This will wear off. Those of us who have kept our carbs controlled for 5+ years usually do find ways to include higher carb foods from time to time and we find the extremism of the new convert a matter of concern rather than delight.

    I suspect it would be easier long-term to stick to any moderate diet versus any extreme diet, but I certainly don’t count Ornish as moderate. His diet is far more extreme than the maintenance phase of Atkins or Protein Power.

    Unfortunately, as Gardner recounted, many people only read part of a diet book and end up not really following the diet. Lots of people who think they tried the Atkins diet never stopped the induction phase, which isn’t meant to be long-term.

    I’m pretty sure this is the first time I’ve been called evangelical about low-carb diets. In discussion groups online, people have complained that Fat Head doesn’t promote a low-carb message strongly enough because my carb count was often over 100.

  4. Amy Dungan

    I watch this the day Dr. Eades posted it and enjoyed every minute. I also wish we had more researchers like Dr. Gardner. I’m sure that was a bitter pill to swallow, yet he seemed to be genuinely interested in the findings and gave an unbiased explanation. Kudos to him!

    When I first listened on iTunes, Gardner was introduced as vegetarian and I thought “Oh, boy, here we go.” What a pleasant surprise when it turned out he wasn’t trying to push his own agenda.

  5. mrfreddy

    Tom, I’ve been low carbing for 8 plus years, most of the time at what Atkins would call induction level (I just call it the way I eat), and I find your “extremism” quite refreshing!

    I appreciate that.

  6. TonyNZ

    It would seem to me that low carb would be difficult to follow for many, not because their bodies scream for starch (though that would also happen) but in that many would not know where to start. People are so inclined to serve potato/pasta/rice/bread with meals and supermarkets are so geared to selling the low-fat high-carb products that many people would give up when they can’t find the constituents of a meal with no carbs.

    I often find myself having a sandwich or toast because that is just what is available/obvious/easy.

  7. Anna W

    Hey, Tom – this is a great video! I saw it on Dr Eades’ website as well and though I haven’t made it past 45 minutes yet, I really enjoyed it. I think it’s important, so thanks for posting it.

    I saw Fat Head a few weeks ago and have rewatched several times since then…this was after a friend hooked me up with the Weston A. Price Foundation. I’m a college student with a lot of weight to lose and after giving calorie restriction and vegetarianism brief, unsuccessful tries, I’m ready to try a nourishing diet. I’m going to blog about it (clicking on my name should take you to the blog, I think)… I’m still in the preparation stage as I’m your average broke college student with next to no cooking skills, ha. Anyway, hope you can take a look from time to time! And thanks so much for your film… I hope you don’t mind the superlative when I say it’s the most important film I’ve seen in my life!

    Well, that’s quite a superlative, but I happily accept. Check in now and then and let us know how you’re doing.

    Your blog, in case it doesn’t show up in your handle:

  8. Willow

    If you miss fettucine alfredo you could try making it like Alton Brown did on The View. He made eggplant pasta parmigiana style but it could easily be alfredo. Do a search on youtube for ‘alton brown on the view’ and watch the video from October 6. It sounds very much like Alton has discovered low-carb btw…..;-)

    Sounds like it’s worth taking a look. I also make reasonable substitute with spaghetti squash.

  9. donny

    “To be fair, the Atkins group drifted back towards a higher carbohydrate intake as well. If you do the math, it appears that by the end of a year, most of the women in the Atkins group were consuming something in the neighborhood of 150 carbohydrates per day. They ended up on a restricted carbohydrate diet, but not exactly a low- carbohydrate diet.”

    I refuse to do the math, but…

    On all of the diets, it looks like most of the actual weight loss took place in maybe 25 percent of the dieters. Gotta wonder what the average carb content was for the Atkins dieters within that twenty five percent.

    These were premenopausal women, right? That means less visceral fat, higher hdl, lower triglycerides, a high proportion of pears over apples, compared to men and post-menopausal women– historically, less metabolic syndrome. But Atkins 1) is most effective for those with metabolic syndrome and 2) was the most effective diet in this study involving premenopausal women? Yikes.

    It would be interesting to see if they break down the data within groups. He did mention adherence seemed to play a big part.

  10. Laurie

    ‘Wheat Head’, further ruminations , via Taubes, Eades, ‘Fat Head’, and ‘The Vegeatarin Myth’

    I’ve been pondering grains and our current addiction to them since I don’t believe they helped us evolve our big brains. But, they factor into the modern diet everywhere so this is what I think may have happened. Millions of years ago we were eating lots of nutritious bugs (modern humans still have a chitinase enzyme), small mammals and other scaveneged or hunted meat, but things really took off when we figured out how to get into the braincases of scavenged or hunted prey to eat their FATTY BRAINS. The carnivourous cats do well on an all meat diet, and they are not as advanced carnivores as we are so I think it was our cleverness in getting at and eating brains that changed us the most. (I bring up the cats because there was a ridiculous comment thread over at Eades’ blog about how we could not have evolved as carnivores because cats are carnivores and they didn’t end up like us!).
    All well and good and then about 10,000 years ago (to less than 5,000 for Northern Europeans) we started being to clever by half and began eating wheat. We aren’t adapted to it except for in one way…….it enhances our reproduction. Lots of carbs, lots of insulin, lots of substrate for good mating and populating (some would say overpopulating) the planet. And wheat’s downside is that after we’ve reproduced it wrecks havoc
    with every system in the human body (the gluten and other proteins and not the carbs in it), but the ‘damage’ is already done if we’ve already produced offspring and the after effects or the longevity and continued health of the individual is moot at that point.

  11. nonegiven

    I suspect we’d see a lot bigger difference in results among the Atkins group if you graphed out each persons results as a function of their carb level, at least among the insulin resistant. The chart only shows the average results, which includes both people who stuck religiously to the carb ladder in the book, and people who pretty much ended up face down in the carbs after a slip because of their sugar/starch addiction. The group probably included people who lost all their excess weight and people who gained because they gave up trying to stick to it.

    I’d like to see the data split out that way too. I suppose the people who actually followed the Ornish diet lost more weight too, but what a way to live …

  12. Wanda

    Hi Tom,
    one thing I did notice was that the data relied on body weight, and not body fat percentages. I suspect that if the researchers measured body fat, even though some people gained weight on the Low-carb diet, it would show increase in lean mass and a decrease in fatty mass. And, of course, the complete opposite for the LEARN and Ornish methods. WE know that it’s not weight, but rather size, that matters…

    I had to laugh when he put in the warning a la “surgeon general” style that high amounts of protein can harm your kidneys.. and laughed even harder when he said that most people get enough dietary protein already. HA! Sure… the food pyramid recommends I get 6.5 oz ( I really need 12 oz) and my husband 9.5 (he needs 16 oz per day). Yeah, that sounds like we get *plenty*!

    Good points. I once managed to starve myself down to 165, but I was losing muscle in the process.

  13. Ted Hutchinson

    I enjoyed the presentation and recommend it to others.
    However, I would caution people to consider that Gardener’s research is now a couple of years old, there has been a lot more information made available since then. I suspect the questions Christopher Gardener would face now many people have read Good Calories Bad Calories, and watched Fathead the Movie, may be somewhat more pointed.

    I feel at times Gardener appears to be somewhat clutching at straws, trying to find other reasons why perhaps it may not have been reduced carbs that was responsible for weight loss recorded or improved health markers. For example he suggests that water consumption may be responsible for the fact that Atkins adherer’s were more successful, but Barry Sears Zone diet also suggests “(a daily water intake of eight glasses of eight ounces each.)” and that did not result in the same weight loss response.

    Similarly he appears in this exchange with Jimmy Moore to be trying to distance himself from being associated with giving any credibility to Atkins.

    As someone who reduced weight after reading Taubes by following a relatively modest low carbohydrate regime I suppose I may have been somewhat evangelical.
    But, I continue to follow that way of eating, without difficulty, and without regaining weight, so I see no reason to change, nor any good reason to refrain from suggesting low carbohydrate diets to others.

    I wondered myself if he’d had a chance to read Taubes’ book, especially when he theorized that people on the paleo diet consumed fewer calories because they were bored with eating the same foods over and over. I suspect it’s because they were satisfied on fewer calories, since they weren’t raising insulin levels and driving calories into storage.

  14. Paul B.

    Thanks for the interesting article. I agree that different people do well on different kinds of diets due to varying ability to process carbs. Some people (esp. those who are more active and have more muscle mass) can lose weight and do fine on high carb diets. Others have to slash carbs to Atkins-induction levels to lose much weight. And the majority of us are somewhere between the two extremes.

    I think I’m somewhere in the middle, based on experience. But I keep the carb count pretty low because I’m convinced grains produce negative effects beyond weight gain.

  15. Trenton

    @ Paul B. and response…

    Yes, I agree. Whether your primary concern is weight loss or not, it’s hard to ignore the other improved health indicators on lowcarb/atkins. Better cholesterol and blood pressure levels for one, and I’m convinced that regularly high insulin levels contribute to mental problems like Alzheimer’s and Dementia.

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