“Eco-Atkins”? The REAL Atkins Responds

Recently, a “vegan low carb diet” has been promoted through a study that showed it provided many of the benefits of the Atkins low carb diet. Media coverage, always fawning and unquestioning of medical news, seemed to accept the study’s conclusions.

Now, Atkins Nutritionals has responded, first with a concise recap:

The study authors started by admitting that low-carbohydrate dieting was indeed effective, not only for weight loss, but for reducing insulin resistance, lowering triglyceride concentrations and for raising HDL (so-called “good” cholesterol). The researchers wanted to see if they could design a low-carbohydrate diet that retained the proven weight-loss benefits of low-carb plans like Atkins and also help people improve their cholesterol while following a vegetarian, vegan approach.

The article goes on to explain the test methodology that compared a low-fat vegan diet to a low-carb vegan diet. In looking at the diet, the Atkins folks say:

The “Eco-Atkins” diet was essentially a maintenance phase diet for vegans. Presumably even more weight loss might have occurred if carbs had been lowered to OWL or pre-maintenance levels.

The Atkins article goes on to state that numerous variations of the low carb approach have been formulated, but claim that only Atkins has both a time tested and scientifically validated plan. I’m not sure that’s true, as other plans such as my favorite, the Protein Power Life Plan, also use a scientific approach. They may be saying that the Atkins plan has been specifically tested by more independent studies than any others, and that could very well be true.

Another Study: Low Fat / High Carb Dangerous

At Low Carb Age, we’re chronicling the end of the low fat / high carb age entered in the early 1970s when Congress (yes, Congress) decided that reducing saturated fat was the best way to improve American health. Yet another crack in the edifice comes from a new study by the University of Glasgow published in the Annals of Nutrition and Metabolism:

Conclusion: In postmenopausal women, following the UK dietary guidelines resulted in changes in the lipid profile that were more likely to favour an increased risk of CHD [coronary heart disease], as TAG [triacylglycerol] concentrations were increased and HDL cholesterol concentrations were reduced. However, in addition, we found a significant reduction in BMI and a significant increase in the ‘antioxidant power’ of plasma, which should benefit health.

Studies don’t venture far from the primary aim of the study, as the scientists don’t like to inject opinions into the research. What the authors of the study didn’t say is the people following a low carb, adequate protein diet including plenty of “good fat” also enjoy a significant reduction in BMI (body mass index). And unlike the diet from the dietary guidelines since the 1970s, a low carb diet lowers triglycerides and raises the good cholesterol, HDL.

This study focused on post-menopausal women in Great Britain. Twelve women participated, and started by chronicling their food intake for a week and taking baseline blood tests. Based on their current diet, the authors recommended the women increase their carbohydrate intake to match the official government dietary guidelines. The women were in a “free living” condition, meaning that they were free to live their normal lives at home, at work, etc., and were not confined to a hospital during the study. Blood tests were taken after a week, and then after 4 weeks.

The dietary guidelines in Great Britain are basically the same as in the US. The guidelines specify that a reduction in dietary fat is important, and half the daily “energy intake” is to be from carbohydrates. (In Europe, “calories” are referred to as “energy”, so this equates to the American guideline to obtain about half your caloric intake with carbs).

After a week on the diet with increased carbs, the women were directed to increase their fruit and vegetable intake. For the final three weeks of the study, they were eating the “balanced diet” so familiar to anyone who has seen the “food pyramid” chart.

The good news was that the women lost weight, a result usually seen in the adoption of a low carb diet as well. They also had an increased level of antioxidants in the blood (although not stated, this was probably from the fruit and vegetables they were now eating). But the bad news?

The bad news was that the women experienced a significant rise in triglyceride levels, and a lowering of the protective, good cholesterol HDL. In other words, in 4 short weeks they became like everyone else who tries to follow the official dietary guidelines: candidates for cardiovascular heart disease (CHD). And post-menopausal women are more likely to develop CHD with elevated triglyceride levels.

They were probably healthier before the study started. Even with a BMI much higher; mortality studies show that it is better to have an “overweight” than “healthy” BMI. Even an “obese” BMI puts you at parity with the so-called “healthy” BMI.

Research: Is a Survey Good Enough?

Diet research is a difficult thing. Researchers try to account for all the variations, but unlike a drug trial … where you can give one group a placebo and another the real thing … dietary research often relies on questionnaires, diaries and surveys. Some studies use a “meta” approach and compile the results of dozens of such studies, averaging the results between them.

Its an inexact way to do research in the first place, and the studies themselves usually point this out in careful language in the conclusions. Those carefully crafted sentences are rarely included in the popular news stories the media puts out.

One thing researchers have to keep in mind is the possibility that people will not remember correctly or cheat, as the Wall Street Journal’s Health Blog recently pointed out:

The kids were supposed to be wearing pedometers to measure the number of steps they were taking each day. But some of those in the study got the bright idea to clip the pedometers to the collars of their pet dogs, upping the distance the youngsters appeared to be moving each day, according to the BBC.

Even worse, some studies are epidemiological studies (often called observational, prospective or cohort studies) where two existing populations are compared and tested for a particular thing. Dr. Mike Eades uses the example of two populations, one with high vitamin C in their blood and one with low vitamin C. The researchers track to see which group has the fewest colds, and publish the results. The study is bound to fail. As Dr. Eades says:

They try to think of all the differences between two large populations of subjects so that they can statistically negate them so that only the observation in question – the vitamin C level in the example above – is different between the groups. Problem is they can never possibly think of all the differences between the groups. As a consequence, they never have a perfect study with exactly the same number, sex, age, lifestyle, etc. on both sides with the only difference being the study parameter. And so they don’t really ever prove anything.

Most of these studies are false. In that their conclusion, as reported by the media, cannot be supported by the evidence presented in the study. That’s why you see conflicting reports on the advantage of vitamins and diet plans. (See this journal article I found linked on Dr. Eades blog for an explanation of why most research articles are false.)

We often think that science works by fortuitous discovery, where a lone scientist spills his martini and it mixes with a polymer on the desk and he discovers the cure for gout. He calls his buddy and everyone cheers, and all the scientists honor him with an award dinner where they all agree that Dr. Martini Spiller has the right idea.

The real way much of science works is that a study reaches a conclusion, and is published. The scientific community looks at the study, and some decide the author must have had a few martinis before the one he spilled, and his conclusion is attacked. The “attack” is often with another study showing a different conclusion. Both of these studies may be false, or at least unsupportable by the facts they present. After a while there is a winnowing out of claims and “truth” comes out. Its a messy, unromantic process that wouldn’t make a movie producer happy.

Often, its a bit more colorful. In Simon Singh’s wondeful book Big Bang: The Origin of the Universe, Singh recounts how Albert Einstein remarked that Georges Lemaitre, one of the early proponents of the Big Bang theory, was a “moron”. Later, Einstein embraced what became known as the Big Bang theory. (Interestingly, the term “Big Bang” was a slur intended to show how naive and wrong-headed Lemaitre’s “hypothesis of the primeval atom” was. “Big Bang” looked better in the newspapers, so the media used that term).

Conflicting studies are frustrating for those of us who want to understand the science behind what works; it doesn’t help that what is “true” is frequently updated as knowledge increases. But such is the way life works. Read research with a critical eye, especially if you are reading a recap or synopsis provided by others. Even in the original research report, pay attention to the details in the conclusion.

Does Being Overweight Harm Your Health?

Looking around at all the fat people that are old, I sometimes wonder what happened to their skinny friends. Asking one particularly witty rotund elder, I was advised that “all the healthy seniors died.”

I’ve always thought the ideal height and weight charts were off by dozens of pounds. Often people forgot to add an inch to their height if using some charts (like the Metropolitan Life charts, that assume you’re wearing 1″ heels).

Realizing the limitations of these charts, one of the more recent ways to estimate ideal weights is to us the “Body Mass Index” or BMI. This is calculated by dividing the weight in kilograms by the square of the height of the individual in meters. I’m now at 220 pounds on my 5′ 10″ frame. The easiest way to make the calculation is to do the hardest part first … convert your height into inches and then multiply by .0254, and then multiply that result by itself to square it.

5′ x 12″ = 60″ + 10″ = 70″

70″ x .0254 = 1.778 meters

1.778 * 1.778 = 3.17

That 3.17 is a number that won’t change, unless I start shrinking. So now I can see what my BMI is by dividing my weight in kilograms by that 3.17. So there’s one more pesky conversion to do.

220# x .45 = 100kg

100kg / 3.17 = 31.46 BMI

The standard: a BMI of 18.5 to 24.9 is “healthy”, 25 to 29.9 is “overweight”, 30 and above is “obese” and above 35 is “extremely obese”. I moved down from that “extremely obese” level over the past few months to the “obese” level, and I’m very close to being just “overweight”.

But what does this mean? We would assume that “healthy” people would live longer, but as it turns out, several studies are showing that they die sooner. Dr. Biffa’s blog recaps the results of two recent studies that show surprising results:

Compared to individuals in the ‘healthy’ category (BMI 18.8-24.9), overall risk of death for the other categories was as follows:

  • Underweight (BMI <18.5): 73 per cent increased risk of death
  • Overweight (BMI 25.0-29.9): 17 per cent reduced risk of death
  • Obese (BMI 30.0-34.9): No statistically significant difference in risk of death
  • Extremely obese (BMI 35 or more): 36 per cent increased risk of death

Here, again, we find that the lowest risk of death was found individuals classified as ‘overweight’. And this result was statistically significant. Perhaps even more surprising than this, though, is the finding that being ‘obese’ did not appear to put individuals at a significantly increased risk of death.

Dr. Biffa makes the point that we should probably move the classifications a bit, so that “overweight” is the new “healthy” category.

But then, my old fat friend couldn’t tell me that all the healthy ones died.

New Gastrointestinal Issues Page Added

I added a new Research Page on Gastrointestinal Issues today, with links to two studies. One, on the effect of very low carb diets (VLCD) on obese GERD patients, mirrors the impact going low carb had on me: I’m off Prilosec for the first time in a dozen years. It wasn’t expected, and wasn’t the reason I went low carb. But if I had known, I would have gone low carb years ago just to eliminate the pain.

The second study linked on that page is a small one about IBS, irritable bowel syndrome. People with IBS suffer quite a bit, and seeing a study that addresses it with an easy-to-use diet plan is helpful. A hat tip to Laura Dolson at the About.com Low Carb Diet site for this one.

Holiday Eating and “Helpful” Advice

With the 4th of July holiday weekend now behind us, I’m breathing a sigh of relief at “staying the course” … an issue every dieter knows. But unlike low fat or other calorie restricted diets, carb counters have an advantage: eat only protein sources until you are full, and then stop.

My sister’s wonderful, sweet and tender baby back ribs provided the carbs for the meal through the barbeque sauce slathered on them. I went light on them in favor of non-carb-coated chicken, tasty as all get out after being seared over a charcoal fire. There was a steak in there too during the day, wonderfully blackened with spices in a pan and then slow-cooked over the fire.

But unorthodoxy has its price. Cornered by at least three “helpful” people over the long weekend, I heard three different variations on the “eat no fat” nutritional advice so common today. Only one of these people actually looked healthy. And she repeated the “no fat” mantra except with a difference … olive oil and coconut oil were “good fat” and should be used. When questioned, they all said fish oil was also helpful. Only the healthy looking one could tell me why eating red meat was bad while eating the oil from hundreds of squished fish was healthy (and it had nothing to do with fat … it was mostly concerned with “impurities” in the beef caused by farmers force feeding antibiotics and grain to fatten the cattle up). Mercury levels in fish didn’t bother her; her prescription was to eat it 4 or 5 times a week. Ignore the mercury warnings; our food has so many impurities that a little more won’t hurt as long as you aren’t eating red meat.

Most cows I know … and my family is full of farmers … graze for most of their life, eating grasses. The feed lots do use grains to fatten the cows before slaughter. “Grass fed” beef is little different than your supermarket variety beef; in fact, the category for people concerned about the impact of the feed lot on their beef is “grass fed, grass finished”. The cows that are “grass finished” are not fed grain at the end of their life. (Let’s put aside why grain is supposedly bad for cows but good for humans).

But I digress. The interesting thing is that this unsolicited advice was given with the zeal of the true believer, even by those who obviously were not following the advice they were giving.

All three of my helpful friends were not doctors. Two hadn’t been to a doctor in a while. The healthy one did see a doctor, who approved of her diet (although I doubt he would agree with the enthusiasm for coconut oil in the diet.)

Because I’m working with my doctor in formulating my diet, I had a pass from the helpful people. The fattest one said he couldn’t understand how eating a bunch of fat could make you lose weight; I didn’t ask if he had lost any weight lately on his diet. I did tell him I had lost 30 pounds.

My doctor is not excited about the amount of fat eaten in the typical low-carb diet; he would rather see me migrate to a more balanced diet but with low carb content. But he’s OK with me continuing on my path, acting like a partner in the process. Its helpful to be able to draw on his expertise (he keeps current on the latest research), but the final decision maker in my health plan is me.