Tag Archives: heart disease

Mass Media Acceptance

The evidence that the Low Carb Age is upon us keeps amassing, albeit with the usual caveats to assuage guilt. As the authors of Mistakes Were Made (But Not by Me) tell us, people in positions of authority rarely admit they were wrong.

Nevertheless, the truth begins to squeak out. This week the NY Times’ Tara Parker-Pope’s Phys Ed column reports on a significant new study from Johns Hopkins to be published this Friday:

With the memory of Memorial Day cheeseburgers and bratwursts still lingering, many of us may be relieved to hear that a new study suggests that a meaty, high-fat, Atkins-style diet can do more than contribute to rapid weight loss. It may also be less unhealthy for the heart than many scientists had feared — provided you chase the sausage with a brisk walk.

So Close, Yet So Far

Parker-Pope makes the mistake of insisting exercise was proven to be part of the solution, but the study shows no such thing. It specifically compares a low fat to a “low carb” diet, both with the same amount of exercise. As The Behavioral Medicine Report explains:

Low-carb dieters showed no harmful vascular changes, but also on average dropped 10 pounds in 45 days, compared to an equal number of study participants randomly assigned to a low-fat diet. The low-fat group, whose diets consisted of no more than 30 percent from fat and 55 percent from carbs, took on average nearly a month longer, or 70 days, to lose the same amount of weight.

Both groups had an exercise component. In the absence of a correlating study showing that the same diets without exercise has a different outcome, Parker-Pope’s assertion is without any foundation. Pre-conceived notions are hard to shake.

How Low is Low

As we’ve seen in other studies, the term “low carb” used here is inexact. The low carbohydrate group consumed up to 30% of their calories from carbs. Considering this a low carb diet is a bit of a stretch. Most people adhering to a low carb diet to lose weight start with about 40 grams of carbohydrates per day, or 160 calories from carbs. For a healthy man consuming 2,500 calories per day, carbs during Induction on Atkins represent about 7% of calories. That same man on the test diet in this study would be consuming about 185 grams of carbs. That’s higher than many people on a low carb maintenance diet.

This study did reduce calorie content by about 700 calories over the baseline for each individual. Even for a 2,000 calorie diet, the “low carb” dieter is consuming 150 grams of carbs.

Why Calories Don’t Matter

This study provides yet another example why the “calories in / calories out” model is flawed, as the low carb group lost weight 30% faster than the low fat group. They both consumed 700 fewer calories per day than before, but the low carb group lost weight faster. If the body reacts to all food the same way, as a strict “calories in / calories out” model suggests, then both groups would have lost weight at the same rate. But in study after study, we find that the low carb group loses weight faster and with less hunger than the low fat group. What you eat matters as much as how much you eat.

The Original Purpose

The trial was designed to test the differences in vascular function for people on both diets, and both showed no change. It is the first study to actually test vascular function among a group of people. That is good news for people considering a low carb diet. As lead investigator exercise physiologist Kerry Stewart, Ed.D, says:

“Our study should help allay the concerns that many people who need to lose weight have about choosing a low-carb diet instead of a low-fat one, and provide re-assurance that both types of diet are effective at weight loss and that a low-carb approach does not seem to pose any immediate risk to vascular health,” says Stewart. “More people should be considering a low-carb diet as a good option,” he adds.

The study is due to be published Friday, June 3.

15 Months Later

15 months ago I weighed 247 pounds, took hydrochlorothiazide (HCZT) for high blood pressure, Prilosec OTC for GURD, and had triglycerides of 344. My BP was 140/96, my waist size was creeping up on 42″, my HDL cholesterol was 20 and my fasting glucose level was 103. I had more than three of the indicators of “metabolic syndrome” — in fact, I had them all — increasing my risk for heart disease, stroke and diabetes:

According to the American Heart Association and the National Heart, Lung, and Blood Institute, metabolic syndrome is present if you have three or more of the following signs:

  • Blood pressure equal to or higher than 130/85 mmHg
  • Fasting blood sugar (glucose) equal to or higher than 100 mg/dL
  • Large waist circumference (length around the waist):
    o Men – 40 inches or more
    o Women – 35 inches or more
  • Low HDL cholesterol:
    o Men – under 40 mg/dL
    o Women – under 50 mg/dL
  • Triglycerides equal to or higher than 150 mg/dL

I wanted to avoid taking statins, a class of drug that has some side effects for some people. In my About page I have the course of action taken over a few years to try and get the situation under control. But nothing seemed to work until my doctor suggested I try reducing carbohydrates to see if I respond. I picked up Protein Power from the local bookstore, started the diet, and responded, very quickly. I then bought The Protein Power Lifeplan, the updated book, and found it a great help. (If you are only going to buy one, get Protein Power Life Plan).

Now, 15 months later, I have lost 44 pounds down to 203 (still 10 – 15 pounds overweight, but progress nonetheless). My size 36 pants are just starting to get a little loose, and I long ago abandoned the size 42, 40 and 38 size pants I wore over the past year and a half. I haven’t taken the HCZT for high blood pressure in over a year … today, it was 122 / 62 … and I stopped taking Prilosec OTC right after starting the diet. My triglycerides dropped first to 103 (from 344), then rose back to 143 as I have transitioned into the maintenance phase of the diet. My fasting glucose is now under 100, at 98. My HDL cholesterol, once at 20, is now 34, just 6 points shy of the desired 40.

My doctor is pleased, I am pleased, but more importantly, I feel great. The low carb way of eating is one I can tolerate long term, and plan to continue on this diet for the rest of my life.

Dieting for Risk Factors

With the usual caveat that I am not a medical professional, I want to propose an idea for your consideration. I would encourage you to discuss this idea with your doctor before embarking on any diet plan.

I think it makes sense to first identify your individual risk factors for the things that kill us. The Centers for Disease Control (CDC) publishes charts showing the leading causes of death for men and for women. Looking at the charts you see that heart disease is the leading cause of death at about 27% of all deaths. We tend to focus on those stats and work to minimize our chances of dying from heart disease. That’s certainly the approach taken on a society-wide level with the low-fat diet recommendations (the low fat diet is thought to reduce serum cholesterol levels leading to less heart disease, although many of us find that it increases cholesterol instead.) What I think we are ignoring is that our individual risk factors may be for something entirely different. Remember, that heart disease is not the cause of death for a majority of the people … 73% of them, in fact. Are we increasing our risk of dying early by trying to reduce our risk for heart disease?

The American Heart Association (AHA) identifies the risk factors for heart disease in two categories, those you can change and those you cannot. The categories are a mistake, in my view. It is the risk factors you cannot change that may be the most susceptible to changes in diet: age, sex and heredity. 83% of the deaths due to heart disease happen after age 65, so time is on your side if you are younger than that. Males are more susceptible to heart disease, and have a higher incidence of dying younger than that age 65 statistic. And family history, including race, plays a factor.

The factors you “can change”, according to the AHA, are things like tobacco use, obesity, high blood pressure, serum cholesterol levels, activity levels, and diabetes.

The standard treatment to reduce risk factors for heart disease is a low fat, relatively high carbohydrate diet and prescription drugs to lower cholesterol. The prescription drugs are necessary because many people find a low fat, high carbohydrate diet raises cholesterol (especially triglycerides). Low carb diet advocates challenge this view, and note that many people find a low carb diet improves their lipid profile without the use of prescription drugs (as well as improving weight, high blood pressure and other factors).

The problem is that there is no easy way to score these factors. Do you check off each factor, and if you have more than three, start to worry? Or is family history such an important factor that it, by itself, compels you to work to reduce your risk? Certainly, if your parents and all your siblings died of heart attacks, you probably realize it “runs in your family.” But for most of us, even getting the full list of risk factors isn’t enough to tell us if we, personally, are at risk.

The place to start is a doctor who knows your medical history. Ask him point blank: what do you think I’m going to die from? The answer will be about risk factors for the diseases on those CDC charts, and which one your history indicates the greatest risk for you. Heart disease and cancer are at the top, by a large margin. But as you read down the list, you see stroke, respiratory disease, and diabetes.

Its interesting that diabetes is a risk factor for heart disease, and diabetes itself is the 6th leading cause of death.

My largest risk factor, given my family history and age, sex and physical condition is diabetes. Several people in my family, a brother and my mother, have adult-onset diabetes. I’m male, over 50, and have more than two of the markers for “metabolic syndrome” (pdf file from CDC on metabolic syndrome). In contrast to that, I have very little heart disease in my immediate family.

My doctor recommended a low carb diet to reduce my high triglyceride level; success is shown by lowering triglycerides from 462 to 113 on my last blood test. I’m staying on it to lower my weight and blood glucose level, as well as meet the other cholesterol goals (HDL, LDL, etc., as shown on the About Page).

The term “diet” is often associated with a reduced calorie, temporary eating regimen that you abandon after reaching a weight goal. The problem with this approach is that it ignores the very real impact your diet has on your health. The real goal should be to live longer, not simply to lose weight and “look good”. A pretty corpse is still dead.

Your diet should reflect the best bet to protect against your individual risk factors, and not to fulfill a broad societal goal.

Low Carb Better than Low Fat

Another article has been posted to our Research pages, this time recapping a study that compared a standard LCD (low carb diet) to the American Heart Association diet that emphasizes low fat. The study was published in the Nutrition, Metabolism and Cardiovascular Diseases journal, and is posted here.

The study selected 39 individuals and divided them into two groups. One group ate a carb-restricted diet for 12 weeks. The other group ate a carb-restricted diet for 6 weeks, and then switched to the AHA diet for the remaining 6 weeks.

In this study, the low carbohydrate diet followed the recommendations of most of the low carb diets: 20 to 25% of calories from carbs. The AHA diet, by comparison, doubles that amount with 50 to 55% of the calories from carbs.

One concern often expressed about eating low carb and increasing saturated fat in the diet is that LDL can rise using the normal calculated value. This study looks specifically at the type of LDL that each of the diets produces, using direct measurements rather than an inaccurate calculation.

The short version of the results is that the low carb diet “had a better effect on atherogenic VLDL and HDL than the low fat diet recommended by AHA.” Atherogenic VLDL and HDL are particles that lead to the formation of atheromas on the walls of the arteries, or what we commonly call atherosclerosis.

This is just one study, and won’t immediately change the dietary recommendations of nutritionists, doctors and the American Heart Association. But the “Low Fat Age” is seeing its reign come to an end, and the Low Carb Age is upon us.

Low Carb Diets – Evidence Mounts

We added a few more links to our Research Pages, including two new studies showing that a low carb diet works better than the traditional low fat diet for metabolic syndrome (scroll to bottom for the section on metabolic syndrome).

I found these studies through a column that is good, but not great. The LA Examiner online has an article about low carb diets and CHD (coronary heart disease). The studies they link to regarding inflammation at the Cleveland Clinic do not mention high carbohydrate diets at all. It is a bit misleading; the author states categorically that inflammation is caused by several factors including “over consumption of processed carbohydrates”, and then links to the Cleveland Clinic article. But I cannot find that sentiment on any of the Cleveland Clinic’s linked pages; they advocate the low fat, high complex carbohydrate diet instead.

The article is valuable for the links to other studies and resources that do connect a low carb diet to reduced inflammation. If the reader checked the Cleveland Clinic source and went no further, he would have to conclude the author is incorrect and may dismiss the article. So check out the other links and information provided.

Site Updates

We added a Heart Disease research page, linking in an important recent study showing low carb eating providing significant benefits.

And a new article has been added to our Diabetes research page.

I evaluated and added three new links. These links are to sites I think provide high quality information. I try to avoid the overly commercial sites hawking their own goods with little additional content. You’ll find these sites updated frequently with interesting content.

First, a medical blog, Dr Biffa. Dr. Biffa is a British physician with an active practice where the low carb lifestyle is actively promoted.

Next up, the blog for the movie Fat Head. That may seem like an unusual choice, but writer/comedian Tom Naughton brings both humor and clear writing to the subject, a great combination.

Finally, Laura Dolson’s resource rich About.com Low Carb Diets site. There is a blog there that is frequently updated, but Laura also provides recipes, links to articles, a low carb glossary, and more.