Low Fat attacks Low Carb

Dr. Dean Ornish, in an opinion piece in the New York Times, slammed low carb eating plans with a review of a recent study containing so many half-truths it is hard to know where to start.  It is exactly this sort of misleading information that kept my daughter overweight, tired, and often sad for so many years before I figured out how to help her.

The study tested the efficacy of a low fat diet, a low glycemic diet, and a low carb diet in maintaining weight loss.  The Atkins-type diet has been shown repeatedly now to produce the most weight loss (and in an interesting twist, in this study it showed the most energy expenditure), but Ornish wants to argue that just because it makes you thinner doesn’t mean it makes you healthy.  Ornish reviews evidence that his eating plan has successfully reversed severe coronary artery disease and halted the progression of Type 2 diabetes.  In contrast, Ornish reports, accurately, that the low carbohydrate eating plan in this study resulted in higher levels of C-reactive protein and cortisol, both associated with increased risk of heart disease and other chronic diseases.  He fails to mention that the study showed that the low fat diet produced the worst outcomes for insulin resistance, triglycerides, and HDL (the good cholesterol), while the Atkins-style diet produced the best.  Furthermore, there are many studies of low carb diets that do show improvements in C-reactive protein: “Not all low carb diet studies have shown significant reductions in biomarkers like CRP or IL-6, but many have. We suspect the variable results seen in other studies may be due to both questionable compliance with the assigned diet, plus the diets not being low enough in carbohydrate to achieve these anti-inflammatory effects.”

Phinney, Stephen; Volek, Jeff (2011-07-08). The Art and Science of Low Carbohydrate Living: An Expert Guide to Making the Life-Saving Benefits of Carbohydrate Restriction Sustainable and Enjoyable (p. 85). Beyond Obesity LLC. Kindle Edition.

He fails to cite any of the voluminous evidence that Atkins-type eating plans have also reversed coronary artery disease and type 2 diabetes, as well as many other chronic health conditions.  See these descriptions of research results from “The Art and Science of Low Carbohydrate Living” (and for more information I highly recommend reading the whole book):

“Type-2 Diabetes

Concurrent with this and subsequent cases that we generated in Vermont, Dr. Bistrian completed a series of seven closely monitored cases in Cambridge/Boston[120]. It was his very low carbohydrate ketogenic (VLCKD) diet protocol that we used in the case study above. All seven of the subjects in his published report were obese, insulin-using type-2 diabetics, and all were able to be withdrawn from insulin therapy (up to 100 units per day) in an average of 7 days after starting the VLCKD. All of these subjects went on to lose a considerable amount of weight, an achievement that is decidedly uncommon in diabetics who are using injected insulin.”

Phinney, Stephen; Volek, Jeff (2011-07-08). The Art and Science of Low Carbohydrate Living: An Expert Guide to Making the Life-Saving Benefits of Carbohydrate Restriction Sustainable and Enjoyable (pp. 193-194). Beyond Obesity LLC. Kindle Edition.

“In 1994, the Lyon Diet Heart Study [48] was terminated prematurely at 27 months due to a dramatic decrease in mortality in the group that consumed a 40% fat Mediterranean-type diet compared to a group that was prescribed the American Heart Association’s ‘prudent diet’. This dramatic difference in heart disease and overall mortality occurred despite the fact that there were no differences in the two groups’ LDL-C responses to the diets.”

Phinney, Stephen; Volek, Jeff (2011-07-08). The Art and Science of Low Carbohydrate Living: An Expert Guide to Making the Life-Saving Benefits of Carbohydrate Restriction Sustainable and Enjoyable (p. 91). Beyond Obesity LLC. Kindle Edition.

Ornish then cites evidence from another study that low carb, high protein diets promote coronary artery disease.  But the Atkins diet is not a high protein diet.  Most of the calories from an Atkins type eating plan come from fat.  Ornish does this for a living.  I’m just a part-time blogger.  I don’t believe he doesn’t know the difference between a high protein and a high fat diet.

Ornish cites evidence from the Nurses Health Study that red meat consumption, which he calls “a mainstay of the Atkins diet,” is associated with “increased risk of premature death, as well as greater incidence of cardiovascular disease, cancer, and Type 2 diabetes.”  And that may well be true.  Lots of things are bad for you in the presence of too much carbohydrate.  I’m pretty sure most of those nurses were eating a typical high carb American diet, not a low carb one.

Ornish ignores the carbohydrate restriction of the Atkins eating plan, and that is where all the action is, as I’m sure he is aware.  Even fat, the real mainstay of the Atkins diet, is bad for you with too much carbohydrate.  In the presence of too much carbohydrate, insulin will direct your body to store the fat calories as fat, rather than burn them for fuel as your body would do on the low carb plan.

Ornish shows a puritanical streak, arguing that low carb eating plans are popular because people want to hear that “cheeseburgers and bacon are good for you.”  On the other side of the opinion spectrum, low carb eating plans are criticized as being too restrictive:  “how long do you want to keep eating that bacon double cheeseburger, hold the bun, thank you?”  (In the small world of this research, the second comment happens to come from Dr David Ludwig, who is also the author of the study Ornish is reviewing.  Ludwig advocates a low glycemic diet).  Clearly, low carb eating plans can’t win:  they’re both too yummy and too limited at the same time, depending on which eating plan you favor.

So What is Ornish pushing?  A mostly plant-based, “low in fat,” low in unhealthful carbs and red meat eating plan.  He reviews the results of a randomized controlled trial of his program.  Participants lost an average of 24 pounds over a year, and maintained a 12 pound weight loss over 5 years.  Sorry, but weight loss of 24 pounds in a year, and gaining half of that back over 5 years, is not that impressive.

Ornish recycles the idea that by replacing fat with carbs, you can eat the same amount of food and still lose weight.  That might be true, if you are successful in eating the same amount of food.  But on a low fat, high carbohydrate diet, (even of “healthy” whole grain carbs), you’re apt to be hungrier than on a high fat, low carb diet, and you won’t be able to hold your food intake constant.

Juliana lost 6 pounds in 10 weeks on a diet similar to Ornish’s.  To comply with the philosophy of the Packard weight loss program, we went heavily into a plant-based low fat diet, without any refined carbohydrates.  She was constantly hungry.  Then we switched to a low carb plan.  She lost 3.5 pounds in a week (most of the early weight loss is water—the first thing that happens on a low carb plan is that you dump excess retained water).  Now she is losing 2 pounds steadily per week, without hunger.

I know Juliana is an “n” of 1; our experience is not a randomized controlled trial.  If Ornish’s patients are satisfied, that’s great for them.  But I don’t see the need for him to publish a misleading attack on low carb plans to tout his program.  If you find that an Ornish-type eating plan works for you and your children, that’s great.  But if you find it doesn’t, then consider joining the low carb club.

 

What does a weekly meal plan look like?

A friend asked me for a sample weekly meal plan.  Juliana and I are still eating very low carb, keeping net carbohydrate under 30 grams per day, and this meal plan reflects that.  Most of Juliana’s carbohydrates come from what are called “foundation vegetables” in the Atkins plan–very low carb, very high nutrient vegetables such as broccoli, romaine lettuce, green beans, cauliflower.  I eat those as well but get some carbs from almonds and tomatoes, which Juliana does not like.

As Juliana gets closer to her goal weight, we will begin adding back more foods, starting with berries, which are a relatively low carb fruit.

The first thing you’ll see is that breakfast is dinner and dinner is breakfast.  Really any meal can be eaten at any time of day, so the categories “breakfast, lunch, and dinner” are arbitrary.  Juliana likes eggs for breakfast.  Eggs in the morning make me nauseous, but I like eggs for dinner.   We eat hard boiled eggs with salt and pepper or deviled eggs for snacks all day long.  Juliana has eaten cheeseburgers for breakfast, and I regularly eat last night’s leftovers for breakfast and pack them for Juliana in her lunch for school.   We try to eat carbohydrates, fat, and protein at each meal.  Even if you are only eating 30 grams of carbohydrate per day, it is preferable not to eat them all at the same time.

Breakfast Lunch Dinner Snacks
3-egg omelet filled with leftover roasted cauliflower Pork Chop and mashed cauliflower Pork Chops, broccoli with garlic, mashed cauliflower Deviled Eggs or Hard-boiled eggs with salt and pepper
Leftover skirt steak and mashed cauliflower; sliced tomato with salt Cheeseburger with roasted cauliflower Quiche with mashed cauliflower Salami and Cheese Rollups
No-sugar added chicken Italian sausage with mashed cauliflower Salad with romaine lettuce, tomato, cucumber, avocado, salami, cheese and almonds on the side Beef with broccoli, mashed cauliflower Ounce of Almonds
Salami and eggs filled with cooked broccoli Tuna salad* romaine lettuce “sandwiches” No sugar added pork Italian sausage, green beans with garlic, mashed cauliflower Egg Quiche with sausage, broccoli, and cheese
Leftover tri-tip and mashed cauliflower Egg salad* romaine lettuce “sandwiches” Chicken with green beans, mashed cauliflower Scoop of chicken salad* 
Broccoli, tomato, bacon and egg scramble Taco meat with toppings Pizza chicken with roasted broccoli Turkey and cheese rollups
Grilled chicken breast (no-carb marinade is ok) and grilled asparagus Roasted chicken with roasted cauliflower and roasted broccoli Skirt steak, brussel sprouts with tamari, mashed cauliflower Bacon slices

*Made with no-sweetener-added mayonnaise.

Can a child be a low carb vegetarian or vegan?

Can I be a low carb vegan?  Short answer:  No.

How about a low carb lacto-ovo vegetarian?  Possibly, but really difficult.

Most of the low carb eating plans I’ve seen suggest that you can be a vegetarian or even a vegan.  I frankly don’t think this is really realistic even for an adult.  But for a child, a low carb vegetarian eating plan may be setting them up for failure.

There is a dizzying array of high carb food available–most of the food in the supermarket is high carb.  The cereal aisle.  The pasta and rice aisle.  The baking aisle.  The chips and crackers aisle.  The cookie aisle.  The bakery department.  The juice and soda aisle.  When you switch to low carb, your universe of acceptable food shrinks.  That’s the bad news.  The good news is that many of the choices are foods you might have wanted to eat but usually didn’t:  pork bacon, steak, cheeseburgers.  At first, the new eating plan is great.  Bacon, again?  Why Not?  After a while, though, you have to get creative with your meal planning.  No one wants to eat cheeseburgers three meals a day.

Now imagine the only protein and fat sources available to you are eggs, cheese and cream, and some tree nuts.   (In my opinion, substituting highly processed soy products, like tofu and tempeh, for animal-based protein is not a good idea).  Try to come up with 3 meals a day where most of your calories come from those fat and protein sources.  You can eat nut butter, but remember you can’t spread it on bread.  Yes, there are a lot of ways to prepare eggs, but probably not enough to keep your child on the eating plan.

My coach at my gym put it well while giving a nutrition talk.  She said she likes animals, and she doesn’t really want to eat animals, but she needs protein and fat, so she does.