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 about “less carb” instead of “low carb”?

What about a “less carb” eating plan?  Wouldn’t that be a good bet if you still have safety concerns about low carb eating plans?  This page:  about.com low carb for kids provides a nice summary of this viewpoint.  What’s wrong with this logic?  At least three things.

1)  A less carb eating plan may not be low carb enough to get the metabolic benefits of low carb–to switch your child’s body over to primarily burning fat, rather than carbohydrates, for fuel.  (Westman, Dr. Eric C.; Phinney, Dr. Stephen D.; Jeff S. Volek (2010-02-17). The New Atkins for a New You (p. 8-). Simon & Schuster, Inc.. Kindle Edition).

2)  A less carb eating plan may not be low carb enough to eliminate carbohydrate cravings, making it much harder for the child to follow.  On a very low carb diet, cravings disappear.  That kid who can’t seem to get enough mac and cheese, muffins, cookies, bread with dinner, potato chips and so forth will disappear.

As you approach your goal weight, you gradually add carbs back in a defined order–but if a given carbohydrate food stops weight loss or causes cravings to return, you eliminate it again.  If you don’t do that, it’s very hard to stay on the eating plan.  (Westman, Dr. Eric C.; Phinney, Dr. Stephen D.; Jeff S. Volek (2010-02-17). The New Atkins for a New You (p. 116-144). Simon & Schuster, Inc.. Kindle Edition.

3) On a less carb eating plan, your child may be hungry even while consuming the same number of calories as on a low carb eating plan that does not result in nagging hunger.  Why?    Carbohydrates stimulate hunger in a way that fat and protein do not.  As Gary Taubes describes in “Good Calories, Bad Calories,” a diet of 1200 calories of fat and protein is satiating.  People find compliance relatively easy, without hunger, and they lose weight.  But a diet of 800 calories of fat and protein and 400 calories of carbohydrate is the classic semi-starvation diet that is successful in perhaps 1 of 100 people.  And a major reason for the low success rate is people can’t tolerate the constant hunger such a diet produces.  (Taubes, Gary (2007-09-25). Good Calories, Bad Calories (Kindle Location 6884-6924). Random House, Inc.. Kindle Edition).

Nor is it necessary to consume only 1200 calories of fat and protein to lose weight on a low carb eating plan.  Taubes summarizes:

“The last decade has witnessed a renewed interest in testing carbohydrate-restricted diets as obesity levels have risen and a new generation of clinicians have come to question the prevailing wisdom on weight loss. Six independent teams of investigators set out to test semi-starvation diets of the kind recommended by the American Heart Association in randomized control trials against “eat as much as you like” Pennington-type diets, now known commonly as the Atkins diet, after Robert Atkins and Dr. Atkins’ Diet Revolution. Five of these trials tested the diet on obese adults, one on adolescents. Together they included considerably more than six hundred obese subjects. In every case, the weight loss after three to six months was two to three times greater on the low-carbohydrate diet—unrestricted in calories—than on the calorie-restricted, low-fat diet.”

Taubes, Gary (2007-09-25). Good Calories, Bad Calories (Kindle Locations 6868-6875). Random House, Inc.. Kindle Edition.

See also:  Westman, Dr. Eric C.; Phinney, Dr. Stephen D.; Jeff S. Volek (2010-02-17). The New Atkins for a New You (p. 49-58). Simon & Schuster, Inc.. Kindle Edition.

Low fat, high carb eating has made us fat.

The low fat, high carb diet that public health authorities began recommending in the 1980s was supposed to be relatively low in calories, and therefore help people achieve or maintain a healthy weight.  Carbohydrates have fewer calories per gram of weight (4) than fat (9) and the same as protein (4).  Consuming more carbohydrates than protein or fat was supposed to supply fewer overall calories in the diet and result in a healthy weight.  But that’s not what happened.  Instead, people have gotten fatter and fatter.

Public health authorities now blame the obesity epidemic on the public not following their advice.  Gary Taubes argues that they have followed the advice, and cites food consumption statistics to back this up:

“Consider, for instance, that most reliable evidence suggests that Americans have indeed made a conscious effort to eat less fat, and particularly less saturated fat, since the 1960s. According to the USDA, we have been eating less red meat, fewer eggs, and more poultry and fish; our average fat intake has dropped from 45 percent of total calories to less than 35 percent”

Taubes, Gary (2007-09-25). Good Calories, Bad Calories (Kindle Locations 219-222). Random House, Inc.. Kindle Edition.

Yet people, including children, have become fatter than ever:

“The prevalence of overweight in children six to eleven years old more than doubled between 1980 and 2000; it tripled in children aged eleven to nineteen.”

Taubes, Gary (2007-09-25). Good Calories, Bad Calories (Kindle Locations 4765-4766). Random House, Inc.. Kindle Edition.

Why is the high carb, low fat dietary advice just plain wrong?  Because it ignores what different types of foods do in the human body.  Carbohydrates produce a different biological response than do fats or proteins.  Specifically, they produce a response that stores food energy as fat.  Fat and protein do not.  However, the energy from fat and protein, if eaten in conjunction with carbohydrate, will be swept up in the same process and stored as fat.  Eating fat and protein with too much carbohydrate (and for many individuals, “too much” is a very small amount), will make you fat.

Calories In/Calories Out–NOT

The calories in/calories out model of weight management says: burn more calories than you consume to lose weight; –balance calorie consumption with expenditure to maintain weight.  Like the public health ad said that I remember from the Washington subway in the late 90′s:  switch from mayonnaise to mustard on your daily sandwich and lose 10.4 pounds a year (savings of 100 calories/day for 365 days).  The CDC recommends that children get 60 minutes of moderate intensity physical activity on most days of the week, and preferably every day.  For a 154 pound person, they estimate that 60 minutes of brisk walking (4.5 mph) will burn 460 calories an hour (more if you are heavier, less if you are lighter).  That’s 3220 calories per week, or 47.8 pounds of expected weight loss over a year.

Virtually all of the dietary advice provided to parents who are trying to help their children achieve or maintain a healthy weight conforms to this model, the most recent and visible example being Michelle Obama’s Let’s Move initiative, which is closely tied to the USDA’s new food plate eating plan, and replaced the earlier pyramid eating plan.  Both the new Food Plate and the old Pyramid are high carb, low fat eating plans.

These diets were recommended by public health authorities beginning in the 1980s because it was believed such a diet was beneficial for preventing heart disease, while at the same time controlling weight because it was supposed to be a relatively low calorie diet.  Carbohydrates have fewer calories per gram of weight (4) than fat (9) and the same as protein (4).  It was further thought that even if the diet itself didn’t turn out to be protective against heart disease, it would control weight, and controlling weight would be protective against heart disease.

There’s just one problem:  high carb, low fat diets like the new food plate and the old pyramid don’t work for weight loss or weight maintenance and don’t improve other health markers either.   Gary Taubes, in the lengthy “Good Calories, Bad Calories,” and the cliffs notes version “Why We Get Fat and What to do About it,” eviscerates the logic behind low fat, high carb diets.  Reading these books completely changed how I thought about Juliana’s struggle with weight.   If you eat like the USDA pyramid and are a normal weight, your body can handle a high level of carbohydrates (for now at least)–the evidence for that is that you are a normal weight.  Your child can’t, and that is why he or she is overweight.

If you are a normal weight adult trying to help an overweight child, you should run to the library or bookstore for these books.