I finished and posted the PDF of the Low-Carb Mediterranean Diet. It’s still free. It will print on the standard 8.5″ x 11″ paper in most U.S. printers.
Also ready is the Grocery Shopping List for the Ketogenic Mediterranean Diet and Low-Carb Mediterranean Diet. Also free. You’ll see that very-low-carb eating is much more than bacon, broccoli, and Brie!
Steve Parker, M.D.
Filed under ketogenic diet, Mediterranean Diet
High-protein, low-carbohydrate diets are safe and effective for severely obese adolescent, according to University of Colorado researchers.
Childhood obesity in the U.S. tripled from the early 1980s to 2000, ending with a 17% obesity rate. Overweight and obesity together describe 32% of U.S. children. Some experts believe this generation of kids will be the first in U.S. history to suffer a decline in life expectancy, related to obesity.
Colorado researchers wondered if a low-carb, high-protein diet is a reasonable treatment option. Why high protein? It’s an effort to preserve lean body mass (e.g., muscle).
They randomized 46 adoloscents (age 12–18) to either a high-protein, low-carb diet (HPLC diet) or a calorie-restricted low-fat diet to be followed for 13 weeks. HPLC dieters could eat unlimited calories as long as they attempted to keep carb consumption to 20 g/day or less. Low-fat dieters were to choose lean protein sources, aiming daily for 2 to 2.5 grams of protein per kilogram of ideal body weight. Study participants underwent blood analysis and body compositon analysis by dual x-ray absorptiometry. These kids weighed an average of 108 kg (238 lb) and average body mass index was 39.
Analysis of food diaries showed the following:
Findings
Both groups lost weight, with the HPLC dieters trending to greater weight loss, but not to a statistically significant degree. They did, however, show a greater drop in body mass index Z-score, however. Study authors didn’t bother to explain “body mass index Z-scores,” assuming I would know what that meant. Average weight in the HPLC group dropped 13 kg (29 lb) compared to 7 kg (15 lb) in the low-fat group.
Total and LDL cholesterol fell in both groups, and insulin resistance improved. Neither diet had much effect on HDL cholesterol.
As usual, triglycerides fell dramatically in the HPLC dieters.
Nearly 40% of the kids—about the same number in both groups—dropped out before finishing the 13 weeks.
The HPLC group did not see any particular preservation of lean body mass, and actually seemed to lose a bit more than the low-fat group.
There were no serious adverse effects in either group.
Surprisingly, satiety and hunger scores were the same in both groups. [Low-carb, ketogenic diets have a reputation for satiation and hunger suppression.]
My Comments
This is a small short-term study with a large drop-out rate; we must consider it a pilot study. That’s why I’m not as enthusiastic about it as the researchers. Nevertheless, it does indeed suggest that high-protein, low-carb diets are indeed safe and effective in obese adolescents. It’s a start.
Reference: Krebs, N., Gao, D., Gralla, J., Collins, J., & Johnson, S. (2010). Efficacy and Safety of a High Protein, Low Carbohydrate Diet for Weight Loss in Severely Obese Adolescents The Journal of Pediatrics, 157 (2), 252-258 DOI: 10.1016/j.jpeds.2010.02.010
Filed under Carbohydrate, Fat in Diet, ketogenic diet, Protein, Weight Loss
Dieters on low-fat and low-carb diets both lost the same amount of weight after two years, according to a just-published article in Annals of Internal Medicine. Both groups received intensive behavioral treatment, which may be the key to success for many. Low-carb eating was clearly superior in terms of increased HDL cholesterol, which may help prevent heart disease and stroke.
The study was funded by the National Institutes of Health and was carried out in Denver, St. Louis, and Philadelphia.
How Was It Done?
Healthy adults aged 18-65 were randomly assigned to either a low-fat or low-carbohydrate diet. Average age was 45. Average body mass index was 36 (over 25 is overweight; over 30 is obese). Of the 307 participants, two thirds were women. People over 136 kg (299 lb) were excluded from the study—I guess because weight-loss through dieting is rarely successful at higher weights. Diabetics were excluded.
The low-carb diet: Essentially the Atkins diet with a prolonged induction phase (12 weeks instead of two). Started with maximum of 20 g carbs daily, as low-carb vegetables. Increase carbs by 5 g per week thereafter as long as weight loss progressed as planned. Fat and protein consumption were unlimited. The primary behavioral goal was to limit carb consumption.
The low-fat diet: Calories were limited to 1200-1500 /day (women) or 1500-1800 (men). [Those levels in general are too low, in my opinion.] Diet was to consist of about 55% of calories from carbs, 30% from fat, 15% from protein. The primary behavioral goal was to limit overall energy (calorie) intake.
Both groups received frequent, intensive in-person group therapy—lead by dietitians and psychologists—periodically over two years, covering such topics as self-monitoring, weight-loss tips, management of weight regain and noncompliance with assigned diet. Regular walking was recommended.
Body composition was measured periodically with dual X-ray absorptiometry.
What Did They Find?
Both groups lost about 11% of initial body weight, but tended to regain so that after two years, both groups average losses were only 7% of initial weight. Weight loss looked a little better at three months in the low-carb group, but it wasn’t statistically significant.
The groups had no differences in bone density or body composition.
No serious cardiovascular illnesses were reported by participants. During the first six months, the low-carb group reported more bad breath, hair loss, dry mouth, and constipation. After six months, constipation in the low-carb group was the only symptom difference between the groups.
During the first six months, the low-fat group had greater decreases in LDL cholesterol (with potentially less risk of heart disease), but the difference did not persist for one or two years.
Increases in HDL cholesterol (potentially heart-healthy) persisted throughout the study for the low-carb group. The increase was 20% above baseline.
About a third of participants in both groups dropped out of the study before the two years were up. [Not unusual.]
My Comments
Contrary to several previous studies that suggested low-carb diets are more successful than low-fat, the study at hand indicates they are equivalent as long as dieters get intensive long-term group behavioral intervention.
Low-carb critics warn that the diet will cause osteoporosis, a dangerous thinning of the bones that predisposes to fractures. This study disproves that.
Contrary to widespread criticism that low-carb eating—with lots of fat and cholestrol— is bad for your heart, this study notes a sustained elevation in HDL cholesterol (“good cholesterol”) on the low-carb diet over two years. This also suggests the low-carbers followed the diet fairly well. The investigators also note that low-carb eating tends to produce light, fluffy LDL cholesterol, which is felt to be less injurious to arteries compared to small, dense LDL cholesterol.
A major strength of the study is that it lasted two years, which is rare for weight-loss diet research.
A major weakness is that the investigators apparently didn’t do anything to document the participants’ degree of compliance with the assigned diet. It’s well known that many people in this setting can follow a diet pretty well for two to four months. After that, adherence typically drops off as people go back to their old habits. The group therapy sessions probably improved compliance, but we don’t know since it wasn’t documented.
How often do we hear “Diets don’t work.” Well, that’s just wrong.
Overall, it’s an impressive study, and done well.
Individuals wishing to lose weight on their own can’t replicate these study conditions because of the in-person behavioral intervention component. There are lots of self-help calorie-restricted balanced diets (e.g., Sonoma Diet, The Zone, Advanced Mediterranean Diet) and low-carb diets (e.g., Atkins Diet, Banting’s Letter on Corpulence, Low-Carb Mediterranean or Ketogenic Mediterranean Diets). On-line support groups—e.g. Low Carb Friends and SparkPeople and 3 Fat Chicks on a Diet—could supply some necessary behavioral intervention strategies and support.
Choosing a weight-loss program is not as easy as many think. [Well, I’ll admit that choosing the wrong one is easy.] I review the pertinent issues in my “Prepare for Weight Loss” page.
Reference: Foster, Gary, et al. Weight and metabolic outcomes after 2 years on a low-carbohydrate versus low-fat diet: a randomized trial. Annals of Internal Medicine, 153 (2010): 147-157 PMID: 20679559
Filed under Carbohydrate, Fat in Diet, ketogenic diet, Overweight and Obesity, Weight Loss
Dieters with particular genetic make-up respond better or worse to specific types of weight-loss diets, suggest researchers who presented data at the 2010 Cardiovascular Disease Epidemiology and Prevention /Nutrition, Physical Activity, and Metabolism conference. Findings are preliminary, but may explain the common phenomenon of two people going on the same diet, but only one achieving good results.
I’ll bet you can imagine several other explanations.
Several years ago, the “A to Z” study compared the weight loss of 311 overweight women on one of four diets: Atkins (low-carb), Ornish (very low fat, vegetarian), Learn (low-fat), and Zone (moderate carb restriction, high protein, moderate fat). Atkins was a bit better than the other diets, in terms of long-term (one year) weight loss. But within each diet group, some women lost 40–50 pounds (18–23 kg), whereas others gained over 10 pounds (4.5 kg).
Stanford University researchers obtained DNA from 138 of the 311 women and noted the occurence of three genes—ABP2, ADRB2, and PPAR-gamma—that had previously been shown to predict weight loss via diet-gene interactions. For example, a particular mix of these genes predict better weight loss with a low-fat diet; a different mix predicts more loss with a low-carb diet.
Women who had been randomly assigned to one of the A to Z diets tended to lose much more weight if they happened to have the gene mix appropriate for that diet (compared to those on the same diet with the wrong gene mix). The difference, for example, might be loss of 12 pounds versus two pounds.
The lead researcher, Dr. Mindy P. Nelson, told TheHeart.Org that the proportion in the general population genetically predisposed to the low-fat versus low-carb approach is about 50:50.
Take-Home Points
These results, again, are preliminary; additional testing is necessary for confirmation. If they had been able to test the DNA of the other 178 women in the A to Z study, the results could have been either stronger or shown no diet-gene interaction. The study hasn’t even been published in a peer-reviewed journal yet.
Men may or may not be subject to similar diet-gene interaction.
If a genetic test is ever clinically available to tell a dieter which type of weight-loss diet would be more successful, it will likely be cheaper to just try a particular diet first and see if it works over 4–6 weeks. Successful long-term weight loss is like smoking cessation—most smokers try 5–7 different times or methods before hitting on one that works for them.
This potential diet-gene interaction could be a major finding that will stop the arguing about which is the single best way to lose excess fat. Many paths may lead to the mountaintop.
Reference: O’Riordan, Michael. Dieting by DNA? Popular diets work best by genotype, reseach shows. HeartWire by TheHeart.Org, March 8, 2010.
Filed under Carbohydrate, Fat in Diet, ketogenic diet, Vegetarian Diet, Weight Loss
Whole grain consumption is associated with a 21% reduction in cardiovascular disease when compared to minimal whole grain intake, according to a 2008 review article in Nutrition, Metabolism, and Cardiovascular Disease.
Coronary heart disease is the No. 1 killer in the developed world. Stroke is No. 3. The term “cardiovascular disease” lumps together heart attacks, strokes, high blood pressure, and generalized atherosclerosis (hardening of the arteries).
Investigators at Wake Forest University reviewed seven pertinent studies looking at whole grains and cardiovascular disease. The studies looked at groups of people, determining their baseline food consumption via questionnaire, and noted disease development over time. These are called “prospective cohort studies.”
None of these cohorts was composed purely of diabetics.
The people eating greater amounts of whole grain (average of 2.5 servings a day) had 21% lower risk of cardiovascular disease events compared to those who ate an average of 0.2 servings a day. Disease events included heart disease, strokes, and fatal cardiovascular disease. The lower risk was similar in degree whether the focus was on heart disease, stroke, or cardiovascular death.
Note that refined grain consumption was not associated with cardiovascular disease events.
Why does this matter?
The traditional Mediterranean diet is rich in whole grains, which may help explain why the diet is associated with lower rates of cardiovascular disease. If we look simply at longevity, however, a recent study found no benefit to the cereal grain component of the Mediterranean diet. Go figure . . . doesn’t add up.
Readers here know that over the last four months I’ve been reviewing the nutritional science literature that supports the disease-suppression claims for consumption of fruits, vegetables, and legumes. I’ve been disappointed. Fruit and vegetable consumption does not lower risk of cancer overall, nor does it prevent heart disease. I haven’t found any strong evidence that legumes prevent or treat any disease, or have an effect on longevity. Why all the literature review? I’ve been deciding which healthy carbohydrates diabetics and prediabetics should add back into their diets after 8–12 weeks of the Ketogenic Mediterranean Diet.
The study at hand is fairly persuasive that whole grain consumption suppresses heart attacks and strokes and cardiovascular death. [The paleo diet advocates and anti-gluten folks must be disappointed.] I nominate whole grains as additional healthy carbs, perhaps the healthiest.
But . . .
. . . for diabetics, there’s a fly in the ointment: the high carbohydrate content of grains often lead to high spikes in blood sugar. It’s a pity, since diabetics are prone to develop cardiovascular disease and whole grains could counteract that. We need a prospective cohort study of whole grain consumption in diabetics. It’ll be done eventually, but I’m not holding my breath.
[Update June 12, 2010: The aforementioned study has been done in white women with type 2 diabetes. Whole grain and bran consumption do seem to protect them against overall death and cardiovascular death. The effect is not strong.]
What’s a guy or gal to do with this information now?
Non-diabetics: Aim to incorporate two or three servings of whole grain daily into your diet if you want to lower your risk of heart disease and stroke.
Diabetics: Several options come to mind:
Extra Credit: The study authors suggest a number of reasons—and cite pertinent scientific references—how whole grains might reduce heart disease:
Disclaimer: All matters regarding your health require supervision by a personal physician or other appropriate health professional familiar with your current health status. Always consult your personal physician before making any dietary or exercise changes.
Reference: Mellen, P.B, Walsh, T.F., and Herrington, D.M. Whole grain intake and cardiovascular disease: a meta-analysis. Nutrition, Metabolism and Cardiovascular Disease, 18 (2008): 283-290.
It’s here. It’s online. It’s free. It’s…
The Low-Carb Mediterranean Diet
Many folks—diabetic or not—following the Ketogenic Mediterranean Diet are interested in expanding their carbohydrate options and consumption. The Low-Carb Mediterranean Diet (LCMD) does that while aiming to control both excess weight and high blood sugar levels in diabetics, prediabetics, metabolic syndrome.
Non-diabetics on the KMD can continue with it or move on to the Low-Carb Mediterranean Diet if they wish. If eating a “diabetic diet” seems weird, just think of the LCMD as a low-carb Mediterranean diet—the world’s first published low-carb Mediterranean Diet, by the way. How low-carb? The KMD supplies about 5% of energy (calories) as carbohydrate; the LCMD goes to the 10–20% range. [By way of reference, most people eat around 55% of caloric intake as carbs.]
I started this whole project with the goal of helping my personal patients with type 2 diabetes gain the health benefits of the traditional Mediterranean diet: longer lifespan and lower rates of heart attack, stroke, cancer, and dementia, for example. It’s my sincere hope that it benefits others as well.
Comments Off on Hello, World! Announcing the Low-Carb Mediterranean Diet
Filed under ketogenic diet, Mediterranean Diet
Here’s my review of The New Atkins for a New You, a weight-loss book by Dr. Eric Westman, Dr. Stephen Phinney, and Dr. Jeff Volek released a week ago. The copyright holder is Atkins Nutritionals, Inc. Under Amazon.com’s five-star rating system, I give it four stars (“I like it”).
The most exciting nutritional medicine development in recent memory is the fact that saturated fat consumption is not a significant cause of heart disease and premature death. The same goes for for total fat and cholesterol. When enough physicians, nutritionists, and dietitians learn this, low-carb eating will take off like a rocket.
For those unfamiliar with the Atkins diet, it is designed for weight loss via high fat consumption and major carbohydrate restriction. Protein intake is a bit higher than average. As long as carbohydrates (carbs) are kept low, other foods are mostly unlimited. Atkins has four phases. As you graduate from one phase tothe next, more carbs are allowed, adding some carb sources before others (the Carb Ladder).
Atkins has been around for years. It’s not just a weight-loss diet; it’s a lifetime way of eating.
Doctors Westman, Phinney, and Volek are leaders in low-carb nutritional science. The last time Atkins peaked (2003), we didn’t have the scientific studies backing up safety of the diet. Now we do, in large part thanks to these guys.
Physicians see beaucoup patients with overweight-related medical conditions. We’re not going to recommend a diet that causes heart attacks, strokes, and other major medical complications. Published research over the last eight years has established the relative safety of very low-carb diets, particularly Atkins. Low-carb diets may even be healthier than the low-fat, high-carb diet that has been recommended by U.S. public health authorities for the last forty years. Come to think of it, our current obesity and diabetes epidemics started around that same time.
The book covers nutrition basics, day-to-day practical application of Atkins eating, recipes and detailed meal plans, and the science behind the program.
What’s New Since Dr. Atkins’ 2002 Book?
The lack of ads for Atkins Nutritionals products is welcome and refreshing. Too many of the official Atkins books read like infomercials, which diminishes credibility.
A vegetarian or vegan “Atkins diet” is just not something I can visualize.
What Could Have Been Done Better?
My favorite sentence: “White flour is better suited to glue for kindergarten art projects than to nutrition.”
My least favorite sentence: “We can’t stress strongly enough that the best diet for you is one composed of foods you love.” I love apple pie and Cinnabon cinnamon rolls, but they won’t help me manage my weight.
The only error I found worth mentioning is minor. The authors state that the American Heart Association recommends consumption of fish three times a week. The official policy is still “at least twice weekly.”
The book is very practical and easily understood by average people. Most will skip the science chapters at the end. I know the basic Atkins program works at least short-term; many of my patients have done it.
In summary, the book has nearly everything you need to be successful with the Atkins diet.
As far as I know, there are no comprehensive long-term studies (e.g., 10+ years) regarding health outcomes of Atkins-style eating. In other words, does Atkins have any effect on longevity, cancer, heart attacks, strokes, etc.? But very few of the popular diets have these data either. The best researched ways of eating in this respect are the Mediterranean diet and vegetarian diets.
Disclosure: I was given nothing of value for this review by the authors, publisher, or Atkins Nutritionals, Inc. I wrote it for the benefit of my patients and readers.
Filed under Book Reviews, Carbohydrate, Fat in Diet, ketogenic diet, Weight Loss
I started my Ketogenic Mediterranean Diet on September 1, 2009. After two months, I stopped compulsive record-keeping and food measurement and made a few other intentional tweaks: fish five times a week instead of seven miminum, more nuts (often two ounces a day—I like nuts and they’re convenient), less salad, more dark chocolate. Otherwise the last four months have been similar to the initial two months of strict KMD. My daily digestible carbohydrate intake has probably crept up to 40 g compared to 20-25 g on the strict KMD—this is still considered very low-carb.
Accomplishments
Starting weight was 170 pounds (77.3 kg) on September 1. After two months—8.6 weeks—my weight clearly stabilized at 155 lb (70.5 kg). I lost the 15 lb (6.8 kg) over the first six weeks then just hovered around 155 lb. So average weekly weight loss over the six weeks was 2.5 pounds. Also lost a couple inches (5 cm) off my waist.
For the last four months—November through February—I’ve been eating the aforementioned liberalized KMD. Weight has stayed around 155-157 lb (71 kg). No calorie counting. I eat as much as I want, except for carbs. The experience of the first two months taught me how to eat 20-25 g of carbs in a day; it’s the gauge by which I estimate I’m eating 40 g daily now.
Has It Been Easy?
Yeah, relatively easy. Two other adults in my house are also eating low-carb, which definitely helps. Blogging here also helps me maintain compliance. I promised myself to report everything—the good, the bad, and the ugly—honestly. Accountability is important.
Staying with the program may be easier for me than for others because I am heavily invested in it, psychologically and time-wise.
It’s also been helpful for me to participate at two low-carb online communities: LowCarbFriends and Active Low-Carber Forums. We support each other. Thanks, guys.
I took diet holidays twice, for three days at both Thanksgiving and Christmas. Gained three to five pounds (1.8 kg) each time on high-carb eating, but lost it over the next week by returning to the strict KMD.
Any Surprises?
Induction flu. I’d never heard of it before. Occurs typically on days 2–5 of very low-carb dieting: achiness and fatigue. Others also experience headaches and dizziness, and it may last 1–2 weeks.
Rapid weight gain during my diet holidays (aka cheat days). I was not gorging. I figure the weight was mostly new glycogen in liver and muscle. And water.
Eating fish more than once a day is a lot of fish! Quickly boring, even unappetizing. But that’s just me. I need to be a more creative. Most of my fish lately has been canned tuna.
Assuming that the Daily Values of various nutrients recommended by the U.S. Food and Drug Administration are valid, the KMD foods come up short in many vitamins and minerals. I bet this is an issue (a problem?) with many, if not most, very low-carb diets if supplements aren’t used. Those Daily Values are debatable, of course. For instance, Gary Taubes argues that you don’t need much vitamin C if eating few carbs. My nocturnal leg cramps and constipation were proof enough for me that I needed at least some supplements. The recommended KMD supplements remedy the DailyValue shortfall in vitamins and minerals. Dr. Richard K. Bernstein has a 30-gram carbohydrate diet for his diabetic patients and himself, as outlined in his Diabetes Solution book: no supplements are required.
As time passes, I worry less about getting enough of various micronutrients. I feel fine. I’m still taking the recommended KMD supplements (5 pills a day) plus sugar-free Metamucil.
I never had hunger that I couldn’t satisfy within the guidelines of the diet.
No major trouble with cravings or longing for carbs. I’ve gone six months now without whole grain bread, oatmeal, pizza, and pasta—very unusual for me. I’d be OK never eating them again. What I do miss are sweet, often fat-laced, carbohydrates: pie, cookies, cinnamon rolls, candy bars, cake, ice cream. I doubt that desire will ever disappear, although it does for some who eat very low-carb.
I counted calories only during the first two months of this experiment. Remember, fats and proteins are unlimited. Nevertheless, I ate fewer calories than my baseline intake. This calorie reduction is a well-documented effect of very low-carb diets. Fats and proteins are more satiating than carbohydrates. It’s possible I’ve limited total calories subconsciously.
[An interesting experiment would be to try to gain weight by over-eating fats and proteins while keeping total digestible carbs under 30 g/day. Has it been done already?]
What’s Next?
I’d like to answer some intriguing questions.
Why did my weight loss stop where it did, at 155 lb (70.5 kg)?
If I’d started the KMD at 270 lb (123 kg) instead of 170 lb (77.3 kg), would my weight loss have stopped at 255 lb (116 kg), 210 lb (95.5 kg) or 155 lb (70.5 kg)?
Will two people, 300 lb each (136 kg), end up at the same final weight when following the program religiously? Probably not, but why not?
Six months ago, I believed many scientific studies supported the idea that a higher intake of carbohydrates is healthier, long-term, than the very low-carb Ketogenic Mediterranean Diet and other very low-carb diets. Studies seemed to support higher carbohydrate intake in the form of traditional fruits, vegetables, legumes, and whole grains. After reviewing the scientific literature over the last few months, I’m not so sure that higher carb consumption is necessary or beneficial for long-term health and longevity. The evidence is weak. Nearly all the pertinent studies are observational or epidemiologic—not the most rigorous science.
On the other hand, I still can’t help feeling that the recommended eating styles of people like Monica Reinagel, Darya Pino, and Holly Hickman may be healthier than the KMD over the long run, at least for people free of diabetes and prediabetes. What features unify those three? Food that is minimally processed, fresh, locally produced when able, including a variety of fruits, vegetables, nuts, whole grains, and legumes.
It seems that the human body is marvelously designed to survive, even thrive, with multiple ways of eating—but not all ways.
The strongest evidence for higher carb consumption supports whole grains as a preventative for heart disease (coronary artery disease). But the effect is modest.
The argument against higher carb consumption is simple for people with diabetes and prediabetes: carbs raise blood sugar levels, sometimes to an unhealthy degree.
I don’t see much role for highly processed, refined carbohydrates except as a cheap source of energy (calories).
What’s next for me is to formalize an opinion on which carbs, if any, and in what amount, to add back into the diet of those who have lost weight with the Ketogenic Mediterranean Diet. The answer will probably be different for two groups:
The goal is to maximize health and longevity without tipping over into excessive carb intake that leads to overweight and obesity with associated illnesses.
The traditional Mediterranean diet—long associated with health and longevity—is rich in carbohydrates. The Ketogenic Mediterranean Diet—much lower in carbs—has great potential to help with loss of excess weight and control of blood sugar levels. Does the KMD incorporate enough of the healthy components of the Mediterranean diet? We may never know for sure.
Filed under ketogenic diet, My KMD Experience
A low-carb ketogenic diet in patients with type 2 diabetes was so effective that diabetes medications were reduced or discontinued in most patients, according to U.S. researchers. The 2005 report recommends that similar dieters be under close medical supervision or capable of adjusting their own medication, because the diet lowers blood sugar dramatically.
Methodology
Twenty-eight overweight people with type 2 diabetes were placed on the study diet and followed for 16 weeks. Seven people dropped out, so the analysis involved 21, of which 20 were men—the study was done at a Veterans Administration clinic. Thirteen were caucasian, eight were black. Average age was 56; average body mass index was 42. The seven dropouts were unable to come to the scheduled meetings or couldn’t follow the diet. No dropout complained of adverse effects of the diet.
Results
Participants were instructed on the Atkins Induction Phase diet, which daily includes:
At the outset, diabetes medication dosages were reduced in this general fashion: insulin was halved, sulfonyureas were halved or discontinued. If the participant were taking a diuretic (fluid pill), low doses were discontinued; high doses were halved.
Study subjects returned every two weeks for diet counseling and medication adjustment (based on twice daily glucose readings and episodes of hypoglycemia). Food cravings and/or good progress on weight goals triggered a 5-gram (per day) weekly increase in carbohydrate allowance. In other words, if a participant’s weight loss goal was 20 pounds and he’d already lost 10, he could increase his daily carbs during the next week from 20 to 25 g. Carbs could be increased weekly by five gram increments as long as weight loss progressed. [This is typical Atkins.] Food records were analyzed periodically.
Results
My Comments
The degree of improvement in hemoglobin A1c—our primary gauge of diabetes control—is equivalent to that seen with many diabetic medications. I see many overweight diabetics on two or three drugs and a standard “diabetic diet,” and they’re still poorly controlled. This diet could replace the expense and potential adverse effects of an additional drug.
In August this year I blogged about a study comparing the Atkins diet with a traditional low-fat diet in overweight diabetic black women in the U.S. As measured at three months, the Atkins diet proved superior for weight loss and glucose control.
This study at hand is small, but certainly points to the effectiveness of an Atkins-style very low-carb ketogenic diet in overweight men with type 2 diabetes.
Yancy, William, et al. A low-carbohydrate, ketogenic diet to treat type 2 diabetes [in men]. Nutrition and Metabolism, 2:34 (2005). doi: 10.1186/1743-7075-2-34
Filed under Carbohydrate, ketogenic diet, Overweight and Obesity, Weight Loss
Low carbohydrate diets tend to contain disproportionate amounts of fat from animal sources. Red meat has long been vilified as a major source of saturated fat that some experts believe cause hardening-of-the-arteries (atherosclerosis) via elevations in LDL cholesterol. Others disagree. Poultry, fish ,and shellfish generally have lower amounts of saturated fat than red meat. Would a low-carb diet with a predominance of poultry, fish, and shellfish lead to a more advantageous cholesterol profile?
A 2007 report from U.S. researchers found no lipid advantage to the poultry/fish/shellfish model. In fact, despite high cholesterol and fat intakes, neither diet caused a significant change in total, HDL, or LDL cholesterol levels. Triglycerides fell in both groups, but to a statistically significant degree only on the poultry/fish/shellfish group.
Fun Fact: Did you know that four of every 10 women in the U.S. are trying to lose weight? The figure for men is one in three.
Methodology
Researchers in Minnesota and Iowa enrolled 18 subjects (6 males, 12 females) between the ages of 30 and 50 who wanted to lose weight. Average body mass index was 31.7, which is mildly obese. The were encouraged to eat an Atkins-style ketogenic diet with a maximum of 20 g carbs/day, providing 1,487 total daily calories, with 7% of calories from carbohydrate, 43% from protein, and 50% from fat. This included two or three cups of salad greens and low-carb vegetables. Three ounces of cheese daily was allowed. Subjects were randomly assigned to eat either red meat or poultry/fish/shellfish. Dietary intervention lasted 28 days.
[This is very similar to Atkins Induction Phase, although Atkins does not limit total calories. The researchers did not say why they wanted to limit total calories.]
Data were not used from six subjects for good reasons (see article). So final data analysis included only 12 subjects.
Results
Both groups lost the same amount of weight: about 5.5 kg (12 pounds) over 28 days.
Average carbohydrate intake was about the same for both groups: 55 g/day.
Average total daily caloric intake was about the same for both groups: 1,380.
The poultry/fish/shellfish group ate 630 mg cholesterol daily, twice as much as the other group. [Eggs and shrimp were popular.]
The difference in intake of saturated fat approached, but did not reach, statistical significance (32 g/day in the red meat group vs 25 g).
Neither diet caused a significant change in total, HDL, or LDL cholesterol levels. Triglycerides fell in both groups, but to a statistically significant degree only on the poultry/fish/shellfish group.
Urine ketones at or above 5 mg/dl were detected on 75% of all dipstick tests.
My Comments
I’m skeptical about the accuracy of the calorie counts. Most people eating Atkins-style take in about 1,800 cals/day. The preponderance of females, however, may explain the unusually low average caloric intake. They didn’t follow their carb restriction very closely, did they? These were free-living subjects not locked in a metabolic ward.
The researchers note that the allowance of cheese in both groups may have sabotaged their efforts for a clear delineation of higher versus lower saturated fat groups.
HDL cholesterol usually rises significantly on low-carb diets. Lack of that here may just be a statistical aberration.
This is such a small study that it’s impossible to draw firm conclusions. Nevertheless, if someone is losing weight on a low-carb diet, it may not matter much from a lipid viewpoint whether they eat a predominance of meat or a predominance of poultry, fish, and shellfish. The study at hand cannot address the long-term consequences of such a choice.
Reference: Cassady, Bridget, et al. Effects of low carbohydrate diets high in red meats or poultry, fish and shellfish on plasma lipids and weight loss. Nutrition & Metabolism, 4:23 doi: 10.1186/1743-7075-4-23 Published October 31, 2007
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Filed under Carbohydrate, Fish, ketogenic diet, Overweight and Obesity
Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords.com.
Bible Verse of the Day
Diabetic Mediterranean Diet 
