Tag Archives: Weight Loss

Once Again, Low-Carbohydrate Ketogenic Diet Beats Low-Calorie For Overweight Diabetes

Kuwait City and Towers

Kuwait City and Towers

A low-carbohydrate ketogenic diet is safe, effective, and superior to a low-calorie diet in type 2 diabetics, according to a report last year in Nutrition.

Kuwaiti researchers gave 102 adult overweight diabetic men and women their choice of diet: 78 chose ketogenic, 24 went low-calorie.  Average age was 37, average weight 211 lb (96 kg).  The study lasted six months.  The ketogenic diet was very much Atkins-style, starting out at 20 grams of carbohydrate daily.  Once good weight-loss progress was made, and if carb cravings were an issue, dieters could increase their carbs in small increments weekly.

This is all they said about the low-calorie diet: “Participants in the low-calorie diet group were given appropriate guidelines and a sample low-calorie diet menu of 2200 calories is presented in Table 1” (it’s typical and reasonable).

What Did They Find?

The low-carb ketogenic dieters lost 12% of body weight, compared to 7% lost by the low-calorie dieters.  Furthermore, the ketogenic dieters showed significant lowering of total cholesterol, LDL cholesterol (bad cholesterol), and triglycerides.  HDL cholesterol (good cholesterol) rose.  The low-calorie dieters seem to have had a significant drop in LDL cholesterol, but no changes in the other lipids.

Fasting blood sugar levels dropped significantly in both groups, but more in the ketogenic dieters.  Both groups started with fasting blood sugars around 162 mg/dl (9 mmol/l) and fell to 108 mg/dl (6 mmol/l) in the ketogenic group and to 126 mg/dl (7 mmol/l) in the low-calorie group.

Glycosylated hemoglobin (hemoglobin A1c) levels fell in both groups, more so in the ketogenic dieters.  The drop was statistically significant in the ketogenic group, but the authors were unclear about that in the low-calorie dieters.  It appears hemoglobin A1c fell from 7.8% to 6.3% with the ketogenic diet (the units given for glycosylated hemoglobin were stated as mg/dl).  In the low-calorie dieters, hemoglobin A1c fell from 8.2 to 7.7%.

What’s Odd About This Study?

The title of the research report indicates a study of diabetics, but only about 25% of study participants had diabetes (total subjects = 363).  (The figures I share above are for the diabetics only.)

Glycosylated hemoglobin, a test of overall diabetes control, is reported in Fig. 1 in terms of mg/dl.  That’s nearly always reported as a percentage, not mg/dl.  Misprint?

None of the participants dropped out of the study.  That’s incredible, almost unbelievable.

The low-calorie diet was poorly described.  Were 140-lb women and 250-lb men all put on the same calorie count?

Food diaries were kept, but the authors report nothing about compliance and actual food intake.

Clearly, some of these diabetics were on insulin and other diabetic drugs.  The authors note necessary reductions in drug dosages for the ketogenic group but don’t say much about the other dieters.  They imply that the drug reductions in the low-calorie group were minimal or nonexistent.

Grand Mosque of Kuwait

Grand Mosque of Kuwait

So What?

Calorie-restricted diets are effective in overweight type 2 diabetics, but ketogenic diets are even better.

The effectiveness and safety of ketogenic diets for overweight type 2 diabetics has been demonstrated in multiple other populations, so this study is not surprising.  We’ve seen these lipid improvements before, too.

The favorable lipid changes on low-carb ketogenic diets would tend to reduce future heart and vascular disease.

I know little about Kuwaiti culture and genetics.  Their contributions to the results here, as compared with other populations, is unclear to me.  Type 2 diabetes is spreading quickly through the Persian Gulf, so this research may have wide applicability there.

Steve Parker, M.D.

Reference:  Hussain, Talib, et al.  Effect of low-calorie versus low-carbohydrate ketogenic diet in type 2 diabetes.  Nutrition, 2012; 28(10): 1016-21. doi: 10.1016/j.nut.2012.01.016

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Mediterranean and Low-Carb Diets Beat Low-Fat for Weight Loss Over Six Years

Israeli flag

Remember Shai et al’s 2008 DIRECT study that compared weight loss over two years on either a low-carb, low-fat, or Mediterranean diet?  I reviewed it at length in 2008.

The same Isreali researchers now report the results of an additional four years of follow-up.  Do you know of any other weight loss study over that length of time?  I don’t.

Of the 322 original study participants, 259 were available for follow-up for an additional four years.  Of these, 67% told researchers they had continued their originally assigned diet.

Over six years, the weight loss was as follows:

  • 0.6 kg (about a pound) in the low-fat group
  • 1.7 kg (almost 4 pounds) in the low-carb cohort
  • 3.1 kg (almost 7 pounds) in the Mediterranean group

The difference between the low-carb and Mediterranean groups was not statistically significant.

Almost all the original study participants (86%) were men, so it’s debatable whether these results apply to women.  I bet they do.  I assume most of the participants were Israeli, so you can also debate whether results apply to other nationalities or ethnicities.

Bottom Line

For long-term weight management, Mediterranean and low-carb diets appear to be more effective than traditional low-fat, calorie-restricted dieting.

Beth Mazur at her Weight Maven blog has some worthwhile comments about the study.

Incidentally, my Advanced Mediterranean Diet (2nd Edition) book features both a traditional Mediterranean diet and the world’s first low-carb Mediterranean diet.

Steve Parker, M.D.

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14 Little-Known Weight-Loss Tips

“Look…the soda’s not for me, OK?”

 

These have worked for lots of my patients.  Take what works for you and discard the rest.

  1. Plan on grocery shopping, meal preparation, and taking meals to your workplace.
  2. Keeping a record of your food consumption is often the key to success.
  3. Accountability is another key.  Do you have a friend or spouse who wants to lose weight?  Start the same program at the same time and support each other.  That’s one of many ways to have accountability.
  4. If you tend to over-eat or snack too much, floss and brush your teeth after you’re full.  You’ll be less likely to go back for more anytime soon.
  5. Eat at least two or three meals daily.  Eat breakfast every day.  Ignore the diet gurus who say you must eat every two or three hours.
  6. Eat slowly and allow yourself time to enjoy your food; you’ll be a better judge of when your’re full.
  7. Don’t eat while watching TV.
  8. Give yourself a specific reward for every 10 pounds (4.5 kg) of weight lost.  Consider a weekend get-way, jewelry, new clothes, an evening at the theater, a professional massage, etc.  Choose the reward in advance, to give you something to work toward.
  9. Don’t start a diet during a time of stress.
  10. Maintain a consistent eating pattern throughout the week and year.
  11. If you know you’ve eating enough at a meal to satisfy your nutritional requirements yet you still feel hungry, drink a large glass of water and wait a while.  Or try a sugar-free psyllium fiber supplement: three grams of fiber in 8 oz (240 ml) of water.
  12. Weigh yourself frequently: daily during your active weight-loss phase and during the first two months of your maintenance-of-weight-loss phase.  Weekly thereafter.
  13. Be aware that you’ll probably regain five or 10 pounds (2.3 or 4.5 kg) of fat now and then.  That’s normal.  Just get back on your original weight-loss plan for a month or two.
  14. Tell your housemates you’re on a diet and ask for their support.  You may also need to tell your co-workers and others with whom you spend significant time.  If they care about you, they’ll be careful not to tempt you off the diet.

Indispensable?  OK, maybe that’s a little over the top.  But each of these tips has  proven indispensable to at least one of my patients.

Steve Parker, M.D.

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The Two Secrets to Prevention of Weight Regain

Researchers are constantly searching for safe, effective weight loss pills.  More helpful would be a pill that prevents weight regain.  Weight loss is relatively easier.

Regain of lost body fat is the most problematic area in the field of weight management.  Whoever solves this problem for good will win a Nobel Prize in Medicine.  Why do most diets ultimately fail over the long run?  Because people go back to their old habits.  Here are the two secrets to prevention of weight regain:

  1. Restrained eating
  2. Regular physical activity

“Successful losers” apply self-restraint on an almost daily basis, avoiding food they know will lead to weight regain.  They limit how much they eat.  They consciously choose not to return to their old eating habits, despite urges to the contrary.

The other glaring difference is that, compared to regainers, the successful losers are physically active.  Oftentimes, they exercised while losing weight, and almost always continue to exercise in the maintenance phase of their program.  This is true in at least eight out of 10 cases.  It’s clear that regular exercise isn’t always needed, but it dramatically increases your chances of long-term success.

Steve Parker, M.D.

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Filed under Overweight and Obesity, Weight Regain

Weight-Loss Secrets

What’s it gonna be? You decide

These have worked for lots of my patients.  Take what works for you and discard the rest.

  1. Plan on grocery shopping, meal preparation, and taking meals to your workplace.
  2. Keeping a record of your food consumption is often the key to success.
  3. Accountability is another key.  Do you have a friend or spouse who wants to lose weight?  Start the same program at the same time and support each other.  That’s one of many ways to have accountability.
  4. If you tend to over-eat or snack too much, floss and brush your teeth after you’re full.  You’ll be less likely to go back for more anytime soon.
  5. Eat at least two or three meals daily.
  6. Eat breakfast every day.
  7. Ignore the diet gurus who say you must eat every two or three hours.
  8. Eat slowly and allow yourself time to enjoy your food; you’ll also be a better judge of when your’re full.
  9. Don’t eat while watching TV.
  10. Give yourself a specific reward for every 10 pounds (4.5 kg) of weight lost.  Consider a weekend get-way, jewelry, new clothes, an evening at the theater, a professional massage, etc.  Choose the reward in advance, to give you something to work toward.
  11. Don’t start a diet during a time of stress.
  12. Maintain a consistent eating pattern throughout the week and year.
  13. If you know you’ve eating enough at a meal to satisfy your nutritional requirements yet you still feel hungry, drink a large glass of water and wait a while.  Or try a sugar-free psyllium fiber supplement: three grams of fiber in 8 oz (240 ml) of water.
  14. Weigh yourself frequently: daily during your active weight-loss phase and during the first two months of your maintenance-of-weight-loss phase.  Weekly thereafter.
  15. Be aware that you’ll probably regain five or 10 pounds (2.3 or 4.5 kg) of fat now and then.  That’s normal.  Just get back on your original weight-loss plan for a month or two.
  16. Tell your housemates you’re on a diet and ask for their support.  You may also need to tell your co-workers and others with whom you spend significant time.  If they care about you, they’ll be careful not to tempt you off the diet.

Godspeed!

Steve Parker, M.D.

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New Analysis Finds Low-Carb Diets Reduce Heart Disease Risk Factors

Obesity Reviews just published details of a recent meta-analyis of low-carbohydrate diet effects on cardiovascular risk factors.

A systematic review and meta-analysis were carried out to study the effects of low-carbohydrate diet (LCD) on weight loss and cardiovascular risk factors (search performed on PubMed, Cochrane Central Register of Controlled Trials and Scopus databases). A total of 23 reports, corresponding to 17 clinical investigations, were identified as meeting the pre-specified criteria.

Over a thousand obese patients were involved.  By eating low-carb, average body weight decreased by 7 kg (15 lb), body mass index dropped by 2, blood pressure dropped by 3-4 mmHg, triglycerides decreased by 30 mg/dl, hemoglobin A1c dropped by 0.21% (absolute decrease), insulin levels fell by 2.23 micro IU/ml, while HDL cholesterol rose by 1.73 mg/dl.  LDL cholesterol didn’t change.

The authors conclusion:

Low-carboydrate diet was shown to have favourable effects on body weight and major cardiovascular risk factors; however the effects on long-term health are unknown.

I haven’t see the full text of the article yet, so I don’t know the carbohydrate level under review.  I bet it’s under 50 g of digestible carb daily.  My Low-Carb Mediterranean Diet starts at 20-30 grams a day.

Steve Parker, M.D.

Reference:  Santos, F.L., et al. Systematic review and meta-analysis of clinical trials of the effects of low carbohydrate diets on cardiovascular risk factors. Obesity Reviews. Article first published online: 20 AUG 2012. DOI: 10.1111/j.1467-789X.2012.01021.x

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Is Heavy Exercise a Reasonable Approach to Obese Diabetes?

Women DO NOT get gross bulky muscles from resistance training

With regards to TV’s “The Biggest Loser” show:

The show’s 24-week regimen consists of approximately 4 hours of daily exercise, including 1 hour of intense resistance, 1 hour of intense aerobic activity, and 2 hours of moderate aerobic activity (for example, walking), along with a caloric  intake of at least 70% of estimated resting daily energy expenditure, explained Dr. [Robert] Huizenga, who is a a former team physician to the L.A. Raiders football team.

This is an excerpt from “The Biggest Loser Pushes Envelope on Diabetes,” in Internal Medicine News, vol. 45, No.11, page 17.

In a previous post about The Biggest Loser, I’d written that I didn’t know how much they exercised.

For purposes of discussion, let’s assume the documented major weight losses of Biggest Loser contestants are not simply due to caloric restriction.

Dr. Huizenga shared some of his experience at the recent annual meeting of the American Association of Clinical Endocrinologists.  In a study of 35 Biggest Loser participants, about half had prediabetes or type 2 diabetes.  Hemoglobin A1c, a measure of blood sugar control, fell significantly in this subset.  Three of the six with diabetes were able to stop metformin early on.  By week 29 of the study, average body mass index for the entire group had fallen from 46 to 29.

Sure, this is a small study, but my clinical intuition is that results are reproducible on a larger scale.  Television exposure and the $250,000 (USD) prize to the winning contestant are major motivators.  Furthermore, I bet there’s also a process for weeding out those who are likely to fail, before they ever get started.

Yes, exercise helps with weight loss.  But most folks aren’t willing or able to exercise vigorously for almost four hour daily.  If I were an obese sedentary diabetic, I’d sure try.

Steve Parker, M.D.

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What Everybody Ought to Know About Exercise’ Effect on Weight

  • Your genetics largely determines your response to an exercise program
  • Physical activity isn’t a great way to lose weight
  • School-based or other programs to increase childhood physical activity probably won’t reverse childhood obesity statistics
  • Disregarding weight loss, exercise has other worthwhile metabolic advantages
  • Highly advanced societies shouldn’t blame our overweight problem on decreased levels of physical activity

Skyler Tanner slaughters some sacred cows in his blog post June 4, 2012. I pulled these bullet points from his post. Click on his embedded links for details.

Steve Parker, M.D.

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Does Cutting Out Sugary Drinks Help With Weight Loss?

Are you obese, love sugary drinks, and want to easily lose four pounds (1.8 kg) over the next six months? Simply cut a couple of sugary drinks out of your daily diet, replace them with water or diet soa, and you may lose the pounds.  Or so say University of North Carolina researchers.
Down 4 pounds in 6 months. I’ll take it!

In the U.S., our consumption of calories from sugar-sweetened beverages (SSBs) almost doubled between 1965 and 2002, now comprising 21% of our total calories.  (I’ve seen lower estimates, too, such as all added sugars accounting for 17% of total calories.)  Remember that our overweight and obesity rates started rising around 1970.  Any connection there?

Some have speculated that cutting back on SSB consumption would lead to loss of some excess weight.  But it’s never really been tested until now.

By the way, your typical sugary carbonated beverage has 145 calories of pure carbohydrate, most often high fructose corn syrup.  That’s equivalent to 10 tsp (50 ml) of table sugar.  Soft drinks are liquid candy.

Methodology

UNC investigators recruited  about 300 overweight and obese folks (average BMI 36, average weight 100 kg (220 lb), 84% female, 54% black) who drank at least 280 calories daily of caloric beverages (sugar-sweetened beverages, juice, juice drinks, sweetened coffee and tea, sweetened milk, sports drinks, and alcohol).  In other words, they all drank at least two soft drinks or the equivalent daily.  Participants agreed to make a dietary substitution for six months.

The participants were randomly assigned to one of three study groups with a hundred participants per group. For the next six months…

  • Group WA substituted at least two of their SSBs daily with water (WA), any type as long as it was calorie-free.  Bottled water was provided.  This reduced sugary drink calories by 230/day.
  • Group DB substituted at least two of their SSBs daily with calorie-free diet beverages (DB).  Beverages were provided.  This reduced sugary drink calories by 230/day.
  • Group AC (attention controls) made no changes in baseline beverage consumption.  Investigators made a point not to talk to them about beverages.

All three groups had monthly group meetings.  WA and DB group meetings were focused on adherence to the beverage substitution guidelines.
The AC group meetings will involved a weigh-in and general weight loss information (e.g., read food labels, increase vegetable consumption, portion control, and increase physical exercise).

“All … groups had access to a group-specific …website, where they recorded the beverages (water and DB only) they consumed, reported their weekly weight, received feedback on progress, viewed tips, and linked to group-specific resources.”

Results

All three groups lost statistically significant amounts of weight, but there was no difference in amount of weight lost among the groups.  In other words, the folks who substituted water or diet beverages for  sweet drinks didn’t do any better than the AC (attentive control) group.

Average amounts of weight lost were in the range of 1.8 to 2.5% of total body weight.  For example, if you weigh 200 lb (91 kg) and lose 2% of your weight, that’s a 4-lb loss (1.8 kg).

Compared to the AC group, the WA group showed a statistically significant decrease in fasting blood sugar (down 3 mg/dl).  BTW, none of the participants were diabetic.

Sugar cane

Take-Home Points

Would the substituters have lost weight if they had simply cut out two sugary drinks a day, skipping the monthy meetings and website?  Don’t know.  But I bet that’s how the mainstream press will spin this.

If I were obese and had a sugary drink habit, I’d start substituting water.  Yesterday.

Substituting water for a couple sugary drinks a day could reduce risk of developing diabetes.

I was hoping to see a significantly greater weight loss in the water and diet drink substituters compared to the AC (Attention Control) group.  Presumably all of these AC folks would have stayed at their baseline weights if they hadn’t done any of this.  The substitution groups apparently didn’t receive the general weight-loss information given to the AC group.

One caveat: All groups had monthly meetings for six months.  What were the substitution groups  talking about other than adherence to the protocol?  Your guess is as good as mine since the researchers don’t say.  Perhaps something about those meetings led to the weight loss, not the act of substituting water or diet drinks for sugar.

So they lost an average of 4–5 lb (2 kg).  Big deal, right?  But remember this was just a six-month study.  Could that 4 lb turn into 12 lb (5.5 kg) over 18 months?  Maybe, but we don’t know.

Here’s the thing about averages.  Some of these people I’m sure lost closer to 5% of body weight, and some didn’t lose any, or gained.  Which group would you be in?  Only one way to find out.

Remember that many medical conditions linked to overweight and obesity improve with loss of just 5% of body weight.

The substituters cut out 230 calories a day of sugary drinks.  All other things being equal, they should have lost 12 lb (5.5 kg).  Problem is, all other things aren’t equal.  Numerous other factors are at play, such as activity levels, replacement of sugary drink calories with other calories, measurement errors, reporting errors, etc.

This was a female-heavy study.  Would this strategy work for men?  Even better in men?  We don’t know.  Why not try it yourself?

Steve Parker, M.D.

PS: I did a sugar-free and wheat-free experiment on myself earlier this year.  Lost some weight, too.

Reference: Tate, Deborah, et al.  Replacing caloric beverages with water or diet beverages for weight loss in adults: main results of the Choose Healthy Options Conscioulsly Everday (CHOICE) randomized clinical trialAmerican Journal of Clinical Nutrition, February 1, 2012, Epub ahead of print.  doi: 10.3945/ajcn.111.026278

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Filed under Carbohydrate, Overweight and Obesity, Sugar, Weight Loss

Alec Baldwin Cut Out Sugar, Lost 30 Pounds

Mother Nature Network last January reported Alec Baldwin’s successful weight loss effort.  An excerpt:

“I gave up sugar,” he told Access Hollywood. “I lost 30 pounds in four months. It’s amazing.”
“(I do) Pilates, spin, not as much yoga as I’d like,” he added. “When we’re shooting (’30 Rock’) it’s tough…When we’re shooting and I can’t work out, I just have to eat less. So, I’m very conscious of that. But sugar was the real killer for me — that was the problem.”
 
 
 

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