Low-carb gaining a foothold…with the mainstream
The video below shows Chris Gardner, Ph.D., researcher from Stanford University, giving a presentation about the data he generated when he compared the Atkins diet to the Ornish diet, the Zone diet and the LEARN diet. You all probably remember this study, which he published in JAMA in 2007, showing the low-carb diet brought about greater weight loss and better lab value improvement than the other three diets.
As you watch this long video (and you should watch it; its extremely entertaining and filled with a ton of good info), there are a few things you should note.
Before we get to that though, let me fill you in on the LEARN diet.
Most of you, Im sure, are familiar with the ultra-low-fat Ornish diet and the 30-40-30 protein-carb-fat ratio of the Zone diet, but you may not be aware of the LEARN diet. LEARN stands for Lifestyle, Exercise, Attitudes, Relationships and Nutrition and is the brainchild of Kelly Brownell at Yale. The LEARN diet is a low-calorie regimen that recommends 55-60 percent of calories as carbohydrate and under 10 percent of calories as saturated fat. The LEARN program is big with academics (since it was created by one of their own) and is the diet typically used when a diet program is required as part of a study. In fact, the LEARN manual was developed to bring some consistency to the nutritional regimens followed in research. As a consequence of its widespread use in academia, it has also become the program that pretty much mirrors the national guidelines. Or, to put it another way, the nutritional guidelines set by academics pretty much mirror the LEARN program.
If you look at the carb content of the LEARN program and realize that it is the basis for the national nutritional guidelines, you can LEARN why we have an obesity epidemic. But thats another subject.
First off, at about 17:10 in the video, Dr. Gardner talks about how Dean Ornish got mad at him for publishing this study. (So did Barry Sears, author of the Zone, but Dr. Gardner didnt mention him.) Both Ornish and Sears got their noses out of joint after this study and sniffed that the study results didnt really apply to their programs because clearly the data showed that the subjects assigned to their specific diets really werent following the diet as designed. Both missed the point.
As Dr. Gardner plainly says, the study is of specific diet books and how patients lose (or dont lose) weight following these books. You cant recruit a million people for a nutritional study in which you hold their hands throughout. But you can write a book that a million or more people read and follow. What Gardner was looking for in this study was how people would do following a diet book advocating a specific program as compared to others on different diet books promoting different diets.
As part of the structure of the study, he randomized subjects to the various diets, then had them come in weekly for eight weeks to visit with a dietitian who went over the book with them. He relates an interesting story at about 26:10 that Im sure is absolutely true. Many of the people who were randomized to their particular diet were demoralized because they had already done that diet in the past and hadnt done particularly well on it. After going through the book with the dietitian, these same people realized they hadnt really read the book very well – if at all – the first time through. Once they really read and understood it, they were fired up and ready to go. Based on may questions MD and I have received about our books, I know this only too well.
Earlier in the video, at about the 17:10 point, Dr. Gardner makes an observation that all of us using low-carb diets know well. He is discussing how reducing carbs makes triglycerides go down and adding fat makes HDL go up. He then says that all these people have come into the clinic he is involved with after having been on Ornish or McDougall only to find their triglycerides have skyrocketed and their HDLs have dropped off the chart. He tells them to replace some of the carbohydrate with good quality unsaturated fats (sigh), and their labs revert to normal.
At about the 29:00 mark, Dr Gardner points out that as the data came in and was charted, it became apparent that it was difficult for people to stick with the Ornish or Zone diets, and when these subjects fell short of following their specific program, their macronutrient-consumption data ended up falling right smack into the middle of the LEARN data, or the national nutritional guidelines. Those on the Atkins diet morphed a little (toward a more Protein Power sort of plan, but not quite), but not nearly as much as those on the low-fat diets did. After a year, the data ended up showing a bunch of subjects essentially following the national nutritional guidelines and another, smaller bunch, following a semi-Atkins diet.
As Dr. Gardner points out, in virtually every parameter measured, those following the Atkins book who ended up following a semi-Atkins diet triumphed over those following the other books, all of whom ended up following the national nutritional guidelines. Which, of course, is no surprise to most readers of this blog.
But it was a huge surprise to Dr. Gardner, a 25-year-long vegetarian. He admitted it was a bitter pill to swallow, but the data are what the data are. And he was man enough to admit it. I think this study and Dr. Gardners engaging presentation style will start getting some notice from mainstreamers. King Canute couldnt hold back the tide, and I dont think the lipophobes will be able to hold back low-carb diets forever. This is a great video to show Doubting Thomases if they will take the time to watch it.
Aside from the finding that the low-carb diet was vastly superior, a lot of other data came to light as a consequence of this study. Some people did great on Ornish or the Zone while others did poorly on Atkins. Why? You would think that since all the subjects were humans, they would all respond the same way, but they didnt.
This intrigued Dr. Gardner, so he began slicing and dicing the data to see what he could come up with. At about the 40:00 point on the video, he discussed a few papers showing that people who are insulin sensitive actually do better on high-carb diets than they do on low-carb diets, whereas those who are insulin resistant do just the opposite.
I pulled all the papers he discussed and plan on reading them over the next ten days while Im spending (literally) about 24 hours in an airplane seat. (As part of our Sous Vide Supreme tour, MD and I leave tomorrow for Dallas, then Vancouver, Seattle, San Francisco, Chicago, New York, and Las Vegas, so Ill have plenty of time to read.) I do find this information fascinating, but I have a few reservations as well. There are very few moderate to significantly overweight people who arent insulin resistant to some degree, so Ill be curious to see how the authors of these papers define insulin resistance.
Based on my own experience with a whole lot of patients, there are a few, but not many, overweight people–usually women, but occasionally men–whose lab reports show normal insulin sensitivity. I treated them with a low-carb diet, and they did well. But I didnt randomize these apparently insulin-sensitive overweight patients into two groups and put one group on a low-carb diet and the other on a low-fat, high-carb diet, so I cant really say the ones I treated did better than they would have on a low-fat diet.
What I do know, however, is that those who have been overweight and insulin resistant, and who lose their weight and restore their insulin sensitivity with a low-carb diet, will regain in a heartbeat if they go on a high-carb diet for maintenance. So, its hard to reconcile this fact that I know from hands-on experience with the data Dr. Gardner presented.
It could have something to do with the genetics that prevent the development of insulin resistance in the first place. Ill post on my thought about this paradox after Ive read the relevant papers and reflected on them.
I had only one real objection to this presentation. At the end, during the Q & A, someone asked a question about ketosis, and Dr. Gardner was clearly in above his head. He did make the distinction between the ketosis one experiences on a low-carb diet and the dangerous ketoacidosis that those with uncontrolled type I diabetes are subject to, but he seemed to be uncertain as to whether low-carb ketosis was harmful over the long run. He did remark that everyone is in ketosis part of the day, but then he kind of tossed it off by saying that the people on the Atkins diet werent really following it that closely and so werent really in ketosis for that long. I wish had addressed the ketosis situation head on. There is no danger in being in ketosis for extended periods of time. Ketones are normal fuels of respiration and dont pose any problems over the long haul. In fact, some research has shown that ketones are a preferred fuel of many organs including the heart. (Veech et al)
As Ill be traveling a lot the next 10 days, and since I dont know my exact schedule even yet, I cant promise a lot of regular posting. But I will check the blog often and put up the comments as they come in. If any of you have experience with trying a low-fat diet after losing on a low-carb diet, I would love to hear about it.
A tardy comment, wondering if you, or anybody else, noticed an article posted on Huffingtonpost.com here http://www.huffingtonpost.com/kathy-freston/heart-disease-a-toothless_b_334285.html, interviewing a Dr. Caldwell Esselstyn, who has apparently been pitching the exclusively “plant-based” diet as a means to prevent and reverse heart disease (also the title of one his books). It’s the typical Ornish-style dogma, but I had never heard of this guy before. Just curious if you have run accross Dr. Esselstyn before. I posted a civil but skeptical comment and was set upon by his fans. I should have known better.
My brother-in-law is on the Esselstyn plan and has my husband very curious about it. My husband asked me to read the book. Since it seems to contradict what I thought I knew about high carb vs. low carb, I was trying to find some more information from Dr. Eades. Esselstyn’s premise is that if you get total cholesterol below 150, you will be heart attack proof. This is accomplished with a plant-based diet that excludes all animal, dairy, avocados, nuts, and fat (except the negligible fat that naturally occurs in fruits, veggies, and whole grains). He also uses cholesterol-lowering medications “when necessary”, which was apparently necessary in all of the 20 or so people in his 12-year study. He claims a cholesterol level below 150 prevents, arrests, and selectively reverses heart disease. As total cholesterol goes down, so does LDL. He doesn’t mention much about HDL or ratios. He also doesn’t mention fluffy vs small LDL. However, results are results. His patients get relief from angina, show arrest and sometimes reversal of plaque build-up on MRIs,etc., lose weight, and report feeling great. Dr. Eades’ patients enjoy similar success, although I don’t remember from reading his books several years ago if heart disease was arrested/reversed or simply slowed down. I’m not a doctor or a scientist. I’m a reasonably intelligent person with a limited amount of time to do research on these subjects, and it has become overwhelming. How can Esselstyn get results like this if a high carb diet is so bad? How can Dr. Eades’ patients achieve such great results if a low carb diet is so bad? Is it possible that one has to follow one extreme or the other to achieve good results? Are the obesity and heart disease problems due to most people falling somewhere in the middle? Are there any readers out there who are following a LC plan and have received medical confirmation of an arrest or reversal of arterial plaque build-up? Thanks in advance for any input you can offer.
The notion that getting total cholesterol down to below 150 making on heart-attack proof is patently false.
Dr. Eades, Thanks for your response. I find Dr. Esselstyn’s science a little fuzzy. My impression is that he overgeneralizes and assumes things that aren’t necessarily there. It reminds me of Dr. Lustig’s comment that the common factor between a low-carb diet and a Japanese diet is the lack of fructose. Dr. Esselstyn is convinced that 3/4 of the world’s population doesn’t have heart disease because they don’t eat meat or fat. He doesn’t really substantiate it. He just states it as fact. Where Dr. Lustig states unequivocally that “fructose, and frustose alone,” is responsible for metabolic syndrome, Dr. Esselstyn is convinced that animal products and added fat are solely responsible. Still, I don’t know how to explain the fact that his patients’ CVD is arrested and other symptoms improved. Can you point me in the direction of some information that might explain how he could get those results on a high-carb diet? Not that I’m planning to embark on that plan. I couldn’t stick with such a severe eating plan even if I was convinced it truly was the only way to be heart attack proof. I have family members following this plan thinking it will stop or reverse CVD. If Esselstyn is wrongly reporting his results, it would be nice to be able to explain how. I feel like there is a puzzle piece missing, and I’m not sure how to find it. Thanks.
I’m not sure how he could get those results, I suppose, because I’m not familiar with his work. The biggest problem in the diet biz is that the standard American diet is so terrible that almost any change is for the better. The name of the game shouldn’t just be an improvement over the standard American diet but instead a quest for the optimal diet for the majority of humans. At this point in my voyage of discovery, I would have to say it is a whole-food low-carb diet.
@peggy stewart
I’ve been on a very-low-carb, high-fat, high-protein diet for almost a year now, and my results are excellent. I had no weight problem, but was pre-diabetic when I was informed of Dr. Eades’ theories by my sister, who had a weight problem and other aliments. I had bypass surgery eight years ago, and was concerned about the possiblity that I’d need another one if I didn’t change my diet. So I embarked on the “Protein Power” plan.
I had a cardiology checkup in January, and the ultrasound and echocardiogram were excellent. My last test results were: total cholesterol (which I now ignore): 220; HDL: 66; LDL: 132; triglycerides: 66; A1C: 6.0; CRP: .06. In addition to the PP diet I take 3 grams of niacin daily. My weight is stable at 165 or so and at 74 I’ve never felt better. I won’t disparage the Esselstyn diet, but that’s the way I ate before my heart surgery became necessary. I would be leery of any diet that required cholesterol-reducing medication, since it has serious side effects for many people and since I’m convinced beyond doubt that cholesterol per se is not the cause of heart disease. Half of all heart attacks occur in people with “normal” cholesterol. And lowering it too much is dangerous, since it’s present in every cell, and is essential to brain health. And drugs that affect the liver’s functions cause problems throughout the body. Plaque, inflammation and high blood viscosity combine to cause the clots that lead to infarcts, so advanced blood testing, not routinely done, is essential if you wish to know the composition and density of your blood. And CRP testing reveals the level of inflammation.
Good luck.
@Roger in Texarkana
Thank you so much for your information. This is very helpful and encouraging. Congratulations on your success!
Dr. Eades,
You opened my eyes back in circa 1997. The science made perfect sense, and the weight loss was like magic. Even though I have a hard time maintaining a low-carb lifestyle, I do believe it makes the most sense of everything I’ve read or tried. I’m making a new start with “any change is better” and working slowly towards a whole-food low-carb habit. Thanks for educating tirelessly.
Thinkering: A New Model for Biotechnology…
There’s a Biomedical Mutual Organization (BMO) taking shape.I suspect William Baines and Seth Roberts would agree.It may still be in the start-up stages, but it’s building momentum as we speak….
The most annoying part of his lecture in his complete dedication to the calories in/calories out mantra, to the point where he assumes the subjects outright lied, rather than perhaps their metabolism slowed in response to the lowered intake.
I realize it has been awhile since you posted this article, but I do have a relevant comment:
My father and his father (and most likely his father’s father except probably wasn’t diagnosed) were diagnosed with type II diabetes right around their 50th birthdays. When my father was diagnosed, it frightened me and I was paranoid I was going to be taking pills for the rest of my life!! At the time I weighed about 200-210 lbs and was 17 years old.
So what I decided to do was exercise at least three days a week. I tried weights, but I grew tired of that and I never really saw any change in my body shape and I’m sure I wasn’t lifting most effectively.
Then I decided to start running. My dad was actually fairly active in his younger years and used to run a lot. So I started running. I could do a couple miles easy after the first couple of weeks. Then I met some others would meet with them to run. I quickly went from being able to run 2 miles (burns about 300 calories depending on weight and intensity) to running 4 miles (burning about 600 cal depending on weight/intensity) to finally being able to run half marathon races (burns around 2000 cal!!).
At any rate, I would run about 15-25 miles per week depending on my “running goals” and other life activities going on. I went from 210 lbs as a senior in high school to about 190 as a junior in college (3 years later). But that was when I was only running a maximum of 4 miles per run. Currently, I’m 23 years old and I weigh 180 lbs. I’ve lost 30 lbs since high school and I have absolutely not consciously tried to change my diet in the slightest (although, I’d imagine I drink a bit more alcohol now than I did in high school–but I don’t drink that much). I worded it that way because I know my diet has changed because I think I do try to avoid carbs more now than I did in high school. But I still eat whatever I want when I get a specific craving and I definitely do not monitor or control the amount of calories I take in what so ever. If I get hungry, I won’t stay that way for long.
Currently, I’m in my first year of law school and really don’t have the time or energy to try to run on a regular basis (even though it would probably help me with stress more than I am willing to admit). But, I have probably run around 10 miles or so in the 3 months I’ve been here. My point is, I still weigh the same 180 lbs (in fact, I’ve dropped a couple lbs due to stress–but that is likely muscle loss not fat).
My completely untested hypothesis is that it is possible to build your ideal metabolism through cardiovascular exercise (running, swimming, cycling, any exercise that gets your heart rate above 140 bpm for the duration of the exercise) and then stop doing that activity for awhile. Then when your metabolism is obviously outside the range that is acceptable for you (i.e. you grow your gut or butt or both), restart your cardiovascular exercise regimen again. Further, I’d also speculate that the period of time you follow a cardio regimen would impact how long it will take for your metabolism to break outside your acceptable range.
Maybe it will take me another 2 or 3 months to feel like I’m getting “fat,” and before my “no-training” sabbatical, I spent roughly 8 months with a running regiment of 15-25 miles per week (which consisted of 2-4 runs of 7.5-11 miles). Perhaps a 2 month regimen such as this would yield a 1 or 2 month period of “no-training” and little change in metabolism? I don’t know. I’d also imagine my youth helps me. But, I’d bet you old folks use your age more as an excuse to not train at all than as a factor which impedes your progress.
Ironic that a VEGETARIAN is deriding a paleo diet BECAUSE IT ELIMINATES ENTIRE CATEGORIES OF FOOD. That’s a good one.
Hey, the foods that it eliminates or reduces are the only foods he’s been eating for 25 years. He may not consider meat to be a food, at least on a subconscious level.
It could have something to do with the genetics that prevent the development of insulin resistance in the first place.
I don’t know if I completely agree with this. Genetics play a minimal part. It’s what goes in your mouth that counts the most.
Louise D., 18. November 2009, 20:52
“Ironic that a VEGETARIAN is deriding a paleo diet BECAUSE IT ELIMINATES ENTIRE CATEGORIES OF FOOD. Thats a good one.”
Very good. And he’s raising his children to be vegetarians. This is, IMAO, less than responsible. And his insistence on polyunsaturated oils, of which butter and coconut oil are not.
On the griping hand, people find it hard to abandon an intellectual position.
Instead of dropping the bacon for toast, perhaps, another egg. Bacon is usually sugar cured, Yes?
I would like to see this experiment repeated with 50+ year olds who are candidates for gastric bypass. With young women they perhaps have not had time to acquire much insulin resistance. Try the diets on those who are 100 pounds overweight and I bet the results would be much more drastic.
interesting video thanks for posting.
i have always believed on low carb diets and this video here makes me even more confident about my choice
[...] out the review, Low-carb gaining a foothold, by Dr. Eades for an in depth analysis of the [...]
Hi Dr. Eades,
Did you ever follow up on the papers on the differential effectiveness of low- vs high-carb diets depending on insulin sensitivity? Did you post your analysis anywhere? It’s a subject on which I was already interested, and didn’t realize there were so many relevant reports.
Thanks!
No, I haven’t. I need to do so, however. I just don’t know when it will be. Keep reminding me.
Thank you for sharing your article.very helpful.
[...] Protein Power – Dr. Eades [...]
Please see the you tube video of BILL CLINTON
he explains why he changed his diet to avoid a second heart attack, and how this helped him to even lose weight
Were his lips moving on the YouTube video?
[...] even in 2007 it proved better than any other “fad diet” in a study done by Stanford University (http://www.proteinpower.com/drmike/ketones-and-ketosis/low-carb-gaining-a-foothold-with-the-mainstre…). Atkins was a revolutionary in the heart disease world for bringing to the forefront information [...]
[...] Gardner Stanford Researcher Video document.write(''); http://www.proteinpower.com/drmike/k…he-mainstream/ Time to post it again. __________________ Started CC 10/6/09 reached final goal 6/18/10 [...]
Low -carb diet really helps a lot of people. Some are focusing on whey protein and carb accompanied by proper body building programs that gives the best result. This site helps individuals with their decisions on handling proper diet.
[...] forwarded this great post from Dr. Eades. I usually try to generate new content for the blog and not just re-cook what other folks have done [...]