Protein Power, low-carb diets and cholesterol
Late last night I was transferring some medical papers from my old moribund PC onto my Mac when I came across an article that infuriated me when it came out. Now it simply made me laugh, although I have to admit to at least a tinge of annoyance still.
As I’ve mentioned before, MD and I often feel like the Rodney Dangerfields of the low-carb diet biz or, worse yet, the Victor Flemings (don’t know who Victor Fleming is? Look him up and see what he did in 1939. And you don’t know who he is, right?). At any rate it seems that whenever low-carb diets are mentioned in a positive way, which, fortunately, that are more and more often these day, we and/or Protein Power never make the list. It’s always Atkins, South Beach and the Zone. And of those three, only one is a true low-carb diet. The other is a quasi, pansy low-carb diet, whose author goes around denying that his diet is a low-carb diet. The other isn’t a low-carb diet, since a diet in which 40 percent of the calories are made up of carbohydrate hardly qualifies for the modifier ‘low.’ But when it comes to attacking low-carb diets, somehow we always seem to make that list.
Now that I’ve gotten that out of my system (sorry for the whine), I can move on to the paper that attacks low-carb diets and in which we prominently figure. This article, published in the May 2000 issue of the Journal of the American College of Nutrition (free full text here), takes an ‘unbiased’ look at several different diets that were on the market at that time. The title says it all.
Health Advantages and Disadvantages of Weight-Reducing Diets: A Computer Analysis and Critical Review
Well see just how critical a review this really was soon enough. The Abstract lays out how the authors went about evaluating the various diets.
Design: Eight popular weight-loss diets were selected (Atkins, Protein Power, Sugar Busters, Zone, ADA Exchange, High-Fiber Fitness, Pritikin and Ornish) to be non-clinically analyzed by means of a computer to predict their relative benefits/potential harm. A summary description, menu plan and recommended snacks were developed for each diet. The nutrient composition of each diet was determined using computer software, and a Food Pyramid Score was calculated to compare diets. The Mensink, Hegsted and other formulae were applied to estimate coronary heart disease risk factors.
So, the authors were going to look at a few hand selected diets, analyze them for nutrient composition, then compare them to the Food Pyramid to rank them in terms of healthfulness. Hmmm. And they were going to use the Mensink, Hegstad and other formulae to estimate coronary heart disease risk factors. Hmmm.
Actually, they ended up using the Mensink and Katan (he of the Katanic verses post) formula to estimate the affect each of these diets would have on the cholesterol levels of anyone following them. To save you the suspense, I can tell you right now that the subtitle of this paper should be: Mensink Katan formula fails miserably at predicting cholesterol levels.
Before we look at what these authors found, let’s look at the lead in to the piece. Again, the abstract says it all.
Background: Some weight-loss diets are nutritionally sound and consistent with recommendations for healthy eating while others are “fad” diets encouraging irrational and, sometimes, unsafe practices.
Any guesses as to which of their categories Protein Power and Atkins fall into?
At least the description of Protein Power is pretty much on the money, all except the part about closely resembling the Atkins diet in nutrient composition. Protein Power resembles the Atkins diet more than it resembles the Pritikin diet, but I wouldn’t say Atkins and Protein Power were carbon copies.
Protein Power, written by Michael R. Eades, MD, and Mary Dan Eades, MD, closely resembles the Atkins diet in nutrient composition. They identify insulin as the culprit for obesity. They believe high levels of insulin cause metabolic disturbances in the body leading to elevated blood pressure, cholesterol and triglycerides, diabetes and obesity. They suggest restricting carbohydrate intake will overcome these metabolic disturbances and alleviate medical problems. Guidelines concentrate on the amount of protein rather than fat consumed. Their book outlines methods to determine the amount of protein to consume and gives instructions for planning meals around grams of protein with restriction of carbohydrates to ≤30 grams/day. They emphasize high-fat food choices but permit limited amounts of fruits and vegetables.
Now, as you might expect, when these authors looked at all these different diets and compared them to the Food Pyramid, Protein Power didn’t fare all that well. A finding of which I am immensely proud. If you look at the graphic below, you can see that Protein Power was even ‘worse’ than Atkins in terms of the magnitude of its negative direction. Atkins just won out by a nose in overall bad (as compared to the Food Pyramid) because it had just a little less ‘good’ than did Protein Power. As far as I’m concerned, having one’s diet be far from the Food Pyramid is good, not bad. But the authors of this paper don’t see it that way.
When these authors looked at saturated fat, evil incarnate in the minds of the lipophobes, they found both Atkins and Protein Power to be full of the stuff. Especially Atkins. And we all know that saturated fat increases cholesterol, don’t we? Well, don’t we? Maybe the readers of this blog don’t know that. But the authors of this study along with fellow lipophobes Mensink and Katan know it. The latter know it so well that they’ve created equations predicting how much dietary saturated fat will raise cholesterol. And if we look at the graph below, we can see just how high the cholesterol levels are predicted to be in the blood of the followers of the various diets.
Apparently cholesterol will be way up in followers of Protein Power and off the charts in those following Atkins. But, remember, these are just their predictions. They aren’t reality.
Before we go on, I want you to take a look at these graphs again. Remember, these authors are looking at popular diets and diet books. Along with Atkins and Protein Power, they selected Sugar Busters!, The Zone, Pritikin and Ornish. And they threw in the American Diabetic Association’s Exchange diet…and something listed on the graph as ‘High Fiber.’ What the heck is the ‘High Fiber’ diet? All the other diets except for the ADA diet are famous and are described in best-selling books that have each sold over a million copies. So, where did the ‘High Fiber’ diet come from? And why is it included?
If we look in the study in the Methods section, we find that the diet is Dr. Anderson’s High-Fiber Fitness Plan. Huh? Who the heck is Dr. Anderson and what is his/her high-fiber fitness plan? If we check the reference citation, we find the following:
Anderson JW, Gustafson NJ: “Dr. Anderson’s High-Fiber Fitness Plan.” Lexington, KY: The University Press of Kentucky, 1994.
Anderson JW? Who could that be? Anderson JW? JW Anderson? Where have I seen that name before? Well, the author of this very article were discussing is named James W. Anderson, MD. Hmm. Could it be? Let’s check Amazon.com. Sure enough. It’s the same guy. And he’s weaseling his own diet book in with the lineup of diet books that are all mega bestsellers. Interesting. And using an article in a mainstream, peer-reviewed journal to substantiate it. Very interesting, indeed.
And what does Dr. Anderson conclude about all these diets to which he has compared his own book?
The Atkins and Protein Power diets are very high in total and saturated fat compared to current dietary guidelines. Long-term use of these diets for weight maintenance are likely to significantly increase serum cholesterol concentrations and risk for CHD. The Sugar Busters and Zone diets would lower serum cholesterol concentrations and likely reduce risk for CHD. Higher carbohydrate, higher fiber, lower fat diets would have the greatest effect in decreasing serum cholesterol concentrations and, thus, the risk for CHD. While high fat diets may promote short-term weight loss, the potential hazards for worsening risk for progression of atherosclerosis or atherosclerotic events override the short-term benefits.
Jesus wept.
So his diet is in there with the ‘good diets,’ the high-fiber, lower-fat diets that don’t worsen the risk for progression of atherosclerosis or heart disease. Amazing!
Let’s switch gears for a minute. Since this paper was published in 2000 there have been numerous scientific papers showing that not only do low-carb diets bring about faster weight loss than do high-fiber, high-carb, low-fat diets, they also improve lipids better.
In 1997 MD and I licensed the Protein Power name and concept along with our own names and likenesses to a company to develop a set of tapes and workbooks to be sold on television. At the time all this was going on, we were moving our clinic from Little Rock, Arkansas to Boulder, Colorado. We had boxes upon boxes of patient files from our clinic in Little Rock that we brought with us and kept in storage (the law requires that doctors keep medical records for a prescribed period of time). The company that licensed our name, etc. wanted to be able to make weight loss claims and lipid improvement claims, which it couldn’t do without substantiation. They hired a professor of statistics from one of the colleges in Maine (the company was located in Portland, Maine) to evaluate the data from our thousands of patient files.
We told him that we checked blood on patients at the end of their first six weeks on the program and again at 12 weeks. We also told him that since most patients had a large weight loss in the first week or two, he probably wanted to evaluate patients who stayed around longer than just a couple of weeks. He decided that since we checked blood at the end of 12 weeks, he would evaluate charts from patients who had stuck with the program for at least that long. He went through his statistical mumbo jumbo to determine the number of charts he would have to evaluate to get data that would be representative of our entire population of patients (or at least those who were on the program for at least 12 weeks). Once he arrived at the number of charts needed, he came up with a way to pull these charts randomly. Once he crunched the data, here is the chart he came up with:
As you can see, a Protein Power diet does not raise cholesterol; it lowers it significantly. And it drops triglycerides and improves the triglyceride to HDL ratio. He noticed that some patients had substantial blood sugar lowering and asked about it. I told him that the patients he had noticed were the ones who came in with elevated blood sugars to begin with. He calculated how many charts he would need to analyze that data point and selected a number of charts of patients who had elevated blood sugars on their initial labs and who were taking no medications. He then determined the average blood sugar lowering, which was pretty impressive.
As you can see, this data (along with the data from a number of other peer-reviewed studies) show that a lot of saturated fat (our patients were encouraged to eat saturated fat) doesn’t raise cholesterol when consumed as a part of a low-carb diet. Which is why I said that the Anderson study discussed above should have been subtitled: Mensink and Katan equations don’t work worth a flip.
So, eat your fat, watch your carbs, and you’ll do fine. And thanks for letting me vent.
Hello Dr. Eades again: Thanx a lot for your accurate comments and reply to my post. I will do like you said, i will eat green vegetables, however i will replace the 250 to 300 calories i used to eat of apples with protein and some fats. Perhaps a good protein shake with 3% milk. Take care
Glad some folks liked the link to the cookbook with the recipe for Bacon Mayo. Ah, bacon….definitely a food group in itself!
So just when I think, like our genial host, that the tide is slowly turning on this stupid low-fat nonsense, my other half pointed out this article about a fat camp for kids where the folks who run it firmly believe that fat is the problem and that it is ok for kids to eat white bread, lots of bananas for lunch and as much artificial sweeteners as they want:
http://www.theglobeandmail.com/servlet/story/LAC.20080913.COVER13//TPStory/Focus
Is this where we usually say Jesus Wept??
This is certainly a good place to say it. The depth of their dumbth is almost unimaginable.
Cheers–
MRE
One quote from the fat camp chef says everything about their dietary wisdom:
School chef Erin Gaughan, who teaches students to flavour food without fat, says they “are almost like smokers. … Their tongues have dried out from all the fat they’ve eaten.”
That one truly does take the cake.
PP is the only diet I’ve been successful on in my 39 years of dieting, and I’ve now been maintaining a “normal” weight for 20 months quite effortlessly (no other diet was maintainable or effortless!).
However, I did not buy PP until 2000 because of the title, which suggests it is a high protein diet, which it is not. Luckily I read the library copy and decided it was exactly what I needed and have bought all your books since then (and copies for friends & family too).
We know that many reviewers do not read the books they write about, so they may not even be aware that PP and PPLP are the perfect LC diet/WOL books.
I’m happy to hear that you’ve done so well. Don’t forget to give yourself a well-deserved pat on the back. No diet is easy, not even PP and/or PPLP. Some are easier than others, but none is a walk in the park. The fact that you’ve hung in there and done so well speaks volumes about your own resolve. Keep it up.
Best–
MRE
Hello Dr. Eades again: How are you? I would like to ask you if all calories are the same? Or if low-carbohydrate diets permit you you to eat more calories a day, than low-fat diets? Because I think you wrote in another article of yours, that not all calories are the same. So is it possible to eat more calories than a low-fat diet and *still* be able to lose weight provided that our total carbohydrate intake is within the low-carb range (between 30 to 60 total grams of carbohydrates a day).
I ask you and comment about this because i’ve noticed that since i began my low-carb diet, i am able to eat more calories than when i used to eat more fruits and carbs.
On a final note: it’s almost amazing how 2 little apples which do not really *KILL* and satisfy our hunger have a whoppling of 50 grams of carbohydrates. That’s right, in order to satisfy hunger with fruits for example a person has to eat like 4 apples (320 calories, 92 grams of carbohydrates). Pineapples are another fruit which have a lot of sugars too
And some nights i used to eat 4 apples, no wonder i used to wake up bloated.
Thankx again and take care
There is a fair amount of evidence that one can indeed consume more calories on a low-carb diet than on a low-fat diet. Not everyone believes in this idea, the so-called metabolic advantage, but I think the data and the laws of thermodynamics pretty much indicate that it does exist. What you’ve experience personally has been demonstrated in numerous studies.
Cheers–
MRE
I have another question about exercise, specially about aerobic-exercises like walking, bikeriding or jogging.
Do we really need to do aerobic-exercises most days of the week? I ask you this because i have a walking routine. I walk 60 to 70 minutes about 5 days a week. But the problem is that I find walking too exhausting. I also lift weights 2 days a week (Whole body weight training workout)
I don’t think we really need to aerobics at all. I much prefer resistance training.
I have another comment about High protein, low-carb diets, that i would like to stress. Well you wrote in your Protein Power book that when we follow a low-carb diet (Between 30 grams to 50 grams of carbohydrates a day), our glucagon-hormone levels get elevated while our insulin-hormone levels decrease; which create the perfect conditions to turn our bodies into a fat-burning machine. Well i think you are right, because since i started this low-carb way of eating, i feel less bloated. Even my face looks and appears less bloated, it’s like if Ihad a plastic surgery.
I think celebrities, hollywood stars and wealthy elites who have science and knowledge highjacked from the oppressed masses also follow the low-carb, high-protein diets. Their personal trainers know that this is the only way to get beautiful.
But of course science and knowledge is highjacked at the top of society. That’s why the masses don’t know about low-carb way of eating, because the corporate media doesn’t spread knowledge to the masses, because if they did corporations like Jenny Graig, Nutrisystem, etc, would go down in profits.
Speaking of books: how will your new book 6week cure for the middle age middle be different from your prior two publications? Great title! Should catch the eye of the boomers!
Also, if one has lots of dense small LDL particles, how long after being on a low carb(no grain,sugars,etc) diet until these can change to large fluffy particles, or is it genetic and they will not change at all depending upon your genotype?
Thanks,
Many differences between the new book and the old ones, but our publisher won’t let us describe it yet. Soon, though. It takes a different approach in that it focuses on the fat accumulation around the waist that plagues many middle-aged people.
We usually found that most patients on rigid low-carb diets had changed their LDL particle size by six weeks. It probably happened sooner than that, but we didn’t recheck blood until the six-week visit.
As I usually do every morning I went to this blog to read the latest posts in order to start the day with confirmation that there actually is intelligent life on earth. As I read NBC’s Morning Show was blaring away in the background. As I was about half way down the posts it was announced that in the next segment their dietitian was going to tell the viewers how to make fast food ‘healthy’. I could barely stand the suspense even though I was pretty certain what was about to come down.
I wasn’t disappointed. The dietitian described saturated fat as a ‘heart attack on a plate’ stressing the importance of keeping sat fat as low as possible. She then described how to fool your kids by substituting ground chicken for a good part of beef in hamburgers and how get them to eat more fruit by dipping fruits in chocolate. Arrrgh. New day same nonsense. If no one believed this sort of misinformation such episodes as NBC featured would be hilarious because they are so patently absurd, at least to most on this blog. But most viewers of such shows do believe what is said and herein lies the tragedy.
I got a graphic example of this a few weeks ago when some friends I was visiting offered me coffee. They apologized because they had accidentally purchased whipping cream (yum, thank god!) and so had nothing else to offer. They wanted to warn before I indulged because another guest had gotten furious because they had failed to warn him that the whitener was ‘Whip Cream’. This fat phob had apparently lashed out at them decrying that all it takes is a splash of whip cream (sat fat) to bring on a heart attack. Jesus didn’t just weep, he sobbed uncontrollably.
I also find it extremely annoying when critics of the Eades or critics of anyone who dares stray from the mainstream makes statements such as “They (Eades) believe high levels of insulin cause metabolic disturbances in the body leading to elevated blood pressure, cholesterol and triglycerides, diabetes and obesity.” I believe it too as does any objective scientist because it is an irrefutable fact. In my opinion this statement was intentionally worded in the manner it was to create the impression that it reflects an unsubstantiated opinion of the Eades’s, one that is not generally accepted. Such deception is nothing short of criminal.
Yeah, I love it when people put the correct words in our mouths and make them sound evil and/or stupid somehow.
Cheers–
MRE
I know you have quoted Cordain in PPLP. I get his Paleo Diet Updates. I assume he has heard of ketones and keto adaptation so I find the following from his latest Paleo Diet Update rather misleading. Have to quote what is in the newsletter as there is no independent link.
“People who go on a low-carb diet will sometimes report feeling weak or light headed during the first few days on their new eating pattern.
Whether this happens depends on two main factors: 1) the total carbohydrate restriction and, 2) the total caloric restriction.
Popular low carb diets typically restrict carb calories to 50 grams (~200 kcal) or 100 grams (~400 kcal). If the diet is low in calories and carbs are restricted to less than 100 grams, many people will feel weakness because their muscle and liver glycogen stores will become depleted and they must rely upon beta oxidation (the metabolism of triglyceride) as their primary substrate source.
Additionally, the brain can only use glucose as an energy source, hence hepatic gluconeogenesis (the synthesis of glucose from either protein or fat in the liver) represents the primary glucose source. However, gluconeogenesis is inefficient and can only supply small quantities of glucose.
All of these metabolic adaptations – beta oxidation, hepatic gluconeogenesis and ketosis (a by product of carbohydrate restriction and beta oxidation) – upset homeostatic mechanisms shaped by a lifetime of high carb intakes for the average Westerner.
With the Paleo Diet, we advise people to get all of their carbohydrates from fruits and vegetables and to restrict grains, sugars, legumes and processed foods. Carbohydrates are not restricted on the Paleo Diet, but because fruits and vegetables contain so much fiber and water, it is difficult to consume more than about 30 percent of the daily energy from these foods.
Most people don’t experience weakness or lethargy upon adoption of the Paleo Diet, but rather the opposite. Their energy levels remain stable over the course of the day.”
We who are ketone adapted know better, don’t we?
Hi Dr Eades,
I am about 1/3 way through The Protein Power Life Plan. It is proving to be the bible I expected and I have just ordered a copy for my folks.
I was devastated (but pleased now that I know) to find out that scrambled egg produces cholesterol peroxides, it being my chief convenience breakfast for taking to work. My alternative technique, trialled this evening, involves frying the eggs in a wok in coconut oil, lid on, for about 15 minutes at medium heat so that they cook all over, then throwing the resulting slab of fried eggs into the blender to produce, effectively, scrambled.
My question: if I blend the cooked eggs when they are still hot from cooking, do I still produce a load of cholesterol peroxides? If so, I assume allowing them to cool entirely before blending should make this a suitable Purist approach….?
Thanks!
M.
I think we’ve kind of created a monster with the scrambled eggs bit. If you scramble them lightly you won’t produce that much oxidized cholesterol. I would just go ahead and scramble them (as long as they’re not like rubber when you get through) rather than doing the whole thing with the blender.
When I wrote about this in the PPLP, I was still a little on board with the lipid hypothesis of heart disease. Now that I’ve gotten past that, I’m not so worried about a little oxidized cholesterol. Ideally it would be better to eat eggs soft boiled, but that’s not always practical, so I say go for a light scramble and don’t stress about it. Even as a purist.
Have never heard of the Protein Power diet before coming across this blog very recently, and I’ve been reading through the entries. Quickly, I totally agree with your diet, just based on what I’ve read in the blog so far. It’s basically the exact diet I’ve been using for several years. At 47, I’m in superb health, 10% bodyfat, and I eat as much as want daily, but almost no processed carbs, practically no grains (except oatmeal in the morning), and probably 50% cals per day from oil/fats, including a lot of MCT oil. I also eat a lot of high quality protein.
Anyway, I think the one mistake you made, speaking as a marketing expert, is picking a horribly generic name for your program. Imagine if Amazon.com had been called Bookstore.com or OnlineShop.com, or what if we had Search.com vs Google.com, or Auctions.com vs Ebay.com, on and on. The fact is that generic names are not memorable, and lack a quality called stickiness. Protein Power is a non-stick name. Atkins, Zone, and South Beach are just the opposite — they are like Google and Amazon in that they have non-generic names, and therefore they’ve become very powerful, memorable brands. There are numerous techniques for creating sticky, cool, memorable brand names. I’ve got a history of success in this area, with killer brand names in the video game industry, like Duke Nukem and Max Payne. Next time you need a name, let me know. I’ll help no charge.
Keep up the great blogs!
BTW, have you followed Dr. Davis’ blog? http://heartscanblog.blogspot.com/
I appreciate the offer. When we wrote our first book it had no title. In the publishing business, the publishers get to pick the titles (for non-fiction books, at least), and our publisher picked Protein Power. We hated the name and fought hard against it, but to no avail. The book went on to sell 4+ million copies and stay on the New York Times bestseller list for 63 weeks, all of which kind of vindicated the publisher’s choice of names (at least in the mind of the folks at the publishing house). The next book we sold to a different publisher, but that publisher wanted to capitalize on the success of the book Protein Power, so named the next, more comprehensive book, The Protein Power LifePlan. We had nothing to do with either name and hated both of them. However, since that’s what we’re known as (the author’s of Protein Power), we figured we would use it as a website.
I do follow Dr. Davis’ blog.
Cheers–
MRE
P.S. If you want to come up with a snappier name than Protein Power, I’m all ears.
The fact that your book sold so well speaks to the quality of your content, more so that the catchiness of “Protein Power.” But, it sounds like you weren’t a fan of the name either, and at this point it’s probably better to stick with it.
The problem is that “Protein Power” isn’t a catchy label, and when people talk about low-carb diets, it’s much easier for them to talk about Atkin’s and South Beach (even though, as you say, South Beach is more about balance, than reducing carbs). Perception trumps reality. Also, when I first came across your site, Protein Power had me thinking, “What about good fats?” Turns out, you are *for* good fats, but the label “Protein Power”–at first impression–leads one to think that your program is mostly protein, at the expense of both carbs AND fats. A name like Atkin’s doesn’t have an inherent flaw like this.
If I were to recommend a better name for your program, I’d pick one that at first doesn’t sound like it has anything to do with anything (for example, why name a computer company “Apple”?), such as your last name (Atkin’s and Ornish style), except that Eades is not an easily pronounced name, so that’s a big strike against it catching on. The reality is that your diet is an insulin busting diet, and insulin comes from the Latin word for island, so this gives you an excuse to go with a name like The Island Diet. Anyway, it can take weeks/months to come up with the perfect name–but at least you get a glimpse at how I would approach it.
I agree with you right down the line, including the fact that Eades is not an easily pronounced name. I often call it the most mispronounced five letter word in the English language. If you come up with any suggestions, as I said before, I’m all ears. Thanks for brainstorming on it a little.
Cheers–
MRE
P.S. For those who don’t know, Eades is pronounced like beads without the ‘b.’
Hi Dr. Mike! I know this is an older post, but I’m still fairly new to your blog and I’ve been spending some time reading back posts. I have a question relevant to this post, I believe. My question is, can you sum up the basic differences between your diet and Dr. Atkins’? My first experience with low carb years ago was Atkins, but I really have come to love your blog here, and I’m curious about how you differ from him. Thanks!
This difference would probably be better explained in a post for all to read rather than in a comment that few may read. I’ll add it to my growing list of post ideas. You can go to the Protein Power forum, however, where a lot of people will be happy to explain the difference.
Hi great site. i have very high cholesterol. I try to exercise and have a good diet. THIS SITE IS GREAT!!!!!!
The Friedewald calculation of LDL is wildly inaccurate when triglycerides are low. Wildly high. So, low-carb diet effects based on LDL-C is inherently bad science, unless based on directly measured LDL or LDL particle count. This is a flaw that runs through much of the so-called science. It has tended to make low fat high carb diets look better than they are in connection with LDL and low carb diets look worse.