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If New Research Says Weight Loss Is All About The Calories, Then Why Was The Atkins Diet Omitted From The Study?


Dr. Frank Sacks thinks his study is a slam dunk on the calorie hypothesis

It’s all about the calories you put in your mouth. Whether it’s low-fat, low-carb, high-protein or whatever, in the end the only thing that makes a difference when it comes to losing weight is calories. That’s the conclusion of this study published in the February 26, 2009 issue of New England Journal of Medicine paid for by the National Heart, Lung, and Blood Institute of the National Institutes of Health that you’ve undoubtedly seen plastered all across the news in the past couple of days. And they’re so proud of themselves for confirming in their minds that weight loss is simply about calories in, calories out and not about any particular diet plan in particular. But there’s only one problem with this: they didn’t include a genuine Atkins-styled low-carb diet in the comparison!

Lead researcher Dr. Frank Sacks, a professor of Cardiovascular Disease Prevention in the Department of Nutrition at Harvard University, and his researchers observed 811 overweight or obese older adults and put them on one of four diet plans with the following fat/protein/carbohydrate ratios over a period of two years:

DIET #1: 20/15/65 (low-fat, low-protein, high-carb)
DIET #2: 20/25/55 (low-fat, moderate-protein, high-carb)
DIET #3: 40/15/45 (moderate-fat, low-protein, moderate-carb)
DIET #4: 40/25/35 (moderate-fat, moderate-protein, moderate-carb)

If you’re playing along at home, then you’ll quickly realize that not a single one of those diets even comes close to any reputable low-carb diet plans like Atkins. Only DIET #4 approaches the lower-carb plan created by Dr. Barry Sears’ called the Zone Diet which has a 40/30/30 ratio. A genuine low-carb diet would look something like 60/20/20 at the highest level of carbs and most likely 75/20/5 for people who read Dr. Atkins’ New Diet Revolution. It’s a very high-fat, moderate-protein, low-carb diet during the weight loss phase. More on why this was omitted from the Sacks study in a moment.

Each of the diet plans used in this study were forced to comply with the “heart healthy” guidelines that restricted saturated fat calorie intake to less than 8 percent of total calories, generous portions of fruits, vegetables and whole grains, and a minimum of 20g of fiber daily. The template for the diets was the infamous DASH (Dietary Approaches to Stop Hypertension) diet rather than any of the more popular diet books over the past decade, including Atkins and Dr. Arthur Agatston’s South Beach Diet.

The study participants were asked to attend weight loss meetings and keep a journal of their food intake on the Internet. Each individual was provided a calorie goal which was approximately 750 calories below their daily needs to allegedly create a “calorie deficit” to induce weight loss. However, none of them were allowed to dip below 1,200 calories a day.

As for exercise, they only had to engage in some kind of moderate physical activity for 90 minutes a week so it would not be a major factor in the weight loss. Dr. Sacks wanted the diet composition to be the driving force in the study results above everything. So, what were the results?

After six months on each of the diets, all of them lost an average of 13 pounds regardless of the diet they were required to follow. By the end of the two-year study, they had kept off an average of 9 pounds and shed 1 to 3 inches off their waist–again, it didn’t matter which diet they were on, it produced the same results. Likewise, increases in HDL cholesterol, drops in LDL cholesterol and triglycerides were all ditto at six months and two years. The study participants all said they experienced satisfaction, fullness, and hunger control on their particular plans.

While this study seems somewhat interesting to the researchers, it really doesn’t mean anything about the differences in weight loss and health benefits of any significant macronutrient ratio comparisons. Why wouldn’t you want a 10/20/70 diet like Dr. Dean Ornish would prescribe for weight loss and health as well as a 70/20/10 diet closer to the one Dr. Robert C. Atkins dedicated his life to? Dr. Sacks had his reasons for purposely omitting a truly low-carb diet.

“People don’t stick with low-carbohydrate intake and we didn’t want to try anything unrealistic,” he said. “We tried a big range but a reasonable range of fats, protein and carbohydrates.”

WHAT?! Dr. Sacks, with all due respect, where did you get your conclusion that people who eat a carbohydrate-restricted diet don’t stick with it? Since you’re a researcher, wouldn’t you want the evidence to guide you rather than coming into an important research study with some pre-disposed ideas about what is truth? I’ve been eating low-carb for over five years as have thousands more who visit my blog–what exactly is “unrealistic” about this way of eating?

Dr. Sacks says his study promotes “a very simple message that cuts through all the hype: To lose weight, it comes down to how much you put in your mouth—it’s not a question of eating a particular type of diet.” Well, when you leave out one of the most popular diet plans over the past decade from this comparison study, I can see how you would think all diets work the same.

Or, should I say, how they all DON’T work the same way. I mean, come on, only a 9-pound weight loss in two years for overweight and obese people? This is progress? Not hardly. And adherence to the chosen weight loss plan was poor to the point that virtually all four diets were the same–so it stands to reason the results would be similar.

The researchers say their study will “give people lots of flexibility” to choose the plan that’s right for them.

“Weight loss is very simplistically just reducing the amount of calories that you take in, and any kind of healthy diet that allows you to do that is the best,” they concluded.

NO, NO, NO! We’ll never know based on this study if a high-saturated fat, ketogenic low-carb diet which may allow more calories than any of the four diets in this study would produce even better health and weight results. Weight loss is so much more than calories…it’s about making the right choices of food for YOU. A Type 2 diabetic, for example, needs to eat a very low-carb, high-fat diet.

I asked a few of my low-carb expert friends to weigh in on this study with their thoughts.

Dana Carpender wrote in this blog post today that “the researchers commented that they tried to make their diets ‘heart healthy,’ low in cholesterol and saturated fats. This tells me that they’re working with a paradigm I consider to be thoroughly disproven.”

Dr. Scott Olson wrote in his Examiner.com column: “If they had really wanted to test a low-carbohydrate diet, they would have tried an Atkins diet, or the sugar-free diet I suggest. Those diets keep your blood sugar low and, therefore, keep you from adding weight. Calories mean nothing when you are talking about weight loss.”

Jackie Eberstein from Controlled Carbohydrate Nutrition responded to this study by describing it as “an unfortunate waste of money.”

“It was flawed from the beginning. It’s clear that the intent was to do a lower carb diet than the typical Western diet but to avoid using the proven very low carb diet. If they used a very low carb diet such as Atkins, the results would have been better and it would be harder to sustain the calories in-calories out theory. By designing the study this way they made sure that didn’t happen.

Why not use Atkins? Because those involved with the study seem to have a strong anti-low carb bias. The designers of this study made sure that on the most carb restricted version the amount of carbs was well above the amount one would eat on Atkins. When carbs are too high, as in this study, the positive metabolic advantages, such as significant fat burning, that occurs with low carb are lost and it simply becomes another calorie-controlled diet.

The bias of one of the researchers was clearly demonstrated with the statement that an Atkins diet wasn’t used because people don’t stick with a low carb intake. Tell that to the millions of people who do everyday–in the process they get thinner, healthier, improve their quality of life and reduce or eliminate medications.”

Well said, Jackie! Let’s see what the always entertaining and on-point Brooklyn, NY-based SUNY Downstate biochemistry professor Dr. Richard Feinman from The Metabolism Society had to say about this Sacks study.

“I suspect that it is part of a new paradigm on the part of the nutritional establishment which is a kind of ‘scorched earth policy.’ In other words, having clearly failed at low fat, they are now trying to say that no diet is good. The technique is NINO–nothing in, nothing out. That is, make minimal changes and then show that nothing happened.”

That’s exactly what they’re doing, Dr. Feinman, and you’ve NAILED ‘em on it! Finally, Dr. Jay Wortman from the My Big Fat Diet documentary chimed in with his own feedback about the study as well.

“Both Sacks and his co-investigator, George Bray, are on record as being very opposed to the idea of a low-carb diet. For them to say that a low-carb diet is as good as a low-fat diet is progress of a sort, I suppose.

I attended a lecture by Sacks a couple of years ago at a big conference where he was promoting the idea of high protein. When I pointed out that to achieve an increase in protein he reduced carbohydrate and that the benefits may have been attributable to the lowered carb, he launched into an angry diatribe about how low-carb had no scientific merit.

The other thing about this study is that the diets were ‘goals’ and the fact is that most people didn’t stick to the assigned diet. A final observation–35% carb is not low enough for people who have developed insulin resistance. For these people, a very low carb diet almost magically reverses their health problems. You would not expect to get this kind of metabolic benefit from a diet of 35% carbs or greater.

Bottom-line: this study adds nothing to our understanding of diet and is being used to shore up the untenable position that macronutrient content is irrelevant, that only calories count. There is a growing scientific literature telling us quite clearly that this is not true. These guys are on the wrong side of a major paradigm shift.

And I couldn’t have summarized this study any better than that. What do you think? Do you believe the researchers PURPOSELY left out the inclusion of a ketogenic low-carb diet to skew their results? Share your comments below.

You can e-mail Dr. Frank Sacks regarding his questionable study results by writing to fsacks@hsph.harvard.edu.

2-27-09 UPDATE: Atkins Nutritionals spokesperson Collette Heimowitz offers up the official response from the Atkins company today:

“The macronutrient distribution suggested in the two lower-carb diet plans was no where near the levels that have been shown to be effective for weight loss as cited in numerous previous low-carb studies. Only after an individual has achieved his weight-loss goal–and assuming his metabolism allows–does Atkins suggest the higher carbohydrate intake level prescribed in the two lower-carb diets used in the NEJM study. These levels approximate the recommended levels a person with a healthy metabolism might achieve in the Atkins Lifetime Maintenance phase. As the name makes clear, this phase is designed to help users maintain their weight loss, not lose additional weight. Furthermore, participants in the study weren’t always consuming the prescribed percentage requirements of different macronutrients, thus blurring the distinctions among the four diets in the study. For example, while the lowest carb content prescribed in any diet was 35 percent (in the high-fat, high-protein diet), the lowest carbohydrate content reported as consumed was actually around 42 percent, seven percentage points higher than the recommended levels. The four diets outlined in the study produced similar weight-loss effects because in actual practice, the diets were closer in the percentages of each macronutrient than the study’s original design. Had at least one of the lower-carbohydrate diets hewed closely to the Atkins’ weight-loss protocols, the results would likely have been considerably different.”

  • http://jgerbermd.com Jeffry N. Gerber, M.D.

    Hello Jimmy,

    As soon as I saw this study being reported in the news, I went to you web site certain that you would be jumping all over this one!

    The conclusions were pointless and useless and I agree with all of your comments.

    Unfortunately the medical community and the public continue to be confused and we are not even close to a general consesus about what is healthy nutrition!

    Jeffry N. Gerber M.D.

    It took me a little while to calm down about this kind of idiocy in the research world, Dr. Gerber, but this is why the work we’re doing is too important to stop now.

    –Jimmy

  • Pam

    I did send an email to Dr Frank Sacks, and here is what I said.

    “I was wondering why you did not include a real Atkins-like diet in your test. Seems to me you have a very limited trial.

    Also according to the newspaper accounts, you are very excited about a 22 pound weight loss over 2 years. I find that a ridiculous amount since I, as a 75 year old long term obese woman on low fat diets for the past 20 years, lost 50 pounds in 10 months on am Atkins like diet and I was considered SLOW.

    Finally I saw no reference to any of the other research parameters that recent studies have included in their reports. Where is the blood work? Blood glucose? Cholesterol?” None of that appeared in these very enthusiastic newspaper accounts so I assume you didn’t get much to brag about.

    What a disappointing study.”

    I agree with you Jimmy. Not much to brag about.

  • http://www.TheBunnellFarm.com Tom Bunnell

    Eat lots of fruit and grain and vegetables and stay high. — What could possibly be wrong with that! — Have some good lean, low fat meat to go with it and you have it all!

  • http://www.centerforbalancedhealth.com Valerie Berkowitz, MS, RD, CDE

    I believe there is something worth mentioning.

    Research is good for information when it is unbiased and we all agree that this research serves its own purpose, it is not for the good of true science.

    Avoiding an important tool, lowering carbohydrates so that one can burn fat to lose weight as recommended by members of the Nutrition and Metabolic Society (www.nmsociety.org), is bad science. As you point out, the carbs are not low enough to make a sensational blanket statement as the authors in this study did.

    However, from a practical standpoint, whether the research is wrong or right, it does not take into account situations where using low carb diets like The Stubborn Fat Fix, will help curb appetite or help to correct metabolic dysfunction. In fact, real low carb diets help so many people feel better that it should be criminal to hide these findings.

    Jimmy, we need to pull our resources together. You, other low carb support groups, the NMS society etc…let’s get people to keep food diaries and paste their calorie/fat/carb intake all over the place. Let’s see if that gets us anywhere!

    Some of us are already doing that, Valerie! Check out my low-carb menus blog which links to others who are posting their low-carb meals.

    –Jimmy

  • http://www.TheBunnellFarm.com Tom Bunnell

    The Mayo Clinic is in sync with these people as well as the federal government in there dietary recommendations, just to point out how extreme and the extent of, this ignorance is ,and this dilemma!

  • http://sparkofreason.blogspot.com Dave

    Telling quote: “Each participant’s caloric prescription represented a deficit of 750 kcal per day from baseline, as calculated from the person’s resting energy expenditure and activity level.” They’re all starvation diets, regardless of macronutrient composition, and thus all induce the known metabolic changes that cause resistance to fat loss. A key component of a “true” low-carb regime is that you eat until you’re not hungry, thus avoiding down-regulation of metabolic rate. The hypothesis is that as insulin is lowered and insulin sensitivity raised, fat is released from the fat cells more readily, and people spontaneous reduce caloric intake. This has been observed repeatedly.

    Not also that the actual adherence values for carb consumption in the high vs. low carb groups were 57+-11% vs. 43+-7% at 6 months, and 53+-11 vs 43+-8 at 2 years. Errors are 1 standard deviation, so this is hardly a compelling statistical difference, and certainly not a test of the insulin hypothesis. Interesting that the high-carb group couldn’t maintain 65% with ease.

    A couple of other observations: lots of grain consumed in all cases. All diets, even the high-fat diet, consumed “tub margarine”, low fat milk, low fat cream cheese, etc. Take a look at the menus – no wonder they had trouble with adherence. Booooooring!

    Don’t waste your time emailing this bozo. He’s not going to change his mind, and annoying a zealot just makes him more strident and vocal. Let’s spend our efforts educating others as to the misleading conclusions he’s pushing.

  • Pam

    Here is Frank Sacks reply to my email:

    “Several past studies of the Atkins diet showed that the study participants couldn’t follow such extreme nutrient levels beyond the first couple of months, so there was no practical reason to repeat this. The lipids and risk factors improved in our study, see attached article. Thanks for your inquiry. Frank Sacks”

  • http://sparkofreason.blogspot.com Dave

    Sacks’ reply above makes my point. He knows the answer, is not going to change, and is only interested in doing research that validates his position. Were he ever to do a study that contradicted that position, I’m sure it would never see the light of day, and be rationalized as “problematic” in some form or other.

    BTW, this study also does lend some support to the metabolic hypothesis. Reducing glycemic load certainly should lead to a reduction in insulin and you would expect an improvement in blood parameters. The obvious extrapolation is to strict carbohydrate restriction, but Sacks is rationalizing that as impossible, and thus in his mind, unverifiable.

    But Sacks should stop playing the role of a REAL scientist if he refuses to let the science dictate the truth. GREAT COMMENTS, Dave!

    –Jimmy

  • bazzta

    I’ve read the study carfully.

    The difference between diets after 2 years were 6% carbs and about 250 kcal. Not a difference you can make any claim with!

    What the study really showed was that even though the paticipants had regular group and individual sessions they couldn’t follow their prescribed diet.

    Ergo – even regular sessions will not help you loose weight. That’s what the results of the study shows!

    Too bad our reporters can’t read and get themselves an informed opinion………

  • http://sparkofreason.blogspot.com Dave

    Hey Jimmy. I agree in principle with your comments about being a “real scientist”. But the ugly (and repeatedly demonstrable) truth is that most practicing scientists aren’t “real” in the sense of following the scientific method. Most behave precisely like Sacks, they just don’t have the same visibility.

    I used to be a research scientist, had to deal with these people all of the time. The reason I got out of science was that I found most scientists to be just like Sacks. In my case it was even worse. I would get in to debates on points which were purely mathematical. Math is clean, because you start with some assumptions, perform a well-defined set of mathematical operations, and wind up at an answer. If you don’t like the answer, you have to either question the assumptions or show an error in the math. The people I argued with would do neither, and still insist that I couldn’t right. A hilarious (yet extremely sad) testament to the strength of dogma.

    The situation is made worse because Sacks, like most scientists, is probably 100% well-intentioned, just horrifyingly misguided. I would guess that every morning he gets up, looks in the mirror, and tells himself “I am a leader in obesity research, and I make the world a better place!” He sincerely believes that, and for us to challenge his position is essentially to imply that his work is actually harmful, and that he’s a self-deluded boob. It would be shocking were he ever to change his position.

    The best we can do is present our case to the rest of the world being ruthlessly rational and considering all of the evidence. We want to change the minds of those directly affected, convince them to think for themselves rather than rely on “experts”. Once empowered, I suspect most will follow the same path we have, and be able to change their lives for the better.

  • Patrick Wanis

    Hey Pam, thanks for posting the email reply in the comments section …..

  • Dan

    Jimmy,

    Thanks for blogging about this “study”! I always enjoy reading your posts on these matters.

    I first heard this study reported on the Today show and their expert Doc (Nancy Sniderman, I think?) went on and on about how this study finally proves that weight loss is all about calories in equals calories out.

    I decided to check out the study for myself, which is not something I typically do, but need to do so more ofter.

    Like the other comments above, I found the results quite unimpressive.

    In fact, if I were looking for data to support the idea of “All I need to do is cut calories and I’ll lose weight”, reading this study would make me despair.

    My take away from the study is that if I cut my intake by 750kcal a day, I should expect some weight-loss in the first 6mos, but then to expect to put half of that back on over the next year and a half! Wouldn’t that make any sane individual despair?

    Further, doesn’t this precisely contradict the hypothesis that a calorie deficit is all that is necessary for inducing weight loss? Despite a 750kcal deficit, the study participants put weight back on!

    When will the world wake up? sigh…

    Keep up the great job you do, Jimmy!

    Dan

  • Gracie

    Jimmy,
    Yet another ‘study’ set up to ‘prove’ what the researches want. I get so sick of things like this. Low carb diets not sustainable? I’ve been eating that way for over a year, and have no intention of eating any other way. I’m losing weight, improving my health, & have more energy than I did in my 20′s!
    Hogwash!
    Hugs,
    Gracie

  • http://www.TheBunnellFarm.com Tom Bunnell

    I think we get discounted a lot because they label us “fatties” and think all of this debate is based on fat people and there diets, rather than realizing that this diet is for everyone, fat, skinny and average alike and there is no other way!

  • Katy

    If all that matters is calories, then I guess 1200-1500 calories of Twinkies is OK, right? What about improving health, i.e. lowering blood sugar, hypertension, insulin output, etc. What idiocy.

    EXACTLY, Katy!

    –Jimmy

  • http://gohealthygofit.com/eat-less-lose-weight/ Andrew R – Go Healthy Go Fit

    Hey Jimmy,

    I caught an article in the front page of the LA Times on this study:

    http://www.latimes.com/features/health/la-sci-diet26-2009feb26,0,4499014.story

    The big problem that I had with this article in the Times, which I wrote about in an article of my own yesterday, was the following sentence:

    “That is, any diet that is low in calories and saturated fats and high in whole grains, fruits and vegetables — and that an individual can stick with for a lifetime — is a reasonable choice for people who need to lose weight. That’s the conclusion of a study published online Wednesday by the New England Journal of Medicine, research that represents the longest, largest and most rigorous test of several popular diet strategies.”

    In my opinion, this is editorial bias that is completely unfounded… given the conclusion from the actual study:

    “Conclusions Reduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize. (ClinicalTrials.gov number, NCT00072995 [ClinicalTrials.gov] .)”

    Where in that conclusion does it ever say you should eat grains and avoid saturated fat?? It is going to take the continual efforts of low-carb bloggers like us, who will outlast bankrupt companies such as the LA Times mind you, in order for people to understand the benefits of a low-carb (paleo) lifestyle.

    What do you think about the statement made by the author of the article in the LA Times?

    All the Best,

    Andrew R
    Go Healthy Go Fit

    THANKS Andrew! Actually, they’re basing that conclusion on the stated rules set forth by the researchers who required the four diets to all follow the “healthy eating” guidelines outlined by the government–low saturated fat, healthy whole grains, fruits, veggies, yadda yadda yadda! I would have LOVED to have seen a HIGH saturated fat, grain-free, fruit-free, non-starchy veggie diet option among the four–it would have blown the rest out of the water!

    –Jimmy

  • http://www.gloriana.nu Elizabeth

    Ah, the New England Journal of Medicine again! I’m recalling Jimmy’s excellent post about their supposed ‘Atkins’ study a few years ago (it was not Atkins at all – but was of those consuming between 120-180 grams of carbohydrates daily – and who lost very little weight.) At the time, I had attempted to post on the Atkins site, which linked to the study, because I knew it was absurd that people TRULY doing Atkins would have lost only 10 pounds (though, at the time, I was unaware that those involved in the study were instructed to take in 120 grams a day – high even for maintenance, and probably 3-4 times what those of us on OWL used.) Unfortunately, there was no explanation from any Atkins staff – only ridiculous word games from a very nasty woman who dominates the Atkins forum, and who objected to my using pronouns (what do you care what ‘they’ do? You’re going to weigh something a year from now…)

    Well, I’m post menopausal, lost 83 pounds, hope to lose 30 more and reach goal – and now weight what I did at the age of 13. Jimmy (or anyone who might know) – has there EVER been a medical study which used actual Atkins ongoing weight loss? Even the one referenced from the Atkins site – and, I believe, funded by the Atkins foundation – is not remotely like OWL.

    I can’t help but wonder if even Atkins advocates aren’t mired in sycophancy. Robert Atkins was ‘up front’ about his approach, regardless of whether the AMA or anyone else agreed. I’m wondering if links to that ’120 gram’ study on the Atkins site are ways to be accepted, rather than ways to successful weight loss. It’s not Atkins at all – but it might meet some doctor or nutritionist’s definition of ‘safe.’ (Don’t lose more than a pound a month – increase intake of grains – don’t go into ketosis…)

    I must add that I think it is pathetic that this study is supposed to be so enlightening, if people only lost tiny amounts of weight and couldn’t even maintain that!

    You’re right on so many levels, Elizabeth! That Atkins study in the NEJM last July was pathetic. And I’ve blogged about the dismal results of low-carb diets in past studies because it’s just too strange that they WOULDN’T use a ketogenic or even an Atkins maintenance level of carbohydrates in these comparison studies. What are they afraid of? Being proven wrong? GET OVER IT!

    –Jimmy

  • donny

    No study on weightloss can ever be taken seriously unless some attempt has been made to measure actual fat loss. One person could lose a pound or two more than the other; the same person could lose a couple of centimeters of waist circumference when compared to that same other. Neither of these changes would be considered significant, but what if one of these people lost ten pounds more actual fat than the other, and replaced it with muscle? Jeff Volek has done at least one diet plus exercise study where the weight loss difference was insignificant, but the fat loss difference was significant. I’m not saying that this was the case in this particular study; I’m just saying that nobody knows. You can’t know what the results of your experiment are unless you take the relevant measurements.

    This is true, Donny. Fat loss is MUCH more relevant than weight loss.

    –Jimmy

  • sally

    I heard this “doctor” on NPR today… very disturbing. He repeated the meme about only wanting to test “healthy” diets… no bias there!

    I don’t understand how he/they can justify their hypothesis that it’s simply calories in/calories out…
    If it’s all just so simple then why do certain drugs cause people to gain weight? Why does having an underactive thyroid cause people to gain weight? Why does simply getting older cause people to gain weight?

    How can researchers come to such broad conclusions when clearly there are so many common examples contrary to their hypothesis…

    To them, anecdotal stories are irrelevant…only the research counts. I can understand that sentiment somewhat, but REAL LIFE cannot be ignored either.

    –Jimmy

  • adam

    Gardner et al, that showed Atkins was best did show that Atkins group only lost about the same as these part. did. 4-5 kg is what you can lose dieting, whatever diet you choose.

    Of course there are a lot of individuals that lose more with any method. But that is individuals, not controlled groups.

    Face it. Dieting is difficult for the man on the street.

    True enough, Adam. But why wouldn’t you include a fair representation of ALL the diets in a comparison study like this? And I think they should have included a HIGH-CARB, VERY LOW-FAT diet in the study a la Ornish as well as Atkins with those two moderate-carb, moderate-fat plans. Then we would see some results worth publishing.

    –Jimmy

  • http://www.TheBunnellFarm.com Tom Bunnell

    Carbohydrate addiction is hard for the man on the street!

  • http://www.gloriana.nu Elizabeth

    But is the tiny weight loss the result of that ‘dieting is hard for the man on the street’? Is it that participants were not able to continue, or that they had no success though they were following the plan?

    That is one of my main gripes about that there are no low carbohydrate studies of which I am aware that show actual adherence to Atkins. The one which I mentioned above (and to which Jimmy linked) did not give me an impression of ‘those involved could not follow Atkins.’ It seemed those in the group were instructed to take in the (much too high) 120 grams of carbs.

    I also find it mind boggling that, in every study I have ever seen, the assumption is that everyone starts gaining after six months! “Success” seems to mean “not gaining everything back,” not continued or significant weight loss.

    I am a confirmed Atkins dieter, but I know from past experience that I could never continue on these low fat, low protein, high carbohydrate diets. (I was raised on that horrid Mediterranean diet – it’s a sure route, for me, to being ravenous 24 hours a day.) That did not keep me from substantial weight loss on ‘genuine’ Atkins – not the ‘healthy’ 120 gram version, which would include no appetite reduction, metabolic advantage, decrease in fluid retention, or removal of cravings. In my experience, Atkins is not at all difficult to follow (yes, alone!) once the appetite reduction and lack of cravings take effect.

    You’re so right, Elizabeth. My theory is they KNOW a genuine Atkins low-carb diet will blow the rest of the diets out of the water and they’re too afraid to show that result and tear down decades of work they have committed their lives and careers to.

    –Jimmy

  • Alan Adler

    The Four Diets Were Actually Nearly Identical

    As Dr. Martijn Katan pointed out in this same issue of the NEJM, the actual nutrients consumed by the four diets were nearly identical. The maximum protein difference was 1 to 2% and the maximum carbohydrate difference was 6%.

    The similarity of all four diets is also revealed by Table 2 of the study. Read for yourself the levels of “Nutrient intake per day” given in that table. They are nearly the same.

    Yet the authors of this study announced:

    “Conclusions: Reduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize.”

    Even the title of their article is a lie, “Comparison of Weight-Loss Diets with Different Compositions of Fat, Protein, and Carbohydrates”. Where are the differences?

    Sadly, the press passed along the lies. Google News lists 577 articles on this study today (2/28/09). I read a handful of them and they all headlined the title and conclusion. None mention that the four diets were nearly identical.

    Many of the articles included interviews with the authors, who amplified the lie. For example the February 26, 2009 NY Times quoted Dr. Sacks, “It really does cut through the hype … The effect of any particular diet group is miniscule…”

    In fact, the “hype” has come from Sacks and his co-authors. They monitored 811 people who all ate nearly the same diet and announced that differences in macronutrients were not consequential. They have done their careers, science and world health a gross disservice. I sincerely hope that enough voices will be raised and heard to correct this huge lie.

    You’re right Alan, the hype has come from Sacks, etal. Unfortunately, their willing accomplices in the media have given them the amplification of their hysteria and made it that much worse. The average Joe will “hear” about this study and say, “Did you know it doesn’t matter what diet you use, they’re all the same if you keep your calories in check? Well duh?” And then they miss the point about carbohydrate leading to increases in insulin and blood sugar and wonder what’s wrong with THEM when they don’t lose weight and their health gets worse eating “healthy.” Frustrating doesn’t even begin to explain how I feel about all this.

    –Jimmy

  • Em

    Why is no one mentioning this study from the Harvard School of Public Health?

    “The biggest surprise, however, was that the low-carbohydrate dieters eating extra calories lost more than those on the low-fat diet. Participants in that low-carbohydrate group lost an average of 20 pounds.”

    http://www.news.harvard.edu/gazette/daily/0310/20-lowcarb.html

    THANK YOU, Em! This research from Penelope Green was FANTASTIC because they allowed the low-carb group to actually eat a HIGH-FAT, LOW-CARB diet (just 5% carbs daily) and even eat MORE calories than the low-fat group. WOW! I am going to work on getting Green on my podcast show soon. Great link…you’d think Sacks would read the work of their colleagues before publishing an asinine study like they did.

    –Jimmy

  • http://lowcarbtransformation.blogspot.com/ c.ghavamian

    Jimmy, I knew you wouldn’t let us down. When I saw the headlines about this study, I immediately thought “what were the parameters of this study?” and “when’s Jimmy going to blog about it?”

    It’s interesting to me that low carb proponents will not just stop at the headline and take it as nutrition gospel. We’ve seen study after study either trying to negate or even vilify the low carb approach and are used to looking deeper.

    Many of us went on low carb diets against our doctor’s wishes and even kept it a secret for a long time – many of us have had people look at us like we’d grown a third eye when we told them what we were eating when they wanted to know how we lost weight.

    Unfortunately there are still a majority of people who will read the headline, hear the soundbites and believe that they are out of control, that they have some kind of defect because they cannot stick to a low fat diet without going stark raving mad.

    I used to think I was defective…thought that I lacked self-control. Once I found the Atkins way of eating, I realized that it was not a personal failing, it was what refined carbohydrates did to my body and how they made me feel. I never dreamed that I could feel satisfied and lose weight at the same time – I never dreamed that I could keep weight off once it was shed. Indeed, it went against everything I’d been told.

    There is this kind of blame that is attached to overweight and obese people. That if they’d “just put the fork down”, all would be well. Overweight people are “lazy”, “stupid”, “sloppy”, etc. It’s just not true but the perception is still there.

    The real defect is not in those desperate individuals trying to lose weight on a low fat/high carb diet, the defect is in those individuals who keep perpetuating it.

    I had to simmer down after reading all the hysteria about this “be-all, end-all” study on diets. Truth has become replaced by sensationalism and convention by people who are desperately hanging on to every vestige of the low-fat lie that they can. Their day of reckoning is coming…SOON!

    –Jimmy

  • http://www.glucoholic.com Glucoholic

    Thanks Jimmy,

    I would also like to get my licks in on the media for its botched coverage of this topic. I saw several news outlets covering this announcement, and not a single one of them mentioned your point, but all simply said “no matter what diet you’re on.”

    This reminds me of the current trend amongst nutritionists pushing a “balanced diet” for everyone – regardless of condition. I’m a type 2 diabetic trying to control blood glucose with medication and ciet and exercise. Many nutritionist will tell you to eat around 45 grams of carbs per meal. I’ve done that experiment, and all that will get me based on my average blood glucose is a fast track to insulin. No thanks.

    Keep doing what you’re doing.

    And it’s not just diabetics either, Glucoholic. It’s people who are predisposed to insulin/blood sugar issues which is a WHOLE LOT MORE than anyone really wants to admit. I wouldn’t be surprised to learn that three out of every four Americans are walking around with some level of insulin resistance, metabolic syndrome, pre-diabetes, or full-blown diabetes today. And livin’ la vida low-carb is the nutritional solution to this problem. Why can’t they get it? THANKS for your support of the work I’m doing.

    –Jimmy

  • http://www.TheBunnellFarm.com Tom Bunnell

    Living on the Atkins induction diet is a piece of cake. — No cravings and always satisfied and no hunger pains whatsoever. — It’s the carbohydrate addiction factor that draws people back to carbohydrates and weight gain!

    AGREED!

    –Jimmy

  • adam

    Tom, it’s probably not the addiction factor but the fact that it’s so retricted that it becomes so boreing after some time.

    How hight is the drop out rate on Atkins?

    100%.

    Well, it’s not 100% because I’m STILL on Atkins over five years later and counting. And I’m sure MANY MORE of my readers here could attest to the same. Nice try, though, Adam!

    –Jimmy

  • http://sparkofreason.blogspot.com Dave

    Nice troll Adam. You should probably stick to the vegetarian boards if you’re looking for someone to take that kind of bait.

  • http://www.TheBunnellFarm.com Tom Bunnell

    adam, on March 1st, 2009 at 11:15 am Said:

    Tom, it’s probably not the addiction factor but the fact that it’s so restricted that it becomes so boring after some time.

    How high is the drop out rate on Atkins?

    100%
    ___________

    “This is the addiction itself talking to this person, Adam, convincing him to use sugar and starch and feed his addiction.”

    He and his addiction will fight to the death to not give up sugar!`

  • http://lowcarbtransformation.blogspot.com/ lctcathy

    Quoting Jimmy:

    “Truth has become replaced by sensationalism and convention by people who are desperately hanging on to every vestige of the low-fat lie that they can. Their day of reckoning is coming…SOON!”

    From your fingertips to God’s ears my friend.

  • http://lowcarbtransformation.blogspot.com/ lctcathy

    Response to Adam:

    Adam, the fundamental difference (for me) in adhering to the Atkins diet is that I am no longer obsessed with what I put in my mouth or what I’m going to eat next. Food, while still enjoyable, is a means to sustain my life and health. Actually this is so freeing that I cannot adequately articulate it.

  • AH

    I found your blog through google after seeing a news report on this study. I think you and the commenters have done a great job of assembling the facts about this study and critiquing it. I’m a public health scientist, so I also looked up the article by Sacks et al in the NEJM. It’s a real shame that all the effort and money the researchers put into the study didn’t actually test the hypothesis they set out to test and was essentially designed, not to prove what they already believed but actually be unable to find anything. As some of the commenters have pointed out, the “variables” didn’t sufficiently vary between treatment groups. This, and several other important methodological issues were actually discussed in an editorial accompanying the article in NEJM. Funny how the media missed those criticisms completely, let alone the ones you all have pointed out. Part of the problem in public health is that research is often conducted by clinicians who, despite long and distinguished careers, are not truly scientifically minded individuals. I hope you will believe me that some of us scientists really are interested in using rigorous methods to find out what’s really going on, even if the answer seems weird or surprising. Indeed, real scientists know that’s where scientific gold lies waiting.

  • Dan (aka Renegadediabetic)

    If you take the “calories in, calories out” dogma to be absolute gospel, cutting 750 calories per day should have produced around 150 lbs weight loss in two years by my calculations. Even if you allow for reduced expenditure as you lose, I’d still expect a greater weight loss. (Or maybe I’m just not using the right “new math” for my calculations. :) )There was no difference in weight loss among the diets and all diets were total flops.

    What we have here is some slick rhetoric to turn a failure into a success. Plus, they are hoping that, in this sound bite culture, no one will analyze the details. Propaganda 101: repeat something over & over again and people will beleive it, whether it is true or not.

  • http://www.gloriana.nu Elizabeth

    I was very glad to see the link to the Harvard School of Public Health link – and equally happy to see that, brief though this study was, it did show some substantial weight loss over the three month period (with anyone able to multiply equally able to see that this could amount to a loss of 100 pounds in a year, not 10!). My only regret is that, inevitably, I’m sure any of the media who reference this study will add nonsense such as “but don’t observe it for more than three months – it’s only been proven ‘safe’ for that time…”

    Atkins dieters tend to learn, soon enough, to turn a deaf ear to many others – one of whom is likely to be a doctor, if they discussed it with them in the first place (most of us long term weight loss failures from the past already know doctors are worse than useless in that area.)

    As one who spends time in the States as well as England, I’ve noticed that, where my friends in England have complimented my weight loss (and usually are quick to mention that they know others who had significant weight loss on Atkins), the moment one mentions low carb in the States there will be all sorts of nonsense – is it safe? are you ‘under doctor’s care’? and so forth. Of course, sometimes that is jealousy. (If “Jane” is listening to her doctor, and trying hard to pretend that she doesn’t mind being ravenous and only losing a pound a month, it’s inevitable. As well, even someone thinner than I may fear she’ll get less adulation for watching her weight than I may get for losing nearly the weight of another entire person!)

    I think it is important to never forget that, in the US, medical care of all kinds is a huge money maker – and what easier way to make a fortune doing little than by manufacturing ‘needs’ that don’t exist? A US doctor can make a good deal just by having someone step on a scale each month to make sure he’s lost his one pound – as long as the doctor convinces the patient that such monitoring (and adherence to the mass produced diet which some are gullible enough to think was crafted for them) is essential to ‘safety.’ No one needs a nutritionist to follow Atkins – but nutritionists can earn substantial amounts convincing dieters that Atkins as it is in the book (Dr Atkins could not have known what his own diet was…) is not ‘safe,’ and clients need the rigid, dictated, ‘safe’ version a nutritionist crafts (which will not eliminate cravings or decrease hunger… so one also needs the pressure and anxiety of having to hand in food diaries…)

    Of course, doctors who recommended Atkins (assuming that any would) in the States would also need to fear that if someone developed a condition (even if it had nothing at all to do with the low carb eating), they could be sued for ‘allowing’ this ‘unhealthy’ method. It does not matter that doctors have no way to see significant, let alone long term or permanent, weight loss in their patients – they usually are looking for ‘slow regain’ or ‘regain with a higher percentage of muscle’ or some such rot. I wouldn’t imagine anyone would be sued for pushing ADA guidelines.

    Jimmy is correct, I believe – were there any long term studies of genuine Atkins, it would indeed put all other programmes to shame. And what a pleasure it is to have the one diet which addresses the problem at the source – eliminating excessive hunger and cravings. That is a blessed relief when the usual approach is “here’s a way to be constantly starved – so one needs the fear of humiliation and shame knowing one has to have ‘weigh ins’ or stupid mind games from diet clubs.”

  • http://bellyfatscience.com Dr. D

    Hey, Jimmy…I am pleased to see that you are attracting some good scientists to your site (i.e., independent thinkers). The study in question did not even come close to using the scientific method as taught by me and lots of other research scientists at schools around the country. After ranting to my wife yet again about idiocy in print (media AND scientific journals), I came back to the basic realization that the authors of this study set out to find the evidence that they wanted to find. This is very easy to do, and this is the voice of experience here. This is a shame on several levels: misleads the public, wastes time and money, gives science another black eye.

    The comments here are generally great, so I don’t want to repeat what others have already written. One thing I will add to the mathematical comment above is that the statistical confidence level of the results (P>0.2 for all comparisons) is very low. It would have not been acceptable from my graduate students, so it is disappointing to see it get past the editors of NEJM.

  • Fran McCullough

    One thing that showed up in this study that got no attention is that there was no difference between the low and high fat group in weight loss. WHAT! Isn’t that the whole premise of US diet dogma (along with calories, of course…)?

    Good point, Fran! This study had so many flaws in logic, it wasn’t even funny. I’m honored you left a comment at my blog today. :) I’d love to have you on my podcast show sometime, so e-mail me.

    –Jimmy

  • carl

    I am glad that I read this. Thanks Jimmy for another great job! I was really scratching my head over this one. This diet report agrees with the common brainwashing propaganda that is so prevalent. Of course the media loved these reported results and gave it a big push. This is just what they wanted to see, these results agree with what they already believe. No controversy here.

    From my experience with weight and glucose control, I know this calorie in/out crap isn’t true. I have friends who can eat the equivalent of a horse (a hell of a lot of calories) every day and never gain weight. I also have friends that gain weight just looking at food. Everyone has a different metabolism. So it is not as simple as just calories in minus calories burned equal weight gained.

    Low carb diets do work! I lost big weight and have kept it off for 7 years on the Atkins diet. The reason why is really simple. As Dr. Atkins said, its all about insulin. Insulin is the fat producing hormone. To produce fat you need insulin. If you control your insulin production you will control your fat production.

    Insulin is dumped into your body by the pancreas when you eat carbs, not fat! Fat does not produce an insulin response! Ingesting carbohydrates causes your blood sugar to go up which in turn caused a insulin response. I measure my blood sugar many twice a day and know this is true. I know what raises my blood sugar and what doesn’t. Glucose in the blood plus insulin causes body fat to be produced by your liver. Not the fat you eat. It really has nothing to do with calories.

  • Trinkwasser

    See Michael Eades takedown of this study

    http://www.proteinpower.com/drmike/bogus-studies/last-gasp-of-the-dark-ages-of-nutrition/

    Also see this

    http://high-fat-nutrition.blogspot.com/2009/02/cholesterol-presentation-between.html

    for a takedown of Ancel Keys: here is the quicksand on which the whole current dietary house of cards has been constructed

    Anecdotally I did this

    http://www.alt-support-diabetes.org/NewlyDiagnosed.htm

    which led me pragmatically to a diet not dissimilar to what Eades, Mark Sissons et al. describe, on around 60g carbs I am normoglycemic with spectacular lipids, the exact opposite of my outcome on the “Heart Healthy” diet, which was the only diet I have ever found that caused me to gain weight (skinny active Type 2 for genetic reasons)