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 firstname.lastname@example.org.
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.”