The most recent Duke study on Atkins
 

New Study: Low-Carb Diet More Effective Than Low-Fat Diet (+better for blood lipids!)
 

http://healthorbit.ca/NewsDetail.as...nltid=119170504

DURHAM, N.C. -- People who followed a low-carbohydrate, high-protein diet lost more weight than people on a low-fat, low-cholesterol, low-calorie diet during a six-month comparison study at Duke University Medical Center. However, the researchers caution that people with medical conditions such as diabetes and high blood pressure should not start the diet without close medical supervision.

Folks, of all the studies I have seen, this is by far the most complete and most definite: 120 subjects, well designed in that both groups had continuing support, and shows a huge difference in not just weight loss, but also a better drop out rate and better lipid profile

Interesting, thanks.

Growing up during the 80s and 90s--the apogee of the low fat & high carb era--when it was universally accepted without doubt that limiting fats were to cure to all diseases, sickness, obesity, and would lead us all to the elusive higher level of enlightenment. During the era, if anyone even dared to question the low fat efficacy was immediately scorned. Admittedly, when I started Atkins over a year ago, I was highly skeptical that it would work as advertised. I assumed it was a gimick, which even if effective would eventually lead to heart disease, high blood pressure, turn my blood into goo, and whatever other maladie might befall me. The ONLY reason I tried it was simply the concept of eating low carbs appealed to my palates--in other words, I like meat and fat foods while naturally disliking...well...veggies and foods with little fat, like breads, grains, and all those other low fat touted foods.

Imagine my utter shock when it not only worked as advertised, but also have my Dr. raving about my lab numbers (here is when it gets amusing, she assumed I was on a low fat diet, which I never bothered to correct her on until later). For most of us, I'd imagine the experience to be similar and equally powerful. We all know this works--we're our own living proof. We're in better shape, have more energy (yes, even for vigorous cardio like running 8 - 10 mph for pro-longed distances) disputing that rubbish about carbs are the ONLY source suitable for high intensity cardio (fat works fine), and we're healthy even by "their" measures. After a year or two, can there be dispute that it works? Not to us, but to the individual dissenter, do they not notice the obvious? Every new scientific study lends credence to the merits of eating a low carb regimen. Do they just ignore that? How long will rhetorical dogma stand in the face of science?

I've always felt that if something is true for a period of time, then studies over a longer period of time will only lend even more credibility to the veracity of it's results. This is what I believe we're seeing, and will continue to see. Are any of us even remotely surprised that new unbiased scientific studies favor the low carb approach over low-fat one? Ironic what's happened to my views where in a year, eating low-fat seems so unnatural to while low-carb is absolutely instinctive.

New science will only proove what we all already know and live everyday.

Now, if they can just--for a moment--stop with this "eating whole grains" rubbish, I'd almost be content.

Frederick

Science is slow, and especially medicine has a lot of unproving folk beliefs that are so strongly helt that it takes a revolution to topple them. I am not surprised about the results but what amazes me is that such studies should have been done right when Atkins came out 20 years ago, and nobody did until now - and these aren't hard studies where you have to wait 20 years for lethality - these studies can be done easily in a year. Why they waited so long is beyond me. Someothing similar happened with acupuncture - hundreds of years of experience in China didn't prevent the establishment from stating categorically it is nonsense - only very recently were studies initiated that tested it, and hallo, it works..

Me too! I've been living for almost 2 1/2 years without grains and I'm doing just fine, thank you very much. And I've never been healthier.

FYI: This is the full text of Walter Willett's editorial on this study. It's kinda hard to track down on the Internet so I thought I'd include it here.

For decades, nutritionists and dietitians have disparaged the very-low-carbohydrate Atkins diet because it is high in saturated fat and because its purported benefits had not been tested in formal studies. According to the conventional wisdom, a diet low in fat and high in starch reduces the risks for heart disease and cancer and promotes weight loss. However, these claims do not have solid evidence to support them. In large prospective studies, total fat intake does not predict cancer risk (1). In addition, dietary fat per se does not predict the risk for coronary heart disease in ecologic and prospective studies or clinical trials (2, 3); however, intake of specific fatty acids is important. Moreover, high-carbohydrate diets, which reduce high-density lipoprotein (HDL) cholesterol and raise triglyceride levels, exacerbate the metabolic manifestations of the insulin resistance syndrome (4). The primary remaining justification for high-starch diets has been weight control, but even this rationale is on shaky ground (5, 6). Meta-analyses of studies that mostly lasted 6 months or less suggest a small benefit for low-fat diets (typically 20% to 25% of energy) compared with moderate-fat diets (usually 35% to 40% of energy) (5). However, patients on low-fat diets typically regain lost weight. Two meta-analyses of studies lasting 1 year or more found no sustained reduction in weight; the weighted mean difference in weight change (low-fat diet group minus control group) was -0.25 kg in one analysis (7) and +3.7 kg in another (8), even though the low-fat groups had more intensive interventions, which would create bias in their favor.

Recently, 4 randomized trials in adults have compared very-low-carbohydrate diets with low-fat diets (9-12). This issue contains 2 of these studies: the 6-month study by Yancy and colleagues (11) and the 12-month report by Stern and colleagues (12); the latter is an update of a report of weight loss after 6 months (13). Although the trials differed in the target population, study design, and intensity of intervention, all 4 studies found that weight loss at 6 months was 4 to 6 kg greater in the low-carbohydrate group than in the low-fat group. In the 2 studies that lasted for 1 year, the differences in weight loss had narrowed to 2 kg by 1 year and were no longer statistically significant. In the report by Foster and colleagues (10), this convergence occurred because the low-carbohydrate group regained weight. In the study by Stern and colleagues (12), the low-carbohydrate group maintained the weight loss seen at 6 months, whereas the low-fat group continued to lose weight.

The low-carbohydrate diet had similar effects on blood lipid levels in the 4 studies. The low-carbohydrate, high-fat diets minimally changed low-density lipoprotein (LDL) cholesterol levels, slightly increased HDL cholesterol levels, and markedly decreased fasting triglyceride levels. The changes in HDL cholesterol and triglyceride levels are consistent with the known effects of reducing carbohydrate intake and body fat. The small effects on total and LDL cholesterol probably result in part from greater weight loss, which reduces total and LDL cholesterol levels, thereby offsetting the effects of a higher intake of saturated fat. Although the low-carbohydrate diet had little effect on weight loss by the end of the two 12-month studies, its favorable effects on triglyceride and HDL cholesterol levels persisted. Thus, despite earlier concerns, the low-carbohydrate diets did not, on average, harm blood lipid levels. The dropout rates have tended to be higher for persons on the low-fat diet; this finding is important because the value of any diet depends on the degree to which patients adhere to it over time.

We can no longer dismiss very-low-carbohydrate diets. The findings raise important questions, foremost being the long-term effect on weight. Almost any diet can lead to weight loss over 6 months, but most individuals regain weight. The earlier experience with low-fat diets and now the diminished effects of low-carbohydrate diets at 12 months emphasize the need for additional randomized trials that last for longer than 1 year and that monitor weight and lipid profile. Such studies should compare various levels of fat, different forms of carbohydrate, and combinations with physical activity programs. More intensive re-enforcement of the dietary interventions is another strategy; whether it will lead to sustained differences in weight requires further research.

If low-carbohydrate diets are effective, what pathophysiologic mechanisms would be responsible? One underlying hypothesis is that a high dietary glycemic load (the contribution to blood glucose of all foods consumed in a meal) increases the difficulty of weight control because the high intake of refined starches and sugars causes rapid swings in blood insulin and glucose levels; these, in turn, stimulate hunger between meals and lead to more snacking. This mechanism has support (14). Some have dismissed low-carbohydrate diets because participants have reported lower caloric intake, even though the diet does not specifically restrict calories. However, this criticism is hardly valid because a diet that facilitates lower caloric intake is the key to sustained weight loss. Whether the mild ketosis that occurs with severe carbohydrate restriction contributes to weight loss is unclear; notably, only half of the participants in the study by Yancy and colleagues remained ketotic during the follow-up, and even fewer did so in the less intensive study by Samaha and colleagues (13). Ketosis may simply be part of a beneficial continuum of carbohydrate restriction. Alternatively, perhaps monitoring for ketosis may be an effective feedback mechanism for maintaining dietary adherence. Some have suggested that food energy is used less efficiently during ketosis, but as Yancy and colleagues point out, testing this hypothesis will require monitoring and much more precise measures of intake and energy expenditure.

How can we maximize the health-enhancing effects of the Atkins diet? Dr. Atkins deserves credit for his observations that many persons can control their weight by greatly reducing carbohydrate intake and for his funding of trials by independent investigators. Nevertheless, advocating unlimited servings of beef, sausage, and butter would not serve our overweight patients well. Other dietary strategies, such as replacing saturated fat with a combination of monounsaturated or polyunsaturated fats, will reduce LDL cholesterol levels, platelet aggregation, endothelial dysfunction, and insulin resistance (15). In addition, considerable evidence suggests that replacing red and processed meats with a combination of fish, nuts, legumes, and poultry would reduce the risks for colon cancer, prostate cancer, diabetes, and heart disease, even if total fat remains high. Also, eating several servings of whole grains high in fiber per day, which is possible while maintaining a relatively low total carbohydrate intake, has consistently been associated with lower risks for type 2 diabetes and coronary heart disease. Replacing refined carbohydrates with whole grains, vegetables, and some fruits such as apples will also reduce the spikes of glucose and insulin that provoke hunger and will provide additional micronutrients and fiber. In his last book, Atkins (16), too, had shifted considerably toward this healthier version of a low-carbohydrate diet.

In the context of these studies of the low-carbohydrate diet, what advice can we offer our patients who want to lose weight? Responses to weight loss interventions typically vary widely; for example, some persons in both groups of the study by Yancy and colleagues lost more than 20 kg, some had modest weight changes, and others lost nothing. These differences are probably due to a combination of genetic, environmental, and psychosocial factors. As an example of a genetic influence, the relation between specific types of dietary fat and body weight appears to depend on a specific polymorphism in the peroxisome proliferator-activated receptor-gamma gene (17). One implication of the large variation in response to diet is that the mean values from randomized trials apply to few individuals and that 'n of 1' experiments with specific diets are valid for any patient. Thus, we can encourage overweight patients to experiment with various methods for weight control, including reduced-carbohydrate diets, as long as they emphasize healthy sources of fat and protein and incorporate regular physical activity. Patients should focus on finding ways to eat that they can maintain indefinitely rather than seeking diets that promote rapid weight loss. For many patients, the roll will have little role.

- Walter C. Willett, MD, DrPH Harvard School of Public Health; Boston, MA 02115


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12. Stern L, Iqbal N, Seshadri P, Chicano KL, Daily DA, McGrory J, et al. The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: one-year follow-up of a randomized trial. Ann Intern Med. 2004;140:778-85. PubMed

13. Samaha FF, Iqbal N, Seshadri P, Chicano KL, Daily DA, McGrory J, et al. A low-carbohydrate as compared with a low-fat diet in severe obesity. N Engl J Med. 2003;348:2074-81. [PMID: 12761364] PubMed

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17. Memisoglu A, Hu FB, Hankinson SE, Manson JE, De Vivo I, Willett WC, et al. Interaction between a peroxisome proliferator-activated receptor gamma gene polymorphism and dietary fat intake in relation to body mass. Hum Mol Genet. 2003;12:2923-9. [PMID: 14506127] PubMed

Interesting. Consider Willett's statement and recommended diet. First he praises very low carb diet and goes to to recommened a diet thats pretty high in carb and low in saturated fat. Read this quote I got from another post called Insulin and chronic diseases