Little Evidence to Support Low-Carbohydrate Diets

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    Little Evidence to Support Low-Carbohydrate Diets


    From this week's MEDSCAPE Medical News

    Little Evidence to Support Low-Carbohydrate Diets

    News Author: Laurie Barclay, MD
    Clinical Reviewer: Gary Vogin, MD
    CME Editor: Bernard M. Sklar, MD, MS



    April 8, 2003 — Low-carbohydrate diets have been all the rage lately, but a systematic review published in the April 9 issue of The Journal of the American Medical Association reveals insufficient evidence to support or refute the concept thus far. The bottom line appears to be that a calorie is a calorie. The editorialist reviews the issue of adult weight loss.

    "Recently, low-carbohydrate diets have resurged in popularity as a means of rapid weight loss, yet their long-term efficacy and safety remain poorly understood," write Dena M. Bravata, MD, MS, from the Center for Primary Care and Outcomes Research in Stamford, California, and colleagues. "Our results demonstrated the marked discordance between the knowledge needed to guide dietary choices and the information that is available in the medical literature."

    Although millions of copies of three books on low-carbohydrate diets have sold in the U.S. over the past five years, the American Dietetic Association, the American Heart Association, and other professional organizations have warned the public against potentially serious medical consequences of these diets.

    The investigators searched the literature for studies of low-carbohydrate diets published between 1966 and February 2003. They identified 107 articles reporting data on 3,268 participants, of whom 663 patients received lower-carbohydrate diets (60 grams of carbohydrates per day [g/d] or less), and 71 patients received the lowest-carbohydrate diets containing 20 g/d or less of carbohydrates, which is the recommended threshold for some of the most popular diets.

    None of the studies evaluated diets of 60 g/d or less of carbohydrates in subjects with a mean age older than 53 years, and only five studies evaluated these diets for more than 90 days. Weight loss in obese patients was associated with longer diet duration (P = .002) and restriction of calorie intake (P = .03), but not with reduced carbohydrate content. Low-carbohydrate diets had no significant adverse effects on serum lipid levels, fasting serum glucose levels, fasting serum insulin levels, or blood pressure.

    "Our quantitative synthesis...on the efficacy and safety of low-carbohydrate diets suggests that there is insufficient evidence to make recommendations for or against the use of these diets," the authors write. "We found insufficient evidence to conclude that lower-carbohydrate content is independently associated with greater weight loss compared with higher-carbohydrate content.... Given the limited evidence in this review, when lower-carbohydrate diets result in weight loss, it also is likely due to the restriction of calorie intake and longer duration rather than carbohydrate intake."

    The investigators recommend additional research evaluating the long-term effects and consequences of low-carbohydrate diets in both older and younger subjects with and without diabetes, high cholesterol, and hypertension.

    None of the authors has financial or other conflicts of interest concerning low-carbohydrate diets or diet projects. No manufacturer or vendor of dietary goods or services funded this study.

    In an accompanying editorial, George A. Bray, MD, from Louisiana State University in Baton Rouge, notes that the worldwide epidemic of obesity will be followed by a worldwide epidemic of diabetes.

    "The broader issue of whether a unique diet exists that will produce long-term weight loss has yet to be evaluated," he writes. "Although the truth of 'a calorie is a calorie' has been reaffirmed by [this review], the question of whether patients can adhere more easily to one type of diet or another remains to be answered."

    JAMA. 2003;289:1837-1850, 1853-1855



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    I love it. Even after a 6 month study done with the Atkins diet that showed more weight loss and better lipid profiles, they still say there is no evidence.

    Duke Health Briefs: Low-Carb Diet Effective In Research Study
    DURHAM, N.C. – The high-protein, low-carbohydrate diet popularized by Dr. Robert Atkins has been the subject of heated debate in medical circles for three decades. Now, preliminary research findings at Duke University Medical Center show that a low-carbohydrate diet can indeed lead to significant and sustained weight loss.

    There has recently been a resurgence of diets promoting low carbohydrate intake, but the scientific evidence supporting the safety and effectiveness of these diets is limited. This is the first published scientific study of the popular low-carbohydrate Atkins diet in two decades, and research is continuing.

    The study appears in the July 2002 issue of the American Journal of Medicine and was funded by an unrestricted grant from the Atkins Center for Complementary Medicine.

    “Study participants were put on a very low carbohydrate diet of 25 grams per day for six months,” said Eric Westman, M.D., associate professor of medicine at Duke and principal investigator of the study. “They could eat an unlimited amount of meat and eggs, as well as two cups of salad and one cup of low-carbohydrate vegetables such as broccoli and cauliflower a day.”
    Researchers found that 80 percent of the 50 enrolled patients adhered to the diet program for the duration of the study and lost an average of 10 percent of their original body weight. The average amount of weight lost per person was approximately 20 pounds.

    “While we’re impressed with the weight loss of this diet, we still are not sure about the safety of it,” Westman said. “More studies need to be done in order to be confident about the long-term safety of this type of diet.”

    For example, all participants developed ketonuria, the presence of measurable ketones in urine. The level seen in this study translates to roughly that of a non-dieting person if they didn’t eat for a couple of days, said Westman. “This is a finding that we need to learn more about. The level of ketones present was not terribly high, but we don’t know if this is safe or harmful to one’s health over a long period of time.”

    The study further showed that patients’ cholesterol levels improved by the end of six months -- a finding that was unexpected, according to Westman.

    “We were somewhat surprised to find that patients’ blood lipid profiles improved, even though there was much more fat in the diet,” he said. “We had thought the fat in the diet would increase the cholesterol.”

    Cholesterol is a fat-like substance that circulates in the blood stream and can accumulate to the point of blocking blood vessels and arteries. Having a high level of blood cholesterol is a major risk factor for heart disease, according to the National Heart Lung and Blood Institute, part of the National Institutes of Health.
    Although exercise was recommended, it was not a requirement for the study. Half of the subjects didn't exercise at all and still lost weight, according to the researchers.

    Because of the intensity of this type of diet program, Westman cautions that “if someone has a medical problem or is taking medications, they should only do this diet under the supervision of a health care provider."

    Abstract:

    Am J Med 2002 Jul;113(1):30-6 Related Articles, Books, LinkOut

    Effect of 6-month adherence to a very low carbohydrate diet program.

    Westman EC, Yancy WS, Edman JS, Tomlin KF, Perkins CE.

    Division of General Internal Medicine, Duke University, 2200 West Main Street, Durham, NC 27705, USA. ewestman~duke.edu

    To determine the effect of a 6-month very low carbohydrate diet program on body weight and other metabolic parameters. Fifty-one overweight or obese healthy volunteers who wanted to lose weight were placed on a very low carbohydrate diet (<25 g/d), with no limit on caloric intake. They also received nutritional supplementation and recommendations about exercise, and attended group meetings at a research clinic. The outcomes were body weight, body mass index, percentage of body fat (estimated by skinfold thickness), serum chemistry and lipid values, 24-hour urine measurements, and subjective adverse effects. Forty-one (80%) of the 51 subjects attended visits through 6 months. In these subjects, the mean (+/- SD) body weight decreased 10.3% +/- 5.9% (P <0.001) from baseline to 6 months (body weight reduction of 9.0 +/- 5.3 kg and body mass index reduction of 3.2 +/- 1.9 kg/m(2)). The mean percentage of body weight that was fat decreased 2.9% +/- 3.2% from baseline to 6 months (P <0.001). The mean serum bicarbonate level decreased 2 +/- 2.4 mmol/L (P <0.001) and blood urea nitrogen level increased 2 +/- 4 mg/dL (P <0.001). Serum total cholesterol level decreased 11 +/- 26 mg/dL (P = 0.006), low-density lipoprotein cholesterol level decreased 10 +/- 25 mg/dL (P = 0.01), triglyceride level decreased 56 +/- 45 mg/dL (P <0.001), high-density lipoprotein (HDL) cholesterol level increased 10 +/- 8 mg/dL (P <0.001), and the cholesterol/HDL cholesterol ratio decreased 0.9 +/- 0.6 units (P <0.001). There were no serious adverse effects , but the possibility of adverse effects in the 10 subjects who did not adhere to the program cannot be eliminated.[/b] A very low carbohydrate diet program led to sustained weight loss during a 6-month period . Further controlled research is warranted[/b]

    Your right its warranted. So I will give you more!


    Effects of a Very-Low-Carbohydrate Diet

    Program Compared With a Low-Fat, Low-

    Cholesterol, Reduced-Calorie Diet (NASSO

    Young Investigator Award Finalist)

    W. S. Yancy Jr., R. Bakst, W. Bryson, K. F. Tomlin,

    C. E. Perkins, E. C. Westman, Duke University

    Medical Center, Durham, NC

    The Effect of a High Protein Weight Loss Diet

    in Overweight Subjects With Type 2 Diabetes

    P. Clifton, M. Noakes, CSIRO, Adelaide, Australia;

    B. Parker, Department of Medicine, Adelaide

    University, Adelaide, Australia

    The Effect of Protein Intake on Bone

    Mineralisation: A Randomised Controlled 6-

    months Trial in Overweight Subjects

    A. Astrup, A. R. Skov, N. Haulrik, S. Toubro, C.

    Mølgaard, The Royal Veterinary and Agricultural

    University, Frederiksberg C., Denmark

    Low Carbohydrate Diet Reduces BMI and

    Fasting Insulin Level in Obese Children

    D. Preud'homme, A. Stolfi, Wright State University

    SOM and Children's Medical Center, Dayton, OH;

    T. Taylor, Children's Medical Center, Dayton, OH

    L. Zarzaur, C. D. Johnson, University of Tennessee,

    Memphis, TN; G. Sacks, K. A. Kudsk, University of

    Wisconsin, Madison, WI

    These represent randomized controlled trial comparing the Atkins Diet with a conventional low-fat, high-carbohydrate plan that restricted daily caloric intake to 1200-1500 kcal for women and 1500-1800 kcal for men.[10] The study included 63 obese (BMI 33.8 ± 3.4 kg/m2 ) males and females who were randomized to 1 of the 2 diets. Subjects received an initial session with a dietitian to explain the assigned diet program. At 12 weeks, the researchers found that the Atkins group had a lower rate of attrition (12%) compared with that of the conventional program (30%). In addition, subjects in the Atkins group lost significantly more weight (8.5 ± 3.7%) compared with the conventional group (3.7 ± 4.0%). In terms of serum lipids, the Atkins group demonstrated slight increases in total cholesterol (TC; 2.2 ± 16.6%) and low-density lipoprotein (LDL) cholesterol (6.6 ± 20.7%), whereas the conventional group showed significant decreases in these measures (TC -8.2 ± 11.5%; LDL -11.1 ± 19.4%). High-density lipoprotein (HDL) cholesterol significantly increased in the Atkins group (11.5 ± 20.6%) but did not change in the conventional group, whereas triglycerides showed a significant decrease for the Atkins group (-21.7 ± 27.9%) and no change in the conventional group. At 26 weeks, these changes persisted in both groups even though the sample size was smaller. The researchers concluded that the Atkins Diet produced favorable effects on weight, HDL, triglycerides, and retention compared with a conventional low-fat, low-calorie program, whereas the conventional plan was associated with more favorable effects on TC and LDL cholesterol.


    A similar randomized-controlled trial from Duke University was also presented at the conference.[11] The researchers in this study also compared the effects of a low-carbohydrate (LC) diet with a low-fat, low-calorie (LF) program. This study included 120 obese (mean BMI 34 kg/m2) males and females, who all received group treatment for their respective diet programs. At 6 months, both groups had similar rates of attrition, but the LC group lost considerably more weight (13.3 ± 4.6%) compared with the LF group (8.6 ± 5.9%). In addition, the LC group lost significantly more fat mass than the LF group (-9.7 kg for the LC group and -6.4 kg for the LF group). Both groups showed decreases in triglycerides, with the LF group also showing a significant decrease in total cholesterol (-13.5 mg/dL). The LC group showed significant increases in HDL and a significant decrease in Chol/HDL ratio. This pattern of results was similar to those of the 3-center study described above. Longer-term studies are needed to more fully evaluate the safety and efficacy of these popular diet approaches.




    But there isn't any research supporting low carb diets.
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    Why the staunch resistance? Let it go people, the diet works.
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    Not sure if Dr. Golf is disagreeing with it. He could just be posting the article for discussion purposes. Lets hope so....
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    I'm a firm believer and user of LOW CARB dieting. I just posted the article for your reading and discussing pleasure.

    After all, discussion is a GOOD thing.
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    Originally posted by Dr of Golf
    I'm a firm believer and user of LOW CARB dieting. I just posted the article for your reading and discussing pleasure.

    After all, discussion is a GOOD thing.
    Thank you sir. My point was that some in the medical community are fighting this diet tooth and nail, when they know good and goddam well that it works.
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    Originally posted by scotty2
    Thank you sir. My point was that some in the medical community are fighting this diet tooth and nail, when they know good and goddam well that it works.

    I've got the next 8 days off and I'm trying to catch up on all of my MEDSCAPE reading. Thought the above article was worth sharing. I'll probably share a few more as I come upon them. I always enjoy the wide variety of discussions that we have here. LOTS of great points of view and knowledge.
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    I actually read the JAMA article that they quoted, when my issue of JAMA came a week or two ago.....

    The JAMA article quoted numerous studies that showed that low-carb diets were effective methods of weight loss. I think they're trying to cover their asses. If the AMA just went ahead and gave the diet 100% backing and something turned out to be wrong with the diet, they'd be screwed. However, I don't blame them for trying to cover their asses because they're right when they say that there aren't any long-term studies that look at the safety rather than the efficacy of the diet.
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    Yeah but now with Atkins dead the only people that bwill be using this type of diet will be us BBers.
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    Of course some in the medical community are fighting this.(Warning: the following is quite cynical)

    If people start doing to the right things for their body and get healthy for the long term, where is the money going to come from to support hospitals, pharmaceutical giants, AMA, etc. These people depend on long-term, chronic health problems to support themselves.

    Chris Rock had it right all along The medical profession is still kicking itself over curing polio. Better to turn disease into something people can live with and they can treat for the rest of their natural lives, which is why we will never probably see a cure for stuff like AIDS. Just long-term management of the disease.
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    Wasn't Dr. Atkins on his diet for like 20+ years and experienced little effects?
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    Originally posted by Ibanez
    Wasn't Dr. Atkins on his diet for like 20+ years and experienced little effects?

    Yep, til he slipped on the ice and cracked his head.
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    Originally posted by Dr of Golf



    Yep, til he slipped on the ice and cracked his head.
    Yeah, that was pretty sad. I think I remember he had a heart infection a while ago, but they said that wasn't related to the diet.
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    Ibanez - it wasn't related to the diet....


    Sulla - I disagree. I think that because of Dr. Atkins mainstream approval, alot of other low-carb advocates are going to start stepping up from under his shadow now that he's passed away.
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    Originally posted by Sheesh
    Sulla - I disagree. I think that because of Dr. Atkins mainstream approval, alot of other low-carb advocates are going to start stepping up from under his shadow now that he's passed away.

    One of those is Dr. Bernstein and his low carb book "Dr. Bernstein's Diabetes Solution".

    Although it was written for folks with diabetes, it is very similar to Dr. Atkins way of thinking. Anyway, I found it a fairly good read.
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    This is all about money like someone mentioned. The medical community saw that Dr. Atkins' diet threatened their profits by helping people lose fat/weight, and get healthier. I WISH DOCTORS WERE PAID TO KEEP CLIENTS HEALTHY INSTEAD OF SICK AND ON MEDS FOR THE REST OF THEIR LIFE. I GUESS BIG PHARMA WISHES TO SEE US ALL SICK AND ON MEDS WHEN WE HIT 50
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    Originally posted by Iron Warrior
    I GUESS BIG PHARMA WISHES TO SEE US ALL SICK AND ON MEDS WHEN WE HIT 50

    Hey, I resemble that age, well a couple of years ago that is.

    Anyway, the only thing I take besides a few pain pills now and then are my many supplements and vitamins.

    I plan to go down swinging very, very hard when it's time.
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    Originally posted by Iron Warrior
    I WISH DOCTORS WERE PAID TO KEEP CLIENTS HEALTHY INSTEAD OF SICK AND ON MEDS FOR THE REST OF THEIR LIFE. I GUESS BIG PHARMA WISHES TO SEE US ALL SICK AND ON MEDS WHEN WE HIT 50
    I wish you knew what you were talking about. You obviously don't know many physicians on the personal level.
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    You know what bro, I did get carried away w/that doctor statement. I was just thinking about the doctor who prescribed 3 meds to my aunt for lowering cholesterol. I thought he should have first recommended diet and exercise to reduce cholesterol. I thought it was wrong of that doctor to do that, but my aunt was like "hey he's a doctor so he must know".
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    Originally posted by Iron Warrior
    You know what bro, I did get carried away w/that doctor statement. I was just thinking about the doctor who prescribed 3 meds to my aunt for lowering cholesterol. I thought he should have first recommended diet and exercise to reduce cholesterol. I thought it was wrong of that doctor to do that, but my aunt was like &quot;hey he's a doctor so he must know&quot;.

    It's exactly this kind of action by some Doctors that make me say, Where's the Beef to most of them.

    PEACE
  

  
 

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