| Media Hypes Low Carbohydrate Diet |  |
Copyright 2003 B and B Connections LLC
This past May, the news media reported two articles published in the
May 22, 2003 issue of the New England Journal of Medicine vindicated
the Atkins' diet. I found this interesting because I had just
finished reading an article in the April 9, 2003 issue of Journal of
the American Medical Association (JAMA) that reviewed 94 medical
articles and concluded the opposite.
This is nothing new. The low carbohydrate diet has always been
controversial. It is interesting to note the first publicized low
carbohydrate diet was described in 1860 by William Banting. Not to
take anything away from the late Dr. Atkins, but the low
carbohydrate diet is not exactly a "diet revolution."
I set aside the articles from JAMA and the New England Journal of
Medicine until I had time to analyze and digest them. I took a few
days off from my practice this past week and finally had time to
thoroughly go through these articles. This was very enlightening.
I would first like to discuss the conclusions of Dr. Bravata in the
JAMA article (Article link: http: //jama.ama-
assn.org/cgi/content/abstract/289/14/1837?
maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=low+carbohydrate&se
archid=1062257830734_67&stored_search=&FIRSTINDEX=0&journalcode=jama) Efficacy and Safety of Low Carbohydrate Diets, a Systemic
Approach. Dr. Bravata had a difficult time finding good medical
studies. Two thousand six hundred nineteen medical studies were
reviewed and only 94 fit the criteria for his group to analyze. What
did they find? Let me quote the article.
"We found insufficient evidence to conclude that
lower-carbohydrate
content is independently associated with greater weight loss
compared with higher-carbohydrate content. We did find, however,
that diets that restrict the calorie intake and were longer in
duration were associated with weight loss. 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."
In other words if you eat less calories over a long period of time,
you lose weight! It has nothing to do with eating less
carbohydrates. Good results come from eating fewer calories.
Did the articles in the New England Journal of Medicine tell us
anything different? In the article by Dr. Samaha titled, A Low-
Carbohydrate As Compared with a Low-fat Diet in Severe Obesity
(Article link:
http: //content.nejm.org/cgi/content/abstract/348/21/2074?
fyear=2000&tmonth=August&where=fulltext&tyear=2003&hits=20&fmonth=Aug
ust&excludeflag=TWEEK_element&sortspec=Score+desc+PUBDATE_SORTDATE+de
sc&searchterm=low+carbohydrate'"orexactfulltext=and&searchid=10622576
35225_235&FIRSTINDEX=0&journalcode=nej it was found that after
six months the low carbohydrate group lost about 13 pounds and the
low fat group lost just over 4 pounds.
Fortunately Dr. Samaha included some very interesting data to
analyze. As it turns out the low carbohydrate diet group reduced
their calorie intake from baseline more than the low fat diet group.
The difference was about 189 calories per day. If this is multiplied
by 180 days, the average low-carbohydrate dieter took in over 34,000
fewer calories than the low fat diet group. Since there are 3500
calories in a pound of stored body fat, this would be almost 10
pounds accounted for by decreased calorie intake alone.
The data also showed the low carbohydrate diet group ate about 37
percent of their daily calorie intake in carbohydrates or about 150
grams of carbohydrates per day by my calculations. This group was
instructed to eat 30 grams per day or less of carbohydrates-they
didn't even come close. Were they really following a low
carbohydrate diet or just a lower calorie diet?
The second New England Journal of Medicine article by Dr. Foster
titled, A Randomized Trial of a Low Carbohydrate Diet for Obesity
(Article link:
http: //content.nejm.org/cgi/content/abstract/348/21/2082?
fyear=2000&tmonth=August&where=fulltext&tyear=2003&hits=20&fmonth=Aug
ust&excludeflag=TWEEK_element&sortspec=Score+desc+PUBDATE_SORTDATE+de
sc&searchterm=low+carbohydrate'"orexactfulltext=and&searchid=10622576
35225_235&FIRSTINDEX=0&journalcode=nej took a slightly different
approach. This study tried to be more like the real world in that
the low carbohydrate participants received initial information from
a registered dietitian and were given a copy of Dr. Atkins' New
Diet
Revolution. The control group received conventional education about
a low fat, lower calorie diet from a dietitian and a copy of The
Learn Program for Weight Management. Very little diet information
was given afterwards.
At the end of six months the low-carbohydrate diet group lost an
average of 7 pounds and the conventional diet group lost 3.2 pounds.
After 12 months the low-carbohydrate dieters had lost 4.4 lbs. and
the conventional dieters had lost an average of 2.5 lbs. The
difference after a year was not considered to be significant enough
to be attributed to diet alone.
I believe it is a stretch to say that these two studies vindicate
the benefits of a low-carbohydrate diet vs. simple portion control.
On the good side, there was no detrimental effect on cholesterol and
triglycerides when on a low-carbohydrate diet.
A low-carbohydrate diet is not for everyone. I know many people who
swear by this plan and if it works for them I think it's great. I
believe it is a very difficult eating style to maintain over a
lifetime. I enjoy eating fruits and vegetables too much to
drastically restrict my carbohydrate intake. However, I try to
follow the Mediterranean Diet guidelines by eating whole-grain
breads and cereals along with fruits and vegetables.
For more information on how to lose weight without using fad diets I
suggest you read my book "Thick to Thin, Seven Secrets to Permanent
Weight Loss" available at www.askdoctorsam.com/thick2thin.html.
Sam Breeding M.D.
Sam Breeding M.D., board certified (American Board of Family
Practice, American Board of Preventative Medicine), practicing
physican and author, is "Dr Sam" of the popular and informative
AskDoctorSam newsletter. He is author of a series of special reports
and an ebook that provide hope to those who struggle with
controlling their weight. All of Doctor Sam's educational materials
are available thorough his website at http://www.askdoctorsam.com.
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