High Fat Low Fat
Earlier this summer an article in the Wall Street Journal, “What if it’s been a Big Fat Lie”, seemingly presented the Atkins’ diet as a plausible solution to obesity. Nobody can argue that thousands of individuals have lost weight on the Atkins’ diet. However to extol the virtues of a diet whose origins predate it by perhaps 10-20 years or more seems to provide the wrong message of health.

As with any diet, one can say, they all work. That is, until one gets bored with it or weight loss slows to a snail’s pace. It is important to view all variables before arriving at any conclusions, especially with diets. Many believe that weight loss is basically a numbers game; calorie expenditure must be greater than calorie intake. In a “closed environment” with all variables controlled, we can argue the simplicity of calorie balance. Unfortunately (or fortunately) the world we live in is not a closed environment.

There are many points of discussion brought up in the article that can be argued. Rather, let’s take a closer look at a number of important points with relevance to scientific studies, weight change and the “health” component of diets. Most important is to consider what are the variables at work in these studies, the diets themselves and their overall impact.

1. Do people lose weight on the Atkins’ diet? Of course they lose weight. But do they maintain the weight that is lost? Has there been a well-controlled study equating the Atkins’ diet to long-term weight loss? If so, where is it? Ask anyone who has ever dieted, weight loss is not the hard part, maintenance is. Do we want to continue to send signals out that it’s all right to diet? Additionally, what is lost? Fat, water, muscle? Most of the weight lost, initially is water. Over the long run, if certain nutrients are not included in the diet and exercise is not a component of the weight loss regime, large amounts of muscle can be lost.
2. Common sense suggests that a high fat (and to some extent a high protein diet) promotes cardio-vascular disease and cancer, our two biggest killers. Atkins claims that his diet does not contribute to disease. Perhaps in those that lost weight, but what about the thousands that didn’t as well as those who gained the weight back. The development of most diseases occurs over a long period of time. A study looking at the health effects of the diet only, irrespective of weight change has never been done. Besides, it would cost million of dollars. Atkins, who has been treated for heart disease recently, claims diet was not a factor in his case. Very strong statement and difficult to prove or disprove. In fact, Mr. Taubes conveys that saturated fats (even lard) many actually be benign!
3. In the article a large finger is pointed at those who promoted the low-fat dietary lifestyle, which began in the 80’s. Obviously it is politically correct to blame someone, as we can no longer take responsibility for our own health. Yes, many practitioners promoted a high carbohydrate intake. It is also likely that there were those who suggested unlimited carbohydrate intake. If so, we can agree that many individuals were misled. In all probability, many of the people who accepted this particular eating style were looking for the green light to eat their favorite foods anyway, just like there are those who are happy to eat as many high-fat/high-protein foods as the Atkins diet recommends. Are we to now believe that those cultures that have eaten primarily low-fat, carbohydrate dominant diets are doing it all wrong? The major point is that there is a world of difference between a carbohydrate dominant diet and a high or unlimited carbohydrate diet. Rice, pasta, potatoes and white flours are the evils to be avoided at all costs. I for one would like to see the data on consumption of these unrefined starches in isolation. Should we ignore the oils, sauces and toppings usually used in cooking or “flavoring” these foods?
4. Is the Atkins’ diet novel? Athletes and bodybuilders have used high fat/high protein/low carbohydrate diet to lose weight for decades often with success. It is important to note that in the world of athletics this type of eating was considered the “final touch” and a temporary program to get in “extremely lean” condition. Additionally, high levels of other nutrients (and perhaps drugs) as well as significant amounts of exercise were used to reap the results. However, which of these variables were responsible for the fat loss? Was it the high fat intake? Was it the exercise? Perhaps it was a combination of exercise and drugs...
5. It seems that there are two main camps, democrats and republicans. Even in the arena of diets we have a political division, high fat/low carbohydrate or high carbohydrate/low fat. With in each camp there is the left and the right as well. What happened to a diet of natural high fiber foods like fresh fruits, vegetables, legumes and whole grains with moderate amounts of protein and sufficient “healthy” (essential fatty acids). Too simple perhaps. Not glamorous? Too “small party”? Doesn’t allow for excessive amounts of our favorite foods? Dr. Atkins’ diet can be “heaven sent” for those looking for a reason to dine (or indulge) in animal foods.
6. Meal plans that promote fruits, vegetables, whole grains, beans, low fat proteins with moderation of fats, alcohol, and on occasional fast and junk food are global recommendations. Where are these mentioned in the article? Does the diet industry perpetuate the obesity dilemma?
7. Do people lose weight on the low fat diet? The article states that collectively, we have gained weight from the high carbohydrate trend. Statistics show that over the last 10 years average calorie intake has increased by 170 +/- calories, with a majority coming from carbohydrates. Actually, we are eating larger portions of refined carbohydrates and sugars (mostly from corn syrup). We are also eating more baked snacks (chips) and cheese (last time I looked both of these foods were high in fat). Mr. Taubes writes that the low fat diet has failed. Failed what? Are there no individuals who have improved their health and well being by following low fat or at least a decreased fat intake?
8. Carbohydrates make us fat! One might interpret some of the data as suggesting this. Gary Taubes would have us believe that millions of people were not successful on the low-fat/high-carbohydrate plan. Glycemic index, insulin response and ketones are all discussed as well as each one’s role in weight management. Again, it is difficult to separate variables out where the human body is concerned.
9. In order for fat loss (not just weight loss) to occur, exercise must be performed. The energy for muscle contraction comes from ATP, which is generated from glucose. Although all foods can be converted to glucose, the body prefers it come from carbohydrates. In the absence of glucose, muscle physiology can be impaired. In order for the maintenance of normal blood glucose levels, the body will often degrade it’s own muscle (from protein to glucose). Lastly, even at rest our brain’s main source of energy is glucose.
10. If we look at anthropological data, unlimited fat and protein, in conjunction with low carbohydrate intake, has never been a “natural” form of eating for humans. Mr. Taubes ignores a simple fact that humans have an inborn desire for variety (as well as a drive for sweets and fats). Eating the same types of foods eventually becomes monotonous. Carbohydrates, in many forms are found everywhere in our environment and provided unlimited temptations for all except the extremely strong-willed.

It is only fair that one mention’s the potential for the diet to provide successful outcomes. For many individuals a high fat/high protein intake satisfies many desires and cravings. Sufficient protein is especially important for the conservation of muscle tissue. It could also be argued that those on the Atkins’ diet eventually consume fewer calories. This may be due to high satiety value or a stable appetite due to enhanced blood glucose control. Hormones and neurotransmitters responsible for appetite control and body fat utilization may be favorably enhanced on the Atkins’.

Would a modified approach to the Atkins’ diet allow for a more “balanced” approach to eating? Perhaps. First, focusing on low calorie, high fiber vegetables would still be in line with the low carbohydrate parameters. Secondly, until it is proven otherwise, the majority of fats should come from nuts, seeds, olives and avocados, not animal products. Lastly, portions are still a factor, especially when the source of calories is high in fat and/or protein. Unlimited food reinforces poor eating behaviors.

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So You Want to Lose Weight?
This is the first in an ongoing series of articles designed to provide suggestions on enhance your diet, improve your health and assist with weight management. Our main goals are:

1. Improve your relationship with food
2. Separate fact from fiction
3. Develop a personal eating plan to last a lifetime

A good place to start would be a brief history of diets. The low calorie eating style was born out of 2 ideas in the late 1800’s.

1. The upper class wanted to differentiate themselves from the lower and middle class (who, due to the industrial age, could now afford to eat better and perhaps “get plump” and appear more “affluent”
2. A number of European poets/writers were “sickly thin”, which was viewed as refinement (in actuality, many of these individuals had tuberculosis).

Extreme methods were also popular back then. In fact, it was not uncommon for people to consume tapeworms, which would eventually lead to calorie deficits.

Kellogg (of Kellogg cereal fame) opened up a health clinic that added chopped thyroid to their diet products, which at the time seemed quite novel. The use of desiccated thyroid or thyroid extract is still in use today. The safety and efficacy however, has never been proven.

In 1878, William Banting, a casket maker decreased starches in his diet and found he was able to reduce his size so he could “test out” the caskets he built for his customers. He had discovered a simple method of weight reduction, which is still popular today.

In the early 1900’s, calorie contents of foods were beginning to be measured. Calorie levels of food can provide quantitative data on one’s intake and help determine levels necessary for weight loss to occur at predetermined rates. Are calorie readings on food accurate? Perhaps, unfortunately most people underestimate portions by ~ 25%.

In the 1950’s high protein diets receive plenty of attention and the birth of “Yo-Yo” dieting begins. In 1966, Dr. Atkins launches his high protein/low carbohydrate (which is also high in fat) regime, which is still followed by thousands of individuals. Although many diets or weight loss programs seem new or “current”, most are just recycled every 10 to 20 years.

Current research provides some interesting data that may change our view(s) about weight management. Very possibly we will be concentrating our efforts on building or maintain lean body mass, rather than on losing body weight. More importantly is that too many people focus on losing weight when they really should be focusing on losing body fat.

We know that most diets, if too low in calories, protein and/or carbohydrates work only as long as you are on them. The main problems with diets are:

• Potential deficiencies in essential nutrients
• Decreased resting metabolic rate
• Decrease in muscle glycogen, which leads to a decrease in exercise performance
• Decrease in lean body mass (LBM)
• Tendency towards extremes such as binging and severe calorie restriction
• Mental, psychological and social problems

Aside from the mental and physical health issues, there are two key areas, which must be addressed if permanent body fat loss is to occur:

1. The establishment of lifetime eating habits
2. The maintenance or increase of muscle mass (muscle mass isn’t always replenished via re-feeding).

If we compare 3 modes of weight reductions, the role of muscle mass becomes clear. In groups that diet only, significant amounts of LBM are lost. Muscle as well as fat is cannibalized for energy. One study showed that for every 22 lbs lost, 3.74 lbs of that weight was muscle or LBM. It is important to keep in mind that for every pound of muscle lost, your resting metabolic rate can decrease by 30-50 calories! Additionally, in diet only groups, fat breakdown and oxidation tend to decline over time. In groups that dieted and performed aerobics weight loss occurs, but there is still varying amounts LBM lost. As a comparison, in groups that use aerobics only, some individuals can lose up to 3 lbs of muscle mass in 12 wks and up to 6.6 lbs in 30 weeks. It is important to keep in mind that aerobics activity is extremely important to improve cardio-vascular health and can assist with weight loss. It’s just that we may need to modify the time and intensity of activity if the goal is to improve body composition. Finally, we learn that in groups that added resistance exercise to their diet programs, little if any LBM is lost. In fact, many people gained small amounts of LBM. Remember that for every pound of muscle gained, your metabolism increases. Even a small gain in muscle of 3lbs, for some, could mean drinking an extra glass of wine or an extra 3⁄4 cup of pasta consumed would not result in any weight gain!

In the coming months we will be providing articles of health and weight management meant to help you design your own eating plan and assist in making sense of the media overload out there. In conclusion, diets are not new. They are rarely the solution by themselves. One must develop habits to last a lifetime. And lastly, we need to take another look at our exercise programs. The key is personalization. There is no one plan for everyone.

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