NY Times Article - Which Diet Works Best?

[Portia]

Which Diet Works?
By MARK BITTMAN


Mark Bittman on food and all things related.
TAGS:

CARBOHYDRATES, DIETS, NUTRITION, WEIGHT LOSS
One of the challenges of arguing that hyperprocessed carbohydrates are largely responsible for the obesity pandemic (“epidemic” is no longer a strong enough word, say many experts) is the notion that “a calorie is a calorie.”

Accept that, and you buy into the contention that consuming 100 calories’ worth of sugar water (like Coke or Gatorade), white bread or French fries is the same as eating 100 calories of broccoli or beans. And Big Food — which has little interest in selling broccoli or beans — would have you believe that if you expend enough energy to work off those 100 calories, it simply doesn’t matter.

There’s an increasing body of evidence, however, that calories from highly processed carbohydrates like white flour (and of course sugar) provide calories that the body treats differently, spiking both blood sugar and insulin and causing us to retain fat instead of burning it off.

In other words, all calories are not alike.

You might need a little background here: To differentiate “bad” carbs from “good,” scientists use the term “glycemic index” (or “load”) to express the effect of the carbs on blood sugar. High glycemic diets cause problems by dramatically increasing blood sugar and insulin after meals; low glycemic diets don’t. Highly processed carbohydrates (even highly processed whole grains, like instant oatmeal and fluffy whole-grain breads) tend to make for higher glycemic diets; less processed grains, fruits, non-starchy vegetables, legumes and nuts — along with fat and protein — make for a lower glycemic diet.

A new study published Tuesday in the Journal of the American Medical Association adds powerfully to the notion that low glycemic diets are the way forward. (Or, actually, backward, since the low glycemic diet is largely traditional.) The work took place at the New Balance Foundation Obesity Prevention Center of Boston Children’s Hospital, and looked at people’s ability to maintain weight loss, which is far more difficult than losing weight. (Few people maintain even a small portion of their weight loss after dieting.) To do this, the researchers — led by the center’s associate director Cara Ebbeling and director David Ludwig — put three groups of people on diets to lose 10 to 15 percent of their body weight.

They then assigned each of the dieters, in random order, to follow four weeks each of three diets with the same number of calories. One was a standard low-fat diet: 60 percent carbohydrates — with an emphasis on fruits, vegetables and whole grains (but not unprocessed ones) — 20 percent from protein and 20 percent from fat. This is the low-fat diet that has been reigning “wisdom” for the last 30 years or more.

Another was an ultra-low-carb diet (for convenience, we’ll call this “Atkins”), of 10 percent of calories from carbs, 60 percent from fat and 30 percent from protein. And the third was a low glycemic diet, with 40 percent carbs — minimally processed grains, fruit, vegetables and legumes — 40 percent fat and 20 percent protein.

The results were impressive. Those on the “Atkins” diet burned 350 calories more per day — the equivalent of an hour of moderate exercise — than those on the standard low-fat diet. Those on the low-glycemic diet burned 150 calories more, roughly equivalent to an hour of light exercise.

Three conclusions you can draw on the face of this: One is that the kind of calories you eat does matter. Two, as Ludwig concludes, is that “the low-fat diet that has been the primary approach for more than a generation is actually the worst for most outcomes, with the worst effects on insulin resistance, triglycerides and HDL, or good cholesterol.” And three, we should all be eating an “Atkins” diet.

But not so fast; the “Atkins” diet also had marked problems. It raised levels of CRP (c-reactive protein), which is a measure of chronic inflammation, and cortisol, a hormone that mediates stress. “Both of these,” says Ludwig, “are tightly linked to long term-heart risk and mortality.”

His conclusion, then? “The ‘Atkins’ diet gives you the biggest metabolic benefit initially, but there are long-term downsides, and in practice, people have trouble sticking to low-carb diets. Over the long term, the low-glycemic diet appears to work the best, because you don’t have to eliminate an entire class of nutrients, which our research suggests is not only hard from a psychological perspective but may be wrong from a biological perspective.”

Almost every diet, from the radical no-carb-at-all notions to the tame (and sane) “Healthy Eating Plate” from Harvard, agrees on at least this notion: reduce, or even come close to eliminating, the amount of hyper-processed carbohydrates in your diet, because, quite simply, they’re bad for you. And if you look at statistics, at least a quarter of our calories come from added sugars (seven percent from beverages alone), white flour, white rice, white pasta … are you seeing a pattern here? (Oh, and white potatoes. And beer.)

So what’s Ludwig’s overall advice? “It’s time to reacquaint ourselves with minimally processed carbs. If you take three servings of refined carbohydrates and substitute one of fruit, one of beans and one of nuts, you could eliminate 50 percent of diet-related disease in the United States. These relatively modest changes can provide great benefit.”

The message is pretty simple: unprocessed foods give you a better chance of idealizing your weight — and your health. Because all calories are not created equal.

[WillBeSkinnyMom]

Is this the Ludwig from the Bitter Truth video??

[clackley]

Originally Posted by WillBeSkinnyMom

Is this the Ludwig from the Bitter Truth video??

No, not the same man.

The report gets a FAIL in my mind for a variety of reasons but the overall message is at least better than the low fat - cut calories dogma that is so prevelant.

[MrsMcDade]

informative thank you

[SlowMovingWoman]

Which diet works best? The one you are able to stay on long term, the rest of your
life. For some that will be Atkins starting out very low carbs and progressing to
still a pretty low number. For some a moderate low carb will be best. I think what
can be agreed on is elimating processed foods, sugars, and eating low amounts
of starches that are whole grain. ABC reported on this same diet study on their
nightly news last night.

[HappyHappyJoyJoy]

Originally Posted by SlowMovingWoman

Which diet works best? The one you are able to stay on long term, the rest of your
life.

That's the truth!!

[juliekaboolie]

This report still hints at the 'whole grain' fallacy, and I just don't buy it. Nobody will ever say a diet that has no processed foods is bad. I guess the key would be to not make it all about fruit and tubers and honey, then.

[picklepete]

A lot of LC plans indicate 50-75g for maintenance ya? That's quite a generous allowance of vegetables, fruits, tubers, and legumes so I don't see where the "entire class of nutrients" is being eliminated. True, 50-75g doesn't stretch very far with pasta and cereal but most of the world survives without them.

I'm always puzzled by the thick line people draw between white bread and brown bread too. Have they looked at the ingredients? The 100% whole wheat brands use at least as much corn syrup and soybean oil as the white. I don't remember my grandmother baking with those.

[~PaperMoon~]

Very interesting article, thanks for posting.

Originally Posted by SlowMovingWoman

Which diet works best? The one you are able to stay on long term, the rest of your
life. For some that will be Atkins starting out very low carbs and progressing to
still a pretty low number. For some a moderate low carb will be best. I think what
can be agreed on is elimating processed foods, sugars, and eating low amounts
of starches that are whole grain. ABC reported on this same diet study on their
nightly news last night.

Exactly!

[gladee88er]

I agree with this. Ultra low carb is very effective at taking the weight off, but if you have a high energy demand job, and / or exercise a lot, adding an apple and some oatmeal for instance during the day definitely helps with energy and performance. At least with me, the difference is noticable.

Now that my weight and bodyfat is near normal, I like to add a few higher carb days in here and there. Not "treats" that might get me binging again, but good, low-glycemic sources. Some people though have problems with carbs like alcoholics have with booze, so those people may tend to disagree with me.

[stellarexplorer]

I agree with you glade. I like low carb a lot, but now that I'm at a good weight, I no longer want to tolerate the decreased exercise performance I experience. I've been close to 100% under 20 gm/day carbs since March, and my tennis and cycling have suffered. Great benefits, no doubt: my labs which were not right are all completely normal now, and I feel great. I'm adding fruit now, and it helps a lot. I tried a banana and it helps more than an apple, I'd have to say, but I'm not wanting to add bananas too often yet. But I don't want to lose a tennis match because I dogmatically ate broccoli instead.

[steady]

Originally Posted by stellarexplorer

I agree with you glade. I like low carb a lot, but now that I'm at a good weight, I no longer want to tolerate the decreased exercise performance I experience. I've been close to 100% under 20 gm/day carbs since March, and my tennis and cycling have suffered. Great benefits, no doubt: my labs which were not right are all completely normal now, and I feel great. I'm adding fruit now, and it helps a lot. I tried a banana and it helps more than an apple, I'd have to say, but I'm not wanting to add bananas too often yet. But I don't want to lose a tennis match because I dogmatically ate broccoli instead.

Stellar I need a like button for this. A weightloss diet has a purpose, but we need to also add balance if we want to live life well. After a while, losing another pound is not nearly as exciting as winning a match.

[stellarexplorer]

[mainemom]

Originally Posted by juliekaboolie

This report still hints at the 'whole grain' fallacy, and I just don't buy it. Nobody will ever say a diet that has no processed foods is bad. I guess the key would be to not make it all about fruit and tubers and honey, then.

AGREED!

[Books and Cats]

I partially agree with the article.

I like the idea of adding in low glycemic carbs at or near goal if they come from fruit or starchy veggies and if this is done in a moderate way. However, I don't think carbs, even the healthier ones mentioned above will ever be 40% of my diet like the article suggests. I also think there are some people who have such big issues with glucose / insulin that they may not be able to do this easily.

I do appreciate that this article isn't too fat phobic either. It states that an Atkins style diet is good for weight loss (even if the author prefers using it short-term only) and the low glycemic diet they recommend is 40% fat which is a great number compared to many of the low fat diets that have been pushed over and over for the last 30 or so years. I remember reading about diets in the 80s and 90s where you were supposed to limit fat to crazy amounts like 10% of your diet!

[drjlocarb]

Originally Posted by Portia

But not so fast; the “Atkins” diet also had marked problems. It raised levels of CRP (c-reactive protein), which is a measure of chronic inflammation, and cortisol, a hormone that mediates stress. “Both of these,” says Ludwig, “are tightly linked to long term-heart risk and mortality.”

This part is wrong.

The LC diet did NOT raise these markers, it lowered these markers, just not quite as much as the LG diet.

[picklepete]

Originally Posted by Books and Cats

I remember reading about diets in the 80s and 90s where you were supposed to limit fat to crazy amounts like 10% of your diet!

Yup, I clearly remember my mom reacting to talk show guests in 1985 about how the avocado is a "heart attack on a tree" and whole milk will shave decades off our lives.

I respect scientists greatly, but sometimes it's a little too easy for them to correlate X and Y and blind themselves to millennia of actual history. No culture anywhere discarded the skin from their chickens, and there's a reason most wild predators eat the liver and belly fat first.

[LiterateGriffin]

Originally Posted by picklepete

I'm always puzzled by the thick line people draw between white bread and brown bread too. Have they looked at the ingredients? The 100% whole wheat brands use at least as much corn syrup and soybean oil as the white. I don't remember my grandmother baking with those.

Well, there is brown bread in my house, because my children would die without sandwiches. (Just ask them.)

And while I DO use wheat flour, you'd love my ingredient-list.

Let's just say that even though I'm a strict Atkins girl myself, I took his ACTUAL MESSAGE to heart enough to quit buying factory bread, and invest in a 50 lb bag of whole wheat flour and some yeast!


Let's face it, people: Atkins = bacon in too many people's brains. They think we don't eat fiber... Cuz, you know, my homemade cole slaw has no fiber.

[SassieladyAZ]

I too read this article. After initially losing nearly 30 lbs doing mainly lowcarb (though jump-started with medifast) I can no longer seem to "stick" with it. I am up 10 lbs from my lowest weight and after 3-5 days back on LC I cave in and eat something that spirals me into a week long binge so to speak. I need to find a solution. I bought some brown rice today, and some dreamfields pasta in hopes of trying to add this in in small amounts along with more exercise. I want to find balance, and for the last year or so I feel like I've been YoYo'ing....