Archive for March, 2007

Carbohydrate Restriction Seminar – Nashville, TN – May 5

It’s a bit of short notice, but anyone interested in learning more about the science and research supporting carbohydrate restriction – register to attend the Nutrition & Metabolism Society Seminar at the 2007 Eastern Regional Obesity Course of the American Society of Bariatric Physicians in Nashville, TN, May 5, 2007.

Saturday, May 5
8-8:45 am Low GI and Very Low Carbohydrate Diets for Type 2 Diabetes
Eric C. Westman, MD, MHS

8-8:45 am Low GI and Very Low Carbohydrate Diets for Type 2 Diabetes
Eric C. Westman, MD, MHS

8:45-9:30 am Carbohydrate Restriction for Type 2 Diabetesin Clinical Practice
Mary C. Vernon, MD, FAAFP, CMD

9:30-9:45 am Break

9:45-10:30 am Using the Traditional Diet for Type 2 Diabetes in a Canadian First Nations Community
James A. Wortman, MD

10:30-11:15 am A Review of the American Diabetes Association Recommendations for Dietary Carbohydrate
Judy Wylie-Rosett, EdD

11:15am-Noon Panel Discussion of Morning Speakers

Noon-1:30 pm Lunch & NMS Award Presentation (lunch provided for Obesity Course & NMS attendees)

10:30-11:15 am A Review of the American Diabetes Association Recommendations for Dietary Carbohydrate
Judy Wylie-Rosett, EdD

10:30-11:15 am A Review of the American Diabetes Association Recommendations for Dietary Carbohydrate
Judy Wylie-Rosett, EdD

NMS ATTENDEES ONLY
1:30-2:15 pm Very Low Carbohydrate Diets and Serum Biomarkers of Cardiac Risk
Jeff S. Volek, RD, PhD

2:15-3 pm The Paradox of Fats in the Low Carb Diet
Steven D. Phinney, MD, PhD

3-3:15 pm Break

3:15-3:45 pm Biochemical Aspects of Carbohydrate Restriction
Richard D. Feinman, PhD

3:45-4:30 pm Panel Discussion of Afternoon Speakers

REGISTER HERE

Accreditation
The American Society of Bariatric Physicians (ASBP) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The ASBP designates the NMS Seminar for a maximum of 6.5 credit hours in category 1 credit towards the AMA Physicians Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the educational activity. The program is eligible for AOA-CME credits under category 2-A.

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March 30, 2007 at 1:07 pm 3 comments

Atkins Editorial Rejected

Five heathcare professionals – Dr. Stephen D. Phinney, MD; Dr. Mary C. Vernon, MD; Dr. Eric C. Westman, MD; Dr. Jay Wortman, MD; and Jacqueline A. Eberstein, RN – recently penned and submitted an editorial response to the recent media attention concerning the A to Z study published in JAMA. It was rejected by JAMA, Newsweek, Time and others. Here it is, in its entirety:

More Science and Less Zealotry, Please.

The controversy over which diet is best for all has again made headlines with the publication of the Stanford University study in the Journal of the America Medical Association March 7, 2007. Since the results are favorable to the low-carbohydrate Atkins diet, the usual criticism can be expected to follow.

Predictably, Dean Ornish has launched a tirade in which he manipulates the study findings to find fault with the low-carb approach and to deflect criticism away from his ultra low-fat diet which did not perform well in the study. Unfortunately, this is an argument based on dogma and not on science. The science speaks for itself.

As scientists and clinicians, we believe that no one dietary approach is going to be ideal for everyone. There is no doubt that, for some, an ultra-low-fat approach may be appropriate. Unlike Dr. Ornish, we recognize that there is no one-size-fits-all approach to the enormously complex problem of obesity and related conditions. Unfortunately, other authoritative sources like the US dietary guidelines also recommend a single lowered fat high-carbohydrate diet approach and have been doing so over the decades that this epidemic has grown.

Gratuitous attacks on the Atkins diet that imply it involves abandonment of wholesome vegetables and fruit for “bacon and brie” are simply wrong. Even in the most restrictive phase it meets the recommended daily guidelines for vegetables and fruits. As one advances through the phases, low-glycemic fruits, more vegetables, legumes and even whole grains are introduced based on an individual’s metabolic tolerance for these foods. One survey found that people who follow the Atkins plan over the long term eat more vegetables than they did before. Another study found that rather than increase the intake of fat and protein to compensate when carbohydrates were reduced, people simply ate less.

The unfortunate reality of today is that too many Americans are eating potato chips and fries and drinking sugar-sweetened beverages. We support the idea that wholesome foods such as meat, fish, cheese and eggs along with vegetables and low glycemic fruits constitute a healthier diet than chips and fries and sodas.

While this study examined four popular dietary approaches, what is clear is that whatever approach one takes to healthy eating, success will depend on how well you can stick to it. In this case, and in many earlier studies, it is clear that the Atkins diet is the one most people can maintain. On the other hand, the extremely low-fat diet advocated by Dr. Ornish is very difficult to follow. In this study, the subjects who were supposed to reduce their fat intake to his recommended intake of 10% could not reach that target.

Another important aspect of this and earlier studies is the beneficial effect that reducing carbohydrates has on metabolic markers. In his criticism, Dr. Ornish states that the LDL-cholesterol level fell in response to his diet, but does not mention that none of the differences in LDL-C in this study were statistically significant. This is therefore not a scientifically valid criticism. On the other hand, it is widely recognized that elevating the HDL-C, the good cholesterol, is an important factor in reducing cardiovascular risk. In this study there was a highly significant 10% rise in HDL-C in the Atkins group but no such change among those who followed the very high-carbohydrate Ornish diet.

In the same vein, the Atkins group demonstrated a significant (both statistically and clinically) greater reduction in systolic and diastolic blood pressure than the other three diets. A difference in mean arterial pressure of 5 mm Hg is about the response we would expect to see with a first-line pharmaceutical in the clinical setting. Any objective observer would acknowledge this as a major beneficial effect of the Atkins diet.

Dr. Ornish suggests that the positive findings of research such as this that supports the Atkins diet will cause problems, and that “many people may go on a diet that harms them based on inaccurate information.” This is a wildly irresponsible statement, given the consistency with which a reduction in important metabolic and cardiovascular risks are achieved by lowering carbohydrate consumption. It is simply preposterous to suggest that an approach that leads to significant risk factor reduction is unhealthy.

The seriousness of the accelerating epidemic compels us to think outside the box to find new solutions where the status quo has failed. The only approach that will be successful is one that people can actually follow. This study adds to the mounting evidence that the Atkins diet is a healthy choice which should be supported as a viable way to lose weight and improve metabolic and cardiovascular risk factors.

The Real Atkins Lifestyle

Before there was research on the Atkins diet it was commonly criticized in the belief that it would elevate cholesterol, ruin one’s kidneys and bones and cause heart disease. None of this has been borne out by the research.

What is clear from this JAMA study, and others like it, is that cardiovascular risk factors actually improve when controlling carbs. The scientific studies of this approach have shown numerous times that a pattern of rising HDL-C and falling triglycerides is the hallmark of carb restriction and that this benefit occurs even in the absence of weight loss.

Research also shows that rising HDL-C (good cholesterol) and falling triglycerides is correlated with larger LDL-C particles which are less likely to cause heart disease. Even the much touted statin drugs do not deliver this kind of improvement in LDL-C particle size. On the other hand, the research shows that eating a high-carb diet and cutting fat intake results in small dense LDL-C particles that are linked to an increased risk of heart disease.

Importance of Fat

There are other problems associated with extremely low fat diets, as well. Cutting fat intake can lead to deficiencies in fat soluble vitamins, depletion of essential fats such as EPA and DHA, and decreases in the absorption of nutrients. Studies also show that people with cholesterol levels that are too low become prone to depression, suicide and cancer and have higher overall death rates than those who have higher cholesterol levels.

When all is said and done, it behooves us to remember that the diet debate is not a horse race where there is only one winner. We know there is a great variability in metabolic and genetic factors that will determine what dietary approach is best for each individual person. Although, in this and many other studies the Atkins diet worked better for more people, it is also evident that other dietary approaches will work for some people as well. The most important thing we have learned from dietary research is that people need to find the approach that will deliver healthy outcomes for them individually. And, just as the proof of the pudding is in the eating, the proof of a diet’s effectiveness is whether it can sustain those benefits over the long haul. Hopefully, the weight of the evidence will now allow the Atkins diet to be recognized and supported as a legitimate option for people who want to improve their health through better nutrition.

On a final note, Dr. Ornish’s repugnant attempt to undermine Dr. Atkins’ credibility by perpetuating the myth that he had heart disease is unconscionable. It is unbecoming of any honorable person to make ad hominem attacks on those who are departed. Enough is enough. Dr. Atkins died of a head injury. He is no longer with us, but the line of scientific inquiry that he started continues to vindicate his dietary approach. And no amount of unfounded criticism will alter the fact that this study, and the 60 others before it, clearly demonstrate that what Dr. Atkins had been telling us all along was right.

  • Jacqueline A. Eberstein, R.N. Co-author, Atkins Diabetes Revolution, President, Controlled Carbohydrate Nutrition
  • Stephen D. Phinney, M.D. Ph.D Emeritus Professor, Department of Medicine, UC Davis, Elk Grove, Cal
  • Mary C. Vernon, M.D., CMD, Co-author, Atkins Diabetes Revolution, President, American Society of Bariatric Physicians
  • Eric C. Westman, M.D. M.H.S, Associate Professor of Medicine, Duke University Medical Center
  • Jay Wortman, M.D, Department of Health Care & Epidemiology, Faculty of Medicine, University of British Columbia

March 26, 2007 at 2:32 pm 5 comments

On Vacation

March 16, 2007 at 1:23 pm 3 comments

Omega-3 & the Brain

Last month I highlighted research out of Sweden that found four year olds already overweight, with features of metabolic syndrome and deficient in essential nutrients such as iron, vitamin D and omega-3 fatty acids. Interestingly, those children with the highest BMI consumed higher intake of sucrose (sugar) and lower fat.

Today the BBC reports on a very small study – involving four children – who were given fish oil supplements. Tests done at the end of the three-month study found the children showed an increase in reading age of well over a year, their handwriting became neater and more accurate and they paid more attention in class. Brain scans which identified a chemical called N-Acetylaspartate (NAA) which is linked to the growth of nerve fibres in the brain also showed dramatic changes.

Researcher Basant Puri said of his findings, “In three months you might expect to see a small NAA increase. But we saw as much growth as you would normally see in three years. It was as if these were the brains of children three years older. It means you have more connections and greater density of nerve cells, in the same way a tree grows more branches.”

A large placebo controlled study is expected to get underway in the coming months to confirm the findings. On this, Puri said “My view is we can’t come to any clear conclusion until a proper trial is done.”

March 12, 2007 at 1:27 pm 2 comments

What is Normal Blood Sugars?

Jenny, over at Diabetes Update, has a great summary of the presentation, What is Normal Glucose? – Continuous Glucose Monitoring Data from Healthy Subjects, presented by Professor J.S. Christiansen, at the Annual Meeting of the EASD last September.

You can read her analysis of the presentation at Diabetes Update: Research Gives More Insight into “What is a Normal Blood Sugar”

March 9, 2007 at 5:03 pm Leave a comment

Might the Brain Not Know the Body is Fat?

A new study published in Cell Metabolism – Diet-Induced Obesity Causes Severe but Reversible Leptin Resistance in Arcuate Melanocortin Neurons – found that in an obese state, the brain becomes “unaware” the body is fat. These findings, in an animal model using obese mice, showed that a sensor in the brain, that normally detects a critical fat hormone, fails to engage to keeps energy balance in check. Without that signal, various metabolic pathways fail to blunt appetite and keep calorie consumption under control.

As Scientific American opened their article about the research, “Could fat be in the brain of the beholder? A new study shows that signals in the brain that warn appetite-modulating neurons of excess fat stores can be suppressed, making the brain unaware of the body’s condition. The result: the body becomes completely ignorant about its own makeup and thus makes no attempt to increase energy expenditure or reduce appetite to help shave flab.”

The biological sensors in question? A suppressor called SOCS-3, is believed responsible for contributing to a loss of sensitivity to the hormone leptin. The researchers found “leptin binds to a receptor in the arcuate nucleus, triggering a cascade of chemical signals that culminate in the activation of SOCS-3, a suppressor that stops the reaction. The scientists determined that obese animals had an adequate quantity of leptin receptors, but that the quantity of SOCS-3 had risen, likely thwarting any activation of the fat hormone.”

Why this may be critically important in our understanding of obesity is that those who are obese often have higher circulating levels of leptin, suggesting something else is limiting it’s action. In this animal model it was found that mice consuming identical calorie intakes did not all maintain similar weight – some became obese. After tweaking the macronutrients (in this instance reducing fat since the mice used in this study are bred to grow obese on a high-fat diet) while maintaining the calorie intake, the mice lost weight back to normal – and, the brain control centers regained sensitivity to leptin.

The researchers caution that the study does not necessarily extrapolate well to humans – additional studies are needed since mice overall have a different physiology than humans. But, the study does have value in the scheme of human metabolism and I hope researchers will continue to look at these metabolic pathways and hormones involved in energy regulation in humans.

March 9, 2007 at 4:55 pm 1 comment

Calling for Low-Carb/Controlled-Carb Success Stories

Dana Carpender is one of the folks within the controlled-carb community whom I adore – she’s “good people” with an insanely fun personality – she tells it like it is and isn’t shy about doing so. She’s defnitely a go-getter and not afraid to speak her mind or tackle the hard questions.

Like many of us who’ve continued along over the years as low-carb waxed and waned in the media, but never stopped gaining in the supporting evidence department, she’s convinced it’s time to set the story straight about carbohydrate restriction – how to do it properly to lose weight, and more importantly, how to maintain weight loss over the years.

She as my vote of confidence – I followed a low-carb diet to lose 80-pounds back in 2001 and have since maintained that weight loss with a basic carbohydrate controlled approach. My husband, Gil, used a low-carb diet to shed over 100-pounds since 2002 and has since maintained that weight loss with the same basic carbohydrate controlled approach. Dana herself has utilized a carbohydrate restricted diet as her eating style since 1995! Twelve years and counting.

I have no doubt there are millions of us out there, across the US and around the world who’ve lost weight and maintained our loss without much fuss.

The big question – how do we do it?

Everyone says it’s impossible to follow a low-carb (carbohydrate restricted) diet for the long-term; that it’s boring; that it eventually will lead to declines in health over the long term. Those of us doing it – day to day, year after year – we know it works and we keep at it because it works.

Now it’s time to share with others the how and why of long-term success with carbohydrate restriction!

Dana is asking for our help – she’d like to interview everyone she possibly can in the coming months about the how they do it and why they continue with carbohydrate restriction.

She’s posed several questions to start a dialogue, initially via email with those interested in participating in this project:

To what do you attribute your success? Was it support from friends? Family? Online support?

Have you learned to cook a wide variety of low carbohydrate meals?

Planning ahead?

Feeling a lot better?

What do you consider to be the two or three most crucial components in your low carb success?

What were your biggest stumbling blocks? Lack of support, or downright sabotage? Naysaying from your doctor? Boredom with the food? Emotional carb cravings? Discouragement with a plateau? Budget and time constraints? Impulsive eating when junk appears in front of you?

Dana would like to get the project off the ground as soon as possible and is asking for your email replies at voiceofthepeople@holdthetoast.com.

Take a few moments to drop her an email if you’d like to share your success!

She’s putting together a proposal and would like to have emails to her by Monday – so what are you waiting for? Email her now!

March 9, 2007 at 2:53 pm 3 comments

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