Tuesday, June 21, 2005

How Do You Create a Quandry?

Have a television show follow 300 dieters for six months with those following an Atkins diet pitted against those following Weight Watchers, Slimfast and Rosemary Conley (a British plan) and then watch as the Atkins low-carb dieters win!

That's what recently happened in Wales, during the BBC's television series, Diet Trials. The results were reported in the ICWales article, Experts in quandary over effects of Atkins diet.

The television show, Diet Trials, followed 300 people on four different diets - Atkins, WeightWatchers, Slim Fast and Rosemary Conley - in a bid to discover which was the best.

The group on the Atkins diet experienced initially high weight loss which soon plateaued and, after six months, was comparable to loss on the three other diets.

After six months the dieters had lost:
  • about 11% of their initial body weight on Atkins
  • about 10% of their initial body weight on WeightWatchers and Rosemary Conley
  • about 8% of their initial body weight on Slim Fast

Dr Truby, who has analysed the results of all the Diet Trials volunteers, said results showed Atkins dieters did not suffer a negative impact on cholesterol levels and other risk factors associated with cardiovascular disease. In particular those people on Atkins had significant drops in their triglyceride levels. But it is unclear whether the effect was directly linked to the diet itself or the fact that the volunteers were losing weight, which in turn reduces the risk factors.

Does it really matter why the triglycerides dropped significantly? I don't think so. The fact that there was a significant reduction adds to the evidence that low-carb diets can reduce cholesterol and triglycerides in most individuals.

The very public results have left the medical community in a quandry though - at the British Dietetic Association conference in Cardiff attendees debated what to recommend to individuals needing to lose weight. It is estimated that three million people in the UK were following the low-carbohydrate regime last year, but those numbers fell amid concerns the diet was associated with an increase in heart disease risk factors and kidney problems.

Now, those on the Atkins diet clearly lost weight and experienced improvements in their lipid profiles - and they did lose the most weight of all the plans followed on the television show.

So what's the problem? Again, it's the long-term effects.

Dr Truby, a senior lecturer in nutrition and dietetics at the University of Surrey, said "We don't know the long-term effects of restricting carbohydrates and the impact of a relatively low-fibre intake. We also don't know what impact a fairly acidic diet, like Atkins, will have on bone health. The Atkins diet was no better or worse in terms of weight and fat loss and there were some beneficial lipid profiles achieved."

The concern over long-term effects is nothing new. It is only in the last few years that scientists have undertaken the time-consuming controlled research to find out the long-term implications of eating a very low-carb diet. In the meantime, recommending a very low-carb program for weight-loss remains questionable for many within the medical community.

In my opinion it is short-sighted to limit options to those who are overweight and obese today while waiting for research data that both clinical case studies and anecdotal evidence suggests is safe and effective. Barring any major metabolic issues, the vast majority of individuals will not need to remain at very limited carbohydrate levels for the long-term.

In fact, most plans recommend reintroducing a broad spectrum of carbohydrate foods - nuts, seeds, fruits, legumes, and whole grains - after an initial period of restriction to provide more nutrient-density in the overall diet. Over time, for most people, a low-carb diet becomes a controlled-carb lifestyle with restrictions on added sugar, refined grains and empty calorie processed foods.

With this in mind, and data from one-year trials available, I think doctors owe their patients information about low-carb diets as an option to consider where, for the individual, it may be an appropriate option. With obesity continuing to rise in the US and in the UK, it is time to take every option and put it on the table for those who are overweight or obese today - provide them with the tools to use low-carb to lose the weight and provide them real help in learning new eating patterns for the long-term. Ultimately controlled-carb nutrition is the goal - where added sugars, highly processed foods and refined/enriched grains are shunned in favor of real whole foods!

Tell me again how that is not healthy in the long-term?

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