Rules to Maintain a Balance

Sometimes when we first start a low-carb diet, our bodies react in ways that might seem off, so the next rule addresses the "potty problems" that some find when they're starting on a new low-carb diet.

Rule 12:

• If you are constipated, mix a tablespoon or more of psyllium husks in a cup or more of water and drink daily. Or mix ground flaxseed into a shake or sprinkle wheat bran on a salad or vegetables.

This rule compliments rule 11 - that is it helps with strategies to avoid and counteract constipation. Water and high-fiber supplements are recommended to help maintain regularity. With any changes to your daily diet your body may experience short-term bouts of constipation and the above rule helps get you through this. It also reinforces for the long-term what works for constipation naturally rather than chemically processed products or sugar-laden fiber mixes that are commercially available.

The secret of this rule is that it is providing you with natural ways to alleviate constipation, not only in beginning, but in the long-term as you look to maintain your goal weight if you still have occasional issues.Important in this rule is to understand what it is to be constipated.

Constipation is not just not having a bowel movement for a couple of days - it is having the urge to have a bowel movement and being unable to go to the bathroom! When you do finally go, the feces are dry and hard. While not going for a day or two may be alarming, if you are not uncomfortable, you are probably not constipated. When you are constipated it is important to be sure you are getting plenty of water and increasing your fiber so that you are able to go without straining. Drinking water as instructed in the previous rule along with this one give you the tools to regulate yourself naturally.

The last rule we'll look at speaks directly to the recommendation to take, at minimum a good multivitamin with minerals. It's pretty much a universal given no matter what type of diet you eat that you should include a vitamin each day, and the same is true for those starting a low-carb diet.

Rule 13:

• At a minimum, take a good daily multivitamin with minerals, including potassium, magnesium and calcium, but without iron.

Many people starting out on a low-carb diet with both feet and take a large number of supplements.

In this rule, Dr. Atkins makes it clear that at minimum you need a good multivitamin each day. Also specifically mentioned are minerals, which are important to maintain electrolyte balance, especially when you're starting a low-carb diet and will experience a metabolic shift to burn fat primarily instead of glucose, which releases a lot of water from stored glycogen.

Much like the rule on water (fluid) intake is universally agreed as a "good rule", so too is this rule. While some people will benefit from additional supplements to their daily multi-vitamin, it is not necessary to start with more than a good multi-vitamin with minerals.

In the long-term, maintaining this habit of taking a good multivitamin is also a good idea no matter what diet you follow.

It is important to note with this rule that the multi-vitamin must have potassium, magnesium and calcium - these control and keep in balance your electrolytes (your body salts), so chooing one with a good balance and ratio of these minerals is important. Important too is to use a multi-vitamin not packed with iron (unless you have a medical reason to take additional iron) since your diet will now contain enough iron (if you follow it correctly) each day without additional supplementation of iron. Too much iron is as deterimental to your health as too little. Unless you have a reason to take more iron, find a good multi-vitamin without iron!

The secret within this rule is to learn to keep a balance - insure you're getting all the nutrients you can with real food and have a multivitamin each day to be sure if you missed somewhere along the way, you had it in your vitamin.

This rule and the one before it aren't about extremes - it is about balance.

By taking care of potential "potty problems" and including a good multivitamin each day, you're developing a habit that will enhance your ability to get all of your nutrients each day - even on those days you may not eat "well".

Rule Six: Empower Yourself

You may recall that in rule one of the Rules of Induction (Atkins), those starting the first phase of the diet are reminded to eat regularly and develop a pattern of eating each day that they're comfortable with, be it three meals a day or four or five. Also within that rule was the caution not to go more than six waking hours without eating something. I bring rule one up again today because it complements rule six, which says:

Rule 6:

• Adjust the quantity you eat to suit your appetite, especially as it decreases. When you're hungry, eat the amount that makes you feel satisfied, but not stuffed. When you're not hungry, eat a small controlled carbohydrate snack to accompany your nutritional supplements.

Where rule one speaks to our need to establish good eating patterns to take with us as we lose weight and then maintain our weight, this rule helps us understand that over time, as our weight declines, our food intake will decline and we still need to be aware that even with a diminished appetite, it's important to nourish our bodies for good health.

So many diets play on our fears - and one of the biggest is our fear that we lack enough willpower to actually stick with a diet long enough to lose the weight; forget about keeping it off!

One of the draws of a low-carb diet is the natural appetite suppression that comes within a few days of carbohydrate restriction. A large number of studies have noted that even when allowed ad libitum access to any and all of the foods allowed on a low-carb diet, those who stick with the allowed foods experience a "spontaneous" reduction on caloric intake while consuming an adequate level of protein and dietary fats to sate appetite and lose weight.

Sometimes the appetite suppression is so good that it's easy to miss a meal or go without eating too long. This rule reminds us that adjusting our food intake as we lose weight is expected, but we do not need to limit our intake to a point where we're potentially doing more harm than good, nor to we have to rely solely on willpower to lose weight or live with hunger pangs as we lose - we need nutrients from food, we need energy from food (even while losing weight) and we need to establish good eating habits.

That means eating for both to nourish the body and to sate appetite; adjust how much you eat to satisfy your appetite, allow yourself - give yourself permission - to eat and feel satisfied. Satisfaction with your meals keeps you motivated as you lose weight.

This rule does have a caution and that is to be aware not to overeat and stuff yourself, not to gorge or binge. For some who are new to low-carb this may be something that could become problematic - eating too little and then binging - so the caution is there to listen to your body, pay attention to your appetite and learn when you're hungry and when you're satisfied. Over time, if you're paying attention to this you'll find your body really does trigger hunger when you're hungry and if you're eating well, establishing an eating pattern happens!

The last part, to include a small carbohydrate controlled snack with your supplements, reminds us that including nutritional supplements is considered a benefit on the diet and eating something small with them can help you with rule one to establish good eating habits!

Over time as you lose weight, your appetite is going to naturally diminish and your energy requirements will adjust too. This is something to be aware of for the long-term - what you eat when you start - whether it's 3000-calories or 2000-calories - is going to slowly decline in time as your body weight is reduced. Someone who weighs 300-pounds needs more calories each day to maintain their weight than someone who weighs 150-pounds. So, in the long term, this rule is establishing this in your mind to remember later, as you reach a lower weight - you won't eat the same as you do at the start of the diet!

Overall this rule fosters a sense of empowerment - the understanding that you can, perhaps for the first time in your life, listen to your body and learn how to eat well over the period of losing weight and then as you maintain your weight!

Keeping Our Eyes on the Ball

Today I'd like to interrupt my series on understanding the short and long-term lessons found within the Rules of Induction (Atkins) and provide space for my husband, Dr. Gil Wilshire, MD to share his thoughts in a guest commentary. So, without further ado:

Keeping Our Eyes on the Ball
Gil Wilshire, MD, FACOG

Back in 2006, Regina and I were interviewed and asked about our thoughts on the future of dietary science and policy. We speculated that carbohydrate restricted diets would be an accepted, main-stream concept by the year 2040. I believe we are well on our way to seeing our goal fulfilled well before this arbitrary temporal milestone.

I try to remain constantly vigilant with regard to new scientific information, and it seems that in every month good, new information is published. Recently, Matt Hayes and colleagues (J. Nutr. 137:1944-50, 2007) drilled deeper into out understanding of carbohydrate restriction, metabolic syndrome, and the biochemistry behind satiety. I am pleased to see that our current shared clinical experience of spontaneous caloric control and rapid reversal of metabolic syndrome is now being bolstered by more clinical data. Although the study in question was rather timid with respect to carbohydrate restriction (it was a South Beach-type protocol) I still found the information valuable.

It is another, peer-reviewed paper to the ever-growing pile of scientific evidence supporting our position.

I would also like to add that my ever-growing clinical experience in my new home of Central Missouri continues to be very gratifying. It seems that not a month goes by where something good happens very quickly after a patient begins their new life style (I dislike the thought of "diets"...this implies a temporary change, instead of a whole new way of being). In my obese, "infertile" patients, it is fairly common for women to become pregnant before instituting hormone therapies. Women who appeared destined for the bariatric surgeon are losing huge amounts of weight...and now are making appointments with the plastic surgeons!

I must say, there are many doctors in the surrounding communities who are truly scratching their heads as our mutual patients make healthy progress eating "high fat" diets. Now, after some period of suspicion, I am actually getting requests to learn more about what we do in my office!

Positive results are very persuasive.

Nothing succeeds like success.

Being married to Regina is never boring, and I am privileged to hear all the latest details occurring within the nutritional community every night when I get home from the office. We are a disparate lot in the "low carb" community, with much independent thinking and talented, innovative thought leaders. I suspect that the field of nutrition and metabolism will never be one of lock-step agreement. However, I would like to take this opportunity to reiterate our common goals and to reinforce our shared understanding:

1) Current dietary recommendations that promote low-fat and low cholesterol diets are unscientific, unproven, and fatally flawed; and,
2) The vast majority of modern humans appear to function best when eating nutritionally dense, whole foods that most closely resemble those foods on which we evolved.

I believe it is these principles that unite us all. There will always be bumps in the road, and we must always be prepared for unexpected turbulence. That's life.

Let's keep our eyes on the ball! Slow, steady progress always wins the race.

Good health to us all!

Gil
Mid-Missouri Reproductive Medicine & Surgery

Rule Five: Break Free from Contradictions

Thus far we've looked at four of the Rules of Induction for the Atkins diet. I've used the Atkins diet rules because no matter which low-carb diet one chooses, these rules have little "gems" that can broadly apply to any controlled-carb diet based on its design, carbohydrate restriction and/or phases.

Today, we'll look at rule five. At first glance, it appears to be in a rather harsh tone toward the reader:

Rule 5:

• Eat nothing that isn't on the Acceptable Food List. And that means absolutely nothing. Your "just this one taste won't hurt" rationalization is the kiss of failure during this phase of Atkins.

Simply put, this rule is reinforcing the importance of being able and ready to begin something new and different while letting go of the "diet baggage" we all had/have that will not serve us well throughout weight loss on a low-carb diet, and certainly not when we maintain our weight later. The only way to say it is straight-out and without sugar-coating it - if you start the diet with bad habits and do not address them, they'll be your undoing on this diet (or any diet) you want to utilize as your means to lose weight.

This rule makes clear that everything on the 'acceptable foods list' is allowed, go and enjoy these foods; those not on the list are not allowed right now - not even one bite, not even if you can manage to include them within your carbohydrate allowance for this period. The time frame here is two weeks and you will not die without the foods that are excluded during this period.

You may crave them, want them, think you need them - but what you 'want' is not always what you 'need' and for now, there are plenty of nutrient-dense foods you are allowed to eat, so take this period to eat those and only those foods; more variety will come in time.

Many wonder why this rule is so harsh. In part it is helping to break habits of the past, in part wiping clean years of eating foods that were not the best choices for health and well-being, in part imploring you to ignore many current dietary contradictions, and in part to help you naturally supress cravings for carbohydrate-rich foods.

Did you catch that last item?

It is true for the vast majority of those starting a low-carb diet; if you can simply stick with the 'acceptable foods list' for your first two weeks, you'll find that cravings for carbohydrate-rich foods diminish quickly and by the end of two-weeks, they're supressed so you no longer think much about having bread or pasta or potatoes or sweets.

Now granted, these foods will always be around you; but you will now have a powerful way to make them less tempting in the future if you can avoid them completely for a couple of weeks.

In the process you'll be rewarded for your efforts and discipline too - you'll lose weight in the first two weeks, find you have more energy at the end of the two weeks, and also realize that the foods you used to reach for in times of stress or to celebrate can be replaced by foods that are better for you and your health.

What this two week period is teaching for the long-term is that you ultimately control what you choose to eat. It is a period that is allowing you time to step back from everything you think you know, retreat from all the contradictions we hear from the "experts," step back from all the habits you've developed over the years, and start again - at the basics.

This particular rule goes against everything we hear and read so often; on the one hand we're repeatedly told part of the underlying reasons for obesity is lack of willpower and discipline; on the other hand we hear often this insistence that if you want something eat it, if you're on a diet and craving whatever it's better to eat it than to not because it's not good to deprive yourself of something you want.

How in the world is one supposed to develop this necessary discipline if they're never challenged and expected to discipline themselves?

As I said, this rule sets a standard for you to hold yourself to, that for a short period of time - two weeks - you will avoid any food that is not on the accepted food list so you can prove to yourself some big things:

• What you think you want to eat isn't always what you need to eat
• Food is not the enemy, nor do you lack willpower; given adequate time and nourishment, your body will help you re-learn how to eat well
• You really don't have to punish yourself to lose weight with feelings of hunger, eat what's allowed and you'll be sated
• You really are empowered to make good decisions and eat delicious food while you lose weight
• You'll really get to experiment and play more with your eating later, as you move forward and continue to lose weight

These first two weeks extend to the longer term as you are empowered to listen to what your body is telling you; you'll initially get over the idea you need starchy or sweet foods all the time, and then understand as you continue, when and where these foods will fit into your long-term menus. Once again, you'll also begin to appreciate just how good real food tastes, and take the foods from these first two weeks into your long-term eating, so they serve as your foundation for the future.

Life Gets in the Way

Just a quick post to let readers know that life has gotten a wee-bit hectic here and this week time is short for writing the continuation of the series in progress. I'll be back on Friday morning with the next installement - hope you'll come back then as we continue looking at the rules of induction (Atkins) and how they provide us with insights for long-term success!

Rule Two: Back to Basics

Over the last few decades, the population at large, has slowly been indoctrinated to fear dietary fat; to limit intake of dietary cholesterol; and to limit consumption of foods rich with saturated fat like meat, whole dairy, butter and eggs. This happened despite little evidence that such an approach to eating provided a long-term health benefit, or ability to maintain weight. But, with decades of reinforcement in the popular thinking, it's understandable how the second rule in the Rules of Induction is the most misunderstood and maligned of them all.

Let's take a look:

Rule 2:

• Eat liberally of combinations of fat and protein in the form of poultry, fish, shellfish, eggs and red meat, as well as pure, natural fat in the form of butter, mayonnaise, olive oil, safflower, sunflower and other vegetable oils (preferably expeller-pressed or cold-pressed).

Is it any wonder that, when a diet comes along and allows these foods, in complete contradiction to decades of fat phobia propoganda, it is vehemently opposed by the leading health organizations and government agencies? That we're innundated with dire warnings of consequence to health, heaped upon us in a concerted effort to discredit and dismiss anyone who says differently; despite scientific evidence and data supporting not only the inclusion of these foods in the human diet, but their inportant contributions to the human diet!

Ignore the man behind the curtain Dorothy....ignore that in the noble attempts to improve the health of our population, researchers and clinicians were lead astray by what we now know was half-truth data, published in the fifties and sixties.

They know it, we know it, but still it's difficult to come to grips with that fact and reverse direction after decades of building the foundation of a "truth" only to find it terribly flawed. It's often easier to continue on in the lie than face the fact you're wrong; moreso when the entire group and community you exist within endorses the continuation of the established dogma, despite the evidence to the contrary.

It's easier to "kill the messenger" than kill the flawed paradigm that hold these foods are to be limited, heck, even avoided at all cost.

To admit such is akin to killing thyself and the core set of beliefs one holds to be true.

Dramatic license here?

Sure, but it does speak of something critically important one must do for their long-term health when they begin to, perhaps for the first time in their life, establish good eating habits for the rest of their life.

Simply put, the second rule of induction grants us permission to dismiss everything we've been told and taught to hold as truth about eating, macronutrients (carbohydrate, protein, fat) and a "balanced, healthy" diet; allows us to re-learn what it means to be human and eat food; and encourages us to enjoy the experience of truly eating a healthy diet while losing weight and then continue to do so along the way to finally, once and for all, maintain that weight well into the future.

I'm quite the optimist aren't I?

Seriously, don't studies tell us again and again that dieting to lose weight fails, that all we really ever do is get good at losing weight, but we're never quite able to master maintaining our weight in the long-term?

Let's start by examining the very base reason most folks even begin a diet to lose weight - they're overweight or obese and have decided it's time to do something about it.

So they begin, they are off to a good start, they're motivated and continue to be motivated with each incremental decline they see on the scale.

Problem?

Absolutely - the focus is on the scale; the number on the scale matters most and damn the torpedos, no matter how inconvenient, stressful or annoying it is to weigh, measure and count every calorie, the individual is in a battle against their bathroom scale to reach a desired number in the shortest period of time possible.

Millions have mastered this task, only to have to repeat it again and again throughout their life. I apolgize now if this sounds crass, but anyone can lose weight with even just a small level of effort; it doesn't take an Einstein to eat less for weeks or months to reach a number on the scale; most will put up with high levels of discomfort to reach that goal - hunger, moodiness, irritability, stress and counting, measuring and weighing anything they consider putting in their mouth.

In the short-term, such measures do work; in the long-term they fail because the person has been mistakenly led to believe "if only..." they do this, measure that, control this and avoid that over the short-term, somehow that alone will enable them to maintain their new lower weight without much more than keeping on keeping on; except the keeping on part is next to impossible!

That's because the very dogmatic recommendations we're repeatedly told are balanced and healthy to lose weight are scaring people away from the very foods that we need to eat to thrive as humans; this forces an unnatural eating patten across the population due to a deeply flawed fear of dietary fat and cholesterol and leads to failure in the long-term because it is not only unsustainable, it's incompatible with true health in the longer term.

The heart and soul of our metabolism is the endocrine system - when it dysfunctions, a cascade of health problems follow - insulin resistance, high blood pressure, dyslipidemia, diabetes, and other chronic and debhilitating diseases.

Why then are we specifically told to avoid the very foods that fuel the proper function of this system?

The current recommendations not only scare us from healthy food, they make simply eating way too stressful for an average person - measure this, weigh that, watch this, avoid that, don't eat this, that's better, blah, blah, blah - who wants to deal with that much stress each day? Sure, a motivated person, desiring weight loss will submit to such stress to reach a goal - but then what happens? They do what is natural and human - they do what they need to do to relieve the stress and relax, are then an easy target to point to as someone lacking willpower, someone just not commited to sticking with it; someone who simply doesn't care and is lazy!

Anyone who has attempted to lose weight only to regain it can relate - no matter how hard you try to stick with a diet that is, for lack of a better phrase, "high maintenance" to follow each day for the rest of your life - sooner or later you find the "benefit" (weight on scale) isn't worth the time and "stress" (weighing, measuring, going hungry, chastising yourself for wanting to eat, etc.).

As I said in my last post, what if the problem isn't you or your "willpower," but a deep flaw within the recommendations that lead not to success, but failure in the long-term?

Here's the rule again:

Rule 2:

• Eat liberally of combinations of fat and protein in the form of poultry, fish, shellfish, eggs and red meat, as well as pure, natural fat in the form of butter, mayonnaise, olive oil, safflower, sunflower and other vegetable oils (preferably expeller-pressed or cold-pressed).

The short and long-term secrets within this rule include:

1. Eating "liberally" is not the same as eating until you are stuffed and goes hand-in-hand with rule 6, which we'll look at later this week. This rule is also a natural extention to rule 1 to eat regular sized portions.

2. You're allowed to eat animal foods such as meats, poultry, fish and eggs provides you with combinations of both fats and protein - necessary for health, losing and maintaining weight on a carbohydrate restricted diet.

Note that in the rule, no one is told they must eat "fatty meats" or must consume "bacon, brie and oodles of t-bone steaks." No, instead they're to eat foods that provide both fat and protein; they can choose whatever cuts they like, whatever combinations suit their tastes; whatever they prefer.

Want boneless skinless chicken breast? Allowed.

Want a filet mignon? Allowed.

Want some eggs? Allowed.

Want some dark turkey meat? Allowed

Want some salmon? Allowed.

This "allowance" of all things that provide a good fat-protein combination reinforces our mindfullness not to fear food, food is not the enemy!

Adding to this is that using fats and/or oils as part of your meals is allowed - from sources of natural, good fats and oils; with those natual oils being preferentially from expeller-pressed or cold-pressed sources.

Why are the animal products with combinations of fat and protein and the use of natural fats & oils so important?

By integrating both into your meals you are also beginning the process of balancing your essential fatty acid ratios in your eating from the fats found in these sources, and perhaps for the first time, consuming adequate protein, thus adequate essential amino acids.

Important too is to choose quality, eat well and enjoy your food and meals. Don't worry each day about how much fat is in a particular food or meal at this stage, over time you'll be able to "tweak" as you go and learn better how to nourish your body and eat what really is a well-balanced, healthy diet.

With fat and protein providing the vast majority of "essential" nutrients, this liberal approach at the start of your weight loss diet takes you "back to basics" and with time, provides you the opportunity to not only learn how to eat well for the long-term, but to actually enjoy your meals again - without fear that you're killing yourself with every bite!

Establishing Good Eating Habits: Rule One

Odds are, overweight or not, by the time a girl reaches adulthood, she's tried one or more diets to lose weight or not gain weight; with boys, the incidence of dieting in the teenage years is less prevalent. In early adulthood this often continues, with many women and men developing what is termed "disordered" eating habits; skipping breakfast or other meals, relying on meal replacement products, like ready-to-drink shakes, rather than eat food for all meals, eating lots of small things on the run, or going long hours without eating anything, then taking one large meal at the end of the day, in the belief that will keep thier calorie intake lower over the day.

These types of habits aren't necessarily "eating disorders," though they may be part of one; more often than not, they are habits that one develops over time that are counter-productive to developing and maintaining a healthy relationship with food, and can stand in the way of long-term success when one loses weight and tries to maintain that loss over the long-term.

Food, while an easy target of blame in the weight loss game, is not an enemy to be avoided or held in disdain; it is essential to our health and well-being and, in the long-term, it's not simply learning what to eat that helps one maintain weight, but how to eat that sets the stage for long-term success.

With this understanding, it is easier to see why I believe the first rule in the Rules of Induction (for the Atkins diet) is the most important:

Rule 1:

• Eat either three regular-size meals a day or four or five smaller meals. Do not skip meals or go more than six waking hours without eating.

The first rule is straight forward and critically important not only in the first two weeks, but throughout the entire weight loss period, and then for maintaining weight in the long-term.

The reason is simple - it establishes that one doesn't need to eat in a typical three-meal-a-day pattern, but highlights the importance that eating regularly - even simple smaller meals multiple times each day - is a habit to continue with if you're already doing so, or establish now as you begin and continue to learn how to eat properly for the rest of your life.

Without establishing this as habit, you'll leave yourself open to disordered eating habits and continue to view food and eating as something bad or to be avoided. Now is the time to set aside all that disdain for food, eating, portions, and all that and dismiss that thinking so you can begin to learn to love food again!

This is the first step to "get back to basics" - a means to develop a healthy relationship with food and avoid continuing in a disordered eating pattern that is counter-productive in the long-term. In anything you do in life, be it your job, your hobbies, or anything else that requires skill, one thing that clearly sets apart those who succeed from those that fail is the feeling of confidence in ones ability. Few are "born naturals" in a given situation - most take the time and put in an effort to learn and do along the way, to build their confidence and master whatever it is they enjoy.

This is no different; by taking the time to work on this as you start a diet to lose weight, you will develop not only a sense of confidence that food is really not an enemy (since you will be losing weight while you establish good eating habits), you will also learn to listen to your body and take cues based on hunger to learn when to eat in a pattern that is in synch with your body. This is because eating regularly keeps your metabolism functioning and enables your metabolism to hum along nicely.

If you read the rule, you'll notice it says " three regular-size meals a day or four or five smaller meals" which hints at learning how much is enough; stated another way, portion size is important. If you're inclined to eat three meals a day, these meals will be larger than if you are inclined to eat four or five smaller meals.

We know from the various publications written by Dr. Atkins, that Induction is not a license to overeat or stuff ourselves. In my view, this Induction period is an opportunity to learn what a "portion size" means to you as an individual.

So many weight loss diets prescribe specfic weights and measures, claiming such portions are more than adequate for anyone attempting to lose weight.

But let's be honest - how many are truly satisfied after eating a tiny 2-to-3 ounce portion of bonless, skinless chicken breast? If you're one of the few who find this intake adequate for you and you're satisfied and not hungry, great!

If not, maybe the problem isn't you, or as you are often told, your lack of willpower, but instead that you have not eaten enough to adequately provide for your needs.

Listen to that - have some more - and as you begin to feel that sense of "satisfied," not stuffed, but satisfied and confident you've eaten well, without worry that you're going to be hungry again way too soon, then stop eating.

In this period, you are allowed to portion your meals as "regular-size" meals, keeping in mind that you won't eat larger portions just because you can. If three "regular-size" meals isn't your style, you simply adjust to more "smaller sized" meals in a regular pattern throughout the day.

The key here is to develop good eating habits and then maintain them as you move along.

Long-term this rule is the "golden rule" of maintenance. It is the most important rule of all the rules if you ask me!

By the time you reach maintenance, if you have been following this rule all the time - not just in induction - you're not only eating an adequate level of calories, no longer in ketosis and at your goal weight - you're also in the habit of eating portions that are "normal" for you and eating regularly to keep your metabolism working at a steady pace.

You've also learned that skipping meals may lead to eating more when you do eat and that it is best to keep your appetite sated by eating regularly for your particular needs - whether it is three regular meals each day or four or five smaller meals each day; and you may also have learned you're less likely to snack as often because your appetite is sated with regular meals!

This rule firmly establishes that you are tasked with setting the frequency of your eating pattern, sticking with an eating pattern that is regular, and develop a sense of what your needs are, learn what your "portion size" is in meals, and learn how to eat regularly instead of fearing food or your appetite!

Over the long-term you'll set the stage for success with this rule because you're allowing yourself to establish a healthy relationship with food and come to know that food is not your enemy, eating well is not a bad thing, and that enjoying your meals is truly a wonderful thing!

Handing you the Keys to Success

All weight loss diets come with some sort of rules; how much to eat, what to eat, when to eat, how to control portions, etc. The weight loss diet that enabled me to finally lose the excess weight was Dr. Atkins' New Diet Revolution (1992/1999), and like all other diets had its rules to follow - the Rules of Induction.

While Induction is heavily criticized by many, it is the period I call "back to basics" for the individual just starting out. While one is to carefully count carbohydrate, eating no more than 20g each day, they are also encouraged to view foods once subject to elimination or strict limitation differently; foods like whole eggs, red meat, full fat salad dressings, cream and real cheese are allowed, while "low-fat" products are strongly discouraged.

Within the books published by Dr. Atkins, the list of foods allowed during the first two weeks includes almost any red meat, poultry, fish, shellfish, fowl or game; with caution to limit or avoid nitrates and processed meats. Real whole milk cheese, cream and half & half are allowed within the dairy group, with limits on intake each day if one is consuming them; a long list of non-starchy vegetables and fruits (that is fruits that are fruits that we often don't recognize as "fruit" but are fruits - olives, macadamia nuts, summer squash, cucumber, tomatoes, etc.); all herbs and spices, and finally what to drink and what types and quantity of artificial sweetener is allowed.

One reason I call this the "back to basics" period in the diet is because it is focused on whole foods and provides for the most important essential nutrients our metabolism needs each day - quality protein (essential amino acids), quality fats (essential fatty acids) and nutrient-dense carbohydrates (essential vitamins, minerals and trace elements). The plan also encourages one to supplement with a high quality multi-vitamin (with minerals including potassium, calcium and magnesium; without iron) and provides additional information about other supplements if necessary.

In addition to the basic foods allowed during the period of Induction, the diet focuses the individual to follow what are called the Rules of Induction as a way to help them follow the diet correctly.

The Rules of Induction, from the 1999 publication of Dr. Atkins' New Diet Revolution are as follows: (they differ slightly from those published online by the company since his death in 2003; to read the updated version, published by Atkins Nutritionals, click here)

1. Eat three regular-size meals a day or four or five smaller meals. Do not skip meals or go more than six waking hours without eating.
2. Eat liberally of combinations of fat and protein in the form of poultry, fish, shellfish, eggs and red meat, as well as pure, natural fat in the form of butter, mayonnaise, olive oil, safflower, sunflower and other vegetable oils (preferably expeller-pressed or cold-pressed).
3. Eat no more than 20 grams a day of carbohydrate, most of which must come from in the form of salad greens and other vegetables. You can eat approximately three cups - loosely packed - of salad, or two cups of salad plus one cup of other vegetables.
4. Eat absolutely no fruit, bread, pasta, grains, starchy vegetables or dairy products other than cheese, cream or butter. Do not eat nuts or seeds in the first two weeks. Foods that combine protein and carbohydrates, such as chickpeas, kidney beans and other legumes, are not permitted at this time.
5. Eat nothing that isn't on the Acceptable Foods list. And that means absolutely nothing! Your "just this one taste won't hurt" rationalization is the kiss of failure during this phase of Atkins.
6. Adjust the quantity you eat to suit your appetite, especially as it decreases. When you're hungry, eat the amount that makes you feel satisfied, but not stuffed. When you're not hungry, eat a small controlled carbohydrate snack to accompany your nutritional supplements.
7. Don't assume any food is low in carbohydrate—instead, read labels! Check the carb count (it's on every package) or use a carbohydrate gram counter.
8. Eat out as often as you wish but be on guard for hidden carbs in gravies, sauces and dressings. Gravy is often made with flour or cornstarch, and sugar is sometimes an ingredient in salad dressing.
9. Avoid foods or drinks sweetened with aspartame. Instead use sucralose or saccharin. Be sure to count each packet of any of these as 1 gram of carbs.
10. Avoid coffee, tea and soft drinks that contain caffeine. Excessive caffeine has been shown to cause low blood sugar, which can make you crave sugar.
11. Drink at least eight 8-ounce glasses of water each day in addition to anything else you may drink, to hydrate your body, avoid constipation and flush out the by-products of burning fat.
12. If you are constipated, mix a tablespoon or more of psyllium husks in a cup or more of water and drink daily. Or mix ground flaxseed into a shake or sprinkle wheat bran on a salad or vegetables.

You may be wondering why I'm posting this here, today, on my blog?

The reason is simple - over the years of following a diet that is controlled-carb, and maintaining my weight loss, I've realized that the above Rules of Induction contain the keys to long-term maintenance. The critical points needed to succeed in the long-term are right there if we look closely and examine why they are in place for the first two weeks, and why they are necessary throughout weight loss and maintenance.

Years ago I wrote an article for a publication that has since gone out of business, and my original copy is long gone. So, without that in hand to simply re-post here, I'm going to re-write it from my longer-term perspective today, some years later, continuing to follow a controlled-carb approach.

In the coming days and next week, I'll take one or two (if they are related) rules and explain why they are critical in the first two weeks, and the lesson I believe they are teaching us for the long-term. I'll begin tomorrow with the first rule, "Eat three regular-size meals a day or four or five smaller meals. Do not skip meals or go more than six waking hours without eating;" and provide data as to why it is important not only in the short-term, but also for long-term success.

As you'll learn in the upcoming posts, each of the rules looks to foster one or more things, including:

1. Your responsibility in what you eat
2. Breaking habits that contribute to weight gain
3. Establishing a solid foundation for healthy eating in the future
4. Providing the tools & strategies you'll need to maintain your weight loss
5. Creating good habits that lead to better health
6. Your health and well-being is in your hands and is your responsibility in the long-term

UPDATE: Thank you to a reader who sent me an archived copy of the original article, which i will link to at the end of the upcoming series, for my readers to compare my changes to with my additional years perspective to add to!

Is There a Secret to Success?

Lou Shuler, over at Male Pattern Fitness wrote about the article in Slate yesterday and asked What if Nothing Works?

Weight loss advice almost never helps anyone lose weight.

And yet, something must work. We all know people who've lost weight and kept it off. We've all known non-exercisers who became exercisers. We all know people who've turned their lives around by eating better and exercising more, or at least more effectively.

[...]

Instead, researchers tend to discover, over and over again, that whatever we're doing now just isn't working for most of the people who try it. And sometimes the results are worse than they would've been if the dieters hadn't tried at all.

His observation is dead on if you ask me.

True, I know some people who have lost weight and maintained their lower weight for years (myself included), but I know many, many more who were able to lose weight effectively in the short term, but then as time passed, the weight was regained, sometimes leaving the person heavier than before they dieted to lose weight.

If we look at data from the National Weight Control Registry (NWCR) a self-reported database of "successful losers," we're told they have four similar behaviors post-weight loss:

1. They eat a low-fat diet (23-24% fat) with just 1300-1500 calories a day
2. They eat breakfast everyday
3. They monitor weight frequently with 75% weighing themself once a week
4. They engage in a high level of physical activity - 60 to 90 minutes a day

Me?

None of the above - daily I eat almost twice as many calories each day with a lot more fat; I skip breakfast more often than not; if I remember I might weigh myself once a month and my activity is daily routine stuff, not a formal exercise program specifically to meet certain targets each day.

For me, it's been eating adequate calories to meet, yet not exceed, my active metabolic requirements each day with primary focus on consuming sufficient quality protein - whatever fat that includes, so be it; eating breakfast if I'm hungry, but not forcing myself to do so if I'm not; I weigh myself occasionally and if my clothes feel a bit snug, weigh to see what's up - if I'm a few pounds up, I review what I'm eating daily and make adjustments if necessary; and I maintain a level of activity that really isn't much more than day-to-day things, but I do have to say includes keeping up with an extremely active almost three child!

Which leaves me wondering - how do you maintain weight once you've lost weight?

If you've lost weight and are able to maintain that loss, share here how you've done it...if you've lost to only re-gain the weight, what do you think is the problem?

What's Stress Got to Do With It?

Getting away on vacation is always so relaxing - there is nothing like kicking back and just doing whatever, whenever you want! Not only does getting away from the daily grind of life allow to you unwind and not think about much, it relaxes body and mind, which reduces stress that you often don't realize you have in your daily life. So while I often get emailed asking "you're going away again?" - I can't help but resume my blog posts with a study just published in Nature Medicine, Neuropeptide Y acts directly in the periphery on fat tissue and mediates stress-induced obesity and metabolic syndrome.

As was reported in the Washington Post today, "Scientists reported yesterday that they have uncovered a biological switch by which stress can promote obesity, a discovery that could help explain the world's growing weight problem and lead to new ways to melt flab and manipulate fat for cosmetic purposes.

In a series of experiments on mice, researchers showed that the neurochemical pathway they identified promotes fat growth in chronically stressed animals that eat the equivalent of a junk-food diet. Researchers found that laboratory mice subjected to daily stress and also fed a high-fat diet for a few weeks became obese. (Georgetown University Medical Center) The international team also showed that blocking those signals can prevent fat accumulation and shrink fat deposits and that stimulating the pathway can strategically create new deposits -- possibly offering new ways to remove fat as well as to mold youthful faces, firmer buttocks and bigger breasts.

"It's very exciting," said Zofia Zukowska of Georgetown University's Department of Physiology and Biophysics, who led the research, published online by the journal Nature Medicine. "This could be revolutionary.""

The study findings are being heavily reported in the media and most are highlighting the potential for pharmaceutical development, but few are talking about the real implications of the findings - can reduction of stress in real life lead to lower weight and a decreased risk of developing chronic disease?

Before I delve into that, first let's see what the researchers did in their experiments. The study was an animal model that involved mice. The researchers divided the mice into various groups - some ate a "normal" mouse diet, some ate a high fat, high sugar "junk-food" mouse diet. To see the effect of stress on the mice with each diet, some mice were highly stressed while others were allowed to carry on as mice do in their cages.

Unstressed mice consuming the "normal" diet did not gain weight.

Unstressed mice consuming the "junk food" diet did not gain weight.

Stressed mice consuming their "normal" diet did not gain weight.

Stressed mice consuming the "junk food" did gain weight.

This finding, especially if replicated in future studies, is critically important in our understanding of diet and health. This is because the findings showed that it was not diet alone that stimulated weight gain, nor was it stress alone. It was the specific combination of stress coupled with what researchers described as a "high-fat, high-sugar" diet that led to weight gain.

And not just any weight gain, but specifically fat accumulation in the belly - visceral fat; which we now understand is more detrimental to long-term health than subcutaneous fat which accumulates in places like the butt, thighs or arms. The stressed mice consuming a junk food diet also experienced glucose intolerance, elevated blood pressure, inflammation of the blood vessels and fat accumulation in the liver and in muscle tissue.

Simply put, they developed Metabolic Syndrome.

They did this not consuming excessive calories either - the researchers noted that the weight gain and fat accumulation in the stressed mice consuming the junk food diet was greater than expected given the calories consumed. Yet the mice consuming the same diet who were not stressed did not gain weight.

So it wasn't just the diet that mattered, it wasn't just stress that mattered; what mattered was the stress together with a junk food diet that conspired with each other to disrupt the production and pathways of neuropeptide Y (NPY).

Which leaves me wondering and pondering about many of the different dots still to be connected as we move forward to resolve the "obesity epidemic"...in the coming days I'm going to present additional data and studies to see what dots we might connect and what might be our solutions in the future.

I'll leave you with what Lou Shuler noted in his Male Pattern Fitness blog yesterday:

So, according to news reports, the "breakthrough" is a magic bullet that will selectively reduce fat deposits. Then there's some kind of opposite pill that will put fat on in selected places. If it works out in human experiments, somebody will make billions of dollars off these pills. I'm happy for them -- I wouldn't mind having some extra commas on my balance sheets -- but let's not forget that it'll be years before people will be able to use this chemical liposuction.

Meanwhile, anybody can stop eating junk food now. Today. The FDA doesn't have to give you permission to not enter the drive-through. The U.S. Patent Office doesn't have to put its seal on your decision not to supersize. It's here, it's free, it's open-source. It's dietary Linux. It doesn't discriminate by race, gender, religion, or income.

And it couldn't be simpler: All you have to do is eat something besides junk food.

It's so easy I couldn't even write a book about it. Chapter 1 tells you not to eat junk food. There is no chapter 2.

Why isn't that discovery being treated as the breakthrough, and the possibility of magic pills as an interesting sidebar?

Oh, yes - and as requested in emails while I was away, some pictures from our vacation:

Driving a boat on Norfork Lake, AR:

The big guy, with a mighty big fish:

My little guy, two months shy of his third birthday!

Oh, Yeah, That'll Work

An article in Sunday's Independent (UK) paints an ominous picture of what may be coming down the pike as a way to solve the epidemic of childhood obesity; simply take these children from their families and place them in care of the state.

"Doctors are calling for the parents of obese children under the age of 12 to be targeted under child protection laws and for their offspring to be taken into care."

Next month a motion will be presented at the British Medical Association (BMA) conference that will include provision for social workers to "treat childhood obesity as neglect" and allow state intervention, including removal from the home.

"Dr Matt Capehorn, who will present the motion on obesity in Torquay, said: "No healthcare professional would want to break up a family unit but this has to be considered if the child's health is being put at risk." Dr Capehorn, a GP, runs an obesity clinic in Rotherham, South Yorkshire."

The motion comes on the heels of our own American Medical Association releasing its latest Expert Committee Recommendations on the Assessment, Prevention and Treatment of Child and Adolescent Overweight and Obesity document on June 6, 2007. Noticably absent - media coverage to highlight its release!

Take some time to read it, I'll be writing more in depth about what appears to be in the works for us here in the United States! I'll note where the evidence stands for the recommendations in the document and point out data that's obviously being ignored in the efforts to reduce the prevalence of obesity in children.

Keep in mind as you read the document, this is from the same organization led by Dr. William Plested III, president of the American Medical Association, who was quoted as saying at a recent Rotary Club meeting in Jacksonville, Florida, “We’re going to pay for this with a generation of ‘fatsos’ with every disease you can imagine.”

Nice, huh?

Back to Our Regularly Scheduled Program

You may recall the alarming headlines reported here that suggested a high-fat meal was very risky to endothelial function; one went so far as to suggest just one bite of a burger might kill you!

Seems some researchers thought maybe it's a good idea to see what effect a high-protein (low-carb) and low-fat (high-carb) habitual diet might have on endothelial function over a longer period of time - say, maybe a year?

Wonder why you haven't seen any headlines on the latest study - Effects of weight loss on a low-carbohydrate diet on flow-mediated dilatation, adhesion molecules and adiponectin - published in the British Journal of Nutrition?

Might be because the researchers found nothing significantly different between the two diets, and noted "weight loss does not improve FMD [flow mediated dialation]."

Paper gets published, media sees it, notes noting to see here, no sexy headlines....not quite juicy enough to waste readers time with (even though it contradicts those one-meal experiements), so let's just move on.

But wait!

Just because the study objective was to see effect (benefit or risk) on FMD, adhesion molecules and adiponectin, was there anything else they measured that did have significance and is worthy of our time to look at?

How about we take a look?

Two groups of subjects were randomized into two different dietary protocols - the first included 13 people assigned a low-carbohydrate diet (40% protein, 27% carbohydrate and 33% fat; 26g fiber daily); the second included 12 people assigned the high-carb diet (20% protein, 60% carbohydrate, 20% fat; 40g fiber daily).

Both groups were weighed, measured, poked and prodded and followed up with a 6-weeks, 12-weeks and 52-weeks. Measurements and testing included weight, BMI, blood pressure, cholesterol, glucose, insulin, CRP, VCAM1, sICAM1, E-selectin, P-selectin, and total adiponectin. In addition, vascular measurements were taken for blood pressure analysis and endothelium-dependent FMD, along with an assortment of other tests.

The various measurements were duly recorded for baseline and re-measured during follow-ups, and were included in the final paper. Some critically important measures were statistically significant, but not the focus of the study design; thus not highlighted in the abstract conclusions.

We hear a lot about how low-carb diets are bad for cholesterol.

In this study, like others, total cholesterol, LDL and triglycerides were lowered over the course of the year and HDL rose while following the low-carb diet.

Total Cholesterol:
Baseline = 5.3
52-weeks = 4.62
[low-fat group went from 5.7 to 4.94]

LDL:
Baseline = 3.5
52-weeks = 2.69
[low-fat group went from 3.8 to 3.07]

HDL:
Baseline = 1.3
52-weeks = 1.44
[low-fat group went from 1.3 to 1.34]

Triglycerides:
Baseline = 1.7
52-weeks = 1.07
[low-fat group went from 1.4 to 1.34]

Intriguing too was the improvements with glucose and insulin following the low-carb diet:

Glucose (fasting):
Baseline = 5.9
52-weeks = 5.19
[low-fat group went from 5.8 to 5.5]

Insulin (fasting):
Baseline = 16.9
52-weeks = 7.28
[low-fat group went from 12.1 to 5.22]

An interesting finding was that adiponectin, a hormone involved in a number of metabolic processes, including glucose regulation and fatty acid catabolism, "did not change significantly after 12 weeks of weight loss" (p=0.10), but increased (good) at the last measurement, 52-weeks, at the end of the study (p=0.05).

Blood pressure (not high at baseline) improved, from 122/75 at baseline to 115/68 at the 52-week measure; for those on the low-fat diet, blood pressure increased from 122/75 at baseline to 130/74 at 52-weeks.

It's clear in the data that both dietary approaches offered improvements with weight loss in the above measures of risk factors. Something though wasn't "right" to help with, improve, endothelial-dependent FMD. We'll explore potentials in a moment.

Somethign troubling that seems glossed over - the higher blood pressure in those following the low-fat diet - where at baseline their blood pressure averaged 122/75, at 6-weeks it improved to 115/72 and again improved at 12-weeks was similar at 118/70. What happened between the 12-week measure and the blood pressure reading at week 52, when blood pressure was now averaging 130/74?

This is something I would consider worthy of noting, even maybe point out and suggesting additional questions and investigation as to why!

In the discussion section, the researchers stated that "The main finding of the present study was that weight loss on a low-carbohydrate diet which brought about reductions in glucose, insulin and LDL-C did not improve FMD either after short-term weight loss or long-term weight maintenance. Irrespective of diet composition weight loss had beneficial effects in the short term on adhesion molecules and blood pressure and in the longer term on adiponectin and P-selectin. There appears to be a delay in improvement in both adiponectina nd P-selection as these molecules did not improve until weight loss had been maintained for a year."

They went on to add, "Lack of change in FMD in the present study confirms our previous finding that weight loss does not improve FMD...One of our goals with the dietary intervetion was a reduction in LDL-C which we achieves, 18% at 6-weeks and nearly 30% at the end of the study with no effect on FMD."

The researchers also noted that "The present study was also designed to achive a reduction in glucose in a 6-week weight loss intervention on a more moderate diet of 6000kJ and we achieved this but with no effect on FMD."

And, "A complex physiological response such as FMD may be related to LDL and glucose cross-sectionally and in post hoc analyses but these may not be casually related but correlate in some circumstances with the real unmeasured mediator of change. For instance, oxidative stress may be a major factor in reducing NO bioactivity but reducing LDL levels may have no effect on this even though the endothielial cell is clearly heathier as judged by a reduced adhesion molecules."

In the end, they concluded that "weight loss on a low-carbohydrate, low-saturated fat diet, does not improve FMD despite improvement in cardiovascular risk factors. The improvement in adiponectin was delayed."

So what was their error of omission?

Well, for one they failed to note the problematic rise in blood pressure observed in the subjects following the low-fat diet. But, let's set that aside for a moment.

They also failed to note that the above failure to improve FMD was also observed in subjects following the low-fat diet; one that happened to be designed well enough to match the American Heart Association recommendations!

Yet even that low-fat diet (20% of calories from fat) didn't help improve FMD, despite their weight loss, improvement in glucose, insulin and cholesterol; but this was left unsaid.

I'm not surprised.

So, what we're left with is the stated null finding of those on the low-carb diet, with no real statement that neither dietary approach did much for FMD.

I hate to say it, but there was also a lack of curiosity as to why this was.

It's pretty much accepted dogma that a low-fat diet improves the cardiovascular system, thus would exert a postive - significant - effect on endothelial-dependent FMD. It didn't, yet the researchers didn't say "hey, wait, this low-fat diet didn't help either" and instead highlighted that the low-carb diet didn't improve FMD in their conclusions.

Some questions really do need to be asked.

First, how did the low-carb diet look compared with the habitual diet?

We know subjects were consuming, on average, 11.4mJ each day (2725-calories) as their habitual diet. The weight loss diet was 6000kJ each day (1430-calories). They followed the weight loss phase of the diet for six weeks and lost 5.8kg, or 12.75-pounds.

Let's do math!

Each day, we're to believe, the subjects were in a calorie deficit of 1295-calories. Six weeks is 42-days, so over the period, a calorie deficit of 54,390 calories - enough to theoretically lose 15.5-pounds. Hmmm....Okay, so it's pretty clear they did not really follow the diet as planned, since it's clear they consumed more calories than was reported. Happens all the time, no biggie.

Except, we have no idea what the excess calories were, so we have a confounding variable here. Did they eat pie? Did they eat broccoli? Did they eat fatty meat instead of lean meat? Did they skip the oatmeal and eat eggs? Who knows?

It's also noteworthy that the low-fat dieters ate a habitual diet of 10.8mJ daily (2581-calories) and were placed on the same weight loss calorie level. So they were in a calorie deficit of 1150-calories each day, or a six week deficit of 48,342-calories. This theoretically would result in a weight loss of 13.8-pounds; they lost 5.9kg (13-pounds). Did they cheat less? Did they stick to the diet more carefully? Who knows?

But, we can be sure we have a confounding variable here - something doesn't add up, and it looks like that something is calorie intake. It appears it was higher than the dietary protocol called for; and an increased calorie intake we have no idea what foods/macronutrients it came from.

So then, is there anything else? Let's see how macronutrient intake changed on the low-carb diet.

At baseline, their habitual diet - 2725-calories - was from 39.6% carbohydrate (270g), 19.6% protein (133.5g) and 36.5% fat (110.5g). We do not know the baseline intake for fatty acids, but do know the dietary protocol was strict - saturated fat 7%, PUFA 6% and MUFA 13% of calories.So, while following the weight loss diet, the macronutrient profile changed to provide 1430-calories each day, of which 33% were carbohydrate (118g), 40% protein (143g) and 27% fat (43g) with 7% from saturated fat (11.1g), 6% from polyunsaturated fat (9.5g) and 13% from monounsaturated fat (20.7g).

The first glaring disparity is the protein-to-fat intake, for every 1g of fat, they were expected to consume 3.3g of protein; this is a highly unusual pattern, heavy with protein and too lean - if you review other studies on "low-carb" diets, the fat intake is usually higher than the level in this protocol and protein typically lower; of note, this intake ratio is next to impossible without some funky planning. I'd like to know how much soy was a part of this diet? How much of the diet was comprised of non-fat dairy? How much fish was allowed, and what type was it? Were protein shakes or supplements part of the protocol? If so, which type of isolate dominated?

Without this specific data, it's difficult to say one way or another if the foods included may have contributed to the null finding or not.

So here, we have a potential confounding variable that is unexplored.

Anything else?

Well, from the data we do know, it seems we find an inadequate level of polyunsaturated fats - with just 9.5g each day; a level at which the subjects are unable to meet essential requirements for omega-6 or omega-3 fatty acids!

I am really starting to wonder why researchers designing diet protocols that are inadequate for known essential nutrients?

The Institute of Medicine (IOM) clearly states in the Daily Recommended Intake documentation, the MINIMUM required each day from omega-6 is 5% to 10% of calories and the MINIMUM requirement each day from omega-3 is 0.5% to 1% - when calories are adequate to maintain weight. In absolute terms - absolute gram minimums - the IOM states that adequate intake of omega-6 fatty acid is 14g-17g for men (depending on age) and 11g-12g for women (depending on age); and that adequate intake of omega-3 fatty acids is 1.6g for men and 1.1g for women.

Combined, the absolute minimum intake for essential fatty acids is between 15.6g-17.6g for men and 12.1g-13.1g for women.

In this study, even if every last gram of polyunsaturated fat was an omega-3 or omega-6, these subjects were deficient for essential fatty acids with only 9.5g of polyunsaturated fats as part of the diet.

So, again, confounding variable - huge confounding variable!

And the researchers question why the diet didn't have an effect on FMD?

Perhaps the researchers haven't read the data showing improvement in cardiovascular health when essential fatty acid intake is optimized to meet or exceed current recommendations?

Recent evidence of the role of omega-3 polyunsaturated fatty acids on blood pressure control and hypertension-related complications

Omega-3 Fatty Acids: Role in Cardiovascular Health and Disease

Fish Oil and Endothelial Function

I can't say it enough - I love good data, but studies like this, with macronutrient intakes, as percentage of calories, is highly confounded data. Designing a dietary approach to lose weight or maintain weight, macronutrient percentages are often inefficient and do not meet essential nutrient requirements.

I'd really like to see some researchers start designing studies to ensure adequate intake of essential nutrients within the calorie deficits - until we start to look at the nutrient-quality of weight loss diets, I'm afraid we're not going to make much progress to provide the public with sound, scientifically supported recommendations.

Eggs = Greater Weight Loss, Maybe?

Imagine reading this sentence:

The study's results are considered statistically unlikely to be due to chance, but were near the mathematical limit for that distinction.

A convoluted way to say "statistically significant."

More important, when data is crunched and the finding shows significance, there is no "near" distinction - either it's statistically significant or it's not, there is no grey.

Is the above a made up sentence to prep readers before I jump into a piece about statisitics and their interpretation?

Nope, it's from a real article I read about a study that found greater weight loss in overweight or obese women who ate eggs for breakfast compared with women, eating the same calories but eating bagels for breakfast instead.

In the study, 160 overweight or obese women were broken into four groups, including two that had diets about 1,000 calories lower than typical. One special diet group had two eggs as part of breakfast, the other had a bagel instead, though they were the same in calories. The average woman on the egg diet lost six pounds, while women on the bagel diet lost 3.2 pounds, a 65 percent difference. Researchers also reported that waist size dropped 83 percent faster for women on the egg diet. They said that there were not significant changes in cholesterol or triglcerides between the two groups.

The author really should consider a course on brevity and to-the-pointness.

Perhaps....

A study, that grouped 160 overwight and obese women into four groups, each consuming 1000-calories less than their baseline diet, found the group allowed eggs for breakfast lost 65% more weight (6-pounds) than the group allowed bagels (3.2-pounds). The researchers also reported no significant differences in cholesterol or triglycerides between groups.

That would be too easy, huh?

But then again, this is from someone who presents statistically significant findings as "unlikely to be due to chance, but were near the mathematical limit for that distinction."

When the data is actually published, I'll see what it really says and report back at that time!

The MIsadventures of Dieting in America

If you're like most Americans, you're bombarded each day with headlines that completely contradict other headlines:

• Health warning: all diets make you fat
• Diets do work... and here's how

---

• Reducing Weight Without Dieting
• Lose weight or lose control

---

• Good' Foods Make you Gain Weight Too
• Lose weight by eating more

---

• Loosing fat without trying
• Leftovers can help you eat a third less!

---

• Obesity is not just gluttony - it may be in your genes
• Get the 'skillpower' to lose weight

---

• Low fat foods trick you into eating more
• Heart Association Explains The Trouble With Fats

---

• Slow down at mealtime to lose weight
• Lose Weight During Dinner: Turn Off TV
• So can you REALLY lose weight just by brushing your teeth?
• Lose weight with push from a stranger
• Thinking thin can help you be thin

---

• Calculating caloric intake — do the math
• It's official: diets make you fatter

Is it any wonder we're confused about how to lose weight?

I sometimes wonder if the mass confusion, conflicting headlines, contrary opinions and such is by design. No, really, I'm not a conspiracy theorist...but, keep in mind, it is highly profitable to keep people fat, and sick, and coming back for more help isn't it?

So, how do we cut through the confusion and contradictions and simply eat right?

As Fred Hahn said it in a recent reply to comments on his blog regarding calories in, calories out - "Fat loss and health is NOT a numbers game - it's a hormonal game. And a game that requires full understanding of the rules."

Monday we'll begin to lay out those rules!

There is Something Perverse About the Atkins Diet...

I've been crazy busy the last few weeks, but absolutely had to stop what I was doing to write about an article today - The Atkins Paradox: What Diet Studies Don't Reveal - by Christopher Wanjek, the "Bad Medicine" columnist over at LiveScience.com.

My headline above was taken directly from the column, "So why not go with Atkins if you can loose weight and eat bacon? The reason, most doctors say, is because there is something perverse about the Atkins diet."

I haven't laughed so hard in, well, a few days. And, what followed was even funnier...Consider the breakfast of a gentleman on the Atkins diet whom I encounter each morning on a commuter train eating an entire block of baloney right out of the package with one hand and washing it down with a diet Coke in his other hand. Between the salt, fat and artificial additives in the lunchmeat and soda, this simply can't be healthy.

Good golly Miss Molly!

I don't know about you, but when I read these stories about someone "on the Atkins diet" - or any carbohydrate restricted approach - doing it completely wrong, well all I can do is laugh. I'm not laughing because the poor fellow eating the bologna and diet coke breakfast is going about Atkins wrong, but because this columnist really, truly believes this guy is a good example to show how "perverse" the Atkins diet is.

For anyone who has not read Dr. Atkins' New Diet Revolution, he was pretty clear to avoid, or at least limit, processed meats - "Processed meats such as ham, bacon, pepperoni, salami, hot dogs, and other luncheon meats - and some fish - may be cured with added sugars and will contribute carbs. Try to avoid meat and fish products cured with nitrates, which are known carcinogens." (page 124, paperback, 1992, 1999, 2002 edition)

In fact, he specifically recommended "Always aim for unprocessed natural foods and select the freshest produce you can find. If possible, purchase organic meats and dairy products." (page 130, paperback, 1992, 1999, 2002 edition)

Not exactly a ringing endorsement of bologna for breakfast each day, huh? Then again, let's not let inconvenient facts get in the way of an article promoting low-fat diets are supreme!

And this presentation of bologna & diet coke for breakfast for an Atkins dieter really isn't the biggest problem with this article.

No, the biggest problem really is the deceptive assessment of the study published in JAMA that I previously wrote about. This is how Mr. Wanjek portrayed the results:

The Atkins and Ornish data have overlapping confidence intervals. This is a measure of statistical strength given sample size and other factors. The study implies that, with 95-percent confidence, the true weight loss could be as low as 6.8 pounds for the Atkins group and as high as 8.2 pounds for the Ornish group.

In fact, the Ornish dieters were closing the gap at 12 months as the Atkins dieters were gaining weight. This supports earlier studies suggesting that a low-fat lifestyle is better at keeping off weight in the long run.

Closing the gap? Who is he kidding? Here is the graph of each group at each measurement interval:





















Note that I've highlighted the Ornish group. I've done that because the contention that they "were closing the gap" and losing weight at 12-months is utter and complete hogwash. As a group, they were gaining weight since the two-month point in the study!

Then the suggestion that the overlapping confidence interval was masking some secret weight loss potential for the Ornish group - more utter and complete hogwash.

What Wanjek didn't say is important and it's that the range of weight loss in those following Ornish and Atkins. Here is the data:

Atkins 4.7kg [95% CI, -6.3 to -3.1kg]

Ornish 2.2kg [95% CI, -3.6 to -0.8kg]

Oh, there was an over-lap all right, but no matter how you slice it, those trying to follow the Atkins diet lost as little as 6.8-pounds (3.1kg) and as much as 13.9-pounds (6.3kg), with an average weight loss of 10.3-pounds for the group. Compare that to those trying to follow the Ornish diet - weight loss was a little as1.8-pounds (0.8kg) and as much as 7.9-pounds (3.6kg) with an average weight loss of 4.8-pounds for the group.

Put another way - the least weight loss in the Atkins group was about the best in the Ornish group. Have a look for yourself:

We're supposed to be convinced that those following Ornish were doing as well as those following (or trying to) Atkins? Oh yeah, that graphic above shows just how close the two dietary approaches were...not.

Pass the nitrite-free bacon and double cream brie, thank you very much.

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