All diets are equally good … or are they?

everybodyWins

How should you eat for weight loss?

In the past, many people used to believe that all fat was bad for you. Today, almost everyone knows that this was a mistake.

The question is what is to come instead? The conventional wisdom today is fraught with confusion and a belief that it doesn’t matter at all what you eat weight-wise – “all diets are equally good”. A new scientific review of selected previous weight studies claims to confirm this… but it turns out not to be that simple.

BBC News: Any diet will do, say researchers, if you stick to it

It really wasn’t “all” diets that were equally good in the review, but low-carb or low-fat. But wait a minute, and let’s look at how they grouped different diets:

worst-800

So, what most would call a low-fat diet, as in the old official or Weight Watcher’s dietary guidelines, turned out to be the worst in this review. It’s what they call “moderate macronutrients in the table above.

This despite the fact that the journalists wrote that all diets were equally good!

The diet groups that shared the first place were either…

  1. The average of all low-carb diets advising up to 40 % carbohydrates (Low-glycemic index diet)
  2. A strict low-fat diet, such as Ornish with less than 20 % fat.

A bit of an unfair comparison, it may seem. What if we instead compare advice on a more efficient strict low-carb diet, such as Atkins or LCHF (below 10–20% carbohydrates) with advice on a strict low-fat diet? Not many studies have compared the two, but by far the largest of them is Gardner and colleages’ study from 2007. Here’s the result:

Skärmavbild-2014-09-04-kl.-21.34.11

When it comes to more moderate low-fat diets, the difference is even more obvious – and they even had the worst results in this comparison! Advice about low-carb diets has won over that for conventional low-fat diets in so many comparative studies  – as recently as earlier this week – that it’s becoming more and more embarrassing to pretend otherwise.

Even a new Swedish government expert committee reached the conclusion that a low-carb diet provides more weight loss.

At children’s birthday parties we may feel free to pretend that all participants are doing equally well. But when it comes to scientific studies on different diets for weight loss it becomes more and more contrived to even try.

Previously

Swedish Expert Committee: A Low-Carb Diet Most Effective for Weight Loss

New Major Study: A Low-Carb Diet Yet Again Best for Both Weight and Health Markers!

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79 comments

  1. Nate
    This points out the need to define terms like 'low fat', 'low carb', 'very low carb', etc. My opinion for years has been that some official agency, be it US, EU, WHO or some country's health department, needs to define exactly what those terms mean. It would make it more difficult to misinterpret test results by biased or uneducated journalists and others.

    In fairness to the low fat tribe, Dr Gardner's 2007 trial did show that a few people did better on the low fat diet. The more insulin resistant people did better on the low carb diet and vis-a-verse. This just means we, the world, should not make the same mistake we made with advising everyone to eat a low fat diet without adequate science having been done. I agree with the philosophy of NuSI and wish them God's speed.

    Reply: #8
  2. Wade Henderson
    Once again, we have a group of overweight women, who are "randomly assigned" to a diet.

    Randomly assigned individuals are seldom going to follow the Ornish diet. Everyone knows that and this study only confirms that.

    They were told to keep their fat calories at 10%.
    At 2 months, they were at 21%
    At 6 months, they were up to 28.3%
    At the end of the 12 months, they were right up to 29.8%..... which interestingly just happens to be the same place that they ended up in the recently discussed "Low carb vs Low fat" study we just saw released.

    The lesson learned, which everyone has long known, if you take average people, with moderate motivation, they will not follow the Ornish style diet.

    So once again we have the "low-fat" version being not low-fat at all.
    This has been published over and over and then is used by the low-carb advocates to show that low-carb does better.

    I agree, for weight loss, especially over the short term, for most people, low-carb will give better results. Never the less, as we see in many studies, from about 6 months on, the Atkins group slowly begins to put the weight back on in a steeper upward curve.
    Just a bit more pronounced because they initially lost more in the beginning.

    As to what will be the cardiovascular impact down the road, well that remains to be seen.

    As indicated in the recent "low-carb" vs "low-fat" (where the fat intake was 29.8%) that article says the following

    "Our study also found reductions in LDL cholesterol level among partici-
    pants in both groups, with no significant difference between the groups"

    So if the low-carb group can get equal cardio protection...or even slightly better then the Low-fat group (29.8%).... that still leaves them at about the same danger level... which has a huge percentage of them headed for trouble by age 50 and beyond.

    Again, my emphasis is more geared toward looking a large impact on cardio issues rather than simple weight loss.
    Of course, simple weight loss, leading to less diabetes, can make a significant difference in heart and vascular problems down the road. So in that sense, it may produce a good impact in the group of individuals prone to diabetes.

    Replies: #3, #4, #13, #15
  3. Paul the rat
    I can not vouch for members/contributors to this blog who follow LCHF lifestyle because I do not know them in person, however I know more than 30 people personally who follow LCHF lifestyle some for more than 1 year some close to 20 years, as it is case with me (and as you know by now).

    What is that troubles you Wade? are you jealous of our health and the fact that we do not go to our family medical professionals anymore?. Tell us please. What are you trying to convince me of - that my 20 years of personal experience is nothing because of a study, which in your understanding is not random, too random or does not account for smoking, swimming, norse-bathing or has too fat or too skinny people in it?

  4. tony
    The low fat diet was thoroughly tested at the soviet gulags. Subjects were on a 300 gram bread diet with 16 hour required labor. Fat less than 10%. Classical eat less, move more. Results, average survival rate of subjects was three months. Now tell me they did not follow the low fat diet.
  5. Zepp
    "Randomly assigned individuals are seldom going to follow the Ornish diet."

    And thats becuse its a bland diet!

    You know.. I know.. everybody know, that this Ornish dieting is more about to belive or not.. its more about that if one belive in the differens about the same molecules comes frome plants or from animal sources!

    Its more about religion.. mostly about Hinduism.

    I dont think that Hinduistic belives are worse than others.. but its only a part of a belive system/religion.. not about sciense at all!

    And there are many good thougts about mainly all belive systems.. if you put them in there right context and time.

    Ornisch and Esseltyne do make people do a life style change,, thats mainly good.. if its to the better.

    Its there flawed explanations thats hillarus.. its not at all about plant based food.. its mainly about avoiding crap food.

    And I can tell you that LCHF is "Plant positive".. its not a questrion about plant based or animal based food.. its a question about nutrient foods!

    I dont give a shit for Ornish et al.. he is for my concern a man that try to promote a lot of bogus on his followers!

    And one can be a vegetarian on LCHF too!

    http://lowcarbdiets.about.com/od/vegetarian/a/Low-Carb-Vegetarian-Die...

    Some people do even tryes to be low carb on a vegan diet!

    http://lowcarbdiets.about.com/od/vegetarian/a/veganlowcarb.htm

    And I can tell you that not everybody need to eat LCHF.. its for those that got problems whit SAD.. or have a geneticaly problem to use carbs as major fuel.

    And at last.. eat your green leafs.. eat as much as you can chew.. it give you some nutrients that you dont get from animal sources!

  6. Vick
    The BBC article is also misleading it states "The Atkins diet has a focus on protein." and they still quote low carb as being "high protein". I am glad that LCHF is getting more air time nowadays and the evidence keeps piling up that it is a healthy way to go. I agree with the sentiment that one diet does not suit all but would like for LCHF to be more accepted as healthy!
  7. FrankG
    It is sadly amusing and predictable to see the backlash to these recent studies...

    "any diet will work so long as you stick to it" -- and in study after study, ad libitum LCHF is shown to be easier to stick to

    "of course its easier to lose weight if you cut out an whole food group" -- interesting how low-carb equals "cutting out an whole food group" whereas low-fat did not??? AND the fact that it is easier is somehow a reason to avoid LCHF???

    maybe a "real diet" must be hard work, discomforting and unpleasant... like doing penance for your sins of gluttony and sloth

    and then of course there is the constant focus on "weight" NOT excess fat mass, NOT health markers -- sure STARVE any group for long enough and they will lose "weight" BUT are they healthy? and how long will it stay off? what has it done to their body composition? what has it done to their metabolism?

  8. FrankG
    "This points out the need to define terms like 'low fat', 'low carb', 'very low carb', etc. My opinion for years has been that some official agency, be it US, EU, WHO or some country's health department, needs to define exactly what those terms mean"

    While it may be possible to put some arbitrary numbers around these terms, I think what you suggest is impracticable...

    These terms simply reflect the relative percentages of energy coming from Carbohydrates, Fats or Proteins (although in ad libitum trials, Protein tends to stay around the same).

    For an example: with a person eating around 2,800 calories per day (and no, I don't count calories) and based on 4.5 calories per gram of carbs or protein as compared to 9 for fat (all very rough-and-ready, and ignoring the different types of each of these macronutrients), then substituting around 45 grams of fat instead of 100 grams of carbohydrate, could be enough to switch a diet from being "high carb, low fat" to "low carb, high fat".

    There is no "one size fits all" diet: as we are all different sizes, different sexes, with varying ages, metabolisms, activity levels, states of health etc.. etc...

    The trouble with simply comparing percentages of calories though (apart from the fact that we don't just nourish our bodies with energy) is that if my baseline was 2,800 calories on an "high carb" diet, then by restricting calories, I could drop the absolute amount of carbs I was eating to say below 100 grams per day -- arguably "low carb" levels of carbohydrate.. especially given that the shortfall in my energy needs is now expected to come from my stored fat which effectively makes this an LCHF diet!

    Nutritional research is fraught with this kind of difficulty; which is one reason it makes it easy for vested interests to massage the data 'till it fits their desired outcomes... something we ALL need to be aware of.

    The ideal RCT is double-blinded and ONLY changes a single variable but you can do neither of these with real people and real food.. change the amount of fat in the diet and you also effect the overall calories, and/or the relative percentages of energy per macronutrients. Plus any change to the recipe affects taste, texture and so on... things which are hard to blind from the participants. People in the real world don't live on food pills or "milk-shakes".. they also don't live in a closed metabolic chamber.

    In these studies, where the relative percentages of energy and even the absolute amounts of each is measured, we are still only focusing on "calories" (energy)... evidently there is more than one type of fat (for example) and the makeup of that fat can have a marked difference as to how it is metabolised so perhaps even testing around macro-terms like "low fat" or "low carb" need to become things of the past as we follow the evidence and move ahead. Trouble is so many researchers seem to have their heads inserted so far up their own (or their mentor's) arses that they can't even see the evidence!

  9. erdoke
    By now it should be perfectly clear to everyone having any interest in nutrition and weight loss diets that the key word is ADHERENCE.
    Then adherence consists of other key words such as satiety, hunger, tasty, etc. We can argue about the exact role of calorie restriction (CICO) until our Sun will become a supernova, the fact is that regardless of the outcome, low carb diets have the definitive advantage of conquering all the areas that above key words cover.
    So why don't we just move over to the discussion about the effect on cardiovascular health now and close the weight loss debate?
    Quite honestly, I believe that a 10 % fat diet is extremely difficult to adhere to simply because it is not what the big majority of humans is adapted to. It is also clear by now that CVD is not caused by natural fats, so why should we attempt to cure it with a low fat diet in the first place?
    Reply: #10
  10. FrankG
    At the risk of being called a pedant (heck I've been called worse names :-P ) our Sun is not massive enough to go supernova.... but I guess that works too; as in any case, it will be an extremely long time coming, which is, I think, your meaning :-)

    https://answers.yahoo.com/question/index?qid=20090219222739AAjvbFx

    ---

    For what it is worth, I agree with you about fat... it makes little evolutionary sense for humans' major energy storage (along with a great many other lifeforms on this planet), to be in a form that will kill us.

    Reply: #11
  11. erdoke
    Thanks for the correction, Frank. Too bad I still carelessly refer to the red giant expansion phase as supernova. :o) Being precise never bothered me much.
  12. Tina
    That's ridiculous, of course all diets lead to weight loss, once you manage to maintain an energy deficit, even if that becomes more and more difficult and your body will fight it with all it has. So the "if you stick to it" is the crucial point. Only diets work long term, if they are easily enough "to stick with", if they work with your body instead of against it. Otherwise you will feel miserable all the time, a nightmare for other people to be around you and you will run into other health problems.

    A diet that is too hard to stick with, is an unsuccessful diet.

  13. Leo from DietBeMedicine.com
    Wade, what diet are you on, Ornish?

    Also on your quote: "Our study also found reductions in LDL cholesterol level among partici-
    pants in both groups, with no significant difference between the groups"

    Are you taking reductions in LDL as a marker for CVD risk reduction?

  14. Vicente
    Hi Andreas,
    that study from Gardner et al 2007 could lead us to wrong conclusions.
    I wrote a little comment about that study.
    Best regards
    Reply: #35
  15. Alan
    Wade,

    You might have read this meta-analysis of low carb diets on cardiovascular risk factors:?
    http://www.ncbi.nlm.nih.gov/pubmed/22905670

    Low carbohydrate diet significantly decreased: body weight, body mass index, abdominal circumference, systolic & diastolic blood pressure, plasma triglycerides, fasting plasma glucose, glycated hemoglobin, plasma insulin, plasma C-reactive protein; significantly increased HDL [“good cholesterol”]; and did not change LDL [“bad cholesterol”].

    That is a very good and long list of risk factors that improved eating low carb. Why are you still so worried?

  16. Wade Henderson
    Alan, a few points first and then I'll explain my emphasis for a particular set of individuals/patients.

    First from you post.

    "and did not change LDL ["bad cholesterol"] "

    Then from your link the following.

    " Low-density lipoprotein cholesterol and creatinine did not change significantly, whereas limited data exist concerning plasma uric acid. LCD was shown to have favourable effects on body weight and major cardiovascular risk factors; however the effects on long-term health are unknown."

    So all in all, we see from that meta-analysis, several favorable risk being helped, or not changed significantly. .... all of that apparently compared to groups of controls.

    The problem for me is that I am looking at the situation, not for a group of individuals who might or might not be on the road to future problems, but instead my posts, mostly in that other thread, are about the best data for individuals who have diagnosed coronary artery disease.
    Those individuals, a great many of them already having angina, usually characterize as having blockages (stenosis) of 70% or greater.
    These individuals number in the millions.... as many as 10 million Americans alone.
    They face the prospect of their 70% blockages growing year after year without a significant alteration in lifestyle. Next stop for them is angioplasty with stenting, or bypass surgery, in order to lessen their angina. Of course they also face the possibility of death.
    Those three choices each have risks and downsides.
    Even if you choose the least radical of them, stenting, your inner processes continue to block other areas, other arteries. Many stents fail early and many others patients will require repeated stents. These procedures are not without dangers, but during the procedure, but also from the years of Plavix (blood thinner) required.

    Oh, BTW, neither the stenting nor the bypass surgery prevent deaths in patients with stable angina. They mostly only relieve symptoms.

    So, the other choice is what significant changes can these millions of patient make to halt or reverse this steady process of narrowing in the arteries?
    Borrowing from observations of arteries progressing, including those not over 70%, we find for example that after 5 years, the average progress in a group of arteries in control groups was from approximately 41% stenosis to 52% stenosis.
    That leaves the opening dropping from 59% down to 48% in only five years. That is about a 18.65% reduction in the open vessel. If you plug such a reduction into a blood flow calculator, you find a amazing reduction in blood flow.
    http://hyperphysics.phy-astr.gsu.edu/hbase/ppois4.html
    That 18.65% reduction can cut potential blood flow by 56% ( a power of 4x)

    Now imagine you are already at or beyond 70% stenosis. If over five years you continue to increase the blockage you rapidly end up with more and greater blockage, with 4x factor working ever more against your blood flow.

    So, you already have a angina and if you stay on track or make only moderate changes you are going to end up in a very bad place in 3 year, 5 years, or 10 years.

    You need some radical lifestyle interventions and probably a statin as well to go for the full effect.

    I have been looking at the various studies, hoping I might see some indication that a variation of the low-carb, high fat, diet might have some potential for halting or reversing coronary artery disease for those who already have angina ( usually indicating a 70% blockage)

    From your meta-analysis and from the recent low-carb vs low-fat study, I only see a relative slight improvement.... or as the meta analysis indicated..."Low-density lipoprotein cholesterol ... did not change significantly", "

    and "Our study also found reductions in LDL cholesterol level among partici-
    pants in both groups, with no significant difference between the groups" from the recent study.

    So apparently the low-carb, diet used in this recent study did OK, perhaps even better than the version of low-fat used in this study, where low-fat was still 29.8% of calories.
    But that is like saying I'm heading to hell on a out of control train, but I can slow it down by 2% and thus I end up in trouble slower than on the "low-fat" diet.

    Its just that folks already at 70% or greater blockage can afford the train to keep rolling down hill at all. The need to stop it right now and hopefully back it up.
    What we see in the various results you've provided and in the recent study, are results that don't give any indication they would have that kind of impact.

    So my problem in my analysis it that they don't appear to offer a substitute for for the kind of diet that some others have studied... wherein they appear to have made some headway in halting or reversing existing coronary artery disease.

    Some folks, numbering in the millions, need such a intervention... probably to include a stent.
    Of course this most recent study was not designed to focus on the current problem of the people I am focused on.

    I sort of wish, though don't expect to ever see well funded, a study that would examine the effects a 10% low-fat diet on both the actual arteries (via coronary angiogram, or IVUS), as well as the outcomes, in terms of future cardiac events (heart attacks, bypass operations, stenting procedures, and hospitalizations for serious angina event...etc)

    So, my focus is probably on a different group, though it does include millions.

    The need a answer to avoid progression to bypass surgery, stenting and especially to death by heart attack.
    The studies included in the meta-analysis offer little or no data indicating they would get the help they need.

    I don't have a huge problem with low carb, high fat diets. I've said over and over the work better for weight loss than a 29.8% low fat diet. They may even work better than a 10% low fat diet just for weight loss, over a year or two, perhaps even longer.

    They just don't seem to have any data indicating the would do anything to halt or reverse existing 70% or greater blockages and the associated cardiovascular events.

    Say what you want about the studies by Ornish and Esselstyn, they do indicate their path can do just that. They were not large or well funded studies, but the offer something and more and more doctors are advising them for existing heart patients, if not the general public.

    Show me some similar outcome focused studies using low-carb, high fat, and I'll read and study every sentence, just like I do with those of Ornish and Esselstyn.
    I take little of what he summaries say. I want to read and sift through ever claim. Question the results, etc.

    OK, to long. I'm clearly more narrowly focused on my particular area.
    If folks object, I wish they would supply me with something addressing my area of concern.

    Replies: #18, #19, #22
  17. Wade Henderson
    VERY FRUSTRATING.... I spent time reading my post, but being so long, I ran out of time to correct some obvious errors and typos....
    ------------------------------------------------------------------------------
    Its just that folks already at 70% or greater blockage ***CAN"T (not can)***
    afford the train to keep rolling down hill at all. The need to stop it right now and hopefully back it up.
    ------------------------------------------------------------------------------
    Some folks, numbering in the millions, need such a intervention... probably to include a
    ***STATIN, (not a stent)***
    -------------------------------------------------------------------------------
  18. FrankG
    You have been offered plenty of "something addressing my area of concern" but you appear to ignore it all. It seems you will only be satisfied with a study structured along the same lines as Ornish's but using an LCHF diet, while knowing full well that such a study does not exist.. somewhat of a fool's errand then?

    The fact that such a study has not yet been done, or that it may prove unnecessary if the LCHF approach heads off many cases of Metabolic Syndrome, Type 2 Diabetes, CVD, Alzheimer's before they even start, or that with the current fat-phobic consensus, such a study would not pass an ethical review board, that there are personal stories here from those who already HAVE benefited in this narrow group of angioplasty, stent-requiring angina sufferers.... while you ignore the fact that the Ornish trial was far more of a lifestyle change than simply what people ate... all of these have been pointed out to you repeatedly and yet you persist as if the lack of this study somehow adds weight to the Ornish position.

    If I am in a position to advise anyone with angina or otherwise confirmed CVD about their diet, I'd have no hesitation in advising they eat: real, whole food, local, seasonal and home cooked. Avoid added sugar. Avoid refined, processed (including "juiced") and packaged foods. Avoid "man-made" products... especially anything making an health claim. Don't fear natural fats. Go for quality over quantity. You might want to try eliminating certain foods to see how that makes you feel... wheat and dairy seem to present issues for some.

    If that adds up to a plant-centric diet for some, fish for some and meat for others, or even a range of all of the above, then great... I have experienced and read enough to be convinced this will be better for them that what they currently eat.

  19. FrankG
    Of course, as we are comparing my "diet" to Ornish's "diet", I'd also advise they quit smoking if necessary, limit alcohol to no more than a glass or two per day and preferably dry wine, take up mediation or a quiet hobby which calms the "soul" and clears the mind, gentle daily physical activity at first (such as walking or Tai Chi) but building as they feel able.. maybe add in some weights, seek out supportive people to be around you...

    No doubt medication has some part to play but I'd advise them to seek out an open-minded physician who is not ruled by the consensus guidelines but rather is aware of and follows the up-to-date evidence. Do your own reading on the topic, to become an expert in your own right (at least so far as it affects your own condition) and self-advocate when it comes to the use of drugs and their side-effects.

    Reply: #20
  20. FrankG
    Correction...

    "...take up meditation or a quiet hobby" :-)

  21. Galina L.
    Many folks who are already at 70% or greater blockage just have trouble to stick to a currently recommended regiment. I see it as cruel to offer only most uncomfortable diet option plus a medication which basically speeds-up aging (a statine).
  22. erdoke
    Wade,
    If you don't want to hear us why are you here pretending that you listen?
    I have already warned you about the main issue with the Ornish studies. It is not the outcome neither the size, but the scientifically poor basic design. He changed so many variables that we simply cannot tell where the results were coming from. Don't you want to know what is the main cause of any improvement experienced, so that you could repeat it every single time needed?
    Maybe the same lifestyle changes work with whatever diet that leaves out certain food types. Maybe many of these changes could be left out without a big negative effect, this way not stressing patients as much.

    I suggest that statins are left out from this discussion. It is literally dangerous waters...

  23. Z.M.
    What's up with the citing of Ornish and Esselstyn?

    Esselstyn did not even have a proper control group to being with, and both employ multiple interventions. Where is Ornish's data showing that his program reduces "hard events"? Maybe his diet is even counterproductive, but we wouldn't know because of so many confounders, and to really show that one diet is better than the other you need a direct comparison.

    It would be more sensible to cite trials such as Lyon, which showed large reductions in mortality (and it wasn't due to cholesterol lowering), likely due to diet since other non-diet factors were controlled. What separates this trial from other failed trials is the reduction in omega-6 with increases in omega-3 (total polyunsaturated fat still kept relatively low), and increases in blood levels of antioxidants. However, this strategy can easily be employed on most diets, even low-carb. Also, some saturated fat containing foods may even be beneficial, and it makes no sense whatsoever to avoid them if tolerated (e.g. full-fat milk, cheese and yogurt).

    FrankG above gave good general advice: "real, whole food, local, seasonal and home cooked. Avoid added sugar. Avoid refined, processed (including "juiced") and packaged foods. Avoid "man-made" products... especially anything making an health claim. Don't fear natural fats. Go for quality over quantity. You might want to try eliminating certain foods to see how that makes you feel... wheat and dairy seem to present issues for some."

  24. Wade Henderson
    I see the usual replies. Trashing the imperfect work of Ornish, Esselstyn, and statins... while offering up next to nothing for the millions of people who have significant blockages resulting in angina. Conditions that will slowly or rapidly progress given all of the alternatives you suggest.
    I would include the Lyon study in that group.

    Out of those millions in that situation there are hundreds of thousands or more, who want to take a proactive approach, rather than waiting for the almost inevitable further narrowing of their arteries.
    Growing stenosis for which the other offered alternative is invasive stenting or bypass surgery where one's rib cage is split in half and where brain damage is a known side effect in many.
    Or the ultimate other course, which is a heart attack and possible death.

    But of course those are the normal courses of treatment. No one will fault you for those.
    Better to stick with that than to dare risk that Esselstyn or Ornish might be a effective choice for many. NO, if they can't institute larger and more perfect studies, without confounding issues such as meditation or exercise, then by all means, it would be foolish to even try such a path.

    Better to stick with stenting, surgery, continued pain in your downward decline.
    Or perhaps go to a low-carb, high fat diet, that has nothing I've yet seen to indicate that it can halt or hopefully reverse the steady narrowing of the arteries.

    By all means, don't even think about the Ornish/Esselstyn style diet, because it may not work for everybody. Goodness, I don't even know why Lancet and JAMA even allowed it to be published.

    NO, some moderate Mediterranean diet is much easier to follow and it may "slow" the progression such that the dangers will appear later than they might have.

    Sorry, but there are a growing group of patients and doctors who are more than happy to take a chance that a more intense and real "low-fat" diet, with or without medication, and with or without meditation, may offer a real chance at halting or even reversing heart disease.
    Which, after all, is the single largest cause of death in our society.

    Wouldn't it be awful if a portion of people found something short of surgical intervention that worked?

    Better to stand by your prior assumptions than to take a chance with such imperfect proof.

    Replies: #25, #31, #38
  25. erdoke
    There is nothing else you can do just trash statins if you do understand the mechanism how they act in the body.
    Regarding Ornish and his studies: It is a perfect example that you are in write-only mode and did not come here to discuss anything. I have a strong impression that you don't even understand the meaning of "trashing" when it comes to science. Please try to argue my point made about the poor design of his scientific work. I am a scientist and I don't hate Ornish and god forgive me not even vegans. I have nothing at stake when choosing or recommending a diet other than my own and my family's health. Which is quite a lot in fact, but not in a way that it could alter my clear view of the underlying science.
    On the contrary, your view on curing lifestyle diseases completely misses the point. These should primarily be prevented by avoiding those lifestyle mistakes causing them. Teach the children what to eat and what to avoid, how to reduce sitting all day in a big way, how sleeping well and handling stress is important and we are good to go. If there is already an emergency one has to rely on stenting and surgery, but definitely not on statins and other questionable drugs.
    Reply: #26
  26. Wade Henderson
    "On the contrary, your view on curing lifestyle diseases completely misses the point. These should primarily be prevented by avoiding those lifestyle mistakes causing them. "

    And for the 10 million Americans alone, that now have angina, mostly caused by narrowing, I guess its just too late, they should have taken your advice earlier.
    Now they should just be resigned to their fate and accept surgery, stenting or bypass, and not try to make a lifestyle intervention that might halt or even reverse their condition.
    Instead, just follow dietary plans that may not, and probably won't, slow the progression.

    As to statins, I am aware of the controversy, but I am also aware that the major problems we hear about occur in a subset of patients. Many people take statins without repercussions.

    In various studies, statins alone, and diet alone, are seen to be effective in some, even without meditation or special exercise. Some folks who just don't want to sit around and wait for a bypass, do all these at once.
    From what I can see, you offer nothing else for these folks, except to say they should have eaten better 30 years ago. ( A time, I might ad, when neither you nor the scientific community was aware of all the facts)

    Just how many decades have you been eating perfectly?

    Replies: #28, #32, #34
  27. Christian
    Hi!

    I got a huge question for ya

    Happily dropped again a lot of pounds but hit a stall again...again!!....

    My lowest was 136.1 kg = 299,42 pounds. (Before around 137-138kg = 303,6 pounds)
    Funny, had that only with really high fat amounts (~230g) and really low protein amounts (60-70g). Calories trying to get around 1700kcal, but the lowest weight was on 2400kcal.
    Really dont understand it!? Anyone ideas??

    Now I wanted to up my testosterone a bit, cause after the doc, I am more on the lower third of the normal range of testosterone.
    BUT the only food I saw to raise testo is HIGH protein (and broccoli.)
    What shall I do now?

    Reply: #30
  28. erdoke
    As I said before, there is no perfect scientific answer to this question at the moment.
    If all that you want is my best guess against your guessing, I assume that FrankG's above recommendation is fine. What I would add on top is regular fasting and making sure that fat soluble vitamins are administered in a proper way with a slight emphasis on vitamin K2.
    And again, low carb is much easier to adhere to and usually tastes better as well.
  29. Z.M.
    Wade Henderson: "I see the usual replies. Trashing the imperfect work of Ornish, Esselstyn, and statins"

    It's not about trashing anything, but about providing evidence for claims. There is little evidence that Ornish and Esselstyn's program reduces death from CHD or improves survival. You're providing beliefs, which is fine once you don't pass it off as fact.

    Wade Henderson: "NO, some moderate Mediterranean diet is much easier to follow and it may "slow" the progression such that the dangers will appear later than they might have."

    Why are you so focused on surrogate markers? As Dr. de Lorgeril would say, regression or progression is not an issue; the important thing is to prevent complications. Not only did his diet achieve this, it also achieved reductions in the most unbiased endpoint of overall mortality, giving the result more credibility. Ornish and Esselstyn can gloat about small surrogate changes all they want, but there is no credible evidence that their diets reduce CV death (leading cause of death) or even better, prolong survival. Regression or progression are surrogates, which carry little weight in terms of evidence, and angina is a very subjective endpoint.

  30. erdoke
    Do increase protein in a balanced way: focus on organ meat and collagen, try to avoid consuming big volumes of whey. Add intermittent fasting to the repertoire.
    Be careful with artificial sweeteners. I limit myself to the occasional chewing gum.
    Reply: #46
  31. FrankG
    "I see the usual replies. Trashing the imperfect work of Ornish, Esselstyn, and statins... while offering up next to nothing for the millions of people who have significant blockages resulting in angina. Conditions that will slowly or rapidly progress given all of the alternatives you suggest."

    Now you are just trolling Wade.. pure and simple. Your choice of words is emotive, hyperbolic and downright misleading.

    Do YOU have angina? Why the fixation on this?

    I have Metabolic Syndrome with Type 2 Diabetes... I am considered to be in the same CVD risk category as a man my age who has already had an MI. Guess how I eat?

    Show your evidence that these "Conditions that will slowly or rapidly progress given all of the alternatives you suggest."... especially given that an LCHF approach has been demonstrated to IMPROVE all the health markers related to CVD. You have NO basis for such a claim other than the old, outdated, consensus... which is not based in evidence.

    Where is YOUR study demonstrating that LCHF worsens CVD?

  32. FrankG
    "Instead, just follow dietary plans that may not, and probably won't, slow the progression." On what basis do you make this claim / threat ?

    Again where is your evidence that LCHF is harmful in a CVD context?

    You are bringing nothing new to the table.

    Endlessly repeating "Orniltyn, Essnish" like some kind of mantra, does not make a rigourous study out of their poor science... say what you will.

    If your trial includes multiple interventions, you cannot conclude that any one of them was responsible for any outcome(s). This is fact, not trash.

    Remember the HRT debacle: where it turned out that the HRT was actually killing women but their other healthy lifetsyle changes were masking this result?

  33. Cindy C
    As a side note, LCHF reduced my chronic pain. NSAiDS are linked to heart attacks and strokes.

    http://www.arthritistoday.org/news/nsaids-heart-attack-stroke-risk114...

    A search will show ketosis reduces pain, and. staying away from sugar and wheat also reduces pain for many. Less, or no pain relieving drugs will be needed..

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4124736/

  34. Paul the rat
    @ Wade,

    Please PubMed the following:
    Metabolic Heart Disease - oxidative stress
    Ketone bodies - oxidative stress
    glucose metabolism - oxidative stress

    This is a good start. Do some reading, draw your own conclusions and please let us know.
    p.s.
    I have the nudge that you won't - because you are a troll, you are not genuinely seeking how this World of ours works with an open mind, are you ?. We went through all these motions more than a year ago , remember?

    One more thing, please let me know if you find a person whose heart conditions deteriorated due to well design and diligently followed LCHF diet.

    Reply: #39
  35. tony
    Good point! You can't blame lchf for weight gain if you stop eating lchf.
  36. erdoke
    Zoë Harcombe's analysis of the paper. Nothing really new, but a good overview and a link to the full article.
    http://www.zoeharcombe.com/2014/09/the-low-carb-vs-low-fat-study/
    What I would add is 2 things:
    - Keep in mind that low carb works usually better for males and this study was done with 90 % females.
    - The low carb group was advised to limit carbs to 40 g NET! They were far from that throughout the study at around 100 g net and still came out way on top of the officially recommended low fat diet. Who by the way managed to keep energy intake from fat below the 30 % upper limit.
    Reply: #37
  37. FrankG
    Most striking for me were the differences in body composition: the "establishment voices" seem to always focus on just "weight", whereas the LCHF approach seems to favour reduction in excess fat mass, with this trial actually observing an INCREASE in lean mass... despite almost twice the "weight" loss of the recommended (typifying public health advice) low-fat diet.
  38. NS
    Beautifully written, compelling. Yet people here don't want to hear that message. They are ALREADY sure which method is best. A pox on your house for disturbing their tranquility. Perhaps when they're in the ER with breathing difficulties, they'll reconsider their conclusions.

    In the meantime, we can see clearly here that eating a highly LCHF/ketogenic diet, fat, north of at least 80% of total daily caloric intake, is the BEST way to lose weight and stay healthy, despite the astronomical LDL-Ps and increasing FBS levels. It's all about the insulin and pure fat produces no insuin response!! Yet somehow, Keto Clarity ketogenic guru Jimmy Moore has now found a way to PROVE to us, for those interested in seeing and hearing, that it is indeed possible, perhaps even easy, to gain on such a high fat regimen. Then again, perhaps it was the (infinitesimal) carb load in the eggs that was the problem. Maybe he wasn't eating enough fat!!

    http://www.news4jax.com/news/lowcarb-dieting/27895582

    Compare to this:

    http://www.youtube.com/watch?v=6yo9E3lFRAk

    Incidentally, Seth Robert's recent demise comes in the face of his rather stellar calcium heart scan results, the same type of results Jimmy is boasting about in the above clip.

    Replies: #40, #41
  39. NS
    Here is your answer, if you're in fact interested:

    Half a stick of butter and many grams of flax oil, daily.

    http://blog.sethroberts.net/2014/05/10/cause-of-death/

    http://blog.sethroberts.net/2013/03/31/better-balance-and-gums-from-f...

    Reply: #42
  40. murray
    Wade is compelling insofar as he concedes there is nothing conclusive either way. Other than that he presents a false dilemma. He is simply not compelling regarding low-fat, Ornish-style diets. My father had a stent put in about 10 years ago, so I seriously re-evaluated my diet and lifestyle. I went from low-fat, no processed foods to high-fat, low-carb based on all the evidence and applying critical thinking skills. I went from ample endurance exercise, with a 42 resting heart rate, to much more moderate cardio (based partly on discussions with a biomedical engineer researching heart arrhythmia and various studies on marathon runners).

    That is, I looked at the evidence and changed my mind, as a result of the evidence and critical thinking. I am not type 2 diabetic and don't have to be keto, but the evidence favours it and the results for me have been unexpectedly positive, improving things like skin health and reversing tinnitus.

    I would never claim that the low-fat regimes of Ornish and others cannot have positive effects. Perhaps they do. But that does not in any way dispel ketogenic LCHF as an effective dietary lifestyle, either in terms of preventative or restorative treatment.

    I should add that my father went on statins and an Ornish diet. Within a year his memory was so badly affected he would tell the same story at the same sitting of dinner. He got off statins and added fat back into his diet and recovered his memory, although not fully. No issues with CVD or heart events since then.

    Reply: #43
  41. erdoke
    First of all it is important that we are only talking about natural whole foods and only after making sure that nobody is gorging on margarine or white bread can we discuss the rationale behind different macronutrient ratios. One can reach a certain fat-protein-carbs energy ratio by eating only processed ham and butter for example, but that's obviously not something anybody here would administer to his dog.
    Bringing examples of people following a diet without proper understanding and without listening to their bodies' needs is similar to any of us coming with Ornish and Steve Jobs and the subsequent superficial conclusions. I respect your precious time, please mind sparing some of mine as well...
  42. Paul the rat
    Thank you, acknowledged. I would love to see his medical history, details of his diet and diet execution. This is why it is important to tailor LCHF diet to the specific conditions.
    p.s.
    from personal experience - more that 1% of total energy from flax oil is pushing the luck (some people can handle it of cause)
  43. Wade Henderson
    Murry, Look, we're both searching for the dietary intake that gives us the best chance for a healthy outcome.

    I was examining the low-carb, high-fat, way of eating, to see if there is any evidence that it would take a typical individual with 70% or greater stenosis (the minimum for angina in most arteries, in most people) and either halt or reverse their narrowing.

    I don't think the changes in your own particular situation address this, because you were never diagnosed with such a condition.
    Apparently your father was, and after having a stent placed, he temporarily did Ornish and a statin. He had possible side effects from the statin, and or the diet combination. Now, for several years, he is on a more normal diet of some sort (unknown) and no longer take a statin.
    Thus far, his dangerous artery which was stented, has not re-occluded. That is excellent, but as you know, it is a anecdotal report of 1 individual. In studies there are people in the intervention group who fail on the Ornish diet, and there are people in the control group who don't progress. That is why I can't go on just one person's results.
    I know none of the details of your fathers blockage,, nor his current diet, or anything else.
    I'm glad he is doing well at whatever age he is.
    My mother lived to 97 , never exercised and never restricted her food intake, except she never ate too much. I'm sure the cause of her death was heart related, but only due to age where it just finally gave up.

    Now, I do wish you could include something you allude to when you say the following...

    "I would never claim that the low-fat regimes of Ornish and others cannot have positive effects. Perhaps they do. But that does not in any way dispel ketogenic LCHF as an effective dietary lifestyle, either in terms of preventative or restorative treatment."

    "either in terms of preventative.....or ---RESTORATIVE treatment---"

    Regarding coronary stenosis, do you have any link to a study showing that LCHF dieting will halt or hopefully reverse a stenosis over 2 or 5 or more years?

    That is the kind of thing I am looking for. My feet are not in cement, but I need something more than anecdotal reports to give a indication that LCHF will accomplish the reversal or even halt the progression long term.
    It may be that it could, but I'd need a study to base a hunch on.

    As much as we can knock the imperfect Ornish and Esselstyn studies, they have put out something addressing the situation that millions face this minute. They offer a hope that a certain way of eating will or might produce measurable results.

    I might add that the hugely funded atorvastatin and Crestor firms, also have produced some results.

    Of course I read ALL those studies, both from those doctors, and those funded by huge drug companies, with a skeptical eye.
    Still the totality of the science indicates that there is a way to halt or reverse stenosis in the majority of patients who fully follow their programs.
    Though imperfect, its all I have to go on.
    We all are doing the best we can based on all the evidence we can gather.

    At some point, you have to choose a path. Just doing the same old lifestyle clearly leads many to poor outcomes.

    Reply: #53
  44. George
    My husband George is having trouble keeping his sugar down and doesn't want to have to get on insulin. PLEASE if you can tell us some foods he can eat and not cause his sugar to stay high. It's been between 80- 150 for a long time and in the past 4-5 days shot up to 389 and now only down to 266, YES he is on several meds for the sugar along with Victozia.
    Please if you can give me some recipes or foods. We both are over weight so I'm sure this will help both of us to take pounds off.
    Reply: #45
  45. Christian
    ok so I up protein to around 150g? what about calories? keep or lower?

    should I start to workout again? used it before for 1year but only lost 2kg :/ due to low fat approach. how good is the fat loss with ketogenic and workout?

    just unsure :/

    IF? but I am already quite low with calories.. and I tried it but felt more crancky and sick than with low calories :/

    AS is a really good point but I just love my coke zero so much :/

    Replies: #50, #51
  46. Gillian
    Statins are shown to reduce cholesterol levels but this doesn't seem to be foolproof for heart health, other studies show that its not about the levels more about the size of the cholesterol particles, and the ratio between good and bad. .My husband had a triple bypass,(age 65 in 2012) and was given statins by his doctor, after a few months he was troubled by cramps, feeling unwell and always being really tired and bad tempered, on removing the statins and upping his healthy fat intake and lowering carbs somewhat, plus CoQ10 and multi vit B caps he is back to normal, his doctor still threatens that he will die if he doesn't get back on the statins! By the way his heart health is better than expected by physicians.
    Reply: #49
  47. Francois
    Gillian,

    We all will die one day. But it is totally false that anyone will immediately drop dead from stopping statins. Your husband technically is part of the very small group of people who should - albeit arginally - benefit from statins. But it is obvious side effects are extremely important. I suggest you look up the blogs of two of my colleagues, John Briffa and Malcolm Kendrick. You will find a mine of info on statins in the various blog entries.

    Just as a matter of interest, while it is true that statins reduce by 30% the risk of cardiac death (in high risk individuals), this is in relative numbers. In fact, the difference saves one person out of 100, not 30 out of 100. There is an enormous difference between relative risk and absolute risk.

    As statins cut the tree to get rid of the cholesterol branch, your idea of taking co Q 10 (use the active form Ubiquinol, not Ubiquinone, the inactive form. You'll prevent the risk of heart failure. This is denied by the pharmaceutical companies, but has been clearly demonstrated in the litterature. My personal experience is that it is possible to reverse statin-induced heart failure.

    Good luck.

  48. Leo from DietBeMedicine.com
    Gillian,

    Any purported benefits from statins could be due to its anti-inflammatory effect than cholesterol lowering.

    There are anti-inflammatories out there which is stronger than statins without the side effects. Look into Nattokinase and Serrapeptase. They lower the C-reactive protein as well as relax the blood vessels. Serrapeptase eats away the arterial plaque too.

    My mother in law had heart failure with the associated symptoms of heart palpatations, tiredness, breathlessness, and pains.

    I gave her Ubiquinol 300mg, Serrapeptase 120,000 SU, Nattokinase 2000 FU. All her symptoms are now gone, and she swims 600 meters 3 times a week with no problems.

    We ultimately have our best interest at heart. We are responsible for our own health. Don't let the doctors bully you into doing what they ask because of their policy and procedures.

    Reply: #52
  49. Galina L.
    Exercise has many benefits, especially anaerobic types and high intensity interval training (HIIT), it is better to keep it in your routine without particularly counting on it as a weight-loss tool . It takes time to be adopted to the exercising in a fasted state and on a LC diet. IFing doesn't mean you have to limit your calories,but rather eating following a eating certain pattern, like 2 - 3 meals a day within 8 - 6 hours without snacking between meals (for example , first meal is at 10 am, last meal is over by 6 pm).
    Unfortunately, no one will be able to guide you step by step. Check the Dr.Andreas blog "how to loose weight" articles, go to the blog of Dr.Eades proteinpower.com - you will find a lot of information there. Also, you have to remember, many people stall in their weight-loss farther from their goal because their body fights it.
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