New major study: a low-carb diet yet again best for both weight and health markers!

Midsection Of Woman Smiling While Adjusting Weight Scale

Is it harmful to eat a low-carbohydrate diet for weight loss? Or is it even HEALTHIER than the current low-fat dietary advice?

A major new study published today further fuels the debate and has already made major headlines. In the study 148 people were told to eat either a low-carb diet (under 40 g of carbs per day) or a low-fat diet, for one year.

The results are similar to those in previous studies. Once again, those on a low-carb diet lost significantly more weight, in this case three times more:

Skärmavbild-2014-09-02-kl.-08.01.14-800x261

Dashed line = the low-carb group

Those who ate a low-carbohydrate diet also lost more fat mass.

What will upset people the most is that the low-carb group also got better cholesterol levels than those in the low-fat group! As usual, they got more of the good HDL cholesterol, lower triglycerides and an improved cholesterol profile (total/HDL). As if this wasn’t enough, the fat eaters in the low-carb group received a significantly lower risk assessment for heart disease according to the 10-year Framingham risk score!

In addition, the low-carb group got significantly less inflammation in the body (measured as CRP).

Finally, conspiracy theorists don’t get any support that “the meat industry” is behind all studies showing that low-carb diets work best. This study was funded by American tax dollars (through the National Institutes of Health). None of the authors have any financial ties to the industry.

Even before this study the results were nearly unanimous that a low-carb diet provides a better weight and better health markers than today’s low-fat advice:

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

After today’s study the truth becomes even clearer. It becomes even harder (and more embarrassing) for people to stick their heads in the sand.

When are people with weight problems going to receive scientifically sound dietary advice from most health care professionals? Hopefully soon.

The study

Annals of Internal Medicine: Effects of Low-Carbohydrate and Low-Fat Diets: A Randomized Trial

Big headlines:

TIME: For Weight Loss, Low-Carb Diet Beats Low-Fat
New York Times: A Call for a Low-Carb Diet
Reuters: Low-carb diets may beat low-fat options for weight loss, heart health
Washington Post: Low carb diets more than low fat ones may help protect against heart disease
USNews: Low-Carb Beats Low-Fat for Weight Loss, Heart Health: Study

Try it yourself

A low-carb diet for beginners

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135 comments

  1. Tiziano Solignani
    Would you suggest a simple SKD or rather a CKD amongst low carb diet?

    Thank you.

    tiziano solignani, da  iOS - http://blog.solignani.it - http://www.parolesottovetro.it

  2. erdoke
    No surprises there.
    I could not find more detailed info on the dietary guidelines applied, especially in the LC group. Was it ad libitum everything, just carbs restricted to <40 g/day?
  3. Sanyog
    I am sorry to say but somehow you have never highlighted the cardiovasuclar risk such kind of diet ( Low carb diet with a lot of meat/egg intake) entails. Clearly, eating a ton of meat is not a healthy choice even if you can get good long term results in weight loss. Low Carb diet still works but clearly one has to focus on what kind of protein he/she intakes. Eating a lot of meat or even eggs is not the answer. Here is the link to a recent research which explains it in detail:
    http://www.bmj.com/content/344/bmj.e4026
    Reply: #9
  4. Leo From DietBeMedicine.com
    @Sanyog,

    The research you linked is an observational study, where participants send in their responses via mail. At most it could only be used as hypothesis generating, not hypothesis testing.

  5. Sanyog
    @Leo
    Thanks a lot for your response. Do you know of any study that refute this hypothesis? I was having a discussion with my girlfriend over this study ( She gave me the link to it in first place). I would like to mention that I have been a fit individual all my life and I am only looking for answers here. I want to understand what is healthy and what is unhealthy for our body,
    Cheers
    Replies: #8, #26
  6. MikeW
    It's sad that with such clear results, the official conclusion of the study was that "Restricting carbohydrate may be an option for persons seeking to lose weight and reduce cardiovascular risk factors".

    "may be an option"? Is that timid statement the best they can do? I think there are plenty of heads still firmly stuck in the sand.

  7. Robbin Hayman
    LCHF is NOT about eating more meat or protein. That is a common misunderstanding. Protein content should remain the same more or less. It is the amount of dietry fat that replaces most of the carbs, thus avoiding high BS, insulin spikes and the corresponding systemic inflammation in the cardio vascular system together with increased fat storage.
  8. Galina L.
    There are so many studies on the subject that the SBU (Swedish Council on Health Technology Assessment) spent two years looking through all accumulated data in order to come to a clear conclusion.( https://www.dietdoctor.com/swedish-expert-committee-low-carb-diet-eff... ) As far as I remember, they went through 10 000 studies.

    "Recent cautions on low-carbohydrate diets are at best based on statistical associations derived from food questionnaires from people who didn’t (!) eat a low-carbohydrate diet. The SBU also dismisses these warnings:

    Most of these studies suffer from major shortcomings, which make them difficult to interpret. The foremost shortcoming in these studies is that it’s often impossible to determine whether those with the lowest intake are knowingly eating a moderate low-carbohydrate diet for health reasons, or if they are high consumers of fast-food."

    http://onlinelibrary.wiley.com/doi/10.1111/j.1467-789X.2012.01021.x/a...

  9. Tyrannocaster
    The helpful diet is a LCHF diet, not a LCHP diet. I don't understand why people have trouble understanding this concept; this is not a high protein diet. This article says the two diets used in the study were low carb and low fat; protein was not mentioned.
  10. Sanyog
    @Tyrannocaster
    In case you didn't realize, the diet mentioned on this website which is LCHF is also high on protein as all the subsitutes for carbs which are high in fat are also high in protein. But again, I am only looking for answers here and I am not trying to make any big claims.
    Cheers
    Replies: #11, #16
  11. Lori Miller
    High in protein compared to what? Low-fat vegan?

    Re: the study you posted a link to. Click on the Responses tab and you'll see many criticisms of the study: the well-known problem of poor reporting in food questionnaires, the associations are barely statistically significant, there was no follow-up on the food questionnaires, and the length of time (15 years!) from baseline to incident is absurd--most people change their eating habits over 15 years.

  12. Alan
    I initially thought you were being deliberately obtuse but now I think you have comprehension problems.
    Where did it say you have to obtain fat via protein?
    Ever heard of butter, olive oil, lard, coconut oil, cream etc?
    Reduce carbs, keep protein the same or slightly less and increase fat (not fatty protein), butter coconut oil and you're good.
  13. Saundra D.
    I have been eating a low carb diet for almost 2 years. I have lost weight but now find myself at a standstill. I have not lost any additional weight for over 6 months. I only would like to loose 10-15 more pounds to be at my goal. I have gone very low carb (25 grams) for two weeks to try and jump start my weight loss but lost nothing. Any pointers or tips you may have would be great. Thanks.
    Reply: #18
  14. Antje
    Saundre D.
    I had the same problem. I had to reduce my carb intake to 20 grams and drastically increase my fat intake to 80 percent of my food intake, give it a go.
  15. murray
    I don't recall seeing any high protein advice in this forum. Yes, high-quality protein, but not large amounts of protein.

    My personal belief is that it is better to get fat in natural form, such as fat stored in animal cells. So I prefer fatty cuts of meat, but only if it is high quality, such as grass-fed non-grain fed beef or other ruminant (especially lamb), legs of pastured chicken, duck or goose, or wild salmon. If the provenance of the meat is unknown, I get the leanest cut and add Bearnaise sauce, avocado mousse (avocado, egg yolk, olive oil, citrus juice, spicing) or some other source of good fat.

    If it comes to a choice between eating more than about 75 grams of protein in a day (I weigh about 75 kilos, about 7 percent body fat), then I go for fat instead of more fatty protein. The fats in 100% chocolate are good fats, for example. Macadamia nuts are always a treat. Lots of options.

  16. erdoke
    I still do not realize this. Any reference to such recommendation?
    I myself strongly advise against gorging on lean meat. We should go for organ meats, bacon, skin, brain, etc. Eggs on the other hand are perfectly fine. Just read the story about the guy eating 2 dozens per day for at least 15 years (he could not tell precisely for how long).
    It's all about nutrient density. One portion of liver, eggs, shellfish, brain, etc. are simply unmatched by anything from the plant kingdom when you consider all the included nutrients.
    One tablespoon of cod liver oil contains similar amount of vitamin A and D to several bowls of vegetables. Furthermore if you are genetically on the poor side of covering carotenoids to vitamin A, it is almost impossible to take sufficient levels without supplementation.
    Reply: #17
  17. murray
    Salmon roe (caviar) with breakfast. Lamb liver for lunch. Venison heart for dinner. Today I'm having plenty of nutrient dense foods, but not large portions. I don't need large portions, as the nutrients in modest portions satisfy all yearnings.
  18. Galina L.
    It is a myth that any one can loose as much weight as one wants on any diet even on a LC diet. Try tips on that particular blog "how to loose weight" http://www.dietdoctor.com/how-to-lose-weight , or may be experimenting with an intermittent fasting will move you from your weight-loss plateau for a while, but most people do not arrive exactly toward their goal, they loose weight, but not as much as they wanted. Consider yourself lucky that you stall within 10-15 lbs from your target weight, not 50+. Body resists weight loss with a very efficient set of actions, and it is better to keep in mind that keeping your weight loss is often harder than the weight loss itself. I believe many will benefit from reading the blog of a young nurse who lost 160lbs and still thin after 10 years of following a LC diet. http://itsthewooo.blogspot.com/2014/08/counting-calories-useful-and-n....
    It looks like increasing fat in your diet is not always a good thing further in your diet when you have reached a weight stall, at some point the people who want to loose more fat should consider eating less in general. I highly recommend avoiding daily bulletproof coffees with way too much fat, eating "fat bombs" between meals, eating any snacks between meals - snacking IS the feature of a low-fat diet, you should last comfortably till your next meal. LC food is very nutritionally dense, eating often often leads to overloading your body with nutrition. Do not think that blog posts about young males eating 5000 calories a day of LC food and loosing weight has any relation to you, especially if you are not a young male. Try to eat only meals, no more than three a day, mostly eggs and fatty meats with veggies, think about morning coffee as a meal, really limit any dairy and nuts. Unfortunately, even though upping fats and cutting on carbs worked as a magic when you started your diet, it doesn't mean going farther in that direction will necessary produce more magic. Often your tactics should be changed as well.
  19. Vicente
    The people following the low-fat diet lost weight but gained fat mass, so am I wrong or they mainly lost muscle?
    Reply: #72
  20. Wade Henderson
    For people who want a more objective look at this study, done by someone who actually read the entire study, you might look here.

    http://www.linkedin.com/today/post/article/20140902121017-23027997-di...

    Now, compare that analysis to that of the Diet Doctor's "unbiased" analysis....

    "After today’s study the truth becomes even clearer. It becomes even harder (and more embarrassing) for people to stick their heads in the sand."

    Replies: #21, #27
  21. FrankG
    And what exactly is it about Dr David L. Katz that makes him "more objective" and "unbiased" than Dr Eenfeldt? That his views more closely match your own Wade?

    Feel free to read all the second opinions you wish, while, of course, always being wary of the writer's motivation... meanwhile the evidence is becoming ever stronger that LCHF is not only an effective way to manage excess fat mass but it also does so with improved health markers; when compared to the establishment's favoured "diets".

    It does indeed become "even harder (and more embarrassing) for people to stick their heads in the sand.

    When are people with weight problems going to receive scientifically sound dietary advice from most health care professionals? Hopefully soon."

    Reply: #22
  22. Wade Henderson
    Frank, I've never really doubted that the average person could lose weight more easily and faster on a LCHF diet. I think studies and practical experience show that.

    However the continued use of 30% of calories as fat as the marker for a low-fat diet is just absurd.
    Why use a diet that cuts fat by only a fraction from 37%, when the low-carb diet cuts its marker massively...about 80% from the norm?

    However, even if a low-fat diet was done using 10% of fat as calories, I still believe that over 6 months or a year, the LCHF diet would still achieve better weight loss.
    Continued for 5 years or more, I seriously question what the health affects would be for both diets.
    Not that the LFHC would't still work better for a select group, but I would question whether it would work better for the general population.

    Further, would love for their to be a study following 200 or more diagnosed heart patients over 3 to 5 years.
    Group one, LCHF and group two 10% fat (with both eating lots of veggies).
    In other words, if I was a cardiologist and had to give my patients the best advice, what would it be.
    Granted, heart patients are a select group, however for most who enter that group, their first sign of trouble is either a heart attack or some mild angina... at which point, they already have a blockage of 70% or greater. A extremely common occurrence in Americans age 50 and above.

    So, I wish a study would be done on that group by advocates of LCHF.

    Which diet would be best for that cardiologist to advocate, either after diagnosis, or 15 years before? I don't think meeting certain Framingham calculator points after 12 months gives a good picture of what will happen after 5 or 15 years on such a diet.
    At 12 months however, ANY diet that induces weight loss will give good cholesterol numbers.
    High fat or low fat.

    Perhaps Taubes and Attia's new group NuSI will some day address some of these points.
    Thus far, their 3 proposed studies they will fund, don't look at those millions who already have early heart disease.
    See 3 studies at the end of the Wired article
    http://www.wired.com/2014/08/what-makes-us-fat/

    Replies: #23, #24, #71
  23. erdoke
    10 % fat is crazy and anybody recommending that has no clue about basic physiology. Below 30 % fat that was actually advised to one of the groups is low and pushing significantly lower might easily compromise health in a different way. You know, essential fatty acids, fat soluble vitamins, etc. You do need fat while there is no short term need for ANY carbs. So arguing that "low" means different values for fat and carbs is just insane. Again, it comes from basic human physiology.
    I'm half way into the critics you linked above and the guy is just shooting claims without any evidence. Sometimes just plain lies like this one:
    "A truly “low carb” diet is, of necessity, low in all plant foods
    It is clear he knows nothing about what he is fighting against. Low carb can mean many things just as low fat can. I could easily do a low carb at or above 90 % plant based, although it makes not much sense, especially that there is no supporting evidence to do so.

    Another very important parameter when putting people on long term diet(s) is adherence. Your suggestion of 10 % fat vs. 10 % carbs while fixing protein around 15 % not only crazy because of the extreme difficulties to provide all essential fats and fat soluble vitamins to the poor low-fat guys, but they would be always hungry, craving different things. Ad libitum carb restriction on the other hand just works fine. You feel full, can get along nicely with only 2 meals a day, etc.

    Reply: #25
  24. FrankG
    So... no reason as to why we should consider Dr Katz any "more objective" or "unbiased" than Dr Eenfeldt
  25. Wade Henderson
    erdoke, I understand completely.

    Eating only 10% or even 15% of calories as fat, is "crazy" and extreme

    While eating 40 grams or less of calories from carbs is normal.

    Yes, you've made it all clear and objective.

    Replies: #29, #32
  26. Leo from DietBeMedicine.com
    @Sanyog, In response to 'Do you know of any study that refute this hypothesis?'

    So what if there is no study to refute this hypothesis? If there is no study to refute this hypothesis, are you taking this as evidence to support the hypothesis? If you are, its called appeal to ignorance (in which ignorance stands for "lack of evidence to the contrary"), is a fallacy in informal logic. You have to be very careful to using observational studies for conclusions. Ancel Keys used his observational study of the 7 countries to conclude fat consumption increases heart disease risk and we can see what that led us.

    Like i said before, observational studies can only generate hypothesis. There are also observational studies which provides an correlation between increased meat consumption and reduced heart disease e.g.

    http://www.ncbi.nlm.nih.gov/pubmed/17069878?dopt=Abstract

    Regarding red meat consumption, the study found that for every 100 grams per day increase in red meat consumption, the risk of heart disease decreased by 31%.

    How about observational studies on egg consumption:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2386667/

    Quote from study:

    'Our data suggest that infrequent egg consumption does not influence the risk of CVD and only confers a modest increased risk for total mortality in male physicians. In addition, egg consumption was positively related to mortality and such relation was stronger among diabetic subjects in this selective population.'

    Moreover, eggs have been clinically shown to improve our CVD blood markers i.e. HDL increases, and LDL particles changes from small to large: http://www.ncbi.nlm.nih.gov/pubmed/19369056

  27. Dr. Andreas Eenfeldt, MD Team Diet Doctor
    Sour grapes...
    Reply: #28
  28. Wade Henderson
    Andreas, I have no doubt that over a year, the LCHF diet will prevail for weight loss.
    I dare say it will prevail even against a 10% low fat diet over that same one year period.

    But here, I have a question for you.

    If you have a group of patients who have been diagnosed with CVD, specifically those with some angina and blockages of 70% or greater ( the minimum for such angina to appear in most arteries).

    Look out 3, 5, and 10 years or more, would you still advise that subset of patients to follow a LCHF diet to halt or possibly reverse their cardiovascular disease.
    Or would a 10% low fat diet be more advisable for the millions of people in that situation.

    And if you have a strong opinion about that condition, which millions are faced with, please give a study or article that backs up the advantage of a high fat diet for those in that situation.

    While that was not the focal point of this latest study, I don't believe I have ever read anything by you regarding the millions of people with that set of conditions.
    (Age 50+, with one or more blockages of 70% or greater, with stable angina)
    Low carb high fat diet, or 10% low fat diet for them? (similar to Ornish, Esselstyn, etc)
    Surely you must meet with patients in such a condition.

    What do you advise them?

    Replies: #30, #33
  29. erdoke
    I don't intend to be rude, but it seems that you so lack some basic understanding of human physiology. Without starting up a short course, here are some facts. Please try to put the pieces together.
    - The human body contains between 16-22 % fat when fit (significant difference between men and women).
    - The human body contains around 1-2 % carbohydrate regardless of how fit it is.
    - The human body can utilize both fat and glucose as sources of energy.
    - The human body can store hundreds of pounds of fat and only 1-2 pounds of carbohydrate energy.
    - The human body needs some fats that it cannot synthesize or only with low efficiency from other macronutrients/fats. Even if it is able to convert one fat to another, there is no way to build everything from carbs.
    - The human body can synthesize glucose mainly from the following substances: glucogenic amino acids, glycerol, lactic acid, pyruvate. Note that glycerol comes from fat stores (triacyl-glycerol) and lactic acid comes from anaerobic oxidation of glucose.
    - To prevent the perfectly natural process of above (called gluconeogenesis), the human body requires 50-150 g glucose from the diet daily. The amount depends on type of physical activities, fat adaptation and individual variables. It is no problem to have 40 g from the diet and build another 40 g from above compounds if the need is 80 g.
  30. Vicente
    I suppose you have a study that says a low-fat diet is better than a LCHF for that condition?
    Can you give me a RCT reference, please?

    If you haven't that reference you would be risking lifes if you advise them a low-fat diet. Would you do do that?

    What do you advise them?

    Reply: #34
  31. Sanyog
    @Leo Thanks for your reply. So far we have only observational studies at our disposal, so this means we can only generate hypothesises. Then how can we prove a certain hypothesis to be true or false? Plus all these studies will have data asymmetries, temporal asymmetries and all other kind of differences in the data observed, which can lead to a case where one study proposes a hypothesis and other study proposes an anti-hypothesis :).
    Cheers
    @Alan I don't know how good is your comprehension but in the LCHF for beginner guide, it is stated that you can eat as much as of meat, eggs etc and it is no where stated what percentage of fat you have to eat and also no guideline that you have to eat only certain amount of meat or eggs. So if someone is only eating meat and eggs, he/she is still technically on LCHF. And please next time, be a little more thoughtful before throwing illogical allegations. LCHF only implies that the food you are eating is high on fat and relatively low on carbs. It doesn't mean that it can't be high on protein.

    I have been on LCHF for past 1 month and so far I have decent results. I didn't start LCHF to lose weight but to try a new way of living. So far I have gained decent amount of muscle mass while losing fat at the same time. But I suppose I will reach a platue sooner than later.

  32. murray
    Wade, it depends what you mean by "normal". It is not normal in the sense of "common", to be sure. However, it is plain that most people have adaptations to go into nutritional ketosis below around 25-50 grams of low-GI carbs per day. So the body has an incredibly complex set of adaptations for a profound metabolic shift (that, incidentally, has numerous benefits) when carbs are low. It is a good thing, or we would not have survived the Ice Age or long winters where there was only game to live on and no plants to forage. So in the sense that LCHF is a state for which the body has elaborate adaptations in genes activated by a shift in nutrients (just as the body has different elaborate adaptations for higher levels of dietary carbs) this indicates that LCHF is a distinct adapted state of the body and thus "normal" (according to a norm of adaptation).

    The body does not appear to have elaborate adaptations for dietary shift to 10% dietary fat. For example, I have not seen any evidence for up-regulation of the conversion of ALA to DHA, or of vitamin K1 to K2. To qualify as "normal", one would expect different genes to be activated by very low dietary fat to make up for the diminished consumption of fatty acids. I would expect the store of body fat to supply some of these for a time, as fasting is a low dietary fat state where the deficiency is met for a time by stored fat. I suspect that long-term very low fat people get by by cheating from time to time. But unlike low-carb, where there are metabolic pathways that take over to supply bodily glucose requirements, there does not appear to be a special set for very low dietary fat.

    As to which route to take with arterial blockage, plainly a different route than the route that got you there.

    Any diet that eliminates starch and sugar would likely help.

    I haven't seen convincing scientific studies on this, but William Davis reports plenty of success on LCHF with patients. One patient went from severe aorta blockage to restored 95% flow following LCHF with vitamin K2 supplementation. My own father had a stent procedure for partial blockage and has gone low-GI carb and higher fat and seems to be doing fine after 10 years, now in his late 70s.

    I would say no question I'd go keto LCHF (with plenty of K2 from cheese, the MK-4 form, along with MK-7 supplementation) if I developed arterial blockage. But I am keto LCHF now, so I would have to revert to principle one: change the route that got you in trouble.

    But, as it is, I am 55 and everything seems fine. Blood pressure has gone from borderline high ten years ago on low-fat, no processed food, to borderline low on LCHF. HDL improved. Triglycerides improved. CRP below measured range. Lp(a) below measured range. etc. I did a two-hour mountain bike up and down a ski hill on Sunday with my son, with plenty of zip. (You can tell a good mountain bike trail when your heart rate is higher going downhill than uphill.) As to sustainability of keto LCHF, I've been LCHF over 8 years and keto-LCHF about 6 years.

    How long do I need to go before the diet is sustainable and safe? It seems the goal posts keep changing.

    The biggest news here is that the study was funded by the NHI. !!! Not long ago it would have been unthinkable that NHI would fund a study that might show benefits to LCHF. Now that the LCHF benefits are becoming more apparent and more widely recognized, perhaps your wish-list of studies will be in the works soon.

    Reply: #37
  33. FrankG
    So here we have a way of eating (LCHF) which has not only been demonstrated as an effective way to shed excess fat mass for a great many people but has also been shown to improve other health-markers, more so than other diets... those self-same health-markers which our Doctors look to when deciding our risk for CVD

    Is your position that promoting this way of eating would be a bad strategy for patients with CVD? Based on what logic?

    Are you parroting the "we don't know the long-term risks of LCHF". Implying that despite being safe and beneficial in the short-term (12 months or much longer for a great many of us) it is somehow dangerous in the long-term? How is eating real, whole food, local, seasonal and home-cooked, dangerous? Please back up your reasoning with studies.

    I have Metabolic Syndrome, including Type 2 Diabetes, so I guess I'm right up there in risk factors for CVD. Now you guess how my BGs A1c, BP, lipids, excess fat mass, muscle size and tone, dental health, hair, skin etc.. etc... has improved with LCHF over more than 6 years now... but OH NOES we don't know the long-term risks!!!

    Your alternative is what? Low-fat? Low-fat vegan perhaps? What? Where are the long-term studies to show the safety of your approach? The mass-experiment with low-fat so far, seems to be a dismal failure but then I guess we didn't do it right.

    It is laughable how a 12 month diet trial, demonstrating the superiority of LCHF, is sloughed off with these patronising criticisms, when if the advantage had gone to low-fat, this would have been hailed as yet more significant proof of the blessed low-fat way.

    I agree... sour grapes. And I'll add another, double standards.

  34. Wade Hendersond
    Vicente, As I suppose you know, RCT (randomized controlled trials) in this area are quite difficult when asking one set of people to do a diet that is quite extreme by most measures.
    That is probably why you framed the question in that way.

    If one has spent much time looking at the studies that are available and are sincere... not just falling into religious fervor over one's chosen way (as happens on most dietary sites), then one has to make use of what you have.

    As I have indicated, I have come to believe that for 1 year weight loss, that LCHF diets produce good and probably superior results for most people. I am aware, as seen in this study, the results for many markers for coronary artery d
    isease. I am also aware that similar markers are achieved in real low-fat diets... not those at 30%... but in the 10% to 15% range.

    The important question for those millions of Americans and others is how it impacts outcomes down the road regarding their CVD (heart disease).... a situation that is either diagnosed or underway in the majority of Americans over the age of 50.

    What impact does the diet have on the longer term... regarding events or deaths or hospitalizations or quality of life.

    As you may know, even after all the recent studies, that 90% of the cardiology world still sticks to the lower fat choice...along with statins etc.
    I doubt you have 2% of cardiologist who would suggest their patients follow a high fat diet.
    Especially if you remove the portion of patients who have a BMI of over 30,
    Except for weight loss or possibly diabetes, I've never heard of a cardiologist recommending a high fat diet to a normal weight, non-diabetic, patient with heart disease ( one or more arteries with a 70% or greater blockage)

    So, we are left to read what is available regarding halting disease progression or possibly reversing the condition a small ways.

    In that regard, the only studies that seem to suggest a benefit are those put out by the like of Dean Ornish and Esselstyn.
    Very small, not RCT, and some published in less than stellar journals.

    Ornish did get into Lancet and JAMA but yes, I know how small the numbers were in that study.

    I only wish the vast number of proponents of high fat diets would have even a similar type of study indicating the benefit of such a diet for the millions of Americans with such conditions.

    Just because the evidence is imperfect, does little to suggest that the heart patient should suddenly do the complete opposite and opt for a high fat,, low carb diet, including butter, meats, cream, and the entire picture some advocate.

    Do you have a study following heart patients for 2 to 5 years and reporting their outcomes regarding the progression of their blockages or their coronary events... or deaths?

    "If you haven't that reference you would be risking lifes if you advise them a low-fat diet. Would you do do that? What do you advise them?"

    I would advise them as I have advised myself.. to go with the best available evidence, along with the best advice of the 95% of cardiologists regarding diet.
    But I don't trust anyone.
    I read and re-read every paragraph and chart. Every bit of the data. Every bending and twisting of the facts to back up a thesis.

    After doing that I make my best choice regarding how to live longest and in the best health regarding my own circumstances. My choice might be different if I was overweight or had diabetes.
    For me, at this point, after looking at all the evidence, I have concluded that there a greater probability that I can halt for possibly reverse CVD through the use of statins together with a 10 of calorie low fat diet, based on not eating trash carbs or almost any sugar.

    You can easily look up the small Ornish studies. Just Google Ornish, Lancet, or JAMA
    There are other studies, but I won't list them.
    Nothing absolutely proving x, y, or z will be my outcome...
    But on the other hand I see nothing at all from the high-fat low-carb Diet Doctor crowd regarding a 1 year, 3 year, or 5 year, outcome trial.

    I don't think anyone is motivated to do such a trail. certainly not one where the HF is compared to a true LF over years in patients who are already diagnoses.
    They number in the millions and according to studies, for what they are, without going full-on in terms of lower fat... 10%.... or such, those CVD patients progress and do so rather rapidly over just a few years. Leading to events, deaths, or stents and bypass interventions.

    So, I don't have any guaranteed answers... I go with the best I can find.
    This recent study was disappointing in that they once again used the 30% standard for "low-fat". Why they keep doing that is beyond me.

    Part of the reason may be because compliance is so low. In the huge nurses study, they aimed for 20% but ended up at 28% by the end.

    Replies: #35, #36
  35. FrankG
    Ahhh. so despite not trusting anyone but yourself you still lean towards consensus science and appeals to authority.

    "As you may know, even after all the recent studies, that 90% of the cardiology world still sticks to the lower fat choice...along with statins etc."

    Where did you get these statistics? 90% of the cardiology world??? Know many cardiologists personally do you?

    At the time of Galileo, I wonder what percentage of astronomers agreed that the Earth was the centre of the Universe?

  36. erdoke
    You should start with Denise Minger's book then. She is anything, but an LCHF advocate. Some topics are still brought into good perspective in an easy to understand way, including Ornish et al. In fact the only places where I feel her research a bit weak or neglecting is the chapter about amylases (maybe just because this is my own area of expertise) and the one about fat and meat intake recommendations. She still seems to have an aversion to many animal foods from her raw vegan years, but there is no evidence that high quality fat and (organ) meat cause health issues if consumed in higher proportions. I'm also not talking about gorging on brain, just to let it play out on natural cravings. If there is such thing left in most of modern people at all...
  37. Wade Henderson
    Murray, thanks for your long reply. I don't have time to comment on all of it right now.

    One point I will make. I see this on the low fat sites and now you post it here.

    The EXAMPLES....
    "I haven't seen convincing scientific studies on this, but William Davis reports plenty of success on LCHF with patients. One patient went from severe aorta blockage to restored 95% flow following LCHF with vitamin K2 supplementation."

    I'm telling you, these kinds of reports are bogus. Bogus for low carb and bogus for low-fat.
    Caldwell Esselstying uses a similar image taken during a angiogram. He keeps using the image even though the patient wasn't part of any of his studies. He abuses that anecdotal image.

    Either these images are profoundly rare, or they are trickery, or they are just lies, one cannot be sure, but they don't represent anything that can happen for 99% of patients.. That is for sure.

    I have read tons about this. You do NOT reverse a 90% blockage to 10%.... Not in anyone.
    The very nature of the blockage makes this impossible. Portions of it are fibrous and portions are calcilfied and portions are softer.
    Only a small portion are normally subject to reversal. NO ONE is going from 95% blocked to clean. Its just a myth.

    Most would do wonderful if they could go from 80% to 65% over 5 years.
    That would be only for a small portion who were fully adherent.
    However reversals such as that can increase blood flow by 60%

    http://hyperphysics.phy-astr.gsu.edu/hbase/ppois4.html

    Most should be happy to just halt the ususal progression.
    Use that calculator above to show what happens if you go from a 75% blockage to 85% blockage. That is why halting progression is so critical.

    Again, I only wish there was even a small example (study) of where high fat, low carb was shown to produce outcomes years down the road... Reversal or halting of coronary artery disease. Even something as small or imperfect as Dean Ornish or Esselstyn studies.

    Reply: #39
  38. Paul the rat
    Very profound finding - please read (at least) Discussion folks.

    I say those of us who are in ketosis/border-line ketosis are protected (at least theoretically - nothing is certain in biology) from the onset of most if not all cancers.

    "…Our present studies indicate that ketone bodies revert metabolic adaptations in pancreatic cancer cells to induce growth arrest and apoptosis. …"

    If late Steve Jobs went ketogenic early enough, who knows we could have another novel Apple gadget by now, unfortunately Mr. Jobs went in the opposite direction.

    http://www.cancerandmetabolism.com/content/pdf/2049-3002-2-18.pdf

    Reply: #40
  39. murray
    The case report was in Kate Rheaume-Blue on Vitamin K2 and calcium regulation in the body. She describes how the patient's echocardiogram indicated aortic valve stenosis that had reduced it to 1.6 cm squared. (I gather normal is between 2.5-3.0 cm squared.) Following the dietary protocol with supplementation of D3, and K2 in MK-4 and MK-7 form, echocardiography ten months later showed the diameter had increased to 2.9 cm squared.

    The Track your plaque site gives another patient case where an echocardiogram measured his effective aortic valve area at 1.5 cm squared. Because of his aortic valve issue, it was suggested that, in addition to the 10,000 units of vitamin D required to increase the patient's 25-hydroxy vitamin D level to 70 ng/ml, he also added vitamin K2, 1000 mcg per day, along with elimination of all calcium supplements. (The K2 supplement contained both forms, short-acting MK-4 and long-acting MK-7.) One year later, another echocardiogram: aortic valve area 2.6 cm squared.

    Wade, you imply these must be myth. But Davis has permitted publication of the first case I referenced above in Kate Rheaume-Blue's book and the second on the website of his program, so evidently he stands behind their authenticity.

    Reply: #42
  40. murray
    Thanks, Paul. Much appreciated, as always.
  41. Jaebea
    A true LCHF diet is moderate protein, not high. LC diets such as Atkins are Ketogenic. Weight loss occurs because of the presence of ketones in the body to burn fat. Protein consumed that is over 50% of total calories will be converted to carbs. LCHP defeats the purpose of LC because ketosis cannot be achieved. 70% fat, 25% prot, 5% carbs: I have been eating this way for over a year. I have lost over 30 pounds, my blood pressure is way down and my triglicerides have gone way down. I am 60yo and have more energy now then when I did when I was 30! What started out as a diet is now my lifestyle.
  42. Wade Henderson
    Murry, Kate Rhéaume-Bleue is a naturopath. Look up wiki naturopathy.

    Her example is in a book. She includes Dr. Davis' case report in the book.

    Is it absolutely impossible for such a occurrence? I won't say impossible. My use of the "myth" was meant to mean that if you take 1000 patients with a blockage of say, 85%... the chance that you would get a 95% reduction in that blockage would be so rare as to be meaningless.

    Patients with heart disease..due to blockage of artery, should look for the following.
    #1. Halting progression.
    #2. If lucky, try to get some small reversal.
    #3. If you get some reversal, try to hold onto it for the following decades.

    95% reduction of "symptoms"... very possible.

    BTW, you for the reversal mentioned above, it talks about "aortic valve area".... There might be a way to make the valve more open that has little to do with reducing a blockage in a artery by some huge percentage.

    Like I said, both sides use extremely rare examples in a way that is misleading.
    Look at this Esselstyn study
    http://dresselstyn.com/JFP_06307_Article1.pdf
    Look at Figure 2. That patient had nothing to do with that study of some 200 people.
    Its just thrown into the article to show something dramatic. He always trots out that image in his presentations.
    That is one, young doctor who got great results. It has nothing to do with what the average patient can expect. I think it is entirely misleading and dishonest.

    I see this tendency on both sides of the debate. Exaggeration to gain attention.
    I would be equally suspicious of anything Kate Rheaume-Blue put out.

    Kate Rheaume is the Educational Spokesperson for Natural Factors Nutritional Products, Canada’s largest manufacturer of nutritional supplements. That just might influence her advice.

  43. Matt
    "Except for weight loss or possibly diabetes, I've never heard of a cardiologist recommending a high fat diet to a normal weight, non-diabetic, patient with heart disease ( one or more arteries with a 70% or greater blockage)"

    Well Wade, I think you've identified one of the major problems with our healthcare system right there. Doctor's have been stuck on some really bad science and despite the dramatically and demonstrably awful results of the last 30 years of giving such advice, continue to do so despite all evidence to the contrary.

    What is a non-scientist supposed to make of all this conflicting advice. Every one of us can site paper after paper that supports our belief and discredits that of another proponent. Even people experts who agree on much with each other may disagree vehemently with others on specifics. To the lay community - it's pretty confusing - and we don't have the ability to properly evaluate the papers and studies.

    But we can evaluate our own bodies and measure the impacts of dietary changes over time on them. I followed all the best advice out there. I'm highly educated with a post-graduate degree from a top university. I am solidly upper-middle class and have access to the best medical care my community offers. I live in a major metropolitan area - there are hundreds of experts with a short drive of my home. I have Dean Ornish's book underlined and dog eared. I did everything my Doctors asked of me including cutting back on fats, calorie restriction, working out more (aerobically, to be in the "fat burning zone"), etc. etc. What did that advice get me? 40lbs of extra central fat and a really healthy case of T2 diabetes.

    So, after following conventional advice for decades and ending up with a pretty horrible outcome, I thought I would try something different. I went LCHF despite all my doubts and belief in Dean Ornish (if only I followed his diet just a bit better, I would have been spared this debacle).

    And then a miracle happened. In about 1/2 year I lost 40lbs. My BMI went from 30 to 24. My body fat went from 32% to 20%. OK, I hear you, anyone can lose weight on a diet - but is it healthy?

    You tell me. My blood pressure went from ~140/90 (on medication) to ~110/55 (no medication), My triglycerides went from 183 to 93. My FBG went from 200+ to under 100. My HbA1c went from 14.3 to 6.6 in 3 months (I expect it'll drop even further the next time I measure it). My RHR went from above 90 to below 50. I stopped taking three medications (including atorvastatin, Hyzaar and Pepcid AC) as I no longer had any problems with cholesterol, blood pressure or the chronic GERD I suffered from. Then there are the harder to quantify health issues that were having a major impact on my quality of lief that I was having including: fatigue and brain fog (gone), snoring and sleep apnea (gone), constant headaches (gone), insomnia (gone), anxiety (gone). In fact, every medical complaint I had prior to changing diets is gone.

    If someone could have bottled a medicine that cured all my complaints and put it in a pill what would it be worth to me?

    So you tell me, am I healthier today on a LCHF diet or before when I was on a high carb/low fat diet?

    But I was a diabetic you say - my results may not applicable to healthy people. I wouldn't conclude that either. My metabolic issues almost certainly began decades prior to be diagnosed with T2 diabetes. If an observant doctor has noticed my 10 lb gain and high blood pressure and elevated triglycerides in my 20s for what it was (almost certainly strong indications of insulin resistance) and educated me about the consequences, and more importantly, the lifestyle changes that could prevent such consequences, I could have been spared this now chronic, expensive, and lifelong condition.

    The diabetic community is an amazing resource - we are collectively doing millions of n=1 experiments, sharing our results on-line and trading information about what works and what does not. Spend a little time on the diabetic forums and you will learn that the almost overwhelming conclusion of these millions of individual experiments is that almost all T2 diabetics began the process having lived on a high carb/low fat diet for decades, per conventional wisdom, and that all of them have found the best course of treatment to lie in restricting carbs greatly and increasing health fats. I believe this amazing community of T2 diabetics will among those leading the way on the sea change that is taking place.

    Reply: #44
  44. Wade Henderson
    Matt, while it might surprise you, I am a fan of Christoper Gardner of Stanford.

    He seems to have no agenda other than finding truth and being open to the fact that not all individuals are alike.

    https://med.stanford.edu/profiles/christopher-gardner

    Here is article highlighting his most recent study

    http://www.sfgate.com/health/article/Slim-chance-of-loss-with-wrong-d...

    Those same differences may apply to coronary artery disease blockages as well as to weight gain and loss. In fact, one would have to be close minded to not believe that there are some people who do terrible on one diet or the other in terms of weight.

    Since the biggest cause of death in the USA and a good part of the rest of the world is from coronary artery disease, I would wish that some part of the HFLC community would conduct a study looking at outcomes for those who have existing heart disease so that their might be some information on outcomes from those who follow a high fat diet.
    Yes, when we can actually get to look at this recent study, we will get to see some of the markers for what is said to be better for heart disease, but we get that from almost any diet where people are losing weight.
    What is needed is some study by anyone showing that for those with existing angina, blockages, etc, that there "outcomes"... events, deaths, hospitalizations, stents, bypasses, and such are made better on a HFLC diet.

    As yet, I have not found anything showing such.
    I really would like to read such a study as I have been looking into this for some time.
    It may yet turn out that even in the area of "outcomes" that different people do better on one diet or the other, just as it is with weight management.

    But for now, the only groups/doctors who seem to be doing the studies...however inadequate or small, are the proponents of the low fat, plant based diets. Ornish, Esselstyn, etc.
    Plus some fairly large studies more focused on statins and outcomes as well as reversal of blockages.

    I think it interesting that after Andreas Eenfeldt followed a earlier post of mine, all he could say was "Sour grapes..." (see post # 27)...

    In post #28, I asked him for some simple basic information, similar to what I am asking of you regarding any studies, and he has failed to come back with even one link to such a study.

    Are there no studies out there, with the millions of existing heart patients, seeing if those with angina and blockages of 70% or greater, do well or get progress to a more dangerous condition when placed on a HFLC diet?
    I don't just want markers, but real outcomes or angiographic measurements showing the results. A study giving the reduction in events, heart attacks, needed stenting, needed bypass, deaths.

    Say what you want about Ornish and Esselstyn, they have done some basic attempts to look at their diets in relation to such. Easy to pick apart Ornish as being to small etc etc.
    But its something.
    What would you tell someone with a very very common 75% blockage in their LAD artery, who has stable angina?
    Eat more fat, meat, oil, dairy, butter... etc?

    I would love to read a study following 20 or 200 such individuals and seeing what happens over 3 to 12 years. Markers, cholesterol , HDL, LDL, Trig, are fine, but what happens to the actual patient over 5 years.

    Perhaps the Diet Doctor will return and give me a link to something showing improve outcomes from his high fat dietary advice.

    Right now, I've not had anyone give me something to read, that would alter my choices.
    Just like most folks here, I want to do what is best but I'm seeing little to nothing to suggest a high fat diet is best for such patients. BTW, in my quest, I'm looking for outcomes of those who are significantly overweight, or diabetic. Just average Joe's, fairly fit, looking for the best diet to halt or reveres heart disease and longer term outcomes.

    Any ideas?

    Replies: #46, #52, #54
  45. Stefan
    Interestingly various media outlets report that the actual carb consumption in the low carb group went up significantly from the 40 grams originally prescribed. Example: http://www.cbsnews.com/news/low-carb-versus-low-fat-best-diet-for-wei...
    So if that's the case how different might the results have been if indeed it would have been 40 grams...
    Reply: #47
  46. Galina L.
    I am an average person who is just interested in keeping my family members and myself healthy and fit. You asked does somebody have any ideas.
    We can't at the moment get the perfect research data which would satisfy everyone. May be we will in a future, but we live and make decisions now. If I were to deal with a family member being diagnosed with a substantial blockage, I would advise dietwise first of all an intermittent fasting with two 20 - 24 hours longer fasts twice a week. I think it will make any diet more healthy.
    Reply: #48
  47. Wade Henderson
    Stefan, A good point.
    "Interestingly various media outlets report that the actual carb consumption in the low carb group went up significantly from the 40 grams originally prescribed.

    Here we are batting this back and forth none of us even know the details of the study.
    If the low carb group ended up at 127 grams a day when the aim was for less than 40, one can only guess where the low-fat group ended up after aiming for 30%.

    So crazy, the study is in all the news outlets and yet they don't allow the public to read the details.
    By the time the details get out, everyone will be onto the next health headline.

    One point seen in one story, but getting little play, is that the average calorie intake of the low-carb group was 79 calories less per day lower.
    If you do the math 79 x 365, you get 28,835. That is 8.23 pounds. The difference between the two groups was only 7.8 pounds.

    I'd like to see the instructions each group of dieters were given. Apparently they were given instructions to not increase or do any exercise they weren't already doing, and this was a obese group to begin.
    110 out of 148 completed the full year.

  48. Wade Henderson
    Galina,, I appreciate the response, but if a person is already at or below a 20.0 BMI, then fasting two full days each week seems out of the question. You have to eat enough over the entire week to maintain a minimum body weight.

    I've heard about fasting to reverse blockages, but I've yet to see a study indicating it works.

    Replies: #49, #51
  49. erdoke
    Wade,
    Fasting is not only promoted by low carbers. Check out recent papers and subsequent interviews with Valter Longo for example.
    http://healthdivas.tv/weight-loss/eat-fast-and-live-longer-a-conversa...
  50. Martin
    I think the above evidence has rattled some cages so much so that they following article has been manufactured to cast doubt and muddy the water.

    http://www.bbc.co.uk/news/health-29031985

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