Written by: Kevin Cann
Recently there was an important research project published in the Journal of American Medical Association (JAMA). Researchers are trying to understand the mechanisms behind the obesity epidemic that is seen in this country. One area that we fail to grasp a solid understanding of is why people will lose weight and over time put that weight back on. In some cases they will even gain more weight then they lost.
For the longest time we have been led to believe that our inability to count calories, and exercise, is why we continue to get more obese as a nation. In a study published in the American Journal of Medicine in 1997 it concluded by saying “Reduced fat and calorie intake and frequent use of low-calorie food products have been associated with a paradoxical increase in the prevalence of obesity” (Heini, 1997). This study goes on to state that it believes it is the lack of physical activity causing us to become obese. Is it really the lack of physical activity?
According to the CDC’s stats for physical activity 46.9% of the American population met the standards for aerobic exercise. If almost half of us are at least going for a run every once in a while and we are eating fewer calories as a country, why do we continue to get more obese and more sick?
This current study in JAMA does not answer the questions, but is a step in the right direction to understanding the mechanisms associated with obesity. This study was attempting to answer the question as to why people put on weight following a weight loss protocol. They attempted to answer this question by examining the effects of 3 diets differing in macronutrient consumption and glycemic load. The test subjects were 21 overweight and obese adolescents. This was a three-way controlled crossover study comparing a low-fat (60% carbohydrate diet), low-glycemic (40% carbohydrate diet), and a low-carbohydrate (10% carbohydrate diet). Carbohydrate sources were “healthy” sources such as whole grains, fruits, and vegetables.
To summarize the results: the low-carb diet had the greatest increase in HDL, the greatest decrease in triglycerides and PAI-1 (arthrogenic factor), showed the greatest insulin and leptin sensitivity, and at rest burned 300 calories/day more than the low-fat diet and 150 calories/day more than the low-glycemic diet. The low carb diet however showed the highest amounts of excreted cortisol, and also the highest levels of C-reactive protein (CRP). This, in the long term, may induce heart disease (Ludwig, 2012).
The media has interpreted this data to mean that the low-glycemic diet has almost the same amount of positives as the low carb diet, but without the risk of heart disease in the future. The data in this research does not say that. The CRP levels in the low-carb group were .87. In the American Heart Association’s journal Circulation, CRP levels of less than 1 correspond to a low risk of heart disease (Ridker, 2003). It is widely known that HDL may be preventative of heart disease, and high triglycerides are a risk factor for heart disease. If the low-carb diet increases HDL the most and lowers triglycerides the most while maintaining a low risk score on a CRP test, how would the risk for heart disease in the future be greater?
When looking at the cortisol excretion rates we need to keep in mind these patients were on a 10% carbohydrate diet. This is extremely low. According to Loren Cordain the paleo diet consists of roughly 20-40% carbohydrates. I would like to see these results recalculated with these patients on a diet of a few more carbohydrates and also removing the grains from the selected carbohydrate sources, but that was not the point of this study.
In the comments of the study, it was stated “This study challenges the notion that a calorie is a calorie” (Ludwig, 2012). This is the biggest take away in my opinion. This study shows that it is not as easy as counting calories and the mechanisms behind the obesity epidemic are much more complicated than most people think. In my opinion, the data in this study shows a low-carb diet to be more effective at decreasing the risk of heart disease, regulating appetite, and maintaining weight loss. Hopefully this research study kicks off other ones like it, and sometime in the near future we have hardcore scientific data supporting a proper treatment plan for the disease of obesity. Until then we still have strong anecdotal data that the paleo diet is the best treatment for obesity.
References
Nataradjan, Pareep (2010). High Density Lipoprotein and Coronary Heart Disease. Journal of American College of Cardiology. Retrieved on June 29, 2012.
Ridker, Paul (2003). Clinical Application of C-Reactive Protein for Cardiovascular Disease Detection and Prevention. Circulation. Retrieved June 28, 2012.
Heini, AF (1997). Divergent Trends in Obesity and Fat Intake Patterns: the American Paradox. UK Pubmed. Retrieved June 28, 2012.
Ludwig, David (2012). Effects of Dietary Composition of Energy Expenditure During Weight Loss Maintenance. JAMA. Retrieved June 27, 2012.
Kevin is owner of Genetic Potential Nutrition. He is a holistic nutritionist, wellness coach, and strength coach. He works with people fighting illness, to competitive athletes. Check out his site at www.geneticpotentialnutrition.
http://wholehealthsource.blogspot.ca/2012/07/why-did-energy-expenditure-differ.html
Although I’m not perfectly paleo, I’ve maintained the loss of 80 pounds for over a year. Maintenance can largely be attributed to eating lower carb, low/no grain, and low/no sugar. No doubt about it.
Great read, Squatchy! I’m glad The Man is starting to come around to the fact that eating a donut is categorically different from eating chicken but I wish they could come off the “low carb is terrible” platform.
Agreed.
Btw, just for clarity, Kevin Cann wrote the piece. I just posted it to the blog.
If 46.9% of the American population met the standards for aerobic exercise, then we need new standards.
All three diet groups had a dramatic decrease in CRP. The end CRP numbers were not significantly different between the three groups.
The only reason that Ludwig said that low carb would induce heart disease is to keep the grants flowing in,
In my own case. I have been paleo low carb for three years and I eat less than 50 grams of carbs a day. My CRP dropped to .41 and has stayed there for the entire three years.
Last year I took a real Resting Energy Expenditure test and my score was 2160 calories. My predicated score based on my weight and age was 1738. My paleo low carb diet gives me a daily metabolic advantage of 400 calories.
Kevin, you are correct when you say that a paleo low carb diet would do significantly better than all of those diet groups tested.
Hi Robb. Don’t know where that “a calorie is a calorie” myth came from. It seems ridiculous that measurements from a bomb calorimeter have anything to do with actual energy usage in living systems.
There already is a paper that is understandable for physicians which highlights that a calorie is not a calorie: Feinman&Fine (2004): “‘A calorie is a calorie’ violates the second law of thermodynamics” Nutrition Journal, 3:9.
NICE!
Robb,
I’ve had this thought (without any knowledge whatsoever to back it up) for a while that hormones are king and calories are one of his (the king’s) advisors. Is this a stupid thought or one brimming with untapped genius? [Note; there is no middle ground answer allowed: genius or stupid, choose.]
Thanks for a good write up. I like the fact that we are finally getting away from the whole all calories are equal crap. I would like to see more about why the low carb protocol burned more calories. But it wasnt really what the study was about I guess.
All three diets showed near identical weight loss. Where is the metabolic advantage of 300 for the low carb group?
That study definitely describes the problems my parents have losing weight. They are all about cutting back calories (a strawberry has four points) combined with immediate intense exercise. They go up and down with weight all the time. No one really talks about the psychological effects that all this has on people. I went on a similar weight watchers style diet in college because I noticed that the campus food was starting to give me a belly. And it made me neurotic as hell. I had a mental collapse into full blown eating disorder. Oh my God I am a pound heavier today than yesterday. Time to cut back more. My parents go the other direction. They restrict, resrict, restrict, and then over eat for days until they are right back where they started. And then comes the mood swings, depression, and all sorts of health problems. I’ve tried to help them but they consider me uncredible in the health advice department given my history, even though a paleo style diet has stabilized me in mood, health, weight, energy, and acne.
I have now seen this covered in like half-dozen blogs. I haven’t yet seen mention of relative success in weight maintenance. Did the three diets differ in resulting changes (or lack thereof) in fat mass? I’d sure like to see this study continue for 2-3 years.
Also, this was very interesting: “Reduced fat and calorie intake and frequent use of low-calorie food products have been associated with a paradoxical increase in the prevalence of obesity.” — My interpretation is that eating industrialized (packaged) foods will make you fat, irrespective of macronutrient ratios. I predict weight gain from low carb foods if they are designed in a lab for commercial sale.
Ed- Agreed. I think all the hyper palatability stuff guyenet talks about is right in this wheel house.
Interesting read. I especially found the info on how using a low-carb diet increases risk for heart disease and increases your cortisol levels. Will definitely start researching more low-glycemic foods vs. low-carb.
AND I’d not throw the baby out quite yet. Was that only an acute phase adaptation? I think so, the work we’ve done at Specialty Health seems to indicate that too. ASLO, the delta in cortisol was barely statistically significant…they were really working to make LC look dangerous.
Are you saying they conspired to make LC look dangerous? Now why would they do that?
Yeah…with regard to the cortisol change, we have to remember that in these kinds of studies, there’s *statistical* significance, and there’s *clinical* significance. And they ain’t necessarily the same thing. What the pencil pushers and statisticians see as significant might be meaningful in math geekery land, but might not be worth a lick when it comes to a living, breathing human being.
I follow this blog daily and I am a big fan, however:
If the low carb diet in this study produced a 300 calorie metabolic advantage per day then why has the weight loss been identical across all three diets in the experiment? Something here doesn’t add up.
because during the weight loss phase they all eat the same low calorie diet. Only in the maintenance phase did they try different diets and they made sure the subjects eat the exact number of calories they expended. So on a low carb diet they simply eat the 300 calories extra. Everything adds up.
I find it interesting that you say, “IN MY OPINION, the data in this study shows a low-carb diet to be more effective at decreasing the risk of heart disease, regulating appetite, and maintaining weight loss.” (Emphasis added).
I must have missed something, as in regards to weight loss, didn’t the researchers make the point that: “Body weight did not differ significantly among the 3 diets (mean [95% CI], 91.5 [87.4-95.6] kg for low fat; 91.1 [87.0-95.2] kg for low glycemic index; and 91.2 [87.1-95.3] kg for very low carbohydrate”.”
Maybe a calorie really is a calorie?
macronutrient percentages are secondary to macronutrient quality.
Following a paleo-ish diet for 2 years (some grain in the form of rice occasionally and periodic cheats) I easily lost 50 lbs and maintained it. No rebound weight gain.
Following a low cal diet, counting calories, etc. and ignoring food quality (a calorie is a calorie approach) made me neurotic about food and resulted in yoyo weight loss/gain and seeking out an alternate solution.
Following a more rigorous low-ish carb paelo diet these last few months my waist has shrunk easily another inch or more, my strength is way up, recovery way up and my muscle mass is noticeably improved (to the point where people are finally commenting positively on it). My weight has not changed but my body comp is definitely better.
I know none of this will be surprising in this community but how many anecdotal successes at doing what every other diet finds impossible (body recomp, losing fat not muscle, maintained weight loss, etc.) is it going to take before people shut their “expert” pie-holes and let this thing get the scientific community and media backing that it deserves.
Great post by the way. I didn’t realise that eating paleo was better for the heart. It shows that we humans are so fragile, and require a lot of maintenance.
Maintaining weight loss has been easier than I thought, but it’s not a straight line of pounds creeping off. It’s more like a drop, followed by a plateau where I relax a little with my diet, followed by another drop when I become strict again. The cycle has been going on and on in this fashion, but no rebound weight. Though this weekend and the last has been too relaxed.
It still surprises me, just how lot of pelpoe are not aware about Kinovelax Diet Plan (google it), despite the fact that lots of pelpoe get great result because of it. Thanks to my cooworker who told me about Kinovelax Diet Plan, I have lost a lot of weight by using it without starving myself.
@Glibly
Someone will have to run a ward study for longer than four weeks to know. But, who cares about “metabolic advantage”? This seems to be a favorite subject for a few fervent low carbers and their opponents who are fond of kicking down strawmen. The important upshot of this study is that a reasonably high fat, low carb diet demonstrated – at the very least – that it is comparable to other diets in terms of improving markers for disease and illness – once we shove the the CRP, cortisol and T3 boogey men back under the bed where they belong, of course. And that’s being understated, I’d say. Studies like this will help provide the basis for the acceptance and prescription of HFLC diets as a safe and desirable method of weight loss and – more importantly – improved health.
Of course, someone might just as easily turn your question back on proponents of higher carb diets: where’s the advantage? This study concluded that there isn’t one.
>> who cares about “metabolic advantage”?
well, if you are trying to lose weight, loads of it, and so reduce calories and endure hunger, then you are grateful you can eat a bit more of more satisfying foods
After being diagnosed as being pre-diabetic in Dec 2010 and adopting a grain-free diet in Jan 2011, I lost +/- 65 lbs in 5 months. I’ve maintained that weight-loss since. My lipid panels are ‘perfect’ according to my husband’s cardiologist. I’m no longer pre-diabetic (yay), no longer anemic (yay) and no longer have to shop in the plus size women’s clothing stores.
I’m still tinkering with what makes me feel good in terms of dairy and quantity of starches. In vanity terms, I sometimes feel I’d like to lose more body fat, but getting to where I am today through dietary changes alone (yep, just diet, no exercise modifications), maintaining the weight loss for over a year and regaining health is a blessing not to be taken lightly. My biggest obstacle to health these days is overcoming adrenal fatigue and dealing with chronic stress.
Roz- that is fantastic!
“overcoming adrenal fatigue and dealing with chronic stress.”
If and when you do choose to exercise, make sure its something you enjoy and have FUN at. And on days where you just dont ‘feel right’ back off. Try simple breathing exercises. Listen to your body.
@Gene
I guess the answer to your carb advantage question lies in your response. The three things you dissmissed as boogeymen (although I perceive them as real issues) being CRP, cortisol and T3. I have had first hand experience with these on a low carb diet and they are very real.
I would wager that lot of people who go on a diet will overdo it, starve themselves or overtrain, which could have two backlash effects: Physiologically, starving yourself may result in burning muscle and brain tissue rather than fat, especially if you don’t get enough exercise, resulting in aot a lower metabolic rate; and mentally, you may feel like you deserve treats and rewards for your hard work and endurance and this could have a snowball effect, or perhaps you feel some shadow side of yourself wanting to cheat which may take over your diet after some time.
Hi Robb,
I have just begun Paleo and have found that I have actually gained weight around my middle, is this normal due to change of diet or do you think I am doing something wrong, I also had severe back pain through this time and was unable to exercise.
Regards
Donna
Donna,
It’s really hard to say – but fat accumulation around the midsection is usually a marker of high cortisol levels. The back injury, stress, sleep, exercise, and diet all play a role in this. Also, be mindful of your portion sizes and if you’d like some help getting things figured out, let me know! http://robbwolf.com/about/team/amy-kubal/
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“Researchers are trying to understand the mechanisms behind the obesity epidemic that is seen in this country. One area that we fail to grasp a solid understanding of is why people will lose weight and over time put that weight back on.”
Sorry but these “researchers” are idiots.
Observe what exists and how nature works. Humans eat what is there (readily available and cheap). The junk is everywhere in that environment, and people eat what is in their environment, the end.
The way of thinking that says “people have a choice, yes we set up all this junk food, but don’t eat it mmmk” is NOT how things work. The US is a case study in that.
In some countries there is healthy food everywhere, and people eat it because it is there, and they are healthy.
Easy.
Corporate profits in the USA prevent it.