Why the Atkins diet doesn’t work and never will

The goal of any diet is to help you lose excess weight and keep it off. The first part is relatively easy to achieve; the second part is incredibly difficult to maintain. Any diet that restricts calories will do the first part, but invariably the lost weight returns. This is definitely the situation for the Atkins diet. I knew Bob Atkins well, and the only answer he had as to why people regain weight on his diet was that they are addicted to carbohydrates. Frankly, I never bought into that explanation from Bob any more than I believed the reasoning of the advocates for low-fat diets saying the failure to maintain weight loss is because people are addicted to fat. To paraphrase former President Clinton, “It’s the hormones, stupid.”

In most cases what really causes weight regain is cellular inflammation induced by hormonal imbalance. This is why any diet that uses the word “low” or “high” to describe itself will induce hormonal imbalance, and therefore ultimately fail. Low-fat diets are generally high-carbohydrate diets. High levels of carbohydrates will increase the production of insulin, which is the hormone that makes you fat and keeps you fat. This increase in insulin will generate increased cellular inflammation that increases the likelihood for weight regain (1). On the other hand, the Atkins diet is a low-carbohydrate diet that is also a high-fat diet. If those fats on the Atkins diet are rich in saturated and omega-6 fats (which they usually are), then their presence will also increase cellular inflammation (1). This increase in cellular inflammation (by either type of diet) disrupts hormonal signaling patterns (especially for insulin signaling) that generate increased insulin resistance. This was shown in one of my earlier research articles that demonstrated that under carefully controlled clinical conditions, following the Atkins diet shows significant increases in cellular inflammation compared to those subjects following the Zone Diet (2). In addition, there was decreased endurance capacity of the subjects on the Atkins diet compared to those on the Zone Diet (3).

The differences are probably due to the fact that the  anti inflammatory diet is a diet that is moderate in protein, carbohydrate and fat. It’s this type of dietary moderation of macronutrients that generates hormonal balance.Now new data from Yale Medical School indicates that a ketogenic (i.e. Atkins) diet may even have worse health implications than simply weight regain (4). In this study, it was demonstrated that although indicators of insulin resistance in the blood may be decreased on a ketogenic diet, insulin resistance in the liver was dramatically increased. Since the liver is the central processing organ for controlling metabolism, this would suggest that long-term use of the Atkins diet would cause metabolic problems leading to accumulation of excess fat. Adding even more fuel to this hormonal fire is another study that demonstrated that a ketogenic diet leads to increased production of cortisol (another hormone that makes you fat and keeps you fat) in the fat cells (5). Any increase in cortisol increases insulin resistance in that particular organ.

So it appears that ketogenic diets (like the Atkins diet) may initially reduce insulin levels in the blood, but increase insulin resistance in organs, such as the liver and the adipose tissue. The bottom line: Any initial weight loss with the Atkins diet is a false hope since it causes insulin resistance in various organs that ultimately cause the regain of any lost weight as excess fat. That’s a very bad prescription.

References:
1. Sears B. “Toxic Fat.” Thomas Nelson. Nashville, TN (2008)
2. Johnston CS, Tjonn SL, Swan PD, White A, Hutchins H, and Sears B. “Ketogenic low-carbohydrate diets have no metabolic advantage over nonketogenic low-carbohydrate diets.” Am J Clin Nutr 83: 1055-1061 (2006)
3. White AM, Johnston CS, Swan PD, Tjonn SL, and Sears B. “Blood ketones are directly related to fatigue and perceived effort during exercise in overweight adults adhering to low-carbohydrate diets for weight loss: a pilot study.” J Am Diet Assoc 107: 1792-1796 (2007)

4. Jornayvaz FR, Jurczak MJ, Lee HY, Birkenfeld AL, Frederick DW, Zhang D, Zhang XM, Samuel VT, and Shulman GI. “A high-fat, ketogenic diet causes hepatic insulin resistance in mice, despite increasing energy expenditure and preventing weight gain.” Am J Physiol Endocrinol Metab 299: E808-815 (2010)
5. Stimson RH, Johnstone AM, Homer NZ, Wake DJ, Morton NM, Andrew R, Lobley GE, and Walker BR. “Dietary macronutrient content alters cortisol metabolism independently of body weight changes in obese men.” J Clin Endocrinol Metab 92: 4480-4484 (2007)

Nothing contained in this blog is intended to be instructional for medial diagnosis or treatment. If you have a medical concern or issue, please consult your personal physician immediately.

Weight loss or fat loss? It makes a difference

With the New Year comes the guaranteed resolution for most people to lose weight. Invariably that resolution is usually abandoned some time in February. Part of the reason is that we really don’t know what we are talking about when it comes to weight loss. Weight loss is composed of three separate components: water loss, muscle loss, and fat loss. If you restrict calories, you are going to lose weight. What that weight loss might consist of (water, muscle, or fat) is a very different question.

There are no health benefits to water loss (i.e. dehydration) or muscle loss (i.e. protein deprivation), but there is something magical about fat loss. If you can lose excess body fat, then you are virtually guaranteed to lower blood sugar levels, blood lipid levels, and blood pressure. Not surprisingly, drugs used to reduce blood sugar, blood lipids and blood pressure are the biggest sellers in the country.

Considering the continuing outcry to reverse our obesity epidemic, no one seems to bother to measure fat loss in any clinical trials. This is why you see a lot of research studies published stating it doesn’t matter what diet you follow because if you restrict calories, you will lose weight. I agree with that statement. But if you want better health (not to mention looking better in a swimsuit), then you want to make sure that you are losing fat at the fastest possible rate while conserving muscle mass at the same time. The published clinical studies that have looked at fat loss make it very clear that the anti inflammatory diet is the best dietary strategy to burn fat faster (1-3).

If the moderate-carbohydrate anti inflammatory diet is good, then shouldn’t an even lower-carbohydrate diet like the Atkins diet be better? Not so fast. The published studies comparing the anti inflammatory diet to the Atkins diet make it clear that there are no benefits to consuming a lower-carbohydrate diet that generates ketosis, but there are plenty of negative consequences, such as increased cellular inflammation and decreased capacity for exercise (4,5).

But losing weight is relatively easy compared to keeping it off. That’s why the recent DIOGENES study is so important (6). This study makes it very clear that if you want to keep lost weight off, then your best choice is maintaining a diet that has at least 25 percent of the calories coming from protein, and about 40 percent of the calories coming from low-glycemic carbohydrates. That’s the anti inflammatory diet.

So if your New Year’s resolution is to lose weight (and really lose fat) and keep it off, then the anti inflammatory diet should be your only choice.

References

1. Layman DK, Boileau RA, Erickson DJ, Painter JE, Shiue H, Sather C, and Christou DD. “A reduced ratio of dietary carbohydrate to protein improves body composition and blood lipid profiles during weight loss in adult women.” J Nutr 133: 411-417 (2003)
2. Lasker DA, Evans EM, and Layman DK, “Moderate-carbohydrate, moderate-protein weight-loss diet reduces cardiovascular disease risk compared to high-carbohydrate, low-protein diet in obese adults. A randomized clinical trial.” Nutrition and Metabolism 5: 30 (2008)
3. Fontani G, Corradeschi F, Felici A, Alfatti F, Bugarini R, Fiaschi AI, Cerretani D, Montorfano G, Rizzo AM and Berra B. “Blood profiles, body fat and mood state in healthy subjects on different diets supplemented with omega-3 polyunsaturated fatty acids.” Eur J Clin Invest 35: 499-507 (2005)
4. Johnston CS, Tjonn SL, Swan PD, White A, Hutchins H, and Sears B. “Ketogenic low-carbohydrate diets have no metabolic advantage over nonketogenic low-carbohydrate diets.” Am J Clin Nutr 83: 1055-1061 (2006)
5. White AM, Johnston CS, Swan PD, Tjonn SL, and Sears B. “Blood ketones are directly related to fatigue and perceived effort during exercise in overweight adults adhering to low-carbohydrate diets for weight loss: a pilot study.” J Am
Diet Assoc 107:1792-1796 (2007)
6. Larsen TM, Dalskov SM, van Baak M, Jebb SA, Papadaki A, Pfeiffer AF, Martinez JA, Handjieva-Darlenska T, Kunesova M, Pihlsgard M, Stender S, Holst C, Saris WH, and Astrup A. “Diets with high or low protein content and glycemic index for weight-loss maintenance.” N Engl J Med 363: 2102-2113 (2010)

Nothing contained in this blog is intended to be instructional for medial diagnosis or treatment. If you have a medical concern or issue, please consult your personal physician immediately.

Ward off the common cold with exercise

There is nothing like fall in New England — the crisp air on your face, the changes in foliage and all the fun activities like apple and pumpkin picking.  Even though the calendar says the season lasts three months, the end of daylight savings in my mind signals the beginning of winter.  I think it’s the combination of the cold air and driving home in the dark that makes me feel this way.  With the change in season comes the rise in sniffles, sneezes and coughs; but before you run out for your supply of Vitamin C or the newest remedy to ward off a cold, you may want to look no further than your activity level.

According to the British Journal of Sports Medicine, individuals who reported five days or more of aerobic exercise per week compared to those who were sedentary (less than 1 day/week of activity) were 43 percent less likely to have an upper respiratory tract infection (URTI) (1).  The investigators studied 1,002 adults aged 18-85 over 12 weeks during the autumn and winter of 2008.  Individuals reported their aerobic level and used a 10-point scale to assess the level of physical fitness.

The authors took into account other factors that may have confounded the results (e.g., lifestyle, diet and stress) in their analyses.  In addition, they found that people’s perception of how fit they felt and the amount of activity performed lessened the severity of URTI and symptoms by 32-41 percent.

More intriguing is another recent paper (2) in which rats that like to exercise, were bred with similar exercise-loving rats for 11 generations.  These were compared to rats that didn’t like to run who were bred with other exercise-hating rats for 11 generations.  The super rats could not only run more distance than their coach potato cousins, but several groups of genes were up-regulated.

1).   D.C. Nieman, Henson D.A., Austin M.D et al. Upper respiratory tract infection is reduced in physically fit and active adults. Brit J Sports Med doi:10.1136/bjsm.2010.077875.

2)  R. Kivela, M. Silvennoinen, M. Lehit et al.  Gene expression centroids that link with low intrinsic exercise capacity and complex disease risk.  FESEB J 24: 4565-4574 (2010)

Nothing contained in this blog is intended to be instructional for medial diagnosis or treatment. If you have a medical concern or issue, please consult your personal physician immediately.

Good thing I listened to Dr. Sears

By Mary Dinehart-Perry

Having recently delivered a baby, I was surprised to see the latest article published in the Journal of The American Medical Association that fish oil supplementation rich in DHA has no impact on postpartum depression or cognitive and language development in early childhood.

The study looked at approximately 2,400 Australian women who began supplementation at around 21 weeks gestation through to the birth of their children (1). Individuals were randomized into one of two groups, one getting a fish oil supplement exceptionally rich in DHA (800mg DHA and 100mg EPA) and the other vegetable oil. It has been know for years that fish oils containing both EPA and DHA have dramatic benefits for fetal outcome. However, since there is little EPA in the brain, it was assumed in the past that it was only DHA that contributed to all of these benefits. However, recent studies have demonstrated that EPA rapidly gets into the brain and is rapidly oxidized, but DHA is not (2).

Lack of awareness has led to the mistaken belief that DHA is the only omega-3 fatty acid attributed to optimal brain functioning. Needless to say, companies that market DHA-rich products work very hard to continue to foster this misconception. This explains why the clinical trials that have used only DHA to treat depression or other conditions such as ADHD have been found it to be wanting. This is because DHA is a structural omega-3 fatty acid, not an anti-inflammatory one like EPA.

As long as adequate EPA is constantly in the blood, there will be enough EPA in the brain to address any neurological problems for both the mother and the fetus. That’s why this published study with only 100 mg of EPA was providing essentially a placebo level of this critical omega-3 fatty acid (3).

Although I myself am only a data point of one, I took the same dosage of DHA described above (800mg) during my pregnancy, however, it was coupled with 1600mg EPA. I can’t help but think that it may have been the combination of EPA/DHA that helped me avoid postpartum depression.

Mary Dinehart-Perry is clinical trials director of Zone Labs.

  • Makrides M., Gibson RA, McPhee AJ, Yelland L, Quinlivan J, Ryan P and the DOMInO Investigative Team. Effect of DHA Supplementation During Pregnancy on Maternal Depression and Neurodevelopment of Young Children: A Randomized Controlled Trial. JAMA 2010; 304:1675-1683.
  • Chen CT, Liu Z, Ouellet M, Calon F, RichardP, and Bazinet RP. Rapid beta-oxidation of eicosapentaenoic acid in mouse brain. Prostaglandins, Leukotrienes and Essential Fatty Acids 2009; 80: 157–163
  • Wojcicki JM, Heyman MB. Maternal omega-3 fatty acid supplementation and risk for perinatal maternal depression. J Matern Fetal Neonatal Med. 2010 Oct 7. [Epub ahead of print]
  • Hill AM, Buckley JD, Murphy KJ, and Howe PRC. Combining fish-oil supplements with regular aerobic exercise improves body composition and cardiovascular disease risk factors. Am J Clin Nutr 2007;85:1267–1274.

Nothing contained in this blog is intended to be instructional for medial diagnosis or treatment. If you have a medical concern or issue, please consult your personal physician immediately.

For losing weight, exercise is good; diet is better

Here’s standard quote: “Losing weight can improve health and reduce many of the risk factors related to diabetes and heart disease.” Unfortunately, that’s not true. The correct statement is “losing excess body fat can improve health and reduce many of the risk factors related to diabetes and heart disease.”

It may seem like a minor difference, but it makes a world of difference. Weight loss could be due to water loss or cannibalization of lean body mass (muscles and organs), neither of which will lead to any health benefits.

If you want to reduce excess body fat, you have to lower insulin levels. How do you control that on a consistent basis? Remember the 80/20 rule. That means 80 percent of your insulin control will come from following a strict anti inflammatory diet, and 20 percent will come from increased physical activity.

This means the best exercise program can be undone by the wrong diet. Physical exercise has many important benefits, such as reducing the likelihood of diabetes and heart disease, improving sense of self-worth and hanging out with like-minded individuals.

Unfortunately, initial weight loss is not one of those benefits since research has demonstrated that exercise increases one’s appetite. This is why following a strict anti inflammatory diet is imperative if you are trying to lose weight by increasing your exercise. Another helpful hint is to increase your high purity omega-3 oil intake, as it has been demonstrated that fat loss is significantly increased when high purity omega-3 oil is used in combination with exercise.

On the other hand, after you reach your weight goals, the balance of diet and exercise to maintain your weight shifts to a 50/50 balance. Now exercise becomes an ideal way to maintain your weight as long as you continue to control insulin through the anti inflammatory diet.

Nothing contained in this blog is intended to be instructional for medial diagnosis or treatment. If you have a medical concern or issue, please consult your personal physician immediately.

What exactly is BMI?

Have you ever had one of those experiences with a child when they ask you a question or to define a word that is so common you should easily be able to, but you are left dumbfounded when trying to search for the best way to explain it to them? Welcome to Body Mass Index or BMI. BMI is a frequently used term these days, yet people often don’t understand exactly what it measures. It is a calculation based on a person’s weight and height and believed to be a reliable indicator of body fatness. Based on the results, it places people into various categories, which are then used as a screening tool to determine an individual’s risk for various health conditions (1).

Despite being an indicator of body fatness, nowhere in the calculation does it factor in a person’s lean body mass, so caution needs to be exercised when using it as a sole diagnostic criterion. Some people who are active and lean may be disappointed to learn they fall in the overweight category since the equation fails to take into account their muscle mass. The reason why it is so commonly used is because it’s an inexpensive and quick tool to assess the population’s risk of being overweight and obese, and for people to see how their BMI compares to the general population (2).

If you are curious to see what your BMI is, you can go to the CDC Web site at http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html#Why. Just remember that despite being a quick tool, it should really be used with other diagnostic criteria as a way to evaluate overall health.

1. Body Mass Index. Available at: http://www.cdc.gov/healthyweight/assessing/bmi/. Accessed: June 8, 2010.
2. About BMI for Adults. Available at: http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html#Why. Accessed: June 8, 2010.

Nothing contained in this blog is intended to be instructional for medial diagnosis or treatment. If you have a medical concern or issue, please consult your personal physician immediately.

Milk helpful in workout recovery

A common question among active people is what is the best snack or drink for recovery or to fuel with after a workout? There have been lots of studies suggesting the importance of fueling your muscles within the first 15-30 minutes after a workout, having the right combination of protein and carbohydrate, coupled with the less scientific ploys for consumers to buy various products, but the answer may already be in your refrigerator.

A study recently done with women examined how supplementation post workout influenced changes in body composition and strength after resistance training (1). Twenty women were separated into two groups. One group received 500mL of fat-free skim milk on two occasions (immediately after exercise and one hour post-exercise), and the other group received 500mL of a carbohydrate control drink (immediately after exercise and one hour post-exercise). Both drinks looked identical in appearance and were flavored with vanilla to have the same odor.

Each group reported to a lab five days per week for resistance training for 12 weeks. At the end of 12 weeks those who were placed in the milk group had significantly greater fat-mass loss, more lean body mass and greater strength gains than the group that received the control carbohydrate beverage.

So, the next time you have a great workout and are wondering how to fuel after, grab the milk. Not only will your bones thank you, but your body will too.

1) Josse AR, Tang JE, Tarnopolsky MA, Phillips SM. Body composition and strength changes in women with milk and resistance exercise. Med Sci Sports Exerc. 2010 Jun;42(6):1122-30.

Nothing contained in this blog is intend to be instructional for medial diagnosis or treatment. If you have a medical concern or issue, please consult your personal physician immediately.

United States’ major export: Obesity

By Dr. Barry Sears

Back in 2005, in my book “The Anti-Inflammation Zone” I wrote that many trends start in the United States and then cover the globe. We’ve exported Big Macs, Coca-Cola and the USDA Food Pyramid.

Now, five years later a report from the research organization, Datamonitor, indicates we have also exported childhood obesity – now more than one-third of European children are obese.

The organization attributes this weight gain to increased affluence and blames the usual suspects. “This is caused by a combination of eating too many calories and not doing enough physical activity,” according to the report.

That’s the same mantra that is used over and over in the United States. But obesity will not be curbed by eating less and exercising more unless we find shelter from the perfect nutritional storm that began in the United States and now has been exported across the globe.

New research indicates the primary factor has been the increasing consumption of omega-6 fatty acids found in vegetable oils, made in the USA.

The United States is also the king as far as processed foods are concerned, and we’ve been happy to share our junk food with children around the world.

And in Europe, as well as here at home, the amount of omega-3s consumed has dramatically declined.

The solution is to follow an anti inflammatory diet, increase intake of omega-3 fatty acids and dramatically reduce the intake of omega-6 fatty acids. Unfortunately this is easier said than done because of the ubiquitous presence of omega-6 fatty acids in virtually every processed food. Fortunately, increased intake of EPA and DHA (about 2.5 grams of EPA and DHA per day) can dilute out the inflammatory impact of these excess omega-6 fatty acids on our genes.

The bottom line, no pun intended, is that if there is no dietary change, children will continue to get fatter no matter how much they exercise because the genes that make children fat and keep them fat are being constantly turned on by diet they consume.

Nothing contained in this blog is intended to be instructional for medial diagnosis or treatment. If you have a medical concern or issue, please consult your personal physician immediately.

Motivation through the buddy system

Think about a time when you’ve been really successful with a health-related goal. It could be something as small as trying to decrease your intake of fast food, cutting back on sodium to reduce your blood pressure, or trying to up your activity either through more steps per day or getting to an exercise class.

Were you able to keep doing these activities even when your motivation was lacking a bit? How?
If you were able to stick with your goal, pat yourself on the back for a job well done! Unfortunately for many of us, we start out really strong but that motivation seems to go away. We have the carrot at the end of the stick, whether it’s Jan. 1, the approach of summer and bathing suit season, the class reunion, or a visit to the doctor that didn’t go as well as anticipated; but at times it’s not always enough.

Sometimes all it takes is someone holding us accountable to keep up the change and add a little push. A study published in the journal Health Psychology found that sedentary adults who received regular phone calls either by a health educator or an automated system reported greater physical activity than those who didn’t (1). The act of being accountable and having to report to someone what they did in terms of physical activity was enough to make these individuals stick with their goals.

So the next time you decide to make a health-related change in your life, think about enlisting the support of others. Join a social network, have friends e-mail or call to make sure you got up in the morning to walk that day or report back to them what you ate for the day or find a “buddy” who may have a similar goal that the two of or you or group of you can do it together.

1) King AC, Friedman R, Marcus B, Castro C, Napolitano M, Ahn D, Baker L. Ongoing physical activity advice by humans versus computers: the Community Health Advice by Telephone (CHAT) trial. Health Psychol. 2007 Nov;26(6):718-27.

Nothing contained in this blog is intended to be instructional for medial diagnosis or treatment. If you have a medical concern or issue, please consult your personal physician immediately.

Women can reduce stroke risk with physical activity

A few weeks back we blogged about the Journal of the American Medical Association’s new guidelines for physical activity being raised for women. The study suggested that for women to be successful in maintaining normal weight and gaining fewer pounds, they need to exercise for about 60 minutes per day of moderate-intensity activity (1). That’s a whopping 420 minutes per week! It always seems like the more chaotic our lives get, the harder it becomes to implement guidelines like this within it.

The good news is that it doesn’t take as much activity or even the same moderate intensity to reap the benefits of lowering your risk of chronic disease. A study published this month in the Journal Stroke involved 39,315 healthy women who took part in Women’s Healthy Study. It examined their activity levels and risk of stroke. Over an average follow-up of approximately 12 years, 579 women had a stroke. Although there was no association between vigorous physical activity and stroke risk, there was an inverse relationship between walking time and pace with the risk of having a stroke (2). For women who walked more than two hours per week at a brisk pace (3 to 3.9 mph), there was a significant reduction in their risk of suffering a stroke (3). Almost twice as many women in the United States die of heart disease, stroke and other cardiovascular diseases than from all forms of cancer (4). This becomes something simple women can do to lessen their risk and can even be broken up into 10 to 15 minute increments a day to make it more realistic to implement.

1. Lee IM, Djoussé L, Sesso HD, Wang L, Buring JE. Physical activity and weight gain prevention. JAMA. 2010 Mar 24;303(12):1173-9.

2. Sattelmair JR, Kurth T, Buring JE, Lee IM. Physical Activity and Risk of Stroke in Women. Stroke. 2010 Apr 6. [Epub ahead of print]

3. Brisk Walking Reduces Stroke Risk. Available at:
http://www.webmd.com/stroke/news/20100406/brisk-walking-reduces-stroke-risk. Accessed: April 6, 2010

4. Women, Heart Disease and Stroke. Available at:
http://www.americanheart.org/presenter.jhtml?identifier=4786. Accessed: April 12, 2010.

Nothing contained in this blog is intended to be instructional for medial diagnosis or treatment. If you have a medical concern or issue, please consult your personal physician immediately.