Fat Loss Documentation - An unbias look at the science of fat loss: part 2
Prologue -
In the previous article we’ve looked at some concepts with regards to weight/fat gained, we cannot deny the laws of thermodynamics with the calories in vs calories out. With the rise of so many trends in the nutritional/weight loss world there is still so much noise that we need to cut through.
In part 2, we’ve looking at the science of low carb diets; touted to be the most revolutionary method to obesity and to counter it - however is it as effective as it turns out to be?
We explore many studies and concept towards this approach and re-look into the concept of low carb and weight loss and all this health benefits that it claims. We shall leave no stones unturned in the quest for knowledge and leaving behind the biasness of one approach over the other.
Disclaimer - As of now, i’m not a pro low carb person nor a pro high carb person. I was a low carb supporter and have felt the great effects of it, I’ve been experimenting with low carb diets in many aspects for the past 3 years and the results were mixed. I wanted to know why it worked, how it worked and if i could make it work better. My opinions have changed after much digging and experimenting and talking to many people who are smarter than me and have went through the process and studies before me.
Introductions - A Commentary
Low carb diets have seen a surge in recent years with helping to bring obesity down, there are many studies conducted and we’ve revealed some of the mysteries of it. The influx of studies came with the popular Atkins Diet by Dr. Robert Atkins for the common folk and Anabolic Diet by Dr. Mauro Di Pasquale’s. There were many before them but these two individuals rocked the boat with their concepts of eliminating carbohydrates to a minimal to lose weight, build muscles.
There were always two side of the coin, the Pro High Carb camp debated the efficacy of using the low carb because of the health complications which was presented in consuming too much saturated fat and high(er) protein intake. Since there was no studies then to conclude the benefits and to demonstrate the safety of such a diet, the argument went both ways and both camp sought to prove other side wrong.
While the medical world was still debating, the people of the real world were doing the diets themselves and got great results. In my opinion, you can’t really argue with results but still the battle raged on through out the course of history. Soon many test, clincal trials was concluded and many findings did go in favour of the low carb camp but some concepts were lost in transition along the way.
Gary Taubes of the Good Calories, Bad Calories concluded that if carbs were kept low, insulin would be suppressed and fat storage would never be a problem. The Atkin’s diet too touted that Insulin was the root of all obesity and many followed on the bandwagon without much verification as results were still seen in the folks who did do their diet.
So does the calories matter? Are low carb diets really something we must do to lose weight?
We’ll discuss them now.
Evidence in support for the low carb diets -
A Randomized Trial of a Low-Carbohydrate Diet for Obesity
Gary D. Foster, Ph.D., Holly R. Wyatt, M.D., James O. Hill, Ph.D., Brian G. McGuckin, Ed.M., Carrie Brill, B.S., B. Selma Mohammed, M.D., Ph.D., Philippe O. Szapary, M.D., Daniel J. Rader, M.D., Joel S. Edman, D.Sc., and Samuel Klein, M.D. ABSTRACT
Background Despite the popularity of the low-carbohydrate, high-protein, high-fat (Atkins) diet, no randomized, controlled trials have evaluated its efficacy.
Methods We conducted a one-year, multicenter, controlled trial involving 63 obese men and women who were randomly assigned to either a low-carbohydrate, high-protein, high-fat diet or a low-calorie, high-carbohydrate, low-fat (conventional) diet. Professional contact was minimal to replicate the approach used by most dieters.
Results Subjects on the low-carbohydrate diet had lost more weight than subjects on the conventional diet at 3 months (mean [±SD], –6.8±5.0 vs. –2.7±3.7 percent of body weight; P=0.001) and 6 months (–7.0±6.5 vs. –3.2±5.6 percent of body weight, P=0.02), but the difference at 12 months was not significant (–4.4±6.7 vs. –2.5±6.3 percent of body weight, P=0.26). After three months, no significant differences were found between the groups in total or low-density lipoprotein cholesterol concentrations. The increase in high-density lipoprotein cholesterol concentrations and the decrease in triglyceride concentrations were greater among subjects on the low-carbohydrate diet than among those on the conventional diet throughout most of the study. Both diets significantly decreased diastolic blood pressure and the insulin response to an oral glucose load.
Conclusions The low-carbohydrate diet produced a greater weight loss (absolute difference, approximately 4 percent) than did the conventional diet for the first six months, but the differences were not significant at one year. The low-carbohydrate diet was associated with a greater improvement in some risk factors for coronary heart disease. Adherence was poor and attrition was high in both groups. Longer and larger studies are required to determine the long-term safety and efficacy of low-carbohydrate, high-protein, high-fat diets.
Gary et al, concluded that there were greater loss in weight for the first 3 months however there was no direct distinctions with the amount of physical activity which gives leads us to question if their diets were because of the nutrition by itself or because of the diet + physical levels of the person that cause them to lose the weight. The dietary outlines itself was very vague and all the person needed to do was keep carbs below 20g per day which is about 80 calories.
This raises many question on how much calories they where actually consuming and if they were restricting their calories due to the fact that they where on a obesity program. So its hard to actually determined the efficacy of the low carb diet and how the guidelines are from the Atkins diet to support their hypothesis.
Still it was interesting to note that the weight loss was accelerated for the first 3 months and later it was the same with the non low carb diet.
Effect of 6-month adherence to a very low carbohydrate diet program☆
Eric C Westman, MD, MHSabCorresponding Author Informationemail address, William S Yancy, MDab, Joel S Edman, DScc, Keith F Tomlina, Christine E Perkins, MSWa
Received 2 April 2001; received in revised form 24 January 2002; accepted 31 January 2002.
Abstract
Purpose
To determine the effect of a 6-month very low carbohydrate diet program on body weight and other metabolic parameters.
Subjects and methods
Fifty-one overweight or obese healthy volunteers who wanted to lose weight were placed on a very low carbohydrate diet (<25 g/d), with no limit on caloric intake. They also received nutritional supplementation and recommendations about exercise, and attended group meetings at a research clinic. The outcomes were body weight, body mass index, percentage of body fat (estimated by skinfold thickness), serum chemistry and lipid values, 24-hour urine measurements, and subjective adverse effects.
Results
Forty-one (80%) of the 51 subjects attended visits through 6 months. In these subjects, the mean (± SD) body weight decreased 10.3% ± 5.9% (P <0.001) from baseline to 6 months (body weight reduction of 9.0 ± 5.3 kg and body mass index reduction of 3.2 ± 1.9 kg/m2). The mean percentage of body weight that was fat decreased 2.9% ± 3.2% from baseline to 6 months (P <0.001). The mean serum bicarbonate level decreased 2 ± 2.4 mmol/L (P <0.001) and blood urea nitrogen level increased 2 ± 4 mg/dL (P <0.001). Serum total cholesterol level decreased 11 ± 26 mg/dL (P = 0.006), low-density lipoprotein cholesterol level decreased 10 ± 25 mg/dL (P = 0.01), triglyceride level decreased 56 ± 45 mg/dL (P <0.001), high-density lipoprotein (HDL) cholesterol level increased 10 ± 8 mg/dL (P <0.001), and the cholesterol/HDL cholesterol ratio decreased 0.9 ± 0.6 units (P <0.001). There were no serious adverse effects, but the possibility of adverse effects in the 10 subjects who did not adhere to the program cannot be eliminated.
Conclusion
A very low carbohydrate diet program led to sustained weight loss during a 6-month period. Further controlled research is warranted.
Looking at the studies, I’m finding it really weird that no researcher actually thought about measuring the calories during the trials. I’ve read a few others and still there was no mention on calorie consumption, and this puzzles me as to why didn’t they just take this important factor into consideration and measure the caloric intake of the low carb diet when they have the means to do it?
Isn’t the design flawed of its effectiveness if we do not measure caloric intake of the low carb diet? Can it be justified with the concepts that was expounded with the diets of low carb?
Has science failed us this time to determine the efficacy of a low carb diet in terms of weight loss and weight gain?
The low carb camp has then argued that they can eat as much as they want to get a weight loss effect due to the metabolic effects of proteins which has a higher Thermal Effect of Feed - TEF and without the presence of insulin. Is it really the case?
Again we look into science to verify such findings and more recent studies was designed so much more intelligently - read common sense, to actually look into measuring calories of the diet and leave nothing to self-reporting and controlled the dietary intake.
Evidence Against - Which is actually quite neutral in my honest opinion -
Effects of Low-Carbohydrate vs Low-Fat Diets on Weight Loss and Cardiovascular Risk Factors
A Meta-analysis of Randomized Controlled Trials
Alain J. Nordmann, MD, MSc; Abigail Nordmann, BS; Matthias Briel, MD; Ulrich Keller, MD; William S. Yancy, Jr, MD, MSH; Bonnie J. Brehm, PhD; Heiner C. Bucher, MD, MPH
Arch Intern Med. 2006;166:285-293.
Background Low-carbohydrate diets have become increasingly popular for weight loss. However, evidence from individual trials about benefits and risks of these diets to achieve weight loss and modify cardiovascular risk factors is preliminary.
Methods We used the Cochrane Collaboration search strategy to identify trials comparing the effects of low-carbohydrate diets without restriction of energy intake vs low-fat diets in individuals with a body mass index (calculated as weight in kilograms divided by the square of height in meters) of at least 25. Included trials had to report changes in body weight in intention-to-treat analysis and to have a follow-up of at least 6 months. Two reviewers independently assessed trial eligibility and quality of randomized controlled trials.
Results Five trials including a total of 447 individuals fulfilled our inclusion criteria. After 6 months, individuals assigned to low-carbohydrate diets had lost more weight than individuals randomized to low-fat diets (weighted mean difference, –3.3 kg; 95% confidence interval [CI], –5.3 to –1.4 kg). This difference was no longer obvious after 12 months (weighted mean difference, –1.0 kg; 95% CI, –3.5 to 1.5 kg). There were no differences in blood pressure. Triglyceride and high-density lipoprotein cholesterol values changed more favorably in individuals assigned to low-carbohydrate diets (after 6 months, for triglycerides, weighted mean difference, –22.1 mg/dL [–0.25 mmol/L]; 95% CI, –38.1 to –5.3 mg/dL [–0.43 to –0.06 mmol/L]; and for high-density lipoprotein cholesterol, weighted mean difference, 4.6 mg/dL [0.12 mmol/L]; 95% CI, 1.5-8.1 mg/dL [0.04-0.21 mmol/L]), but total cholesterol and low-density lipoprotein cholesterol values changed more favorably in individuals assigned to low-fat diets (weighted mean difference in low-density lipoprotein cholesterol after 6 months, 5.4 mg/dL [0.14 mmol/L]; 95% CI, 1.2-10.1 mg/dL [0.03-0.26 mmol/L]).
Conclusions Low-carbohydrate, non–energy-restricted diets appear to be at least as effective as low-fat, energy-restricted diets in inducing weight loss for up to 1 year. However, potential favorable changes in triglyceride and high-density lipoprotein cholesterol values should be weighed against potential unfavorable changes in low-density lipoprotein cholesterol values when low-carbohydrate diets to induce weight loss are considered.
So now the researchers placed more brains and measured the caloric intake for both diets and kept it fairly constant - The only changes made with the diet was to adjust the carb/fat intake accordingly.
The low carb side got 15% carbs to their diet of their total calories, the higher carb side has 45% carbs to their diet. Everything was kept constant through out the study and weight loss was about the same, so we have now calories do matter in this sense and even with suppressed presence of insulin the weight loss was the same after at the 12th month mark - which is towards the end of the diet.
However we must note that again the same phenomena of low carb diets experienced with accelerated weight loss within the 6 months trial but both diets even out at the 12 months mark - towards the end of the study. Still it leaves out the metabolic advantage of low carb diets as oppose to high carb which could explain the accelerated weight loss for the 6 months mark. The question still is hanging in the air with this study with the physical activity, as there was no control what the participants were doing outside of the study on their own.
Ketogenic Low-Carbohydrate Diets have no Metabolic Advantage over Nonketogenic Low-Carbohydrate Diets - Research Review
Title and Abstract
Johnston CS et. al. Ketogenic low-carbohydrate diets have no metabolic advantage over nonketogenic low-carbohydrate diets. American Journal of Clinical Nutrition. (2006) 83: 1055-1061
Background:Low-carbohydrate diets may promote greater weight loss than does the conventional low-fat, high-carbohydrate diet. Objective:We compared weight loss and biomarker change in adults adhering to a ketogenic low-carbohydrate (KLC) diet or a nonketogenic low-carbohydrate (NLC) diet. Design:Twenty adults [body mass index (in kg/m2): 34.4 ± 1.0] were randomly assigned to the KLC (60% of energy as fat, beginning with 5% of energy as carbohydrate) or NLC (30% of energy as fat; 40% of energy as carbohydrate) diet. During the 6-wk trial, participants were sedentary, and 24-h intakes were strictly controlled. Results:Mean (±SE) weight losses (6.3 ± 0.6 and 7.2 ± 0.8 kg in KLC and NLC dieters, respectively; P = 0.324) and fat losses (3.4 and 5.5 kg in KLC and NLC dieters, respectively; P = 0.111) did not differ significantly by group after 6 wk. Blood ß-hydroxybutyrate in the KLC dieters was 3.6 times that in the NLC dieters at week 2 (P = 0.018), and LDL cholesterol was directly correlated with blood ß-hydroxybutyrate (r = 0.297, P = 0.025). Overall, insulin sensitivity and resting energy expenditure increased and serum -glutamyltransferase concentrations decreased in both diet groups during the 6-wk trial (P < 0.05). However, inflammatory risk (arachidonic acid:eicosapentaenoic acid ratios in plasma phospholipids) and perceptions of vigor were more adversely affected by the KLC than by the NLC diet. Conclusions:KLC and NLC diets were equally effective in reducing body weight and insulin resistance, but the KLC diet was associated with several adverse metabolic and emotional effects. The use of ketogenic diets for weight loss is not warranted.
This has placed the nail in the coffin for the Low Carb Talibans affectionately termed by Martin Birkin of Leangains.com - one of the experts in Intermittent Fasting.
So with this study, it was the turn of what we once knew of the low carb generation. Everything was controlled, no physical activity no self reporting and everything was measured and strictly control with randomized testing. There’s nothing much to comment on this study because the researchers had covered all angles and discrepancy with regards of the physical and nutritional aspect to measure the advantages but it is interesting to note that for the nutrition was adjusted to 70% of their maintenance - which mean that at all times they’ll be in 30% caloric deficit.
No difference was seen within the low carb or low fat diet within a deficit and both were as good to curb insulin resistance.
So what now? Low carb? High carb? - Quit Confusing me!
So now we know that calories count and are extremely important to weight/fat loss on the whole, and not to beat a dead horse - we need to be more accountable with it.
Lets explore some facts about carbohydrates - Do we need them to survive? No. Theoretically, one can do away without carbohydrates altogether in their life and there are many people who are diabetic who stay this course to control their insulin spikes.
I’ve been on a low carb diet for a very long time, and even now I’m still using low carb diet but once a week, I’ll stuff myself silly with carbohydrates just to re-feed my muscles. This is to ensure my performance and intensity can be kept high and not too sluggish all the time. Some people do better with lower carbohydrates and some people just cannot function without carbs.
They’ve experience mental fuzziness and down turn in mood, usually the start of a low carb diet is very much tough as the adaptation towards using fats as fuel.
Choosing which kind of diet is purely up to one’s physical activity, body composition and their goals in mind. Lets break down the different factors and put into perspective of each one mentioned.
Physical Activities -
Carbohydrates is often used by endurance athlete and there is many research to support the use with regards of performance. Carbohydrates usage is also another tool for gym rats to spike their insulin to usher nutrients into their muscles when they ingest protein, this has been documented well in recent research and studies with regards to protein synthesis and recovery as well as muscle building.
Body Composition -
Body composition dictates the amount of muscles mass vs fat mass on one’s body and that affects some hormones in the body, particularly insulin. Insulin is a ushering hormone which ushers nutrients to your muscles or bodyfat to store the nutrients. When people are diabetic they get insulin resistant, and the insulin doesn’t work the same way as it used to - that is why there is a need for external insulin injection.
Body composition will determine the compatibility of the diet - People who are leaner; lower body fat will find it hard to function properly on a low carb diet because they don’t have “ready fuel”
But I write it myself.
Defeats the objective in my case....and i think why don't they get to the point!
