And the Winner Is . . . Well, Nobody
Put down your steak knife and stop salivating over the butter.
Just because a new study finds that the high-protein Atkins diet doesn't appear to cause the heart disease once feared is no reason to celebrate by loading up on high-fat fare.
Whether you're trying to shed pounds or just eat healthily, the take-home message shouldn't be to "eat the steaks and the whipped cream, but the fish and the fiber," says Christopher Gardner, assistant professor of medicine at the Stanford Prevention Research Center and lead author of the comparative study of popular diets that was published last week in the Journal of the American Medical Association.
In case you missed the recent headlines, Gardner and his colleagues reported on a year-long trial in overweight and obese women that compared four weight-loss regimens: the very-low-carbohydrate Atkins approach; the Zone diet, a reduced-carbohydrate regimen created by author Barry Sears; the very-low-fat, mostly vegetarian plan by physician Dean Ornish; and a conventional reduced-calorie-and-fat approach developed by Kelly Brownell, director of the Rudd Center for Food Policy and Obesity at Yale University.
Women in the Atkins group had shed an average of 10 pounds at the end of the year-long study, which was funded by the Community Foundation of Southeast Michigan and the National Institutes of Health. Statistically speaking, that's not significantly more than the six pounds lost by the conventional-diet group, the five pounds for the Ornish plan and the four pounds for the Zone. As Gardner notes, all represent "just a modest amount of weight," and far less than most of the dieters had hoped to shed. (Women in the study needed to lose 15 to 100 pounds to reach a healthy weight. Only a few women in each group lost substantial amounts of weight.)
Also lost in many of the news reports of the results was the difficulty that all four groups had in sticking with their plans. The 331 participants received much more help than most dieters get. Each read a book about their particular plan. For the first two months of the study, they attended a weekly session with a registered dietitian. They also had regular phone and e-mail reminders to return for weigh-ins and blood tests. But the sweetest part is that they were paid up to $75 per session for their participation.
Despite these incentives, the groups struggled. After the first two months, the Atkins group didn't adhere strictly to eating only very few carbohydrates. The Ornish group couldn't stick with the very-low-fat approach. And if all the women really ate as few calories as they reported, "they would have lost a lot more weight," notes Bonnie Brehm, professor of nutrition at the University of Cincinnati School of Nursing and co-author of two other studies of the Atkins diet.
Why the Atkins group shed weight a little faster and managed to lose a few more pounds may be due to the higher amount of protein they consumed. Protein is more satiating than carbohydrates or fat. But in any case, Gardner -- who has been a vegetarian for 25 years -- says the findings don't point to the Atkins diet "as the solution to the obesity epidemic."
What the results do underscore are the benefits of cutting back on processed carbohydrates, the kind found in white bread and in popular foods and beverages with added sugar, such as sweetened breakfast cereals and soft drinks. The Atkins group ate the fewest processed carbohydrates and reaped some of the best benefits from improved blood sugar and insulin levels. So it's best to get your carbohydrates from fruit, vegetables and whole grains -- advice that is consistent with all four diet books and with the U.S. Dietary Guidelines.
Just how important that can be is illustrated by a new report drawn from the Iowa Women's Health Study, a 10-year research project of nearly 42,000 women age 55 to 69 that was begun in 1986. New findings published this month in the American Journal of Clinical Nutrition by a team of scientists from the University of Minnesota, the University of Oslo and Exponent, a Washington-based research group, find benefits from eating foods rich in flavonoids: Women who regularly ate bran, apples, pears, grapefruit, strawberries and chocolate and who sipped a little red wine had the lowest risks of heart disease, heart attacks and death from all causes.
As for the small amounts of weight lost in the Stanford study, that need not be seen as failure, experts say. The results suggest that shedding less than 5 percent of total body weight produced significant improvements in blood pressure, cholesterol, blood sugar and insulin levels. "Even a little bit of weight loss can have some positive effects," Brehm notes.
If you plan to try a low-carbohydrate diet, advises Walter Willett, professor of nutrition at the Harvard School of Public Health, choose foods that will make a difference in your long-term risk for heart disease and diabetes. So reach for fish, beans, the leanest cuts of red meat and poultry without the skin as well as for small amounts of nuts and healthy oil, such as olive, canola or safflower.
Finally, social support can be key. One woman in the Ornish group of the Stanford study followed the program with her husband. "They made it a contest," Gardner says. "She managed to lose 40 pounds."