Which Diets Are Best In 2022?

February 8, 2022 by Dr. Steve Chaney

Which Diet Should You Choose?

Author: Dr. Stephen Chaney

Many of you started 2022 with goals of losing weight and/or improving your health. In many cases, that involved choosing a new diet. That was only a month ago, but it probably feels like an eternity.

For many of you the “bloom” has gone off the new diet you started so enthusiastically in January.

Perhaps the diet isn’t working as well as advertised…

Perhaps the diet is too restrictive. You are finding it hard to stick with…

Perhaps you are always hungry or constantly fighting food cravings…

Perhaps you are starting to wonder whether there is a better diet than the one you chose in January…

Perhaps you are wondering whether the diet you chose is the wrong one for you…

If you are rethinking your diet, you might want to know which diets the experts recommend. Unfortunately, that’s not as easy as it sounds. The diet world has become just as divided as the political world.

Fortunately, you have an impartial resource. Each year US News & World Report invites a panel of experts with different points of view to evaluate popular diets. They then combine the input from all the experts into rankings of the diets in various categories.

If you are still searching for your ideal diet, I will summarize the US News & World Report’s “Best Diets In 2022”. For the full report, click on this link.

How Was This Report Created?

US News & World Report recruited panel of 27 nationally recognized experts in diet, nutrition, obesity, food psychology, diabetes, and heart disease to review the 40 most popular diets. The panel is not the same each year. Some experts are rotated off the panel, and others are added. The experts rate each diet in seven categories:

How easy it is to follow.

Its ability to produce short-term weight loss.

Its ability to produce long-term weight loss.

its nutritional completeness.

Its safety.

Its potential for preventing and managing diabetes.

Its potential for preventing and managing heart disease.

They converted the experts’ ratings to scores 5 (highest) to 1 (lowest). They then used these scores to construct nine sets of Best Diets rankings:

Best Diets Overall combines panelists’ ratings in all seven categories. However, all categories were not equally weighted. Short-term and long-term weight loss were combined, with long-term ratings getting twice the weight. Why? A diet’s true test is whether it can be sustained for years. And safety was double counted because no diet should be dangerous.

Best Commercial Diets uses the same approach to rank 15 structured diet programs that require a participation fee or promote the use of branded food or nutritional products.

Best Weight-Loss Diets was generated by combining short-term and long-term weight-loss ratings, weighting both equally. Some dieters want to drop pounds fast, while others, looking years ahead, are aiming for slow and steady. Equal weighting accepts both goals as worthy.

Best Diabetes Diets is based on averaged diabetes ratings.

Best Heart-Healthy Diets uses averaged heart-health ratings.

Best Diets for Healthy Eating combines nutritional completeness and safety ratings, giving twice the weight to safety. A healthy diet should provide sufficient calories and not fall seriously short on important nutrients or entire food groups.

Easiest Diets to Follow represents panelists’ averaged judgments about each diet’s taste appeal, ease of initial adjustment, ability to keep dieters from feeling hungry and imposition of special requirements.

Best Plant-Based Diets uses the same approach as Best Diets Overall to rank 12 plans that emphasize minimally processed foods from plants.

Best Fast Weight-Loss Diets is based on short-term weight-loss ratings.

Which Diets Are Best In 2022?

Are you ready? If this were an awards program I would be saying “Envelop please” and would open the envelop slowly to build suspense.

However, I am not going to do that. Here are the top 5 and bottom 5 diets in each category (If you would like to see where your favorite diet ranked, click on this link). [Note: I excluded commercial diets from this review.]

Best Diets Overall

The Top 5:

#1: Mediterranean Diet. The Mediterranean diet has been ranked #1 for 5 consecutive years.

#2: DASH Diet (This diet was designed to keep blood pressure under control, but you can also think of it as an Americanized version of the Mediterranean diet.)

#3: Flexitarian Diet (A flexible semi-vegetarian diet).

#4: MIND Diet (This diet is a combination of Mediterranean and DASH but is specifically designed to reduce cognitive decline as we age.)

#5: The TLC Diet (This diet was designed by the NIH to promote heart health.)

The Bottom 5:

#36: Whole 30 Diet (A whole food, restrictive diet, designed for a 30-day jump start to weight loss. It was not designed for long-term use).

#37: Modified Keto Diet (A slightly less restrictive version of the Keto Diet).

#38: Keto Diet (A high protein, high fat, very low carb diet designed to achieve ketosis).

#39: Dukan Diet (High protein, low carb, low fat diet).

#40: GAPS Diet (A diet designed to improve gut health).

Best Weight-Loss Diets

The Top 5:

#1: Flexitarian Diet

#2: Volumetrics Diet (A diet based on the caloric density of foods).

#3: Vegan Diet (A diet that only allows plant foods).

#4: Mayo Clinic Diet (A diet designed to establish lifelong healthy eating habits).

#5: Ornish Diet (A whole food, semi-vegetarian diet designed to promote heart health).

The Bottom 5:

#36: Fertility Diet (A diet designed to improve fertility, but the experts were skeptical that it would increase your chances of becoming pregnant)

#37: Whole 30 Diet

#38: Alkaline Diet (A diet designed to make your blood more alkaline, but the experts were skeptical about that claim)

#39: AIP Diet (A diet designed for people with autoimmune diseases)

#40: GAPS Diet

Best Diabetes Diets

The Top 5:

#1: Mediterranean Diet

#2: Flexitarian Diet

#3: Vegan Diet

#4: Mayo Clinic Diet

#5: DASH Diet

The Bottom 5:

#36: Alkaline Diet

#37: Dukan Diet

#38: GAPS Diet

#39: Sirtfood Diet (a very low calorie, fad diet that emphasizes plant foods rich in sirtuins)

#40: Whole 30 Diet

Best Heart-Healthy Diets

The Top 5:

#1: Mediterranean Diet

#2: Ornish Diet

#3: DASH Diet

#4: Flexitarian Diet

#5: TLC Diet

#6: Vegan Diet

The Bottom 5:

#36: Keto Diet

#37: AIP Diet

#38: Whole 30 Diet

#39: Modified Keto Diet

#40: Dukan Diet

Best Diets for Healthy Eating

The Top 5:

#1: Mediterranean Diet

#2: DASH Diet

#3: Flexitarian Diet

#4: MIND Diet

#5: TLC Diet

The Bottom 5:

#36: Raw Food Diet

#37: Atkins Diet

#38: Dukan Diet

#39: Modified Keto Diet

#40: Keto Diet

Easiest Diets to Follow

The Top 5:

#1: Mediterranean Diet

#2: Flexitarian Diet

#3: Fertility Diet

#4: MIND Diet

#5: DASH Diet

The Bottom 5:

#36: Modified Keto Diet

#37: Keto Diet

#38: Whole 30 Diet

#39: GAPS Diet

#40: Raw Foods Diet

Best Fast Weight-Loss Diets

The Top 5 (Excluding Commercial Diets):

#1: Atkins Diet

#2: Biggest Loser Diet

#3: Keto Diet

#4: Raw Food Diet

#5: Vegan Diet

The Bottom 5

#36: Dr. Weil’s Anti-Inflammatory Diet

#37: The Fertility Diet

#38: AIP Diet

#39: Alkaline Diet

#40: Gaps Diet

Which Diets Are Best For Rapid Weight Loss?

There are 3 take-home lessons from the rapid weight loss category:

1) If you are looking for rapid weight loss, any whole food restrictive diet will do. The top 5 diets are very different. For example, the keto and vegan diets are polar opposites, yet they both are in the top 5 for rapid weight loss.

The Atkins and keto diets are meat heavy, low carb diets. They restrict fruits, some vegetables, grains, and most legumes.

The Biggest Loser diet relies on restrictive meal plan and exercise programs.

The restrictions of the raw food diet are obvious.

The vegan diet is a very low-fat diet that eliminates meat, dairy, eggs, and animal fats.

I did not include commercial diets that rated high on this list, but they are all restrictive in one way or another.

2) We should ask what happens when we get tired of restrictive diets and add back some of your favorite foods.

If you lose weight on a vegan diet and add back some of your favorite foods, you might end up with a semi-vegetarian diet. This is a healthy diet that can help you maintain your weight loss.

If you lose weight on the Atkins or keto diets and add back some of your favorite foods, you end up with the typical American diet – one that is high in both fat and carbs. This is not a recipe for long-term success.

3) Don’t pay too much attention to the bottom 5 diets. None of them were designed with weight loss in mind.

Which Diet Should You Choose?

With rapid weight loss out of the way, let’s get back to the question, “Which Diet Should You Choose?” My recommendations are:

1) Choose a diet that fits your needs. That is one of the things I like best about the US News & World Report ratings. The diets are categorized. If your main concern is diabetes, choose one of the top diets in that category. If your main concern is heart health… You get the point.

2) Choose diets that are healthy and associated with long term weight loss. If that is your goal, you will notice that primarily plant-based diets top these lists. Meat-based, low carb diets like Atkins and keto are near the bottom of the lists.

3) Choose diets that are easy to follow. The less-restrictive primarily plant-based diets top this list – diets like Mediterranean, DASH, MIND, and flexitarian.

4) Choose diets that fit your lifestyle and dietary preferences. For example, if you don’t like fish and olive oil, you will probably do much better with the DASH or flexitarian diet than with the Mediterranean diet.

5) In case you were wondering, intermittent fasting ranked 26-30 and the Paleo diet ranked 26-33 on most of the list – not the worst diets, but a long way from the best. If you have a favorite diet I didn’t mention, check the US News website to find where it is ranked.

6) Finally, focus on what you have to gain, rather than on foods you have to give up.

On the minus side, none of the diets include sodas, junk foods, and highly processed foods. These foods should go on your “No-No” list. Sweets should be occasional treats and only as part of a healthy meal. Meat, especially red meat, should become a garnish rather than a main course.

On the plus side, primarily plant-based diets offer a cornucopia of delicious plant foods you probably didn’t even know existed. Plus, for any of the top-rated plant-based diets, there are websites and books full of mouth-watering recipes. Be adventurous.

The Bottom Line

For many of you the “bloom” has gone off the new diet you started so enthusiastically in January. If you are rethinking your diet, you might want to know which diets the experts recommend. Unfortunately, that’s not as easy as it sounds. The diet world has become just as divided as the political world.

There are probably two questions at the top of your list.

#1: Which diets are best for rapid weight loss? Here are some general principles:

If you are looking for rapid weight loss, any whole food restrictive diet will do.

We should ask what happens when we get tired of restrictive diets and add back some of our favorite foods.

Long term weight loss is possible if you transition to a healthy diet after you have lost the weight.

#2: Which diet should you choose? Here the principles are:

Choose a diet that fits your needs.

Choose diets that are healthy and associated with long term weight loss.

Choose diets that are easy to follow.

Choose diets that fit your lifestyle and dietary preferences.

Finally, focus on what you have to gain, rather than on foods you have to give up.

For more details on the diet that is best for you, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

Which Diet Is Best?

December 28, 2021 by Dr. Steve Chaney

Tips For Loosing Weight And Keeping It Off

Author: Dr. Stephen Chaney

Diet season starts in just a few days! Like millions of Americans, you will probably be setting a goal to eat healthier, lose weight, or both. But which diet is best? Vegan, Paleo, Keto, 360, Intermittent Fasting, low-carb, low fat – the list is endless.

And then there are the commercial diets: Meal replacements, low calorie processed foods, prepared meals delivered to your door – just to name a few of the categories.

You can choose to count calories, focus on portion sizes, or keep a food journal.

And, if you really want to live dangerously, you can try the latest diet pills that claim to curb your appetite and rev up your metabolism.

The advertisements for all these diets sound so convincing. They give you scientific-sounding mumbo-jumbo to explain why they work. Then they talk about clinical studies they say prove their diet works.

If you are like most Americans, you have already tried several of these diets. They worked for a while, but the pounds came back – and brought their friends with them.

But, as the saying goes, “Hope springs eternal in the human breast. Surely some diet you haven’t tried yet will work for you.

There are such diets. But they will require effort. They will require a change of mindset. There is no magic wand that will chase the extra pounds away forever.

If you are searching for the perfect diet to start the new year, let me be your guide. Here are:

4 tips on what to avoid and…

6 tips on what to look for…

…when you are choosing the best diet for you.

What Should You Avoid When Choosing The Best Diet?

Endorsements.

Endorsements by your favorite athlete or public person are paid for. They don’t necessarily represent their opinion. Nor do they assure you that they follow that diet or use that diet supplement.

Endorsements by Dr. Strangelove and his buddies can be equally misleading. They usually tell you that the medical establishment has been lying to you, and they have discovered the “secret” to permanent weight loss and the “Fountain of Youth”.

Recommendations of the medical and scientific communities usually represent a consensus statement by the top experts in their field. I would choose their advice over Dr. Strangelove’s opinion any day.

2) Testimonials

Most of the testimonials you see online or in print are either paid for or are fake.

Testimonials by your friends can be equally misleading. We are all different. What works for your friend or your trainer may not work for you.

For example, some of us do better on low-carb diets, and others do better on low fat diets.

[Note: Some DNA testing companies claim they can sequence your DNA and tell you which diet is best. However, as I reported in a recent article in “Health Tips From The Professor”, independent studies show that DNA testing is of no use in predicting whether low-carb or low-fat diets are better for you.]

3) Diets Based on “Magic” Or “Forbidden” Foods or Food Groups.

I have often said we have 5 food groups for a reason. Each food group provides a unique blend of nutrients and phytonutrients. And each plant food group provides a unique blend of fibers that support the growth of different types of friendly gut bacteria.

The bottom line is that each of us does better with some foods than others, but there are no “magic” or “forbidden” foods that apply to everyone.

4) “Magic” Diets.

I have written perhaps the first diet book, “Slaying The Food Myths”, that doesn’t feature a “magic” diet that is going to make the pounds melt away and allow you to live to 100. Instead, I recommend a variety of healthy diets and suggest you choose the one that fits you best.

However, I understand the allure of “magic” diets. Dr. Strangelove claims the diet will be effortless. He gives you some scientific-sounding mumbo-jumbo to convince you the diet is scientifically sound. Then he cites some clinical studies showing the diet will cause you to lose weight and will improve your health parameters (things like cholesterol, triglycerides, blood sugar, and blood pressure). It sounds so convincing.

Before you fall for Dr. Strangelove’s latest “magic” diet, let me share two things that may blow your mind:

- The studies are all short-term (usually 3 months or less).

- When you rely on short-term studies, the very low-fat Vegan diet and very low-carb Keto diet give you virtually identical weight loss and improvement in health parameters!

Those two diets are as different as any two diets could be. That means we can forget all the scientific-sounding mumbo-jumbo as to why each of those diets work. Instead, we should ask what these two diets have in common.

The answer is simple:

#1: The clinical studies are comparing “magic” diets to the typical American diet. Anything is better than the typical American diet! It is high in sugar, refined carbohydrates, saturated fat, and highly processed foods. No wonder the “magic” diets look so good.

#2: The diets are whole food diets. Anytime you eliminate sodas, fast foods, and highly processed foods, you will lose weight.

#3: The diets eliminate one or more food groups. Whenever you eliminate some of your favorite foods from your diet, you tend to lose weight without thinking about it. I call this the cream cheese and bagel phenomenon.

- If you are following a low-fat diet, it sounds great to say you can eat all the bagels you want. But without cream cheese to go with the bagels, you tend to eat fewer bagels.

- If you are following a low-carb diet, it sounds great to say you can eat as much cream cheese as you want, but without bagels to go with your cream cheese, you tend to eat less cream cheese.

#4: Because they eliminate many of your favorite foods, “magic” diets make you focus on what you eat. Whenever you focus on what you eat, you tend to lose weight. That is why food journals and calorie counters are effective.

#5: Finally, whenever you lose weight, your health parameters (cholesterol, triglycerides, blood sugar, and blood pressure) improve.

What Should You Look For In Choosing The Best Diet?

1) Choose whole food diets. Avoid sodas, fast foods, and highly processed foods.

2) Choose primarily plant-based diets. These can range from Vegan through semi-vegetarian, Mediterranean, DASH, and Nordic. All are healthy diets. I have discussed the evidence for this recommendation in my book “Slaying The Food Myths”. Here is a brief summary.

When we look at long term (10-20 year) studies:

- Vegetarians weigh less and are healthier than people consuming the typical American diet.

- People consuming semi-vegetarian, Mediterranean, and DASH diets are healthier than people consuming the typical American diet.

If you look at low-carb diets:

- People consuming plant-based low-carb diets weigh less and are healthier than people consuming the typical American diet.

- People consuming meat-based low-carb diets are just as fat and unhealthy as people consuming the typical American diet.

- The Atkins low-carb diet has been around for more than 50 years, and there is no evidence it is healthy long-term.

3) Choose diets that include a variety of foods from all 5 food groups. I have discussed the rationale for that recommendation above.

4) Choose diets that consider meat as a garnish, not a main course.

5) Choose diets that feature healthy carbs and healthy fats rather than low-carb or low-fat diets.

6) Think lifestyle, not diet. If you choose a restrictive diet so you can achieve quick weight loss, you will probably be just as fat and unhealthy next December 31^st as you are this year. Instead, choose diets that teach healthy eating and lifestyle changes that you can make a permanent part of your life.

Tips For Losing Weight And Keeping It Off

You know the brutal truth. Around 95% of dieters regain everything they lost and then some within a few years. You have probably gone through one or more cycles of weight loss and regain yourself – something called “yo-yo dieting”. You may even be asking yourself if it is worth bothering to try to lose weight this year.

Rather focusing on the negative statistics of weight loss, let’s look at the good news. There are people who lose the weight and keep it off. What do they do?

There is an organization called the National Weight Control Registry that has enrolled more than 10,000 people who have lost weight and kept it off. The people in this group lost weight on almost every diet imaginable. However, here is the important statistic: On average people in this group have lost 66 pounds and kept it off for 5 years.

The National Weight Control Registry has kept track of what they have done to keep the weight off. Here is what they do that you may not be doing:

They consume a reduced calorie, low fat diet.

2) They get lots of exercise (around 1 hour/day).

3) They have internalized their eating patterns. In short, this is no longer a diet. It has become a permanent part of their lifestyle. This is the way they eat without even thinking about it.

4) They monitor their weight regularly. When they gain a few pounds, they modify their diet until they are back at their target weight.

5) They eat breakfast on a regular basis.

6) They watch less than 10 hours of TV/week.

7) They are consistent (no planned cheat days).

Which Diet Is Best?

Now it is time to get back to the question you are asking right now, “Which diet is best?” I have covered a lot of ground in this article. Let me summarize it for you.

If you are thinking about popular diets:

Primarily plant-based diets ranging from Vegan to Mediterranean and Dash are associated with a healthier weight and better health long term.

- If want to lose weight quickly, you may want to start with the more restrictive plant-based diets, like Vegan, Ornish, Pritikin or semi-vegetarian.

- If you do better with a low-carb diet, my recommendation is the low-carb version of the Mediterranean diet.

- If your primary goal is rapid weight loss, you could also start with one of the healthier of the restrictive low-carb diets, like the Paleo or the 360 diet. I do not recommend the Keto diet.

No matter what diet you start with, plan to transition to the primarily plant-based diet that best fits your lifestyle and food preferences. This is the diet you will want to stick with to maintain your weight loss and achieve better health long term.

Plan on permanent lifestyle change rather than a short-term diet. Otherwise, you are just wasting your time.

Eat whole foods. Big Food keeps up with America’s favorite diets and is only too happy to sell you highly processed foods that match your favorite diet. Avoid those like the plague.

If you are thinking about commercial diets featuring meal replacement products:

Look for meal replacement products that:

- Do not contain artificial sweeteners, flavors, or preservatives.

- Use non-GMO protein. A non-GMO certification for the other ingredients is not necessary. For a more detailed explanation of when non-GMO certification is important and when it is unnecessary, see my article) in “Health Tips From the Professor”.

- Have stringent quality controls in place to assure purity. “Organic” and/or “non-GMO” on the label do not assure purity.

Look for programs that can provide clinical studies showing their diet plan is effective for weight loss and for keeping the weight off. Many programs have short-term clinical studies showing they are effective for weight loss, but very few have longer-term studies showing the weight stays off.

Finally, look for programs that teach permanent lifestyle change. This should include guidance on exercise and healthy eating.

I do not recommend most commercial diets that feature prepared low-calorie foods “shipped right to your door” as a major part of their program. The foods are highly processed. Plus, they include all your favorite unhealthy foods as part of the program. Even if they include lifestyle change as part of their program, they are undermining their message with the foods they are providing you.

I would be remiss if I didn’t mention that Weight Watchers is highly recommended by most experts in the field. Weight Watchers emphasizes journaling and counting calories, which is a plus because it makes you focus on what you are eating. They also have a good lifestyle program and support that can help you transition to permanent lifestyle change if you are willing to put in the effort. However, I don’t recommend their prepared low-calorie foods. They are no better than foods provided by the other commercial diet programs.

The Bottom Line

Weight loss season is upon us. If you plan to lose weight and/or adopt a healthier diet in the coming year, you are probably asking, “Which Diet Is Best?” In this issue of “Health Tips From The Professor” I give you:

4 tips on what to avoid when selecting the diet that is best for you.

6 tips on how to choose the best diet.

5 tips on what to look for when selecting a diet featuring meal replacement products.

7 tips on how to keep the weight off.

Then I put all this information together to help you choose the best diet, the best meal replacement product, and/or the best commercial diet program.

For more details read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Do Low Fat Diets Reduce The Risk Of Diabetes?

May 4, 2021 by Dr. Steve Chaney

Why Is Nutrition So Confusing?

Author: Dr. Stephen Chaney

Sometimes the professor likes to introduce you to the frontiers of nutrition. Epigenetics is such a frontier. In recent years, the hype has centered on DNA sequencing. It seems like everyone is offering to sequence your genome and tell you what kind of diet is best for you, what foods to eat, and what supplements to take. But can DNA sequencing fulfill those promises?

The problem is that DNA sequencing only tells you what genes you have. It doesn’t tell you whether those genes are active. Simply put, it doesn’t tell you whether those genes are turned on or turned off.

This is where epigenetics comes in. Epigenetics is the science of modifications that alter gene expression. In simple terms, both DNA and the proteins that bind to DNA can be modified. This does not change the DNA sequence. But these modifications can determine whether a gene is active (turned on) or inactive (turned off).

This sounds simple enough, but here is where it really gets interesting. These modifications are affected by our diet, our lifestyle (BMI and exercise), our microbiome (gut bacteria), and our environment.

In today’s “Health Tips From The Professor” I am going to share a study (CQ Lai et al, American Journal of Clinical Nutrition, 112: 1200-1211, 2020) that looks at the effect of diet (low-fat versus low-carb diets) on a particular kind of DNA modification (methylation) that affects a gene (CPT) which influences our risk for metabolic diseases (obesity, high triglycerides, low HDL, insulin resistance, pre-diabetes, and type 2 diabetes).

[Note: For simplicity I will just refer to type 2 diabetes in the rest of this article. Just be aware that whatever I say about type 2 diabetes applies to other metabolic diseases as well.]

Previous studies have shown that:

Methylation of the CPT gene is the only epigenetic change in the entire genome that is associated with decreased risk of type 2 diabetes.

CPT gene activity regulates multiple metabolic pathways that influence the risk of type 2 diabetes.

High fructose and sucrose consumption increases CPT gene methylation in rats, and high fat diets suppress that methylation.

Based on those data, the authors hypothesized that carbohydrate and fat intake affect the methylation of CPT gene, which:

Alters the activity of the CPT gene and…

Affects the risk of developing type 2 diabetes.

Since we are talking about our diet making alterations to our DNA, we could consider this as an example of, “We are what we eat”.

Biochemistry 101: Why Is Nutrition So Confusing?

Now it is time for my favorite topic, Biochemistry 101. Along the way you will discover why nutrition is so complicated – and so confusing.

The CPT gene codes for a protein called carnitine palmitoyltransferase or CPT. CPT transports fats into the mitochondria where they can be oxidized to generate energy. Simply put, without CPT we would be unable to utilize most of the fats we eat. And, as you might expect, CPT is not required for carbohydrate metabolism.

In a simple world where our DNA sequence determines our destiny, we would either have an active CPT gene or an inactive mutant version of the gene. If we had the mutant version of the CPT gene, we would be unable to use fat as an energy source.

However, we don’t live in a simple world. Epigenetic modifications alter the activity of the CPT gene. When the CPT gene is unmethylated it is fully active. Methylation inactivates the gene.

In a simple world, a high fat diet would activate the CPT gene so our body would be able to utilize the fat in our diet. It would do that by decreasing methylation of the gene. Conversely, a high carbohydrate, low fat diet would decrease CPT gene activity by increasing methylation of the gene.

This is the one simple prediction that works exactly as expected.

In a simple world, CPT would be involved in transport of fat into our mitochondria and nothing else. In that world, the activity of the CPT gene would only affect fat metabolism.

However, we don’t live in a simple world. By mechanisms that are not completely understood, carnitine palmitoyltransferase (CPT) also influences both insulin resistance and release of insulin by our pancreas. That means the activity of the CPT gene also affects our risk of developing type 2 diabetes.

In the simplest terms, we can think of diabetes as an inability to properly regulate blood sugar levels. In a simple world, that would mean that carbohydrates are the problem, and we could reduce our risk of developing diabetes by restricting our intake of carbohydrates.

However, we don’t live in a simple world. There are short-term studies supporting the effectiveness of both low carb and low fat diets at helping to control blood sugar levels. However, longer term studies generally show that only whole food, low fat diets are associated with reduced risk of developing type 2 diabetes.

In other words, healthy carbohydrates aren’t the problem. They are the solution for reducing your risk of type 2 diabetes. This isn’t intuitive. It isn’t simple. But the weight of evidence points in this direction.

[I should add the emphasis is on “healthy” carbohydrates. I am talking about diets that emphasize whole food sources of carbohydrates (fruits, vegetables, whole grains, and legumes), not diets loaded with sugar, refined carbohydrates, and highly processed foods.]

Confused yet? Don’t worry. The authors of this study combined all this information into a single, unifying hypothesis.

They proposed that the fat and carbohydrate content of the diet influence methylation of the CPT gene, which influences the activity of the CPT gene, which influences both fat metabolism and the risk of developing type 2 diabetes. Specifically, they proposed that:

High fat diets reduce methylation of the CPT gene. This activates the CPT gene which results in more carnitine palmitoyltransferase (CPT) being produced. This improves fat metabolism, but also increases the risk of developing type 2 diabetes.

High carbohydrate, low fat diets increase methylation of the CPT gene. This inactivates the CPT gene which results in less CPT being produced. This is OK because there is little fat to be metabolized. However, it also has the advantage of reducing the risk of developing type 2 diabetes.

This can be visually represented as:

How Was This Study Done?

This study combined the results from 3,954 selected participants in three previous clinical trials:

The Genetics of Lipid Lowering Drugs and Diet Network (GOLDN) study.

The Framingham Heart Study.

The REGICORE study. This study is similar in design to the Framingham Heart Study except the participants were drawn from a region of Spain.

The participants were selected based on 4 criteria:

The study they were in measured metabolic disease outcome.

The study they were in included a detailed diet analysis.

A DNA methylation analysis was performed on blood taken from these participants so that the methylation status of the CPT gene could be determined.

mRNA levels were measured for the CPT gene (This is a measure of how active the gene is. Active genes will produce lots of mRNA. Inactive genes will produce very little mRNA).

The study then analyzed the data and looked at the associations between carbohydrate and fat intake with:

Methylation of the CPT gene.

Activity of the CPT gene (measured as the amount of CPT mRNA produced by the gene).

Type 2 diabetes and other metabolic diseases.

Do Low Fat Diets Reduce The Risk Of Diabetes?

The authors systematically tested the predictions of their unifying hypothesis (To help you understand the significance of their findings, I am repeating the visual representation of their unifying hypothesis below):

Methylation of the CPT gene was negatively associated with type 2 diabetes. Simply put, when the methylation of the of the CPT gene was high, the risk of type 2 diabetes was low. This confirmed the results of previous studies.

2) Carbohydrate and fat intake influenced methylation of the CPT gene. Specifically:

- Carbohydrate intake and the ratio of carbohydrate to fat intake were positively associated with CPT methylation. Simply put, a high carbohydrate, low fat diet resulted in increased methylation of the CPT gene.

- Fat intake was negatively associated with CPT methylation. Simply put, a high fat, low carbohydrate diet resulted in decreased methylation of the CPT gene.

3) Carbohydrate and fat intake influenced the activity of the CPT gene. Specifically:

- Carbohydrate intake and the ratio of carbohydrate to fat intake was negatively associated with CPT mRNA levels (a measure of CPT gene activity). Simply put, a high carbohydrate, low fat diet resulted in lower CPT gene activity. This means the CPT gene produced less CPT. And, combined with the previous data, it also means that methylation of the CPT gene decreases its activity.

- Fat intake was positively associated with CPT mRNA levels. Simply put, a high fat, low carbohydrate diet resulted in greater CPT gene activity. This means the CPT gene produces more CPT. And, combined with the previous data, it also means that reducing methylation of the CPT gene increases its activity.

4) CPT gene activity influenced the prevalence of type 2 diabetes. Specifically:

- High CPT gene activity was positively associated with the risk of type 2 diabetes.

- Low CPT gene activity was negatively associated with the risk of type 2 diabetes.

Putting this all together, as the authors had predicted,

High fat, low carbohydrate diets reduce methylation of the CPT gene. This activates the CPT gene which results in more CPT being produced. This improves fat metabolism, but also increases the risk of developing type 2 diabetes.

2) High carbohydrate, low fat diets increase methylation of the CPT gene. This results in less CPT being produced. This is OK because there is little fat to be metabolized. However, it also has the advantage of reducing the risk of developing type 2 diabetes.

In short, the results of the study confirmed all the predictions of the author’s unifying hypothesis.

Putting it all together, the authors concluded, “Our results suggest that the proportion of total energy supplied by carbohydrate and fat can have a causal effect on metabolic diseases [like type 2 diabetes] via the epigenetic status (DNA methylation) of the CPT gene.” Simply put, their data suggested that high carbohydrate, low fat diets reduced the risk developing type 2 diabetes.

What Does This Study Mean For You?

Let me start by saying that occasionally I like to give you a peak behind the curtain and talk about emerging areas of research. We should think of this article as the beginning of an exciting new area of research rather than as a definitive study.

I should start with the disclaimer that this study looks at associations between diet, methylation of the CPT gene, and risk of developing type 2 diabetes.

Associations do not prove cause and effect. This study does not prove that epigenetic changes to the CPT gene caused the reduction in type 2 diabetes risk.

High carbohydrate and high fat diets likely influence the risk of developing type 2 diabetes in other ways as well. For example, the fiber in healthy high carbohydrate diets may support friendly gut bacteria that reduce the risk of developing type 2 diabetes.

I also don’t view this study as one that settles the debate as to whether low carb or low fat diets are better for reducing the risk of type 2 diabetes. It does not clinch the argument for low fat diets. Rather, this study suggests a mechanism by which low fat diets may reduce the risk of metabolic diseases.

In summary, this study does not end the debate as to whether low carb or low fat diets are best. However, it does remind us just how complex the human body is. It reminds us that simple assumptions about how foods affect our bodies may not be the correct assumptions. It also helps us understand why nutrition can be so confusing.

The Bottom Line

In recent years, DNA sequencing has become all the rage. It seems like everyone is offering to sequence your genome and tell you what kind of diet is best for you.

That is where epigenetics comes in. Epigenetics is the science of modifications that alter gene expression. In simple terms, both DNA and the proteins that bind to DNA can be modified. This does not change the DNA sequence. But these modifications can determine whether a gene is active (turned on) or inactive (turned off).

Epigenetics makes nutrition more complicated, and more confusing. For example, diabetes is characterized an inability to control blood sugar levels properly. Accordingly, it seems only logical that carbohydrates, especially sugars and simple carbohydrates, are the problem.

This study showed that high carbohydrate, low fat diets cause epigenetic modifications to a gene that reduces the risk of developing type 2 diabetes and other metabolic diseases. Conversely, high fat, low carb diets have the opposite effect.

This mechanism is consistent with multiple long-term studies showing that whole food, low fat diets reduce the risk of developing type 2 diabetes.

This study does not end the debate as to whether low carb or low fat diets are best. However, it does remind us just how complex the human body is. It reminds us that simple assumptions about how foods affect our bodies may not be the correct assumptions. It also helps us understand why nutrition can be so confusing.

For more details read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

What Is An Anti-Inflammatory Diet?

July 21, 2021April 6, 2021 by Dr. Steve Chaney

Can Diet Douse The Flames?

Author: Dr. Stephen Chaney

If you have arthritis, colitis, bursitis, or any of the other “itis” diseases, you already know that inﬂammation is the enemy. Chronic, low level inﬂammation is also a contributing factor to heart disease, cancer, and many other diseases. Clearly, inﬂammation is a bad actor. It is something we want to avoid.

Obesity and diabetes are two of the biggest contributors to inﬂammation, but does diet also play a role? With all the anti-inﬂammation diets circulating on the internet, you would certainly think so. How good is the evidence that certain foods inﬂuence inﬂammation, and what does an anti-inﬂammatory diet look like?

The Science Behind Anti-Inflammatory Diets

Let me start by saying that the science behind anti-inﬂammatory diets is nowhere near as strong as it is for the eﬀect of primarily plant-based diets on heart disease and diabetes. The studies on anti-inflammatory diets are mostly small, short duration studies. However, the biggest problem is that there is no standard way of measuring inﬂammation.

There are multiple markers of inﬂammation, and they do not change together. That means that in every study some markers of inﬂammation are altered, while others are not. There is no consistent pattern from one study to another.

In spite of these methodological diﬃculties, the studies generally point in the same direction. Let’s start with the strongest evidence and work our way down to the weakest evidence.

Omega-3 fats are anti-inﬂammatory (I. Reinders et al, European Journal of Clinical Nutrition, 66: 736-741, 2011). The evidence is strongest for the long chain omega-3s found in ﬁsh and ﬁsh oil, but the shorter chain omega-3s found in foods like walnuts, ﬂaxseeds, chia seeds and ﬂaxseed oil, soybean oil, and canola oil also appear to be anti-inﬂammatory.

Inﬂammation is directly correlated with glycemic index (L. Qi and F.B. Lu, Current Opinion in Lipidology, 18: 3-8, 2007). This has a couple of important implications.

The most straightforward is that reﬁned carbohydrates and sugars (sodas, pastries, and desserts), which have a high glycemic index, increase inﬂammation. In contrast, complex carbohydrates (whole grains, most fruits and vegetables) decrease inﬂammation. No surprise there. The second implication is that it is the glycemic index, not the sugar, that is driving the inﬂammatory response.

That means we need to look more closely at foods than at sugars. Sodas, pastries and desserts are likely to cause inﬂammation, but sugar-containing foods with a low glycemic index are unlikely to be inﬂammatory.

Fruits and vegetables are anti-inﬂammatory. This has been shown in multiple studies. At this point most of the research is centered on identifying the nutrients and phytonutrients from fruits and vegetables that are responsible for the reduction in inﬂammation. I suspect the investigators are hoping to design an anti-inﬂammatory supplement and make lots of money. I will stick with the fresh fruits and vegetables.

Saturated fats are inﬂammatory. At face value, the data on saturated fats appear to be contradictory. Some studies say that saturated fats increase inﬂammation, while others say they do not. However, similar to my earlier discussion on saturated fats and heart disease), the outcome of the study depends on what the saturated fats are replaced with.

When saturated fats are replaced with reﬁned carbohydrates, sugar and highly processed foods (the standard American low-fat diet), inﬂammation doesn’t change. This doesn’t mean that a diet high in saturated fat is healthy. It just means that both diets are bad for you. Both are inflammatory.

However, when saturated fat is replaced with omega-3 polyunsaturated fats (J.A. Paniagua et al, Atherosclerosis, 218: 443-450, 2011) or monounsaturated fats (B. Vessby et al, Diabetologia, 44: 312-319, 2001), markers of inﬂammation decrease. Clearly, saturated fats are not the best fat choice if you wish to keep inﬂammation in check.

I would be remiss if I did not address the claims by the low-carb diet proponents that saturated fats do not increase inﬂammation in the context of a low-carb diet. I want to remind you of two things we have discussed previously:

The comparisons in those studies are generally with people consuming a diet high in simple carbohydrates and sugars.

These studies have mostly been done in the short-term when the participants are losing weight on the low-carb diets. Weight loss decreases inﬂammation, so the reduction in inﬂammation on the low-carb diet could be coming from the weight loss.

The one study (M. Miller et al, Journal of the American Dietetic Association, 109: 713-717, 2009) I have found that compares a low-carb diet (the Atkins diet) with a good diet (the Ornish diet, which is a low-fat, lacto-ovo vegetarian diet) during weight maintenance found that the meat based, low-carb Atkins diet caused greater inﬂammation than the healthy low-fat Ornish diet.

Red meat is probably pro-inﬂammatory. Most, but not all, studies suggest that red meat consumption is associated with increased inﬂammation. If it is pro-inﬂammatory, the inﬂammation is most likely associated with its saturated fat, its heme iron content, or the advanced glycation end products formed during cooking.

What Is An Anti-Inflammatory Diet?

Anti-inﬂammatory diets have become so mainstream that they now appear on many reputable health organization websites such as Harvard Health, WebMD, the Mayo Clinic, and the Cleveland Clinic. Each have slightly diﬀerent features, but there is a tremendous amount of agreement.

Foods an anti-inﬂammatory diet includes: In a nutshell, an anti-inﬂammatory diet includes fruits and vegetables, whole grains, plant-based proteins (like beans and nuts), fatty ﬁsh, and fresh herbs and spices. Speciﬁcally, your diet should emphasize:

Colorful fruits and vegetables. Not only do they help ﬁght inﬂammation, but they are a great source of antioxidants and other nutrients important for your health.

Whole grains. They have a low glycemic index. They are also a good source of ﬁber, and ﬁber helps ﬂush inﬂammatory toxins out of the body.

Beans and other legumes. They should be your primary source of protein. They are high in ﬁber and contain antioxidants and other anti-inﬂammatory nutrients.

Nuts, olive oil, and avocados. They are good sources of healthy monounsaturated fats, which ﬁght inﬂammation.
Fatty ﬁsh. Salmon, tuna, and sardines are all great sources of long chain omega-3 fatty acids, which are incorporated into our cell membranes. Those long chain omega-3s in cell membranes are, in turn, used to create compounds that are powerful inﬂammation ﬁghters.

Walnuts, ﬂaxseeds, and chia seeds are good sources of short chain omega-3s. The eﬃciency of their conversion to long chain omega-3s that can be incorporated into cell membranes is only around 2-5%. If they ﬁght inﬂammation, it is probably because they replace some of the saturated fats and omega-6 fats you might otherwise be eating.

Herbs and spices. They add antioxidants and other phytonutrients that ﬁght inﬂammation.

Foods an anti-inﬂammatory diet excludes: In a nutshell, an anti-inﬂammatory diet should exclude highly processed, overly greasy, or super sweet foods, especially sodas and other sweet drinks. Specifically, your diet should exclude:

Reﬁned carbohydrates, sodas and sugary foods. They have a high glycemic index, which is associated with inﬂammation. They can also lead to weight gain and high blood sugar, both of which cause inﬂammation.

Foods high in saturated fats. This includes fatty and processed meats, butter, and high fat dairy products.

Foods high in trans fats. This includes margarine, coﬀee creamers, and any processed food containing partly hydrogenated vegetable oils. Trans fats are very pro-inﬂammatory.

French fries, fried chicken, and other fried foods. They used to be fried in saturated fat and/or trans fat. Nowadays, they are generally fried in omega-6 vegetable oils. A little omega-6 in the diet is OK, but Americans get too much omega-6 fatty acids in their diet. Most studies show that a high ratio of omega-6 to omega-3 fatty acids is pro-inﬂammatory.

Foods you are allergic or sensitive to. Eating any food that you are sensitive to can cause inﬂammation. This comes up most often with respect to gluten and dairy because so many people are sensitive to one or both. However, if you are not sensitive to them, there is no reason to exclude whole grain gluten-containing foods or low-fat dairy foods from your diet.

Can Diet Douse The Flames?

In case you didn’t notice, the recommendations for an anti-inﬂammatory diet closely match the other healthy diets I have discussed previously. It should come as no surprise then that both the Mediterranean (L. Gallard, Nutrition in Clinical Practice, 25: 634-640, 2010; L. Schwingshackl and G. Hoﬀmann, Nutrition Metabolism and Cardiovascular Diseases, 24: 929-939, 2014) and DASH (D.E. King et al, Archives of Internal Medicine, 167: 502-506, 2007) diets are anti-inﬂammatory.

Vegan and vegetarian diets also appear to be anti-inﬂammatory as well. The anti-inﬂammatory nature of these diets undoubtedly contributes to their association with a lower risk of heart disease, diabetes, and cancer.

As for the low-carb diets, the jury is out. There are no long-term studies to support the claims of low-carb proponents that their diets reduce inﬂammation. The few long-term studies that are available suggest that low-carb diets are only likely to be anti-inﬂammatory if vegetable proteins and oils replace the animal proteins and fats that are currently recommended.

What does this mean for you if you have severe arthritis or other inﬂammatory diseases? An anti-inﬂammatory diet is unlikely to “cure” your symptoms by itself. However, it should deﬁnitely be a companion to everything else you are doing to reduce inﬂammation.

The Bottom Line

Obesity and diabetes are two of the biggest contributors to inﬂammation, but does diet also play a role? With all the anti-inﬂammation diets circulating on the internet, you would certainly think so. In this article I review the evidence that certain foods inﬂuence inﬂammation and describe what an anti-inﬂammatory diet looks like.

For more details read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

Which Diets Are Best In 2021?

March 16, 2021 by Dr. Steve Chaney

Which Diet Should You Choose?

Many of you started 2021 with goals of losing weight and/or improving your health. In many cases, that involved choosing a new diet. That was only 2 months ago, but it probably feels like an eternity.

For many of you the “bloom” has gone off the new diet you started so enthusiastically in January.

Perhaps the diet isn’t working as well as advertised…

Perhaps the diet is too restrictive. You are finding it hard to stick with…

Perhaps you are always hungry or constantly fighting food cravings…

Perhaps you are starting to wonder whether there is a better diet than the one you chose in January…

Perhaps you are wondering whether the diet you chose is the wrong one for you…

If you are still searching for your ideal diet, I will summarize the US News & World Report’s “Best Diets In 2021”. For the full report, click on this link.

How Was This Report Created?

US News & World Report recruited panel of 25 nationally recognized experts in diet, nutrition, obesity, food psychology, diabetes, and heart disease to review the 39 most popular diets. They rated each diet in seven categories:

How easy it is to follow.

Its ability to produce short-term weight loss.

Its ability to produce long-term weight loss.

its nutritional completeness.

Its safety.

Its potential for preventing and managing diabetes.

Its potential for preventing and managing heart disease.

They converted the experts’ ratings to scores 5 (highest) to 1 (lowest). They then used these scores to construct nine sets of Best Diets rankings:

Best Diets Overall combines panelists’ ratings in all seven categories. However, all categories were not equally weighted. Short-term and long-term weight loss were combined, with long-term ratings getting twice the weight. Why? A diet’s true test is whether it can be sustained for years. And safety was double counted because no diet should be dangerous.

Best Commercial Diets uses the same approach to rank 15 structured diet programs that require a participation fee or promote the use of branded food or nutritional products.

Best Weight-Loss Diets was generated by combining short-term and long-term weight-loss ratings, weighting both equally. Some dieters want to drop pounds fast, while others, looking years ahead, are aiming for slow and steady. Equal weighting accepts both goals as worthy.

Best Diabetes Diets is based on averaged diabetes ratings.

Best Heart-Healthy Diets uses averaged heart-health ratings.

Best Diets for Healthy Eating combines nutritional completeness and safety ratings, giving twice the weight to safety. A healthy diet should provide sufficient calories and not fall seriously short on important nutrients or entire food groups.

Easiest Diets to Follow represents panelists’ averaged judgments about each diet’s taste appeal, ease of initial adjustment, ability to keep dieters from feeling hungry and imposition of special requirements.

Best Plant-Based Diets uses the same approach as Best Diets Overall to rank 12 plans that emphasize minimally processed foods from plants.

Best Fast Weight-Loss Diets is based on short-term weight-loss ratings.

Which Diets Are Best In 2021?

The word WInner in white letters surrounded by a burst of colorful stars in 3d

Are you ready? If this were an awards program I would be saying “Envelop please” and would open the envelop slowly to build suspense.

Best Diets Overall

The Top 5:

#1: Mediterranean Diet

#2: DASH Diet (This diet was designed to keep blood pressure under control, but you can also think of it as an Americanized version of the Mediterranean diet.)

#3: Flexitarian Diet (A flexible semi-vegetarian diet).

#4: Mayo Clinic Diet

#5: MIND Diet (This diet is a combination of Mediterranean and DASH but is specifically designed to reduce cognitive decline as we age.)

The Bottom 5:

#35: Modified Keto Diet

#36: Whole 30 Diet

#37: GAPS Diet (A diet designed to improve gut health).

#38: Keto Diet

#39: Dukan Diet

Best Weight-Loss Diets

The Top 5:

#1: Flexitarian Diet

#2: Vegan Diet

#3: Volumetrics Diet (A diet based on the caloric density of foods).

#4: Mayo Clinic Diet

#5: Ornish Diet

The Bottom 5:

#35: Fertility Diet

#36: Whole 30 Diet

#37: Alkaline Diet

#38: AIP Diet (A diet designed for people with autoimmune diseases)

#39: GAPS Diet

Best Diabetes Diets

The Top 5:

#1: Flexitarian Diet

#2: Mediterranean Diet

#3: DASH Diet

#4: Mayo Clinic Diet

#5: Vegan Diet

The Bottom 5:

#35: The Fast Diet

#36: AIP Diet

#37: GAPS Diet

#38: Whole 30 Diet (A diet designed for people with autoimmune diseases)

#39: Dukan Diet

Best Heart-Healthy Diets

The Top 5:

#1: DASH Diet

#2: Mediterranean Diet

#3: Ornish Diet (A diet based on the caloric density of foods).

#4: Flexitarian Diet

#5: Vegan Diet

The Bottom 5:

#35: Keto Diet

#36: AIP Diet

#37: Whole 30 Diet

#38: Modified Keto Diet

#39: GAPS Diet

Best Diets for Healthy Eating

The Top 5:

#1: DASH Diet

#2: Mediterranean Diet

#3: Flexitarian Diet

#4: TLC Diet (A diet designed to promote heart health)

#5: MIND Diet

The Bottom 5:

#35: Atkins Diet

#36: Raw Food Diet

#37: Modified Keto Diet

#38: Dukan Diet

#39: Keto Diet

Easiest Diets to Follow

The Top 5:

#1: Mediterranean Diet

#2: Flexitarian Diet

#3: MIND Diet

#4: DASH Diet

#5: Fertility Diet

The Bottom 5:

#35: Keto Diet and Modified Keto Diet (tie)

#36: Whole 30 Diet

#37: Dukan Diet

#38: GAPS Diet

#39: Raw Foods Diet

Best Fast Weight-Loss Diets

The Top 5 (Excluding Commercial Diets):

#1: Atkins Diet

#2: Biggest Loser Diet

#3: Keto Diet

#4: Raw Food Diet

#5: Volumetrics Diet

Which Diets Are Best For Rapid Weight Loss?

Let me start with some general principles:

#1: If you are looking for rapid weight loss, any whole food restrictive diet will do.

The Atkins and keto diets are meat heavy, low carb diets. They restrict fruits, some vegetables, grains, and most legumes.

The Biggest Loser diet relies on restrictive meal plan and exercise programs.

The restrictions of the raw food diet are obvious.

The volumetrics diet restricts foods with high caloric density.

The vegan diet, which ranks #7 on this list, is a very low fat diet that eliminates meat, dairy, eggs, and animal fats.

I did not include commercial diets that rated high on this list, but they are all restrictive in one way or another.

#2: Restrictive diets ultimately fail.

The truth is 90-95% of people who lose weight quickly on a restrictive diet regain most of that weight in the next two years. The pounds come back and often bring their friends along as well. Many people regain more weight than they lost. This is the famous “Yo-Yo Effect”.

If dieters paid for one of the commercial diets, they may as well have burned their money.

When I talk with people about weight loss, many of them tell me the Atkins diet is the only one they can lose weight on. That would be impressive if they were at a healthy weight, but most are not. They are overweight. I am starting to see the same thing from overweight people who have used the keto diet to lose weight and have regained their weight.

#3: We should ask what happens when we get tired of restrictive diets and add back some of your favorite foods.

If you lose weight on a vegan diet and add back some of your favorite foods, you might end up with a semi-vegetarian diet. This is a healthy diet that can help you maintain your weight loss.

If you lose weight on the Atkins or keto diets and add back some of your favorite foods, you end up with the typical American diet – one that is high in both fat and carbs. This is not a recipe for long-term success.

Long term weight loss is possible if you transition to a healthy diet after you have lost the weight. In a recent article in “Health Tips From The Professor” I wrote about an organization called the National Weight Control Registry. These are people who have been successful at keeping the weight off. For purposes of this discussion, two points are important.

They lost weight on every possible diet.

They kept the weight off by following a healthy reduced calorie, low fat diet. (For what else they did, click here).

Which Diet Should You Choose?

With rapid weight loss out of the way, let’s get back to the question, “Which Diet Should You Choose?” My recommendations are:

Choose a diet that fits your needs. That is one of the things I like best about the US News & World Report ratings. The diets are categorized. If your main concern is diabetes, choose one of the top diets in that category. If your main concern is heart health… You get the point.

Choose diets that are healthy and associated with long term weight loss. If that is your goal, you will notice that primarily plant-based diets top these lists. Meat-based, low carb diets like Atkins and keto are near the bottom of the lists.

Choose diets that are easy to follow. The less-restrictive primarily plant-based diets top this list – diets like Mediterranean, DASH, MIND, and flexitarian.

Choose diets that fit your lifestyle and dietary preferences. For example, if you don’t like fish and olive oil, you will probably do much better with the DASH or flexitarian diet than with the Mediterranean diet.

Finally, focus on what you have to gain, rather than on foods you have to give up.

- On the minus side, none of the diets include sodas, junk foods, and highly processed foods. Teose foods should go on your “No-No” list. Sweets should be occasional treats and only as part of a healthy meal. Meat, especially red meat, should become a garnish rather than a main course.

- On the plus side, primarily plant-based diets offer a cornucopia of delicious plant foods you probably didn’t even know existed. Plus, for any of the top-rated plant-based diets, there are websites and books full of mouth-watering recipes. Be adventurous.

The Bottom Line

There are probably two questions at the top of your list.

#1: Which diets are best for rapid weight loss? Here are some general principles:

If you are looking for rapid weight loss, any whole food restrictive diet will do.

Restrictive diets ultimately fail.

We should ask what happens when we get tired of restrictive diets and add back some of our favorite foods.

Long term weight loss is possible if you transition to a healthy diet after you have lost the weight.

#2: Which diet should you choose? Here the principles are:

Choose a diet that fits your needs.

Choose diets that are healthy and associated with long term weight loss.

Choose diets that are easy to follow.

Choose diets that fit your lifestyle and dietary preferences.

Finally, focus on what you have to gain, rather than on foods you have to give up.

For more details on the diet that is best for you, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

Which Foods Should I Avoid?

May 26, 2020 by Dr. Steve Chaney

What Is Nutritionism?

Recently, I have been reading Michael Pollan’s book “In Defense of Food”. Yes, I know the book has been around for a long time. Normally I read the scientific literature rather than popular health books. However, in the past few weeks I have had a lot more time to read books, so I decided to read this one.

Some of the things he says are “off the wall”. As he readily admits, he isn’t a scientist or a medical doctor. However, a lot of what he says is “right on”. He echoes many of the things I have been talking about for years. But he does a masterful job of pulling everything together into a framework he calls “nutritionism”.

If you have a chance, I highly recommend that you read his book.

I will briefly summarize his discussion of nutritionism below. I will also share some scientific support for what he is saying. Finally, I will close by sharing what the Bible says on the subject.

What Is Nutritionism?

Simply put, nutritionism is the belief that we can understand food solely in terms of its nutritional and chemical constituents and our requirements for them. I use the term “belief” purposely. As Michael Pollan puts it: “As the ‘-ism’ suggests, nutritionism is not a scientific subject, but an ideology.”

As he points out, that leads to debacles like the creation of margarine as a substitute for butter. Of course, everyone reading this article knows that we subsequently found out that the trans fat in margarine was worse for us than the saturated fat in butter. He offers many other examples like this.

He also points out that the nutritionism concept has given free rein to the food industry to replace whole foods with processed foods that are cholesterol-free, sugar-free, low-fat, low-carb, or high in fiber, omega-3s, etc. He says that these foods are seldom healthier than the foods they replace. I agree.

Finally, he points out that the scientific support for the classification of individual ingredients or foods as “good” or “bad” is weak. That’s because when scientists design a study that removes a chemical constituent or a food from the diet, they have to replace it with something. And what they replace it with determines the outcome of the study. I give some examples of this in the next section.

The essence of Michael Pollan’s message is:

The effect of an individual nutrient or chemical constituent on your health depends on the food it is found in. Forget the fancy nutrition labels. Whole foods are almost always healthier than processed foods.

The effect of a food or food constituent on your health also depends on your overall diet. We should be thinking about healthy diets rather than the latest “magical” or “forbidden” food.

I will discuss these points below.

Which Foods Should I Avoid?

Now, let’s get to the question, “Which Foods Should I Avoid?” If we are talking about whole foods, the short answer is “None”. As I said in my book, “Slaying The Food Myths”, “We have 5 food groups for a reason”.

For example, if we are talking about plant foods, each plant food group:

Has a unique blend of vitamins and minerals.
Has a unique blend of phytonutrients.
Has a unique blend of fiber.
Supports the growth of a unique combination of beneficial gut bacteria.

Dr Strangelove and his friends are telling you to eliminate whole grains, fruits, and legumes (beans) from your diet. Recent studies suggest that might not be a good idea. Here is one example.

If we are talking about animal foods, each animal food group:

Has a unique blend of vitamins and minerals.
May have unique components that are important for our health. [Note: This is an active area of research. Theories have been proposed for which components in animal foods may be important for our health, but they have not been confirmed.]

Vegan purists will tell you that you have no need for meat and dairy foods. Recent studies suggest otherwise. Here is one example.

With that as background, let’s turn our attention to nutritionism and look at some of science behind claims that certain food components are either good for us or bad for us.

Saturated Fat. Saturated fat is the poster child for nutritionism.

First, we were told by the American Heart Association and other health organizations that saturated fat was bad for us. Recently Dr. Strangelove and his friends are telling us that saturated fat is good for us. Instead of limiting saturated fat, we should be limiting carbs by cutting out fruits, whole grains, and legumes. Both cite clinical studies to support their claims. How can this be?

Perhaps a little history is in order. When the American Heart Association recommended that we decrease intake of saturated fat, they were envisioning that we would replace it with monounsaturated and polyunsaturated fat in the context of a healthy diet of fruits, vegetables, whole grains, and legumes. That never happened.

Big Food quickly realized that if the American public were to follow the AHA guidelines, it would be disastrous for their bottom line. So, they sprang into action. They mixed sugar, white flour, and a witch’s brew of chemicals to create highly processed, low fat “foods”. Then they told the American public, “Don’t worry. You don’t have to give up your favorite foods. We have created low fat alternatives.”

This is the essence of what Michael Pollan refers to as nutritionism. By marketing their fake foods as low fat Big Food created the halo of health. In fact, Big Food’s fake foods were less healthy than the foods they replaced. Americans got fatter and sicker.

Now let’s look at the conflicting claims that saturated fat is bad for us or good for us. How can clinical studies disagree on such an important question? The answer is simple. It depends on what you replace it with. You need to consider saturated fat intake in the context of the overall diet.

I discussed this in a previous issue of “Health Tips From the Professor”, but let me summarize it briefly here. The American Heart Association tells us that replacing half of the saturated fat in a typical American diet with:

Trans fats, increases heart disease risk by 5%.

Refined carbohydrates and sugars (the kind of carbohydrates in the typical American Diet), slightly increases heart disease risk.

Complex carbohydrates (whole grains, fruits & vegetables), decreases heart disease risk by 9%.

Monounsaturated fats (olive oil & peanut oil), decreases heart disease risk by 15%.

Polyunsaturated fats (vegetable oils and fish oil), decreases heart disease risk by 25%.

Unsaturated fats in the context of a Mediterranean diet, decreases heart disease risk by 45%.

My advice: Saturated fat is neither good for you nor bad for you. A little bit of saturated fat in the context of a healthy diet is fine. A lot of saturated fat in the context of an unhealthy diet is problematic.

Red Meat. Is red meat bad for you? Like saturated fat, it depends on the amount of red meat and the overall diet. I covered this in detail in “Slaying The Food Myths”, but let me summarize briefly here:

According to the World Health Organization, red meat is a probable carcinogen. If we look at the postulated mechanisms by which it causes cancer, they can be mostly neutralized by components of various plant foods.

My advice: An 8-ounce steak with fries and a soda is probably bad for you. Three ounces of that same steak in a green salad or stir fry may be good for you.

I should make one other point while I am on the topic. Dr. Strangelove and his friends have been telling you that grass-fed beef is better for you than conventionally raised beef. Once again, that is nutritionism. Grass-fed beef is lower in saturated fat and high in omega-3s than conventionally raised beef. That may be better for your heart, but it has no effect on the cancer-causing potential of red meat. It doesn’t give the license to eat 8-ounce steaks on a regular basis. You still want to aim for 3-ounces of that grass-fed beef in a green salad or stir fry.

High-Fructose Corn Syrup. This one seems to be on everyone’s “naughty list”. You are being told to read labels, and if the food has high-fructose corn syrup on the label, put it back on the shelf. But is that good advice?

It turns out that all the studies on the bad effects of high-fructose corn syrup have been done with sodas and highly processed foods. This should be your first clue.

Of course, as soon as high-fructose corn syrup gained its “bad” reputation, Big Food started replacing it with “heathier” sugars. Does that make those foods healthier?

The answer is a clear “No”. Both chemically and biologically, high-fructose corn syrup is identical to sucrose (table sugar), honey, molasses, maple syrup, coconut sugar, date sugar, or grape juice concentrate. Agave sugar is even higher in fructose than high-fructose corn syrup. This is your second clue.

Substituting these sugars for high-fructose corn syrup doesn’t turn sodas and processed foods into health foods. This is nutritionism at its worst.

My advice: Forget reading the label. Forget trying to avoid foods with high-fructose corn syrup. Avoid sodas and processed foods instead.

Sugar. Once the public started to realize that natural sugars in processed foods were just as bad for us as high-fructose corn syrup, sugars became “bad”. We were told to avoid all foods containing sugar in any form. In fact, we were told we needed to become “label detectives” and recognize all the deceptive ways that sugar could be hidden on the label.

I have discussed this in detail in a previous issue of “Health Tips From The Professor”.

Let me just summarize that article with one quote, “It’s not the sugar. It’s the food. There is the same amount and same types of sugar in an 8-ounce soda and a medium apple. Sodas are bad for you, and apples are good for you.” If you are wondering why that is, I have covered it in another issue of “Health Tips From the Professor”.

Before leaving this subject, I should mention that nutritionism has risen its ugly head here as well. Big Food has struck again. They have replaced sugar with a variety of artificial sweeteners.

Once again, nutritionism has failed. Those artificially sweetened sodas and processed foods are no healthier and no more likely to help you keep the weight off than the sugar-sweetened foods they replace. I have covered the science behind that statement in several previous issues of “Health Tips From the Professor”. Here is one example.

My advice: Forget about sugar phobia. You don’t need to become a label detective. Just avoid sodas, sugar-sweetened beverages, and sweet processed foods. Get your sugar in its natural form in fruits and other whole foods.

Carbs. Dr. Strangelove and his friends are now telling you that you need to avoid all carbs. That is pure nutritionism. Carbs are neither good nor bad. It depends on the type of carb and what you replace it with.

Once again, clinical studies have given conflicting outcomes. Each side of the carbohydrate debate can provide clinical studies to support their position. How can that be? The answer is simple. It depends on what assumptions went into the design of the clinical studies. I have written several articles on this topic in “Health Tips From the Professor”, but let me give you one example here.

In this example, I looked at two major studies. The PURE (Prospective Urban Rural Epidemiology) study included data from 135,000 participants in 18 countries. In this study, the death rate decreased as the % carbohydrate in the diet decreased. The low-carb enthusiasts were doing a victory dance.

However, it was followed by a second, even larger study. The ARIC (Atherosclerosis Risk In Communities) study included 432,000 participants from even more countries. In this study, the death rate decreased as the % carbohydrate decreased to about 40%. Then a curious thing happened. As the % carbohydrate in the diet decreased further, the death rate increased.

How can you explain this discrepancy? When you examine the PURE study:

The % carbohydrate only ranged from 70% to 40%.

The data for the PURE study was obtained primarily with third world countries. That is an important distinction because:

- In those countries, it is primarily the well to do that can afford sodas, processed foods, and meat.

- The poor subsist on what they can grow and inexpensive staples like beans and rice.

Simply put, in the PURE study, the type of carbohydrate changed as well as the amount of carbohydrate.

- At the highest carbohydrate intakes, a significant percentage of the carbohydrate came from sugar and refined grains.

- At the lowest carbohydrate intakes, most of the carbohydrate intake came from beans, whole grains, and whatever fruits and vegetables they could grow.

When you examine the ARIC study:

The % carbohydrate ranged from 70% to 20%.

The ARIC study added in data from the US and European countries. That is an important distinction because:

- Low carb diets like Atkins and Keto are popular in these countries. And those are the diets that fall into the 20-40% carbohydrate range.

- Most people can afford diets that contain a lot of meat in those countries.

Simply put, at the lower end of the scale in the ARIC study, people were eating diets rich in meats and saturated fats and eliminating healthy carbohydrate-containing foods like fruits, whole grains and legumes.

My advice: The lesson here is to avoid simplistic nutritionism thinking and focus on diets rather than on foods. When you do that it is clear that carbs aren’t bad for you, it’s unhealthy carbs that are bad for you.

Which Foods Should I Avoid? By now the answer to the question, “Which Foods Should I Avoid?” is clear. Avoid sodas, sugar-sweetened beverages and processed foods (The term processed foods includes convenience foods, junk foods, and most sweets).

What Does This Mean To You?

Now that we are clear on which foods you should avoid, let’s look at the flip side of the coin. Let’s ask, “Which foods should you include in your diet?

As I said at the beginning of this article, “We have 5 food groups for a reason”. We should consider whole foods from all 5 food groups as healthy.

Of course, each of us is different. We all have foods in some food groups that don’t treat us well. Some of us do better with saturated fats or carbs than others. We need to explore and find the foods and diets that work best for us.

However, whenever we assume one diet is best for everyone, we have crossed the line into nutritionism.

What Does The Bible Say?

Let me start this section by saying that I rely on the Bible for spiritual guidance rather than nutritional guidance. However, as part of our church’s Bible reading plan, I was reading 1 Timothy. A passage from 1 Timothy 4:1-5 leapt out at me. It reinforces the theme of Michael Pollan’s book and seems uniquely applicable to the times we live in.

“The Spirit clearly says that in later times some will abandon the faith and follow deceiving spirits and things taught by demons. Such teachings come through hypocritical liars, whose consciences have been seared as with a hot iron. They…order people to abstain from certain foods, which God created to be received with thanksgiving by those who believe and who know the truth. For everything God created is good, and nothing is to be rejected if it is received with thanksgiving, because it is consecrated by the word of God and prayer.”

Interesting.

The Bottom Line

In this article, I have discussed the concept of “nutritionism” introduced in Michael Pollan’s book “In Defense Of Food”. He defines nutritionism as the belief that we can understand food solely in terms of its nutritional and chemical constituents and our requirements for them.

What Michael Pollan is referring to is taking food constituents like saturated fats, cholesterol, sugar, carbohydrates, polyunsaturated fats, monounsaturated fats, fiber, antioxidants, and probiotics and labeling them as either “good” or “bad”. He points out that when we accept these simplistic labels, we often end up creating foods and diets that are less healthy than the ones we were trying to replace.

At the beginning of the article, I asked the question, “Which Foods Should I Avoid?” I then looked at several foods or food groups we have told to avoid, including saturated fats, red meat, high-fructose corn syrup, sugar, and carbs. When you look at the science behind these recommendations from the lens of nutritionism, you come to two conclusions:

We should avoid sodas, sugar-sweetened beverages and processed foods (The term processed foods includes convenience foods, junk foods, and most sweets).

Whole foods from all 5 food groups should be considered as healthy.

However, whenever we assume one diet is best for everyone, we have crossed the line into nutritionism.

For more details and a bible verse that supports the theme of Michael Pollan’s book and seems uniquely applicable to the times we live in, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

Could A Probiotic Supplement Make You Healthier?

February 25, 2020 by Dr. Steve Chaney

What Is The Truth About Our Microbiome?

Our gut bacteria, often referred to as our microbiome, are a “hot” topic in today’s world. They have been in the news a lot in recent years. If you believe the headlines, the right gut bacteria can make you smarter, healthier, and cure what ails you. They appear to have almost mystical powers. Could a probiotic supplement make you healthier?

How much of this is true and how much is pure speculation? It’s hard to say. Our microbiome is incredibly complex. To make matters more confusing, the terminology used to classify our gut bacteria into groups is not consistent. It varies from study to study.

Perhaps it is time to take an unbiased look at the data and separate fact from speculation.

Could A Probiotic Supplement Make You Healthier?

To answer the question of whether a probiotic supplement could make you healthier, we need to differentiate between what we know is true and what we think might be true. Let’s start with what we know for certain:

Our gut bacteria are affected by diet. People consuming a primarily plant-based diet have different populations of gut bacteria than people consuming a primarily meat-based diet.

- The populations of gut bacteria found in people consuming a plant-based diet are associated with better health outcomes, but associations have their limitations as discussed below.

Our gut bacteria are affected by exercise.

- It’s not clear whether it is the exercise or the fitness (increased muscle mass, decreased fat mass, improved metabolism) associated with exercise that is responsible for this effect.

Most of the other claims for the effects of gut bacteria on our health are based on associations. However, associations do not prove cause and effect. For example:

Certain populations of gut bacteria are associated with obesity.

- Do our gut bacteria make us obese, or does obesity affect our gut bacteria? There is evidence to support both viewpoints.

Certain populations of gut bacteria are associated with better mental health.

- Do gut bacteria influence mental health, or does the stress associated with poor mental health influence our gut bacteria? Again, there is evidence to support both viewpoints.

Certain populations of gut bacteria are associated with better health outcomes (reduction in diseases like heart disease, diabetes, and high blood pressure).

- Here the question is a little different. In general, the populations of gut bacteria associated with disease reduction are produced by a healthy diet, exercise, and weight control. In this case, the question becomes: Is it the gut bacteria that caused disease reduction, or is it diet, exercise, and weight control that caused disease reduction?

To better understand these points, let’s look at four recently published studies. After reviewing those studies, I will come back to the question of whether a probiotic supplement might decrease our disease risk.

Is Our Microbiome Better Than Our Genes For Predicting Disease?

This study (T. Tierney et al, bioRxiv, 2020) reviewed 47 studies that analyzed people’s microbiome (their gut bacteria) and their genes and asked which was better at predicting their risk of various diseases. The study focused on 13 diseases that are considered “complex” because they are caused by both genetic and environmental factors such as diet and exercise. Examples include diabetes, high blood pressure, digestive disorders, asthma, Parkinson’s disease, and schizophrenia.

The study found that our microbiome was a better predictor of these diseases than our genes. This finding is not surprising. Our microbiome is heavily influenced by diet and other environmental factors. Our DNA sequence is not.

This study supports previous studies in suggesting that our microbiome is a better predictor of most diseases than our DNA sequence. The exception would be diseases that are clearly caused by gene mutations, such as sickle cell disease.

Does this mean our microbiome is directly influencing these diseases, or is it merely serving as a marker for diet and other environmental factors that are influencing these diseases? Nobody knows.

Does The Mediterranean Diet Support Gut Bacteria Linked To Healthy Aging?

This study ( TS Ghosh et al, Gut, 17 February 2020) divided people aged 65-79 into two groups. One group consumed a Mediterranean diet rich in fruits, vegetables, nuts, legumes, olive oil, and fish and low in red meat and saturated fat. The other group consumed a typical western diet. After a year on the diets the gut bacteria in the microbiomes of the two groups was analyzed.

The study found that the group consuming the Mediterranean diet had an increase in gut bacteria associated with healthy aging, reduced inflammation, and reduced frailty.

The title of the paper describing this study was “Mediterranean diet intervention alters the gut microbiome in older people, reducing frailty and improving health status”. But is that true?

There is already good evidence that the Mediterranean diet improves health status. Is it the gut bacteria supported by the Mediterranean diet that were responsible for healthy aging, or were other aspects of the Mediterranean diet responsible for healthy aging? Nobody knows.

Are Low Fat Diets Healthy Because Of Their Effect On Our Microbiome?

This study (Y Wang et al, Gut Microbes, 21 January 2020) put participants on a low fat diet (20% fat and 66% carbohydrates), a moderate fat diet (30% fat and 56% carbohydrate) or a high fat diet (40% fat, 46% carbohydrates). To assure the accuracy of the diets, participants were provided with all foods and beverages they consumed. After 6 months on the three diets, the gut bacteria of each group were analyzed.

Note: Because all food and beverages were provided, none of the diets included sodas, added sugar, refined flour, saturated fats, or highly processed food. In short, the diets were very different than the typical low fat or low carb diets consumed by the average American.

This study found that participants consuming the high fat, low carb diet had gut bacteria associated with increased risk of heart disease and diabetes. In contrast, the low fat, high carbohydrate diet group had gut bacteria associated with decreased risk of heart disease and diabetes.

To understand this study, you need to reevaluate what you may have learned from Dr. Strangelove’s health blog. It is true that low fat diets in which fat has been replaced with sugar, refined flour, and highly processed low-fat foods are unhealthy. But that’s not what happened in this study.

Remember that all the food and drink the participants consumed was selected by dietitians.

When you replace the fat with whole foods – fresh fruits and vegetables, whole grains, nuts, and legumes, as was done in this study, you end up with a very healthy diet.

The authors talked about the importance of the “diet-gut axis” for reducing the risk of heart disease and diabetes. However, is it the gut bacteria that influenced the risk of heart disease and diabetes, or is it the diets themselves that influenced disease risk? Nobody knows.

Can Gut Bacteria Reduce Heart Disease Risk?

This study (Y Heianza et al, Journal of The American College Of Cardiology, 75: 763-772, 2019) focused on the interactions between diet, gut bacteria, and a metabolite called TMAO (trimethylamine N-oxide).

Here is what we know for certain:

L-carnitine (found in high levels in red meat) can be converted to TMA (trimethylamine) by gut bacteria and then to TMAO in the liver.

The gut bacteria of meat eaters are very efficient at converting L-carnitine to TMA. Thus, meat eaters tend to have high levels of TMAO in their blood.

The gut bacteria of vegans and vegetarians are very inefficient at converting L-carnitine to TMA. Thus, people consuming a primarily plant-based diet tend to have low TMAO levels in their blood.

Here is what we are uncertain about:

High TMAO levels are associated with increased heart disease risk. However, there is no direct evidence that TMAO causes heart disease.

What made this study unique is that it measured TMAO levels in the study participants at their entrance into the study and again 10 years later. The study found:

Participants with the greatest increase in TMAO levels over the 10 years had a 67% increased risk of heart disease compared to participants whose TMAO levels remained constant.

Participants consuming a healthy, primarily plant-based diet had little or no increase in TMAO levels over 10 years. It was the participants consuming an unhealthy diet who had significant increases in their TMAO levels.

This study strengthens the association between TMAO levels and heart disease risk. Because gut bacteria are required to produce TMAO, it also strengthens the association between gut bacteria and heart disease risk. However, is it the high TMAO levels that increased heart disease risk or is it the unhealthy diet that increased heart disease risk? Nobody knows.

What Is The Truth About Our Microbiome?

By now you have probably noticed a common theme that runs through all four studies. This is also true of most published studies on our microbiome.

We have good evidence that whole food, primarily plant-based diets lead to improved long-term health outcomes.

We also have good evidence that whole food, primarily plant-based diets influence the populations of gut bacteria found in our microbiome.

We know the populations of gut bacteria supported by primarily plant-based diets are associated with improved health outcomes.

We don’t really know whether it is the gut bacteria or the diets that are responsible for the improved health outcomes.

Don’t misunderstand me. I am not a microbiome skeptic. I think we have enough evidence to say that our gut bacteria are likely to have an important effect on our health. However, to claim that gut bacteria play a primary role in influencing our health would be pure speculation at this point.

A Cautionary Tale

Why do I make this point? It’s because I suspect that some in the supplement industry will be tempted to make probiotic supplements and claim they contain bacteria “known” to reduce the risk of heart disease, diabetes, or cancer. You wouldn’t need to change your diet. All you would need to do to improve your health would be to take their probiotic supplement.

Lest you be taken in by such future claims, let me share a cautionary tale.

High HDL cholesterol levels are associated with a reduced risk of heart disease. Exercise and weight loss increase HDL levels. However, those require work. They aren’t easy. So, pharmaceutical companies were constantly looking for ways to raise HDL levels without the hard work.

A few years ago, a pharmaceutical company discovered a drug that increased HDL levels. They thought they had discovered a wonder drug that would bring in billions of dollars. People wouldn’t need to exercise. They wouldn’t need to lose weight. All they would need to do would be to take their drug. HDL levels would go up and heart disease risk would go down.

However, when they tested their drug in a major clinical trial, it didn’t move the needle. HDL levels went up, but heart disease risk stayed the same. It turns out it was the exercise and weight loss that decreased heart disease risk, not the increase in HDL levels.

My message is simple. Even if our gut bacteria are found to play a major role in mediating the effect of diet on health outcomes, don’t assume we can take a probiotic and forget about the role of diet and exercise. Good health starts with a whole food, primarily plant-based diet and a healthy lifestyle.

The Bottom Line

Our gut bacteria, often referred to as our microbiome, are “hot”. If you believe the headlines, the right gut bacteria can make you smarter, healthier, and cure what ails you. How much of this is true and how much is pure speculation? In this article I reviewed four recent studies on diet, gut bacteria, and health outcomes. I took an unbiased look at the data and separated fact from speculation.

There was a common theme that ran through all four studies. This is also true of most published studies on our microbiome.

We have good evidence that whole food, primarily plant-based diets lead to improved long-term health outcomes.

We also have good evidence that whole food, primarily plant-based diets influence the populations of bacteria found in our gut, also known as our microbiome.

We know the populations of gut bacteria supported by primarily plant-based diets are associated with improved health outcomes.

We don’t really know whether it is the gut bacteria or the diets that are responsible for the improved health outcomes.

My message is simple. Even if our gut bacteria are found to play a major role in mediating the effect of diet on our health outcomes, don’t assume we can take a probiotic and forget about the role of diet and exercise. Good health starts with a whole food, primarily plant-based diet and a healthy lifestyle.

For more details, read the article above. You may be particularly interested in the cautionary tale I shared about HDL and heart disease risk.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease

Is The Paleo Diet Bad For Your Heart?

November 12, 2019 by Dr. Steve Chaney

Is The Paleo Diet Bad For Your Gut?

There is a lot to like about the Paleo diet:

· It is a whole food diet. Any diet that eliminates sodas, junk foods, and highly processed foods is an improvement over the American diet.

· It includes lots of vegetables and some fruits.

· It helps you lose weight, and any diet that results in weight loss improves your blood work – things like cholesterol, triglycerides, blood sugar control and more.

However, there are concerns the Paleo diet may not be healthy long term.

· In part, that is because the diet is high in meat, red meat, and saturated fat.

· Equally important, however, is what the diet eliminates – namely whole grains, legumes (beans), and dairy.

Those of you who have read my book, “Slaying The Food Myths”, know that I say: “We have 5 food groups for a reason”. This is particularly true for the plant food groups. That’s because each plant food group provides a unique blend of:

· Vitamins and minerals. Those can be replaced with good multivitamin/multimineral supplement.

· Phytonutrients. You can only get the full complement of health-promoting phytonutrients from a variety of foods from all 5 food groups.

· Fiber. There are many kinds of fiber and they each play different roles in our intestine. You can only get all the health-promoting varieties of fiber by consuming fruits, vegetables, whole grains and legumes.

· Gut bacteria. What we call fiber, our gut bacteria call food. Each of the plant food groups supports different populations of friendly gut bacteria.

Based on this reasoning, one might suspect that the Paleo diet might alter our gut bacteria in ways that could be bad for our health. Until recently, this sort of reasoning was just a theoretical concern. That’s because:

1) We knew far too little about the health effects of different populations of bacteria. This is rapidly changing. Several recent studies have systematically investigated the connection between gut bacteria and health outcomes.

2) We knew our diet influenced the bacteria populations found in our gut, but we had no understanding of how these changes might influence our health. This too is changing. The study (A Genoni et al, European Journal of Nutrition, https://doi.org/10.1007/s00394-019-02036-y) I discuss this week is an excellent example of recent studies linking diet, gut bacteria, and risk factors for disease.

How Was The Study Done?

This study recruited 91 participants from Australia and New Zealand. It was a very well designed study in that:

· The Paleo diet group (44 participants) was recruited based on self-proclaimed adherence to the Paleo diet (< 1 serving/day of grains and dairy products) for one year or more. This is important because short term effects of switching to a new diet are confounded by weight loss and other factors.

o After analyzing the diets of the Paleo group, the investigators found it necessary to subdivide the group into Strict Paleo (< 1 serving/day of grains and dairy products) and Pseudo-Paleo (> 1 serving/day of grains and dairy).

· The control group (47 participants) was recruited based on self-proclaimed adherence to a “healthy diet” for 1 year or more with no change in body weight (A healthy diet was defined as a whole food diet containing a variety of foods from all 5 food groups). This is important because far too many studies compare the diet they are promoting to an unhealthy diet with a lot of sugar and highly processed junk foods. These studies provide little useful information because almost anything is better than an unhealthy diet.

· The participants completed a diet survey based on the frequency of consumption of various foods during the previous year. However, because diet surveys based on the recollection of participants can be inaccurate, the investigators used two rigorous tests to validate the accuracy of those diet surveys.

o The first was a 3-day weighed dietary record (WDR). Simply put, this means that participants weighed and recorded all foods and beverages before they were eaten for 3 days. Two of those days were weekdays, and one was a weekend day.

o Secondly, the investigators used blood, urine, and metabolic measures to independently determine protein and energy intake of each participant. Participants who were identified by these means as under reporting both protein and energy were considered unreliable dietary reporters and were excluded from the analysis.

o It is very rare to find a study that goes to this length to validate the accuracy of the dietary data used in their analysis.

The participants also provided blood, urine and stool samples and completed a physical activity assessment.

What Were The Differences Between The Paleo Diet And The Healthy Control Diet?

Only the Strict Paleo Diet group was faithfully following the Paleo diet. In addition, most of the results with the Pseudo Paleo Diet Group were intermediate between the other two diets. Therefore, to simplify my discussion of this study I will only compare the Strict Paleo Diet group, which I refer to as the Paleo Diet group, with the Healthy Diet control group.

The Paleo diet emphasizes fresh vegetables, especially green leafy vegetables, and discourages grains. Thus, it is no surprise that:

· The Paleo Diet group ate 74% more vegetables and 3 times more leafy green vegetables than the Healthy Diet group.

· The Paleo Diet group ate only 3% of the grains and 3% of the whole grains compared to the Healthy Diet group.

The Paleo diet encourages consumption of meat and eggs and discourages consumption of dairy and plant proteins. Thus, it is not surprising that:

· The Paleo Diet group ate 3 times more red meat and 5 times more eggs than the Healthy Diet group.

· The Paleo Diet group ate 10% of dairy foods compared to the Healthy Diet group.

· The Paleo Diet group consumed two times more saturated fat and cholesterol than the Healthy Diet group.

The most interesting comparison between the two diets was the following:

· Intake of total fiber, insoluble fiber, and soluble fiber was comparable on the two diets.

· However, intake of resistant starch was 50% lower in the Paleo Diet group. This is significant because:

o Resistant starch is a type of fiber found primarily in whole grains, legumes, potatoes, and yams (Potatoes and yams are also dietary “no nos” on most low-carb diets).

o Resistant starch is an especially good food for certain species of healthy gut bacteria.

Is The Paleo Diet Bad For Your Gut?

Because resistant starch affects gut bacteria, the study next looked at the effect of the two diets on the populations of gut bacteria. This is where the story starts to get interesting. When they looked at different groups of gut bacteria, they discovered that:

· Bifidobacteria were much more abundant in the Healthy Diet group than in the Paleo Diet group, and the amount of Bifidobacteria in the gut was directly proportional to the amount of whole grains in the diet.

o This is important because previous studies have suggested Bifidobacteria help maintain intestinal barrier integrity and protect against irritable bowel syndrome and obesity.

· Roseburia were also much more abundant in the Healthy Diet group and proportional to the amount of whole grains in the diet.

o This is important because previous studies have suggested Roseburia protect against inflammatory bowel diseases like Crohn’s disease and ulcerative colitis.

· Hungatella were much more abundant in the Paleo Diet group and were inversely proportional to the amount of whole grains in the diet.

o This is important because Hungatella metabolize carnitine and choline, which are found in meats (especially red meats), egg yolks, and high fat dairy, into a compound called trimethylamine or TMA. TMA is then further metabolized in the liver to trimethylamine-N-oxide, or TMAO.

o TMAO is a bad player. It is positively associated with heart disease, stroke, kidney disease, diabetes, and Alzheimer’s disease. However, the evidence is strongest for heart disease. TMAO has been called an independent risk factor for cardiovascular death.

Because of this, the study looked at TMAO levels in the blood of the two diet groups. These results were concerning:

· TMAO levels were 2.5-fold higher in the Paleo Diet group than in the Healthy Diet group.

· As might be expected, TMAO levels were positively correlated with red meat intake and inversely proportional to whole grain intake.

Is The Paleo Diet Bad For Your Heart?

When you put all the evidence together you have a compelling argument that the Paleo diet is likely to increase the risk of heart disease. Let me summarize the data briefly:

1) The Paleo diet discourages the consumption of whole grains.

2) Whole grains are a major source of a dietary fiber called resistant starch.

3) Because the Paleo diet is low in resistant starch, it causes a decrease in two healthy types of gut bacteria and an increase in a type of gut bacteria called Hungatella.

4) Hungatella metabolize compounds found in meat, eggs, and dairy to a precursor of a chemical called TMAO. This study showed that TMAO levels were 2.4-fold higher in people consuming a Paleo diet.

5) TMAO is associated with coronary artery disease and is considered an independent risk factor for cardiovascular death.

The authors of the study concluded: “Although the Paleo diet is promoted for improved gut health, results indicate long-term adherence is associated with different gut microbiota and increased TMAO. A variety of fiber components, including whole grain sources, may be required to maintain gut and cardiovascular health.”

Of course, studies like this are looking at associations. They are not definitive. What we need are long term studies looking at the effect of the Paleo diet on heart disease outcomes like heart attack and stroke. Until we have these studies my advice is:

· Don’t accept claims that the Paleo diet is heart healthy. There are no long-term clinical studies to back up that claim.

· Be aware that the Paleo diet affects your gut bacteria in ways that may be bad for your heart.

The more we learn about our gut bacteria, the more we appreciate the importance of including all 5 food groups in our diet, especially all the plant food groups.

Are Low Carb Diets Healthy?

The Paleo diet is not the only diet that is high in red meat and low in whole grains. The same is true for virtually all the popular low-carb diets. There are studies showing other low-carb diets also alter gut bacteria and raise TMAO levels, so there is a similar concern that they may also increase the risk of heart disease.

This is in addition to concerns about the high saturated fat consumption which increases the risk of heart disease and red meat consumption, which may increase the risk of certain cancers.

Finally, there are no studies showing that any low-carb diet is healthy long term, even the Atkins diet, which has been around for more than 50 years. Until we have long-term studies about the health consequences of low-carb diets, my advice is similar to that for the Paleo diet.

· Don’t accept claims that low-carb diets are healthy. There are no long-term clinical studies to back up that claim.

· Be aware that low-carb diets affect your gut bacteria in ways that may be bad for your health.

The Bottom Line

A recent study looked at the effect of the Paleo diet on an important risk factor for heart disease. Here is a brief summary of the data:

1) The Paleo diet discourages the consumption of whole grains.

2) Whole grains are a major source of a dietary fiber called resistant starch.

3) Because the Paleo diet is low in resistant starch, it causes a decrease in two healthy types of gut bacteria and an increase in a type of gut bacteria called Hungatella.

4) Hungatella metabolize compounds found in meat, eggs, and dairy to a precursor of a chemical called TMAO. This study showed that TMAO levels were 2.4-fold higher in people consuming a Paleo diet.

5) TMAO is associated with coronary artery disease and is considered an independent risk factor for cardiovascular death.

Of course, studies like this are looking at associations. They are not definitive. What we need are long term studies looking at the effect of the Paleo diet on heart disease outcomes – like heart attack and stroke. Until we have these studies my advice is:

· Don’t accept claims that the Paleo diet is heart healthy. There are no long-term clinical studies to back up that claim.

· Be aware that the Paleo diet affects your gut bacteria in ways that may be bad for your heart.

· Virtually all the popular low-carb diets discourage consumption of whole grains, so my advice for them is the same as for the Paleo diet.

The more we learn about our gut bacteria, the more we appreciate the importance of including all 5 food groups in our diet, especially all the plant food groups.

For more details on the study and what it means for you, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease

A Low Carb Diet and Weight Loss

January 15, 2019 by Dr. Steve Chaney

Do Low-Carb Diets Help Maintain Weight Loss?

Author: Dr. Stephen Chaney

Traditional diets have been based on counting calories, but are all calories equal? Low-carb enthusiasts have long claimed that diets high in sugar and refined carbs cause obesity. Their hypothesis is based on the fact that high blood sugar levels cause a spike in insulin levels, and insulin promotes fat storage.

The problem is that there has been scant evidence to support that hypothesis. In fact, a recent meta-analysis of 32 published clinical studies (KD Hall and J Guo, Gastroenterology, 152: 1718-1727, 2017 ) concluded that low-fat diets resulted in a higher metabolic rate and greater fat loss than isocaloric low-carbohydrate diets.

However, low-carb enthusiasts persisted. They argued that the studies included in the meta-analysis were too short to adequately measure the metabolic effects of a low-carb diet. Recently, a study has been published in the British Medical Journal (CB Ebbeling et al, BMJ 2018, 363:k4583 ) that appears to vindicate their position.

Are low carb diets best for long term weight loss?

Low-carb enthusiasts claim the study conclusively shows that low-carb diets are best for losing weight and for keeping it off once you have lost it. They are saying that it is time to shift away from counting calories and from promoting low-fat diets and focus on low-carb diets instead if we wish to solve the obesity epidemic. In this article I will focus on three issues:

How good was the study?
What were its limitations?
Are the claims justified?

How Was The Study Designed?

The investigators started with 234 overweight adults (30% male, 78% white, average age 40, BMI 32) recruited from the campus of Framingham State University in Massachusetts. All participants were put on a diet that restricted calories to 60% of estimated needs for 10 weeks. The diet consisted of 45% of calories from carbohydrate, 30% from fat, and 25% from protein. [So much for the claim that the study showed low-carb diets were more effective for weight loss. The diet used for the weight loss portion of the diet was not low-carb.]

During the initial phase of the study 161 of the participants achieved 10% weight loss. These participants were randomly divided into 3 groups for the weight maintenance phase of the study.

The diet composition of the high-carb group was 60% carbohydrate, 20% fat, and 20% protein.
The diet composition of the moderate-carb group was 40% carbohydrate, 40% fat, and 20% protein.
The diet composition of the low-carb group was 20% carbohydrate, 60% fat, and 20% protein.

Other important characteristics of the study were:

The weight maintenance portion of the study lasted 5 months – much longer than any previous study.
All meals were designed by dietitians and prepared by a commercial food service. The meals were either served in a cafeteria or packaged to be taken home by the participants.
The caloric content of the meals was individually adjusted on a weekly basis so that weight was kept within a ± 4-pound range during the 5-month maintenance phase.
Sugar, saturated fat, and sodium were limited and kept relatively constant among the 3 diets.

120 participants made it through the 5-month maintenance phase.

Do Low-Carb Diets Help Maintain Weight Loss?

The results were striking:

The low-carb group burned an additional 278 calories/day compared to the high-carb group and 131 calories/day more than the moderate-carbohydrate group.
These differences were even higher for those individuals with higher insulin secretion at the beginning of the maintenance phase of the study.
These differences lead the authors to hypothesize that low-carb diets might be more effective for weight maintenance than other diets.

What Are The Pros And Cons Of This Study?

This was a very well-done study. In fact, it is the most ambitious and well-controlled study of its kind. However, like any other clinical study, it has its limitations. It also needs to be repeated.

The pros of the study are obvious. It was a long study and the dietary intake of the participants was tightly controlled.

As for cons, here are the three limitations of the study listed by the authors:

#1: Potential Measurement Error: This section of the paper was a highly technical consideration of the method used to measure energy expenditure. Suffice it to say that the method they used to measure calories burned per day may overestimate calories burned in the low-carb group. That, of course, would invalidate the major findings of the study. It is unlikely, but it is why the study needs to be repeated using a different measure of energy expenditure.

#2: Compliance: Although the participants were provided with all their meals, there was no way of being sure they ate them. There was also no way of knowing whether they may have eaten other foods in addition to the food they were provided. Again, this is unlikely, but cannot be eliminated from consideration.

#3: Generalizability: This is simply an acknowledgement that the greatest strength of this study is also its greatest weakness. The authors acknowledged that their study was conducted in such a tightly controlled manner it is difficult to translate their findings to the real world. For example:

Sugar and saturated fat were restricted and were at very similar levels in all 3 diets. In the real world, people consuming a high-carb diet are likely to consume more sugar than people in the other diet groups. Similarly, people consuming the low-carb diet are likely to consume more saturated fat than people in the other diet groups.
Weight was kept constant in the weight maintenance phase by constantly adjusting caloric intake. Unfortunately, this seldom happens in the real world. Most people gain weight once they go off their diet – and this is just as true with low-carb diets as with other diets.
The participants had access to dietitian-designed prepared meals 3 times a day for 5 months. This almost never happens in the real world. The authors said “…these results [their data] must be reconciled with the long-term weight loss trials relying on nutrition education and behavioral counseling that find only a small advantage for low carbohydrate compared with low fat diets according to several recent meta-analyses.” [I would add that in the real world, people do not even have access to nutritional education and behavioral modification.]

What Does This Study Mean For You?

This study shows that under very tightly controlled conditions (dietitian-prepared meals, sugar and saturated fat limited to healthy levels, calories continually adjusted so that weight remains constant) a low-carb diet burns more calories per day than a moderate-carb or high-carb diet. These findings show that it is theoretically possible to increase your metabolic weight and successfully maintain a healthy weight on a low-carb diet. These are the headlines you probably saw. However, a careful reading of the study provides a much more nuanced viewpoint. For example, the fact that the study conditions were so tightly controlled makes it difficult to translate these findings to the real world.
In fact, the authors of the study acknowledged that multiple clinical studies show this almost never happens in the real world. These studies show that most people regain the weight they have lost on low-carb diets. More importantly, the rate of weight regain is virtually identical on low-carb and low-fat diets. Consequently, the authors of the current study concluded “…translation [of their results to the real world] requires exploration in future mechanistic oriented research.” Simply put, the authors are saying that more research is needed to provide a mechanistic explanation for this discrepancy before one can make recommendations that are relevant to weight loss and weight maintenance in the real world.
The authors also discussed the results of their study in light of a recent, well-designed 12-month study (CD Gardener et al, JAMA, 319: 667-669, 2018 ) that showed no difference in weight change between a healthy low-fat versus a healthy low-carbohydrate diet. That study also reported that the results were unaffected by insulin secretion at baseline. The authors of the current study noted that “…[in the previous study] participants were instructed to minimize or eliminate refined grains and added sugars and maximize intake of vegetables. Probably for this reason, the reported glycemic load [effect of the diet on blood sugar levels] of the low-fat diet was very low…and similar to [the low-carb diet].” In short, the authors of the current study were acknowledging that diets which focus on healthy, plant-based carbohydrates and eliminate sugar, refined grains, and processed foods may be as effective as low-carb diets for helping maintain a healthy weight.
This would also be consistent with previous studies showing that primarily plant-based, low-carb diets are more effective at maintaining a healthy weight and better health outcomes long-term than the typical American version of the low-fat diet, which is high in sugar and refined grains. In contrast, meat-based, low-carb diets are no more effective than the American version of the low-fat diet at preventing weight gain and poor health outcomes. I have covered these studies in detail in my book “Slaying The Food Myths.”

Consequently, the lead author of the most recent study has said: “The findings [of this study] do not impugn whole fruits, beans and other unprocessed carbohydrates. Rather, the study suggests that reducing foods with added sugar, flour, and other refined carbohydrates could help people maintain weight loss….” This is something we all can agree on, but strangely this is not reflected in the headlines you may have seen in the media.

The Bottom Line

A recent study compared the calories burned per day on a low-carb, moderate-carb, and high-carb diet. The study concluded that the low-carb diet burned significantly more calories per day than the other two diets and might be suitable for long-term weight control. If confirmed by subsequent studies, this would be the first real evidence that low-carb diets are superior for maintaining a healthy weight.
However, the study has some major limitations. For example, it used a methodology that may overestimate the benefits of a low-carb diet, and it was performed under tightly controlled conditions that can never be duplicated in the real world. As acknowledged by the authors, this study is also contradicted by multiple previous studies. Further studies will be required to confirm the results of this study and show how it can be applied in the real world.
In addition, the kind of carbohydrate in the diet is every bit as important as the amount of carbohydrate. The authors acknowledge that the differences seen in their study apply mainly to carbohydrates from sugar, refined grains, and processed foods. They advocate diets with low glycemic load (small effects on blood sugar and insulin levels) and acknowledge this can also be achieved by incorporating low-glycemic load, plant-based carbohydrates into your diet. This is something we all can agree on, but strangely this is not reflected in the headlines you may have seen in the media.
Finally, clinical studies report averages, but none of us are average. When you examine the data from the current study, it is evident that some participants burned more calories per hour on the high-carb diet than other participants did on the low carb diet. That reinforces the observation that some people lose weight more effectively on low-carb diets while others lose weight more effectively on low-fat diets. If you are someone who does better on a low-carb diet, the best available evidence suggests you will have better long-term health outcomes on a primarily plant-based, low-carb diet such as the low-carb version of the Mediterranean diet.

For more details read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Are Low Carb Diets Healthy?

October 31, 2017 by Dr. Steve Chaney

Can You Eat Low Carb & Live A Long And Healthy Life?

Author: Dr. Stephen Chaney

Are low carb diets healthy?

Atkins, Paleo, Keto…It seems like everyone is following a low carb diet nowadays. They are popular, but they are also controversial. At this point you are probably wondering are low carb diets healthy and is there any evidence to support it one way or the other? I searched the literature to find the answer to that question. The answer is:

Yes, there is evidence that some low carb diets are healthy…

…but, not for the reasons low carb enthusiasts give…

…and, not for the diets they promote.

Let me elaborate.

Why Are The Arguments Of Low Carb Enthusiasts Misleading?

Most proponents of low carb diets claim they are healthy based on improvements in blood parameters, usually things like lower triglycerides, higher HDL, lower blood glucose and insulin levels, and lower blood pressure. They sometimes claim lower LDL levels and lower levels of inflammation, although clinical studies are inconsistent for the effects of low carb diets on LDL and inflammation. They then go on to extrapolate from these data to claim their diet will reduce the risk of heart disease, diabetes, and other diseases.

These extrapolations are misleading for three reasons:

#1: Most of these comparisons are with the standard American diet. As I have said previously, almost anything is better than the standard American diet.

#2: Most of these studies are short term. The comparisons are generally made during the weight loss phase of these diets or at a time when the dieters have achieved significant weight loss. That is significant because weight loss improves all those parameters. If the comparisons were made during the maintenance phase or after most of the weight had been regained (as it usually is), the results might have been completely different.

#3: These blood parameters are imperfect indicators of disease risk. I find it particularly amusing that low carb proponents downplay the risk of saturated fats by saying that LDL and HDL cholesterol are imperfect indicators of disease risk and then use the same indicators to predict their diet will lower the risk of heart disease.

The only accurate way to determine the effect of a diet on disease risk is to conduct long term studies that measure the health outcomes of the diet. Those studies have been done, but they don’t support popular diets like Atkins, Paleo, or Keto.

Are Low Carb Diets Healthy and If So, Which Ones?

There are, in fact, several long-term studies showing that low carb diets are healthy, but only if you ditch the animal protein and animal fats, and replace them with vegetable protein and vegetable oils.

For example, a 20-year study of 82,802 women in the Nurses’ Health Study found that women who ate a low-carbohydrate diet that was high in vegetable protein and oils had 30% lower risk of developing heart disease compared to women who ate high-carbohydrate, low-fat diets (T.L. Halton et al, New England Journal of Medicine, 355: 1991-2002, 2006). In contrast, the women who consumed a low-carbohydrate diet that was high in animal protein and fat fared no better than women consuming a high-carbohydrate, low-fat diet.

A follow-up study with the same group of women compared the effect of the same diets over a period of 20 years on the risk of developing type 2 diabetes (T.L. Halton et al, American Journal of Clinical Nutrition, 87: 339-346, 2008 ). The results were very similar. Women consuming a low-carbohydrate diet high in vegetable protein and oils had an 18% decreased risk of developing diabetes. Once again, the women consuming a low-carbohydrate diet high in animal protein and fats had just as high a risk of developing diabetes as women consuming the high-carbohydrate, low-fat diet.

This may have been because women consuming a low-carbohydrate, high animal protein and fat diet gained just as much weight over 20 years as women consuming a high-carbohydrate, low-fat diet. In contrast, women who consumed the low-carbohydrate diet high in vegetable protein and oils gained much less weight. At the end of the 20-year study, they weighed significantly less than the women in the other two groups (T.L. Halton et al, New England Journal of Medicine, 355: 1991-2002, 2006 ). This is not surprising, since we already know that vegetarians weigh less than their meat-eating friends.

However, it does run counter to what the low carb diet promoters have been telling you. They claim their diets help you lose weight. You do lose weight more rapidly on a typical low carb diet, but at the end of a year or two you end up weighing just as much as if you followed a low-fat diet (F.M. Sacks et al, New England Journal of Medicine, 360: 859-873, 2009) . By the end of 20 years you will have gained significant weight compared to someone following a more plant-based diet (T.L. Halton et al, New England Journal of Medicine, 355: 1991-2002, 2006 ). It appears that the only low carb diet likely to give you permanent weight loss is a low carb vegetarian diet.

This is reinforced by another study showing that consumption of junk foods (potato chips and fries), sodas, processed meats, red meats, butter, sweets & desserts, and refined grains was associated with weight gain over a 4-year period (D. Mozaffarian et al, New England Journal of Medicine, 364: 2392-2404, 2011 ). In contrast, consumption of vegetables, fruits, nuts, whole grains, and yoghurt was associated with weight loss.

It’s not just women. A 20-year study of 40,475 men found that men consuming a low-carbohydrate diet high in animal protein and fat had a 37% increased risk of developing type 2 diabetes (L. de Koning et al, American Journal of Clinical Nutrition, 93: 844-850, 2011 ). In contrast, men consuming a low-carbohydrate diet high in vegetable protein and oils had a 34% decreased risk of developing type 2 diabetes.

Other Healthy Low Carb Diets

I have previously shared evidence that a Mediterranean diet reduces the risk of developing type 2 diabetes. Several recent studies have shown that a low-carbohydrate version of the Mediterranean diet is preferable for managing people who already have diabetes.

For example, one recent study put people who had just developed type 2 diabetes on either the low-carbohydrate Mediterranean diet or the low-fat, calorie-restrict diet usually recommended for overweight patients with diabetes (K. Esposito et al, Annals of Internal Medicine, 151: 306-314, 2009). At the end of 4 years, only 44% of the patients on the low-carbohydrate Mediterranean diet required drug treatment compared to 70% in the low-fat group.

Another entry into the low carb diet category is the eco-Atkins diet. It is a low-carbohydrate vegan diet (I find it amusing to label a diet “Atkins” when it has no meat and no saturated fat). For example, one recent study suggests it is more effective than a low-fat diet at reducing blood lipid levels and reducing blood pressure (D.J.A. Jenkins et al, Archives of Internal Medicine, 169: 1046-1054, 2009 ).

If you want to follow a low carb diet, the low carb Mediterranean and eco-Atkins diets are both healthy diets. You could create your own plant-based low carb diet, but you can find meal plans and recipes for both these diets online.

What Does This Mean For You?

Vegan, vegetarian, and primarily plant-based diets like the Mediterranean diet are all healthy diets. Long-term studies show they decrease your risk of developing heart disease, diabetes, cancer, and other diseases. Long-term studies also show that plant-based low carb diets help keep the pounds off and reduce your risk of heart disease and diabetes.

In contrast, meat-based low carb diets offer no advantage over low fat diets at keeping the pounds off or reducing the risk of heart disease or diabetes. There are no long-term studies on meat-based low carb diets and cancer risk, but we already know that red meat is a probable carcinogen. We also know that plant-based diets decrease your risk of several cancers. In short, there is no long-term evidence that the low-carb, meat-based diets decrease your risk of any disease and some evidence they may increase your risk of disease.

So, are low carb diets healthy? Yes, if you stop eating animal protein and animal fats and make vegetable protein and oils a part of your diet.

The Bottom Line

Ignore the claims by proponents of the popular low carb diets that their diets are healthy. Those claims are based on:
- Comparisons with the standard American diet. Anything is better.
- Short term studies when the participants were losing weight. Any diet looks good during the weight loss phase.
- Blood parameters (HDL, triglycerides, blood sugar, etc.). These are imperfect measures of long-term health outcomes.

Long-term (20-year) studies of the effects of low carb diets on health outcomes have been performed. Those studies show:
- People following a meat-based low carb diet (one that focuses on animal proteins and animal fats):
  - Gained just as much weight over a 20-year period as people following a low-fat diet.
  - Had the same or greater risk of developing heart disease and diabetes as people following a low-fat diet.
- People following a plant-based low carb diet (one that focuses on vegetable protein and vegetable oils):
  - Weighed significantly less than the other two groups at the end of 20 years.
  - Had a significantly lower risk of developing heart disease and diabetes than the other two groups.

In summary, vegan, vegetarian, and primarily plant-based diets like the Mediterranean diet are all healthy diets. Long-term studies show they decrease your risk of developing heart disease, diabetes, cancer, and other diseases. Long-term studies also show that plant-based low carb diets help keep the pounds off and reduce your risk of heart disease and diabetes.

For more details and the low carb diets I recommend, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.