[cyberus]

Originally Posted by shiny!

LCing is probably going to save my life where diabetes is concerned. Please do your research before offering advice of this nature.

I'm glad you've found something that works for you, but for every Weight Watcher who say's they have found the way, you will find someone who does Atkins/LC that will say the same thing.

AMEN

Low carb is whats working for me and keeping me from having to go to stronger meds (that I can't afford BTW) but while I wouldn't hesitate to recommend someone trying low carb if the ADA diet isn't cutting it I surely wouldn't put anyone down for going for what works for them.

After all .. like we all say to the newbies (like I was 6 months ago) TEST TEST TEST and find out what works for YOU

[BlueSky]

Originally Posted by EeyoreButterfly

The Atkins diet is successful only because it eliminates an entire food group. Therefore people are likely to eat less since so many foods are off limits, which results in a lower caloric intake. Many people are not able to keep up with such a limited routine and will soon go back to their old patterns.....

With respect, this misses the point. At the end of the day, whether a diet works or not depends on how hungry adherents to it get. The Atkins diet works because people on it don't get hungry. At least not during the induction phase. This is why they lose weight without restricting calories. None of the competing diets, including Weight Watchers, allows unrestricted calories. Caloric intake declines under the Atkins diet because of increased satiety. Atkins diet food is typically energy dense, because of all the fat it contains. People lose weight on it because they are no longer hungry after eating small amounts of these foods.

The biggest shortcoming of the Atkins diet is that carbohydrates are re-introduced aftter the induction phase. Because carbohydrate stimulates hunger, weight is regained.

Here is a graph that shows comparative weight loss for low-fat, mediteranean and Atkins diets in a recent Israeli study. In spite of calories not being restricted under the Atkins diet, the greatest weight loss was achieved with it.



NEJM -- Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet

[REDLAN]

In spite of calories not being restricted under the Atkins diet, the greatest weight loss was achieved with it.

Depsite not having calories restricted, the Atkins group had the lowest calorific intake of the 3 groups - which rather proves Eyorebutterfly's point.

In the graph, you will notice that the Atkins group experienced the greatest weight loss. They also experienced the greatest weight gain of the three groups.

The weight regain is not all it seems either, and includes a bias in the way it is calculated. The dropout rates in the study were fairly high, and they were highest for the Atkins group. The researchers however included the results for ALL the study participants, and the way they included them was to assume that they maintained their weight loss until the end of the study period. This would have the effect of flattening off the curve towards the end of the study, when most participants are experiencing weight gain.

The modest benefit shown here by the Israeli for Atkins style diet is an atypical result. The typical pattern is initial weight loss and regain is greatest for the Atkins group, and there to be no significant difference between diets at the 2 year mark.

[fgummett]

Originally Posted by REDLAN

Depsite not having calories restricted, the Atkins group had the lowest calorific intake of the 3 groups - which rather proves Eyorebutterfly's point.

So are you saying that because the participants felt least hungry of the groups but lost weight anyway that is a bad thing? Isn't that the point of a successful weight-loss diet?
Or are you taking this a proof that they may just as well have reduced calories across all food groups... and in my experience been hungry all the time?

Originally Posted by REDLAN

The modest benefit shown here by the Israeli for Atkins style diet is an atypical result. The typical pattern is initial weight loss and regain is greatest for the Atkins group, and there to be no significant difference between diets at the 2 year mark.

Can you please quote a study or two to back up this statement? If you read posts above like the recent one of Yannah you will see that the "significant difference" is a singular lack of hunger cravings on a low-carb diet.

[Subby]

Originally Posted by REDLAN

Depsite not having calories restricted, the Atkins group had the lowest calorific intake of the 3 groups - which rather proves Eyorebutterfly's point.

Which point is that, and how does it prove it?

In the graph, you will notice that the Atkins group experienced the greatest weight loss. They also experienced the greatest weight gain of the three groups.

So, a negative and a benefit. And, from the look of things, the negative is slightly outweighed by the benefit. You certainly don't have a compelling argument here...

The weight regain is not all it seems either, and includes a bias in the way it is calculated. The dropout rates in the study were fairly high, and they were highest for the Atkins group. The researchers however included the results for ALL the study participants, and the way they included them was to assume that they maintained their weight loss until the end of the study period. This would have the effect of flattening off the curve towards the end of the study, when most participants are experiencing weight gain.

10 in LF, 16 in Med, and 24 in LC, with various dropouts at various places for all diets. From a pool of 322. Sorry if I don't join you in denouncing the results, due to this variance. Some variation for sure. But nothing to shake it all up.

The modest benefit shown here by the Israeli for Atkins style diet is an atypical result. The typical pattern is initial weight loss and regain is greatest for the Atkins group, and there to be no significant difference between diets at the 2 year mark.

Which means that the Atkin's diet is the son of the devil because... it's as effective at a low fat diet at 2 years? That is nonsensical.

But then again I'm forced to be presumptuous about your intended point, because you don't actually state your position upfront, at all. If you want to help us out here, maybe you could say what do you actually think, and why?

(NB, I don't actually subscribe to Atkins. I'm interested, which is why I'd like to see some quality discussion, not point scoring at the expense of perspective).

[fgummett]

So lets look at other aspects of this 2 year trial:

Among the 36 participants with diabetes, only those in the Mediterranean-diet group had a decrease in fasting plasma glucose levels (32.8 mg per deciliter); this change was significantly different from the increase in plasma glucose levels among participants with diabetes in the low-fat group.

But isn't low-fat the diet of choice for the ADA, NIH etc...

The level of high-sensitivity C-reactive protein decreased significantly (P<0.05) only in the Mediterranean-diet group (21%) and the low-carbohydrate group (29%), during both the weight-loss and the maintenance phases, with no significant differences among the groups in the amount of decrease.

I understand this to be a marker of chronic inflammation.

HDL cholesterol increased during the weight-loss and maintenance phases in all groups, with the greatest increase in the low-carbohydrate group (8.4 mg per deciliter [0.22 mmol per liter], P<0.01 for the interaction between diet group and time), as compared with the low-fat group (6.3 mg per deciliter [0.16 mmol per liter]). Triglyceride levels decreased significantly in the low-carbohydrate group (23.7 mg per deciliter [0.27 mmol per liter], P=0.03 for the interaction between diet group and time), as compared with the low-fat group (2.7 mg per deciliter [0.03 mmol per liter]). LDL cholesterol levels did not change significantly within groups, and there were no significant differences between the groups in the amount of change. Overall, the ratio of total cholesterol to HDL cholesterol decreased during both the weight-loss and the maintenance phases. The low-carbohydrate group had the greatest improvement, with a relative decrease of 20% (P=0.01 for the interaction between diet group and time), as compared with a decrease of 12% in the low-fat group

There are also some interesting differences between the sexes and I find that significant as I have read that the majority of this kind of research has concentrated on men when clearly there are differences.

I recommend that each of you read the study for yourself before making your mind up.

[fgummett]

Originally Posted by REDLAN

The weight regain is not all it seems either, and includes a bias in the way it is calculated. The dropout rates in the study were fairly high, and they were highest for the Atkins group. The researchers however included the results for ALL the study participants, and the way they included them was to assume that they maintained their weight loss until the end of the study period. This would have the effect of flattening off the curve towards the end of the study, when most participants are experiencing weight gain.

Study says...

The overall rate of adherence was 95.4% at 12 months and 84.6% at 24 months; the 24-month adherence rates were 90.4% in the low-fat group, 85.3% in the Mediterranean-diet group, and 78.0% in the low-carbohydrate group

So a 9.6% dropout over 2 years for low-fat compared to a 22% dropout rate over two years for low-carb. How do you quantify "fairly high"?
I see nothing in this paper (published in the New England Journal of Medicine) describing the extrapolation of weight loss you describe... can you please elaborate on that?

---

As for the drop-out rate, it has previously been discussed how the weight of the media, food industry and health establishment is behind the low-fat dogma, so I suspect (personal opinion here) that a low-carb diet may be harder to maintain in the long-term due to peer pressure (TV ads, friends all eating low-fat at home, dinner parties etc..), and/or scare tactics like "oh my gosh that is dangerous... think of your poor kidneys!"

[fgummett]

Originally Posted by EeyoreButterfly

Recommending Atkins to a person with diabetes is irresponsible. Atkins can result in ketones because the kidneys must work harder to filter protein. This is very dangerous for people with diabetes

I think I made a comment above about "scare tactics"...

Ketones are a normal byproduct of fat-metabolism. Ketosis is natural and occurs during normal periods of fasting. NOT to be confused with Ketoacidosis which is a dangerous condition most often caused by untreated Type 1.

And a recent study The Impact of Protein Intake on Renal Function Decline in Women with Normal Renal Function or Mild Renal Insufficiency... which concludes

High protein intake was not associated with renal function decline in women with normal renal function. However, high total protein intake, particularly high intake of nondairy animal protein, may accelerate renal function decline in women with mild renal insufficiency.

---

As to my "intentions": I subscribe to "low-carb", having come there by way of Gary Taubes and Dr Bernstein... I have not even seen the Atkin's book. As I may have mentioned above, the biggest single point I have to make about this way of eating is the absence of hunger cravings. BUT I accept that people (and the sexes) may be different and what works for me may be different for you.

[REDLAN]

Sorry, I don't have time to pick up all the points

Depsite not having calories restricted, the Atkins group had the lowest calorific intake of the 3 groups - which rather proves Eyorebutterfly's point.

Which point is that, and how does it prove it?

Atkins virtually eliminates a food group - carbohydrates. They do not make up for it by eating more fat/protein, hence the finding that people on Atkins have a lower calorie intake.

Bluesky was implying by the statement

In spite of calories not being restricted under the Atkins diet, the greatest weight loss was achieved with it.

that the participants were not restricting calories. In fact the Atkins group restricted their calorie intake the most and lost the most weight initially. Weight loss on Atkins is therefore explained by calorie restriction alone.

The researchers however included the results for ALL the study participants, and the way they included them was to assume that they maintained their weight loss until the end of the study period. This would have the effect of flattening off the curve towards the end of the study, when most participants are experiencing weight gain.

I see nothing in this paper (published in the New England Journal of Medicine) describing the extrapolation of weight loss you describe... can you please elaborate on that?

The authors themselves explain this in the section on Statistical Analysis.

For intention-to-treat analyses, we included all 322 participants and used the most recent values for weight and blood pressure.

For those who dropped out, they took the last reading they got and included it in the analysis. They could have adjusted the data to account for the weight regain experienced by the remaining participants in the study, BUT

We analyzed the dietary-composition data and biomarkers with the use of raw unadjusted means, without imputation of missing data.

Imputation is a statistical technique where you extrapolate missing data, but they didn't do this.

But then again I'm forced to be presumptuous about your intended point, because you don't actually state your position upfront, at all. If you want to help us out here, maybe you could say what do you actually think, and why?

I'm not trying to point score. I'm trying to point out (using reasoned argument) that the study is flawed. As far as I understand it, there is no particular advantage in weight loss terms of one diet over another. It would be interesting to see what results this study would show if the dropouts were either excluded or extrapolated - it might show that the mediterranean diet was superior, or that there was no significant difference between them.

The rapid weight loss on Atkins is explainable by calorie restriction alone, and not some issue around carbohydrate metabolism. Although Bluesky has a point about high protein diets leading to more rapid satiety. I do not subscribe to the carbs are bad philosophy, but then neither do I subscribe to the fats are bad philosophy either.

I personally believe that the use of low-carb diets to lower insulin requirements in the treatment of type 2 is of benefit, and is rational. I'm not convinced that the same argument applies in type 1, but low carbing may be of benefit to some individuals with type 1.

[Subby]

Originally Posted by REDLAN

I'm not trying to point score. I'm trying to point out (using reasoned argument) that the study is flawed. As far as I understand it, there is no particular advantage in weight loss terms of one diet over another. It would be interesting to see what results this study would show if the dropouts were either excluded or extrapolated - it might show that the mediterranean diet was superior, or that there was no significant difference between them.

Ok, thanks for clearing that up.

I personally believe that the use of low-carb diets to lower insulin requirements in the treatment of type 2 is of benefit, and is rational. I'm not convinced that the same argument applies in type 1, but low carbing may be of benefit to some individuals with type 1.

I think it can be, at least in the case of cravings caused by carbs, which I find is extremely strong for me. Cravings and the often resulting excess of appetite, not only are very unpleasant, but also the enemy of good control. (Even if the carbs are matched with insulin, the bigger the amounts, the bigger the errors and variances and mismatches stack up).

Mind you though, my enthusiasm for this is just in carb limitation, which I know really helps stem hunger and fatigue, for a certain subset of people. I'm not talking about unlimited fats etc, which is the only part of the Atkins diet I really hesitate on (but haven't really researched).

[fgummett]

Well REDLAN, I certainly can't argue your superior knowledge of statistical analysis terms but, as a layman, surely that whole discussion hinges on how significant you view the drop-out rate? In their own words:

The strengths of the study include the one-phase design, in which all participants started simultaneously; the relatively long duration of the study; the large study-group size; and the high rate of adherence.

I also agree that the lower calorie intake on the low-carb diet* is an explanation of the weight loss, but another explanation is the difference in metabolism of carbohydrates versus proteins and fats.

To me, the bigger question is: why, when given a diet where you can eat as much as you want, would people voluntarily eat fewer calories... why didn't that happen spontaneously in the low-fat or Mediterranean groups... were they being force-fed?

Let's not forget that weight loss, at least on par with the low-fat diet, was not the only health benefit shown here.

---

*Interesting observation as to who chooses to use the term "low-carb" and who chooses "Atkins" with all its attendant negative connotations.

[shiny!]

*For me*, the whole issue of Atkins or LC eliminating an entire food group therefore consuming less calories is so moot. What exactly is the arguable point? That I should be doing Weight Watchers because you can eat anything because it doesn't discriminate against carbohydrates?

I'm sorry, but I'm definitely consuming more calories than I was before, because I'm consuming more fat. I'm not being overtaken with cravings for sweets, I'm not being driven by constant thoughts of eating, I don't have to worry about portion control (because I automatically feel satisfied after a normal amount with normal intervals) or counting points or calories, like I used to. Most importantly, it has lowered my numbers dramatically, and I'm steadily losing weight.

So all the other arguments about statistics, studies, etc., mean squat to me. All I need to know is it gets the job done.

That's my story and I'm sticking to it.

[Harold]

Does anyone here in the last 18 posts remember what the topic was originally? This is why LC'ers get a bad rap. You all get on your soap boxes and drive everyone crazy with your fanaticism. Besides I am with owlyn on this thread.

[shiny!]

I wasn't aware LC'ers had a "bad rap". I also wasn't aware that anyone was being "fanatical" in this thread, only having a discussion and debating points. Is that not what a board is for? My take is if it bothers you, don't read it.

[notme]

If you go back and look at this thread I think you will see that two members must have felt like people were ganging up on them. I think Harold's point on this thread and others is pretty much on target.

I know people feel passionate about their choices in how to treat diabetes. Lets just try to keep it a little more thought provoking and less gang mentality. Post your point and then stop and let others have their say without fear that four or five people will post, repost and make them feel like their ideas aren't valid.