Is The Paleo Diet Bad For Your Heart?

Is The Paleo Diet Bad For Your Gut?

the paleo dietThere 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?

can you believe clinical studies doctorThis 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?

Paleo FoodsOnly 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?

Bas BacteriaBecause 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?

heart diseaseWhen 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?

low carb dietThe 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

Do Low-Carb Diets Help Maintain Weight Loss?

Author: Dr. Stephen Chaney

 

low carb dietTraditional 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?

low carb diet studyThe 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?

low carb diet maintain weight lossThe 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?

low carb diet pros and consThis 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.]

 

low carb diet and youWhat 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?

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

Author: Dr. Stephen Chaney

 

Are low carb diets healthy?

are low carb diets healthyAtkins, 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?

are low carb diets healthy enthusiastMost 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?

which low carb diets are healthyThere 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

 

are low carb diets healthy vegetablesI 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.

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.

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.

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