The Battle of the Diets: Is Anyone Winning (At Losing?)

[Music] this program is brought to you by Stanford University please visit us at stanford.edu I'm a very informal speaker so you can interrupt me anywhere along the way if you get bored of my slides you can ask me to stop and clarify any kind of questions I did want to start and say that I actually had absolutely no interest in this topic to begin with I'm a 25-year vegetarian I run garlic trials soy trials vegetarian trials gko trials I go to research conferences or public speaking engagements like this and I would finish my garlic talk and I would ask if anyone not wanted to know the putative active agent of garlic and hands would go up and they'd say no but can I lose weight on Atkins and my whole talk was on garlic okay anybody else yes can I lose weight on the Zone I said it was a soy talk why do you want to know about we loss and I was very frustrated because there weren't really any studies to show that any of these things worked or not there's actually a good reason why most people don't study these they're fat diets they go out of fashion so fast that from a researcher's perspective I write a grant gets rejected I resubmit it gets rejected I get it funded I run it I write up the results I submit it it gets rejected I send it out it's rejected they accept it and a year later they put it in the paper or in the journal and 10 years have gone by so if it's a fat diet and it goes out of fashion it's kind of pointless to fund it because nobody will pay any attention to it later except these things have been around for a while and so people started to recognize they weren't going away and people were still on them and it was still a controversy and so I thought I would try to write something up I actually wrote it up five different ways before it got funded um but to the tune of $2 million some of which was your taxpayer dollars we did a study in weight loss with 311 women and I would like to put that in the context of not just our research but a lot of other things that are out there and try to give you a broad perspective of where I think this whole Battle of the diets is right now but I'll bring some other factors in okay that's pretty much the goal I hope that's what you thought you were coming for if not there's plenty of food out there you can go check out more of the food so we have this standard National recommendation for weight loss this is a big NIH 1998 consensus conference that said you should follow the lowfat high carbohydrate diet and restrict your calories and exercise a bunch and it's been around for a long time now I don't know how many of you have seen this kind of map I'm going to go through a whole bunch of slides where the colors are going to change here so this is the prevalence of who obese in 1985 by state by percentage and then it changes from year to year o I forgot to fix that one and the colors get darker oh my goodness this is the obes and then we add a new category in 1991 oh my gosh and then we had a new category in 1997 then we add a new category in 2001 oh my God and in 2005 Louisiana adds a new category so that's the prevalence not just of overweight that's the prevalence of obesity people have 30 pounds or more to lose is that col a hold out Colorado is the hold out it's holding down the fort at 10 to 14% yep if everybody wants to move to Colorado now this is your chance yeah actually Vermont and Connecticut two are in there how did we get those Figures it's actually a self-report so these are probably underestimated if anything it's a big telephone survey the brfss behavioral risk factor survey surveillance surveillance survey okay there's one more s there thank you very much so they do a random sampling of the United States every single year and they ask a lot of questions this is just one how much do you weigh in how tall are you so if you exaggerate how tall you are and you underestimate how heavy you are which a lot of people do we probably get a few more colors here so this is pretty shocking and if you noticed it didn't really stop in 1998 when that recommendation came out for the diet did you see that it didn't all of a sudden just stop and reverse because we decided you should follow a lowfat high carbohydrate diet so several people took advantage of that and they said oh well the reason is the recommendation is wrong you shouldn't really have that proportion of fat and carbohydrate in fact you should have a much lower carbohydrate diet so Atkins said that well this isn't very bright can you even see that okay you can figure it out Atkins on the left Zone sugar Busters South Beach things like that and actually it went further to the right also so if any of you are familiar with pritkin ornish mcdou McDougall or Barbara rolls volumetrics they actually say you should have more carbohydrate than the national recommendation because you should have the big bulky salads that fill you up that are all carbs so it's quite a battle and it's kind of hard to believe that they're all right right so do anybody really have any credibility here but like I said there haven't really been very many studies so I don't know if we can dim the lights at all most of my slides will show up can we dim the front ones at all or do they go side to side it doesn't really matter I have some these are the next topics but you don't need to see them now because I'm going to present them later ah see isn't that a little better yes okay there we go no that we don't need that much all right ah now it looks really colorful oh should we go back and do the states again no that's right so let me show you some carbohydrate fat and protein data even though that I don't think that's actually the right way to approach this but let me let me go there because we have some studies now that have finally looked at this so in the last four or five years a number of people did get funding to do this and for the first time ever we really had some studies on weight loss comparing different kinds of diets like this a lot of them before this were all done housed in a unit where people fed you for six weeks and now we've got longer studies with people eating popular diet type things like Atkin so here's the very first one that came out is in the New England Journal of Medicine I'm Green With Envy that they're in the New England Journal of Medicine I'm also totally irritated that the New England Journal of Medicine took a study that had 63 people in it of whom 26 quit by the end of the study somehow that see aren't you upset too I think this got published cuz this is the first thing there was really nothing on this and so many people were in the on the Atkins died it was such a craze at that point statistically for those of you who aren't statisticians these little p values are called probabilities and you have to have a probability of less than 005 to be statistically significant so it was here and it was here but it wasn't anymore here but so many people dropped out by the end it was hard to get a firm conclusion if anything the Atkins group lost more weight than the traditional diet learn stood for lifestyle exercise attitudes relationships and nutrition and it was basically the health professionals approach to nutrition it was a lowfat high carb diet so picture that is health professionals versus The Challenger Atkins and Atkins did a little bit better okay but not a very compelling study tiny study with a lot of dropouts here was the only one I can find on South Beach and these are the South Beach guys that ran it and published it it has all of the 54 people you see here and it only goes for 12 weeks so I'm not very convinced uh they did lose a little more weight on South Beach versus the National Diet but not many people and not very long okay here's another one I'm not even going to show you the results these folks had a stud design very similar to mine so maybe that's why I'm not showing you the results but partly I'm concerned because they started with 40 in each group and in two of the groups half the people quit before they got to the end so I find it hard to come up with a solid conclusion if that many people quit although it brings up a a really good point these weight loss studies are hard to run you can imagine the people who don't lose weight don't really want to come back at the end and tell you that they didn't lose weight so it's hard to run a study to give you a good answer to see whether or not these work so here's one that I liked in particular by Bonnie bream it was not a particularly large study this is the sample size of these uh groups here she got better retention than almost anybody so more people stuck with the study it was only 6 months though um these mean it was highly statistically significant at 3 months and 6 months the one thing I really liked about her study which you may find shocking is she's one of the only ones who actually measured their diet when they were in the study if you go back to these studies they either did a really poor job or they didn't do it at all they just gave the advice and didn't assess how well they had been doing so I found this pretty informative so here's on the top the low fat group on the bottom the low carb group okay and the Baseline Data before they got any advice and they have the typical high-fat diet it's more than 35% fat it's less than 50% carb you can also tell if you look at the calorie level these are overweight people maintaining their overweight on 16 or no no people always under report right it's just classic there's no perfect way to do this you can feed them but then it's a whole different kind of study so if you ask people what they eat they characteristically under report and all you can hope is that they consistently under report so you can compare them to another group that's also Under reporting and you can compare them over time but don't take the number of calories very seriously okay given that after they got some advice they did what they were supposed to the top group lowered their fat below 30% and the bottom group got their carbs down to 15% interestingly they both cut out about 450 calories so they were pretty even there but what I found really interesting was at 6 months start with a top and see almost the same caloric level virtually the same distribution of of nutrients but on the bottom they actually couldn't do it they really fell back a lot they got to 15% carb when they were all excited at 3 months but they really couldn't keep it up now 30% carb is still really low to be perfectly honest but it's not as low as 15 so really really low carb diets are hard to do so that's just a fact of life and it's also true for really really low fat diets which I'll show you in a little bit okay so this was interesting at least she had some some data there and this is interesting too because the way they're reporting it since they couldn't keep their carbs so low their calories popped back up a little bit although she still showed that they lost more weight than the others so it's a little hard to reconcile so that's mostly what we have and actually I was a little bit jealous cuz we had a study ongoing while all these folks were publishing there when we started our study nobody had published anything and then study after study after study kept coming out and we kept wondering if we should quit early unpublished before somebody else scooped us just one more time but we kept going and we really got a lot of people in this study which we called the a toz study this is the only cool acronym I've ever had for a study so far so I want you to appreciate this and it was it was not my idea it was my colleague Bill Haskell's idea so if you call the learn manual by Kelly BR now the traditional health professionals approach you come up with A2Z which is the spectrum of really low carb to really high carb so Atkins anchors the bottom ornish anchors the top Zone's 40% carb and the learn is the health professionals approach that's about 60% carb now there's a couple different ways you can run these kinds of studies and you only get to choose one when you run yours instead of just having people follow specific carbohydrate levels we ask as them to read popular books that had very different carbohydrate levels and I need to give you a caveat at the very beginning we asked them to follow the book the whole book and nothing but the book a research dietitian the same one taught the four classes to all these folks she swore God wrote each one of these books there was no absolutely every word was truth she had to show equal enthusiasm for all of them they differed in more than diet some promoted supplements more than others some promoted exercise more than others but we were really teaching the book so a little sideline here is it's not really just a study of carbohydrate and fat there's some other things built into it but we picked popular books because we thought that would have the most public health impact people buy these books we should find out if people can follow them and how they do so of all the different approaches we could take that's the one we did we got 311 women to sign up yes please you back I sure can I don't understand that you s energy over the fine I can see the ratio of fat the carbs the proteins to the different ones but what's the percent energy supposed to represent that's percent calories that's all it means it's percent calories so it's a every one of these is 100% of your calories okay right so this is 15% and interestingly Atkins doesn't say how much fat or protein so I had to do that slurred color there isn't that clever you like that thank you and then this is supposed to be 10% % fat and this is supposed to be 40 30 30 okay no problem okay so the way we did this we didn't get 20 or 50 we got 311 local folks all women all premenopausal women which I can go into later if you want to ask me why but not at the moment they got these eight weeks of classes they had to read an eighth of the book each week and then rysa Sharon went through each book with all of them she was so cute you should have seen these books she had 100 poits or so around the pages of each one of these books highlighting all the important things that she wanted to cover that she got through the books um we had to scat spread it out over several years so they did it in four completely different groups or cohorts that we followed but they did that and they got all their measurements at Baseline and then eight weeks and they came back at six months and they came back at a year and another important thing we did in this study somewhat of an arbitrary decision but we helped them all the way till eight weeks and then we didn't help them anymore if they called us up at 6 weeks and said ah I'm really having a terrible time I need a refresher said thank you so much for calling and that is really important we will write that down talk to you next week and we didn't help them at all because we wanted to see once they knew the books how well could they stick with them on their own in fact they really got a lot more help than anybody who just goes and buys the book but intentionally we didn't help them anymore which is kind of important cuz a real study would probably help them the whole time and and see if it could do its best no we really wanted to see how people could do reading these popular books okay so the main outcome was weight but we looked at lots of other things and we're doing a lot of things on the side right now with the all the data that we collected so here's what they said their beginning diet was before they started the study we got them to be a little more honest than the other folks we got them to say 1,900 calories but they had the same high fat kind of low carb diet not really low carb um so this is exact ly where you would have room for improvement you could lower your fat and increase your carb and follow the national guidelines okay so here's what we got we actually collected over 3,000 days of records from the women in the study and if you broke it down into What proportion of carb fat and protein those little pie charts represent the huge spread we got in fact at eight weeks every group was different than every other group not just in carbohydrate but also in fat and also in protein which is an important thing to remember because when you eat a low carb diet you don't just get low carb you get more protein and more fat so you can't just say if you get an effect that it's due to low carb you have to assume that it may be due to some of the other things okay so remember then we stopped no more help after that and look what happens at six months so our top two um pie charts here look just like Bonnie bream so they got down to 177% car but they really couldn't do it on their own they bopped back up to 30% carb and this is intriguing Dean ornish is really mad at me for this study okay his diet is 10% fat even with a dietitian and 8 weeks of help they only got to 20% fat and 6 months later they were already back to 29 so he's really mad that I didn't test his diet and I said I didn't feed them you're right but I gave them the book and I made sure everybody read it and they did their best and that's really what they did so it's just a different perspective yes they got your book and they read it and that's what they did so we still have a Continuum there and then whatever they got at 6 months they did pretty well they kind of held out to a year so you can see they didn't lose much ground between 6 months and a year so we're pretty happy with that and we actually still have a big spread especially if you look at the extremes so we're 52% carb and 32% carb that's what some studies start out at as a goal and they don't quite get there and then they lose it over time and they're very close at the end so after a year we actually had a pretty pretty big spread here um Christopher uhhuh so when I look at 46 verus 52% what's your kind of your plus or minus percentage there card three at one year oh the plus or minus was a huge range within each diet group so my question ultim is are those the Zone learn or at the very end really only these are different statistically the ones in the middle aren't but the ones at the extremes are so the mean would be those are all the those are all the yep what would the average be Med the median I don't have the I don't have it off top of my tongue but there certainly is a huge range some people did you know there's a couple people there was one woman who religiously did the 10% ornish fat diet she lost 50 lbs and her husband went on it with her and he lost 50 lbs and then there were people who just gave up and said oh my gosh this is too vegetarian for me I'm just going back to my old diet so it was a wide range that's real life so I don't have the spread of that but it was pretty wide these are just averages so that's a good point to make after six months it looks like the analysis of variant which show the protein is all the same basically so yeah the protein comes back together uhhuh so it's it's all a between uh carbohydrate and fat pretty much yeah protein's actually pretty hard to shift in Big Numbers if you eat a variety of foods it's usually around 15 to 20% okay good questions all right now this was interesting because Atkins and owners say eat all you want if you just really get rid of your carbon you really get rid of your fat you won't have to count calories at all you'll just eat less whereas Zone and learn really had very specific guidelines for how many calories so I was really interested to see that when we added up the calories they all said they cut back the same number and they were none of them differed at any time point in all four groups now to be honest if they had really cut back that many calories all four groups would have lost 40 pounds and they didn't so they exaggerated how many calories they cut back on but like I said I'm assuming that they consistently underestimated the same way so I'm intrigued to see that they all seem to say they're eating the same number of calories even some even though some get very specific criteria for cutting back and some say eat as much as you want in fact Dean ornish's book says eat more weigh less just eat as much as you want till you're full okay so having said that drum roll this is this is what we found in our study um well you have to look at this because it's up in front of you but take your eyes away from that just for a minute this is one of the things we're the most proud of a year later we had 80% retention in our study of 311 women which actually isn't perfect for sure but it far out does anybody else who's ever published this before they usually have 50% 60% retention um sometimes that's at 6 months this was at 12 months so we were really pleased and I have to say I believe I attribute this to our approach when the women came in the study we said you know if you're having a hard time on the diet or if you're not losing weight we really need you to know that you're not kicked out of the study and you're not bad it may be that your diet is really really hard to follow and the American public wants to know how hard it is to follow so if you come back we'll be able to represent that and if you don't come back then it'll make your group look better than it really should be and that'll that'll be misinformation so somehow I think that message sunk in for a lot of people so we had women who gained 20 pounds and came back at the end of the year even though they were supposed to lose weight okay so you can see at six months Atkins actually these are highly statistically significant and by the time you get here and you do the appropriate thing which is to adjust for multiple testing the only real difference is Atkins versus Zone but my simple take-home message for one is that all three of the other diets were almost identical and if anything stuck out it was a lower carb diet that picture this isn't really the Atkins diet as it says in the book it's higher carbohydrate and to be honest it's a Apollo Alto Atkins diet you know I think it's an educated premenopausal woman in uh California diet so I don't think it was all steak and whipped cream like he says right another thing to notice is these women had 30 to 100 lb to lose and you can see they were losing 6% of their body weight 2 3 4% of their body weight overall it wasn't really a big loss on average but I'm going to show you another slide to show you how variable that was so you can't say this is fabulous this is the end of the Obesity epidemic everybody should be on the low carb diet it worked a little better but nobody really lost on average none of the diets did fantastically well which is really what we thought in the beginning we just didn't have enough data to show it okay so now let me show you some other tweaks to this so for one thing losing weight isn't what it's all about it's your health getting better so we looked at some other things and everybody said oh on that Atkins diet you might lose weight but your health is going to go to hell oh your cholesterol is going to go through the roof Etc so we compared all the diets for different things so here's all the things that were statistically significant and every one of these actually favored Atkins over one or more of the other groups there was no group that did better than Atkins in anything not cholesterol not blood pressure not insulin not glucose maybe some things we didn't measure but of the classic risk factors that people were worried about nothing got worse they did a little better than the other folks and then if you compare the other three diets to themselves there were absolutely no differences but that makes sense because you could see how they all tracked for weight right now I can't actually say going back one slide did they do better because of the diet or because they lost a little more weight I don't know I can't really tease that apart and it's kind of a stupid question because if it helps you lose more weight and you do better because you lost more weight that should be part of the answer but there are people who want to know what if I lost exactly the same amount of weight on that diet and it was a different diet would I still do better it is a good question but I can't answer it because the study wasn't set out that way they lost different amounts of weight okay so no difference is among the other diets uhhuh could you go back two slides um not that one one the uh HDL cholesterol versus ornish uhuh okay does that mean that the Atkin or the ornish did better no Atkins did better on a low carbohydrate diet your triglycerides go down and your hdls go up we actually have people show up at preventive Cardiology who've been doing McDougall or ornish on a really high carbohydrate diet it raises your triglycerides and lowers your HDL and we say can you please put some more nuts and seeds and avocados and real salad dressing in your diet and they cringe because they worked so hard to get all that fat out of their diet but we tell them that's the good unsaturated fat and they do it and they come back and their triglycerides are back down and their hdls are back up now that actually tends to happen mostly for people who are insulin resistant which is something I'm going to bring up in just a little bit so it's not everybody that doesn't happen to everyone some people can do a low-fat diet all right um but for a lot of people a lowfat diet makes their triglycerides and their HDL worse it makes their LDL particles smaller not bigger which is worse so there are some metabolic downsides to a a lowfat really high carb diet patient randomized to the groups yes it was a completely no selection as to what di NOP in fact I when they sat in the room and where I did my big orientation I told them to look at the diet pick the one that they liked the least and assume that that was the one they were going to get cuz that's how life works out sometimes right and I said if you're not happy with that you can't sign up for the study you have to be prepared to do the one you like the least even if it's one you already tried and it didn't work for you although that in itself was an interesting anecdote we had several women who did say that and then they got in the study and they went through the whole book and they sheepishly came up afterwards and said you know I told you I was on this diet before but I never really read the book and I never understood it and now I do and it's really much more impressive than I thought so a lot of these people buy the books but don't read the whole thing or don't get it so we made sure that's one of the reasons we had them read the whole book with the dietician to make sure they at least got all the principles uhhuh yeah I have a question it seems like with this what I've heard so far with the studies that you mentioned the the people who were participating they were they would either meet however however many times a week or once a month or whatever and they they read the books and it would be they report back and they you know go through the wi process and all that but it seems like it would be somewhat no matter what plan they were under it would seem like they would be under a they saw an uncontrolled uh study because to be an a holy controlled study you would have to be in a fly controlled environment to where you you would you would food take to be monitored your your activities will be monitored so it seems like oh it's a great Point can I can I follow up on that so you really can approach it two ways so if you want them to follow the ornish diet you clearly have to house them and feed them right and so if it works then you have to promise it will work for everyone who's willing to be housed and fed but if you really say this is a popular book I'm on the New York Times bestseller list and a million people have bought this book and they didn't get that kind of help then this is addressing the concerns of those people if you buy this book from a bookstore and try to follow it this is what's likely to happen one's more of a controlled way to answer address the question and one is more practical and more Public Health oriented we picked the public health oriented approach but they're both important questions they're both entirely valid they're just different questions so we picked this way prior to all the studies that I showed you almost all the studies that were out there were reviewed by um Marjorie fredman and the biggest complaint was they were all housed and given all their food so it was hard to understand what the general public would be able to do with the same kinds of diets but those studies are actually there short-term closely monitored okay so let me show you a little twist oh that's really funny it just took away part of my slide let me see if I can do this up it's back did you see that yeah lost some weight that was a new trick isn't that impressive that was fascinating I don't think that's ever happened to me before okay so for one look at especially in the beginning the Atkins di isn't just lower in carbohydrate it's lower in carbohydrate and higher in protein so I want to bring that to your attention now I want to show you at a year just the extremes okay those are still pretty big differences at a year if you take the two extreme diets now consider this that's the National Health guideline right there so it looks like shooting for ornish and falling short puts you right smack into the middle of the national guidelines doesn't it is that fair so we won't call it ornish we'll call it the national guidelines and we'll pit the national guidelines against the Challenger the heretical Atkins who said everything else is wrong everybody stand on your head and so finally with some science behind it how does it how does it work out when you pit the national guidelines versus Atkins and every single difference favored Atkins Head to Head not that they were really following Atkins right they got more they didn't follow it perfectly but they definitely got a much lower carbohydrate diet so how can you dismiss it a low you might want to tweak it and you might want to talk about whipped cream versus nuts and seeds but on a lower carbohydrate diet not only did their weight get better but their risk profile got better too which seems to be countered to what we've been saying for a decade or two so you're picking the carbo part of it but it's I could say it's a much higher fat diet you could I mean that's how I would look at it cuz that's what I and it'll have to be because as you lower your carbs you'll really lose a lot of weight if you don't replace the fat or up your protein we don't really know about Atkins like you were saying before what you're focusing on the carb part but it could be okay a higher fat diet is is is better for you perfectly fair so I really should say a lower carb higher fat diet and modestly higher protein diet uhuh this take into consider typ that yeah I can I don't have time to do that now but we've got the saturated the mono and the poly and the omega-3 and the trans yeah I've got another study by Ron Krauss that it really doesn't make any difference it's more big picture carb versus fats you can go little picture for glycemic index and I'm going to get into that in a little bit but probably the big thing is lowering your car but let me let me address that a little later did you control for exercise we didn't control for it everybody was encouraged to exercise everybody was told to follow the directions of the person who wrote the book and we did a Cess exercise and it increased slightly in all four groups and not differentially between the groups or among the groups so good question exercising on CS is we didn't we didn't see a difference uh-uh we had a lot of women say they felt incredibly energetic on a low carb diet anecdotally but monitoring their physical activity in a 7-Day standardized physical activity assessment it was the same a little higher in all four groups definitely the focus was the diet but exercise was encouraged for everybody is this blood chemistry uh result independent of level of intake or weight loss or anything else so if you didn't lose weight did you still have a blood chemistry Improvement most of these remain significant after you adjusted for the the small difference in weight loss uhhuh but like I said that's a hard question to ask I mean you'd really have to Ron Krauss actually did the study that way he made them lose exactly the same amount of weight he controlled it and actually their profile was much better on the low carb diet so it's a whole another study in the American Journal clinical nutrition just last year okay so let me toss some other things out here because you started to bring these up so a higher protein diet is really interesting for years it's always been keep protein the same and mix up fat and carb well in the last 5 10 years I've seen a number of studies come out that I've never seen before where they kept fat constant and played with the protein and carbs or they kept carbs constant and played with the protein and fat and almost every time protein won and I mean by winning they're appetite was more satiated and they lost more weight and their insulin got better and their triglycerides got better when you kept one of the other things constant and you raised the protein so when you go lower carb you end up going higher protein usually so this is to get back to your point that maybe it's not the carb maybe it's something else or maybe they're working synergistically okay now we do have a concern on a really high protein diet if you don't know this already there's no place to store it in your body you store a little bit of carb and you store endless amounts of fat anywhere you can but you don't store any protein in your body it's all functional any protein you eat in excess of your need and if you're not growing or building muscle right now you need very little protein we all get way more protein than we need I can almost promise you you have to break the protein down and turn it into carbohydrate and fat and you have to take the nitrogen off it and the nitrogen turns into ammonia and your kidney and your liver have to deal with it um we're a little worried somebody who has some kind of subclinical kidney problem and they're pouring all this protein into their body that could exacerbate something so I I want to point out those intriguing protein findings but I want to be a little cautious that if you do really high protein for decade after decade I'd be a little worried about your kidney I don't have any data to show that but I would be a little worried so but I'll just toss that in it's not just low carb it's high protein too okay now let me go a little beyond that and into types of nutrients okay because it's not just low versus high carb fat or protein we're way more sophisticated than that now that's way that's so much that's so overly simplistic okay so for carbs we can do glycemic index glycemic load complex refined fiber rich for the fats we can get our Omega-3s we can avoid the trans we can argue about flax seed versus fish oil for Omega-3s we can do the mufa poofa the monounsaturated fatty acids and the polyunsaturated fatty acids and protein isn't the same if it's plant marine or animal if you get the plant protein from soil you get fiber with it there's no fiber in any animal food if you get the Marine protein from fish you get Omega-3s there's hardly any Omega-3s in beef or pork unless they're grass-fed which they're not these days and the animal protein has a lot more saturated fat so it's really overly simplistic to just say carbohydrate fat or protein so we can do a lot better than that and for a long time we've said come on you know better than this you should be eating your brown rice and your whole wheat bread cuz at the same level of calories for the same serving you'll get the same number of carbs but you'll get double the fiber and a lot more nutrients from the brown rice and the same thing will happen for the whole wheat bread right same calories same carbs but a lot more nutrients if you go for the whole wheat and we can say that for the fats if you get your fat from avocado and look how I tried to do this I tried to make each one of those servings the same number of calories even though it makes it a a little bit odd in some cases so to get about 175 calories if I go red light green light and I make saturated fat the bad guy which might be an overstatement but we'll go with that for now Omega-3s fiber maybe the protein's good so for an avocado look at all this fiber you get you're not going to get any from fish or cheese if you get the fish you're going to get gobs of protein when you get the fat right you're going to get a little omega-3 in walnuts and a bunch in fish when you eat that so not all the fats are the same name and if you go for protein how many of you like edamami I hope everybody's tried it yes I should have know preaching to the choir here okay so a cup of edamami 250 calories 4 ounces of fish three and a half eggs to get that many calories and a 3 ounces a steak so if you match all those levels you get far more fiber from the edamami you get a bunch of Omega-3s here I don't know if you found the omega-3 eggs yet but potentially you could get omega-3 from the eggs I don't know if it's fish omega-3 I'm guessing it's flax omega-3 and that's a whole another discussion um but you'd get a bunch of saturated fat from the eggs and more from the steak you'd only get this much if you ate three and a half eggs though so that's a little high on the egg scale but we're much more sophisticated than just fat protein and carb so it's not just low carb we could do low carb several different ways we could do high fat several different ways and we probably should but most people don't buy nutrients they buy foods and the thing that's hardest for nutritionists to do is not just simply say go get more Omega-3s go get less saturate fat we should tell you what to buy tell you to buy salmon and tell you to buy avocados but we usually don't we usually tell you to buy nutrients did anybody read Michael pollen's book yet indefensive food or omnivores dilemma oh great read he makes so much fun of nutritionist and I I I don't take it badly at all because he he makes fun of us for focusing way too much on nut nutrients and not enough on food CU people eat food okay so having said that nutrients are different but people are different PE too not all the overweight people are the same there's a huge amount of variability in people who have more weight than their neighbor okay so let me show you an interesting finding that we've looked at in our data so here's Tracy mcgloin's data where they have a really fancy test to see among overweight people who's close to being diabetic who's insulin resistant and who isn't so this is a group of people that are all pretty heavy a body mass index of 30 to 35 is first stage obesity they've got 30 to 50 lbs to lose okay so it's a fairly tight range it's not 10 lbs to 100 lb to lose and then they do this fancy test called steady state plasma glucose which they have to hook you up to a bunch of IVs for eight hours and and do some incredible things to you but they figure out whose insulin works really well and whose doesn't at roughly the same level of fat and then they split put them into tertiles who's the most insulin sensitive who's the most insulin resistant this is close to diabetes and who's in the middle and then they look at their blood pressure and their triglycerides and their HDL and their glucose and the point of this paper was to say in roughly the same weight range you can get a four six three or fourfold difference in some classic risk factors even though you're pretty much the same level of overweight depending on how insulin resistant you are so this is a really hot time topic right now I'm just curious how many of you have heard the term insulin resistance pretty common okay more than half easy okay so here's a study that just got published in the journal American Medical Association um I think last summer or so so here's somebody who didn't do as well as we did but they did an admirable job they got all of 73 people and they put them on a low glycemic load diet that's a low carb diet where they put them on a low fat diet and I put the portions up there so you could see and they did 18 months which is really admirable that's far longer that's longer than our study that's pretty much the longest study I know of so far these were young adults who were overweight and they lost some but they pretty much lost exactly the same amount of weight according to this now they actually broke their results up after they were all done and looked at it a different way they looked at who in the beginning was more or less insulin resistant they did a simple oral glucose tolerance test which means you give them s 25 gram of glucose in their mouth sorry not their arm in their mouth and then you take blood samples for a couple hours and you see how much their insulin responds and they took the 30 minute time point in that test and they said okay who's at the low end of the below the median for this insulin concentration they only had 15 and 13 people who had it and it really wasn't any different than the full group those were the insulin sensitive folks cuz their insulin didn't have to go up very much to put the glucose away but the other half they called it insulin resistant because they were Above This level and these were dramatically different results which were getting diluted in the whole study you can't see it over there you can't see it till you break them up so I thought that was really intriguing and as I read their paper I saw them site a couple other people and these are kind of some odd studies but let me show you these so these are not big studies there's five people four six and six but they came up with their own criteria nobody agrees what they are they called insulin sensitive people fasting insulin below 10 and Insulin resistant fasting insulin above 15 and they fed all these people here's your controlled condition fed all these people for four months and that's why the numbers are so small it's incredibly expensive to feed people all their food for months at a time and who can do that who I've done it for 120 people for a month this was for four months in this study and so their conclusion was the insulin sensitive people on a high carb versus a low carb they actually did a little better on the high carb but the insulin resistant people did just the opposite they did better on the low carb so it may be who you are pre or or your characteristics predisposes you to see how well you're going to do there's another study this is going to look almost identical it's like I didn't change slides but it's a completely separate study there's eight in each group they had yet another way of picking who is insulin sensitive and who is insulin resistant they called it a high glycemic load and a low glycemic low diet but it's the same thing it's a high carb and a low carb diet and they saw the same thing they saw this reversal of effect so the insulin resistant folks did better again they fed them all their food this time for six months okay so we thought hey we got that data we have people who did that we have Atkins versus ornish and we have some measures where we could figure this out and we had four different measures and they all look the same so I'm only going to show you one we picked fasting insulin tertiles we split them into third so this is the group who was the most insulin sensitive and this is the most insulin resistant we actually have more people than those other studies even though it's just a little subset of our study right so if you're insulin sensitive and you're on ornish versus Atkins it's actually a much smaller difference than we saw in the whole study but if you were insulin resistant it was actually a much bigger difference than we saw in the whole study so on the one hand we exaggerated and on the other hand we underestimated so it may be that insulin resistance predisposes you to being more successful on a low carbohydrate diet which is a little bit intuitively impaling if you're insulin resistant you have a hard time putting away your glucose so you go on the National Diet that says lowfat high carb and they're just pumping carbohydrates into you and you have a hard time with that so maybe there's good reason to believe that the insulin resistant people would be like this now how unique is this is this just one or two people out of 100 no this is the top third of our study and the other studies I showed you split people at the median half above and half below all the people in their study so this isn't something that's unique this isn't something where you have to be really out of whack to see this happen this is a pretty large proportion of the overweight population in the US that something may be going on here so we're actually writing a grant proposal right now to address this specifically to start a whole new study to get insulin resistance and insulin sensitive people to do that so let me I'm going to go on to a couple final tips but I don't know if this is one of the more interesting things we found in our study and I suspect that'll be new for a bunch of people so I'll stop just for a minute to see if anybody wants me to uhhuh if you're a person is obese do they tend to get pushed more into one group or the other because obesity itself or is that just something that's Conant from the normal weight through obesity the more overweight you are the more insulin resistant you are it does work that way so if you took the people who are bmis of 35 and over and 30 and under you get far more insulin resistant people in the upper end but what's intriguing is in the same range you'll get a split or you get a wide range of people who are more or less insulin resistant okay so it looks like it wouldn't matter which diet you were on if you're ins sensitive that would be good news you'd have more options if you're insul resistant you might think wait a sec before I follow the national guidelines in particular I'm the one who probably wouldn't do well on the national guideline and for those of you there aren't really any fabulous ways to test this so if you've heard of the metabolic syndrome if you meet the criteria for the metabolic syndrome you're probably insulin resistant and the measures for that are the same things as they use to differentiate people it's having a high triglyceride a low HDL Central fat so some people look like apples and some pairs some people get it around the hips and some around the belly it's the belly folks it's high blood pressure it's high insulin uh so those are some of the things that you can get from your dock uh it's triglyceride over HDL ratio if you have a big ratio above three of triglyceride over HDL that's another way to do it there's about a dozen different ways to measure it but you could look it up online there's a lot of simple things that you'd get in a in a basic Clinic visit it wouldn't be entirely definitive but it would tell you which way you were leaning toward okay all right so let me go on and just say a few other things on the side uh this is one of my favorite slides to show and Marsha taught me how to do this a long time ago I showed you all the averages of weight loss from our study these are all the individual weight loss by person by diet I love this slide because it shows I only showed you the mean before I actually think those look much more similar than different and importantly look how many people lost and kept off 30 lbs after a whole year you can take off 30 lbs and keep it off after a year on any diet it's probably more an issue of adherence than diet although I do like that whole insulin resistance thing I just showed you I mean there are more people in Atkins who lost and kept off 30 pounds than the other groups kilograms but you can yeah that's kilos right there so that's twice well that's CU it's it's about 15 kilos so I'm talking I circled the people who lost at least 15 kilos to say those are the folks who lost and kept off 30 pounds after a whole year and look how many people gained weight they gained weight on all four diets too right so it's not like you can oh it's obvious if I go on the Atkins diet I'll do better than the others it's really not very obvious from that particular slide is it so it's really more similar than different so that's something to keep out there keep in mind okay so if if you do think you might get a little Edge on your diet by going lower carbohydrate keep in mind that we still like the good carbohydrates right it doesn't matter what you call them it's all kind of the same high fiber low glycemic index complex bulky high water but consider this for a minute oh wait sorry I thought I had another slide coming okay and here's our fats we still tell you to eat the good fats and we still tell you the good protein right so we're going to be more sophisticated and differentiate but I don't know about this low carb thing should we really switch from low fat to low carb the low fat clearly isn't working is the low carb going to work a little bit better I we could use any Edge we could get in this whole area so think about this for a minute here's those carbs I showed you a little while ago the brown rice and the bread and I don't know who read Guns Germs and Steel the whole idea about when we started growing crops and Grains for the first time and cultivating them and whole new sets of diseases that came on okay so here's some grains there's some other carbohydrates wait AR G it I thought forgot to set okay so the bottom of our food pyramid is all carbs right huge thing of carbs how many of you eat all whole grains or how many of you eat pizza crust and white rice and white bread or how many of your neighbors how many of our calories come from all those white refined grains Okay so now pit the whole grains even the whole grains whole grain bread brown rice against broccoli okay so a half a cup of rice or a slice of bread is 125 calories to get 125 calories from carrots you'd have to eat four carrots still high carbs but I don't know if you could eat four carrots in a row could you I could much more easily eat rice and bread or try broccoli can you put down 2 and 1/2 cups of broccoli I think I would stop short of the two and 1/2 cups but if I got to two and 1/2 cups I'd have much more fiber I'd have much more protein you know what if I could eat the edamami if I ate 125 calories of edamami not bread or rice I'd actually end up with fewer carbs more protein more unsaturated fat so if there's something to this low carb I'm wondering I'm still wondering sure it's really easy to say get rid of the refined carbohydrate which I hope is my next slide yeah you finally remembered where I'm going okay so yeah it's easy to say no more sugar no more sodas no more refined but what about even the refine the whole grains which we've been pushing for a long time I'm really curious here I wonder if we should be saying this at least for the insulin resistant folks I I know they're going to be mad if we keep changing our minds first low fat now low carb but think about this will you be really mad at me if I say this you're eating eggs and bacon and we got you to get rid of the bacon and have some bread we patted you on the back but scolded you because you picked the white bread so we got you to pick the whole grain bread and then we were proud of you but you were getting a little heavy so we asked you to eat less and you're having a hard time eating eating less and you're still putting on calories so he said okay toss the bread and have your eggs with some mashed up some sauteed broccoli and veggies and onions and put some salsa on top you'd actually get fewer calories that way you'd fill up quicker because of the stuff I just showed you you have to meet more broccoli and more bell peppers to get the same number of calories as the bread so maybe I don't know if the insulin resistant folks are going to be mad at me but maybe I should even say not eat so much bread or you had the steak and we convinced you to have fish and you did it with some broccoli and rice but you had the white rice and we scolded you gently and we asked you to try brown rice which you did and we were happy with that but you gained weight so we asked to eat a little smaller portion and you did that but you were still hungry so he said you know what toss the rice and double the broccoli and see if you're full now I don't know that might be that's the level at which I feel comfortable right now if you're really going to low carb definitely get rid of the refined but maybe maybe even get rid of some of the grains even if they're whole grains I don't know this is a really small interesting recent study I saw on the Paleolithic diet so if Atkins just turns your stomach if you just can't do it thinking of Atkins think Evolution okay so here's a study where they put half the people and look there's a tiny study 14 and 15 people half of them go on the Mediterranean diet which we all say is healthy and half of them go on the pale Paleolithic diet which is more of this and less of this if you read down there okay and actually they lost more weight on the Paleolithic diet look at the difference in calories of what they reported on the two diets think what would happen to you if I told you you can't eat any grains or any dairy because that wasn't around when you evolved in Paleolithic times how many What proportion of your calories a day is grains and dairy I mean you've wiped out huge food groups if you just take those out of the realm of possibility you're going to get sick and tired of the other Foods there's these fascinating satiety studies where they say okay take a bite of your favorite food now take a second bite now take a third bite now take a fourth bite even if it's your favorite food pretty soon you want another food you're sick of your favorite food right so if you limit these other choices and you're only going with the others you're just not hungry you're not hungry for another bite of that same food if you've wiped out the grains and the dairy okay so I'm not sure if this is the right thing but I like this twist it was you know maybe it's not a nutritional twist it's a psychological twist try the Paleolithic diet will that make you feel good and what what about those high fiber cereals why not just throw the bread away and and the all the rice away and eat those heavy high fiber cereals the Fiber One and all those you know those lean lean you could maybe throwing the Breads and doing the high fiber cereal would work but maybe you could throw away the high fiber cereal too oh I don't know I'm not I'm not pushing it yet I'm just thinking about it you got to realize what a bitter pill this was for a 25 year vegetarian to have to write in a paper that Atkins did better than the other diets you know I should get a little extra credibility for saying that cuz I was going totally the other way when I started the study my 16 13 and 2-year-old are all vegetarians and I expect the one coming in 8 days to be a vegetarian so but I I think there might be something there okay I think this is one of my last tips then we can leave it open for questions here's one of the most clever studies I've seen so far this is all about calories picture this Barbara rolls who's a clever woman in Penn State got these young women I'm imagining these are students to come in on four different weekends and eat in this confined controlled situation and they had to eat all their meals Saturday and Sunday and they had a certain proportion of size and she had another thing that she calls energy density we'll explain a little better in a minute but for the moment picture having a bowl of soup and then adding a cup of water to it and then splitting it into two and starting with the original and then eating the same size bowl that has half as much water added to it one has more calories than the other one has more energy density for the same amount of weight it has fewer calories because it's got more water in it now but it weighs the same so that's what the energy density idea is and I'll give you a better example in just a minute so she had 100% energy density and 100% portion size on one weekend and then on one of the four weekends they got their portion size reduced by a quarter on one of the weekends they got their energy density reduced by a quarter and on one weekend they got them both reduced by a quarter and here's the real kicker they were told to eat until they were full every weekend they were told to eat till they were full and they did tests to see what they reported for their appetite and hunger and it was equal across all four weekends and yet if you lowered the portion size they ate an average of 250 calories less a day if you did the energy density less than 550 less a day not the weekend this is a day 800 calories less a day and they were just as full if they made the portion sizes smaller and the energy density lower and that's not saying anything about protein carbohydrate or fat that's really psychological for the portion size and for the energy density that's her principle of volumetrics you're more full you eat a huge spinach salad that's fills up this bowl but you go really light on the dressing and there's not many calories in the whole salad you're just full from the bulk so I think this is a great direction to go on the side of what I just said so I think portion size and energy density are going to be a big thing I'm not a food photographer but I took all these pictures myself here is my Clover organic yogurt okay here's plain and raspberry they're both lowfat to make sure it's right now there's all the ingredients on the left and the right you can see on the right it gets a little long ER just to have raspberries you notice it's not just raspberries they added a few extra things which is a what a crime this is my organic local you know yogurt how could they have not just added raspberries now here's the breakdown so 90 calories if you have plain 130 calories if you get the fruit kind right and look at the sugars 11 G of carbs which is pretty much all sugar 23 g of carbs which is pretty much all sugar that's that's where it's coming from that evaporated cane juice okay now go out and buy some of those raspberries and I took these a long time ago it's probably the wrong time to ask although I can still get Driscoll's organic raspberries and Whole Foods and Trader Joe's I can't believe it it's January I'm not sure it's certainly not the seasonal thing to do but I'm really hooked on raspberries so put a half a cup of raspberries in there and compare it to this and here's what it goes if I add a half a cup of raspberries I still don't get up to this level of calories and and I get some more sugar but I don't come close to this and I get 4 gr of fiber how do they add raspberries to this and not have any fiber that makes me really nervous okay so here's an energy density idea this one has 120 calories and this has 130 but this now weighs a lot more the yogurt's 170 but the raspberries are 60 right this is just 170 from the yogurt it's the same size container it's the same weight so energy density wise this one's a lot lower than this one so if you ate that thing you're either more full because you ate a bigger serving or if you cut that serving down you ate fewer calories if you match the amount that's in this 8 ounces I don't know I think that's part of the trick okay less sugar more fiber more filling lower energy density uh I forgot had this one final tost one of my post dos we call her water woman jod stooky thinks water is the answer to everything and it's kind of a neat trick because if you eat foods that have a higher water content you actually get less energy density the water doesn't have any calories right so if you have the bowl of soup that's diluted if you have juice that's diluted if you have a lot of you have veggies they have a lot more water than cheese she actually did a little analysis the Atkins book tells everybody to have 8 ounces of glass eight 8 oz glasses of water of day which is more than the other ones did and it was a little side thing I wasn't thinking about remember in the beginning I told you we had them follow the book the whole book and nothing but the book jod thinks she can explain the difference in weight with a different water intake so maybe having more water will fill you up and you won't have the juice or you won't have the milk or something drinking lots of water takes your appetite it does so interesting if you look at the literature on water here's what happens you have a meal and you add water and it doesn't make you eat any less but you have a meal with a Coke and then the next you have a meal with water and even though you took the coke away you don't eat more to make up for not getting the coke you eat the same amount but now you don't have the coke so you end up with fewer calories and the same works for juice or milk or other things like that you eat the same amount of food when you add the beverage so if it's a non-caloric beverage you end up reducing your calories that way too see there's his wife see he was trying to I should have a glass of water says a neat little write up on beverages by Barry po if anybody's interested okay so I think actually is that the name of yeah you want to go back that's um Barry Popkin and anybody who wants these slides is welcome to ask me by email for some more information or I'll give Jana copies or I'm not really sure okay now if I've entertained you enough you have to indulge me for a couple more minutes because my whole job getting promoted to to the next stage depends on me getting another thousand people so we've recruited a th people for about eight studies I've only showed you one of them um we now have some other studies we have an antioxidant study we have an omega-3 study we're trying to find out if people eat antioxidant rich foods versus antioxidant Rich pills if we can lower inflammation which is a really hot new topic in research that you get funded for maybe your cholesterol is high but you don't get a heart attack because you have low inflammation maybe your cholesterol is low you get a heart attack anyway because you have really high inflammation these are the kinds of things that might lower inflammation so it's an 8-week study you have to have be in general good health but have high something to get into this particular study because you got to have room for improvement here come on I can't make normal people more healthy we got another study where we're trying to tease out Omega-3s so we have fish versus flax which I find fascinating now we have a low dose and a high dose of each the low dose is designed to be what you could get from food alone the high dose you'd have to get from a supplement it' be pretty unrealistic to get it from food in a daily diet so we're going to compare two doses and two sources of Omega-3s for their effect on inflammation and you pretty much have to be insulin resistant to get into this study it's a little more stringent than the one I showed you a minute ago okay and then I have a colleague who's doing a pine bark extract study so it's like think Ginko here Ginko comes from a tree pine bark extract this is a native traditional that's supposed to lower blood pressure and he's almost done he only needs a few more people I still need to get half of my people for the studies I need 190 altogether I have about 100 so I'm always promoting I have these little Flyers outside that tell you how to join our study and since you're all too healthy to get in please take these and give these to your neighbors who are unhealthy okay or just go to nutrition. Stanford edu for our two studies or poop stanford.edu for his studies and I'd be happy to entertain any other questions thanks for your attention and your questions so far you can have more lights if you want and go have some food if there's any left and stay and ask questions uhhuh you talking fiber what happened to fiber pardon no you were talking about fiber I was wondering valuable versus non valuable fiber is that it's still out there soluble fiber still lowers your cholesterol insoluble fiber still helps keep you regular and you don't get it in refined processed carbs there's plenty of it in carrots and broccoli and it's in brown rice and whole wheat bread you can get it from all those places you'd get more if you had carrots and broccoli and whole wheat bread and brown rice you know I don't have one simple answer soluble is what helps with all uhhuh but most foods are actually a mix you don't really find foods that are just soluble or just insoluble it's like you don't find fats that are just mono or just saturated or just poly they're all mixes but oat brand has more soluble and wheat brand has more insoluble but for the most part if you eat a vared diet that has a lot of plants in it you get a lot of fiber uhhuh has there been any St done comparing culture or culture of food uh you know versus the United States mean like European or Asian or sure those are Classics but the problem is if you go to that culture then there's always a lot more things different than just their diet but one of the classic things to do is take a population with a really low rate of a disease and follow the migrants to a new country and have them change their diet and adopt the diet of the new country and watch and see if their disease rates change and if they do you know it's not their genes they obviously didn't change their genes when they migrated and they've done those a bunch and we lose all the time the American diet loses all the time they had better rates of disease there and they come adopt our Western diet and their prostate cancer goes up their breast cancer goes up their heart disease goes up they lose the protection they had now it wasn't just the diet that they changed they lost some of their social structure and other things so you can't say that for sure that's always a good starting line of evidence for that kind of that's where some of these hypotheses come from oh look the Asians had this and then they came here and that happened it was probably the soy it was probably the ice of flavones in the soy which I actually haven't panned out really well but that's what we thought for a while it's a good starting point I like some of your slides I'm sorry to interrupt um will you be putting posting the slides on on the nutrition or maybe Jana can if Jana lets me yeah I'll send them to Jana yeah yeah we can post them at the women's he s yeah I'm not sure I like I work really hard on those I'd be happy if somebody else would look at them I I was delighted with the ones with when you had like the bread and the rice and all the breakdown yeah that was an inspiration one night I just woke up and said oh wouldn't that be fun to show um just question about um decreasing the neut density have there been any studies that that measured um an hour later how hungry somebody was yeah that's exactly what Barbara rules has done in fact she's done some really fun stuff I can't cite that one in particular about energy density I know she had a lowfat yogurt and a regular yogurt and they had the same number of calories and she didn't tell them and the people who ate the lowfat yogurt ate more the rest of the day because they patted themselves on the back for doing so well in the morning they took advantage later in the day but what about the people that didn't know like they decreased the nutrient density of the food like as she had in that that one side with the um the students in the three in the four settings and increase the volume with with water did they measure um how you know when you know hunger hour 2 hours later well what was well I can't remember exactly when they measured the hunger but they said it was the same over the weekend and it was the whole weekend it wasn't just a meal they were eating they ate for the whole weekend which is why I was so impressed 800 calories fewer a day and they say they're not any hungrier eating 800 fewer calories a day that's impressive uhhuh you know what was really impressive um in the beginning of your lecture were the slides where it showed um over the years the increase scary it's very scary and you know what I would be interested in seeing um comparing that with the growth of the fast food industry in this country I mean somebody should do a study okay and and put those side by side and you're going to find that you know the more McDonald's and the more Wendy's and the more fast food you know it's it's just you can do it a little bit with a refined carbohydrate you can do it a little bit with high fructose corn syrup but it doesn't prove it for sure and there's always another way somebody can look at it and say something else was changing at the same time like what well I once told my epidemi my social epidemiology Professor that I could parallel all these diseases with telephone poles and the more telephone PS there are there more diseases and I told them quite honestly I bet if you ripped all the telephone pulls out we'd lower the diseases because people wouldn't be able to communicate the same way and life would really slow down and they'd go back to their old rates of disease so I did it as a joke at first but I was almost serious so there's a lot of things that go in parallel the McDonald's and the TV and the internet the yeah time on the Internet it's really hard to separate one thing out it's probably all of them contributing a little it's a it's a great idea but and plus you don't know it might be that the might go up but it's because of the demand because all those people that you want to spend I mean there things like cross light correlation which are going to tell you which came first the chicken of the egg so but the data and the politics I've got an interesting for you woman a uh study for you a woman in Australia took some Aborigines who are really predisposed to diabetes and she took them back to the bush She Made Them hunt on their own all their diabetes went away do you think they stayed in the bush or do you think they went back to Sydney Sydney but why they cured their disease when they went back to the bush yeah so unless we can go back I don't think that's going to happen we have to find another solution it would work we could go back but I don't think we're going to go back so we have to go forward somehow and so that way I'll always have a job right cuz we always going have tons of problems you just have a different job have a different job uhhuh some studies showing a caloric restriction and Longevity what's your thoughts I would hate to be that hungry for that long I bet you those rats are miserable you look at those skinny rats that live forever I don't think they have the questioners to ask them how happy they are are but they do have some natural experiments if you were in some kind of War situation and you were starving for a while you actually all kinds of things clear up so there is something to it they had a Big Splash in Lancet just a couple years ago about a group that followed a really low calorie diet for a year and everything was great but I don't think it's for a year I think it's for life so the weak grass lady that was her experience and W that was her experience growing up in in Germany she came here and she got sick yeah so fewer calories I I think that's how not many people can do it I saw an interesting paper the other day about fasting every other day versus trying to lower your calories constantly all day as an optional way fast every other day how it come out and it w it said it was viable I don't know if I don't know it was just an interesting twist that I saw it's the same thing you were talking about the yogurts uh they may make you may make up for it on the day yeah you have 5,000 calories a day you're not fasting but but honestly a lot of these are interesting because they're viable to different people if adherence is the biggest issue which I bet it is you know interestingly just a second I'll get you the D the American Diabetes Association for the first time has just recently buckled and said okay we agree a low carb diet might actually be okay for a long time they've been worried a low carb diet would be a high fat diet and a high fat diet would give them heart disease because diabetics are three times at risk for for heart disease relative to others but the way they phrased it was we admit that actually probably the biggest issue is adherence and if some people have an easier time adhering to a low carb diet and they lose the weight then we agree losing the weight would be more powerful than following Our advice to not eat low carb so are there any valuable insights to be obtained by studying the C everybody we have a large group of people who have been through a lot of this yeah somehow they're different the folks yeah the folks who did really well that would be a wonderful way to start like who did really well for a hundred years yep I I don't know how to say I know they've done that with weight loss they've actually So to avoid that question because I don't know how to answer it entirely I don't have a great idea for it they have there is somebody who's taken the national weight control registry has found 4,000 people who lost 35 PBS or more and kept it off for 5 years and asked them what they did it's not a study it's just a descriptive thing and the biggest thing they did is they exercise for an hour a day it's not the diet their diets all over the board and it's not sweaty exercise it's walks it's taking a half an hour walk in the morning and a half an hour walk in the evening every day year after year and that seemed to be one of the most striking things about this very successful group how what's the easiest way to find out your insulin sensitivity go to your doc and have a measure the best way is to do an oral glucose tolerance test but then you have to sit there for three hours and have multiple blood samples just get I would say get your triglycerides and your HDL and get a ratio and if you're more than three you're more likely to be insul resistant that would be the simplest way what do you think of the nibblers versus Gorges oh I like that I like the ni yeah that's another adherence thing is is that another way you can do it or even I I don't know how to answer the question because I haven't seen those David but I've seen the fidget or data so there was a it was a paper that was a years ago now in New England Journal where they took the same calories and they either ate them as six small meals or three meals and the people who ate those calories is six small meals lost weight relative to the other group but I've never seen it replicated and no one seems to talk about it was in the New England Journal medicine for what that's worth yep there's probably other strategies but I don't know those data uhhuh yes in the conate of ketosis and is that dangerous no really to get into ketosis on Atkins you have to be really low carb and they didn't really follow it you have to be and I was in that and I really really when I was yeah if so the induction diet you could be in ketosis at a year nobody was in ketosis they were getting 30% of their carbs so it's just 30% of di yeah if you go really low if you do that 20 grams of carb a day you'll go in ketosis your breath will feel bad smell bad it's not the same as keto acidosis which people mix it up with which can be deadly it's ketosis which you're actually in ketosis every single night you actually use some of your ketones for energy because you don't have enough stored carbohydrate to make it through the night but on Atkins you're in ketosis a lot throughout the day even while you're eating but it's not dangerous I have I'm not really an expert on that part because nobody not too many people get that low but it's not as dangerous as it makes it sound if you look it up and and think it's keto acidosis which it isn't okay oh one more back here read a study and I don't remember from where that people that women who ate the same amount that the women who slept 8 hours a night uh didn't gain weight or lost weight and the women who slept less had slept steep de uh did poorly on the same diet do you know anything about that I only know that I propose doing that study it's under review right now we're going to get overweight people who have sleep deprivation and half of them are going to get help and half of them aren't and they're all going to get diet and exercise advice but you have to have sleep deprivation are you sleep deprived we'll call you you should all get some snacks thanks for your long attention and your great [Applause] questions [Music] the proceeding program is copyrighted by Stanford University please visit us at stanford.edu

Channel: Stanford

Views: 306,849

Keywords: diet, weight, loss, obesity, epidemic, diabetes, Atkins, Dr., New, Diet, Revolution, Zone, LEARN, Lifestyle, Exercise, Attitudes, Relationships, and, Nutrition, Dean, Ornish, Eat, More, Weigh, Less, low-carbohydrate, food, pyramid, protein, low-fat, wate

Id: eREuZEdMAVo

Length: 76min 43sec (4603 seconds)

Published: Fri May 23 2008