All Calories are Not the Same!

Recently, The New England Journal of Medicine (NEJM) published a study comparing the effects of different diets on weight loss. Their conclusion? It doesn't matter what you eat, only how much you eat. So, pick a diet you can stick with, as that's all that really matters.

It's only partially true.

How much you weigh is a balance between calories in--how many you eat--and calories out--how many you burn, i.e., how much you exercise. The laws of thermodynamics haven't changed recently.

However, it is emphatically not true that all foods are equally healthful. In general, losing weight is a good thing for those who are overweight, but it's important to lose weight in a way that enhances your health rather than one that may compromise it.

Although many news reports of this study made it seem as though the researchers were comparing an Atkins diet with the way of eating that I recommend, they weren't. One of the major reasons that an Atkins diet may be harmful to your health is that it raises LDL-cholesterol, sometimes referred to as "bad cholesterol" because it is the fraction of cholesterol most strongly linked with coronary heart disease and stroke.

One of the reasons that it raises LDL-cholesterol is that red meat, eggs, bacon, brie, and butter--the foods that Dr. Atkins used to say are really good for you and your heart--are rich in saturated fat and dietary cholesterol, which have been shown in numerous studies to raise LDL-cholesterol. Atkins acolytes such as Gary Taubes continue to say that saturated fat and dietary cholesterol do not affect your blood cholesterol level despite decades of research clearly showing that they do. (He also writes that exercise does not help you lose weight--being a contrarian is one thing, being obtuse is another.)

In the recent NEJM study, the researchers significantly limited the intake of saturated fat and cholesterol in all of the diets that they tested. Specifically, they limited dietary cholesterol to less than 150 mg per day--this is half of what the American Heart Association recommends for a heart-healthy diet. They also limited the intake of saturated fat to less than 8% of calories per day, which is also essentially what the American Heart Association recommends. This is not surprising, since the lead author of the NEJM study, Dr. Frank Sacks, who is one of the country's leading nutrition researchers, is also vice-chairman of the American Heart Association's nutrition committee and co-authored their dietary guidelines.

In other words, all of the diets were made heart-healthy. Significantly limiting the amount of saturated fat and dietary cholesterol in an Atkins diet is like, well, putting lipstick on a pork rind.

Even so, the NEJM researchers found that "At 2 years, the two low-fat diets and the highest-carbohydrate diet decreased LDL-cholesterol levels more than did the high-fat diets or the lowest-carbohydrate diet (low-fat vs. high-fat, 5% vs. 1%; highest-carbohydrate vs. lowest-carbohydrate, 6% vs. 1%."

In other words, the low-fat/high carbohydrate diets decreased the fraction of cholesterol most strongly linked with heart attack and stroke five to six times more than did the high-fat/low-carbohydrate diets. And this was after asking those on an Atkins-type diet to significantly limit their dietary intake of cholesterol and saturated fat, which is likely why LDL-cholesterol did not increase on the Atkins diet as it has it other studies.

Despite this finding, The New York Times wrote, "For people who are trying to lose weight, it does not matter if they are counting carbohydrates, protein or fat. All that matters is that they are counting something." The Associated Press wrote, "Low-fat, low-carb or high-protein? The kind of diet doesn't matter, scientists say. All that really counts is cutting calories and sticking with it, according to a federal study that followed people for two years."

It may not matter if all you're concerned about is losing weight, but it does matter if you're concerned about losing your health. Studies that measured blood flow rather than only risk factors such as cholesterol levels found that blood flow and inflammation worsened in those who consumed an Atkins diet but not in those following the dietary guidelines I recommend, causing these researchers to conclude that "the Atkins diet may negatively impact cardiovascular health." Another study showed that heart disease got worse on an Atkins diet.

HDL-cholesterol levels were a little higher on the low-carbohydrate diet than on the low-fat/high carbohydrate diets, but as I have written about many times before, a rise in HDL in the context of eating a high-fat diet is not necessarily beneficial. Your body makes HDL to remove excessive cholesterol from your blood and tissues, a process known as "reverse cholesterol transport." When you eat more fat and cholesterol, your body makes more HDL. The easiest way to increase your HDL is to eat a stick of butter.

In contrast, my colleagues and I have published numerous studies showing that when people follow a very low-fat diet rich in fruits, vegetables, whole grains, legumes, and low in refined carbohydrates along with moderate exercise, stress management techniques, and social support, their health improves dramatically. My colleagues and I at the nonprofit Preventive Medicine Research Institute and the University of California, San Francisco, have studied this diet and lifestyle program for more than three decades and published our findings in the leading peer-reviewed journals.

We reported in a randomized, controlled clinical trial published in the Journal of the American Medical Association a 24-pound weight loss after one year and 13-pound average weight loss after five years in a group of men and women, much more than weight lost in the NEJM study. These findings were replicated in larger demonstration projects as well. Using state-of-the-art measures in randomized controlled trials, we found that this program caused reversal of coronary heart disease after only one month, even more reversal after one year, and still more improvement after five years. This is why Medicare is now covering intensive lifestyle programs such as this. We also measured a 40% decrease in LDL-cholesterol levels after one year in a free-living group of men and women without cholesterol-lowering drugs.

We also conducted a randomized controlled trial showing that this program was able to stop or even reverse the progression of early prostate cancer and, by extension, may affect breast cancer as well.

Our latest study showed that these diet and lifestyle changes caused beneficial changes in gene expression in over 500 genes in just three months-"turning on" disease-preventing genes and "turning off" genes that promote heart disease, cancer, and other illnesses. And we found increases in telomerase, and thus telomere length, by 30% in only three months. Our telomeres are the ends of our chromosomes that control how long we live--the longer our telomeres, the longer we live.

Dr. Atkins and I agreed that too many refined carbs such as sugar, white flour, and concentrated sweeteners are harmful. Because these are low in fiber, you can consume large amounts without getting full. Also, these are absorbed quickly, causing blood sugar levels to spike; this, in turn, causes insulin surges. Too much insulin accelerates the conversion from calories into fat. Over time, insulin surges may lead to insulin resistance and, ultimately, type 2 diabetes.

However, fruits, vegetables, whole grains, legumes, and soy products in their natural forms are rich in fiber which fills you up before you get too many calories and slows the absorprtion, thereby reducing wide swings in blood sugar.

Optimal nutrition for losing weight is also lower in fat because fat is dense in calories: 9 calories/gram versus only 4 calories/gram for protein and carbs.

There is a convergence of dietary recommendations, as I describe in an essay I wrote a few years ago.

You have a spectrum of dietary choices, but some are more healthful than others. What you choose to eat is a very personal decision. I just want to make sure that you have the information you can use to make informed and intelligent choices.

So, to paraphrase Gertrude Stein, a calorie is a calorie is a calorie in its effect on your weight but not in its effect on your health.

More information is available at the nonprofit Preventive Medicine Research Institute site, www.pmri.org.

Comments

[RTIII]

Interesting.

I didn't like the first half of the article - too much negative attitude - but the second half was VERY much better.

I don't eat any particular diet; I just indulge whatever my body asks for. Overall, I eat a lot of whole mixed nuts, dairy (esp eggs & milk), New Orleans style red-beans and rice, stews with heavy vegetable content & some meat, BBQ @ at least once a month, steamed veggies of various sorts - or raw whenever practical.

... I frequently get a good quantity and go with it as the main intake for 4 or 5 days or so. For example, I'll get a big pile of bell peppers and snack on those for a few days, a 10 lb bag of naval oranges. I'll cook up a whole slab of "country style" pork ribs - or red-beans and rice, or a big stew, or something else done as "service for eight" - eat for a week.

The key for me is HOME COOKING, first and foremost, with few processed foods. I avoid pre-made everything if it's avoidable. ...I do buy bread and the occasional breakfast cereal, but I'd rather mix up some pancake batter and lay a few eggs on top! Odd thing is, I only eat when I'm hungry, usually only once a day, depending on what kind of exercise I'm getting. If I'm going skiing, I'll tank up, but if I'm sitting in front of the computer - I'll probably not

[RTIII]

Hey, it cut my post!

I finished the sentence, "...I'll probably not eat."

I don't quite have the 32" waist I had from about 14 to 32, but at 35", my average range hasn't changed in a long time - about 200 lbs at just over 6' tall... I'd say my non-diet diet works well for me - I just listen to my body... ...And I don't _ever_ listen to people who tell me I'm hurting myself by this or that. A big one is eating only once a day - hey, if I'm not hungry, I'M NOT EATING! Got a problem with that? ...I just tell em to do their thing and I'll do mine. The only times I tend to put on weight is when I'm spending a lot of time with others who have to eat on a regular schedule and I get included in - and so I over-eat. -frown-
.

[Pearlswan]

Great read. Thanks for digging beneath the numbers and reporting the facts behind them. It is extremely helpful to know these things when making those healthy food choices that lead to a higher quality of life, not just a longer one.

[Guitarsandmore]

Good health may have more to do with your community than with any diet you may choose; so says Malcom Gladwell in his new book “Outliers”. Gladwell sites a study conducted by Bruhn and Wolf on a Pennsylvania town named Roseto where heart disease did not exist at all; zero; zippo; none in people under the age of 65.

The people have horrible diets, are vastly overweight, but have no heart disease. The secret says the Bruhn and Wolf study is in the community based support systems, the three generations of families under one roof, the talk from rocking chairs on the front porch, and people reaching out to help each other……

interesting book

[MenloPark]

I hear from people all the time about how this combination or that combination of foods will help you loose weight quicker than some other combination. Hopefully this study will help to finally end these old tales that keep popping up over and over again once and for all.

I don't think that anyone thinks that a steady 1200 calorie diet of pork rinds, although effective at reducing weight, is actually a healthy thing to do.

[krocklin]

Michael Pollan is certainly the most influential commentator on dietary health currently, and he has contradicted these views to an extent.
One study cited above says 80% of the cholesterol reduced or increased by diet is "low density" cholesterol.
I am kind of confused as to whether that is supposed to be good or bad.

Too much food packaging saying "low in cholesterol" makes me suspicious.
Pollan says there is NO correlation by how much cholesterol a food has and how much you have in your bloodstream. Eggs for example are very high in cholesterol and yet they are not generally considered "bad" for you anymore. The same is true of nuts.
And then there are all those studies that say there is no correlation between high or low cholesterol and the risk of heart disease!!! Yes. High cholesterol vs. low cholesterol doesn't lead to more or less heart disease according to studies reported on in the New York Times recently.
All this about cholesterol is malarky; it just amounts to a fadsand pseudoscientific pronouncements.
Like whent the McGovern Commission 40 years ago recommended transfats, which now are not "in fashion".

[Guitarsandmore]

I got my cholesterol down from 330 to 129 by taking 10 mg of Crestor each night. My LDL is lower than that.

The real culprits I believe are Ice Cream, candy bars, cola of any kind- diet or otherwise, pasta, bread, fruit juice, etc.

I think you can eat turkey breast, chicken breast, and a host of vegetables for a good balance. A food values book can help determine which vegetables and when.

I would welcome any new cookbook that features vegetables and will check out Deans new book to see what kind of recipes he has come up with. Thanks for playing Dean.

[DrP]

Please let it go!!! Your battle with Dr. Atkins(RIP) is almost funny, except that it is tragic for those who still buy into the myth of low-fat diets.I followed a very low-fat diet for 20 years. At 40, I was suffering from energy/mood swings and could not control my weight, even with cutting more calories and increasing exercise. I had headaches, brain fog, panic attacks, constant IBS, GERD, and a constant gnawing "hunger." I have no doubt I was months away from Type II Diabetes (it is prevalent in my family). After 10 years on a very low-carb diet, at age 56 am in excellent health and my weight is under control. At last check my HDL was 96 and triglycerides were 77. (What are your numbers, Dr. Ornish? )
I even proved that one can participate in strenuous physical activity on a very low-carb diet, having done multi-day long distance bike rides of 40 - 70 miles at 15+ mph - on my meat and green veggie diet.
I am thankful I discovered the proper diet for my genetic type before suffering the fate of so many poor, misguided people who are trying to prevent/treat Type II diabetes with low-fat diets. Any doctor or "nutritionist" recommending low-fat, high grain diets for Type IIs should have his/her license revoked. Any wonder the obesity/diabetes epidemic has sky-rocketed in this country since "eat low-fat" became the national medical mantra?

[Matt51]

I agree DrP. Low fat diet was disastrous for me. Eliminating grains, adding meat, eggs, fruits, vegetables, worked for me.

[ephoenix5]

Bravo! Well said.

[jennifer s]

Your story exemplifies how no single diet is right for everyone. Some people do well on a low-fat diet, but many do not, like those with hypoglycemia.
-Jennifer Schonborn, Holistic Nutrition Counselor
http://www.jenniferschonborn.com

[Gary Katch]

"Atkins acolytes such as Gary Taubes continue to say that saturated fat and dietary cholesterol do not affect your blood cholesterol level.."

It really lowers your credibility when you deliberately misquote people. In Taubes' book p.168 he reports that "...saturated fat raises both LDL and HDL." He never disputes those findings, and repeats that fact elsewhere in the chapter.

[Dr. Dean Ornish - Huffpost Blogger]

I didn't make this up:
http://tierneylab.blogs.nytimes.com/2008/07/21/good-news-on-saturated-fat/
and my reply:
http://tierneylab.blogs.nytimes.com/2008/08/05/end-of-the-diet-wars/

[Fred Hahn - Huffpost Blogger]

Dr. Ornish - Is there a reason why you did not include my comment in this section? In it I asked if you could provide a single study that compares a low carbohydrate diet to your diet which shows that your recommended diet to be superior. There must be many to support your position stand.

Are there any you can share? And please also tell us about the different types of LDL and how eating saturated fat affects them. Thanks!

[Idytme]

The Atkins diet does not raise your cholesterol profiles. (Although I do not eat Atkins per say, I eat Paleo which is similar). There is a direct relationship between insulin and triglycerides, the higher your blood insulin levels, the higher your triglycerides, lower your circulating insulin and you get better blood profiles. Most every post I have seen on an Atkins support board has seen people's cholesterol go way lower on the diet. You cannot fight mother nature, we evolved as hunter gatherers and in every instance as soon as a culture switches to a diet that is high in carbs they get bad blood profiles, cancer, heart disease and diabetes to only name a few problems.
My main problem with some people following Atkins is they spend most of their time trying to find carb replacements. Paleo is so much easier "if you can poke it with a stick or gather it, you can eat it" Leave out grains, potatoes, and for many people dairy (although I eat cream and butter) and you are following what evolution says is the best for your body. Lots and lots of anthropological studies to back this up. Also there was a Canadian study 2 years ago that showed that Asian populations that ate the least carbs had the best blood cholesterol profiles than those that ate the highest carbs.

[Schaz]

What Gary Taubes does in his book is analyze the research that led to various nutritional positions. His research, and research that I've read on other topics in a similar vein, (plus learning more about medical statistics in general) make me skeptical of all study claims. And of course, when the claim is made by someone seeking to profit from convincing people of something, I'm even more dubious.

[SolarPowerGuy]

In ancient times we got by with whatever food there was to eat, because the consequences of less-than-perfect diets only affect older people. Long before hardened arteries had their chance to kill us, we died from infections, broken bones, violence, or being eaten by tigers.

It's probably 10-20 years too early to make concrete recommendations -- but I will hazard a guess that there are at least a few different "optimum" diets. Just as some people have specific food allergies, so we will probably learn that some people metabolize the various macronutrients (fats, carbs, proteins) in different ways.

I know someone who would LOVE to be a vegan but simply can't do it. She has ZERO energy, unless she eats a little meat.

The best diet for each person will be largely determined by their genetic background. There will be tests to help us choose our ideal foods. It could make family dinner time a bit challenging, though...

[odyssey58]

Very well said. I believe that there are different metabolic types. Some are protein types and do well on Atkins. Some are carb types and do better with more carbs. Others are mixed types.

It's interesting to note that Coronary Artery Disease (CAD) is a 20th century disease that was unknown 100 years ago when people ate lard, butter, cream and meat. It wasn't until people started eating more refined sugar and grains, and eventually hydrogenated vegetable oil, that CAD skyrocketed. We also took cattle out of pastures and into feedlots. It wasn't the lard, butter, cream and meat from pasture raised animals that caused the increase in CAD.

[Matt51]

Odyssey,
Very well said, you are absolutely correct. There was essentially no heart disease in the US prior to 1930. Only a few cases a year.

[Guitarsandmore]

Solar power guy,

If you are trying to go Vegan and find yourself with no energy a lack of calcium is usually the culprit. A certain amount of calcium can be absorbed from Broccoli and tofu but most vegans also have to take a calcium supplement of some kind. Energy level goes way up.

[manojjangid]

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[SolarPowerGuy]

Manojjangid, was your comment intended to be posted somewhere else?

[ProudLiberalDan]

I think that Dr. Barry Sears with the Zone diet had it about right.

Ultimately, it's about eating a nutritious, balanced diet in moderate proportions and getting plenty of diverse exercise.

[Clavis]

I went from about 260 lbs. to about 200 in about 7 months. How? No gimmicks, just good practices:

1. Smaller portions. Meals can be smaller than you think.
2. Snacks throughout the day. Only with snacks will 1. work.
3. Cut out fried foods, red meat and junk food! (Duh!)
4. Find fruit you really enjoy and make them your new best friend at snacktime. (Buy a Banana Bunker and always have a banana on you as an emergency snack instead of a candy bar.)
5. Monitor your salt intake so that you aren't wasting the water you take in; you want all your ingested water to go towards digestive turnover, not salt-balance maintenance!
6. Walk more. Make sure you're never a lump sitting in a chair for more than a half-hour.
7. Don't eat within 90 min. of going to bed if you can at all help it.
8. Pay more and buy those veggie patties, nuggets, etc. Replace the meats in your diet with them. Every veggie replacement means hundreds fewer calories.
9. NO HIGH FRUCTOSE CORN SYRUP IF YOU CAN AVOID IT! Every stupid soda is 150-250 calories you aren't taking into account when you calculate your 2000. Drink water or seltzer.
and
10. Find low-calorie, low-fat foods that YOU *REALLY* ENJOY EATING, so that sticking with them and not cheating isn't a task, but rather, just comes naturally.

Once you lose the weight, you can be less stringent. BAM!

[Matt51]

You need to moderately salt your food 2-3 times a day, to get a consistent flow of iodine.

[hartland]

What are the causes of obesity in the American diet? Refined carbohydrates and sugar. Limit these and you will be leaner. First proved by William Banting who published "The Banting Diet" in 1863.
Take a native population, introduce them to the western diet of flour, sugar, etc, then add twenty years of eating the western civilized diet and you get western diseases that were prieviously unknown to the isolated native populations.... ulcers, heart attacks, high blood pressure, and diabetes.
Vilhjalmur Stefansson, explorer in the early 1900's, studied the Eskimos finding them to be very healthly while subsisting on a diet composed entirely by the meat and fat of fish and animals. Without eating citrus fruits, the vitamin-C content in an average Eskimos's blood was much higher than that of the average Canadian who was eating a "normal" diet and living in a simialr climate. (The above material comes from "Calories Don't Count" by Herman Taller, M.D. published in Simon and Schuster, New York, 1961.
Fat burns. Fat does not spike your blood sugar. When blood sugar rises, insulin is released into the bloodstream. Excessive Insulin prevents fats, carbs, and protein from being used for fuel and causes fat accumulation in the body. Whole Grain on the brain is not good!!! I've tried the most expensive whole grain breads and pasta...they still lead to weight gain(immediate and rapid). Fruits and veggies are not unequivocally good. Getting tired of this mantra as spouted by everyone pushing a healthy diet.

[TheBaffler]

Sorry, the facts are not on your side. A high carb, high fruit diet is much healthier than a high fat, high cholesterol diet. Did you even read the blog?

[Fred Hahn - Huffpost Blogger]

Baffler - provide your evidence to support your claim that a high fruit, high carb diet is healthier than a high fat and cholesterol, low carb diet. The burden of proof lies upon the claimant. Dr. Ornish's blog is incorrect and misinforms.

[odyssey58]

hartland, I absolutely agree with you. I tried that lowfat/high carb thing and I was hypoglycemic and miserable, I can't eat as much fruit as my taste buds would like. Low carb veggies are ok. And grains are just not for me. either. I stick with grass-fed meat and dairy, low carb veggies, and small amounts of fruit. We all need to listen to our bodies, don't we?