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Eating for Diabetes Reversal: Part 3
The Tufts Popular Diet Trial
About 10 years ago, during the summer of 1999, the Atkins diet was starting to catch on like wild fire. I first learned about it from another doctor. We were out to dinner with friends, and he ordered a bacon cheeseburger without the bun and a side dish of buttered vegetables. I was flabbergasted by such an odd choice, and dumbfounded when he explained he was eating this way to lose weight! "You can't lose weight on a high fat diet" I insisted, but his wife backed up his ludicrous claim that the pounds were melting off week by week on this crazy diet. This doctor friend encouraged me to read Dr. Atkins' New Diet Revolution so I could understand the scientific rationale, and I came to understand Dr. Atkins' hypothesis: in the absence of carbohydrates, the body is forced to use its own fat for fuel, resulting in weight loss and reduction in heart disease and diabetes risk factors. The Atkins diet is the prototype for an entire category of popular diets I refer to as "Low-Carb" diets.
At the same time, the Zone diet, by Barry Sears PhD., was also becoming increasingly popular. He too hypothesized that the modern diet was too high in refined carbohydrates, and should be more like the natural human diet. He proposed using food like a powerful drug to keep insulin levels in the optimal range – or zone – by eating 40% of calories as carbohydrate, 30% as fat, and 30% as protein. Like Atkins, he too cited many scientific studies supporting his hypothesis. There were many spin-offs of the Zone diet that became bestsellers, including Sugarbusters! and the Suzanne Somers diet book series. The Zone diet is the prototype for an entire category of popular diets I refer to as "Moderate Carb" diets.
Low carb and moderate carb diets flew in the face of conventional wisdom. The nutrition experts had reached a consensus that fat, especially animal fat, was a major problem in the Western diet. Discouraging excess fat and meat consumption has been (and remains) an important public health goal, and likewise for encouraging whole grain consumption, and these new and unproven "fad diets" were running counter to the public health message. Such diets were mainly viewed as pseudoscientific and largely dismissed and criticized by the authorities. A few scientific papers projected such diets would be harmful, and such diets became easy targets for nutritionists who were eager to bash them in the popular press. Moderation, balance, and variety are the keys to healthy eating and weight control, according to popular wisdom, and the Weight Watchers diet is a prototype for this type of "Moderate Fat" diet.
In addition to the classical moderate fat dietary approach embraced by the mainstream, there has also been a school of thought dedicated to pushing dietary fat very low. In theory it makes a lot of sense to follow a very low fat diet – the food is low in calories, and minimizes artery-clogging saturated fat. Most non-Westernized cultures follow a very low fat diet high in complex carbohydrates and fiber, and their rates of heart disease, obesity, and diabetes have been much lower than in Western cultures. Dean Ornish MD has been the most outspoken expert to advocate for this dietary approach, and his popular diet books on this topic are the prototype for the "Low Fat" cate gory of diets.
So, in late 1999, while I was starting a fellowship training program in medical research at Tufts University and Medical Center in Boston, I sought out the opportunity to work with USDA nutrition scientists to compare the health effects of various eating strategies. I was intrigued and bothered by the large gap between the enormous growing public interest in popular diets, and the absent body of scientific research directly comparing them to one another. As popular press articles about the "Diet Wars" drew the nation deeper into the debate, the importance of conducting a comprehensive research study seemed to grow exponentially, and it was a thrilling opportunity for me to actually design and conduct a research study that some might call a popular diet "smack down".
With the help of my research mentors Ernst Schaefer MD, and Harry Selker MD of Tufts University/Tufts Medical Center, and USDA research dietitian Joi Gleason RD, I was able to recruit 160 overweight or obese men and women to follow either the Atkins, Zone, Weight Watchers, or Ornish diets for a year. We needed to randomly a ssign participants to their study diet, in order to ensure that each diet group was evenly matched at the start. Participants agreed to attend diet training classes during the first 2 months, and to follow their assigned diet to the best of their ability during that time. Participants were then encouraged to follow their diets to whatever extent they wanted during the following 10 months, because we wanted to determine how well these diets would work under "real-world" conditions where people only follow the diets voluntarily, rather than being pushed to do so for "study purposes". We measured their dietary intake according to diet records, as well as their weight, blood pressure, cholesterol levels, glucose, insulin, hemoglobin A1c, and C-reactive protein (a measure of artery inflammation) at 0, 2, 6, and 12 months, thus enabling a scientifically valid comparison between the 4 diets at various time points. The study was paid for by the National Institutes of Health, Tufts Medical Center, and the USDA Human Nutrition Research Center at Tufts. No diet book authors were involved in the funding, design, or conduct of the study.
The study took 5 years from conception to publication, and was the lead article in the highly respected Journal of the American Medical As sociation (JAMA) on January 5th, 2005. It received a large amount of media coverage, and was one of the most highly read scientific research articles of the year. See these links for WebMD coverage of the study:
4 Popular Diets Heart Healthy Whether it's Atkins, Ornish, Weight Watchers or Zone, it's the pounds that matter
4 Diets Face Off: Which Is the Winner? The Best Diet: The One You Stick With
In my view, the study results provided the scientific data to support a new way of thinking about "which diet is best?"
In short, it was a 4-way tie between the diets. There was no winner! All 4 diets produced weight loss by reducing daily caloric intake, but most people found it difficult to stick closely to their diets as time went on. Those people who consistently stuck to their assigned diet ate less calories than they did prior to starting the study. They lost weight, and the weight loss produced improvements in their risk factors for heart disease and diabetes. Adherence level, rather than diet type, was the key determinant of weight loss and risk factor reduction. The best diet turns out to be the one you can stick to! This is a whole different mindset and viewpoint than the previous view, that the classical approach should be best for everyone. In the 5 years since I published the Tufts Popular Diet Trial, many other studies have been published that confirm and strengthen the validity of our findings and this new viewpoint.
I'm eager to hear your comments about the findings I describe above. Stay tuned for the implications and applications of these findings to the field of diabetes reversal.
- Michael Dansinger, MD
Read the entire series:
Related Topics:
About 10 years ago, during the summer of 1999, the Atkins diet was starting to catch on like wild fire. I first learned about it from another doctor. We were out to dinner with friends, and he ordered a bacon cheeseburger without the bun and a side dish of buttered vegetables. I was flabbergasted by such an odd choice, and dumbfounded when he explained he was eating this way to lose weight! "You can't lose weight on a high fat diet" I insisted, but his wife backed up his ludicrous claim that the pounds were melting off week by week on this crazy diet. This doctor friend encouraged me to read Dr. Atkins' New Diet Revolution so I could understand the scientific rationale, and I came to understand Dr. Atkins' hypothesis: in the absence of carbohydrates, the body is forced to use its own fat for fuel, resulting in weight loss and reduction in heart disease and diabetes risk factors. The Atkins diet is the prototype for an entire category of popular diets I refer to as "Low-Carb" diets.
At the same time, the Zone diet, by Barry Sears PhD., was also becoming increasingly popular. He too hypothesized that the modern diet was too high in refined carbohydrates, and should be more like the natural human diet. He proposed using food like a powerful drug to keep insulin levels in the optimal range – or zone – by eating 40% of calories as carbohydrate, 30% as fat, and 30% as protein. Like Atkins, he too cited many scientific studies supporting his hypothesis. There were many spin-offs of the Zone diet that became bestsellers, including Sugarbusters! and the Suzanne Somers diet book series. The Zone diet is the prototype for an entire category of popular diets I refer to as "Moderate Carb" diets.
Low carb and moderate carb diets flew in the face of conventional wisdom. The nutrition experts had reached a consensus that fat, especially animal fat, was a major problem in the Western diet. Discouraging excess fat and meat consumption has been (and remains) an important public health goal, and likewise for encouraging whole grain consumption, and these new and unproven "fad diets" were running counter to the public health message. Such diets were mainly viewed as pseudoscientific and largely dismissed and criticized by the authorities. A few scientific papers projected such diets would be harmful, and such diets became easy targets for nutritionists who were eager to bash them in the popular press. Moderation, balance, and variety are the keys to healthy eating and weight control, according to popular wisdom, and the Weight Watchers diet is a prototype for this type of "Moderate Fat" diet.
In addition to the classical moderate fat dietary approach embraced by the mainstream, there has also been a school of thought dedicated to pushing dietary fat very low. In theory it makes a lot of sense to follow a very low fat diet – the food is low in calories, and minimizes artery-clogging saturated fat. Most non-Westernized cultures follow a very low fat diet high in complex carbohydrates and fiber, and their rates of heart disease, obesity, and diabetes have been much lower than in Western cultures. Dean Ornish MD has been the most outspoken expert to advocate for this dietary approach, and his popular diet books on this topic are the prototype for the "Low Fat" cate gory of diets.
So, in late 1999, while I was starting a fellowship training program in medical research at Tufts University and Medical Center in Boston, I sought out the opportunity to work with USDA nutrition scientists to compare the health effects of various eating strategies. I was intrigued and bothered by the large gap between the enormous growing public interest in popular diets, and the absent body of scientific research directly comparing them to one another. As popular press articles about the "Diet Wars" drew the nation deeper into the debate, the importance of conducting a comprehensive research study seemed to grow exponentially, and it was a thrilling opportunity for me to actually design and conduct a research study that some might call a popular diet "smack down".
With the help of my research mentors Ernst Schaefer MD, and Harry Selker MD of Tufts University/Tufts Medical Center, and USDA research dietitian Joi Gleason RD, I was able to recruit 160 overweight or obese men and women to follow either the Atkins, Zone, Weight Watchers, or Ornish diets for a year. We needed to randomly a ssign participants to their study diet, in order to ensure that each diet group was evenly matched at the start. Participants agreed to attend diet training classes during the first 2 months, and to follow their assigned diet to the best of their ability during that time. Participants were then encouraged to follow their diets to whatever extent they wanted during the following 10 months, because we wanted to determine how well these diets would work under "real-world" conditions where people only follow the diets voluntarily, rather than being pushed to do so for "study purposes". We measured their dietary intake according to diet records, as well as their weight, blood pressure, cholesterol levels, glucose, insulin, hemoglobin A1c, and C-reactive protein (a measure of artery inflammation) at 0, 2, 6, and 12 months, thus enabling a scientifically valid comparison between the 4 diets at various time points. The study was paid for by the National Institutes of Health, Tufts Medical Center, and the USDA Human Nutrition Research Center at Tufts. No diet book authors were involved in the funding, design, or conduct of the study.
The study took 5 years from conception to publication, and was the lead article in the highly respected Journal of the American Medical As sociation (JAMA) on January 5th, 2005. It received a large amount of media coverage, and was one of the most highly read scientific research articles of the year. See these links for WebMD coverage of the study:
4 Popular Diets Heart Healthy Whether it's Atkins, Ornish, Weight Watchers or Zone, it's the pounds that matter
4 Diets Face Off: Which Is the Winner? The Best Diet: The One You Stick With
In my view, the study results provided the scientific data to support a new way of thinking about "which diet is best?"
In short, it was a 4-way tie between the diets. There was no winner! All 4 diets produced weight loss by reducing daily caloric intake, but most people found it difficult to stick closely to their diets as time went on. Those people who consistently stuck to their assigned diet ate less calories than they did prior to starting the study. They lost weight, and the weight loss produced improvements in their risk factors for heart disease and diabetes. Adherence level, rather than diet type, was the key determinant of weight loss and risk factor reduction. The best diet turns out to be the one you can stick to! This is a whole different mindset and viewpoint than the previous view, that the classical approach should be best for everyone. In the 5 years since I published the Tufts Popular Diet Trial, many other studies have been published that confirm and strengthen the validity of our findings and this new viewpoint.
I'm eager to hear your comments about the findings I describe above. Stay tuned for the implications and applications of these findings to the field of diabetes reversal.
- Michael Dansinger, MD
Read the entire series:
- "Natural Food" versus "Modern Food"
- A Spectrum Of Options
- The Tufts Popular Diet Trial
- Dating the Diets
- Caloric Density, Glycemic Load, and Saturated Fat: Key Players In Diabetes Reversal
- Dr. Dansinger's Eating Strategy for Diabetes Reversal
- Sample Meals
Related Topics:
2 Comments:
What are your thoughts on a vegan diet for diabetes health? My father tried it after reading a book about how the lack of added cholesterol in your diet unclogs your insulin receptors so you can eat carbs and still effectively process them.
I'm currently on the Atkins diet (more or less) in order to maintain my sugar levels, but its getting old and I might consider trying something new.
What's interesting in your study is that some of the most serious improvements such as triglycerides on Atkins/Zone fell off markedly over time while other factors (HDL) stayed improved.
This has not been my experience: I used this technique
http://loraldiabetes.blogspot.com/2009/04/test-test-test.html
which told me how few carbs I could get away with while not spiking my postprandial glucose, then fine tuned the results by following my lipid panels which told me that your fear of saturated fats is unfounded: in the absence of the excess carbs, high BG, trigs and insulin I turn them into HDL at the expense of LDL - and I have maintained these improvements for five years now.
The major benefit of diabetes is that you have the ability to fine tune your own condition yourself - so long as you test and pay attention to the results - with my genes the result comes out in the region of Michael Eades' Protein Power and Mark Sisson's Primal lifestyle. Someone with a different gene set may need a different macronutrient balance yet still achieve the same improvements.
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