Potatoes or Bacon: Which is better for weight loss? Laura Zakowski, MD.

Potatoes or Bacon:Which is better for weight loss?

Potatoes or Bacon:Which is better for weight loss?

Laura Zakowski, MDLaura Zakowski, MD

ObjectivesObjectives

Compare various low carbohydrate Compare various low carbohydrate dietsdiets

Review risks of low carbohydrate dietsReview risks of low carbohydrate diets Define net carbohydratesDefine net carbohydrates Define glycemic indexDefine glycemic index Review year long weight loss studiesReview year long weight loss studies

Copyright restrictions may apply.Mokdad, A. H. et al. JAMA 2003;289:76-79.

Prevalence of Obesity and Diagnosed Diabetes Among US Adults,

1991 and 2001

55 year old female interested in weight loss

55 year old female interested in weight loss

Wants to take medications or use the Wants to take medications or use the Atkin’s dietAtkin’s diet

PMH:PMH: DiabetesDiabetes HypercholesterolemiaHypercholesterolemia HypertensionHypertension ObesityObesity

YearYear WeightWeight HgbA1cHgbA1c TxTx

19901990 242242

19911991 160160 Diet and Diet and exerciseexercise

19961996 279279 Phen-fenPhen-fen

19991999 264264 6.7%6.7% Diet and Diet and exerciseexercise

11/13/0311/13/03 248248 7.9%7.9%

Atkin’s dietAtkin’s diet

Atkin’s Dietatkins.comAtkin’s Dietatkins.com

Phase 1: InductionPhase 1: Induction 20 gm carbs20 gm carbs

Phase 2: On going weight lossPhase 2: On going weight loss Add 5 gms carbs per weekAdd 5 gms carbs per week

Phase 3: PremaintenancePhase 3: Premaintenance Add 10 gms per weekAdd 10 gms per week

Phase 4: Lifetime MaintenancePhase 4: Lifetime Maintenance Usually about 45-100 gms per dayUsually about 45-100 gms per day

“Net Carbs”“Net Carbs”

Net carbs = Net carbs =

Total carbs – (Fiber + “carbs not turned in Total carbs – (Fiber + “carbs not turned in blood glucose”)blood glucose”) MaltitolMaltitol SucraloseSucralose GlycerinGlycerin PolydextrosePolydextrose

Zone dietzoneperfect.com

Zone dietzoneperfect.com

Zone dietZone diet

Glycemic indexGlycemic index

The rate at which a carbohydrate enters The rate at which a carbohydrate enters the blood stream as glucosethe blood stream as glucose

Low glycemic index: fruits and Low glycemic index: fruits and vegetablesvegetables

High glycemic index: breads, pasta, High glycemic index: breads, pasta, grains, starchesgrains, starches

Unfavorable carbohydratesUnfavorable carbohydrates

Breads, Rice, Pasta, PotatoesBreads, Rice, Pasta, Potatoes BananasBananas CarrotsCarrots CornCorn PeasPeas PineapplePineapple WatermelonWatermelon

South Beach Dietsouthbeachdiet.com

South Beach Dietsouthbeachdiet.com

Phase 1Phase 1 Limit carbsLimit carbs No: Breads, rice, potatoes, pasta, baked goods, No: Breads, rice, potatoes, pasta, baked goods,

fruitfruit

Phase 2Phase 2 Add back carbs in moderationAdd back carbs in moderation Based on glycemic indexBased on glycemic index

Phase 3Phase 3 ““A diet for life”A diet for life”

Risks of low carbohydrate diets


Bone loss:Bone loss: Protein affects how calcium is handled in Protein affects how calcium is handled in

the kidneythe kidney Study over 9 weeks showed no change in:Study over 9 weeks showed no change in:

Urinary calcium excretionUrinary calcium excretion 25OH Vit D, PTH25OH Vit D, PTH

Evidence of less bone turnover in high Evidence of less bone turnover in high protein groupprotein group

Conclusion: no negative effect on CaConclusion: no negative effect on Ca

Dawson-Hughes, et al. J Clin Endocrinol Metab 2004; 89: 1169-73.



HypercholesterolemiaHypercholesterolemia Impaired hepatic and renal functionImpaired hepatic and renal function Accumulation of ketonesAccumulation of ketones Salt and water depletionSalt and water depletion ConstipationConstipation

Systematic reviewSystematic review

Randomized controlled and cross over Randomized controlled and cross over studies:studies: 7 low carb diets and 75 higher carb7 low carb diets and 75 higher carb

OK studiesOK studies 34 low carb and 130 higher carb34 low carb and 130 higher carb

None longer than 90 daysNone longer than 90 days Very limited studies of patients Very limited studies of patients

Over 50Over 50 With co-morbid illnessesWith co-morbid illnesses

Bravata, et al. JAMA2003;289:1837-50

Systematic reviewSystematic review

No evidence of adverse effects onNo evidence of adverse effects on Serum lipidsSerum lipids Serum glucoseSerum glucose Blood pressureBlood pressure

Areas for further study:Areas for further study: Long-term outcomesLong-term outcomes Ethnic groupsEthnic groups ExerciseExercise Intention to treat analysesIntention to treat analyses

What about longer studies?What about longer studies?

6 month and 12 month outcome studies6 month and 12 month outcome studies EvaluatingEvaluating

Weight lossWeight loss Diabetes outcomesDiabetes outcomes Cholesterol valuesCholesterol values

Low carb vs Conventional Diet:

One year outcome

Low carb vs Conventional Diet:

One year outcome Philadelphia VA outpatient practicePhiladelphia VA outpatient practice BMI > 35 kg/m2BMI > 35 kg/m2 N = 132N = 132 All: weekly then monthly counselingAll: weekly then monthly counseling Randomized: Low carbohydrate or Low Randomized: Low carbohydrate or Low

fatfat

Stern, L. et. al. Ann Intern Med 2004;140:778-785

Study subjectsStudy subjects

60% African American60% African American 80% Male80% Male 40% diabetic40% diabetic 50% hyperlipidemic50% hyperlipidemic 60% hypertensive60% hypertensive

Are the results likely to be valid?

Are the results likely to be valid?

Patients randomized and similarPatients randomized and similar Follow-up long and complete??Follow-up long and complete??

1 year study1 year study Continued in entire study 66%Continued in entire study 66% Final weight: 96%Final weight: 96%

Patients analyzed in their groupPatients analyzed in their group Patients not blind; Researchers??Patients not blind; Researchers?? Groups treated equallyGroups treated equally

Stern, L. et. al. Ann Intern Med 2004;140:778-785

Dietary resultsDietary results

BaselineBaseline 1 Year1 Year

CALORIESCALORIES Not sigNot sig

Low calorieLow calorie 19191919 18221822

Low carbLow carb 19721972 14621462

CARBSCARBS p = 0.01p = 0.01

Low calorieLow calorie 252252 230230


Blood test resultsBlood test resultsBaselineBaseline 1 year1 year

TGsTGs p = 0.041p = 0.041

Low calLow cal 162162 166166


HDLHDL p = 0.014p = 0.014

Low calLow cal 4141 3636


HgbA1cHgbA1c Not sigNot sig

Low calLow cal 7.37.3 7.27.2

Low carbLow carb 7.4 7.4 6.66.6

ConclusionsConclusions

Needed 284 persons to show a Needed 284 persons to show a differencedifference

Is the low carb diet less sustainable?Is the low carb diet less sustainable? What are the long term outcomes?What are the long term outcomes?

A second Study:One year outcomeA second Study:

One year outcome

N = 63N = 63 68% female68% female Excluded patients with diabetesExcluded patients with diabetes Randomized to Atkins or low fatRandomized to Atkins or low fat

60% carbs, 25% fat, 15% protein60% carbs, 25% fat, 15% protein No counseling sessionsNo counseling sessions

Foster, et al. NEJM 2003;348:2082-90

A second Study:One year outcomeA second Study:

One year outcome 37 subjects completed the study37 subjects completed the study HDL increased significantlyHDL increased significantly

P = 0.04P = 0.04 11% change11% change

TGs decreased significantlyTGs decreased significantly P = 0.04P = 0.04 17% change17% change

Diastolic BP and insulin sensitivity better in Diastolic BP and insulin sensitivity better in both groupsboth groups

Foster, et al. NEJM 2003;348:2082-90

ConclusionsConclusions

Similar findings to other weight loss Similar findings to other weight loss treatmentstreatments

High attritionHigh attrition How safe is it?How safe is it?

DateDate WeightWeight HgbA1cHgbA1c TxTx

11/13/0311/13/03 248248 7.9%7.9% Zone dietZone diet

2/09/042/09/04 231231 6.9%6.9%

5/20/045/20/04 235235 6.6%6.6%

Potatoes or Bacon: Which is better for weight loss? Laura Zakowski, MD.

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