Half As Heavy, but Twice As Fat: "Atkins-Style" No-Carb Diet + Exhaustive Exercise Compromise Body Composition

Image 1: Your scale is a fat liar and putting too much trust in it is a potential hazard to your health.

In the past couple of months the shrine with the image of the Dr. Atkins has begun to totter. "Lower your carbs!" What sounds easy and works pretty well as a short- to medium-term intervention for the morbidly obese 100% insulin resistant sedentary slob is getting more and more "healthy" or "newly healthy" and active individuals into serious trouble. I have been blogging about the fallacy of athletes dieting like Biggest Losers and Biggest Losers training like athletes before and do not want to go through all the arguments again. What I do yet want to do is to point you to the intriguing results of recently published (unfortunately rodent) study from the Ludwig Maximilian University here in Munich, Germany (Caton. 2012)

Extreme "Atkins diet" minimizes weight gain, but induces a "skinny fat" phenotype in exercised rodents

If you take a cursory look at the results you see exactly what the disciplines of Dr. Atkins will tell you: "It is so easy to lose weight and/or maintain your weight on this diet! You just cut your carbs and are good to go!"

Figure 1: Change in body weight in mature and adolescent rodents on "Atkins" or standard diet after the initial 10-day phase without exercise and at the end of the 21-day period with daily running exercise (to exhaustion, max. 30min; data adapted from Caton. 2012)

And in fact, though a strictly controlled rodent study certainly is not the best model for the largely psychologically determined dietary patters of human beings, the results of the study at hand clearly show that a 94% fat diet does in fact reduce the diet induced weight gain in both adolescent and mature rodents (and the practical experience of thousand of people tells us that this works for humans, as well). Compared to the rodents on the standard diet (9% fat, 33% protein, 58% CHO, 3.04 kcal/g; fat from soybean oil!), the "Atkins rats" with their calorically more than twice as dense (7.5kcal/g) lard + butter diet exhibited a lower increase in body mass - specifically in the initial 10-day phase without exercise (the sedentary slob phenomenon I hinted at in the introduction).

Figure 2: Adipose tissue weight (mature animals, left) and volume (adolescent animals, right) at the end of the study period (data adapted from Caton. 2012)

The data on the exact body composition of the animals in figure 2 does yet confirm what I (and even the advocates of Atkins diets) have been reiterating time and again: The figure on the scale is only signficant if you ware still morbidly obese (cf. "Intermittent Thoughts on How to Measure Your Success"). After all, the  "Atikins rats" may have gained only ~50% of the body weight of their peers on the standard diet, but they had significantly more subcutaneous, visceral and total body fat (volume, adolescents) and heavier epididimal and inguinal visceral fat depots (% of body weight, mature rodents) - and that despite identical caloric intakes (due to pair-feeding) and a +38% higher post-exercise energy expenditure and in the presence of 2x and 6x lower insulin levels (adolescent and mature, respectively), ~25% reduced IGF-1 levels, 2x higher leptin levels, lower cholesterol levels and identical total serum protein.

"Was that grass-fed butter and lard from pastured pigs?"

I can already hear them, the voices complaining how "unfair" this study was, how the Atkins group got "omega-6 laden fats" from "conventionally raised pigs" and butter that was not made from milk of "grass-fed cows". This, the low protein content of this extreme interpretation of the "Atkins diet" and the mere fact that we are dealing with a rodent, not a human study, are certainly all valid arguments (the latter two more than the former, though), but they don't change the basic message that no-carbing (without regular carb-loads) and working out hard don't go well together, at least not if your goal is to improve your health and physical appearance.

Image 2: If your inside looks like that of adolescent rats on the high fat diet (A), you should better forget about what the scale is telling you and how much weight you may already have lost on whatever type of diet you have been following.

Practically this means that when you have come down 100lbs from morbidly obese to chubby and are starting a preferably intense (cf. HIIT) exercise regimen to finally get in "decent shape", you better make good use of your improved insulin sensitivity and reintroduce a reasonable amount of carbs. Starting with 10g per meal, or 30g per day (not counting veggies) and building up to a level that allows you to keep losing body fat, while gaining or at least maintaining all the muscle mass you have, will also enable you to consume a decent amount of protein (get 20g of quality protein with every meal) without running into problems related to the sudden occurrence of large amounts of amino acid derived glucose in the veins of your "fat adapted" body. If, on the other hand, you are already in "at least decent" shape, fit and metabolically healthy, but still cannot lose those unaesthetic love handles. It may be time to start "playing" a little with your macros, in the way, but not just 1:1 like Adelfo has done it. A 5-6 day lower carb (carbohydrate intake placed around workouts; veggies don't count) strategy + 1weekly re-feed, where the reduction in carb intake gets you into a <20% caloric deficit will keep your insulin levels lowish and steady, will gradually reduce your glycogen stores, will ramp up AMPK and insulin sensitivity and will force your body to come up with the missing 20% of the energy from your adipose tissue, could be one way to success - a way, which unquestionably won't work for everyone and a way which will have to be tweaked to your own demands, but also a way which is not going to leave you lean on the outside and fat from within (cf. image 2).

The "Best Diet" for Obese Kids Has a Low Glycemic Load and Still 40-50% Carbs. Plus: Kids Hate Atkins / Low Carb!

Image 1: It's the "day of healthy eating", here in Germany... but wait: What exactly is "healthy eating"?

I don't know if it was a "happy coincidence", but it was a coincidence that I heard on the radio that today is the "Day of Good Nutrition" (here in Germany, at least). Unfortunately, nobody appears to really know what "good nutrition" means. While the experts are still arguing whether you may or may not eat meat, whether all carbs are created equal etc. the average customer has absolute no idea, what "good nutrition" may be. The one thing he (or she) knows is what the radio moderator mentioned as well "this means you are not allowed to go to the fast-food outlet, today". Now, while for a still astonishingly (or should I say shockingly?) large proportion of the obese population of the western convenience society, fast food remains one of the biggest obstacles to weight loss, Mc Donalds and Co. are probably not a major problem for the majority of people in the ever-growing health-conscious Internet community with its 1001 podcasts and blogs on weight loss and "healthy eating" in all its different incarnations. In the debate around paleo, ancestral, low carb, low fat, high protein, medium protein, grains-yes, grains-no, dairy-yes, dairy-no and all the other "sacred cows", the most important point in losing weight, fat and, by the way, also building muscle, i.e. consistency, is still overlooked way too often. If you consistently eat the SuperSize menu at McDonalds, you'll probably end up as obese type II diabetic. If, on the other hand, you do crossfit six times à week and follow a "healthy" low-carb diet, consistently, you end up spending bazillion of bucks for useless supplements about which you read on one of the countless bulletin boards where you posted your complains about "central fatigue" and "adrenal burnout"... as you see: Consistency is key!

Success in life come with consistency ...

... and when we define success as "dietary success", we measure "consistency" as dietary adherence; and exactly that, i.e. the degree to which the dieters adhered to their prescribed diets was also the first and, in my mind, most important determinant of dietary success in a 2012 study involving 100 obese children aged between 7-12 years (Kirk. 2012). The scientists, who financed their study with a grant from the Thrasher Research Fund and an Institutional Clinical and Translational Science Award, took a quite intriguing look at the effects of a 3-months (+9-months follow up), three-tiered dietary intervention, with a...

• low carb arm (LC), in which the subjects had to limit their carbohydrate intake to induce ketosis (had to be measured with keto sticks daily; if the subjects were not in ketosis the diet was reviewed / carbs further restricted); that was accomplished by an initial 2-week induction phase with <20 g CHO/day and unrestricted intake of high-pro tein foods (eg, meat, poult ry, fish, eggs) and added fats and a subsequent maintenance phase with in which the subjects were allowed to consume max. 60 g of carbs /day, with no limit on intake of high-protein foods and fats.
   
• reduced glycemic load arm (RGL), in which the subjects were instructed to limit their intake of high-glycemic index (GI) foods based on a "stoplight approach" (red, high GI [>70]; yellow, medium GI [56-69]; green, low GI [<55]); green foods were unrestricted; yellow foods were to be consumed less frequently; red foods were restricted to <7 servi ngs/week and <2 servings/day; there were no specific restrictions on protein or fat intake .
   
• portion control arm (PC), in which subjects were in structed to consume "age-appropriate" amounts of grains, vegetables, fruits, lean proteins, and skim/low -fat dairy products [help me I am puking!]; calories were distributed as 55%-60% CHO, 10%-15% protein, and 30% fat; the exact dietary prescriptions aimed at a daily caloric deficit of -500kcal

Exercise in the form of biweekly diet-specific group sessions fo 1hr of "active 'play', resistance training, aerobic activities" were obligatory and supervised by an exercise specialist. Additionally, subjects were "encouraged" to be physically active (=at least playing Wii instead of Playstation ;-) for >30 minutes/day.

Diet Wars! Atkins vs. South Beach vs. Weight Watchers

As you can see this study turns into a battle of Atkins vs. South Beach vs. Weight Watchers and the most important result, i.e. the reduction in body fat percentag (cf. figure 1), shows once more that "done right", or I should say "done the way it is supposed to" and "done consistently", everything works!

Figure 1: Change in body fat (%) over the 3 months controlled intervention and the follow up period - left; adherence to diet (%) - top-right; glycemic load (g/1000kcal) - bottom-right (data calculated based on Kirk. 2012)

The data in figure 1 does yet also show that the dietary adherence in the Atkins group was ridiculously low. While the adherence in the RGL arm of the study was constantly >75%, ...

[...i]n the LC group, only 16% of subjects tested positive for urinary ketones at any point (only 8% [6 of 76] of all tests done), and CHO intake exceeded the goal of 60 g/day at all time points (3 months, 85.3 +/- 11.8 g; 6 months, 108.2 +/- 11.6 g; 12 months, 122.6 +/- 11.4 g).

Against that background it is actually quite astonishing that the subjects lost that much body fat. It does yet not explain, why the body fat levels (measured by DEXA, not with hilarious body impedance scales) of the "Atkins dieters" bounced back up so profoundly (within the statistical margin, back to where they came from) in the months following the controlled intervention, while the fat loss in the other groups did slow down, yet remained persistent (and that despite the fact that the glycemic load was still -26% lower than in the RGL group).

Figure 2: Daily caloric deficit in months 1-3 (I), months 4-6 (II) and months 7-12 (post) - left; ration of body fat lost / reduction in caloric intake - right (data calculated based on Kirk. 2012)

If we also take into consideration that the low carb group had the largest caloric deficit in the post-study period (months 6-12) and still regained the greatest amount of body fat, while the reduced glycemic load group, who consumer ~47% of their daily caloric intake in the form of carbs ate only 240kcal less than at baseline and still kept losing body fat, it is pretty clear that this is a points win for the "South Beach" = reduced glycemic load diet.

"Do you want to tell me that South Beach was the way to go?"

Image 2: This is Alexa Iwan who "advertises" her strawberries on the website for the Day of Healthy Eating

As usual, these results are not representative of the average human being, not representative of the average American and by no means representative of you. So, if you asked me what a "healthy diet" looks like and expect me to answer your questions in terms of percentages and macronutrient ratios I will send you to another "guru"... if you are yet willing to accept an answer that revolves around my repeated recommendation to eat eggs, dairy (unprocessed = full fat), (organ-)meat, fish, coconut oil, olive oil, grass-fed butter, avocados, rice, potatoes, tubers, fruit (e.g. Alexa's strawberries, cf. image 2 ;-) and tons of veggies, to make sure not to starve yourself, to exercise and sleep(!), and to do all that consistently, you are no longer dieting, but just leading a healthy lifestyle - and at least for those who are still obese, this is more than enough to get to a pretty decent and moreover healthy bodyfat level - which, by the way, rarely is below the 10% mark ;-)

Eat Whole Eggs All Day and Throw Your Statins Away? 375x Increased Dietary Cholesterol Intake From Eggs Reduces Visceral Fat & Promotes Healthy Cholesterol Metabolism

Image 1: You better make sure you don't miss out on these delicious heart- and brain-healthy cholesterol bombs.

Most of you will probably be familiar with the good old saying "An apple a day, keeps the doctor away!", right? And if you are an otherwise healthy individual the micronutrients from the apple will probably really help you maintain this status. But what if the doctor was already there to put you on the healthy low fat diet, the negative health consequences of which I have addressed in yesterday's blogpost? In that case, whole eggs probably provide a more promising escape route from that low-fat, high-carb trap - at least this is what the the results of a soon to be published study from the Huazhong Agricultural University in Wuhan, China would suggest (Yang. 2012).

Surprising(?) -9% belly-fat reduction on whole egg diet

In their 60 to 90 day experiment, the Chinese researchers put a group of 8-week old Sprague-Dawley rats (n=18 for each group) on dietary regimen which differed in either cholesterol content (control vs. experimental groups) or the source of dietary cholesterol, i.e. 17.5% lard + synthetic cholesterol, 31.25% freeze dried egg yolk or 55.56% whole egg powder.

Figure 1: Composition of the control and the three experimental diets (adapted from Yang. 2012)

If you take a closer look at the exact composition of the diets in figure 1 the you will probably notice that macronutrient-wise the three standard-chow + lard/yolk/whole egg "high cholesterol" diets are miles-apart from what the average "low carber" would consider a healthy high fat diet. Still, the idea of choosing whole eggs as a major constituent (>55%) of one's diet should ring a bell for everyone who is familiar with the practical realization of the so-called "induction phase" of the purportedly (from the perspective of the same people who recommend the purportedly "heart-healthy low-fat diet") artery-clogging Atkins diet.

Figure 2: Body weight gain, food intake, food efficiency (food intake / weight gain) and relative visceral fat weight (per body weight) in Sprague Dawley rats after 60 and 90 days on experimental diets; data expressed relative to control group on standard rodent chow (data calculated based on Yang. 2012)

Interestingly, the data in figure 2 shows that even this version of "Atkins gone wrong", with a 40% carbohydrate content in the whole egg group (cf. figure 1) lead to significant reductions in weight gain and food efficiency (weight gain per gram of chow) and, more importantly, produced statistically significant reductions in the visceral fat / total body weight ratio at the end of the 90day study period (at 60 days there were no statistical significant inter-group differences).

55.56% whole egg diet kickstarts healthy cholesterol metabolism

In view of the fact that it has never been the notion that eggs would make you fat, but rather their purported negative effect on cholesterol levels due to which eggs, in general, and yolks, in particular, have gotten a bad rep over the last years, I guess that the visceral fat argument, alone, won't suffice to convince the egg-white consumer that they are missing out on the best part of the egg. After all, it was and unfortunately still is their purported negative effect on cholesterol that is literally at the heart of the egg(yolk)-scare.

Figure 3: Triglyceride, total, low density (LDL) and high desnity (HDL) cholesterol in Sprague Dawley rats after 60 and 90 days on experimental diets; data expressed relative to control group on standard rodent chow (data calculated based on Yang. 2012)

If you do yet take a look at the actual effects the natural cholesterol from the egg-containing diets had on the blood lipids of the rodents (cf figure 3), you will notice that those were statistically non-existent. In other words, only the lard + synthetic cholesterol diet had a statistically significant negative impact on the plasma lipids of the rats.

Figure 4: mRNA expression of hydroxymethylglutaryl CoA reductase (HMG-CoA R), LDL receptor (LDL-r), cholesterol 7a -hydroxylase (CYP71A), acyl-CoA:cholesterol acyltransferase (ACAT) lecithin cholesterol acyltransferase (LCAT) expressed relative to control (data adapted from Yang. 2012)

The 375x higher dietary cholesterol intake in the egg-groups, on the other hand, did not only shut down the endogenous cholesterol synthesis, as evidenced by the reduction in hydroxymethylglutaryl CoA reductase expression (HMG-CoA R, cf. figure 4) and increase its metabolization into bile acid via cholesterol 7a -hydroxylase (CYP71A), it also increased the LDL receptor expression in the liver (lack of LDL-r expression in the brain is associated with increased plaque formation in Alzheimer's, cf. Katsouri. 2011), lowered the formation and storage of cholesterol esterified cholesterol in the tissue by reducing acyl-CoA:cholesterol acyltransferase (ACAT) and increased the maturation of HDL and peripheral tissue cholesterol efflux via increased lecithin cholesterol acyltransferase (LCAT) expression.

In case you doubt that this rodent data has any significance for human beings, I just want to remind you that a 2008 study by Mayurasakorn et al., which found that "[i]n the majority of healthy adults" the addition of one egg per day to a "normal fat diet" lead to increases in HDL-c and decreases of the total cholesterol to HDL ratio (Mayurasakorn. 2008). Their conclusion that "egg consumption might benefit blood cholesterol" was however similarly ignored as the absence of scientific data to support the "eggs = increased risk of heart disease"-myth.

It is thusly not surprising that the Chinese scientists conclude that contrary to the "conventional approach to weight reduction", of which the scientists state that it is "a high-carbohydrate, low-fat, energy-deficient diet" that "has not proven to be very effective for many obese and over-weight individuals [I am not making that up, it is the exact wording from the study ;-]", an "egg diet", which "theoretically [...] would be more likely to cause obesity", could not only help those individuals finally shed unhealthy visceral fat, it could also lead to significant improvements in their lipid metabolism. If it were not for the statement that

[...] the mechanisms by which an egg diet lowers plasma cholesterol need to be further characterized and the special functional factors in egg need to be identified

one could be led to believe that Yang et al. had finally grasped the notion that just eating the right (whole) foods could solve the problem... the term "functional factors" does yet tell me that they are probably just trying to developing an "egg in a pill" that will soon be patented and sold as an adjunct to the standard statin therapy,