MD and I had a great time at the American Society of Bariatric Physicians (ASBP) [Now Obesity Medicine Association] meeting.
We ran into a lot of old friends and met some new ones. And my talk (the annual Robert C. Atkins Memorial Lecture) went off without a hitch.
Thanks to all of you who wished me well.
I was amazed at the change in the types of material presented at this meeting compared to that MD and I saw the last time we attended in the late 1980s. During our early years at the ASBP everyone was pretty much deep into the low-fat movement. All the lectures were from practitioners telling the attendees how to implement low-fat diets or, worse yet, how to implement low-fat diets and give diet pills. Since MD and I were using low-carb very successfully in our practice at the time, we didn’t see any real need to drop the $300 or $400 each on membership fees and the money to attend meetings only to be presented with information and ideology in which we didn’t subscribe. How things have changed.
I found myself in front of the attendees debating the merits of the minor differences between different low-carb plans. Ron Rosedale, M.D., our former partner, agreed on virtually everything except the amount of protein necessary–I argued for more; he argued for less. He was, of course, wrong, but we didn’t let that interfere with our good time.
There were a couple of papers presented that I think the readers of this blog would be interested to read about.
First, Eric Westman, M.D., from Duke, presented a study he had recently completed in which he had compared a low-carbohydrate diet to a low-glycemic diet in diabetics. I was keenly interested in the outcome of this study because I have never been a big believer in the glycemic index as a weight-loss of health improvement tool. If I could get my patients to cut carbs, I didn’t have to worry about the glycemic-index. I suppose that eating a lot of low-glycemic index carbs is better than eating a lot of high-glycemic index carbs, but neither–in my opinion–is as good as simply restricting carbs altogether.
Dr. Westman’s data showed that indeed a low-carbohydrate diet is better in controlling blood sugar and lipid levels as compared with a low-glycemic index diet, at least in diabetics. You can read about his study at the link above.
Steve Phinney, M.D., Ph.D., gave the other presentation I found most interesting. He and Jeff Volek, Ph.D., from UConn, randomized subjects with Metabolic Syndrome into two groups of 20 who went on diets containing the same number of calories but different amounts of carbohydrate. One group went on a low-carbohydrate, high-fat diet (LCHF); the other on a low-fat, high-carb diet (LFHC). The researchers were looking to see if the carbohydrate content of the diet had any influence on the amount of saturated fat in the blood.
The researchers calculated that the subjects on the LCHF diet consumed about three times as much saturated fat as those on the LFHC diet. Upon examining the blood after 12 weeks on the two diets, it was found that the subjects on the LCHF diet had a 57% decrease in the amount of saturated fat over the course of the study compared to those on the LFHC diets, who decreased the saturated fat content of their blood by only 24%. A three fold increase in dietary saturated fat when taken as part of a low-carb diet reduced the amount of saturated fat in the blood by a factor of 2.
Steve and Jeff also measured the degree of decrease in palmitoleic acid (PA) in the two groups. PA is a marker for endogenous (inside the self) lipogenesis (new fat making). In other words more PA in a subject means that the liver of that subject is making more fat from carbohydrate.
Over the course of the study, subjects on the LCHF diet decreased the amount of PA in their triglycerides (the transport and storage structure of fat) by 32% whereas those on the LFHC diet didn’t reduce their levels of PA at all. In measuring the amount of PA in the cholesterol esters (cholesterol esters are a transport and storage form of cholesterol in which the cholesterol is attached to a fatty acid by an ester (a type of chemical attachment) bond.) it turned out that the subjects on the LCHF diet reduced the amount of PA in their cholesterol esters by 44% while those on the LFHC diet reduced theirs by only 1%.
The conclusion of the researchers was that with decreased carb intake there is better processing of the saturated fat load. In other words, those on the LCHF diet, despite eating three times more saturated fat, burned it off much better than those on the LFHC diet. And those following the LCHF diet made much less fat than those on the LFHC diet.
These results show what we’ve all known for a long time. As long as one keeps the carbs under control, it doesn’t seem to matter much how much saturated fat is consumed. It all gets dealt with by the body in harmless ways. I guess that’s how I eat all that steak and keep my lipids normal.