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.


  1. Anytime you can post links to those results, I’d love to have ’em. My doctor insists that I have to cut down on saturated fats and increase my carbs to keep losing the weight I’ve been losing by doing just the opposite. Otherwise I’m gonna die a horrible heart attack death.
    Thanks for everything you do, by the way.
    Hi Brad–
    Your comment reminds me of a great quote I just came across in a great book I’m reading, “The Family That Couldn’t Sleep.”  Arthur Young, an 18th century English journalist asked:

    Who is it that says there is a great difference between a good physician and a bad one; yet very little between a good one and none at all?

    Sometimes I think that no physician at all would be better than one who prescribes expensive and potentially harmful drugs for non-existent conditions.

  2. Sir thankee yr time.
    After whatever time the fat burning takes the ‘lead’ is there any data/s suggesting what percentile is fat burning and what is glucose burning ?
    Sorry to be an arse if this is a redudant question
    Hi Simon–
    Not any data that I’m aware of, but that doesn’t mean it doesn’t exist.
    Sorry I couldn’t be more of a wellspring of information.

  3. Oh! I love it. Finally some recognition from mainstream doctors of the benefits of this wonderful way of life.
    I’ve gone from 131 kgs to 103.5 (so far) on low carb and have never been so healthy. (Have even lost lifelong migraines – frequency 1-3 a week from infancy – not one since starting low carb!)
    Blood pressure from 190s/100s to 110s/70s.
    It is marvellous.
    Hi Odille–
    It is nice to see them coming around.  And it is a wonderful way of life.  Keep after it.

  4. How very interesting and very gratifying to see low carb being vindicated.
    Apparently I don’t know the difference between low glycemic and low carb because I just thought that low gly was a euphemism for low carb. It’s good to know that simply cutting down on carbs does the trick, and that another chart of low and high this and that is not necessary.
    Now I know why I wouldn’t lose weight even on the low cal diets like the SlimFast. Two SlimFasts a day plus dinner would be well below a thousand calories — I would be hungry all day, and still not lose one pound ! So now I know I was activating my own fat mechanisms !
    How different intermittent fasting is when one is not eating products full of HFCS(slimfast) and keeping blood sugar low to avoid hunger. I can eat a bit more than a thousand calories per day, and still lose weight.
    Dr Mike does the paper on LCHF vs LFHC explain how eating fat does NOT activate endogenous lipogenesis? Is the mechanism known at all?

  5. Dear Dr Mike – So you went among the Philistines and yeah, they had morphed into lambs. Dr RCA must be LOL – Congrats – It must be very gratifying! – Jim C
    Hi Jim–
    It is most gratifying.  I knew it had to happen; I just didn’t know if it would happen in my lifetime.

  6. Interesting stuff. What are your thoughts on the concept of glycemic load?
    Hi Dave–
    See today’s post.

  7. I’m struggling to get people believe in how dangerous Carbohydrates are, and how much better you feel on saturated fat. In Norway the Nutrition and Health advisers refuse to see the obvious truth about Carbohydrates making people sick and saturated fatty eating gives you energy, makes you slim and cure many from Diabetes. I’m a teacher, and for children it’s dangerous not to eat natural saturated fat that is so important for growing.
    Hi Elizabeth–
    I agree with you 100%.  I haven’t been to Norway in many years, but I have fond memories of the time I spent there long before the days of saturated fat paranoia.  I’m sorry to hear that your country is traveling down the same idiotic anti-saturated fat road that this one is.

  8. I have recently begin a very low carb diet. I am eating only meat, eggs, cheese, fats, cream and some alcohol. Ocasionally I have awful acid and some fat seems to cure it. This morning I felt queasy and nearly didn’t eat my (2 egg) breakfast. I chopped up the eggs, added butter and felt fine.
    I would appreciate knowing if I am doing anything wrong.
    Hi Ophelia–
    From your brief description it doesn’t appear that you’re doing anything wrong, but it’s hard to tell without more info.
    If you follow the program as outlined in our book Protein Power, which is available in paperback in the UK, or any of our friend Charles Clark’s (a UK physician who treat patients with low-carb diets) books, you will be on the right track.

  9. Thank you:)
    I have in fact just bought the book but haven’t had a chance to read it yet:)
    I shall explore it thoroughly after Christmas when I have some time:)
    Should I take meds to cope with the acid, or is it likely to calm down?
    Hi Ophelia–
    The acid should calm down, but it won’t hurt to take the meds for a few days until it does. Take a look at this post from last year and search for GERD on the site for more info.
    Good luck–

  10. Dear Dr. Eades is there any need to be concerned with the effect on kidney function re protein consumption in seniors such as myself? I’ve heard there my be.
    Hi Jim–
    This is a question I’m asked often. As long as you have normal kidney function you don’t have to worry about protein consumption.
    You might want to take a look at this post from about a year ago where I go into more detail on this subject. 

  11. Dear Dr Mike. One more question: I’m 64, in good shape (6′ 1″ 176 lbs): however, I have high blood pressure (no ills yet) and about once a year I get “good” attack of gout for which I get a NSAID prescription. This is the only other concern I have. Would it not be prudent to keep my protein down to about 60 – 70 grams/day? Thank you.
    Hi Jim–
    I don’t think protein is the driving force behind gout.  MD and I have treated many people who are prone to gout with low-carb diets.  Keeping the carbs down and reducing insulin levels seems to prevent almost all attacks.
    As for the high blood pressure, a low-carb diet gets rid of it in 75-80 percent of cases. 

  12. Ophelia, I was experiencing the same exact thing, until I cut out my (lovely, wonderful, high-fat, raw) cream and dairy that I love so much. I was getting acid after every meal, and decided to try going without dairy at all for a few days. My acid instantly disappeared, so it appears I can only eat it occasionally as a treat 🙁

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