Wednesday, 31 July 2013
For Calories, It's All About Quality Over Quantity, Harvard Study Says
By CARRIE GANN and STEPHANIE ALBIN, M.D.
When is a calorie not just a calorie? When it comes to losing weight, a new study from Harvard University found that the number of calories consumed is not necessarily as important as the quality of those calories.
The kind of calories the body gets may affect how efficiently people burn their body's energy, which can be key for losing weight and keeping it off.
"It's not that calories don't matter, but the quality of the calories going in can affect the number of calories going out," said study author Dr. David Ludwig, at Boston Children's Hospital.
The researchers studied 21 overweight and obese adults, starting each on a diet that helped them lose at least 12.5 percent of their body weight. Then, to help them maintain that weight loss, the researchers put the participants on a cycle of three diets, and they were to stick to each for four weeks.
One was a low-fat diet, similar to the one recommended by the American Heart Association, which had participants reduce their dietary fat, that emphasized eating whole grains and plenty of fruits and vegetables.
Another was modeled on the Atkin's Diet, a plan in which participants ate more protein and fat but severely curbed their consumption of breads, pastas and other carbohydrates.
The final diet was a low-glycemic index plan, a model based on regulating the body's blood sugar levels used in many commercial diet plans, such as Nutrisystem and the Zone diet. The plan didn't require the participants to reduce the fat or carbohydrates in their diets but focused on the quality of the carbohydrates they ate. The plan pushed participants to replace some grain products and starchy vegetables with vegetables, legumes, fruits and foods rich in healthy fats.
The results weren't good news for low-fat diet aficionados. When dieters followed that plan, their bodies burned fewer calories than when they were following the low-carb or low-glycemic index diets. And the low-fat diet changed certain metabolic factors in their bodies that typically predicted weight regain.
The low-carb diet seemed to help participants burn the most calories. But it also increased certain markers of stress and inflammation in the body, such as the stress hormone cortisol, which are risk factors for cardiovascular disease and other health problems.
In the end, the researchers found that the low-glycemic index diet struck the right balance for the participants. It helped the dieters burn more calories, though not as many as the low-carb diet, but didn't seem to increase disease-causing stress markers in the body.
The study was published today in the Journal of the American Medical Association.
The results provide physiological evidence for a growing consensus among doctors and diet specialists: that low-fat diets, long a staple of advice for shedding pounds, aren't as beneficial as many once thought.
"There is a growing feeling that we need to go beyond low-fat diets, that was too simplistic a vision," Ludwig said. "Instead, focus on reducing highly processed carbohydrates."
Heavily processed carbohydrates - white bread, white rice and some breakfast cereals, to name a few - make sugar readily accessible, rather than securing it to more healthy elements, like the fiber in an apple. Ludwig said easily absorbable sugar leads to a rapid surge and crash in blood sugar after a meal, which can wreak havoc on weight loss.
The advice to steer clear of processed foods sounds familiar, but it hasn't always been so prominent.
"Remember the old food pyramid, with six to 11 servings per day of bread, pasta or rice at the base? In light of this article, it would seem to provide an efficient prescription for weight gain," said Dr. Jana Klauer, a doctor in private practice in New York.
Other studies have found results in favor of weight-loss diets based on the glycemic index, including one study published in the New England Journal of Medicine in 2010 that found that the diet plan was the most effective in helping people maintain their weight loss.
Dr. Louis Aronne, director of the Comprehensive Weight Control Program at New York Presbyterian Hospital, said the glycemic index has become a key part of his practice in helping obese patients lose weight.
"Many obesity specialists who treat patients all day long, as we do, favor low glycemic diets, those with less sugar and starch, because patients seem to do better," he said.
But not everyone favors the diet plan. Critics argue that the nutrition standards of the glycemic index are out of whack compared with what people know are healthier choices, giving foods like candy and soda healthier ratings than potatoes or rice. Dr. Xavier Pi-sunyer, director of the New York Obesity Nutrition Research Center, said the concept is too confusing for most consumers to follow for the long-term.
"I think a message of eating more whole grains, fruits, vegetables and high-fiber foods is a much better and easier measure to give people," he said.
The study did not follow patients for the long term, and the authors note that it's difficult to say whether the dieters would have maintained their weight loss outside of the study's highly controlled setting.
Ultimately, doctors agree that balanced diets that cut out junk are the most healthful ones. Sarah Bleich, an assistant professor at the Johns Hopkins Bloomberg School of Public Health, said the best weight loss advice boils down to a simple message: eat fewer calories than you burn through exercise.
"Even if the type of calorie matters for maintaining weight loss, it still boils down to simple arithmetic - eat less, exercise more," she said.