Foster's POUNDS LOST Study

A recurring theme in my career has been this discovery of a little packet of data, just stuffed in an unmarked envelope, left on my desk or slipped under the door, or pushed towards me in a conference room while others aren't paying attention.  Or, colleagues might pass by in a hallway, and furtively motion me over to some quieter place to "just take a look at something."

The challenge, after opening these envelopes and having a look inside, was for me to determine who gave me the secret data.  Surely, they would be wanting some sort of response.
I was reminded of this while I was reading through Dr. Foster's POUNDS LOST study, and wondering which researcher was getting a little packet of the real data hidden in an in-box somewhere.

I promised you all I would get back to the POUNDS LOST study.  Here's Dr. Foster's paper, finally published in 2010.  It's the study said to compare a low carb diet and a low fat diet for two years.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2949959/?tool=pubmed  They concluded that there really wasn't much difference between a low carb reducing and a low fat diet except some markers for heart disease (better in the low carb dieters!)

I really wanted to like this study.  Oh well....

I also really wanted to read this one very carefully before commenting on it.  Initially, it didn't seem like it would be as bogus as some of the other studies, but I still had concerns.

The first thing that really popped out for me is that while the participants were overweight, they were excluded if they had diabetes, high blood pressure, were taking lipid-modifying drugs, and other illnesses.  In short, they didn't even include people with metabolic syndrome.

This omission wouldn't have made such a difference if I hadn't read Dr. Gardner's A to Z study and also saw his lecture.  In the lecture, Dr. Gardner showed how the participants in his study did when they had insulin sensitivity issues that are associated with metabolic syndrome.  This information was in his lecture, not in the published paper.  In short, Dr. Gardner discovered that the participants tending towards metabolic syndrome did much better on the low carb diet than they did on a higher carb diet.  When all the data was thrown together, it didn't look like there was much difference between the diets, but when insulin sensitivity was taken into consideration, the low carb diet was the very clear winner for dieters with metabolic syndrome.

I think the American Diabetes Association has been taking a careful look at all of this.  It seems like every year, they relax their admonition against low carb diets a little bit more.  There are so many diabetics that prefer a low carb diet that the group is becoming difficult to ignore, both in terms of numbers and in terms of success.  (Oh yea, in terms of the actual data.)

The second thing I noticed about the POUNDS LOST study is their wonky description of the way they made up missing data.  (I usually don't read studies in order, I tend to jump to certain places first, like what methods of data analysis they use, and then go back and read the intro part more carefully.)  Lots of people dropped out of both groups over the two years.  My guess is that there were many critical reviews of the way data was made up in earlier studies done by Foster, so they made extra sure to explain it this time.  But, I read it, and kept re-reading it, and the BS meter started to move up a bit.  I couldn't figure out what they were talking about.  I am not a huge fan of making up data anyway, I think it is misleading.  This study just modifies the method a bit, but is still just making up data.

The other thing I found odd is that there was no actual data shown.  Instead, they used some statistical model, made up the missing data, and then showed the predictions from THEIR MODEL, not the actual pounds lost by anyone.  Now I am thinking that the only reason that they did this is to try to weasel out of something.  Nowhere in the paper do they talk about the validity of their model in terms of how it actually fits the real data.  All the charts show plots of the predictions, not any actual data.  The BS meter is really up higher now. I hope the actual data shows in somebody's in-box.

Then I went back to the top, and read carefully about the two diets.  One was called "Atkins", but the Atkins book wasn't given to the participants.  The description of the diet doesn't sound like Atkins at all.  This low carb group was on an induction-style diet for three months, and then started adding carbs.  

"After 3 months, participants in the low-carbohydrate diet group increased their carbohydrate intake (5 g/d per wk) until a stable and desired weight was achieved."

This isn't Atkins, this is something else.  And that something else is that they seemed to follow Atkins initially, lost lots of weight, and then went into maintenance mode.  The Atkins plan is to start slowly adding carbs back in as the desired weight is achieved.  In this study, the participants rose their carbs after three months, with the result being that of course they didn't lose as much as they would have if they had actually stayed on the Atkins plan.  And maybe its just the I'm-From-Missouri in me, but I'm thinking that if they wanted to test the Atkins diet, they would have actually tested the Atkins diet.  So here's the recap so far:

1.  We put a bunch of people on one of two diets, an Atkins diet and a low fat diet.
2.  After the first three months, the Atkins group looked much better.  Better weight loss.  Better blood lipid factors.
3.  We told the Atkins diet people it was OK to start adding 5 g carb per day every week instead of following the Atkins diet.  
4.  People on the diet that used to be the Atkins diet started gaining weight.
5.  By the end of the study, the weight loss of the two groups wasn't different.
6.  We concluded that the Atkins diet and the low fat diet are the same after 2 years.
The fourth thing I noticed is the reason I decided to call this study a bogus study.  I looked at the plots of the triglycerides.  It didn't make sense that the triglycerides went down so nicely in the low carb group during the first several months, and then went way up, to the point where they were even higher than in the other group that was eating so many carbs on purpose.  This just shouldn't be.  If these people were really following Atkins, their triglycerides would continue to stay low.  This plot is just further proof that these dieters weren't on Atkins anymore.
These researchers and their associates also made sure that the media was alerted to the ho-hum nature of the study.

Here's TheHeart.org, slamming reporting on the paper in a scholarly way, minimizing the success of the low carb approach.  The majority of the commentary was not by anyone who actually wrote the paper.  So, even though the low-carb diet was clearly better in weight loss and heart risk factors in the early stages of the study, everything eventually evened out and the early-stage success wasn't mentioned.  The reviewers did want to make sure that we all knew that the low carb people had bad breath, which was also rectified by the end of the study, but they still felt the need to bring it up anyway.  We haven't gotten actual values of actual weights, or any food logs, and yet the bad breath data was quite important?

http://www.theheart.org/article/1108461.do

There's no doubt about this article.  It's a slam for sure.
http://www.fathead-movie.com/index.php/2010/08/19/another-biased-study-maybe/ It's by the guy who did the movie "FatHead".  He brings up some of the same concerns I had about the low carb diet not really being an Atkins plan, and how the study is full of made-up data.  The comments on this blog post are pretty interesting, too.
A little while later, Tom Naughton wrote this enlightening blog post:

http://www.fathead-movie.com/index.php/2010/08/30/inside-information-from-fat-throat/

It seems like Tom Naughton was the recipient of the plain manila envelope, too!

Here's another blog post a bit later:

http://www.acupuncturebrooklyn.com/alternative-health/two-year-low-callow-carb-diet-study-misleading
She says it much better than I could ever do.

The. Most. Shocking. Rose. Ceremony. Ever.

You'all remember my post about Frank Sacks.  If not, here it is:
http://exceptionallybrash.blogspot.com/2011/03/it-just-gets-better-and-better.html
Here's what Dr. Richard Feinman has to say about another study done by Sacks:  http://livinlavidalowcarb.com/blog/?p=3933
I had been wanting to get back to this important topic.  Even though it was already getting better and better in my last post on the topic, I soon found out it was even more and more better than ever.
A few days after I read about our researcher friend, I was casually looking at a stack of magazines at a friend's house.  I found a Nutrition Action newsletter and skimmed through a couple of articles touting the low fat diet, and just on a lark, I checked to see who the author was.  I went to the info page where they have all the directors and advisory board people listed.  And who was on the list?  Frank Sacks!
As you recall, Frank Sacks is an author of a bogus study, and his study had been published by a journal, The American Journal of Clinical Nutrition, where he served as editor.  Sure, every "researcher" is biased towards the things they study, but there is a big problem when these researchers mis-represent their work and block the flow of information from other researchers who have data that disagrees with them.
Frank Sacks was also on the scientific advisory board of the Center for Science in the Public Interest newsletter, the Nutrition Action Newsletter.  Here's an article by the CSPI about how wonderful the OmniHeart diet is.

http://www.cspinet.org/nah/articles/whatshouldeat.html

http://www.cspinet.org/new/pdf/cover_-_what_should_i_eat.pdf

This article discusses the famous OmniHeart trial.  They tested three different versions of the OmniHeart diet and guess which diet was the best?  It was a tie between the OmniHeart diet and the OmniHeart diet!!!!!!  (No, this is not a computer glitch.  You read this right.)  Of course, the OmniHeart diet is Frank Sack's.
So, here's the Clif notes:
1.  Unsatisfied with his other bogus studies, Frank Saks designed an even better bogus study, and tested three versions of his own diet, the Omniheart diet, the OmiHeart diet and the OmniHeart diet
2.  The OmniHeart and the OmniHeart diet tied for the best, and beat out the OmniHeart slightly.
3.  The researcher concluded that the OmniHeart is the best healthy diet of all!
4.  The researcher got this crap published in a newsletter where he was on the scientific advisory board.
Wow!  This has been The. Most. Shocking. Rose. Ceremony. Ever.

My Take on Eades' Take on Taubes' take on Tierney's article on Sat Fat

Don't you love blogs?  In one catchy title, I have managed to link myself to several of the weight-loss science journalist titans!   I found this really hilarious blog post by Dr. Mike regarding the controversy over the health effects of saturated fat.  
Here's Dr. Mike's take on things.
http://www.proteinpower.com/drmike/lipid-hypothesis/more-on-tierney-taubes-and-saturated-fat/#more-1344
Scroll down to the quotes attributed to Dr. Eckel.  Again, Priceless!


In Gary Taubes' reply to Tierney's blog post, he hinted at a new 2-year study that was coming out shortly.  He asked readers to predict what the results would be.  These predictions were made in July of 2008.


"Predictions:

1) The study will show (again) that controlled carbohydrate nutrition results in superior cardiovascular health markers as well as weight loss.

2) The medical and scientific community will be “surprised” that such an “unhealthy diet” could have such better results.

3) Dean Ornish and the PCRM crew will publish rebuttals claiming that obviously these results are only because the low-fat diet was not low-fat enough. Various vegan groups will admonish people to read The China Study so they can know just how “dangerous” meat based diets really are. Katie Couric will ask a talking nutritional head on the national nightly news that “this latest study results aside, in the end its really about portion control, right?”. The talking head will nod appropriately and enthusiastically.

4) Various “authorities” will publish statements to the public warning that the long term effects on health of the Atkins diet are not known, so no one should start cutting carbs thinking its actually good for them.

5) The USDA will revise its food pyramid, emphasizing even more whole grains.

6) and once again we’ll inch ever so slowly toward the medical community understanding that eating low-carb is best for optimal health…"

and another:

"Add to your prediction: 6) The AHA will lower its fat recommendation even more."


 (You can read the whole thing here:  http://tierneylab.blogs.nytimes.com/2008/07/24/the-fat-fight-goes-on/#more-345 )


How did they do?
Here's Dr. Foster's paper, finally published in 2010:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2949959/?tool=pubmed
They concluded that the diets were pretty much the same as far as weight loss, but that the low-carb people had an improvement in heart disease risk factors.  (I'll be having more to say about this soon....hint:  look under "bogus studies" category.)


Here's a botched report of the study:  http://www.fitnesshealthzone.com/diet-nutrition/low-carb-low-fat-long-term-weight-loss-program/ I can't believe that someone actually posted this article.  I could do a whole blog post just on how many things were wrong here.  Paragraph after paragraph after paragraph.  They couldn't have actually read the study and come up with this.


Well, here's the revised food pyramid!:  http://www.mypyramid.gov/guidelines/index.html  Looks like we are in for less fat.


And here's another whine-y Dean Ornish's rebuttal!:  http://www.annals.org/content/153/3/147/reply#annintmed_el_125662


Here's another spin article extolling portion control, and even saying that such a "moderate" diet will improve heart risk factors when the study clearly showed that the low-carb diet resulted in better numbers for heart risk factors. (Although readers here don't care about that minor discretion, because they know that a risk factor is not a cause anyway.)  Note the caption emphasizing the grains, calling them heart-healthy.  This little tale was spun by another Temple University "researcher", the same place that Dr. Foster is from, in a transparent attempt to undercut their own research:  http://www.jacksonsun.com/article/20110309/LIFESTYLE01/103090302/0/NEWS19/Meals-packed-nutrition-all-heart?odyssey=nav|head


Here's another report with repeat warnings.  Even though this website looks research-y, this article contains really old information and was just cut-and-pasted from somewhere else, without the references.
http://www.bidmc.org/YourHealth/HolisticHealth/LowGlycemicIndexDiets.aspx?ChunkID=38729


Here's what the AHA wants you to do:  http://www.pbs.org/wnet/need-to-know/the-daily-need/aha-urges-stricter-guidelines-for-sodium-fat-intake/7002/ The prediction was correct.  They want even lower fat!

Great Testimonial!

This is a great testimonial on Free The Animal, from a gal who lost a bunch of weight on a paleo-type diet.  Her story is inspiring and provides hope to those of us who have been struggling, especially after having children.  Enjoy!
http://freetheanimal.com/2011/03/phd-med-school-biology-researcher-goes-paleo-racks-up-70-pound-weight-loss-gets-hot.html

How much Exercise do you really have to do to Lose Weight?

I follow Dr. Mike Eades on Twitter and he alerted his fans (that would be me) to a great study on exercise and weight loss that was published last year.  (I read the study, and it is OK except I am not all that thrilled with the way they threw out some data points, but I'll save that rant for another post someday.)  Like Dr. Eades hinted, the conclusion is a bit odd.
Here's the study in a nutshell:
1.  We found a bunch of studies about exercising and weight loss and they didn't show much of a relationship, so we designed a newer, bigger, better, longer study.
2.  We found and measured a bunch of fat, lazy, old women.
3.  We told them to exercise but not to go on a diet.
4.  After a year of exercising at an average of 9256 minutes, they lost an average of 4.4 pounds.
5.  We conclude that exercise helps you lose weight
Now I don't know about you, but that doesn't sound like alot of weight lost for all those hours put in.  That works out to about 1/2 oz. of weight lost per hour of exercise.  I think that I would get better results by skipping the weekly exercise and just shave and trim my nails before the weekly weigh-in.
Dr. Briffa has a great article about this clinical study, with a bunch of links to other studies that showed little to no weight loss associated with exercise.
http://www.drbriffa.com/2010/09/13/study-reveals-that-women-need-to-exercise-for-77-hours-to-lose-a-kg-of-fat-and-why-knowing-this-can-help
You might find in some places where folks have analyzed the weight you should expect to lose while exercising.  You know, where you would have to be on the treadmill for another X minutes to burn off that Y amount of strawberry jam on that bagel.   If you assume that you can burn off 100 calories in 10 minutes of intense exercise, that would give you weight loss change of about 100 times better than this new study actually shows.  So, it's even much worse than we thought for weight loss.
Here's the original study:
http://www.nature.com/ijo/journal/v35/n3/full/ijo2010147a.html

Trashing the Experts

This message was recently posted by a coach on a weight loss website:
"Hi everyone
I've been getting reports about a few of your threads here recently because they tend to trash our experts. Here's the deal: You are welcome to follow whatever program you'd like, and to share your experiences. But we have certain recommendations and guidelines we follow on this site, based on years of sound research. You don't have to agree with it, but it really creates a negative situation when a member asks a simple question about pizza dough and gets a lecture about why low carb is the way to go. As you can see from her response, that wasn't anything close to the information she was looking for.
We won't allow members to constantly challenge or talk negatively about our experts. If you can't just share an experience or talk about our staff in a respectful way, then you'll be asked to leave the site.
Any questions, let me know.

Coach Jen"


When I first saw the post on the low carb team, as I started to post a response, I decided to stop.  I'll post my controversial and dangerous thoughts here instead.
This post is still a work-in-progress, but I just wanted to be sure that people had access to it in case it is erased or modified.  This e-mail from the coach was not a message to a particular person who may or may not have crossed the line on a particular thread.  It was a great shot across the bow, and was posted to and meant to be read by an entire low-carb team.  If there was a problem with a post, a message should have been sent to that poster, not to almost 4000 other low carb fans who had nothing to do with it.  Apparently, thousands of other people needed to hear this important warning.
The coach's message was clear.  "If you disagree with our gold-standard recommendations based on years of peer-reviewed data in the gold-standard publications that have been carefully reviewed by our designated experts, we will go after you and kick you out."  While it has always been their policy to ban attack posts, now it is being made very clear that any challenges to their authority on the carbohydrate topic will be considered an attack and will not be tolerated, regardless of whether that challenge has merit based on the data.
Here's my original response:

"I think that the difficulty that some are having is that when some person goes on that board and asks a simple question about low carb, there are some regular "troll" posters who are all over it, telling people they are crazy, that they can't follow it, etc. It can be really discouraging. As far as I know, the [redacted] moderators aren't going over to their [redacted]teams leaving them warnings. And, it is kind of hard to track some of those posters down since they don't have pages and they haven't been on long. (Kind of a dead giveaway that they are trolls.)
Then again, I can certainly see the [redacted] experts' point. It's their site, and they call the shots. If people don't like that then they can go somewhere else."

Here's what else I had to say.  We all have choices.  This weight loss site is free, and we are also free to come and go as we please.  No one is holding a gun to our heads.  While it may be true that our doctor, our family, our society may be holding a gun to our heads with regard to weight loss, there are other sites and tools we can use to get to our goals.  
Honestly, I do not understand why a website that depends on people visiting and clicking on their ads would deliberately try to piss off over 20 percent of their users, so I am going to assume that it is unintentional.  If it is intentional, then it is ill-advised.  Their own poll shows that over 20 percent of the responders prefer low carb over low fat.  If they want to base their business model on attracting visitors who are interested in reaching their goals based a high carb diet, then they can fight with other sites like Weight Watchers or Dr. Oz for their share of that market.  Meanwhile, an ever-increasing group of low carb fans will gravitate towards the low carb and Paleo blogs and sites, click on their ads and buy their books instead.  If I were this weight-loss website's marketing director, I would insist that a good portion of these "expert" blogs, recipes and articles be revised so as to be more welcoming to people who have found a different way of eating to be more suitable.  From a marketing perspective, the only disastrous and dangerous aspect of the low carb diet is that the more people who succeed with it, the less interest people will have in their website.
I started this here blog a while before I started posting on it.  After I received my first letter from the coach (http://exceptionallybrash.blogspot.com/2011/03/message-from-spark-coach.html ), I was concerned that I would get kicked off the site, so I started moving my posts over here more quickly.  After this incident, I am even more comfortable in my decision to wean myself off any of the trackers so I am not beholden to ANY website.  I have already moved my diet tracking onto the Dr. Oz site, and am working on trying to get rid of computer tracking altogether.
I did post information on one message board, which I removed after receiving a warning letter.  I did not post on the cited pizza thread, preferring instead to respond directly to the original poster.  (Yes, I would freeze the pizza dough!)  I trash bogus research studies, researchers and poorly-done studies, not nutritionists.  If they continue to stand behind their data, they may get knocked down from time to time as the avalanche of newer data pushes everything aside.

Refueling the Protein Debate and Questioning Gravity

[I used to blog on a weight loss website, but now I am moving my entries pertaining to low-carb research and other controversial topics over here.  This was originally posted on Jan 28.]


Many thanks to another friend for posting the original information and the link to the article on protein consumption. 
Here's the article that was cited in her blog: 
http://www.thefactsaboutfitness.com/news/exerpro.htm 
I hope that you will "like" my blog, even if you don't like or even understand what I am going to say. I think that we need to jump the conversation to a higher level. 
When I first started reading "The Real truth.." and actually tried to tease out the information, I started to get a bit annoyed. The explanations seemed a little murky, so I decided to find the source. I googled a few lines and found that this article, or portions of it, are posted all over the internet, on sites having to do with all sorts of topics. 
My "beef" with this article mostly has to do with the sloppy way that results are reported in the media, and not as much in the way that many of these studies are designed and/or analyzed. Usually a first problem is that the sample sizes may too small to make sweeping generalizations intended to apply to entire populations not included the original study. Or, the study might have applied to a different group, say, young healthy college-age males. I finally found what I think was one of the articles referenced, and while the sample size was small, I learned other facts that were more disturbing. 
The problem with many of these studies is that they are classic mixture experiments. One group (called a treatment) starts out with a mix of carb:protein:fat, and then one of the macronutrients is changed for the second treatment. But then, to supposedly make everything even, the total calories are kept constant. 
(This is because EVERYBODY knows that if you change the number of calories taken, it certainly affects weight loss. This is a diet dogma, CALORIES IN EQUALS CALORIES OUT that cannot be questioned. It is like gravity.) 
But what is REALLY going on with this experiment is that in an attempt to keep things even, two things have been changed. It's sort of like taking a tube of toothpaste with the cap on and pushing down on one side. It just goes higher up on the other side. 
In this experiment, there are two groups: one with a 60:15:30 ratio of carbs:protein:fat and the other with a ratio of 45:30:30. And, while it is true that the second treatment has twice as much protein by percentage of total caloric intake, it is also true that the second treatment also has 25% less carbohydrate by percentage. 
Stellar results were declared for the second treatment. Was it because of the added protein? Maybe. Was it because of the lowered carb? Maybe. The trouble is, you can't tell. 
The writer had no trouble concluding that it was because of the protein. As I was reading this, plus the quotes by the study's main author, I started to think, "Hey, wait a minute...". 
Now I am going to illustrate my point that mixture experiments can be murky by taking what this author says Dr. Layman said and TWIST it around, just cause I like doing that and I can. An equivalent and equally-valid statement based on the experiment would be: 

"Both diets work because, when you restrict calories, you lose weight. But the people on the lower-carbohydrate diet lost more weight," 
"There's an additive, interactive effect when a lower-carbohydrate diet is combined with exercise. The two work together to correct body composition; dieters lose more weight, and they lose fat, not muscle."

And I am still wondering why Dr. Layman made the statements he did about protein but not about carbohydrate. 
So....... I went looking for more info. Eventually I did find the second article discussed. It had the same problems as the first study. In his study, Dr. Layman did mention in the very first part that the the diet was both a change to a higher-protein AND lower-carbohydrate diet and did mention near the end that the experiment had some design problems and he proposed a different way. 
However, the title of the study, "Dietary Protein and Exercise Have Added Effects on Body Composition during Weight Loss in Adult Women" obviously is biased towards the high-protein conclusion rather than the low-carbohydrate conclusion. Possibly a nod to the the people who funded the study, The National Cattlemen's Beef Association? The Beef Board? Just sayin'.   Or, maybe it is just because doing any kind of paper on about the "evil low carb" idea is career suicide.
And here's the original article:

http://jn.nutrition.org/content/135/8/1903.long
I didn't find the part where Dr. Layman said what was with the quote marks and attributed to him. Perhaps it came from another article he did, or from a seminar, or from another organization, like the Egg Nutrition Center, another organization he works for. Maybe he never even said it, or more likely, it was taken out of context and "spun". 
I'm not even going to comment that much on the third study discussed in the fitness article, only to say that I found the original article and things are even murkier. Explaining what the problem is would make this blog even longer, and as it is, my head already hurts. So, stay tuned for more... And please, hit the "like" button. Thank you for reading this far.