A study posted this month in JAMA — the Journal of the American Medical Association — reported that a low glycemic load diet may be just what is needed to improve the metabolic syndrome. What is the metabolic syndrome? Last month I wrote about the set of biomarkers that define the syndrome. Recall these biomarkers may be warning signs, or red flags, for the development of diabetes and cardiovascular disease. This means an increase of stroke, high blood pressure and heart attacks, and maybe even Alzheimer’s disease, arthritis, and osteoporosis. There is accumulating evidence that the majority of chronic disease today can be prevented by reducing the incidence of metabolic syndrome.
People frequently ask me “what diet type is best?” when trying to reduce body fat and control factors leading to the metabolic syndrome. So far that answer has yet to be determined. This hallmark study, however, gives some insight into that answer. This is a summary of the article taken directly from Internal Medicine News July issue:
“Three different diets designed to maintain a recent weight loss were found to exert markedly different metabolic effects independently of their energy content in obese and overweight young adults,” according to a report in the June 27 issue of JAMA.
“The results of our study challenge the notion that a calorie is a calorie from a metabolic perspective,” said Cara B. Ebbeling, Ph.D., of the New Balance Foundation Obesity Prevention Center, Children’s Hospital Boston, and her associates.
Researchers took a close look at the effects of three weight-loss maintenance diets on energy, hormones and components of the metabolic syndrome. Each had markedly different metabolic effects.
The researchers performed a controlled feeding study to compare the effects of three weight-loss-maintenance diets on energy expenditure, hormones, and components of the metabolic syndrome. Their first step was to screen 681 men and women, aged 18-40 years, with a BMI of 27 or higher for participation in the study. Of these, only 32 potential subjects (17 men and 15 women) met entry criteria and agreed to the rigorous dietary restrictions of the study. Of these 32 subjects, 21 completed the study and were included in the data analysis.
During the run-in phase of the study, subjects followed a standard low-calorie diet that restricted energy intake to achieve a 12.5% decrease in body weight. Detailed assessments also were done to establish each subject’s energy requirements for stabilizing their weight at this reduced level.
After the subjects achieved a 10%-15% weight reduction, they each consumed one of the three isocaloric diets for 4 weeks, then switched to another of the diets for another 4 weeks, then to the third diet for a final 4 weeks in a three-way crossover design.
The three diets were the following: a low-fat diet with a high glycemic load and 20% of energy from protein, which reflected conventional recommendations to reduce fat, increase whole grain products, and included a variety of vegetables and fruits; a low-glycemic-index diet with moderate glycemic load and 20% of energy from protein, which replaced some grain products and starchy vegetables with other vegetables, legumes, and fruits; and a very-low-carbohydrate diet with a low glycemic load and 30% of energy from protein, which was modeled on the Atkins diet.
Body weight did not differ significantly among the three maintenance diets, nor did total physical activity or time spent performing moderate to vigorous-intensity activity. Subjects’ ratings of subjective hunger and well-being did not differ significantly among the diets, and blood pressure levels also did not differ.
Both resting energy expenditure and total energy expenditure decreased with all the diets, but the decrease was significantly greater with the low-fat diet. In addition, serum leptin levels were highest with the low-fat diet. These two findings suggest that people following the low-fat diet would be more likely to regain weight than those following the other diets, Dr. Ebbeling and her colleagues said (JAMA 2012;307:2627-34).
Moreover, the low-fat diet also had the most unfavorable effects on peripheral and hepatic insulin sensitivity, serum HDL cholesterol, triglycerides, and plasminogen activator inhibitor 1.
In contrast, the very-low-carbohydrate diet had the most favorable effects on these components of the metabolic syndrome and on energy expenditure.
The very-low-carbohydrate diet, however, produced higher C-reactive protein levels and higher cortisol excretion levels than the other diets, both of which signal physiological stress and chronic inflammation. In addition, “higher cortisol levels may promote adiposity, insulin resistance, and cardiovascular disease,” the investigators wrote.”
After reading this I felt very confident in the lifestyle program we are offering at Balanced Well-Being Healthcare. Our program combines a balanced portion of carbs, fats and protein while maintaining a low glycemic or sugar load. I know that much more research is needed in determining this question “what diet is right for me?” For now, I feel strongly that reducing carbs while reducing glycemic, or sugar load and allowing for healthy fats is the right balance. At Balanced Well-Being Healthcare we carefully and cautiously follow all biomarkers of metabolic syndrome and look for signs and/or symptoms of inflammation or high cortisol when recommending any lifestyle changes.
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