Monday, September 1, 2014

Low-carbohydrate vs. Low-fat diets for Weight Loss: New Evidence

A new high-profile study compared the weight loss and cardiovascular effects of a low-carbohydrate diet vs. a low-fat diet.  Although many studies have done this before, this one is novel enough to add to our current understanding of diet and health.  Unlike most other studies of this nature, diet adherence was fairly good, and carbohydrate restriction produced greater weight loss and cardiovascular risk factor improvements than fat restriction at the one-year mark.  Yet like previous studies, neither diet produced very impressive results.

The Study

Lydia A. Bazzano and colleagues at Tulane University randomly assigned 148 obese men and women without cardiovascular disease into two groups (1):
  1. Received instructions to eat less than 40 grams of carbohydrate per day, plus one low-carbohydrate meal replacement per day.  No specific advice to alter calorie intake.  Met regularly with dietitians to explain the dietary changes and maintain motivation.
  2. Received instructions to eat less than 30 percent of calories from fat, less than 7 percent of calories as saturated fat, and 55 percent of calories from carbohydrate, plus one low-fat meal replacement per day.  No specific advice to alter calorie intake.  This is based on NCEP guidelines, which are actually designed for cardiovascular risk reduction and not weight loss.  Met regularly with dietitians to explain the dietary changes and maintain motivation.
Participants were followed up for one year, with data reported for 3 month, 6 month, and 12 month timepoints.  This study actually measured body fat percentage, but unfortunately did so using bioelectrical impedance (like on some bathroom scales), which is essentially meaningless in this context.

Results

About 20 percent of people in each group dropped out before the end of the study.  Over the course of a year, they followed their respective diets well enough to make the study informative.

The low-carbohydrate group didn't achieve the target of less than 40 grams of carbohydrate a day, however participants did reduce carbohydrate intake substantially, from 242 g at baseline to 97, 93, and 127 g at 3, 6, and 12 months, respectively.  Even at the 12-month timepoint, this group was only eating about half its initial carbohydrate intake.  This is a low-carb diet any way you slice it, although not "very low carb" or particularly ketogenic.  This relatively high level of diet adherence sets this study apart from most other low-carb studies.

The low-fat diet group reduced fat intake from 81 g per day at baseline to 45, 46 and 52 g per day at 3, 6, and 12 months, respectively.  This qualifies as a moderately low-fat diet, although not "very low fat".

What happened to body weight and fatness?  At one year, body weight was down by 12 lbs (5.3 kg) in the low-carb group and 4 lbs (1.8 kg) in the low-fat group, with the difference being statistically significant.  This is notable because most studies show no difference in weight loss between these two diets at 1-2 year timepoints.  This could be because the low-fat diet group didn't receive calorie advice, because the low-fat diet wasn't specifically designed for weight loss, and/or because diet adherence was fairly good in the LC group.  It's also notable that both groups maintained their weight loss fairly well over time, which also isn't typical.  This is probably because the daily meal replacement that was provided facilitated a higher level of diet adherence over time.

Waist circumference decreased by about the same amount in both groups, indicating similar reductions in harmful abdominal fat.  The change in body composition they reported was tiny, but again the method they used to measure it is unreliable.

Improvements in cardiovascular risk factors were greater in the low-carb group.  Total cholesterol and LDL ("bad") cholesterol remained the same in both groups, despite substantial differences in saturated fat intake.  HDL ("good") cholesterol increased in the low-carb group, and the ratio of total:HDL cholesterol consequently improved.  C-reactive protein, an inflammatory risk factor, was lower on the low-carb diet.  The Framingham Risk Score, a measure used to estimate the overall risk of having a heart attack over the next 10 years, improved on the low-carb diet and didn't change on the low-fat diet.  The FRS is based on age, total cholesterol, HDL cholesterol, smoking status, and blood pressure.

Interestingly, there were no differences in fasting glucose or insulin between groups, and if anything there was a trend for both to be lower in the low-fat group.

Summary

The low-fat diet had modest beneficial effects on weight and health.  The low-carb diet caused greater weight loss that was fairly well sustained over a one-year follow-up, however the degree of weight loss was modest, amounting to a 5.5 percent reduction in body weight.  This is important because the low-carb diet group reduced carbohydrate intake by 48-60 percent and sustained it for a year.  

The low-carb diet did improve estimated cardiovascular risk somewhat, but the effect was modest.  

Perspective

The low-carb vs. low-fat weight loss debate is getting somewhat stale, but this study was novel enough to warrant a post.  This study is one of the minority of trials that demonstrated a long-term (1-2 year) weight loss advantage for a low-carb diet over a low-fat diet, however it's consistent with all previous studies suggesting that neither approach is very effective for fat loss in the long term.  Both diet groups went from obese to slightly less obese.

I view the low-carbohydrate diet as a tool in the fat loss toolbox, but one that's most effective as part of a broader overall fat loss strategy.  In the Ideal Weight Program, both of our fat loss diets are lower in carbohydrate and high in protein.  Our approach is to incorporate multiple diet and lifestyle factors that have been shown to impact food intake and body weight, rather than limiting ourselves to a single-factor intervention.

However, this study does have a substantial silver lining.  Both diet groups, but particularly the low-carb group, were able to sustain their weight loss over a one-year period.  This is in contrast to most other diet studies.  I've always wondered how much of this regain is due to decreasing diet adherence over time, and how much is due to physiological and behavioral adaptation to the diets.  Adherence was pretty good in this study, probably due to the fact that the investigators provided daily meal replacements.  This argues that weight regain over time may have more to do with relaxed adherence than to adaptation, which is good news.

This study also adds to the evidence that low-fat high-carbohydrate diets can cause weight loss.  Even though the degree of weight loss is very modest, and possibly not significant from a clinical standpoint, this further undermines the argument that the carbohydrate-centric USDA dietary recommendations caused the obesity epidemic.  It turns out, when you put people on a diet that's similar to the USDA guidelines, they don't generally gain weight, and they often lose a little bit.

A key unanswered question is whether low-carbohydrate diets are compatible with cardiovascular health.  This study adds to the evidence suggesting that they are, although we still need long-term studies with hard cardiovascular outcomes to be certain.

A key virtue of low-carbohydrate and low-fat diets is that they're easy for people to understand.  "Carbs/fats are bad; avoid them" is a simple heuristic that's easily internalized and put into practice.  This advice can lead to weight loss and apparent improvements in cardiovascular health, and in some individuals it can be quite effective, but it's not a silver bullet.

31 comments:

Jesús Bernal said...

I greatly appreciate your open-mindedness. Thanks.

Gretchen said...

"this further undermines the argument that the carbohydrate-centric USDA dietary recommendations caused the obesity epidemic."

I think the problem is that actual dietary recommendations were not followed by most people. But people heard the message that anything low fat was healthy and indulged on foods like Snackwells cookies and ate a lot more than the 6-11 servings of carbs allowed.

Because in many people eating lots of carbs and no fat to slow it down causes low blood sugar that is fixed by eating more carbs, in this sense that advice may have contributed to obesity epidemic.

One problem with many of these diet studies is that they're somewhat controlled, and real life isn't.

Garrett MacDonald said...

It would've been interesting if they had a third group who was told to restrict calories without any input on macros.

Charles Grashow said...

http://circ.ahajournals.org/cgi/content/meeting_abstract/125/10_MeetingAbstracts/AP306

"At 12 months, mean total energy intake on the low carbohydrate diet was 1,448 kcal/day with 23.6% from protein, 40.7% from fats, and 34.0% from carbohydrate versus 1,527 kcal/day with 18.6% from protein, 29.8% from fats, and 50.0% from carbohydrate on the low fat diet."

It's not that low carb (34%) is it?

brec said...

Why is <30% of calories from fat still being regarded as "low fat"? I would regard <=10% as "very low fat" and <15% as "low fat".

...Perhaps a topic for you to discuss with John McDougall next weekend, Stephen.

Peter Attia said...

Hi Stephan, there is one thing about this study that I did find interesting: the change in Framingham risk score. Allan Sniderman (the "father" of apoB) has written repeatedly about the risk of CHD. His work makes it clear that there is no greater risk for CHD than age--it trumps non-HDL-C, TG, HDL, even apoB. In other words as we age, each passing year, exposes our endothelium to apoB particles, which are driving our risk.
Now, if you look at the low-fat group they had a small increase in the Framingham risk score after one--this is to be expected with the passage of time, even though they experienced some improvement in their biomarkers. However, the low-carb group actually saw a reduction in their risk, despite "aging up" by a year. I asked both Allan Sniderman and Ron Krauss about this, along with Tom Dayspring (these 3 guys, as you know, understand CHD risk more than most everyone else combined). They were also impressed by this.
So while this study isn't earth shattering, it does offer (to me, at least) one very interesting finding about free-living applications of LC and LF diets. To be clear, I'm not suggesting the LF diet made things worse beyond a control--a greater analysis than I have time for would be needed for that--but it didn't hold back time, as the LC intervention appeared to.

Chris Masterjohn said...

Hey Stephan,

Do you have any writings on the reliability of different measures of body fatness?

I'm wondering for home use, outside of a research context, what is the best way to monitor it? Or is it better to just measure waist circumference?

Thanks,
Chris

Margot said...

Do you have a link to the article or has it not been published yet? I couldn't find anything on a quick search of PubMed. I'm interested to know what the weight loss at 6 months was, and whether they were regaining at 12 months (as most people in most diet studies are) or truly maintaining most/all of the initial loss.

brec said...

Well, dammit, I left a comment, presumably awaiting moderation, and I misspelled Stephan's given name.

said...

Does this account for glycogen & water loss that will drop on the low carb, but not low fat diet? I.e the entire weight loss difference (3%) could entirely be due to this.

brec said...

@Margot, here's a link.

You have to be an insider or pay to access the full text.

valerie said...

"Even though the degree of weight loss is very modest, and possibly not significant from a clinical standpoint, this further undermines the argument that the carbohydrate-centric USDA dietary recommendations caused the obesity epidemic. It turns out, when you put people on a diet that's similar to the USDA guidelines, they don't generally gain weight, and they often lose a little bit."


Wait a second.

They took a bunch of obese people and got them to follow the USDA diet. The subjects stayed just as obese as they ever were. And therefore you conclude that if the subjects had always followed the USDA diet, surely they would not have become obese???

As for the unusual maintenance after weight loss, if the subjects never lost more than 5ish percent of their initial body weight (and never actually tried to lose weight either), then I would not expect much of a metabolic fight back. Would you?

Stella B. said...

Also, the lower carb group was encouraged to eat lean protein such as fish and poultry and cook with canola and olive oil. That is a long way from whizzing half a stick of butter in your morning coffee.

Evelyn aka CarbSane said...

Would it be too much to ask for actual hard data to be presented? (sorry, not asking you but this drives me crazy!)

They provide baseline measures with mean and SD, and then predicted changes and 95% CIs in what appears to be an intent to treat analysis at various time points. Sometimes percent change, etc.

With BIA analysis for body composition, the two groups started out at exactly the same %BF with exactly the same standard deviation?? Odd.

I would note that the low fat group decreased protein consumption by roughly 20 grams/day while LC dipped by about 6 grams/day then rebounded to baseline levels at 6 months. They nicely itemized fiber -- yeah, THAT was held pretty constant! But you had to calculate absolute grams of protein to see the differential (and who knows how accurate that fat and carb grams calculated from %'s are inconsistent when compared with reported grams)

This game is frustrating. Millions of dollars being wasted is the only thing we know for sure.

All groups at all time points decreased absolute calorie, carbs and fat, some might say to starvation levels if 24 hour recall is to be believed.

Erik Arnesen said...

Do you think there is any reason to believe that the difference in weight loss was because of anything else than calorie intake? For instance, Bazzano et al. speculate about possible increased energy expenditure in the low-carb group, but that was not assessed.

And do you have any thoughts about the role of protein in the low-carb diet, which was a lot higher than in the low-fat group? Some (like Westerterp-Plantenga) has suggested that it's the high protein content, not the fat or carbs, that makes a difference.

I also notice that both groups ate very little fiber compared to what they were instructed to (25 g/day). This suggests that the "high-carb" group got a lot of their carbs from refined grains and sugar.

Nigel Kinbrum said...

Erik Arnesen said...
"This suggests that the "high-carb" group got a lot of their carbs from refined grains and sugar."
So, NOT the USDA diet.

karl said...

If one ends up with more muscle mass after a year - that is a huge health gain. It also means that they are likely less insulin resistant and much of heart disease is linked to higher postprandial Blood sugars. ( Postprandial of over 110, in my mind, tells me I am eating way too much carbohydrate - the ability to tolerate carbs varies from person to person - 40% have elevated GB)

Heart disease - CAD - looks to be an immune system event where oxLDL (not LDL) is misidentified as a dead or dying bacteria and stimulates monocytes that turn into macrophages in artery walls that continue to engulf the oxLDL partials. These macrophages become huge - and are then called foam cells, narrowing the arteries causing ischemia - heart attacks etc.

What can one do to lower oxLDL? There are several non patentable approaches - including things like fishoil, Quercetin, Lycopene. Because there is no patent potential, they are not likely to be promoted to your doctor. Even the test for oxLDL is not used as statins don't lower oxLDL. No profit, no such treatment is promoted.

The other thing that greatly lowers oxLDL is a LOW CARB DIET. Low GI foods probably don't help because while the BG spikes are lower - the BG is elevated for a much longer time (might be that it is the area under the curve that counts).

Now - what I am talking about is heart health - not weight. If you want to see what has changed to cause the obesity pandemic - a prime suspect is the change in plant oils. It turns out that PUFA's have been increased as they provide frost resistance - we eat about 5x more PUFA's than in 1960. There is good evidence that PUFA's cause inappropriate insulin sensitivity which induces weight gain. (Yes - PUFAs will improve your cholesterol test - but do you really want to do that at the expense of getting fat? All is good until you quit getting fatter. )

One last tip - it turns out that not all exercise is created equal. For the same amount of time in the gym - strength training (bar-bell squats etc) is MUCH more effective at restoring insulin sensitivity than the common low impact exercises generally recommended. Look up Rippetoe for more info.

Evelyn aka CarbSane said...

karl said:

>>>If one ends up with more muscle mass after a year - that is a huge health gain. <<<

The data reporting is sketchy at best in this study. An increase in the percentage of lean mass is not necessarily an increase in lean mass. Further, not all non-fat mass is muscle.

I find their measurement of body mass sketchy at best. Most studies will report absolute masses before and after, here they did not. It is highly suspect that at baseline both groups averaged exactly 40% fat, 60% lean with standard deviations of 10 for both measurements.

Margot said...

Thanks, brec. Looks like both groups did regain weight between 6 months and 12 months, though not much. The "low fat" group went from an average loss of 2.3 kg at 6 months to 1.8 kg by 12 months; the "low carb" groups went from an average loss of 5.6 kg at 6 months to 5.3 kg at 12 months. However, waist circumference in both groups decreased between 6 months and 12 months.

Anyhow, doesn't seem like very meaningful evidence in favor of the idea that regain is caused by failures of adherence (rather than adaptation) to me. There was a slight trend towards relaxed adherence in both groups, and maybe that caused the regain. Or maybe the regain was happening anyway and that's why some started slipping.

jcgeesling said...

Stephan,

If you read the full document, did it mention any affects on Apob/LDL-p?

Thanks,

George Henderson said...

The low fibre intake is probably because of the meal replacement shake, probably not much fibre in that.

Sam said...

I'd like to expand on Erik Amesen question, which deals with the role of proteins in these diets.
It has been suggested many times that it is the high protein content of low carb and low fat diets that is responsible for weight loss. I am wondering if this is one of the 'hidden' variable here? The satiating effect of proteins, and possibly their thermogenic effect, could be proximate factors contributing to weight loss. Higher fat diets include more protein in general, and low carb diets are maybe less rewarding as well…
To put it in perspective, two researchers in the ecology of nutrition advanced a nice theory (I am not one of them!), with some degree of experimental support, coined the 'protein leverage hypothesis'. It is detailed here:

https://www.swissmilk.ch/fileadmin/filemount/simpson-05-obesity-the-protein-leverage-hypothesis.pdf

www.obesityaustralia.org/_literature_135882/The_geometry_of_human_nutrition geometry of human nutrition

and a human study:

http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0025929

or their book The Nature of Nutrition for a much broader perspective.

As a summary, the main assumption is that each individual requires a daily amount of proteins, for structural and functional purposes, and this requirement takes priority over energetic needs (i.e. carbohydrates and fat) in non-optimal diets. Therefore, until we ingest that absolute amount of protein, we will keep searching for more food. Because of the low protein content of many processed foods and sugar-rich foods (and the price of protein-rich foods), we are compelled to ingest more calories in the form of carbohydrate and fat (mixed with proteins), until we ingest enough protein, overall driving excess calorie intake. Because humans need relatively little protein compared to fat and carbohydrate (calorie-wise), small differences in protein intake can drive large intakes in calories, in the form of fat or carbohydrates.
I would be interested in getting your opinion on this general subject. It seems maintenance of weight loss is indeed strengthened by higher or normal protein intake.

Nigel Kinbrum said...

karl said...
1. "If one ends up with more muscle mass after a year - that is a huge health gain."
The LF diet was a crap-in-a-bag diet. ∴ Your argument is invalid.

2. "It also means that they are likely less insulin resistant and much of heart disease is linked to higher postprandial Blood sugars. ( Postprandial of over 110, in my mind, tells me I am eating way too much carbohydrate - the ability to tolerate carbs varies from person to person - 40% have elevated GB)"
More low-carb scaremongering. Also, see 1.

3. "Heart disease - CAD - looks to be an immune system event where oxLDL (not LDL) is misidentified as a dead or dying bacteria and stimulates monocytes that turn into macrophages in artery walls that continue to engulf the oxLDL partials. These macrophages become huge - and are then called foam cells, narrowing the arteries causing ischemia - heart attacks etc."
Looks to be ≠ is. See Neovascularization of coronary tunica intima (DIT) is the cause of coronary atherosclerosis. Lipoproteins invade coronary intima via neovascularization from adventitial vasa vasorum, but not from the arterial lumen: a hypothesis. ∴ Your argument is invalid.

4. "What can one do to lower oxLDL? There are several non patentable approaches - including things like fishoil, Quercetin, Lycopene. Because there is no patent potential, they are not likely to be promoted to your doctor. Even the test for oxLDL is not used as statins don't lower oxLDL. No profit, no such treatment is promoted."
See 3. ∴ Your argument is invalid.

5. "The other thing that greatly lowers oxLDL is a LOW CARB DIET. Low GI foods probably don't help because while the BG spikes are lower - the BG is elevated for a much longer time (might be that it is the area under the curve that counts)."
See 1. and 3. ∴ Your argument is invalid.

6. "Now - what I am talking about is heart health - not weight. If you want to see what has changed to cause the obesity pandemic - a prime suspect is the change in plant oils. It turns out that PUFA's have been increased as they provide frost resistance - we eat about 5x more PUFA's than in 1960. There is good evidence that PUFA's cause inappropriate insulin sensitivity which induces weight gain. (Yes - PUFAs will improve your cholesterol test - but do you really want to do that at the expense of getting fat? All is good until you quit getting fatter. )"
Association ≠ Causation. PUFA's don't cause inappropriate insulin sensitivity. Inappropriate insulin sensitivity doesn't induce weight gain. Learn how stuff works. ∴ Your arguments are invalid.

7. "One last tip - it turns out that not all exercise is created equal. For the same amount of time in the gym - strength training (bar-bell squats etc) is MUCH more effective at restoring insulin sensitivity than the common low impact exercises generally recommended. Look up Rippetoe for more info."
Finally, some semi-useful information. Look up how to insert HTML tags into blog posts, for more info. It's intensity & volume, not impact. :-)

Alfred Pennyworth said...

Why do you say that the study subjects were obese? The summary only says that "Participants: 148 men and women without clinical cardiovascular disease and diabetes." It would be helpful if someone posts the full paper here so we can all read it for ourselves. Thanks

RLL said...

I wonder if the study paid any attention to the 'diabetes' status of the subjects. Many of us who are diabetic suspect that switching to a very low carb and high fat may compensate for metabolism dysfunctions for most diabetics. Which does not mean that there may be some downsides to that diet.

Evelyn aka CarbSane said...

I thought I'd put this link here that someone posted in the comments on my blog. It's Bazzano talking about the LC Diet. It's leaner proteins and veggie fats, butter and red meat in moderation and some whole grains and beans. I got a kick out of the bean discussion given the current flap going on in paleo.

https://www.youtube.com/watch?v=9FllD_4u0Rk

Don S said...

Subjects had BMIs from 30 to 45.

If you get a copy of the actual paper what becomes evident looking at the details is that the "low carb" group had 25% of energy intake from protein and that they kept their fiber intake pretty steady while they cut their carb intakeby more than 50% - in other words they cut out REFINED carbs including added sugars dramatically while preserving complex carbs with high fiber. Intake of all fats, including saturated fat, actually was down in an absolute amount sense , but calories were down more so percent of energy intake was slightly up. Protein% went up more than SFA or total fat % so these subjects were choosing leaner protein sources.

So this was a moderately high protein, low refined carb condition and it resulted in fewer calories being eaten (on average 100 to 200 less a day than the "low fat" condition).

"Low fat" kept up the same amount of refined carbs and decreased all fats modestly - including those often presented as "good" as well as those thought of as "bad".

High protein with carbs pretty much exclusively from complex carb sources results in better weight loss than keeping up with lots of refined carbs! News at 11!

Agreed the subject is staler than old bread. The pivot from SFA as the be-all and end all is long done. Eat vegetables, nuts, seeds, whole grains, likely fruits, beans, and lentils (but avoid them if your Paleo mindset feels beter that way), some fish, seafood, poultry, meats, dairy and eggs if you like 'em, and avoid highly processed foods, including processed deli meats and refined carbs inclusive of added sugar, in whatever combination rocks your boat. And don't bother rocking someone else's.

Don S said...

RLL -

Yes they paid attention to "diabetes status" - slight trend to lower plasma glucose and lower serum insulin in the "low fat" group surprisingly enough but not enough to be statistically significant. Both had lower insulin levels compared to baselines.

Again though, this was not a high fat diet. It was a low refined carb, high protein diet. Complex carb intake was maintained. Maybe if it was increased they would have seen more reduction in insulin levels

Erik Arnesen said...

Murray Skeaff, Lisa Morenga, Jim Mann and Rachael McLean just wrote comment to Bazzano et al.'s paper, and I found this part interesting:

"Katan remarked in an editorial several years ago (2) that participants in weight loss trials “may eat less not because of the protein or carbohydrate content of a diet but because of the diet’s reputation or novelty or because of the taste of particular foods in the diet.”. The widespread promotion of low carbohydrate diets may well explain these findings."

Hafthor Bjornssen said...

Hi Stephan,

It's Raz. I cannot remember my password today for my main account. It is written down somewhere. Sorry about this. I am Hafthor for today :)

Science can ONLY give us what is plausible.That's all. Science only deals in what is likely or unlikely. At best, "highly likely" or "highly unlikely". This is often missed in the Blogosphere.

All of my information is from world renowned science educators such as Nobel Prize winner David Gross.

The amount of studies on a given health topic is meaningless UNLESS there is an effort to identify underlying causes. Correlations, in science, do not mean anything UNLESS there is an underlying principle that deeply explains correlations. It does not mater much how many studies are conducted that only measure effects.

A real quality theory can make predictions of things not yet observed.

There is LOTS and LOTS of junk in the "peer-reviewed literature". We have to be careful. Many top physicists ( who also dabble in biology) warn of this. Most scientific ideas are wrong. Most experiments are wrong too the first time they are done.


Nobody is focusing on genetics enough. There are genes involved in determining everybody's body mass thermostat- the potential we have to increase in mass. ( DTC1 or adipose). We need MUCH more investigation in to how cells work and research in genetics. Biologists and physicists need to start working on that.How cells work is not understood anywhere near good enough.

This has HUGE implications as far as proper healthful diets , diseases and medicine. Obesity too. Studies like "the almighty Lyon Diet Heart Study" remain WEAKER evidence UNTIL we learn how cells work much, much better.We need deep explanations.

Extreme obesity is SO much more complicated than dietary factors and lifestyle. There are many thin people overeating and staying lean.


We need collaboration. Both ( all) sides ( low carb vs vegans vs high carb) need to try to disprove themselves. This is what is currently being done, for instance, with the gravitational waves vs dust argument.

Best wishes,
Razwell

Wisdom Shift said...

Useless. This is yet another study that falsely defines low fat, and then uses this as a scapegoat.

A Real low fat diet is less than 15 percent fat, using real whole foods not sugar and junk.

This is the diet of the blue zones, where numerous people live to be over 100 years old. Three of the researched blue zones eat around 85 percent complex carbs, and have virtually none of the western diseases, and long healthy, lean life.

But there is a lot of money to be made with diet books and the like. And so you keep seeing these fake studies. Any study that purposefully uses a false definition of low fat is built incorrectly from the start.

The research on blue zones, and on virtually every modern diet-based disease, shows the same result. Eat natural like blue zones, great. Eat high protein or high fat and get long term problems. Eat somewhere in the middle, and it is a mess.

Dr. Esselstyn and Dr. Ornish cured " about to die" cardiovascular disease ... By eating blue zone style. Diabetes has been cured that say, and even complex diseases like auto-immune diseases and cancer have shown corrolation and in at least one case causation from eating blue or not blue.

But ... there is money to be made.