Atkins Research Update

Press Release Source: Atkins Health & Medical Information Services

Atkins Health & Medical Information Services Research Update
Monday January 12, 9:03 am ET
Controlled carbohydrate research from around the world

NEW YORK, Jan. 12 /PRNewswire/ -- As an ongoing service from Atkins Health & Medical Information Services to practicing physicians and medical and lifestyle journalists, our communications department provides the latest developments in clinical research on controlled carbohydrate nutritional practices and the Atkins Nutritional Approach™ (ANA) as they occur and are reported. If you would like any further information or access to our complete library of published controlled carbohydrate research, please contact Gina Mangiaracina at gmangiaracina@wwafsp.com. You can also find the complete library of published studies in The Science Behind Atkins section at www.atkins.com.

Press Release Source: Atkins Health & Medical Information Services
ATKINS NUTRITIONAL APPROACH SHOWN TO REDUCE EPILEPTIC SEIZURES

Although the efficacy of a low-calorie ketogenic diet in treating epilepsy without medications is well documented in the literature, maintaining the level of caloric restriction necessary to produce the needed level of ketosis is challenging. Specifically, these results are typically obtained by mimicking the effects of starvation--restricting a patient to a high-fat, low carbohydrate, low-protein diet that provides only 75 percent of the recommended caloric intake. Researchers believe that this Spartan regime controls seizures by creating ketone bodies in the blood, which are burned by brain cells in the place of glucose. Though primarily prescribed for children, this diet may be beneficial to adult epileptics as well.

Eric H. Kosoff, M.D., of Johns Hopkins, wondered whether the Atkins Nutritional Approach™ (ANA), which achieves ketosis by less severe means- restricting carbohydrates but not caloric intake-might be as effective in reducing seizures in patients with epilepsy. To test this hypothesis, the researchers put six epileptic patients at the Johns Hopkins Hospital of Neurology on the ANA. The patients, who were equally divided between male and female and ranged in age from 7 to 52 years old, had previously failed treatment with anticonvulsants.

In half the cases, the patients' seizures appeared to be controlled by the ANA. Given the small size of this study and the relatively short duration of seizure freedom observed, the researchers have not yet recommended Atkins as a replacement for the usual ketogenic diet in the treatment of epilepsy, claiming that larger studies are clearly needed.

In the meantime, the researchers suggest that patients awaiting in-house treatment with ketogenic diets may be put on the ANA, which has the additional virtue of having "an easily readable and widely available paperback" to test their ability to comply with a low carbohydrate diet (compliance can easily be checked by testing for ketosis) and its possible effectiveness.

Kossoff, Eric H., Krauss, Gregory L., McGrogan, Jane R., Freedman, John M. Efficacy the Atkins diet as therapy for intractable epilepsy. Neurology. In press.

FAT INTAKE DOES NOT INCREASE SERUM MARKERS FOR
ATHEROSCLEROSIS WHEN STARCH IS RESTRICTED

In an earlier study, while testing a dietary approach to controlling diabetes involving the replacement of starches by saturated fats, James Hays, M.D., and his colleagues at Christiana Health Services, Inc. in Newark, Delaware, were struck by the fact that patients following this diet lost weight with no apparent adverse effects on serum lipids.

To shed additional light on these intriguing findings, and to clarify issues relating to "the changing mix" of medications patients were receiving, these researchers embarked on a second study to look specifically at the effect of their high-fat, starch-avoiding diet on serum risk factors for atherosclerosis in a group of obese patients with established atherosclerosis.

Preliminary results of a six-week study involving 17 men and six women were encouraging: On average, participants lost 5 percent of their total body weight with no adverse effects on serum lipids, in fact, showing decreased fasting glucose, insulin and triglyceride levels.

This is remarkable in light of what the researchers call the "overwhelming evidence" that the addition of saturated fat to an otherwise low-fat diet leads to increased serum markers of atherosclerosis. The diet Dr. Hays and his colleagues arrived at to treat patients with chronic diabetes and atherosclerosis is similar to the ANA with regard to restricting carbohydrate intake rather than fat consumption. In Hays' study, half the calories came from saturated fat and protein from red meat, cheese, eggs. Carbohydrates were severely restricted. However, participants were prescribed a consistent calorie intake, as this was favored for the management of diabetes. According to Dr. Hays, "We have prescribed a consistent intake of certain fruits and vegetables rather than the Atkins step-wise approach, and this may have resulted in some other differences." As a result, only five of the participants in the study went into ketosis, a metabolic shift considered key to appetite control and weight loss in the ANA. In light of this, caloric restriction likely explains the observed weight loss, in contrast to that seen with a typical Atkins approach.

According to the researchers, these studies "suggest, but by no means prove, that long term compliance with a high-saturated fat, starch avoidance diet can result in continued weight loss without adverse effects on serum lipid levels."

James H. Hays, MD, Angela DiSabatino, RN, MS, Robert T. Gorman, PhD, Simi Vincent, PhD, MD, Michael E. Stillabower, MD, Effect of a High Saturated Fat and No-Starch Diet on Serum Lipid Subfractions in Patients With Documented Atherosclerotic Cardiovascular Disease, Mayo Clin Proc, November 2003, Vol 78, pages 1331-1336.

LOW-FAT DIET INFLAMES FATTY LIVER

One frequent consequence of obesity is a condition known as nonalcoholic fatty liver disease (NAFLD), the accumulation of fat in the liver. NAFLD is a serious disease, which can lead to fibrosis or cirrhosis. Common sense would suggest that lowering dietary fat might benefit those with NAFLD. However, a recent study done at Johns Hopkins shows that this supposition is wrong, and that a low-fat diet can exacerbate the condition, leading to increased liver inflammation, while high-fat diets seem to reduce the inflammation.

In a paper presented at the 54th Annual Meeting of the American Association for the Study of Liver Diseases, Jeanne M. Clark, M.D., described her study in which she examined liver biopsies taken from 74 morbidly obese patients undergoing surgery for their obesity. Before the surgery, the patients filled in a 24-hour food recall questionnaire, which allowed the researchers to estimate the total calories, carbohydrates and fats in the patients' diets. Of the patients biopsied, 89 percent had fatty livers, 69 percent had inflammation and 41 percent had progressed to fibrosis. Clark found that compared to those patients with the lowest carbohydrate intake, those who ate a high carbohydrate diet had a seven-fold increased risk of liver inflammation. By some mechanism that is still a mystery, a high-fat diet seems to shield the fatty liver from damage.

HIGH-FAT DIETS MAY BE EFFECTIVE IN MANAGEMENT OF TYPE 2 DIABETES

The importance of diet in the management of Type 2, or adult onset, diabetes is universally acknowledged. Exactly what this diet should consist of is somewhat more controversial. Recently, physicians have been prescribing diets high in monounsaturated fats with a restricted amount of starches. The reasoning behind such diets is that, since dietary starches act like sucrose, if monounsaturated fats are substituted for these starches, control of blood sugar would improve. Now, a group of researchers has taken this idea one step further by totally eliminating dietary starch from the diet in exchange for an unlimited amount of saturated fat. To the researchers' surprise, the extra consumption of dietary cholesterol and saturated fat did not increase serum lipids, and patients not only lost more weight, but blood sugar also was better controlled.

The study compared 151 patients on the no-starch, unrestricted saturated fat diet, and 132 control patients following a diet that allowed unrestricted monounsaturated fats and a controlled amount of starch. The study was not randomized, and the varying cocktails of drugs consumed by the patients made analysis difficult, which the researchers admit clouded their conclusion that substituting saturated fat for starch leads to better control of diabetes. Still, they conclude in their article that, "the stark differences between the high-saturated fat plus starch-avoidance diet and the diet currently recommended by the ADA [American Diabetes Association] are disturbing. Nevertheless, this information needs widespread critical appraisal, not because it conclusively proves the superiority of a dietary prescription so much as it provides reason to question the relatively recent dietary prescription of high-carbohydrate diets to patients with diabetes mellitus."

James H. Hays, Robert T. Gorman, K.M.M. Shakir, Results of the use of Metformin and replacement of starch with saturated fat in diets of patients with type 2 diabetes, Endocrine Practice, 8 (3), pages 177-183.

LOW GLYCEMIC INDEX MEALS SATE HUNGER IN ADOLESCENTS

Despite a general reduction in fat consumption, one in five children are overweight. One hypothesis about why this is so is that children today consume more high-glycemic foods that quickly raise blood glucose levels, than in the past. To determine the effect of high-glycemic diets on children, University of Utah researchers fed 10 adolescents (5 boys, 5 girls) meals with either high- or low-glycemic index.

As expected, blood glucose and insulin levels were much lower after eating the low-glycemic index meals. More intriguing, however, was that after consuming a low-glycemic index meal, the adolescents waited longer (3.9 versus 3.1 hours) before requesting additional food, though they then ate as much as after a high-glycemic meal. The researchers speculate that this prolonged period of satiety might reduce the daily caloric intake of adolescents on a low-glycemic index diet and lead to long-term weight control.

Ball SD, Keller KR, Moyer-Mileur LJ, Ding YW, Donaldson D, Jackson WD., Prolongation of satiety after low versus moderately high glycemic index meals in obese adolescents, Pediatrics. 2003 Mar;111(3):488-94.

LOW CARBOHYDRATE DIET HAS POSITIVE EFFECT ON BLOOD LIPIDS

To investigate the effects of very low carbohydrate diets on the blood lipids and other markers of cardiovascular disease in women, investigators attempted to repeat work previously completed on male subjects, using female subjects. This balanced, randomized two-period crossover study looked at numerous serum markers in 10 healthy women who consumed both a low fat (<30%) and a very low carbohydrate (<10%) diet for four weeks each. Although modest increases were noted in LDL, favorable effects on cardiovascular disease risk status occurred by virtue of a relatively larger increase in HDL and a decrease in fasting and postprandial triglyceride levels.

Volek, J.S., Sharman, M.J., and Gomez A.L., et al., "An Isoenergetic Very Low Carbohydrate Diet Improves Serum HDL Cholesterol and Triacylglycerol Concentrations, the Total Cholesterol to HDL Cholesterol Ratio and Postprandial Lipemic Responses Compared with a Low Fat Diet in Normal Weight, Normolipidemic Women," The Journal of Nutrition, 133(9), 2003, pages 2756- 2761.

STUDY SUGGESTS DIETARY FAT INTAKE HAS LITTLE EFFECT ON STROKE

In a result that has confounded the expectations of physicians and medical researchers, scientists at Northwestern University and Harvard have shown that the amount of fat a person consumes apparently has no effect on stroke risk.

Northwestern University's Ka He, M.D,. and his colleagues at Harvard monitored a group of almost 44,000 male health care professionals for 14 years. The men periodically mailed in detailed questionnaires about their diets, lifestyles and medical histories. Men who initially reported cardiovascular disease or diabetes mellitus were excluded from the study. After analyzing the results, the researchers found that the total amount of fat consumed had no appreciable effect on the incidence of ischemic or hemorrhagic stroke. Diets rich in animal fat, vegetable fat, saturated fat, monounsaturated fat or trans fat were all equally benign with respect to stroke. The consumption of red meat, high-fat dairy products, nuts or eggs also was not related to the incidence of stroke.

Ka He, Anwar Merchant, Eric B Rimm, Bernard A Rosner, Meir J Stampfer, Walter C Willett, Alberto Ascheri, Dietary fat intake and risk of stroke in male US healthcare professionals: 14 year prospective cohort study, British Medical Journal, 23, pages 777-780.

CORONARY ARTERY CALCIUM, DIABETES AND METABOLIC SYNDROME

The amount of calcium deposited in the coronary arteries is a strong predictor of future fatal cardiac events in apparently healthy individuals. It is also known that people with diabetes or the metabolic syndrome, also known as Syndrome X, have an increased risk of cardiac disease. But until now the relationship between diabetes, the metabolic syndrome and coronary artery calcium has not been studied.

The metabolic syndrome is closely related to insulin resistance, which makes it related to, and possibly a precursor of, diabetes. People suffering from the metabolic syndrome have at least three of the following health issues: obesity, low HDL cholesterol, high triglycerides, glucose intolerance and high blood pressure. Researchers at the University of California, Irvine, examined 1,823 patients, measuring their coronary artery calcium in addition to the various symptoms of metabolic syndrome and diabetes. They found that the more factors of the metabolic syndrome a patient had, the higher the coronary artery calcium. Similarly, diabetics also had an increase in coronary artery calcium, raising the need for further investigation as to the relationship between these findings and the risk of future cardiovascular events in the subset of individuals with metabolic syndrome or diabetes and coronary artery calcification.

Wong ND, Sciammarella MG, Polk D, Gallagher A, Miranda-Peats L, Whitcomb B, Hachamovitch R, Friedman JD, Hayes S, Berman DS., The metabolic syndrome, diabetes, and subclinical atherosclerosis assessed by coronary calcium, J Am Coll Cardiol. 2003 May 7;41(9):1547-53.

LOW CARB DIET EFFECTIVE IN SHORT-TERM TREATMENT OF OBESITY
IN SCHOOL-AGE CHILDREN

With childhood obesity reaching epidemic proportions, physicians everywhere are looking for treatments that are effective. Doctors at the Marshall University School of Medicine in Huntington, West Virginia. report that 23 percent of their pediatric patients are obese. In an effort to find an effective treatment for these patients, they performed a small study comparing a low-fat, calorie-counting diet to a low carbohydrate, calorie-unrestricted diet.

The study consisted of 70 obese children divided into two groups. One was given a low-fat, hypocaloric diet whose calories consisted of 55 percent carbohydrates, 15-20 percent protein and less than 30 percent fat. The other group was put on a diet without calorie restriction that kept the carbohydrates to about 7 percent of the daily caloric intake, protein at 49 percent and fat at 44 percent. The result was that of the 47 children who completed the study with a minimum of two months of follow up, those on the low carbohydrate diet lost an average of 6 kilograms, with a decrease in body mass index of 2.6 kg/m2 compared to those on the low-fat diet, who gained an average of 4.6 kilograms and whose BMI increase by .8 kg/m2. While this study was small and the error bars large, the result does suggest that the low carbohydrate diet is indeed an effective treatment for juvenile obesity.

Misty Trent Strow, James R. Bailes, Adrian R. McGinnis, Lewis Spangler, Jr and Isabel Pino, Successful Short Term Treatment of Obesity in School-Age Children, West Virginia Chapter American Academy of Pediatric Residents Research Contest Winner, 2001.

COMPLEX CARBOHYDRATES, THE BREAKFAST OF CHAMPIONS

Carbohydrates come in two basic varieties: sugars and starches. Sugars, also known as simple carbohydrates, are quickly absorbed by the body. Starches-complex carbohydrates-must first be broken down into simple carbohydrates before they are absorbed by the body. This difference can have an important effect on energy and appetite, as a recent study shows.

Researchers in the Netherlands fed 26 male subjects breakfasts high in simple carbohydrates one day and high in complex carbohydrates on the next. For the four hours following their meals, the researchers measured the subjects' blood glucose, insulin, triglycerides, free fatty acids and cholecystokinin levels. Following the simple carbohydrate breakfast, glucose and insulin levels were both higher at 30 minutes after feeding, triglyceride levels were higher at 180 minutes and free fatty acids were higher at 180 and 240 minutes. In addition, the subjects were asked to assess their satiety and levels of fatigue. The researchers found that those consuming a complex carbohydrate breakfast (whole grain breads and cereals) felt more energetic and less hungry than those who ate simple carbohydrates.

Pasman WJ, Blokdijk VM, Bertina FM, Hopman WP, Hendriks HF., Effect of two breakfasts, different in carbohydrate composition, on hunger and satiety and mood in healthy men, Int J Obes Relat Metab Disord. 2003 Jun;27(6):663-8.

Source: Atkins Health & Medical Information Services