Show 1149: Is Cutting Carbs More Important Than Cutting Calories?
I'm Joe Graydon. I'm Terry Graydon. Welcome to this podcast of the people's pharmacy. You can find previous podcasts and more information on a range of health topics at people's pharmacy dot com. For years. We've heard that the secret to wake control this balancing calories in calories out. Why isn't it that simple? This is the people's pharmacy with Terry. And Joe Graydon. The dogma in nutrition science has long been that all calories are created equal. Recent research has shown however that this belief may be wrong. Dr David Ludwig lettuce study that looked carefully at the metabolic effects of carbohydrates one hundred calories of sugar and one hundred calories of almonds. Don't do the same thing to our bodies. We'll find out more about Dr Ludwig research, and how should the results affect our food choices coming up on the people's pharmacy. How a low carb diet could help with weight control. First this news. In the people's pharmacy health headlines older, people who'd like to stay sharp can take one simple step. Keep moving research from rush University Medical Center examined four hundred fifty four older individuals for as long as twenty years the volunteers took cognitive tests and had physical exams every year. They also agreed to donate their brains for examination upon their deaths. Each participant also wore an accelerometer for seven days during the study. This is a device worn like a wristwatch that measures movements including small actions such as walking from one room to another or larger actions such as a vigorous exercise routine. Some of the study subjects had dementia while the others did not the accelerometer picked up differences between these two groups those with dementia made an average of one hundred thirty thousand movements daily as counted by the excel Ramadan. That may sound like a lot. But the people who were in better cognitive shape had an average of one hundred eighty thousand movements daily people with better motor skills. Also, scored better on measures of memory and thinking those who moved more during the day were more likely to be thinking, clearly and remembering things better physical activity and motor skills accounted for eight percent of the differences in cognitive test scores for years doctors have used beta amyloid plaques and tangles in the brain as a way of identifying dementia due to Alzheimer's disease. Now, scientists at the university of southern California's say they found an independent marker that may show up much earlier in the development of dementia. One hundred sixty one people over forty five years old took part in the five year study all of them completed cognitive tests that resulted in a score of zero that's normal to three severe dementia. The scientists also. Also, analyzed Cerebrospinal fluid for markers of brain capillary permeability. In addition the volunteers submitted to contrast enhanced m are is the researchers report a strong correlation between breakdown of the blood brain barrier and poor performance on cognitive tests. Further research may refine the measure of capillary leaking as an early signal of possible dementia, whether it's possible to reverse capillary, permeability and delay or prevent the onset of dementia remains to be seen dermatologists prescribed proportionally more antibiotics than other medical specialties frequently they prescribe antibiotics to treat non-infectious conditions such as acne or resign frequent antibiotic use can lead to bacteria developing resistance. So the news from a new study in JAMA dermatology is encouraging between two thousand eight and two thousand sixteen dermatologists prescribed few. You're anti-biotics overall dropping from three to two prescriptions per hundred visits antibiotic prescriptions rose, however for surgical procedures insists of study of nineteen million patients suggests that other specialists in the US, maybe prescribing antibiotics too often the scientists reviewed antibiotic prescriptions from an insurance database and examined the diagnostic codes associated with them about three fourths of the patients covered by the study. We're adults the remaining records belonged to children nearly one fourth of the antibiotics have been prescribed for common colds or coughs and were therefore inappropriate another third might be appropriate. But also might not be because they were for problems like sore throats or sign you Seitis which frequently are caused by viral rather than bacterial infections. This is the time of year when lots of people have nagging coughs, traditional cough medicine leaves a lot to be desired. Now scientists. In Great Britain, say chocolate could be a good substitute. They conducted a randomized controlled trial comparing coating containing cough syrup to a chocolate based cough medicine. This recoup goes study included one hundred sixty three patients people getting chocolate got relief from the coughs within two days that was faster than those taking codeine the trial medicine containing chocolate compounds is sold in Great Britain under the name unique off one of the authors suggest that sucking on a piece of chocolate might be a tasty and effective way to comma cough. This isn't the first time chocolate has been studied as a cough. Suppressant? A previous study found that the OBE roaming a crucial component of chocolate is an effective cough treatment. And that's the health news from the people's pharmacy this week. Welcome to the people's pharmacy. I'm Joe Graydon. And I'm Terry Graydon. Everyone agrees that obesity is one of the world's most pressing health problems overweight contributes to type two diabetes, heart disease, joint problems, and a host of other serious medical conditions. But there is little agreement about the best strategies to control weight. Some experts emphasize cutting calories. Others insist that exercise is key. When it comes to diet. There are proponents of both low fat and low carb approaches clinical trials to test. These approaches are uncommon today. We're talking about one of the largest and best controlled clinical trials on diet and metabolism. Our guest is one of the principal. Investigators. Dr David Ludwig is co director of the new balance foundation obesity prevention center at Boston children's hospital. He's all. Also, a professor of pediatrics at Harvard Medical School and a professor of nutrition at Harvard's t h Chan school of public health. Dr Ludwig has written three books for the public ending the food fight always hungry, and the cookbook, always delicious, welcome back to the people's pharmacy. Dr David Ludwig, great to be with you Joan Terry. Dr Ludwig we've been talking about these issues for not just weeks months years decades about dieting and about weight loss, and it seems that this entrenched belief that all calories are created equal is really hard to change. I it's foundational and the idea that you should just eat less exercise more. And the problem is solved has just not gonna way you have conducted as part of. A team. A fascinating study believe it was published in the J. And it has created a firestorm of controversy. Not surprisingly. But the data is just really interesting exciting. I'm quite quite intriguing. Can you tell us why you did how you did it and what you discovered? Sure. Well, the notion that a a calorie is a calorie is a fact of science in physics, but humans aren't toaster ovens you? We're dynamic biological systems. So that when you increase calories or specific to obesity treatment, try to cut back on calories. The body fights back in predictable ways. You know, we get hungrier. That's an experience that most dieters have long before their weight loss goal is within sight. But even if you could ignore your hunger, which is a challenge for many people just going one day. But even if you. Could ignore your hunger for months or years. The body fights back in other ways most specifically by slowing down metabolism. And that combination of hunger and slowing metabolism is a recipe for weight gain and explains why so few people can keep the weight off over the long term success of long-term obesity treatment is really less than ten percent. But it raises the question, you know, why is the average body weight? Why is the weight that our bodies seem to want to defend going up year after year? Why does the average man today say five foot nine inches way thirty five pounds more than he would have in the nineteen fifties the nineteen sixties that is a good question. Why that's what our study is aiming to explore according to another way of thinking about it called the carbohydrate insulin model. The influx of processed carbohydrates into her diet during the low fat years nineteen seventies eighties. Nineties has raised insulin levels. Now, insulin is extremely potent hormone. I call it the miracle grow fear fat cells just not the sort of miracle. You want happening in your body. Insulin promotes fat storage, and it prevents calories from being released from fat cells. So for example, in states of excess insulin action so someone with diabetes type two diabetes put on insulin weight gain, predictably occurs and the opposite. Also happens without enough insulin. It's impossible to gain weight a child with new onset type one diabetes. That's the kind of diabetes where the body can't produce enough insulin because of an autoimmune attack these children when they first come to attend. Action might be consuming three five or seven thousand calories a day. And despite that they still lose weight put the child on the right amount of insulin and wait returns to its normal trajectory give that touch held too much insulin. And he or she will gain too much weight. So the question is could these processed carbohydrates the white bread white rice prepared breakfast, cereals, potato products, cookies crackers, low fat dressings could those foods that were actually advertised as helpful during the low fat years be raising insulin levels and driving weight gain for metabolic reasons. Not because people lack will power, but simply because their body is being programmed to store too many calories and attempts to cut back calories are doomed to failure. So that's what our study aims to examine. Well, it's really innovative research. And because there haven't been. Been that many studies that are that will controlled so please describe the methodology sure one of the big controversies about this new the this hypothesis, which frankly isn't new it's got its origins back a hundred years called the carbohydrate insulin model one of the big criticisms is that the studies that exist today. The feeding studies where you give people prepared foods under a highly controlled conditions. So you can make rigorous assessments of metabolism that these studies have mostly been negative. They don't show an advantage too, low carb or low fat, particularly, but the big issue with these studies is that they're hard to do they're expensive. And almost all the studies available today are extremely short term typically less than one week. And there are only a couple that are as long as four weeks. So what's the issue with these short-term studies? Well, we know. No that the process of adapting to a low carbohydrate diet isn't immediate fact, there's a popular name for it. It's called the Kito Fluor the Keita genyk flu when you cut back carbohydrates. It takes the body. A while to adapt to using fat in more extreme cases of low carbohydrate diets using key towns and that process is predictable. It takes two or three weeks. So we need studies of at least one month to understand how these different diets will affect our metabolism and the likelihood of maintaining weight loss over the long term. That was the purpose of our study. We didn't design it for just a few days or few weeks. The study looked at low medium and high carbohydrate diets over five months, so that's plenty of time to see what happens after the body adapts, and we used a large number of partic-. Percents one hundred sixty four which compares with typical studies that might have a dozen or so so we had enough power and jurisdiction to ask this question with precision. And fortunately, we we we we saved a large philanthropic grant much larger than a typical national institutes of health grant, which oftentimes capped at five hundred thousand dollars a year. You know, one can't do this kind of study at five hundred thousand dollars a year. Our study was twelve million dollars from philanthropy. And so here's what we did. We took our participants a hundred and sixty four after they had lost twelve percent weight loss, we cut back their calories to bring their weight down by typically twenty to twenty five pounds. So what's going to happen to them? Well, we know that they're going to be hungry. The metabolism will be slowing down their body will be fighting back against that weight loss and primed to begin to regain weight. Then. We randomly assign them to these three different times. Twenty percent forty percent or sixty percent carbohydrate. And those diets had the opposite gradient fats sixty forty and twenty percent fat. We kept protein the same twenty percent. That's the rest of the calories among all three diets. So as not to have any confounding factors. So after the weight loss we randomly assigned people to these three diets, and we did one more thing we adjusted the calories to keep their weight constant for the next five months. We know that changes of body weight will greatly affect metabolism. We wanted to factor that out. So the question we're asking is does the ratio of carbohydrate to fat in the diet affect metabolism. And specifically the number of calories were burning at the same body bodyweight. We used a technique called doubly labeled water that's stable isotopes. It's considered the gold standard for measuring metabolism. Among people who are freely moving about living their regular lives. That's the most relevant question. We want to ask. And so what we found was that metabolism. Sped up on the low carbohydrate diet by about two hundred to two hundred fifty calories a day compared to the high carbohydrate diet and that difference persisted throughout the five months of our study. Now if that difference remained over the long term, it would spontaneously lead to about a twenty pound weight advantage weight loss without any changes in how much food was being eaten if a low carb diet, also produced more tidy greater sense of fullness, less hunger. Then it could potentially lead to even greater weight loss over the long term. So these findings suggest that the. Type of calories you consume affect the number of calories. You burn and that a focus on reducing carbohydrate rather than calories may be more effective for long term weight control. You're listening to Dr David Ludwig. He's a pediatric endocrinologist and professor of nutrition at Harvard's t h Chan school of public health. Dr Ludwig is professor of pediatrics at Harvard Medical School and director of the new balance foundation obesity prevention center, his books include ending the food fight always hungry, and the cookbook always delicious, we need to take a short break when we come back. We'll find out how attitudes towards dietary fat are changing will we eventually be able to end the diet wars and come to consensus about what people should eat to stay healthy. Why do people get so emotional go crazy over dietary choices? Has the study that Dr Ludwig and his colleagues published in the B M J changed how they think about diet, especially about fat. How can we put the studies findings to use in real life and lose those extra pounds? You're listening to the people's pharmacy with Joe and Terry Graydon. The people's pharmacy podcast is sponsored in part by Kaya -biotics, K A Y A -biotics offers the first probiotics which are both certified organic and Hypo allergenic I'll probiotics are produced in Germany under laboratory conditions with high quality ingredients and under strict regulatory oversight. The three available formulas are created for very specific purposes such as strengthening the immune system, fighting eastern factions and helping with weight loss to learn more about Kaya -biotics, probiotics and the important topic of gut health you can visit their website Kaya, -biotics dot com. That's K A Y A -biotics dot com. Use the discount code people for ten dollars off your first purchase. Welcome back to the people's pharmacy. I'm Joe Graydon. And I'm Terry Graydon if he would like to purchase a CD of this show, you can call eight hundred seven three two two three three four. This is shown number one thousand one hundred forty nine that number again, eight hundred seven thirty to twenty three thirty four or you can place the order online at people's pharmacy dot com. You can also download the podcast from I tunes. The people's pharmacy is brought to you in part by Kaya -biotics probiotic products made in Germany from certified organic ingredients. That's K A Y A -biotics dot com today were tackling the diet wars, why are people so emotional about their dietary choices for decades, many dietary prohibitions were based on a some. Sion's beliefs rather than scientific evidence. Even when studies were done that showed eggs don't increase the risk for heart disease. For example, many people simply didn't believe it. It's difficult to do. Well controlled clinical trials in nutrition. So we're pleased to be discussing one of the largest and most carefully executed such studies today we're talking with Dr David Ludwig. He is co director of the new balance foundation obesity prevention center at Boston children's hospital. He's also a professor of pediatrics at Harvard Medical School and a professor of nutrition at Harvard's t h chance school of public health. Dr Ludwig has written three books for the public ending the food fight always hungry, and the cookbook always delicious that led wig. You have just written a an important s. Say in science, which is the leading science journal here in the United States, and it is titled the dietary fat from foe to friend. Most people think that if they want to lose weight or maintain weight, they need to be very cautious about avoiding sources of fat your recent research that you have just described to us suggest that's not the case how can people catch their attitude about dietary fat? The purpose of this review. Article in science was to put together perspective based on dialogue among friendly rivals. And so in fact, our title had a question Mark at the end dietary fat from foe to friend. So so often with these kinds of articles scientist will team up with like minded individuals to write one perspective. And then the opposite happens from the other side of the debate. And what we make of this. There's very little that can be very little progress with polarization. So our goal was to put together a collaboration that represented the whole spectrum of opinion from people who were predisposed to preferring a low carbohydrate high fat diets to the opposite people who had been advocating low fat, high carbohydrate diets and other and someone. Else who was really focused on the just the quality of the foods. And what we aim to do is decide will what do we agree on? What what do the fact show what we disagree on? And then just be explicit about that. And then craft a plan for resolving these ongoing controversies with new research. So I I think that we in this paper provide a roadmap for how we can begin to get out of the diet wars that so polarized the nutrition community, especially around obesity. Well, I guess that's what fascinates me the most because the diet wars and the diet dicta crats are so adamant that they're thinking is the only right way to think and those other guys whatever it may be there wrong. So there's a tremendous emotional content. And and that translates. To the public at large. Because when we talk about, you know, fat issues, you know, how fat may not be our foe. And might even be our friend. We get inundated by messages from people who go well, haven't you read this book or that book, and don't you know about this study? Hey, you guys are just totally wrong. And you're misleading the public. I notice that one if you're co-authors Dr Walter Willett who is a frequent guest on the people's pharmacy. Arguably one of the leading nutrition experts in the world and one of the most knowledgeable epidemiologists in the world. And he's certainly come around when it comes to the fat issue. So why do you think at such an emotional target for criticism? Well, just a complete our author list. We had Jeff full IQ who's been preeminent among the low carb Kita genyk research area and Marian Neuhausler who's for many years. Advocated the advantages of low fat, the hallmark of the heart and soul of science is controversy debate. If they were no controversy, why bother doing any research to begin with. We would have all the answers in many fields and science things. Get too personal. You know, scientists have egos, and sometimes we tend to argue in ways that promote unnecessary polarization and things, of course, get much worse when you come to social media where with whatever it is two hundred eighty characters you may come up with a beautiful quip that puts your opponent into his place you think, but it's not really it's just getting more heat, not light. So we really need to reestablish a tradition of respectful dialog in my belief the pendulum had swung much too far toward demonizing. All fat storing the eighties nineties, I think that we all agree in this paper. That was a mistake that to say that all fats were bad and all carbohydrates were. I think all of Sagres with that. So I like to see the pendulum swing in the other direction. But as to whether some people would do best on relatively low fat diets other people might do best on relatively high fat diets how do identify them what about heart disease, what about cancer? There are many unresolved controversies we haven't pedantic of diet related disease sweeping the country sweeping the world, we need to work together. Nobody has the all of the answers and to be demonizing and disrespecting opponent. I think strikes at the very fabric of the scientific process decker. Not what you said that you and your co authors, we're looking for what you could agree upon. And you've just mentioned that you all agreed that the anti-fat. Dogma during the nineties was too extreme. What else did you agree on? Will we have a table in this paper, I won't go through it specifically, but we have points of consensus, and there are seven of them. And we think that the quality of the carbohydrates and the quality of the fats are key. That's actually our first point. We agree that saturated fats, at least for the general public who are also eating a lot of carbohydrate are going to raise cardiovascular disease risk now. This is a hotly contended topic. And it's not saying that we're not saying that saturated fat is public health enemy number one. That was a mistake that was made in the seventies and eighties and justified removing saturated fat and replacing it with sugar and starch, but we're saying compared to unsaturated fats for the general public too much saturated fat will raise cardiovascular disease risk, but we leave open the possibility that if you're eating a low. Carbohydrate diet, which will necessarily have a lot of saturated fat that in that state saturated fat may not be an issue. Why would that be we don't go into this much in the paper? But the ideas that when you're not eating a lot of carbohydrate the saturated fat that you consume is rapidly burned. It's rapidly oxidized metabolize. And so it doesn't stick around long for your body to to cause problems the amount of saturated fat you eat on a low carbohydrate diet doesn't reflect how much saturated fat is in your bloodstream. Dr ludwig. I wonder how your study in B M J has changed the thinking of some of your colleagues, and even perhaps some people who have been critical of your research. It is revolutionary and I wonder if it's starting to change the thinking that not all calories are created equal. Are studying B M J is among the largest and longest and most rigorously conducted to address the specific question. But it's also just one study first of all we need replication one study can never answer all questions on on a major topic like metabolism and obesity. So the study needs to be replicated we need to see how it can be applied. These principles can be applied in a real world setting. Ours was a feeding study where we prepared all of the foods that people consumed for basically a full academic year actually made a total of one hundred and sixty thousand meals during the course of the study. But of course, people will ultimately have to be able to make their own meals and put these principles into effect in a real life setting. We're up domestic in that regard in that people were able to follow these diets, and they were made from normal everyday foods, but that needs. To be examined. And then we need more research about mechanisms. So we don't claim that this is the last word, but we do hope that this study makes a more credible case for a principle that we actually all in too many of us intuitively. No one hundred calories of sugar and one hundred calories of almonds. Don't do the same thing to our bodies right hundred calories of almonds actually are a lot more filling because presumably because of the fiber. I don't know if that's the actual reason. Well, the according to the carbohydrate, insulin model when you're eating less processed carbohydrates doesn't mean getting rid of all carbohydrates, but getting rid of these highly processed sugars and starches. Levels of the hormone, insulin drop that helps to redirect calories away from deposit, in fact cells and toward the muscle the organs in the brain to help support metabolism to help you feel more satiated more full after eating and to help you burn off those calories. Dr lead the reason, I'm assuming that you all provided prepared one hundred and sixty thousand meals during that academic year and provided them to the people in your study was that that way they were much less likely to stray from what they were supposed to be eating because nutrition studies are notoriously difficult, and one of the most difficult parts is getting people to actually eat what they're supposed to end not eat what they're not supposed to so. Does it really seem likely that what you found in your study will be translatable into real life? There two basic questions that need to be asked in nutrition. Studies one is how to foods affect the body metabolism hunger. The expression of genes how do those foods affect the body under optimal conditions when you can control everything the second question is how do we take that knowledge and develop behavioral interventions and environmental public health strategies to help people eat in a way that's going to best support their health. The problem is these two questions get conflicted. They get mixed up into studies. So obscuring the signs many, unfortunately, many of the most died studies or behavioral where you tell people. You know, you're going to eat a low fat diet, and you're going to eat a high-fat diet. Or a high protein diet? And here's some recipes meal plans will meet as a group with a dietitian three or four times over the next six months now, go out and do it. Actually, I'm going to disagree with you, Dr Ludwig, I think most of these studies are epidemiological in h and so well, some researcher says, well, what are the people in northern China eating? Yes, they're eating rice. That tells the story and somebody else does. Well, I'm going to study the people in Italy in look at the Mediterranean diet, and they're not even controlled they're just sort of. Well, we make assumptions about what they're eating and then draw conclusions which may be completely inappropriate. Yeah. Well, the certainly problems with epidemiological studies, and they can be misinterpreted. There's a range of quality that doesn't mean all epidemiological observational. Studies are are this leading many critical, and there's some questions we can never ask with a clinical trial. But there's this Doshi. In that just because it's a clinical trial means it's high quality data. And that's not the case in most dietary behavioral trials where you put people even if you randomize them on different diets the level of support the intensity of support is low. So that people don't maintain differences in their ways, they're eating, and how do we know that will you can look at biomarkers things that we'd know should change in the blood. If people are eating one way or the other and more often than not these biomarkers show, virtually no difference between the diets so out of these studies, people conclude that diet doesn't matter and it's all about compliance. But that's a false conclusion. What we have to clue from these studies as we need more intensive interventions. The think of doing a study with a new cancer drug. Let's say you came up with a potentially remarkable cure for childhood leukemia, and you put one group of kids. Assigned one group of kids to consume the strike and another group to consume a placebo. But it turns out they never took the drug maybe it was too expensive to afford. Or maybe the parents couldn't find a pharmacy that provided it or maybe there were minor side effects that could have been worked with would you conclude that the drug didn't work? No, you'd say we need a better study before we dismiss that truck. Unfortunately, that basic logical principle doesn't apply to most diet research. How did your research work did people follow it for the most part and did your biomarkers reinforce that idea? So in our study, we didn't use behavioral approach we did a feeding study where we actually produced and provided meals for all of our participants. Basically for a full academic year. It was based on a college campus framingham state university in Massachusetts. And because we were providing foods observing at least one meal a day. For most people and making it really easy for them to eat this way, we could confidently obtain much higher levels of compliance and our biomarkers. We looked at multiple ones demonstrated that very substantial and sustained discrimination between the groups which lets us know that they were actually eating very differently and that provides a basis for making more informative conclusions about how diet affects biology. The next step is to figure out are are these findings real can they be replicated? And if so how can we apply them to a real world setting? But we don't want to jump to that translation to quickly that was the mistake made in the nineteen seventies and eighties with the low fat diet. We jumped to try to get population to change their ways of eating without understanding how that new way of eating would actually affect our biology. You're listening to Dr David Ludwig. He's a pediatric endocrinologist and professor of nutrition at the Harvard t h Chan school of public health. Dr Ludwig is professor of pediatrics at Harvard Medical School and director of the new balance foundation obesity prevention center, his books include ending the food fight always hungry and always delicious unitary. This kind of study is unusual number one that they controlled for the food intake, so carefully. You know morning noon tonight, they had large number of people involved. And it was a long-term study months. Well, in fact, the fact that they prepared a hundred and sixty thousand meals for those participants during the study that's pretty impressive after the break will find out what seems to work to help. People lose weight sometimes exercise mix people super hungry. What's going on? How can you manage this affect what it makes sense to reduce easy access to processed carbohydrates through pricing or taxes? How does a low carb diet change our bio markers, and how should we interpret those changes, and which biomarkers might be most helpful in detecting and preventing diabetes and heart disease. You're listening to the people's pharmacy with Joe and Terry Graydon. If you've Allieu the health information, you get when you listen to the people's pharmacy consider subscribing to our Email newsletter. You'll get the latest health news and information on upcoming podcasts delivered to your inbox twice a week look for the link at people's pharmacy dot com. Welcome back to the people spire Masih. I'm Terry Graydon, Joe Graydon to purchase a CD of today's show or any people's pharmacy broadcast. You can call eight hundred seven three two two three three four today show is one thousand one hundred forty nine that number again, eight hundred seven three to twenty three thirty four or you can find it online at people's pharmacy dot com. You can also download the free podcast for my tunes or from our web store, and we invite you to consider writing a review that people pharmacy is brought to you in part by Kaya deke's probiotic products made in Germany from hypoallergenic organic ingredients K A Y A -biotics dot com. The diet wars have been raging for years each side has ardent proponents. Those who insist that a low fat diet is the best way to control weight and those. Those who are convinced that a low carb diet is better have had a hard time finding common ground for far too long. The nutrition arena has been dominated by such preconceived ideas, large scale surveys. Don't always provide the details. We need to understand how nutrition works at a metabolic level, the carbohydrate insulin hypothesis was recently tested in a rigorous trial conducted by our guest, we're talking with Dr David Ludwig. He is co director of the new balance foundation obesity prevention center at Boston children's hospital. He's also a professor of pediatrics at Harvard Medical School and a professor of nutrition at Harvard Chan school of public health. Dr Ludwig has written three books for the public ending the food fight always hungry, and the cookbook always delicious that led wig. We understand. You have some exciting future research in mind. Can you tell us a bit? About it. Sure. Well, our most recent study, which we called f s to framingham. State. Interstate study looked at what happens when you keep bodyweight the same. What happens to metabolism? And we saw that metabolism. Speeds up by about two hundred to two hundred fifty calories a day on a lower carbohydrate diet twenty percent carbohydrate. But the next question to ask is what happens when you lock calories on these different diets what happens to body, bodyweight and most importantly body fat. And that's the purpose of our next study. And in fact, we're taking to the next level of rigor in our last study, we prepared foods for people and observed meals being consumed, but they were free living and some degree of noncompliance is inevitable. So to look at changes in body weight or body fat. We've got it. Make sure that everyone is eating. Exactly the same number of calories. This is the ultimate test of whether all calories are like and so to do this. We're presently recruiting honored and twenty five people who will I lose on average about fifteen percent of their weight on a low calorie low carbohydrate diet, we'll stabilize them and then stabilized their weight and then at that new lower weight, they'll take up residency at a beautiful lakefront retreat center in the woods. Very isolated long away from any long way away from fast food chips crackers soda as we'll be able to maintain twenty four seven oversight of our participants. Giving them every Neil that they're observing every meal that they're consuming closely monitoring their metabolism and then doing eva-britt studies of their body composition in. In other relevant biological outcomes. So that studies ongoing we welcome anybody in the greater New England area to apply it's called the F B four study, and you can find us at Boston children's hospital. So this study is really our next up. But we also need other. Studies by independent groups to ask these questions into fit ways that let read the last time we talked to you. You had just published always hungry, and that book has a number of stories in it about people who have come to you for help, which you mind sharing a couple of stories about how people approach weight loss, and what seems to work, and what doesn't seem to work. Right. So we're undergoing so we're making a transition from science which is meticulously controlled two, anecdotes and. Any import? Yes, they really show us. And there's a long history of case stories case studies and medicine, but it's important to note that anecdotes are just individual experiences, and they don't necessarily apply to everybody. But with that said, I'm happy to to summarize some common stories that we've heard both in the pilot project leading up to our book. But also in our Facebook group, we have a free and noncommercial Facebook group called the official always hungry book community. We welcome your listeners to join and very frequently. We hear that when people give up processed carbohydrates phase one of our three face program brings carbohydrates down to twenty five percent. So you can still have whole fruits plenty of vegetables and other sources of carbohydrate, but in at least for two weeks. Completely eliminates the processed grains sugar potato products, very common antidote is that before people have seen any weight loss. They suddenly experience a shift in their control around food. In other words, the go to a party, and the, you know, the keys the cake the ice cream are displayed. Whereas it used to be a constant battle for them. They have to walk out of the room. So is not to be tempted somehow those foods very quickly lose lose their power over people that people are able to take a bite and say, all right. That's you know, that's nicer might they might even say, wow, that's just too sweet. I don't like it anymore. But they're now more in control. And then once that shift has happened. That's a very good sign that the the weight will will come come soon. One of the things that is sort of. We'll say semi personal as we know an individual who exercises really vigorously and sometimes at the end of that exercise experience, there's this ravenous hunger feed me feed me now or I will kill you kind of situation. I'm wondering what's happening metabolic -ly after somebody has like maybe run ten or fifteen miles, and then has this incredible hunger that requires immediate gratification. That question goes to the heart of why it is so difficult to lose weight and what our current paradigm of calories in calories out. All calories are like might be missing. We know that simply cutting back on calories shut low calorie diet should produce weight loss. But it's so hard to follow and that's not just poor willpower. People who try to lose weight are very disciplined. But somehow, they get overwhelmed with hunger and the same is true, physical activity time, and again analyses of exercise studies show that it's certainly a good thing for health might improve your cholesterol or lower some other cardiovascular disease risk factors, but exercise is a really poor way to cause weight loss in any reasonable timeframe over months even a few years, and that again has to do with the same problem that the body fights back against efforts to change wait that when you eat less. Your body says I need more calories. And when you try to burn off calories without. Changing metabolism through exercise. The same thing happens you finish the exercise. You burned off a lot of calories, but your body is screaming at you. What we need to do is figure out what is going on metabolic -ly. That's driving weight up year after year after year making the average person way twenty five to thirty five pounds more than forty years ago. If the problem is hormonal if the problem is too much insulin caused by all of the processed carbohydrates and our diet, then just cutting back calories while continuing to eat all those process carbohydrates trying to force calories out of the body with exercise is setting up a battle between mind and metabolism were doomed to lose. So it sounds as though your recommendation, essentially as a policy would be to reduce the amount of processed carbohydrates that we all have. Such easy access to. Many of the policy recommendations that would naturally flow from this way of thinking are already being incorporated in a we we we all now recognize that the de-emphasis on sugar that the the focus on just getting rid of all fats. Remember, the top of the food guide pyramid. Put all fats knots. Avocado olive oil dark chocolate some of the foods that we know are exceedingly healthy in don't promote weight gain per se. They were all put at the top and a whole host of processed carbohydrates six to eleven servings were placed at the bottom sugar was identified only as a concern for special populations specifically children at risk for getting cavities. So we all now recognize that that obsession with fat, and you know, the the past that was given processed carbohydrates was a mistake. And we need to be cutting back on sugars, processed grains too much. Potato products where are this carbohydrate, insulin model this way of thinking about obesity, would take it to the next step is that we want to bring the total amount of carbohydrates down a bit doesn't mean getting rid of all them. In fact, you can still have plenty of whole fruits vegetables, certain kinds of root vegetables. And some minimally processed, grains, the kinds of grains, that we would have consumed generations back things. Like steel cutouts, barley teff keen watt. These are slower digesting. So you can still have some of those. But we want to emphasize the healthy fats olive oil nuts nut butters full-fat. Gary. There's really no advantage of fat free milk overhaul milk and then get enough protein, and that this will be a more sustainable way for most people to maintain a healthy weight over the long term Dr. Twig in the old way of thinking fat was blamed for not just obesity, diabetes, and heart disease, and possibly even cancer that has to a larger extent been discredited. I'm wondering in your study in which for example, the low carbohydrate group who were getting twenty percent of their calories from carbohydrates sixty percent of their calories from fat and twenty percent if I'm not mistaken from protein, how did their biomarkers respond is that kind of diet the so-called low carb diet in your group? Did they have better biomarkers when it comes to things like, diabetes and heart disease? We just published the initial results of the study, and we're still in the process of examining a whole range of diabetes, and heart disease risk factors but included with that I study where. HDL cluster all in triglycerides. We included them as compliance markers. We know that triglycerides HDL change in predictable ways with increasing and decreasing carbohydrate. We saw that that was evidence that people were complying and to answer your question. The those two that we didn't look at everything we haven't yet looked at LDL cholesterol, and such but those two improved markedly on the low carbohydrate diet, triglycerides, decreased and HDL increased and those are key risk factors that relate to insulin resistance and metabolic syndrome, and that's a good thing to have HDL higher and triglycerides lower. Absolutely. In fact, the the ratio of triglycerides to HDL clustering is a key marker for metabolic health. How? Sensitive. You are to insulin. How likely you are or are not to get diabetes and heart disease, and this ratio looked best on the low carbohydrate diet, but a hasten to add we haven't looked at a whole range of other cardiovascular disease risk factor set. But let me just say that there is an extensive body of research on fat intake, and diabetes and heart disease. We know that some of the highest calorie highest fat foods around nuts olive oil of KADO real dark chocolate that despite their maximum calorie density. They look great for long-term, diabetes and heart disease risk. Compare those to the processed grains added sugar or potato products, which characteristically top list for weight gain and chronic disease. So Dr Ludwig in the very short time, we have left what should our listeners take away from the scientific findings of your study. Well, the the scientific findings are going to need to be replicated. So we can't make specific recommendations from this one study, but my view of based on the the strength of the literature in support of the carbohydrate, insulin model of obesity is that we want to focus on reducing the processed carbohydrates that invaded our Dieter in the low fat years so much less processed grains, potato products and headed sugar. You can still have plenty of whole fruits, especially the non tropical fruits, you know, not so much banana, but the whole fruits non starchy vegetables some root vegetables beans, small amounts of minimally, processed, grains, maybe a touch of added sugar, but to really emphasize the healthy fats, the ones we talked about, you know, others absolutely no reason to be consuming fat-free rather than full-fat trash. In fact, olive oil OB, you know, one of the most healthy things we can add to a meal of KADO nuts, dairy, if you're eating dairy make it full-fat, tastier. It's more satisfying. And then we wanna get an adequate amount of protein. But that doesn't tell us what what the sources, you know. Proteins can come from animal or vegetable products in one can eat a low fat diet with plenty of animal products, like Turkey breast, egg, whites low fat, dairy or one can eat a high-fat diet with plenty of plant products such as the healthy fats that we discussed actor David Ludwig. Thank you so much for talking with us on the people sperm ac- today. The pleasure to be back again with you. You've been listening to Dr David Ludwig. He's co director of the new balance foundation. Obesity prevention center at Boston children's hospital. He's also a professor of pediatrics at Harvard Medical School and professor of nutrition at Harvard t h chance school of public health. Dr Ludwig has written three books for the public ending the food fight always hungry, and the cookbook, always delicious Lynne Segal produced today show would our ski engineered Dave Grayton at. It's our interviews. People's pharmacy is produced at the studios of North Carolina public radio W U N C that people sperm ac- thing music is by B J Liederman. The people's pharmacy is brought to you in part by Kaya deke's probiotic products made in Germany from Hypo allergenic organic ingredients, that's K A Y A -biotics dot com. If you'd like to buy a CD of today's show or any other people spire Masih episode you can call eight hundred seven three two two three three four. Today's show is number one thousand one hundred forty nine that number again, eight hundred seven thirty to twenty three thirty four or you can place the order online at people sperm ac- dot com. When you visit our site, you can share your thoughts about our conversation with Dr David Ludwig have you found success with a particular approach to weight loss? Tell us about it. In the comments section for today's show at the website. You'll also find links to the publications we discussed today in the B M J in science and in JAMA internal medicine. There's also a link to an article Dr Ludwig wrote for the LA times, titled the case against carbohydrates, get stronger at people's pharmacy dot com. You can sign up for our free online newsletter or subscribe to the free podcast of the show. When you sign up for the newsletter. You get our free to favorite home remedies in Durham, North Carolina. I'm Joe Graydon and. Terry Graydon, thanks for listening. Please join us again next week. We hope you enjoyed this podcast if so please consider taking a minute to write a review on tunes and thanks for listening to the people's pharmacy.