What's a Healthy Diet?

Over at the GCBC post on weightology.net, Fred Hahn weighed in with statements about low carb diets being the most healthy.  He also repeatedly mentioned speed of weight loss regarding the health of a weight loss diet.  He also seemingly mocks adherence as a factor to consider.

I really believe that in the long run, a healthy diet is one that allows you to maintain a healthy weight.  That need not necessarily be super lean or buff either.   What REALLY gets lipids, blood sugar and hormones out of whack???  Being in chronic positive energy balance, OR being in chronic negative energy balance.  Catabolism is a stressful state, so a case could be made for taking expediency into account.  But the more extreme the caloric restriction (and LC works by creating this spontaneously in most people) the more stress.

Blogger Jimmy Moore, having regained roughly 1/3rd of his 180 lb weight loss over the past couple of years recently went on an "eggfest".  Actually if one looked at his menus for his month long experiment, this could probably have been called a butter fest, but that's not the point.  This was a very high fat, very low carb diet, but something else also happened, Jimmy cut calories.  Jimmy doesn't always post portion info over at his menus blog, but given the amount of added fats he was probably consuming double that prior to going on this diet.  He lost around 30 lbs in a month.  Then he added back meat and very few carbs from veggies and started to see a stall and small gains.  But what else did he add?  Around 4-500 cal/day on average.  Yet to this day he cannot bring himself to recognize the plain truth right there in front of him.  It's the calories stupid!  (And if Jimmy should happen to read this, no I'm not calling you stupid)  -- I've followed his blog for a little over a year now.  When intake went down so did the weight and vice versa.  Jimmy also had blood lipids done after the eggfest, and they were horrible.  I'm not trying to pick on Jimmy here, but this version of LC, at least in the short run, is not reaping improvements in those lipids.  He's been assured by LC experts that this is perfectly normal for someone who has lost significant weight as quickly as he did.  Normal and healthy are not the same thing.  It is normal (aka expected) for lipids to go awry during rapid weight loss and/or drastic dietary change.  So I leave the question out there -- is the most expeditious reducing diet necessarily the healthiest?  Is it better in the long run to lose weight as fast as possible to have the shortest period of haywire lipids, or would it be healthier to lose weight more slowly while stressing the body less?

So what about adherence.  Study after study after survey after survey demonstrates that the single best predictor of success in losing and maintaining weight, is COMPLIANCE.  There are some that can remain on a VLC diet for all eternity.  More power to them.  But what of those who can't?  Read any LC discussion board or various blogs and such and one will find a ton of postings by folks who go up and down the scale and almost invariably the ups were periods of "falling off the wagon".  Myself, my first LC stint I lost 40 lbs.  But when I went off, and couldn't find a way to get back on the wagon, I not only gained 40 but tacked another 60 lbs on top of that!!!  Then you have those who slowly regain as the appetite suppression or whatever wears off.  LC is my chosen WOE because it requires the least amount of attention.  Eat low carb foods and it is difficult to get the count up too high.  But after a while it is easy to consume too many calories.  This is usually blamed on carb creep, but everyone who has re-gained on LC can't all be lying.  Jimmy's foods weren't always perfect, but he was pretty consistently LC but packed on 20 pounds last year.  Thing for LC is that long term compliance may require added effort for some -- carb restriction may not be sufficient to maintain energy balance.  Bottom line, lifestyle change is what works, and it has to be something that can be kept up for the long term.

The web abounds with examples of folks eating LC diets without losing weight and even gaining.  Is low carb healthy in this context?  This is my biggest concern, especially where elevated NEFA's are concerned.

I hear a lot that "low fat made me fat", but I don't believe this.  Low fat reducing diets, especially for women, tend to be too low in protein for adequate satiety.  Therefore they can be difficult to adhere to.  Going off a low fat diet can make you fat.  For me going off a low carb diet made me truly fat.  And no, I didn't binge my way up 100 lbs either.

In any case, Atkins probably didn't intend the super rapid losses on Induction to be the primary goal of that phase as much as getting into ketosis to kickstart the appetite suppression, etc.  But so many long time low carbers do induction for a while then fall off and go on carb binges, and repeat the cycle.  Studies have shown that regardless of diet type, yo yo dieting is HORRIBLE for your health.  With LC I think it is even worse.  Consider that long term low carbing induces an insulin resistant state that essentially makes us semi-diabetic.  Low carbers are advised to "carb up" for several days before taking a glucose tolerance test because insulin response and/or sensitivity is likely impaired.

Whatever level of carbs someone considers "healthy", if  a person can't adhere to that fairly consistently, especially if they binge and gain in between so that their body is essentially perpetually in flux, that can't be healthy.  This is why, although I still weigh more than I would like, I am most satisfied with the fact that I have never back-slid in the past three years (more than a few pounds on vacation).  I think our bodies can handle the occasional indulgence ... severe obesity is unhealthy, yes, but so is chronic energy imbalance.

I think Fred is trying to argue that LC is "intellectually" the healthiest diet.  I'm not sure I would agree with that, but I guess I wonder in the end if that matters much.  If low carbers think they'll gain "converts" or do anything for the "cause" by peddling flawed theories and trashing anyone who disagrees with them for "not getting it" they're sadly mistaken.  If the absolutism that permeated the low fat contingency permeates LC it will be counter productive.  There really aren't examples of longevity amongst cultures consuming VLC diets.  Anyone pointing to the Inuit and the Masai as relevant to their diets is fooling themselves.  There are examples of longevity in cultures consuming moderate and even high carb diets.

I leave you with this graphic from the Shai study commonly cited for the superiority of LC diets.

Which is healthier?  Mediterranean where most of the losses were achieved in ~6 months and then maintained on average for 18 months, or LC where greater losses were achieved in that time but the difference was regained over the next year?

Do these lipid changes make a difference in the long run?

This study was published roughly 2 years ago.  A "where are they now" would be interesting to see.