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Friday, July 8, 2016

Weight Loss on a Very Low Fat High Sugar Diet

A Facebook friend recently posted a screenshot of some papers he'd been reading this past month.  Being the geek that I am, I of course scanned the titles to see if there was anything I might be interested in, and I was shocked to discover this study for the first time!  Shocked in that I'd never seen it before or seen anyone reference it.  Read on and discover that this isn't quite true ...  (As of this post, full text available HERE.)

Metabolic and behavioral effects of a high-sucrose diet during weight loss ... 1997 ← Almost two decades ago!!

Promoters of extreme diets -- culturally, nutritionally and otherwise -- seem to be fanning the flames of the anti-moderation fires of late, and as such, the whole "addictive carbs", "all carbs are sugar" etc. mantras are being bandied about. 

recent image search on sugar fattening
I'm much busier than usual this summer so make no promises but hope to put out a rant on that soon!   I have no problem with however anyone wishes to live their lives and form their relationship with food.   I do, however, have a huge problem with presenting clearly disordered behaviors as healthful and encouraging others to adopt similar lifestyles.   I especially rebuke efforts to demonize foods based on lies and hyperbole and often simply arbitrary edicts.    In calling this out, I do not, however, wish to be seen as an advocate for eating a diet high in refined foods.  I don't see that as a healthy lifestyle, though I'm sure many a person has lived a long and disease-free life living such a way.    

That said, the following passages from this 1997 journal article demonstrate how this whole "cutting the fat means upping the sugar" dichotomy has been around for a long time.  
Both epidemiologic and experimental evidence link the high incidence of obesity in the United States with the high fat content of the American diet (1-6). Consequently, health advocacy groups, including the American Heart Association and the American Diabetes Association, have recommended reducing dietary fat to achieve as well as maintain weight loss (7, 8). The food industry has responded with a cornucopia of reduced-fat and nonfat food items, many of which derive a relatively high percentage of their energy from sucrose or other sugars.
As a veteran of dieting in that era, I find this odd.  Long, LONG, before ever trying low carb, I learned that you cut sugar to lose weight.  Even before there were palatable alternative sweeteners, there were tons of sugar free products.  While some diets may have opted for a half-cup of regular Jello (~20g sugar, < 100 cal) over a mini-cup of Haagen Daz (same ~20g sugar,  ~ 250 cal) we certainly weren't encouraged to add more sugar to the diet.   I wasn't a habitual sugar consumer at the time, but I certainly didn't take up eating it to replace fat I was cutting.  To the contrary, I added a few sugar free things I didn't previously consume --  ♬Tab cola jingle playing in head!♬.   I challenge folks to look through old women's magazines and find any diet plans that advocated sugar.  You may find some that, like Mark Sisson, allowed for a teaspoon or two in coffee, etc., but nothing like what you're about to see.  And yet, in What if I'm a Big Fat Liar What If It's All Been a Big Fat Lie, Gary Taubes claimed that sugar had escaped vilification and sodas were given a pass (leading to skyrocketing consumption).
...  if you bought the glycemic-index concept, then you had to accept that the starches we were supposed to be eating 6 to 11 times a day were, once swallowed, physiologically indistinguishable from sugars. This made them seem considerably less than wholesome. Rather than accept this possibility, the policy makers simply allowed sugar and corn syrup to elude the vilification that befell dietary fat. After all, they are fat-free.
Sugar and corn syrup from soft drinks, juices and the copious teas and sports drinks now supply more than 10 percent of our total calories; the 80's saw the introduction of Big Gulps and 32-ounce cups of Coca-Cola, blasted through with sugar, but 100 percent fat free. When it comes to insulin and blood sugar, these soft drinks and fruit juices -- what the scientists call ''wet carbohydrates'' -- might indeed be worst of all. (Diet soda accounts for less than a quarter of the soda market.)
The dishonesty here astounds me, and always will, because this doesn't square with any recollection of what I learned about healthy eating.  Soda was way up in the peak of the pyramid as an occasional treat.    Nonetheless, our researchers saw a problem that needed addressing: 
... questions regarding the prolonged effects of dietary sugars on weight loss or weight maintenance remain unanswered.  Epidemiologic evidence suggests that obesity, insulin resistance, and non-insulin-dependent diabetes mellitus (NIDDM) are associated with high-fat diets (1-6, 9), whereas carbohydrate intake, including sucrose, is negatively correlated with the incidence of these problems (1, 9).  ...
... Another potential problem with low-fat, high-sucrose diets is that high intakes of carbohydrate, especially sucrose, are purported to lead to metabolic derangements, particularly with regard to lipids. [... listing of findings ...] Other studies, however, suggest that increased dietary carbohydrate leads to elevated triacylglycerol concentrations, hyperinsulinemia, and hyperglycemia only when fat and energy contents are not reduced ( 13, 22). These conflicting reports indicate that the metabolic result of long-term consumption of high amounts of sucrose (or indeed complex carbohydrate) on weight loss is not known.
These researchers seem to presume low fat goes with high sucrose, but they ran with that ... 
To determine both the safety and efficacy of high-sucrose foods during weight reduction, we studied the comparative effects of high- and low-sucrose, low-fat, hypoenergetic diets on a variety of metabolic and behavioral indexes in subjects in a controlled weight-loss program.
... with some surprising results ... to some, anyway.   

What happened when they put women averaging about 40 y.o., 35 BMI, 210 lbs, and fed them 1100-1200 cal/day of a low fat diet for 6 weeks?  

They all lost weight.  Fairly consistently.  The weight loss was around 15 lbs (average 2.5 lbs/week) of which around 10 lbs was fat (1.67 lbs/week).

When one diet was high in sugar, and the other not?  They lost roughly the same amount.    

Since energy expenditure is in the news, it is interesting to note that their roughly 1500 cal/day REEs did not change (but more importantly put TBL values in context).

I might add that this was what I've come to call a semi-metabolic ward study -- not as compliance-controlled as actually admitting people to a secure facility, but all foods were prepared for the subjects and provided to them, and there was regular face-time/consumption at the facility.  This is somewhat similar to Ebbeling-Ludwig 2012 study that has been unearthed to "prove" metabolic magic in action.   The compliance is evident in the weight/fat loss.  Here were the averaged diet macros and micros for a week's worth of food (they were also given a women's One A Day).

The first thing of note is that these are actually low fat diets, both by percentage (~11%) and absolute amounts (< 15g or about 1T).  The high sugar diet is almost 60% sugar calories, coming from 120 grams sucrose.  This amounts to about that in a liter or 3 cans of Coke, or about half a cup of sugar.  I find the menu interesting for a few reasons:

The degree of refinement is similar in the control diet which is a refreshing change from comparing instant oatmeal to eggs and spinach.  But I find the choice of foods -- double frosted Rice Krispies, marshmallows, jello,  drink mixes and meringue cookies -- especially interesting.  I followed a few diets in women's magazines in my day and there was no frosted Rice Krispies, let alone double frosted!  No, you got the Special K (original!) type cereal.  On the right, cereal and a bagel?  Rice and a roll with dinner?  This is nothing like what I recall as your typical 1200 cal/day fare.  But the food choices on the right side seem much more reasonable than those on the left, which just goes to show how "out of the way" these researchers needed to go to create a sixty percent sucrose diet!    Also, this low fat diet looks nothing like the "LF" SAD we're supposed to believe made us all fat!

But it's not about weight loss it's about health gain.

The world's least healthy health guru is fond of saying this of late.  If it were true I'd be the first person to support him!  But first, we need to be honest and admit to ourselves that, HAES (Healthy At Every Size) rhetoric aside, at some point excess adiposity negatively impacts most who have it.  This is especially true when your health markers -- all of them, not those cherry picked few that may or may not even have clinical significance -- paint a dismal picture.  

As the article states, high refined carbohydrate and sugar in particular has been associated with increased triglycerides and a worsening lipid profile.  This was long before the Cox and Stanhope trials in more recent years.  The main issues with those studies are:
  1. Calories weren't controlled for and "substituting" 25% of baseline intake with "sugar" sweetened beverages led to a chronic caloric surplus and weight gain.
  2. Sugar was not tested.  Drinks were either isolated fructose or glucose sweetened.  Isolated fructose unbalanced by glucose is rare in nature (agave syrup is the only example I can think of) and therefore metabolic effects are difficult to generalize to any typical diet.
"Looking back" one wonders why they even did such a study.  After all, Surwit had been on the books for a decade plus.  Here are those lipids.
table adapted from Table 6 to group results by treatment
For the triglycerides, the high sucrose went from about 105 to 95 mg/dL, and from about 115 to 95 in the low sucrose group.  These results are important in that they isolate the effect of sugar and even refined carbs from fat and total calories.  The lipid profiles improved nominally in both cases.  Does this mean folks can eat high sugar diets and be "safe"?  No.  Not if they also eat high fat and calories (and I'm not saying high fat is inherently high calorie).   The reason Stanhope/Cox/Havel and others are able to show a deleterious effect is due to the combination with other factors.  As always, context matters and these results do not exonerate these dietary agents.  However the commonly misconstrued mechanism of triglyceride and/or LDL production and refined carbohydrate -- particularly fructose -- is not supported by these results.

Bottom Line

Sugar, or the fructose that is part of it, is NOT in and of itself fattening or metabolically harmful.   If it were, results like these, and those seen on the Kempner diet would not be conceivable.

Diets "high" in refined carbohydrate do not impede weight loss.  Compared with each other sugar is no different from refined starches.

And Now, A Flashback!

I just knew that name Surwit sounded familiar.  It's probably from some other article I've seen from this research group, or perhaps it's because it made it into a title of a post on Petro Dobromylskyj's Hyperlipid blog:  Surwit and sucrose or when is a high sucrose diet a high fat diet?   According to Peter, this is "a core paper on why you should be cautious about simply accepting conclusions from papers without thinking them through."

By "thinking them through", perhaps he means arbitrarily omitting data points that don't support your biases?    Who knows.  Peter sprinkles some math on over 120 grams of sugar to contend that these subjects were actually "eating" a high fat diet because of all the (body)fat calories they were "consuming".  Ugh.  Make it stop please?  But such passed for scientific high-mindedness back in 2011.  And since he invoked Grey & Kipnis in the Surwit post, it is worth revisiting that as well.

Three of the obese women in that study were put on iso-protein hypocaloric (1500) alternating liquid diets of essentially sugar vs. fat.  They all lost weight.  Consistently.  QED.

How many more millions are going to be wasted on this fraudulent crusade to blame something or someone else?

1 comment:

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