<p>You can tell how significant (and controversial) a new diet study is by the prominence of the “experts” trotted out to write the editorial critiques. When the Journal of American Medicine trots out he granddaddy of American US nutrtiion, George Bray, to write the “hummina hummina’s” in response to a new study, you know it’s a big deal. And, that’s the case in the new issue of JAMA, with the publication of a major NIH funded study and George Bray’s editorial.</p>
<p>The study was an incredibly expensive 4-year endeavor by Harvard Medical School professor David Ludwig and conducted in part at the Boston Children’s Hospital, in part at Brigham & Womens Hospital in Boston, and in part at Baylor in Texas, funded entirely by NIH. This is gold-plated research. They paid 21 overweight men and women $2500 each to:</p>
<p>a) lose an average of 12% of their body weight on a carefully controlled diet (45% carb, 30% fat, 25% protein)</p>
<p>b) Then spend a month each on three different maintenance diets prepared for them by the study with fixed calories, but different compostions: one month on a low-fat diet (60% carb, 20% fat, 20% protein), one month on a very low carb Atkins diet (10% carb, 60% fat, 30% protein), and one in-between low-gycemic index moderate carb diet (40% carb, 40% fat, 20% protein). The kicker is that at the start of study and again at the end of each of the month-long maintenance diets, each participant was hospitalized for an extensive battery of metabolic tests, including comprehensive measurement of the daily resting energy expenditure (zero exercise) and their total energy expenditure (days where they were allowed to exercise). Weight maintenance was the same on all three diets (as you would expect from the same people eating the same calories.</p>
<p>**Everything else was different! ** Most significantly, the energy expenditure on the maintenance diets (both resting and total) was highest on the low carb diet, lowest on the low fat diet, and in between on the in-between diet). With such large weight loss, all of the subjects burned fewer calories at their lighter weights, but the drop off was less pronounced when they were eating the low carb maintenance diet. Something metabolically was going on to keep the energy expenditure higher, just from eating low carb.</p>
<p>They also measured insulin sensitivity (the opposite of insulin resistance). At the end of the month of low carb eating, the subjects had the highest sensitivity to insulin. They had the lowest sensitivity at the end of the low-fat month. And, again, in between for the in-between diet.</p>
<p>These are pretty significant findings in support of the notion that a calorie is not just a calorie and that there are hormonal/metabolic complexities to this stuff. Obviously, burning an extra 300 calories a day is an advantage for maintaining weight loss.</p>
<p>Here’s the layman’s article on the study in USA Today, with quotes from a Who’s Who list of nutritional luminaries:</p>
<p>[Low-carb</a> diet burns the most calories in small study ? USATODAY.com](<a href=“http://www.usatoday.com/news/health/story/2012-06-27/calories-low-carb-weight-loss/55843134/1]Low-carb”>http://www.usatoday.com/news/health/story/2012-06-27/calories-low-carb-weight-loss/55843134/1)</p>
<p>Here’s the PDF of the full-study in JAMA (it’s a tough slog to get through it…)</p>
<p><a href=“http://jama.jamanetwork.com/data/Journals/JAMA/24277/jpc120005_2627_2634.pdf[/url]”>http://jama.jamanetwork.com/data/Journals/JAMA/24277/jpc120005_2627_2634.pdf</a></p>
<p>And, here’s George Bray’s editorial trying to poke some holes in what he describes as a “well-designed” study. As perhaps the world’s most prominent proponent of “calories in/calories out”, Bray had to have indigestion on this one:</p>
<p><a href=“http://jama.jamanetwork.com/data/Journals/JAMA/24277/jpc120005_2627_2634.pdf[/url]”>http://jama.jamanetwork.com/data/Journals/JAMA/24277/jpc120005_2627_2634.pdf</a></p>