After one month, the response has been nothing short of phenomenal. People from all over the world have been pouring in, sharing their emotional struggles and stunning transformations in vivid detail. Below is a wordle of the responses thus far to the question below, separated by gender. The size of the words in the wordle are a function of how prevalent they were - the bigger the word, the more it appeared.

Worth noting: "Wife" seems to pose a bigger challenge to men than: cravings, pasta, restaurants, or sugar.
 

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The American Heart Association (AHA) recently published a report entitled Triglycerides and Cardiovascular Disease, chronicling the rising rates of serum triglyceride levels and its role in cardiovascular disease, in order to "update clinicians on the increasingly crucial role of triglycerides in the evaluation and management of CVD risk and highlight approaches aimed at minimizing the adverse public health–related consequences associated with hypertriglyceridemic states."

This report is interesting and important for physicians to be aware of, but the major concepts are absolutely predictable with a basic understanding of serum cholesterol responses to carbohydrates in the diet. Simply stated, when people eat carbohydrates their HDL (good cholesterol) goes down and their triglycerides go up. This is uncontroversial, and so consistent that researchers use triglycerides and HDL as objective measures of carbohydrate consumption. Dr. Frank Sacks of Harvard Medical School explains in a recent paper on low carbohydrate diets that "HDL is a biomarker for dietary carbohydrate." High triglycerides and low HDL means the subjects are eating lots of carbs. The AHA's report confirms this as well, explaining that "very high intakes of carbohydrate (>60% of calories) is accompanied by a reduction in HDL cholesterol and a rise in triglyceride." 

Perhaps the most interesting quote in the report comes in the introduction:

"It is especially disconcerting that in the United States, mean triglyceride levels have risen since 1976, in concert with the growing epidemic of obesity, insulin resistance, and type 2 diabetes mellitus." 

It is quite disconcerting, but it is EXACTLY what should be expected. If it is true that triglycerides increase in response to carbohydrates, then one would expect that at some point around 1976, there should have been an increase in carbohydrate consumption. And there was. It was in response to the first ever Dietary Goals for the United States, issued in 1977 by the U.S. Senate Select Committee on Nutrition and Human Needs. Here are the first few recommendations:

• Increase carbohydrate consumption to account for 55 to 60 percent of the energy intake.
• Reduce overall fat consumption from approximately 40 to 30 percent energy intake
• Reduce saturated fat consumption to account for about 10 percent of total energy intake

So the recommendation to eat more carbohydrates happened almost precisely at the same time that triglyceride levels began to increase to "disconcerting" levels. The next question is if people actually followed this advice and ate more carbohydrates. And they did:

As you can see, since about 1976 carbohydrate intake increased and dietary fat intake decreased.

Here is another graph of carbohydrate intake over the past 30 years:

As explained in the introduction, this report will be of value to the Adult Treatment Panel IV (ATP IV) of the National Cholesterol Education Program (NCEP), from which evidence-based guidelines will ensue. 

So what does the NCEP recommend in order to lower our triglycerides? Why nothing more than the exact same recommendation we received in 1977:

"Very high intakes of carbohydrate (>60% of total calories) are accompanied by a reduction in HDL cholesterol and a rise in triglyceride …. These latter responses are sometimes reduced when carbohydrate is consumed with viscous fiber …; however, it has not been demonstrated convincingly that viscous fiber can fully negate the triglyceride-raising or HDL-lowering actions of very high intakes of carbohydrates...Carbohydrate intake should be limited to 60 percent of total calories."

You can read more about triglycerides, HDL and carbohydrates here.


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If you have not seen this yet, it is quite remarkable. Dr. Wahls is a physician who was diagnosed with multiple sclerosis, an autoimmune disease that damages the myelin sheath insulating the nerves in your body. Without myelin, your nerve signals may slow down, or stop altogether. Dr. Wahls went from being nearly bed-ridden, to biking and horeback riding after adopting an intensive, paleo diet.
  

She emphasizes consuming these foods:

• Sulfur rich vegetables - Cabbage,broccoli cauliflower, kale, onions, mushrooms asparagus
• Colored vegetables or fruits - three different colors of vegetables each day - beets carrots, peppers, red cabbage, or fruits like berries and oranges
• High quality protein rich in Omega-3 fatty acids - wild fish, especially salmon and herring, and grass fed meat every day
• Organ meat - liver onion, heart tongue, etc.
• Seaweed - rich source of iodine and sellenium, atleast once a week

She is now testing the effects of this paleo diet on multiple sclerosis in a clinical setting. The results are quite promising. You can read more about her story and foundation here. If you would like to donate to her research, here is more information.

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I recently came across a criticism of the AWLR from the carbsanity blog, criticizing the scientific method and overall veracity of this website. She describes it as a "JOKE", condemning the fact that I describe it as an "international assembly" or that I am interested in hearing from those who have gained or maintained their weight while eating a carb-restricted diet as well: 

"They want to hear if you've gained weight! Yeah ... right ... LOL."

This registry is then compared to the National Weight Control Registry (NWCR), describing how inferior our data is, praising the fact that the NWCR only accepts registrants who have lost weight and kept it off for at least a year.

Strength of the data
Speaking specifically to the fact that the data created from this site is of poor quality, I say you are absolutely correct.  This is conspicuously explained on the about page. The Ancestral Weight Loss Registry is self-selected, self reported data and should not be interpreted as a scientific study. Of course, people can "pad their stats", saying they've lost more weight than they actually did. They can lie, or they may enter false data. This is a simple fact that plagues all self-reported data. The carbsanity author eloquently describes this fact in her post:

"Feel free to fill out this survey from each email you own or don't own.  Make shit up all you want ... just beware, we have very special double secret statistical methods to catch you if you lie!  Really!!  No ... really really!!  Don't lie or we will send out the fraud patrol to spam your fake email address. What a JOKE. "

I would simply hope that the same criticism be conjured up when describing the NWCR data. The fact that the NWCR require their registry members to mail in a packet of information and provide their home address does not necessarily improve the quality of self-selected, self-reported data. 

The carbsanity author describes the NWCR, saying  "In a word, there's a lot of ACCOUNTABILITY.  You have to give them your mailing address, and as memory serves you must provide some visual verification of your weight loss.  Not a lot of optional there."

In fact, her memory may not be entirely correct.  You can give a visual verification of your weight loss (before and after pictures), as you can with the AWLR, but it is not required. As Dr. Wing explains in their published findings, "19% (145 subjects) were unable to provide any source of documentation" verifying their weight loss. 

Exclusion criteria
Carbsanity criticizes me for allowing anyone, whether they have lost, gained, or maintained their weight to join the registry and share their story, as opposed to only allowing those who were successful to join:

"Let's see what we need to join NWCR.  For one thing, you have to have lost a minimum of 30 lbs and KEPT IT OFF for at least a year.  The criteria for joining the AWLR?  Laughable -- we don't care how much you've lost or gained, we want to hear from you?  This IS a joke ... right?"

No it isn't a joke. Only allowing people who have lost 30 pounds and kept it off for over a year is like Yelp.com only allowing you to review a restaurant if you are going to give it 5-stars. Excluding those who may have been less successful biases the data to immeasurable proportions. Those people who are most successful at losing weight and qualify for the NWCR may be systematically different in ways uncaptured by the registry questionnaire, further confounding the already weak data these questionnaires can provide. 

In contrast, I specifically want to incorporate all people who have tried a carb-restricted or paleo diet, whether they lost weight or gained it. I believe this will provide a deeper insight into the most effective ways to lose weight and improve health.

What I hope for this registry to become is not proof that carb-restricted diets are more or less effective than a low-fat diet, or any other way of eating. It is not meant to belittle the findings of the NWCR. Far from it. What I do hope it can be is a lens by which the clinical data can be viewed. The most rigorous data we have on effective dietary practices is the randomized clinical trial. Since the early 90s the potential benefits of a carb-restricted or low fat diet have been tested, and there have been a few consistent findings:

• The carb-restricted, calorie unlimited diet usually - but not always - results in more weight (and fat) loss, than a low calorie, low-fat diet. This has been demonstrated at least 14 times. Whether they spontaneously eat less calories because of the satiating nature of a high fat, high protein diet, or they lose weight due to the net reduction in insulin levels, they consistently lose more weight. You can see all the clinical trials (both successful and unsuccessful here). Each study is linked to its original source in the medical literature.
• The people consuming a carb-restricted diet consistently report feeling full between meals, often eat less at subsequent meals. 
• A carb-restricted diet consistently reduces triglyceride levels, increases HDL levels, and improves the atherogenicity of LDL-C, by morphing these particles from small and dense - associated with high carbohydrate diets, to the large and buoyant LDL particles associated with a decreased risk of heart disease.

These results are consistent in the clinical data and brought about with one sweeping recommendation: Limit your carbs. 

While I agree with Carbsanity that the strength of data created in the Ancestral Weight loss registry is weak, I don’t think Rose or Jackie or the hundreds of people throughout the world signing up to AWLR each day, many of which have tremendously inspiring stories of weight loss and improved health without calorie counting and devoid of hunger, would agree that carb-restricted eating is a “joke”.

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Professor Robert H. Lustig, MD, an obesity researcher and endocrinologist from UCSF describes the carbohydrate-insulin-obesity hypothesis, which is the idea that the high carbohydrate content in our diets is overstimulating insulin secretion, the main regulator of fat storage, causing more calories to be stored in our fat cells as opposed to burned as fuel. This, in turn, will cause the person to remain hungry since a certain amount of necessary energy did not reach the cells but rather was stored away as fat, perpetuating a vicious cycle of hunger co-existing with adipose tissue growth.


This theory was originally presented by Dr. Pennington, many years ago, and is re-emerging, through the efforts of Dr. Lustig and many others.

I started canning weight when I hit puberty.  Not sure what changed with me but life was never the same from then on.  I went from a very thin girl to a girl that couldn't quit gaining weight.  I tried all different types of diets, from the cabbage soup diet, to low calories, weight watchers, and many others.  I did well at first, but then would struggle and back came the weight and the frustration.  I have known since I was in my early 20's that I had insulin resistance and Poly Cystic Ovarian Syndrome, but I never had a doctor explain to me what was the real cause of these issues.  

Last year my husband and I decided that we needed to take our health into our own hands and get the weight off.  We started going to a bariatric weight loss doctor.  He explained insulin resistance us, and in more depth how carbs turn to sugar and how your body processes them.  With this information in hand, my husband and I started to cut our carbs to 50 grams per day. 

The weight started coming off and so far this is what I have accomplished:  

I have lost 12 inches around my waist, 8 inches on my hips and 6 inches in my chest. My BMI started at 39, and on my last body composition test it was at 29.8. My percent body fat went from 48.9 to 36.7. I went from a size 22 pants to a size 11-13. I still have about 15 pounds to go to hit my weight loss goal. I maintained through the holidays which is good for me. I am now getting back on track to get the rest of my weight off, and I am loving life!!

What was the biggest challenge to adopting a carbohydrate-restricted or paleo diet?
Learning to cook again.  My husband and I would love to eat chips and salsa.  This was our main snack food.  So when we decided to change our lifestyle, I had to learn to look for new ideas that we could have.  We now make our own jerky, we eat nuts and lots of protein.  We do still have some of our favorites that I have learned to convert to low carb.  One of these is New York Style Cheesecake.

What advice (if any) would you give to someone interested in trying a carbohydrate-restricted or paleo diet? Were there any obstacles that you overcame that could help future dieters?
Stick with it! The first two weeks are the hardest.  Find a partner to follow the plan with you, it sure makes it easier and you can keep each other on track.  There are lots of books and websites that can help you with recipes and additional information.  Do your research, it will pay off.

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U.S. News and World Report recently put out an evaluation of the most effective diets for various outcomes, according to these experts. The outcomes varied from weight loss, to the best diet for heart health or diabetes. The "Heart-health" award was awarded to the ultra-low-fat Ornish Diet.

The summary even states that "if [dieters] use a rigorous version of the plan they could actually reverse heart disease." This claim - which is ubiquitous in the medical literature - is based on one study on 35 people, deemed the "landmark heart disease-reversal trial" by the reviewers of this diet assessment.

20 of the 35 people were randomized to receive the intervention which included consuming a low-fat vegetarian diet for at least a year. The diet consisted of fruits, vegetables, grains, legumes, and soybean products without caloric restriction. No animal products were allowed except egg whites and one cup per day of non-fat milk or yoghurt; 10% of calories as fat, 15-20% protein, and 70-75% carbs. Cholesterol intake was limited to 5 mg/day. 

Subjects also asked to practice stress management techniques at least 1 hour per day, exercise for at least 3 hours exercise per week, and quit smoking if they were smokers. They also attended group meetings two times per week. The control group was given no guidance besides to continue following their own physician's advice. 

After one and five years, the experimental group had less cardiac events, and a decrease in the size of the plaques in their coronary arteries. 

This is perhaps one the most refferenced study in support of a the protective effects of a low-fat diet, cited over 930 times (previous publication cited over 1500) according to Google Scholar, which is unfortunate due to the tremendous amount of confounding interventions. Along with an extremely low fat diet, the experimental group ate more fruits and vegetables, lost 23.9 pounds (control lost no weight), performed relaxation techniques 1 hour each day, exercised at least 3 hours a week, and had group counseling. The control group had none of this. The experimental group contained only 20 subjects (all male), and the control group had 15 (12 men and 3 women). 

The small sample size resulted in an uneven distribution of risk factors between groups. At baseline, the mean age of the control group participants was 4 years higher, mean total cholesterol 8% higher and mean LDL 10% higher than those in the experimental group. Mean BMI was three points higher in the experimental group. 

The results are great and demonstrate that the sum total of all interventions - vegetarian diet, exercise, smoking cessation, stress management, and group meetings, and weight loss - resulted in a reversal of heart disease. However, it does NOT say that the diet specifically caused all or any of it. This insight simply can't be determined from this study because there were so many interventions.

Despite these extreme limitations to this study, it has been propagated as a panacea, constantly cited as proof that a low-fat, vegetarian diet reverses heart disease. 

The restaurant industry is a common scapegoat for health authorities and medical professionals when conjuring up contributors to the obesity epidemic. Usually filled with condescending rhetoric, the main theme is usually similar: high calorie, high fat, high sodium foods are bad for their patrons WooFood and the health of the community. These foods are contributing to the obesity-related problems that plague our society, and it is the restaurant’s responsibility to fix this. Unfortunately they rarely venture a business friendly solution.

Enter Matt Dewolf.

Along with his colleagues at UMASS medical school, Matt created WooFood, a non-profit company founded to improve the health and nutrition in the town of Worcester, Massachusetts. The concept is simple and genius. Restaurants who would like to be WooFood certified have to meet a set of certain criteria for their food options, such as healthful portion sizes, whole grain options, or healthful children’s menu foods. Depending on the level of certification each restaurant achieves, they will receive a WooFood certification of certified, silver, or gold, which can be displayed proudly in their windows. This allows the restaurant to demonstrate its healthy choices, and provides the customer with an easy tool to determine which restaurants are certified, and which are not.

The specific meals at each restaurant which meet WooFood’s standards are clearly labeled with an easily identifiable logo, signifying a healthy choice. Here are the founders describing it themselves:

There are now three WooFood certified restaurants in Worcester, and many more are in the process of becoming certified. Any potential solution to our nation’s health problems that may stifle businesses is not a real solution. WooFood is brilliant because it does just the opposite, and is a win:win for both the consumer and the restaurants. Thanks to these insanely smart, forward-thinking medical students, Worcester will be a healthier city for years to come.

Visit WooFood.org to check out their site or here to read about the team.