Low-Carb, High-Fat Diet Drops Weight

Atkins-Like Plan Won't Hurt Cholesterol Levels, but Critics Aren't Impressed

http://content.health.msn.com/content/article/76/90284?printing=true

By Sid Kirchheimer

Reviewed By Michael Smith, MD

on Tuesday, November 11, 2003

WebMD Medical News

Nov. 11, 2003 -- Is it really possible to lose weight on a no-starch, high-fat diet, similar to Atkins, without hurting cholesterol levels? Apparently so, even for people with heart disease, according to the latest study on the topic.

The new study details the effects of a no-starch, high-fat diet on 23 patients at risk for diabetes. All were overweight, were taking cholesterol-lowering statin drugs, and had been diagnosed with heart disease. The high-saturated fat and no-starch diet was developed eight years ago by endocrinologist James Hays, MD, in an effort to help his diabetic patients.

On average, those following his low-carb, high-fat diet lost 5% of their body weight after only six weeks. For example, a 200-pound person would have lost 10 pounds.

Importantly, the high-fat diet did not have harmful effects on cholesterol levels. In fact, the participants saw a lowering of the blood fat called triglycerides. "Bad" LDL and "good" HDL cholesterol levels didn't change, but the size of the HDL and LDL molecules increased.

Larger LDL molecules are less likely to form artery-clogging plaques. Larger HDL molecules stay around in the body longer to clean up more plaque.

"We also saw a significant drop in glucose and insulin levels," Hays tells WebMD. Higher blood sugar (glucose) and insulin levels indicate the early signs of diabetes.

Lots of Fat Allowed

Under Hays' plan, half of the daily 1,800 calories come from saturated fats -- mostly red meats and cheese. "We're not talking about protein, egg whites, and turkey and white-meat chicken," he says. "We're talking about fat."

Just days ago, another study at the American Heart Association's annual meeting compared the low-carb, high-fat Atkins diet to three other popular diets -- the very low-fat Ornish plan, the high-protein, moderate-carb Zone diet, and the low-fat, moderate-carb Weight Watchers plan. When devotedly followed, all produced similar weight loss and reductions in heart disease risk.

Hays tells WebMD that he believes the heart-healthy benefits of his Atkins-like eating plan are because of its high intake of saturated fats -- considered by most experts to cause heart disease.

"Cholesterol leaves our body through bile, and high-fat foods cause bile secretion," he says. "Although I would caution that this is genetically determined, I think that most people are able to excrete huge amounts of cholesterol they're consuming with this bile secretion." Still, he advises that anyone starting any type of high-fat diet keep close tabs on their cholesterol and triglyceride levels.
 
 

Under Hay's low-carb, high-fat diet, milk and starches such as pasta and baked goods are forbidden and only certain fruits and vegetables can be eaten. And unlike Atkins, which allows for increased but still low amounts of carbohydrates the longer participants remain on the plan, Hays' plan remains constant.

A typical dinner on the Hays plan: "A half-pound of red meat or chicken dark meat (after cooking), with 1/2 cup of vegetables, 1/2 cup of salad, and a half piece of fruit. There's lots of oil but no vinegar or other condiments," he says. Acceptable vegetables include broccoli, cauliflower, and others that grow above ground; allowed fruits (which must be eaten last at every meal to keep glucose levels low) include apples, oranges, peaches, and pears, as long as they are not processed.

"It's very vigorous to eliminate starches completely, but those who do seem to do very well," Hays says. "We followed two other groups of patients who weren't taking statin medications for six months and a year, and they lost 15% and 20% of their body weight respectively and had no adverse effects on their [blood fats]. I've had some patients lose up to 40% of their weight on this plan."

But Is It Healthy?

Not all are convinced a high-fat diet is the best strategy for the long term.

"The main reason people lost weight on this diet is because they're consuming fewer calories than they're used to," says Jen Keller, RD, staff nutritionist for the Physicians Committee for Responsible Medicine, a nonprofit organization that promotes preventive medicine and a vegetarian diet.

"It doesn't matter how you lose weight -- you can starve yourself, you can eat eggs all day, however you do it, if you're eating fewer calories that you're used to, your blood fats will improve in the short-term," she tells WebMD. "But a lot of times, when the weight loss plateaus, the benefits in cholesterol are erased and you're no better off than when you started, and sometimes worse."

Her group has been a longtime and vocal critic of low-fiber, high-fat diets such as Atkins, and she is concerned that such eating plans raise the risk of colon cancer, kidney disease, and other health problems.

"A new study comes out every day talking about what's the best way to lose weight. If you look at the world's population, the healthiest and thinnest people are people who follow a plant-based diet," she says. "As they start to eat more fats, they gain weight and develop health problems."

In an accompanying editorial, Mayo Clinic cardiologist Gerald Gau, MD, urges doctors to keep an open mind about these high-fat diets. "But I am concerned about the long-term cardiovascular risk," he writes. "We should continue to examine the risk-benefit profile of caloric-restricted, more rational diets such as the Mediterranean diet, which recently was associated with a striking decrease in cardiovascular risk."

SOURCES: Hays, J. Mayo Clinic Proceedings, November 2003; vol 78: pp 1331-1336. Gau, G. Mayo Clinic Proceedings, November 2003; vol 78: pp 1329-1330. American Heart Association Scientific Sessions 2003, Orlando, Fla., Nov. 9-12, 2003. James Hays, MD, endocrinologist, Christiana Care Health Services, Cardiology Research, Newark, Del. Jen Keller, RD, staff nutritionist and nutrition projects coordinator, Physicians Committee for Responsible Medicine (PCRM), Washington, D.C.

© 2003 WebMD Inc. All rights reserved.
 
 
 
 

http://content.health.msn.com/content/article/67/80070

Mediterranean Diet: More Than Olive Oil

'Divine Mix' Prevents Death From Cancer, Heart Disease By

Sid Kirchheimer

Reviewed By Michael Smith, MD

on Wednesday, June 25, 2003

WebMD Medical News

June 25, 2003 -- In the largest study ever done on the Mediterranean diet and one of the few to test it in adults of all ages -- in Greece, no less -- researchers found that the real bang of this ballyhooed magic bullet appears not to be olive oil but a combination of all food in the diet.

Scores of studies suggest that the high-fat Mediterranean diet translates to a slimmer risk of heart disease and cancer. And olive oil has sometimes gotten the lion's share of credit -- possibly undeservedly, according to the new findings.

Secret Sauce?

The olive oil-drenched diet is believed to be why residents of the16 countries that border the Mediterranean Sea typically live longer than Americans and have lower rates of these diseases -- despite consuming a high-fat diet. The theory: Most of the fat comes from monounsaturated fat, the type in olive oil that -- unlike saturated fats – is heart-healthy and may have cancer-prevention effects.

Not surprisingly, the researchers found that Greeks who follow the Mediterranean diet more closely have significantly lower death and disease rates than those who don't. But they also report in this week's issue of The New England Journal of Medicine that olive oil itself produced no significant reduction in overall death rates.

Divine Mix

"Olive oil plays a central role, but it is not alone," says Dimitrios Trichopoulos, MD, PhD, of Harvard School of Public Health.

"It's among the divine mix of several factors that, when used in combination, help provide strong evidence of something that is very important -- eating the proper diet can significantly reduce your risk of early death."

He and researchers from Greece studied some 22,000 adults, aged 20 to 86, from all regions of that country; most previous studies tracked only older people who were more likely to die during the study. The participants answered detailed questionnaires about their eating habits throughout the four-year study. Then they were rated on how closely they followed the key principles of the Mediterranean diet.

Sticking to the Mediterranean diet cut the risk of death from both heart disease and cancer. For every two points higher on this 0-to-9 scale -- with top numbers going to those most closely following the Mediterranean diet – the death rate dropped by 25%.

So what does that mean exactly? Substantially increasing the intake of monounsaturated fats relative to saturated fats and reducing in intake of meat would do the trick.
 
 

Olive Oil, Fish, Veggies ... What Is It?

When the researchers looked at the individual components of the Mediterranean diet, they found no significant decrease in death with any one type of food.

In addition to having olive oil with most meals, the typical Mediterranean diet is very high in vegetables, fruits, legumes, nuts, and cereals; moderate in fish intake; and has lower amounts of meat and dairy than the typical American diet. Drinking alcohol is also a frequently practiced dining ritual.

"God knows what sorts of interactions take place within the foods, and we need further research to pinpoint them exactly," Trichopoulos tells WebMD.

"But typically, people in Greece eat twice as many vegetables as Americans -- nearly a pound a day. And you really can't eat a pound of vegetables a day unless you have olive oil to make them appetizing. My advice is to try to double the amount of vegetables and fruits you currently have, and eat more fish, legumes, and non-refined cereals."

While olive oil itself showed little benefit, the researchers note a significant reduction in death rates from a higher overall ratio of monounsaturated fats to saturated fats. Olive oil is among the best sources of monounsaturated fats -- and happens to be the main cooking oil in most Mediterranean countries -- but other oils frequently consumed by Greeks and others surrounding the Mediterranean Sea also contain these healthy fats.

Calories Versus Healthy Oils

Trichopoulos' finding may also help explain why Asians, who typically use these other cooking oils, also have lower disease and death rates. Although they rarely use olive oil, they traditionally follow other principles of the Mediterranean diet -- lots of produce, legumes, nuts, and minimally processed grains, with little saturated fat.

"The message remains the same, and is consistent with other findings: A diet lower in saturated fats and higher in monounsaturated fats, and potentially, polyunsaturates, will result in better health outcomes,"

says Alice H. Lichtenstein, DSc, of Tufts University and a spokeswoman for the American Heart Association.

"If the main message that Americans get is to just increase their olive or canola oil consumption, that's unfortunate because they will increase their caloric intake and they are already getting too many calories. What they need to do is eat more fruits, vegetables, and legumes and fewer foods rich in saturated fats."

SOURCES: The New England Journal of Medicine, June 26, 2003. Dimitrios Trichopoulos, MD, PhD, professor of epidemiology, Vincent L. Gregory Professor of Cancer Prevention, Harvard School of Public Health, Boston. Alice H. Lichtenstein, DSc, senior scientist and director, Cardiovascular Nutrition Laboratory, Jean Mayer USDA Human Nutrition Researcher Center on Aging, Tufts University, Boston; spokeswoman, American Heart Association.

© 2003 WebMD Inc. All rights reserved.
 
 
 

http://content.health.msn.com/content/article/76/90281?printing=true

Mediterranean Diet Fights Heart Disease

Diet Lowers Levels of Inflammation Marker Linked to Heart Disease

by Charlene Laino

Reviewed By Michael Smith, MD

on Tuesday, November 11, 2003

WebMD Medical News

Nov. 11, 2003 (Orlando) -- A Mediterranean diet rich in olive oil and low in red meat can combat inflammation that silently simmers away for years inside blood vessels, lowering the risk of a heart attack, a new study suggests.

Many people have questioned whether previous benefits attributed to the Mediterranean diet were actually due to other lifestyle factors -- such as increased exercise -- in people following this diet. But the study clearly shows that this heart-healthy effect was independent of any other lifestyle factors, including exercise, says Demosthenes Panagiotakos, PhD, lecturer in the department of nutrition and dietetics at Harokopian University of Athens in Greece.

Panagiotakos, who presented the findings at the American Heart Association Scientific Sessions 2003, says that previous studies have suggested that sticking to a Mediterranean diet -- which also emphasizes grains, fish, vegetables, and fruit -- may cut the risk of heart disease by up to 30%.

However, it is not fully understood how the Mediterranean diet exerts its protective effect, he says.

"Some have suggested it lowers blood pressure; others speculate it reduces cholesterol levels. Still others say it is not the diet itself but other characteristics of people who follow the diet, such as a healthy lifestyle."

The new study, which applied a sophisticated statistical analysis to tease out the effects of any confounding lifestyle factors, should help put an end to the debate, Panagiotakos says.

"The Mediterranean diet, independent of any other factor, reduces levels of inflammation related to heart disease risk," he tells WebMD.

Alice H. Lichtenstein, DSc, vice-chairwoman of the AHA's Nutrition Committee, agrees.

"While no one study ever puts an issue to bed, this research offers really strong data that diet makes a difference," she says.

The researchers followed more than 2,200 men and women, aged 18 years to 89 years, without any history or signs of heart disease or stroke. The participants were asked what types of food they ate and how often. The study showed that the closer their eating habits came to matching the Mediterranean diet, the lower their levels of C-reactive protein, a sign of general inflammation in the bloodstream.

According to Lichtenstein, the heart-healthy benefits most likely came from the Mediterranean diet as a whole, not from specific components.

"People are always trying to say, 'It's the vitamin E, it's the beta-carotene,' or whatever," she says. "And then the next study proves them wrong. That's because it is the relative balance of all the vitamins, minerals, and other components of the foods we ate that makes a difference."

SOURCES: American Heart Association Scientific Sessions 2003, Orlando, Fla., Nov. 9-12, 2003. Alice H. Lichtenstein, DSc, Gershoff Professor of Nutrition Science and Policy, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston; vice-chair, AHA's Nutrition Committee. Demosthenes Panagiotakos, PhD, lecturer, department of nutrition and dietetics, Harokopian University of Athens, Greece.

© 2003 WebMD Inc. All rights reserved.

---------
Footnote:   I couldn't find any research that would support dr. Liechtenstein's statement that mono fats are supposed to be beter than natural saturated fats. In fact her statement seems to contradict the study itself since all Mediterranean cooking that I am familiar with (eg. French, Greek, Italian) is equally rich in natural saturated fats (in lard, meat, butter, cream) as in mono-unsaturated fats (olive oil & fish fat). For example - I would recommend to visit a Greek restaurant as a typical illustration of it. [Stan Bleszynski]
 
 
 

http://www.second-opinions.co.uk/spanish_paradox.html

The Spanish paradox

By Barry Groves

A study published in 1995 noted that heart disease deaths in Spain from 1966-1990 dropped by 25% for men and by 34% in women.[1] The study published a table which indicated that between 1964 and 1991:

What they did say in their conclusions was:

"Nevertheless, our results, in the context of current knowledge about the relation between diet and health, suggest several dietary recommendations that might be applied to the prevention of CVD in Spain:

Promote moderate consumption of all meat (beef and pork in particular)

Increase consumption of foods rich in complex carbohydrates (bread…rice)

Encourage use of skim milk and low-fat cheese…."

In other words, stop the Spanish eating their protective diet, and get them to change to our version of 'healthy eating'!

The British Medical Journal published another Spanish study in its 13 September 2003 edition.[2]

The authors say they "found unexpectedly high numbers of plaques in young Spanish men, similar to the prevalence in populations with much higher rates of coronary heart disease". So the Spanish diet did not prevent the build-up that is thought to be the cause of heart attacks. They go on to point out that "In Spain, coronary atherosclerosis evolves more slowly. Although a time lag to increased rates of coronary heart disease could be approaching its end, unknown protective factors might also prevent coronary plaques from becoming unstable in this population."

Could it be the Spanish high-fat, low-carb diet that protects them as it does other populations throughout the world? Or would it be heresy to suggest such a thing?

References

1. Serra-Majem L, Ribas L, Tresseras R, Ngo J, Sallerus L. How could changes in diet explain changes in coronary heart diease mortality in Spain? The Spanish paradox. Am J Clin Nutr 1995;61(suppl):1351S-9S.

2. Bertomeu A, García-Vidal O, Farré X, et al. Preclinical coronary atherosclerosis in a population with low incidence of myocardial infarction: cross sectional autopsy study. BMJ 2003;327:591–2.
 
 

http://content.health.msn.com/content/article/76/90205?printing=true

4 Popular Diets Heart Healthy

Whether It's Atkins, Ornish, Weight Watchers or Zone, It's the Pounds That Matter, Say Experts

By Peggy Peck

Reviewed By Michael Smith, MD

on Monday, November 10, 2003

WebMD Medical News

Nov. 10, 2003 (Orlando, Fla.) -- Pound for pound, four very popular weight loss diets are all good for shedding weight and lowering the risk of heart disease, say researchers, with one important caveat: You have to stick with the diets, not just start them.

The diet scene has heated up in the past year with low-carb and low-fat diets battling it out. But until now no one actually compared four of the most popular diets -- Atkins, Ornish, Weight Watchers and the Zone -- to find out which was really better for weight loss and lowering the risk of a heart disease.

It turns out, says Michael L. Dansinger, MD, assistant professor of medicine at Tufts University, New England Medical Center in Boston, Mass. that as long as the pounds are shed, heart health improves.

"Losing 20 pounds corresponded to about a 30% reduction in heart risk score," he says. Although he explains that at this point "it isn't clear if a 30% reduction in risk score is the same as a 30% reduction in heart attacks." Dansinger presented his results here at the American Heart Association's Scientific Sessions 2003.

The Contenders

The Atkins diet -- a low-carb diet consisting primarily of protein and fat. In the first two weeks, carbohydrates are severely restricted but then are introduced back into the diet in the form of fiber-rich carbohydrates.

The Ornish diet -- a high-carb, low-fat vegetarian diet of mostly beans, fruits, grains, and vegetables. Dairy products are eaten in moderation and meats are discouraged.

Weight Watchers -- a low-fat, high-carb diet where each food is assigned a point value and participants are allowed a certain number of points per day.

The Zone -- a diet based on a 40-30-30 system where participants eat 40% of their calories from "favorable" carbohydrates such as vegetables and beans, 30% from low-fat proteins, and 30% from unsaturated fats, such as olive and canola oils, nuts, and avocados.

Low-Carb vs. Low-Fat

Dansinger studied 160 overweight men and women who volunteered to participate in a yearlong diet study. Forty volunteers were assigned to each diet, he says. Dansinger says he was "just testing the diets, not any exercise or other lifestyle modifications that are part of the entire diet program." The researchers also calculated a score to estimate a person's heart disease risk -- based on common heart disease risk factors, such as cholesterol and blood pressure.

The benefits from the diets were limited to those who carefully followed them -- and following the diets was no easy task since the drop out rate for each diet was 22% at two months. By one year half of the volunteers assigned to Atkins or Ornish had dropped out as had 35% of those assigned to Weight Watchers or Zone diets.

Participants following the Atkins, Weight Watchers, and Zone diets achieved significant reductions in the heart risk score. Those following the Ornish diet did not show any significant improvement in the heart disease risk score.

Dansinger tells WebMD that this does not mean that the "Ornish diet doesn't reduce heart disease risk. I have great faith in the Ornish diet, but it did not meet the statistical test in this study."

Ornish Responds

Dean Ornish, MD, founder and president of the Preventive Medicine Research Institute in Sausalito, Calif., was immediately critical of the results. Ornish tells WebMD that the people assigned to his diet "lost more weight, had greater reductions in LDL (the 'bad' cholesterol), and were the only dieters to significantly lower insulin -- even though the Atkins and Zone diets claim to be specifically designed to lower insulin." Lower insulin levels indicate a lower risk of developing diabetes, another powerful heart disease risk factor.

Dansinger, who joined Ornish in fielding questions from reporters, agrees that the Ornish diet posted impressive results for those who stayed the course for a year: a nearly 20% reduction in insulin levels while the Atkins diet dropped insulin by about 8% and the Zone was associated with a 17% drop in insulin. Likewise, the Ornish diet reduced LDL cholesterol by 17%, while the Atkins dieters reduced LDL by 9%, followed by Weight Watchers dieters at 8% and Zone dieters at 7%.

Good Cholesterol: How Important Is It?

But the heart disease risk score is based on the ratio between LDL cholesterol and HDL "good" cholesterol.

"The Ornish diet does not increase HDL, while the other diets do achieve significant increases in HDL," says Dansinger. The Atkins and Zone diets increased HDL by 15%, while Weight Watchers posted an 18.5% gain. But the Ornish diet increased HDL by just 2.2%.

Ornish says HDL is not really a factor because "HDL is really like a garbage truck that goes around picking up the garbage, which is bad cholesterol. When you don't have as much bad cholesterol -- garbage -- you don't need as many garbage trucks." He adds, "raising HDL is easy: eat a stick of butter. That will drive up your HDL, but it's not good for you."

Dansinger says HDL is a little more complicated. For example, "exercise increases HDL and we do think that low HDL is a risk factor for heart disease," he says.

"The good news about this study is that we have demonstrated that all these diets work. That means that physicians can work with patients to select the diet that is best suited to the patient. For example, if you have a patient who likes meat, it is unlikely that he or she will comply with the Ornish diet," says Dansinger.

"In the short run, I think weight loss trumps everything. If you lose weight, it doesn't matter how you lose it. But in the long run we don't know the effect of the macronutrients [carbohydrates, fats, and proteins] that you are eating," says Robert H. Eckel, MD, chair of the American Heart Association's Nutrition, Physical Activity, and Metabolism Council and professor of medicine at the University of Colorado Health Sciences Center. Eckel was not involved in the study.

Source: American Heart Association Scientific Sessions 2003, "One Year Effectiveness of Atkins, Ornish, Weight Watchers and Zone Diets in Decreasing Body Weight and Heart Disease Risk," Michael Dansinger, MD, Tufts; Dean Ornish, MD, Prevention Medicine Research Institute; Robert H. Eckel, MD, chair, AHA Nutrition, Physical Activity, and Metabolism Council. WebMD Medical Reference: Evaluate the Latest Diets.

© 2003 WebMD Inc. All rights reserved.
 
 
 
 

http://content.health.msn.com/content/article/76/90200?printing=true

Almonds May Help in Weight Loss

Almond Diet Sheds More Pounds Than Low-Fat, High-Carb Diet

By Denise Mann

Reviewed By Michael Smith, MD

on Friday, November 07, 2003

WebMD Medical News

Nov. 7, 2003 -- Nut lovers, rejoice: New research suggests another good reason to sprinkle some almonds on your salad or toss a handful into your morning cereal. Almonds may help you shed those unwanted pounds.

Researchers found that people eating a diet rich in almonds lost more weight than those on a high-carb diet with the same number of calories. The finding goes against the traditional belief that a calorie is a calorie is a calorie. The findings also support those from a recent study that showed people on a low-carb diet lost more weight than those on a low-fat diet -- even when the low-carb dieters ate 300 more calories a day. In the new study, researchers followed 65 overweight and obese adults -- 70% of whom had type 2 diabetes - for 24 weeks. One group ate a 1,000 calorie/day liquid diet supplemented with 3 oz of almonds (384 additional calories). The other group ate the same liquid diet but instead supplemented with a mix of complex carbohydrates (such as wheat crackers, baked potatoes, or air-popped popcorn). The two diets were equal in calories and protein but differed in fat. Besides the liquid diet, they could also have salads with lemon juice or vinegar dressing. The almond diet contained 39% total fat including 25% from heart-healthy monounsaturated fats, while the non-almond diet contained 18% total fat, 5% from monounsaturated fats. The study appears in the new issue of the International Journal of Obesity.

Participants in the almond diet saw an 18% reduction in weight and body mass index (BMI) -- a measure of weight based on height -- compared with an 11% reduction in the non-almond dieters. Additionally, waist circumference in the almond group decreased by 14%, compared with a 9% decrease in the non-almond group. Systolic blood pressure, the upper number in blood pressure readings, dropped by 11% in almond eaters and stayed the same in the non-almond eaters.

Good Diabetes News

Both groups had improvement in their type 2 diabetes with lower blood sugar and insulin levels. But those on the almond diet were able to lower their need for diabetes medication more so than the non-almond dieters.

"It seemed as though 96% of participants with type 2 diabetes were able to be well-controlled on less medication as compared to 50% of in the [non-almond] group," she says.

Study researcher Michelle Wien, DrPH, RD, CDE, a clinical dietitian and research fellow at City of Hope National Medical Center in Duarte, Calif., calls this finding "exciting." "The almonds definitely had an impact on blood sugar."

She says that a side effect of some diabetes medication is increased hunger, "so the faster one can get off of medications during weight loss, the better because when you take away something creating hunger behind the scenes, it can lead to greater success in weight-loss effort."

"When patients would come to me and tell me they wanted crunchy food with texture, I used to suggest crunchy vegetables. So this study was almost a feasibility study in that I didn't know whether nuts would be satisfying and meet their needs [without sacrificing their waistline] -- they did," Wien says.

Do Almonds Have a Magic Ingredient?

The researchers speculate that the fat in almonds may not be completely absorbed and point to earlier research suggesting that the cell walls of almonds can act as a physical barrier to fat.

They also may make you feel fuller, longer.

"In order to be satisfied, there is a need to eat foods that contain fiber, protein, and fat, and nuts definitely qualify in that regard," says Wien.

"They may have an effect on satiety because if you snack on nuts, you will feel filler for a longer period of time and may help curb extra calories," says Felicia Busch, RD, a St. Paul, Minn.-based nutritionist who reviewed the new findings for WebMD.

Almonds Help Cut Cholesterol, Too

In a study last year, researchers found that a diet that included about one handful of almonds decreased LDL "bad" cholesterol by 4.4%. When the diet included two handfuls of almonds -- accounting for a little less than a quarter of the day's total calories -- LDL cholesterol dropped by 9.4%. When the diet was supplemented with a low-fat, whole-wheat muffin that had the same amount of calories, protein, and fat (saturated and polyunsaturated) as the almonds, there was no significant change in cholesterol. This study, funded by the Almond Board of California, appeared in a recent issue of Circulation: Journal of the American Heart Association.

Although nuts aren't exactly low in calories or fat, nuts contain high levels of unsaturated fats that are known to lower LDL cholesterol levels in the blood and reduce the risk of heart disease.

In fact, in July 2003, the FDA approved the first qualified health claim for almonds, hazelnuts, pecans, pistachios, walnuts, and peanuts for use in advertising and package labels. Packages of nut products that meet the FDA's requirements will now be able to carry the following claim:

"Scientific evidence suggests but does not prove that eating 1.5 ounces per day of most nuts, as part of a diet low in saturated fat and cholesterol, may reduce the risk of heart disease."

A 1.5 oz serving of nuts is about a third of a cup or a small handful.

"Our epidemiological studies have shown eating about one ounce of nuts every day will reduce the risk of heart disease in the long run by 30%," Frank Hu, MD, PhD, associate professor of nutrition and epidemiology at the Harvard School of Public Health, tells WebMD in response to this announcement.

Go Nuts -- but Not Too Crazy

"If you want to start using more almonds or nuts, sprinkle them on salad, that's great advice," says Busch, who is also the author of The New Nutrition: From Antioxidants To Zucchini. "Nuts used to get a bad rap as a concentrated source of fat," she says. In fact, Busch remembers asking clients, "Do you really want to waste those calories?" But, she says, "we are learning that type of fat is more important than total amount of fat -- as long as you don't overdo it."

A handful or an ounce of almonds a day has a place in a healthful diet; a whole can does not.

SOURCES: Wien, M. International Journal of Obesity, November 2003; vol 27: pp 1356-1372. Felicia Busch, RD, nutritionist, St. Paul, Minn. Michelle Wien, DrPH, RD, CDE, clinical dietitian and research fellow, City of Hope National Medical Center, Duarte, Calif. WebMD Medical News: "FDA OK's Nutty Heart Health Claim." WebMD Medical News: "Low-Carb, More Calories, Lose Weight?"

© 2003 WebMD Inc. All rights reserved.

----------------------
Footnote:    My comment:  it is conceivable that the real reason behind for the success of the “almond diet” had nothing to do with almonds but with the fact that it was simply higher in fat and lower in carbohydrates – 39% of fat as opposed to 18% in the control group [Stan Bleszynski]

---eof---