Regina Wilshire, who writes Weight of the Evidence, has, IMO, a must-read blog for anyone interested in following the science of weight and who speculates, as I do, that there’s a lot more going on to weight loss than “eat less, exercise more.” Composition of foods in the diet is a particularly valuable research topic these days.

And if you read WofE, you’ll see Regina regularly pick apart research protocols to dig out what’s going on behind the abstract.

So, while I’m very sympathetic to Regina’s low/managed carb bias, I must admit to being a bit bummed that she seems so gleeful about the recent Women’s Health Initiative study, which claims to show that:

a dietary intervention that reduced total fat intake and increased intakes of vegetables, fruits, and grains did not significantly reduce the risk of CHD, stroke, or CVD in postmenopausal women and achieved only modest effects on CVD risk factors.

So sue me, but I’m one of those people who have to ask…were the study participants’ diets really so different?

According to Regina, the control group ate 595 fat calories per day, the “low-fat” group ate 431 (do the math: 38.1% of 1564 calories for the control; 29.8% of 1445.9 calories for the “low-fat” group).

The difference in fat calories per day is 119-164 calories (depending on whether or not you keep the calories per day constant and adjust just the percent fat). That’s about 1 to 1 1/2 tablespoons of butter or 1 to 2 tablespoons of regular salad dressing.

Now, I’m a math major, and I realize that eating 29.8% of calories from fat is statistically a big difference from 38.1%. It’s an 8.3% reduction when you consider the overall diet, but it’s a 22% reduction in fat.

But here’s the thing…22% reduction in fat is big. And statistically valid. But does it really sound like that big of a deal when you’re talking about 120-160 calories over the course of a day?

If you thought lowering fat in your diet would help, would you expect to see a lot of improvement while continuing to eat nearly a third of your calories from fat?

And I’m not sure why the Dansiger et al study that Regina blogged recently “simply cannot provide us with usable data” due to non-compliance (an issue I’ve complained about before), yet it’s okay to simply disregard the fact that the WHI study authors couldn’t get their participants to comply with the intended level of fat in the diet (closer to 20%) after the first year.

Now, I’m not an Ornish or McDougall evangelist. And like I said, I’m very, very sympathetic to the idea that carb metabolism is the key to understanding weight gain and related health issues.

But I’m just a tad concerned that the low-carb camp, like the low-fat camp, is so polarized, and so entrenched in their positions, that we’ll miss the opportunity to really find out what’s going on.

Now it looks like another study looking at a fairly narrow aspect of the glycemic index re diabetics is being mischaracterized by the media. One story even ran with the title as “Researcher finds glycemic index useless” (UPI…UPI?!?)

You didn’t ask, but here’s what I think about the low-carb versus low-fat diet war. First, re the low-carb diet. I’ve done a number of low-carb diets. I did a low-carb version of NutraSystem in the late 70s (complete with peeing on the stick) and I did low-carb when I did my liquid fast back in 1991/92.

What’s great about low-carbing it is that reducing carbs, for me at least, was fabulous, as it reduced the cravings to overeat.

I get so annoyed reading all these books that attempt to “ding” low-carb approaches because they are thought to make you lose weight faster, or more weight, or whatever. Depending on which study you look at, low carb diets may or may not do these things.

And I’m also annoyed by the straw man that low-carbing it is about eating eggs, butter, meat, and cheese all day. Yes, those are all permissible foods on a low-carb diet, but if you’re going to be successful low-carbing it, your diet will include all the things people don’t think you’d be eating: fruits, veggies, whole grains, etc. That some people make bad choices on a low-carb diet doesn’t necessarily mean the approach is bad.

I wish there was a lot more discussion about the seemingly true fact that, once people are established at low-carbing, they find it easier to comply with the diet. Years ago, I called my fast a “humane” way to diet because there were no cravings, no pain. I wasn’t hungry.

So why hasn’t it caught on? Aye, but there’s the rub. There are your real low-carb success stories, but for every one of those, there are probably many more who try low-carb but fail, mostly because they don’t understand that cheating, even a little, defeats the purpose of low-carbing it.

But I think there are some problems with the low-carb diet. First, some fairly respectable academics in the low-carb camp point to real problems with this much protein in the diet, particularly animal protein. Whether or not it will damage your kidneys, whether or not it leads to osteoporosis, whether or not it can provide an environment to promote cancer, are all subjects for discussion.

Also, I think the “this is what the caveman ate” argument is a bit weak, IMO. We cannot eat what the caveman ate. Yes, a low-carb diet is closer than a current American diet, but the caveman wasn’t catching his steak from the Piggly Wiggly after he drove up there in his SUV after having sat at his desk at work for 8 hours.

Unless I’ve got lots and lots of money, the meat I’m eating has way more fat, hormones, and pesticides in it (some of which may be the reason that girls are reaching puberty younger).

And while Regina isn’t swayed by economic arguments, I wonder about the implications of this kind of diet and the health of the planet.

For me, I gave up on low-carbing after I decided I personally couldn’t adopt a diet for a lifetime that reduced carbs to the level low-carbing does.

As far as the low-fat camp goes, there’s only one complaint I have, but it’s a biggie. My biggest gripe with the low-fat camp is that while the diet focuses on generally healthy foods, they aren’t looking AT ALL at the role of carbs in the diet and bio/neurochemistry. For them, it’s fat that is the demon, and by god, the less the better.

What are the implications of such a diet for someone with metabolic syndrome? A compulsive overeater? I don’t think I’ve ever done a serious very-low-fat diet (unless it was also low-carb, re the fast). I might be more successful now that I’m focusing on whole foods, but in the past, I fell for the “if it’s low-fat, I’ll eat it” and then watched as the rice cakes wound up doing a number on my blood glucose.

I believe that Dean Ornish, John McDougall, and Joel Fuhrman are all seeing great results with people motivated (usually by health problems) to eat their really low-fat vegan diets. But just like the low-carb diets, the average person often finds that they can last for a while, and either hunger or cravings drives them right back to the way they used to eat.

So where I am right now is doing a managed carb approach. I eat more carbs than a low-carb dieter would, but I’m also eating more fat and animal protein than the very-low-fat dieter would. But every day I read yet another reason why low-carb or low-fat are “stupid” or “debunked” or whatever, and the analysis paralysis begins to set in.

I sometimes despair for myself and my heavy sister and my not-so-heavy sister and my friends who have weight issues. We are simply S-O-L when it comes to being able to turn to someone for a clear answer…they just don’t exist.

I can only hope that things improve by the time my nieces are my age. Hearing that the US Surgeon General thinks we’re in bigger trouble from the obesity epidemic than from terrorism doesn’t exactly leave me terribly optimistic.

But on the other hand, I’d like to believe that we’re learning more. What I actually expect is that just as we really learn what’s going on, we’ll find out that we just got over the hill to see another mountain, which is how to deal with the cultural pressures to eat the diet that got us here. Given the current war on terrorism, that’s a bleak prospect too.

But like I said the other day, I’m going to take a page from Deepak Chopra and do what I can to make my own personal transformation. That should be enough for now!