"Get The Skinny."   by Caroline J. Cederquist, M.D.

What if it wasn't about low-carb or low-fat, but it was about YOU?
Just when you thought it was safe to go back in the kitchen, here we go again. 

   The Atkins diet empire is in bankruptcy. The trendy 
low-carb versions of your favorite foods are piled up 
in the clearance carts at the back of your grocery 
store. Those monster all-bacon breakfasts have 
quietly slid off the specials board at your local 
eateries, to be replaced once again by cheap piles of 
hash browns and eggs. 

But if you thought you'd heard the last of the low-
fat/low-carb diet debate, think again. There is some 
very exciting new research sure to bring it back to 
the fore, and finally  "one hopes" in a meaningful 
way. It seems now that scientists have shown that 
the big variable in deciding which is better isn't so 
much the fat or the carbs it's you! 

Of course, some of us have been saying that for a 
while. 

   The low-fat vs. low-carb dietary debate has been 
raging since long before the good Dr. Atkins 
introduced his smash-hit diet plan, dripping with fats 
and oils. The phenomenon of marketing that 
accompanied his plan brought tremendous attention 
to a fairly extreme, carnivorous version of low-carb 
eating, and while it was effective for some, it was 
dangerously unhealthy for others. 

   And like other diet theories before it, it was no one-
size-fits-all solution; though to be fair to the late Dr. 
Atkins, it really wasn't intended to be. 

That's because people are not theoretical. Your 
body isn't some anatomical embodiment of various 
average results of research studies proving one thing 
or another. General principles of weight management 
generally apply to the general population, and there 
are some fundamental truths that hold for pretty 
much everyone. But how those are expressed in any 
given individual, well, that's subject to a lot of 
variables. 

   Frustrated and sincere people have been coming to 
us for years complaining of failure after failure with 
different diets that they say seem to be working for 
their friends, but just not for them. On top of the 
frustration of their diet failures, they're demoralized 
because their concerns have been poo-pooed and 
doubted. But we've found over and over that they're 
not sandbagging. 

   Your individual weight problem has to be treated 
individually, based on your fat, and your muscle and 
your body chemistry. This new study makes that 
case beautifully. 

Less in, but less of what? 

   Supermarket tabloids notwithstanding, everyone 
understands that for weight loss to occur, there 
have to be fewer calories consumed than calories 
burned. But the ongoing debate tends to be about 
how we make up the calories we do consume, and 
whether there is any significantly superior way to 
compose a low-calorie diet for weight loss based on 
the proportions of the macronutrients: fat, 
carbohydrates and protein. 

   At the heart of the low-fat/low-carb debate lies a 
little-discussed matter of body chemistry: insulin 
sensitivity. Whole-body insulin sensitivity is a 
measure of your body's naturally produced insulin to 
regulate your glucose uptake and metabolism. 
People who are insulin resistant have to produce 
more insulin than normal to do those jobs, because 
their bodies are not responsive at normal levels of 
insulin production. 

   Normally, you don't just start out insulin resistant or 
wake up that way one morning. Bodies tend to 
become more and more insulin resistant over time 
with weight gain, but it's a vicious cycle, because 
insulin resistance then makes it easier to gain weight, 
and so much harder to lose it. As you might 
suppose, insulin resistance is a red-flag precursor to 
the dangerous disease of diabetes, in which patients 
are so resistant that their bodies can't churn out 
enough extra insulin no matter how they try, and 
they have to take supplemental insulin. Before it 
gets to that point, it's not irreversible. Insulin 
sensitivity can be increased with weight loss and 
other health improvements that come from diet and 
exercise. 

   Some scientists have suspected that there?s a 
relationship between the degree of insulin sensitivity 
a person has and the way they would respond to 
different macronutrient proportions in low-calorie 
diets. And those of us who have been doing patient 
care have certainly been trying to encourage that 
suspicion. After seeing this proven out in the blood 
work of thousands of patients, it?s not really a 
mystery to us anymore. But a clinical caseload, no 
matter how vast, is not a controlled study and 
treating physicians are typically not in the business 
of research science. 

   But at last, some research scientists have produced 
such a study, and it shows just what we've seen 
with patients all along: what's good for the goose 
isn't always good for the gander, or even another 
goose. 

High fat or high carb?

   The researchers took 21 obese, non-diabetic women, 
did their blood tests and divided them according to 
whether they were insulin sensitive or insulin 
resistant. Then they were randomly assigned to 
receive either a high-carb/low-fat diet, or a low-
carb/high-fat diet. Both diets offered the same 
overall caloric content; only the macronutrient 
proportions were different. The HC/LF diet was 60 
percent carbs, 20 percent fat and 20 percent 
protein, while the LC/HF diet was 40 percent carbs, 
40 percent fat, and 20 percent protein. 

   The subjects were kept on the controlled diets for 16 
weeks. They were tracked for changes in their body 
weight, overall insulin sensitivity, blood lipids (fats) 
and their resting energy expenditure, a measure of 
metabolism. 

   And take a look at how these numbers shook out. 
The normally insulin-sensitive women on the high-
carb/low-fat diet lost about 13 percent of their initial 
body weight, whereas those on the low-carb/high-
fat diet lost only about 7 percent of their initial body 
weight. 

   But among the insulin-resistant women, the inverse 
was true! Those on the low-carb/high-fat diet lost 
about 13 percent of their initia body weight, as 
compared with only about 8 percent lost by those on 
the high-carb/low-fat diet. 

   The differences were not explained by changes in 
their resting metabolic rate, activity level, or overall 
intake, which of course was the same for both 
groups. And the changes in overall insulin sensitivity 
during the course of the study corresponded with the 
degree of weight lost by the participants. Those 
who had been insulin resistant developed improved 
sensitivity. 

   It was a small study, but it was well-designed and 
with results this dramatic, it's likely to stimulate the 
further investigation the researchers say should now 
be done. And if their findings are confirmed in 
additional, larger studies, it could have great 
implications for how we go about tailoring weight loss 
plans in the future. 

   For doctors and even patients who have long 
understood the need for individualized weight-loss 
treatment, we won't necessarily say we told you so, 
but not because we weren't trying. 

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Caroline J. Cederquist, M.D. is a board certified Family Physician and a board certified Bariatric Physicians (the medical specialty of weight management). She specializes in lifetime weight management at the Cederquist Medical Wellness Center, her Naples, FL private practice, you can also get more information about Dr Cederquist and her 
weight management plan by visiting www.DietToYourDoor.com