Dette er en meget omfattende studie som har undersøkt hvilken type kosthold kan forebygge vektoppgang etter vektreduksjon, UTEN å måtte telle kalorier eller noe annet. Konklusjonen er at et kosthold mer mer protein og med karbohydrater med lav glykemisk indeks er det som er optimalt, ikke de offisielle kostanbefalinger. Ikke minst hjelper et slikt kosthold hele familien, særlig barn med overvekt.
Velkommen etter
Dette er helt i tråd med det jeg har sagt i ti år. Ja, kostholdsdebatten mine bøker utløste feirer i år hele ti år! For de aller fleste vil kostholdet som skisseres ovenfor være riktig. De med større overvekt vil trenge å også redusere mer eller mindre kraftig karbohydratmengden, men et slikt kosthold var ikke en del av den aktuelle undersøkelsen. Kombinasjonen av høyere proteinnivå og karbohydrater med lav glykemisk indeks/belastning og mer fett gir lavere og mer stabilt blodsukker og lavere insulin. Dette kostholdet er optimalt for å forebygge og behandle fedme, type 2 diabetes, forebygger hjerte- og karsykdommer, reduserer kroniske betennelser og risikoen for en rekke kreftformer.
De gjeldende norske kostholdsrådene er stikk i strid med kostholdet som denne store og viktige studien anbefaler. De nye kostholdsrådene som er ventet fra Helsedirektoratet i januar er litt mer nyansert, men man er fortsatt redd for fett og anbefaler ikke høyere proteinnivå. Man finner heller ikke et ord om glykemisk indeks og belastning i de nye kostrådene, som for øvrig ikke tar hensyn til at 50 prosent av de voksne i Norge er overvektige. De nye kostholdsrådene anbefaler grovt brød og faktisk mindre brød, og fjerner poteter som anbefaling. Imidlertid er det fortsatt stor avstand fra de nye kostholdsrådene til kostholdet denne forskningen anbefaler.
Hvorfor tar det så lang tid å endre de offisielle anbefalingene?
Det som er trist er at det tar altfor lang tid før myndighetene reagerer og tar ny forskning inn over seg. De siste 10 årene har det kommet massivt med dokumentasjon på at et lav fett kosthold er definitivt IKKE veien å gå, men at det er gunstig å øke protein og fett i kosten, redusere karbohydrat og velge dem med lav glykemisk belastning. Jeg er dessverre ikke overbevist om at den nye undersøkelsen vil medføre store endringer i kostholdsrådene med det samme. Det er trist. Jeg tror det er investert altfor mye prestisje fra mange profilerte ernæringseksperter som har sagt noe annet i lang tid. Det burde det ikke være.
Det hadde vært spennende å vite hva ernæringseksperter som prof. Kåre Norum, prof. Christian Drevon og Wenche Frølich (som anklaget meg for å være uvitende, tullete og farlig tilbake i 2002-2004) mener etter denne rapporten. Jeg frykter dessverre det vil ta lang tid før vi ser vesentlige endringer i kostholdsrådene.
Myndighetene svikter i forhold til forebygging
Jeg sier for øvrig ikke at man ikke skal spise brød i det hele tatt, men at brød tar altfor stor plass i det norske kostholdet. 25 prosent av energiinntaket kommer fra brød, og det er altfor mye. I Norge er det årlige forbruket av grønnsaker i overkant av 60 kilo, mens det i Hellas er over 200 kilo. Norge har det laveste forbruk av grønnsaker i Europa. Samtidig spiser vi mer frukt enn grønnsaker, mens vi helst burde spise to til tre ganger mer grønnsaker enn frukt. Alle er enige om at vi må spise mer fisk og grønnsaker og mindre sukker, men hvilke konkrete tiltak blir egentlig iverksatt av myndighetene – utover at de kommer med rapporter som forteller hvor ille det står til? Norge bruker bare to prosent av helsebudsjettet på forebygging. Det brukes nesten ikke penger på forebygging av livsstilssykdommer, mens man bruker 160 milliarder på sykehus. Det rimer ikke, og jeg mener man må begynne å tenke helt annerledes. Det er politikerne som må bestemme seg for at det skal satses mer på forebygging. Man kan ikke forvente avkastning i form av bedre helse og mindre sykdom, medikament- og sykehusutgifter uten investering.
Med vennlig hilsen
Dr. Fedon A. Lindberg
Danish researchers finally solve the obesity riddle
Researchers at the Faculty of Life Sciences (LIFE), University of Copenhagen, can now unveil the results of the world's largest diet study: If you want to lose weight, you should maintain a diet that is high in proteins with more lean meat, low-fat dairy products and beans and fewer finely refined starch calories such as white bread and white rice. With this diet, you can also eat until you are full without counting calories and without gaining weight. Finally, the extensive study concludes that the official dietary recommendations are not sufficient for preventing obesity.
The large-scale random study called Diogenes has investigated the optimum diet composition for preventing and treating obesity. The study was conducted by eight European research centres and headed by Thomas Meinert Larsen, PhD, and Professor Arne Astrup, DrMedSc and Head of Department at the Faculty of Life Sciences (LIFE) and is funded by an EU grant of EUR 14.5 million.
The results were recently published in the distinguished New England Journal of Medicine and have already attracted considerable international attention.
The objective of the Diogenes study has been to compare the official dietary recommendations in Europe, including the Danish recommendations, with a diet based on the latest knowledge about the importance of proteins and carbohydrates for appetite regulation. A total of 772 European families participated, comprising 938 adult family members and 827 children. The overweight adults initially followed an 800 kcal/day diet for eight weeks, losing an average of 11 kg. They were then randomly assigned to one of five different low-fat diet types which they followed for six months in order to test which diet was most effective at preventing weight regain. Throughout the project, the families received expert guidance from dieticians and were asked to provide blood and urine samples.
The five diet types
The design comprised the following five diet types:
- A low-protein diet (13% of energy consumed) with a high glycemic index (GI)*
- A low-protein, low-GI diet
- A high-protein (25% of energy consumed), low-GI diet
- A high-protein, high-GI diet
- A control group which followed the current dietary recommendations without special instructions regarding glycemic index levels
A high-protein, low-GI diet works best
A total of 938 overweight adults with a mean body mass index (BMI) of 34 kg/sq m were initially placed on an 800-kcal-per-day diet for eight weeks before the actual diet intervention was initiated. A total of 773 adult participants completed this initial weight-loss phase and were then randomly assigned to one of five different diet types, where 548 participants completed the six-month diet intervention (completion rate of 71%).
Fewer participants in the high-protein, low-GI groups dropped out of the project than in the low-protein, high-GI group (26.4% and 25.6%, respectively, vs. 37.4%; P = 0.02 and P = 0.01 for the two comparisons, respectively). The initial weight loss on the 800-kcal diet was an average of 11.0 kg.
The average weight regain among all participants was 0.5 kg, but among the participants who completed the study, those in the low-protein/high-GI group showed the poorest results with a significant weight gain of 1.67 kg. The weight regain was 0.93 kg less for participants on a high-protein diet than for those on a low-protein diet and 0.95 kg less in the groups on a low-GI diet compared to those on a high-GI diet.
The children's study
The results of the children's study have been published in a separate article in the American medical journal Pediatrics. In the families, there were 827 children who only participated in the diet intervention. Thus, they were never required to go on a diet or count calories – they simply followed the same diet as their parents. Approx. 45% of the children in these families were overweight. The results of the children's study were remarkable: In the group of children who maintained a high-protein, low-GI diet the prevalence of overweight dropped spontaneously from approx. 46% to 39% – a decrease of approx. 15%.
Proteins and low-GI foods ad libitum – the way ahead
The Diogenes study shows that the current dietary recommendations are not optimal for preventing weight gain among overweight people. A diet consisting of a slightly higher protein content and low-GI foods ad libitum appears to be easier to observe and has been documented to ensure that overweight people who have lost weight maintain their weight loss. Furthermore, the diet results in a spontaneous drop in the prevalence of overweight among their children.
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*Re. Glycemic index, please see the accompanying appendix
References:
1. "Diets with High or Low Protein Content and Glycemic Index for Weight-Loss Maintenance" Thomas Meinert Larsen, PhD, Stine-Mathilde Dalskov, MSc, Marleen van Baak, PhD, Susan Ann Jebb, PhD, Angeliki Papadaki, PhD, Andreas F.H. Pfeiffer, MD, J. Alfredo Martinez, PhD, Teodora Handjieva-Darlenska, MD, PhD, Marie Kunešová, MD, PhD, Mats Pihlsgård, PhD, Steen Stender, MD, PhD, Claus Holst, PhD, Wim H.M. Saris, MD, PhD, and Arne Astrup, MD, DrMedSc, for the Diet, Obesity, and Genes (Diogenes) Project; New England Journal of Medicine, published online 25 Nov. 2010.
2. The Effect of Protein and Glycemic Index on Children's Body Composition: The DiOGenes Randomized Study; Angeliki Papadaki Manolis Linardakis, Thomas M. Larsen, Marleen A. van Baak, Anna Karin Lindroos, Andreas F. H. Pfeiffer, J. Alfredo Martinez, Teodora, Handjieva-Darlenska, Marie Kunesová, Claus Holst, Arne Astrup, Wim H. M. Saris and Anthony Kafatos on behalf of the Diogenes Study Group; Pediatrics, Vol. 126, 5 Nov. 2010.
For more information, please contact:
Professor Arne Astrup, DrMedSc, Head of the pan-European diet intervention study Diogenes
Email: ast@life.ku.dk
Tel.: +45 2143 3302
Associate Professor Thomas Meinert Larsen, PhD, Head of Project and Principal Author of the NEJM article
Email: tml@life.ku.dk
Tel.: +45 2271 7058
* Eat more proteins and less refined starch (low GI)
The glycemic index is a measure of the ability of carbohydrates to increase blood glucose levels when absorbed in the body. Food with a low-glycemic index (LGI) causes blood glucose levels to increase more slowly and to lower levels compared to high-carbohydrate foods with a high glycemic index
Drastic increases in blood glucose levels give rise to several potentially undesirable effects that can influence the body's metabolism as well as our ability to perform mentally. It is therefore most appropriate to maintain a diet that results in slow digestion and thus more stable blood glucose levels and greater satiety.
A diet with a high protein content contains many protein-rich foods such as lean meat, poultry, fish, eggs and low-fat dairy products. Legumes also contain high levels of protein, as do nuts and almonds. Proteins are significantly more filling than both carbohydrates and fat.
Special requirements for a low-glycemic diet
The glycemic index applies to carbohydrate-containing foods. The recommendations are that some types of fruit may be consumed ad libitum, such as apples, pears, oranges, raspberries and strawberries. Other types should be eaten in only very limited amounts, including bananas (especially overripe bananas), grapes, kiwi, pineapple and melon. Nearly all vegetables are permitted, with the exception of corn, which should be limited. Carrots, beets and parsnip should preferably be eaten raw.
With regard to cereal-based foods (bread, grain, corn, hulled grains and breakfast products), the goal is to eat as many coarse and wholegrain foods as possible, i.e. wholegrain breads with many kernels, wholegrain pasta, whole oats and the special varieties of wholegrain cornflakes
Potatoes should be cooked as little as possible. Try to stick to new potatoes, and it is a good idea to eat them cold. Avoid mashed potatoes and baked potatoes.
Pasta should be cooked al dente and is best eaten cold.
Choose rice varieties such as brown rice, parboiled rice or basmati.
White bread without kernels, white rice and sugary breakfast products should be avoided. In general, sugar intake should be limited, not so much because of its GI but to avoid all those 'empty calories'.
Recommended GI values:
Over 70 – high GI
55-70 – medium GI
Under 55 – low GI
High-GI foods can still be healthy and vice versa. Carrots, for instance, have a high GI (72), while chocolate has a low GI (49). Fats help decrease the absorption of sugar in the blood, which means that carbohydrate-containing foods and fat can have a low GI.
Example of a day's menu for a high-protein, low-GI diet
If you want to maintain a high-protein, low-GI diet, daily meals could be composed as follows:
Breakfast: Low-fat A38 with muesli (without added sugar), wholegrain crispbread with low-fat cheese, an orange
Morning: Vegetable sticks and low-fat cheese sticks
Lunch: Wholegrain rye bread with lean meat or chicken cold cuts, mackerel in tomato sauce and misc. vegetables
Afternoon: Wholegrain rye bread with low-fat liver pâté and cucumber
Dinner: Stir-fried turkey with vegetables and wholegrain pasta; avocado salad with feta cheese and sugar peas
It is best to drink water or low-fat milk with meals.”
Originalartikkel (pdf)
