Low carbohydrate diets in family practice: what can we learn from an internet-based support group

Abstract

The Active Low-Carber Forums (ALCF) is an on-line support group started in 2000 which currently has more than 86,000 members. Data collected from posts to the forum and from an online survey were used to determine the behavior and attitudes of people on low carbohydrate diets. Members were asked to complete a voluntary 27-item questionnaire over the internet. Our major findings are as follows: survey respondents, like the membership at large, were mostly women and mostly significantly overweight, a significant number intending to and, in many cases, succeeding at losing more than 100 lbs. The great majority of members of ALCF identify themselves as following the Atkins diet or some variation of it. Although individual posts on the forum and in the narrative part of our survey are critical of professional help, we found that more than half of respondents saw a physician before or during dieting and, of those who did, about half received support from the physician. Another 28 % found the physician initially neutral but supportive after positive results were produced. Using the same criteria as the National Weight Registry (without follow-up) -30 lbs or more lost and maintained for more than one year -it was found that more than 1400 people had successfully used low carb methods. In terms of food consumed, the perception of more than half of respondents were that they ate less than before the diet and whereas high protein, high fat sources replaced carbohydrate to some extent, the major change indicated by survey-takers is a large increase in green vegetables and a large decrease in fruit intake. Government or health agencies were not sources of information for dieters in this group and a collection of narrative comments indicates a high level of satisfaction, indeed enthusiasm for low carbohydrate dieting.The results provide both a tabulation of the perceived behavior of a significant number of dieters using low carbohydrate strategies as well as a collection of narratives that provide a human perspective on what it is like to be on such a diet. An important conclusion for the family physician is that it becomes possible to identify a diet that is used by many people where the primary principle is replacement of starch and sugar-containing foods with non-starchy vegetables, with little addition of fat or protein. Used by many people who identify themselves as being on the Atkins diet, such a strategy provides the advantages of carbohydrate-restricted diets but is less iconoclastic than the popular perception and therefore more acceptable to traditional nutritionists. It is reasonable for family practitioners to turn this observation into a recommendation for patients for weight control and other health problems.

A low-carbohydrate survey: Evidence for sustainable metabolic syndrome reversal

“…75 A survey of more than 2000 members of an online, lowcarbohydrate support group found positive health outcomes for participants, such as decreased body weight and an improved lipid profile. 76 A survey of more than 2500 people following a low-carbohydrate diet of some type (or a paleo diet, which is often a reduced-carbohydrate diet) found a variety of positive health benefits such as reduced weight, hunger, irritable bowel syndrome symptoms, joint pain, arthritis pain, brain fog and acne, as well as improved glycaemic control, psychological well-being, athletic performance and energy. 77 About 100 people from the National Weight Control Registry, which tracks people who have long-term weight loss success, reported using a low-carbohydrate diet approach and reported long-term weight loss with reduced hunger.…”

Food consumption among overweight and obese working Malay women in urban settings

“…For example, increase in carbohydrate consumption was found to be associated with increased weight. [2][3][4] On the other hand, increased consumption of vegetables and fruit was associated with weight reduction efforts. 5,6 High protein diet was promoted as a weight reduction diet regime because protein was found to induce sustained reduction in appetite.…”

Fad Diets in the Treatment of Diabetes

“…Until we reach agreement on the recommended definitions and conditions, we recognize that "fad" diet is a term meant to disparage people from trying a dietary strategy that, in the case of low-carbohydrate diets is, in fact, not unconventional [27] or recent [18]. Although low-carbohydrate diets have always been considered one alternative, recent results and the underlying physiology suggest that it should be the default diet, the one to try first.…”

“…However, because the diet was hypocaloric, in absolute terms, this represented a switch from 97.0 (± 35.2) g/d to only 100.2 (± 37.9) g/d. In terms of food consumed, a poll of the Active Low-Carber Forums (http://forum.lowcarber.org/), an online support group, found that the major change was increased consumption of vegetables and leafy greens and not large increases in the meat or fat as popularly portrayed [27].…”

“…In distinction to the predictions of faddish behavior, membership has increased monotonically and is very close to 130,000 members as of December 2010. In our survey, members were asked if they had lost 30 lb or more and kept it off for 1 year [27]. This benchmark was set by the National Weight Registry (NWR), which is widely cited for their identification of 4000 participants over an approximately 10-year span who met this criterion, most of whom had been on a low-fat diet.…”