Posted: March 18, 2005

Science of Sport: Can Low-Fat Diets Help Runners Shed Weight?

By Owen Anderson, Ph. D. (copyright © 2003-2005)

Are you a runner who would like to lose a pound or two - in hopes of improving your running? Have you toyed with the idea of reducing the fat content of your diet - in hopes of losing weight? In either case, you may find the following article to be interesting:

On its face, it seems like a decent proposition. Eat less fat, and you should lose both pudginess and pounds.

After all, fat is the most energy-dense "macronutrient" in the human diet, offering up nine calories per gram, versus just four calories for each gram of either carbohydrate or protein. In cases in which dietary intake is unregulated (i. e., when humans are eating as they please), a propensity to ingest fat could easily lead to an excessive consumption of energy and a gain in body weight.

In addition, many people seem to believe that fat increases the flavor and overall palatability of comestibles and thus are very attracted to foods which have a substantial fat content. For individuals with such inclinations (and a lack of expertise in the use of herbs and spices to make edibles more exciting), fat-free foods can be rather bland and tasteless. Fatty fare, on the other hand, "tastes good" and draws them toward high-calorie banqueting.

Making matters worse, some research has shown that fat produces a smaller "thermogenic effect," compared with carbohydrate (i. e., an intake of fat produces a smaller boost in metabolic rate, compared with the ingestion of a calorically equivalent amount of carbohydrate). Thus, fat might be utilized by the human body more efficiently (with less of its energy lost as heat), compared with carbohydrate, a situation which could promote the accumulation of body fat whenever dietary intake skews toward blubber (1).

To make matters still worse, some experts believe that the human body is naturally set up to regulate the intake of carbohydrate, but not fat (2). Although this might seem to be a strange state of affairs, the human nervous system is almost entirely dependent on carbohydrate for its metabolism and might jealously protect intakes of carbohydrate - while being more cavalier about fat ingestion. If this view is correct, and there is evidence to support it, individuals who enjoy eating fatty foods would tend to take in a greater amount of total energy in order to obtain their mandated amounts of carbohydrate, compared with people on low-fat, high-carbohydrate diets.

The notion that a diet laden with fat leads to a body loaded with lard is reinforced every time you visit a grocery store, where you can find low-fat entrees, low-fat dairy products, and even low-fat versions of foods which are almost synonymous with high levels of fat (chips, cookies, and chocolates, for example). There are also "fake fats" in certain foods (potato chips) and - at your pharmacy - prescription medicines which block the absorption of fat across the walls of the small intestine. Naturally, the book market is pinguid with popular books about fat-thwarting diets and fat-free cooking.

As Walter Willett, M. D. points out in his outstanding new book (3), the idea that fat is bad has become an extremely powerful public-health message, one which has been accepted by health-conscious elements of the American public. As Willett notes, fat has become a kind of dietary Public Enemy Number One, a food feared for its ability to produce obesity, heart disease, and Type-II diabetes, as well as cause cancer (excess body fat has been linked with increased risks of colon, breast, kidney, and uterine cancer). Suitably horrified, Americans spend billions of dollars each year on "fat-fighting" products (foods, books, and medications).

Fat hasn't always had such a bad rap (or even rep). Until as recently as 50 years or so ago, high-calorie diets loaded with bountiful quantities of fat were actually believed to be protective against disease - and valuable in the recovery process following a serious illness (ibid). Growing up in the Midwest in the 1950s, I routinely consumed "healthy" breakfasts of eggs slathered in bacon grease along with toast fully saturated with home-made butter, all washed down with a hefty glass of whole milk. For the evening meal, hearty helpings of beef were the rule, along with potatoes coated with generous dollops of high-fat gravy. Millions of other Americans were consuming the same kind of fare - and believing that such consumption was the healthy way to go.

However, as I was consuming my oleaginous meals with great gusto, emerging nutritional research began to paint dietary fat in rather dark tones. Specifically, a notable investigation called the Seven-Countries Study (4 & 5) appeared in the scientific literature, and this international survey linked the consumption of saturated fat with a significantly increased risk of heart disease. The Seven-Countries Study was initiated by a remarkable scientist named Ancel Keys, who celebrated his 100th birthday on January 26 of this year.

Keys, the nephew of movie actor Lon Chaney, graduated from the University of California at Berkeley, carried out graduate studies at Berkeley and the Scripps Institute, and completed post-graduate work in Copenhagen with the Nobel-prize-winning August Krogh. In 1939, Keys created the Laboratory of Physiological Hygiene at the University of Minnesota, located beneath Gate 27 at the University Stadium, and he began a long career which systematically explored the relationships between physiology, nutrition, epidemiology, and the prevention of disease. During World War II, Keys developed the K ration - easily transportable, light-weight, high-calorie food to be carried by American military personnel during combat. The ingenious Keys found all of the materials for the K ration - biscuits, dried sausage, chocolate, and candy - at his neighborhood grocery store in Minneapolis.

As he searched for research ideas after the war's end, Keys was startled by the high number of obituaries in the Minneapolis Tribune for men who had suddenly dropped dead as a result of heart attacks. He commenced a pioneering investigation of heart disease among nearly 300 businessmen in the Minneapolis-St. Paul area, and he followed the Minnesota study with his Seven-Countries work, which surveyed approximately 12,000 men in Finland, Greece, Yugoslavia, Italy, the Netherlands, Japan, and the United States (6). The Seven-Countries Study convincingly showed that heart-attack rates were related to saturated-fat intakes. Finnish men, who went so far as to spread butter not only on their bread but also on their cheese (!), had the highest risk of keeling over with an infarction, while men in the Mediterranean countries, who ate much less saturated fat and consumed lots of olive oil, pasta, bread, fruits, and vegetables, had the lowest likelihood of ticker troubles.

Keys' findings regarding the death-promoting properties of saturated fat became rather widely known, and the Minnesota researcher ultimately appeared on the cover of Time magazine in 1961. In an interview with Time, he commented that the main trouble with the America diet was that "Americans have Sunday dinner every day" (ibid). He ultimately published two cookbooks on healthy eating, Eat Well and Stay Well and The Benevolent Bean, and he is credited with establishing the popularity of the "Mediterranean Diet," a plan of eating which is low in saturated fat and replete with fruits, vegetables, and olive oil (a dietary lubricator which contains low levels of saturated fat). His work pushed the fat-is-bad concept firmly into the American consciousness.

Interestingly enough, even though Keys had good, hard data for the link between saturated fat and coronary catastrophes, he did not find much evidence to support the idea that dietary fat was linked with being overweight or obese. Although this seems like a paradox (given our current fat-is-bad paradigm), the additional, relevant information concerning fat intake and body weight which has been collected since Keys' groundbreaking study was conducted provides very little reinforcement for the notion that a higher fat intake leads to a more-abdominous body.

For one thing - and this may come as a bit of a shock if you routinely watch your fellow citizens eating in restaurants or other public places - Americans have actually done a fairly decent job of cutting back on the amount of fat in their diets. Since Keys appeared on the cover of Time, the fat content of the average American diet has dropped from 40 percent to around 34 percent, a 15-percent downturn. However, during this same time period there has actually been a gradual increase in the weight of the average American - and a dramatic upswing in obesity. If fat consumption were truly the key culprit underlying excessive body weight, Americans should be getting slimmer, not fatter.

In addition, although the proposed mechanisms by which dietary fat might spike the incidence of obesity are fairly impressive, there are also some forceful arguments to support the notion that high-fat diets are not a strong player in the portliness game. Note, for example, that humans seldom eat foods which are pure fat or pure carbohydrate - and that the energy density of food (its caloric content per unit volume) is determined primarily by water and fiber content, not fat composition. Along these lines, consider a salad with dressing: Although the dressed-up salad might derive most of its calories from fat, it would have a fairly low energy density, since it would be composed primarily of water and fiber (7). If you ate salad with dressing for all of your meals, you would be on a high-fat diet, but your total caloric intake would generally be quite modest, and your risk of gaining weight would be relatively small. High-fat diets are not necessarily the same as high-calorie diets, and ultimately excessive caloric intakes are what make people overweight.

Note, too, that when carefully controlled metabolic studies (the kind which reveal that fat has a lower thermogenic effect than carbohydrate, for example) are extended beyond a few hours to several days in duration, such investigations generally show that humans gain about the same amount of weight, whether they are overfed with carbohydrate or stuffed full of fat (8). In these overfeeding studies, fat has no particularly pernicious qualities from the standpoint of putting on poundage. The total quantity of ingested calories is what really matters.

It is certainly true that individuals who live in relatively affluent countries tend to pursue relatively high-fat diets, compared with people from poorer countries, and that citizens in prosperous countries are likely to be more corpulent than folks in impoverished regions of the world. These observations have been used to support the notion that increased intakes of dietary fat necessarily lead to higher body fatness. However, such findings are confounded by a number of variables, including the facts that food may be considerably less available and physical activity may be substantially greater in the less-flourishing regions of the world.

When countries with more-similar degrees of economic development are compared, the relationship between dietary fat and body fat looks quite different. For example, country-to-country surveys carried out in Europe have revealed a startling fact: Women with the fattiest diets have the smallest risk of becoming obese, while females with the lowest dietary fat contents suffer from the highest likelihood of becoming rotund (9)! In addition, there is absolutely no relationship between fat intake and chubbiness among European men, even though country-to-country fat intake varies rather widely - from 25 to 47 percent of total calories (ibid). If you are a Continental man, enjoying a high-fat diet does not magnify your risk of stocking up on suet; if you are a European woman, consuming fat-rich foods is actually linked with gracility. Please pass the goose liver!

The examination of specific countries seems to throw additional, acquitting light on dietary fat as a perpetrator of obesity. For example, the average diet of citizens of South Africa derives about 22 percent of its energy from fat, a relatively low number by world standards (approximately 70 percent of countries surveyed in Africa, Asia, Europe, North American, and South America, as well as Australia and New Caledonia, have average diets which are higher in fat content (10)). Nonetheless, almost 60 percent of South Africans have a BMI of greater than 25 - and thus can be considered overweight. In fact, out of 20 counties recently examined from around the world, South Africa is # 3 when it comes to adiposity.

Since I have mentioned BMI, I should take a moment to explain it. As you are probably aware, BMI is a kind of index of fatness, and its development was the result of difficulties surrounding the question of what constitutes a "healthy weight." Obviously, 180 pounds might be a great weight for someone who stands six feet three, but it is far too heavy for a five-footer. The BMI (body-mass index), also known as the Quetelet index, gets around this problem by adjusting weight for height, thus taking into account the fact that tall people tend to naturally be more massive than short individuals. To calculate your BMI, simply divide your weight in pounds by your height in inches. Divide the resulting number by your height in inches, and then multiply the result by 703. If you are not crazy about math, you can also have your BMI calculated for you on the Harvard Health Publications web site (www.health.harvard.edu).

Establishing guidelines for "healthy BMIs" has been accomplished by looking at rates of death in large groups of people and then selecting those BMIs with the lowest death rates as the healthy ones. A long series of investigations, including one study which included more than a million adults, have shown that having a BMI above 25 significantly increases the risk of premature death (3). Generally, individuals with BMIs ranging from 25 to 30 are considered to be overweight, while those checking in above 30 are classified as obese.

As mentioned, South Africans tend to follow diets low in fat but are nonetheless quite corporational; close-to-60 percent of the population has managed to hoist BMI above 25. In contrast, Italians derive nearly 40 percent of their calories from fat, and yet "just" 40 percent of Italians have lofty BMIs. Countries on the same continent can have wildly different diet-BMI relationships. In the Congo, for example, Congolese obtain about 23 percent of their calories from fat, very close to South-Africa levels. However, fewer than 5 percent of Congolese citizens have overweight BMIs (above 25). In contrast, people in Morocco get just 17 percent of their calories from fat, and yet the percentage of Moroccans with too-lifted BMIs is close-to-six times greater, compared with the Congo. As you can see, when the world is surveyed rather broadly, the supposed link between dietary fat and bodily rotundity comes unglued.

Of course, these country-to-country surveys are plagued by confounding factors, including potentially major differences in physical activity and food accessibility between nations, along with varying attitudes about the desirability of weight gain. With that in mind, it is important to ask what has happened in those controlled, randomized, scientific trials in which individuals have gone on low-fat diets to lose weight.

Somewhat surprisingly, the number of such studies is fairly modest. In the short-term trials which have been conducted (i. e., in those investigations lasting six months or less), small weight losses are observed when 10 to 15 percent of the energy usually obtained from fat is replaced by energy from carbohydrate (11). These weight reductions are generally in the one- to eight-pound range.

Although small, such corpulence cutbacks could lead to substantial improvements in body composition if the observed rate of weight loss continued for longer periods. After examining these short-term studies, some obesity researchers have concluded that a reduction of 10 percent of total energy intake from fat would trim body weight over the long term by about 16 grams per day (10). Over the course of a year and one-half, such paring would lop nearly 19 pounds of lard from the average person; after four years, a ton of tallow would be lost (just kidding - the real loss would be around 51 pounds per capita).

Do long-term studies support such projections? Unfortunately for proponents of the fat-makes-you-fat hypothesis, the answer is no. As you might expect, the total number of long-term randomized trials of dietary fat reduction is smaller than the quantity of short-term probes (longer studies trim scientists' publication rates, a critical factor for advancement in the scientific field, and long-term studies are also more likely to be "wrecked" by either high numbers of drop-outs or by individuals who do not actually drop out but are unable to faithfully abide by the restrictions of the research for extended periods). In addition, much of the relevant data on fatty eating and body fat exists as secondary information from research in which body weight was not the key variable (7). In fact, most of the investigations which provide clues about the link between dietary fat and weight were actually pilot studies which looked for a link between dietary fat reduction and a downgraded risk of cardiovascular disease or cancer.

The single, double-blind, long-term investigation of fat reduction and body weight is the National Diet Heart Study (12), an investigation in which foods with differing fat content were provided to 900 subjects. Members of the "high-fat" group obtained about 35 percent of total calories from fat (very close to current American intake patterns), while individuals in the "low-fat" collection of subjects received 30 percent of calories from lipid. After one year, the high-fat participants weighed just .8 kilograms (1.75 pounds) more than the low-fat communicants, a difference which would be unlikely to produce a significant disparity in overall health between the groups. Interestingly, many health officials now recommend a reduction in fat intake to around 30 percent of total calories, even though the National Diet Heart Study strongly suggests that such a fall-off in fat foraging would not have a significant impact on plumpness.

I do anticipate what you are thinking here (and it is certainly good thinking on your part): If the individuals on the low-fat diets lost 1.75 pounds after one year, would they not lose 17.5 pounds of mass after 10 years - and 35 pounds after 20? Would not such ample suet shearings lead to better body sculpturing - and greatly improved overall health?

Yes, they would, but unfortunately the evidence suggests that the losses in body fatness tend to be reduced rather than amplified over time. Take the Women's Health Trial, for example, a long-term investigation in which fat intake was snipped from 38 to 20 percent of total calories for about half of the study's participants (13). Impressively, women in the low-fat (20-percent-of-calories) group dropped about seven pounds of weight after six months. However, almost half of this weight was slowly regained over the ensuing 18-month period. After 24 months, members of the low-fat group weighed just four pounds less, compared with high-fat women, a difference which would be unlikely to produce significant health benefits.

Fat flunked badly as a fatness promoter in a separate, carefully conducted piece of research in which fat ingestion was pared from 36 percent to just 18 percent of total caloric intake over a one-year period (control subjects in this study continued to get about 36 percent of daily energy from fat). At first glance, the low-fat people appeared to have done better, losing 2.6 more kilograms (5.7 more pounds) than the steadfast suet-eaters after 12 months (14). However, most of this change was due to a loss of lean mass in the low-fat dieters; the difference in change in body-fat percentage worked out to be less than 1 percent, and there was no difference in waist-to-hip circumference ratios (a commonly used measure of obesity) between groups.

It's clear that long-term studies do not link low-fat diets with significant upgrades in body composition. In addition, even if low-fat diets produce impressive improvements in body composition in future investigations, there is a problem associated with low-fat eating which has not yet been discussed - the high "drop-out" rate associated with the eschewal of fat. That is, low-fat diets are less likely to be followed for prolonged periods of time, compared with diets which are richer in lipid. In one study in which fat intake was reduced to determine whether low-fat diets would reduce the risk of breast cancer, 194 women were randomly assigned to either a low-fat (15 percent of total calories) or traditional diet (15). After 12 months, 31 percent of the low-fat eaters had completely dropped out of the study, a significantly higher frequency than in the control group. The remaining low-fat women lost an average of 3.3 pounds, but the higher-fat consumers dropped 5.3 pounds!

Note that low-fat eating has fared rather unimpressively in these studies, in spite of the fact that low-fat supping enjoys a major advantage in the investigations. In the research which has been carried out on the effects of low-fat eating, the low-fat subjects are always given state-of-the art dietary instruction and are routinely provided with high levels of motivation. In many cases, low-fat eaters are even provided with scales to weigh their food and control the sizes of their portions; control subjects receive no such support. As a result, in those cases in which low-fat eating does lead to superior weight loss, it is possible that the pound slippage is simply the result of a greater attention to overall food ingestion, rather than the reduction in fat-based calories.

When all subjects in a scientific study receive similar levels of instruction and motivation, fat-fighting usually does not prove to be a superior weight-loss strategy. In one investigation, for example, 444 men were randomly placed into four different groups with four levels of fat intake (16). Each of the four groups lost similar amounts of weight, and the highest- and lowest-fat-ingestion groups lost exactly the same amount of mass - 6.4 pounds.

Finally, there is a dark side to the argument that cutbacks in fat intake are desirable; the truth is that some fats are very good for you, and cutting back on these salubrious fats will make you no slimmer - and could harm your overall health.

What exactly are these "good fats?" Monounsaturated fat, the kind found to a significant extent in olives, olive oil, peanuts, peanut butter, peanut oil, canola oil, avocadoes, cashews, almonds, and most nuts tends to raise your good (HDL) cholesterol and lower your bad (LDL) cholesterol. Ridding your diet of monounsaturated fat and replacing it with carbohydrate as part of an effort to lose weight would be likely to leave the number you find on the scales every morning the same - while pushing your blood-cholesterol profile in a negative direction.

Polyunsaturated fat, the type found in oily fish as well as corn, soybean, safflower, and cottonseed oils, also tends to raise HDL cholesterol and lower cholesterol, when compared with the intake of an energetically similar amount of carbohydrate. As is the case with monounsaturated lipid, paring the polyunsaturates wouldn't push your pounds down but might very well frustrate your attempts at achieving healthy cholesterol concentrations.

In addition, one specific kind of polyunsaturated fat - the n-3 (omega-3) fatty acids - appears to provide special benefits. These omega-3 fats are important components of cell membranes throughout the body, and they are the building blocks for the hormones which control inflammation, blood clotting, and the relaxation and contraction of blood vessels. Omega-3s have a strong protective effect against heart disease; their precise mechanism of action is not exactly known, but they seem to prevent unusual heart rhythms, make blood more slippery and less likely to clot (most heart attacks occur when a clot forms inside one of the heart's arteries), and control inflammation on the interiors of blood vessels. Many experts suggest that humans should consume at least one good source of omega-3 fats per day (the n-3s are found in significant quantities in oily fish such as wild-caught salmon, tuna, and herring, as well as in flaxseeds, flaxseed meal, and flaxseed oil). Unfortunately, reductions in fat intake (as part of an effort to lose weight) often lead to reduced ingestions of omega-3 fatty acids, other polyunsaturated lipids, and monounsaturated fats, with potentially negative consequences for health.

Instead of shunning fat in an effort to lose weight, a superior strategy would be to eat reasonable amounts of monounsaturated and polyunsaturated fat - and to gradually substitute these health-promoting fats for the saturated and "trans" fats in your diet. An elevated consumption of saturated fat, the kind of fat found in whole milk, butter, cheese, cream, ice cream, red meat, chocolate, coconuts, coconut milk, and coconut oil, has been linked with an increased risk of cardiovascular disease and unfavorable upswings in LDL cholesterol. Significant ingestion of trans fats (the kind found in "partially hydrogenated" oils and thus in most margarines, vegetable shortening, deep-fried chips, French fries, most fast foods, and most commercial baked goods) has been connected with reductions in good (HDL) cholesterol, increases in bad (LDL) cholesterol, spikes in blood fats, and an increase in blood "stickiness" which may unnaturally heighten the likelihood of clot formation inside small arteries (3). Replacing saturated and trans fats with polyunsaturated and monounsaturated fat can reverse these negative tendencies.

If you made an effort to eat more poly- and monounsaturated fat, would you be at increased risk for weight gain? In one study, 101 men and women were randomly assigned to either a standard low-fat diet (with 20 percent of energy coming from fat and no special preference for polyunsaturated and monounsaturated fat) or a moderate-fat, Mediterranean diet (with 35 percent of calories originating in fat and most of the lipid in the form of monounsaturated fat). After 18 months, only 20 percent of the individuals in the low-fat group were sticking it out (i. e., there was an 80-percent drop-out rate!), versus 54 percent of the moderate-fat, Mediterranean eaters. Furthermore, low-fat subjects actually gained an average of 6.4 pounds, while individuals on the moderate-fat plan lost close to nine pounds, a difference which was statistically significant. Over a follow-up year, individuals in the moderate-fat group sustained a weight loss of around eight pounds (17). This study strongly suggests that a moderate-fat diet is easier to follow and permits better weight loss in the long term, compared with low-fat eating. Eating healthy fats doesn't fatten you up; in fact, consuming healthy fats tends to make diets more pleasing and palatable, with enduringly positive effects on weight.

So what are the bottom lines? In controlled scientific studies, people who embark on low-fat diets tend to lose three or four pounds after a month or so, but then - dishearteningly - they begin reverting back to their previous body-weight opulence, even when they continue on with their low-fat bread-breaking like faithful fat-fighting soldiers. In the "free world" (outside of the randomized studies), people who remove fat from their diets usually replace it with something else (carbohydrate or protein), and the something else can make them just as overweight as the fat did.

The ultimate bottom line is that the fat in your diet does not necessarily pile weight onto your body. If you routinely ingest more calories than you expend, your body is going to burgeon like a balloon, regardless of whether the calories come from fat, carbohydrate, protein, or alcohol; your job is to cut back gradually on calories and/or steadily increase your quantity of exercise until you begin to lose weight. Although it is a fine idea to cut down on saturated and trans fats from an overall health standpoint (although not necessarily from a weight standpoint), you should not - in most cases - try to reduce your consumption of poly- and monounsaturated fats. Instead, figure out ways to substitute reasonable quantities of such fats for the saturated and trans fats which are already in your diet. The polys, the monos, and the special polys called omega-3s won't make you fatter, but they will make you healthier! And healthier, of course, means that you will be able to train more consistently, one key to becoming a better runner. ©

To find out more about improving your body composition and losing a few extra pounds, please go to www.rrnews.com, and click on the yellow "Samples" button. By doing so, you will be able to read a free issue of Weight-Loss Research, along with a sample copy of Running Research News.

References

(1) "Dietary Composition, Substrate Balances and Body Fat in Subjects with a Predisposition to Obesity," International Journal of Obesity, Vol. 17, pp. S32-S36, 1993
(2) "Energetics of Intermediary Metabolism," In Garrow, J. & Halliday, D., Eds. Substrate and Energy Metabolism in Man. John Libbey: London, 1985, pp. 58-69
(3) Willett, Walter C., Eat, Drink, and Be Healthy. Free Press: New York, 2003, pp. 56-84
(4) "Coronary Heart Disease in Seven Countries. 1970," Nutrition, Vol. 13(3) (March), pp. 249-253, 1997
(5) "Diet for Preventing Cardiovascular Diseases: Light from Ancel Keys, Distinguished Centenarian Scientist," Nutr Metab Cardiovascular Disease, Vol. 14(1) (February), pp. 52-57, 2004
(6) "A Century of Science: Ancel Keys, A Pioneer in Study of Diet, Soon Will Mark His 100th Birthday," Twin Cities.com Pioneer Press, January 24, 2004, Available at
http://www.twincities.com/mld/twincities/news/7784489.htm
(7) "Dietary Fat Plays a Major Role in Obesity: No," Obesity Reviews, Vol. 3, pp. 59-68, 2002
(8) "Macronutrient Disposal during Controlled Overfeeding with Glucose, Fructose, Sucrose, or Fat in Lean and Obese Women," American Journal of Clinical Nutrition, vol. 72, pp. 369-377, 2000
(9) "Dietary Fat and Obesity: Evidence from Epidemiology," European Journal of Clinical Nutrition, Vol. 49, pp. 79-90, 1995
(10) "Dietary Fat Intake Does Affect Obesity!" American Journal of Clinical Nutrition, Vol. 68, pp. 1157-1173, 1998
(11) "Dietary Fat and Body Fat: An Intervention Study," International Journal of Obesity and Related Metabolic Disorders, Vol. 20, pp. 1022-1026, 1996
(12) "The National Diet-Heart Study Final Report," Circulation, Volume 18 (Supplement), pp. 1-154, 1968
(13) "Weight Loss in Women Participating in a Randomized Trial of Low-Fat Diets," American Journal of Clinical Nutrition, Vol. 54, pp. 821-828, 1991
(14) "Dietary and Anthropometric Determinants of Plasma Lipoproteins during a Long-Term Low-Fat Diet in Healthy Women," American Journal of Clinical Nutrition, Vol. 57, pp. 146-153, 1993
(15) "A Randomized Trial of a Low-Fat Dietary Intervention in Women at High Risk for Breast Cancer," Nutr Cancer, Vol. 27, pp. 136-142, 1997
(16) "Long-Term Cholesterol-Lowering Effects of 4 Fat-Restricted Diets in Hypercholesterolemic and Combined Hyperlipidemic Men. The Dietary Alternatives Study," Journal of the American Medical Association, Vol. 278, pp. 1509-1515, 1997
(17) "A Randomized Controlled Trial of Moderate Fat, Low Energy Diet Compared with a Low Fat, Low Energy Diet for Weight Loss in Overweight Adults," International Journal of Obesity and Related Metabolic Disorders, Vol. 25, pp. 1503-1511, 2001

To learn about Owen-Anderson's running camps in California, please send a note to Owen at owen@rrnews.com.

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