psyllium supplements of 30 g per day to obtain
adequate fiber. CSIRO recommends that a dietician
be consulted if significant adjustments to the diet are
required.
The TWD was designed for foods readily avail-
able to Australians and assumes the intake of signifi-
cant amounts of processed foods. It is not suitable for
societies and cultures with eating habits that are very
different from those of Australians. A high-carbohy-
drate diet may be better suited to those who prefer to
not eat large amounts of protein.
Risks
Although many people find it relatively easy to
lose weight on high-protein low-carbohydrate diets
during the first few weeks, some people find it difficult
to maintain a diet that is high in meat. In addition
some dieters find it difficult to maintain low-carbohy-
drate diets.
Nutritionist Patrick Holford has argued in the
prestigious scientific journalNaturethat the abnor-
mally high amount of meat in the TWD could lead
to long-term health problems, such as breast orpros-
tatecancer, kidney stress, or reduced bone mass.
Although some research has suggested that diets high
in meat can increase the risk of colon cancer, other
research has contradicted this or suggested that the
risk is associated only with high-fat processed meat,
which is not a part of the TWD.
Research and general acceptance
Research
The TWD is based on research conducted by
physicians at CSIRO, a highly-respected organization.
Earlier research had indicated that high-protein diets
were at least as good, if not better, for women than
high-carbohydrate diets, in terms of weight loss and
muscle preservation. As of 2007 CSIRO had com-
pleted five studies on the TWD, one funded by Meat
and Livestock Australia and one by the dairy industry.
The other studies were funded by CSIRO. According
to CSIRO, their research proves that the TWD:
is safe
leads to improved nutritional status
results in weight loss
lessens the risk factors for diabetes and heart disease.
In the initial CSIRO study, 100 overweight and
obese women were divided into two groups. One
group was placed on a high-protein low-fat diet and
the other group on a high-carbohydrate low-fat diet
for 12 weeks. Thehigh-protein dietconsisted of 34%
protein, 20% fat, and 46% carbohydrate. The high-
carbohydrate diet consisted of 17% protein, 20% fat,
and 63% carbohydrate. The caloric content of each
diet was the same. The researchers monitored weight
loss, changes in body composition, vitamin-B 12 status,
bone-turnover markers, and disease-risk factors
including LDL cholesterol and triglycerides.
Although on average the women in each group
lost the same amount of weight—18–20 lb (8–9 kg)—
women with high triglyceride levels lost significantly
more weight on the high-protein diet. Only women
with high triglycerides lost more abdominal fat than
the women on the high-carbohydrate diet. The two
groups of women did not differ in the other bench-
marks that were examined. The researchers did find
that more women dropped off the high-carbohydrate
diet and that the women appeared to prefer the high-
protein diet.
In subsequent studies CSIRO found that women
with symptoms of ‘syndrome X,’ also called metabolic
syndrome, a condition that increases the risk of devel-
oping heart disease and type 2 diabetes, lost more
weight and twice the amount of body fat on a high-
protein low-fat diet, as compared with similar women
on a high-carbohydrate low-fat diet. It was pointed out
inNaturethat the TWD proved superior to the high-
carbohydrate diet only for the subpopulation of over-
weight women with this type of metabolic dysfunction.
As of 2007, CSIRO was expanding its studies on
the TWD to include male volunteers. However the
TWD has not been compared with other alternative
diets. In particular CSIRO has been criticized for not
comparing the TWD to a high-protein vegetarian diet
or comparing a high-protein vegetarian diet with a
high-carbohydrate vegetarian diet. Furthermore theQUESTIONS TO ASK YOUR
DOCTOR Am I a person who would be expected to lose
weight and maintain my health and weight loss
on the TWD?
Do I have symptoms of ‘syndrome X’?
Should I be eating such a large amount of
protein?
Should I be eating such a large amount of meat?
Have you had other patients try the TWD?
Are there other types of diets that I should
consider?CSIRO total wellbeing diet