Skinny on diets

[Guest guest]

Hi All,

Designing your diet to you as an

individual, may be what the below

suggests that we do.

[No authors listed]

The skinny on popular diets. Bestselling diet plans don't

necessarily work any better than do-it-yourself programs.

Harv Heart Lett. 2005 Feb;15(6): 4-6. No abstract available.

PMID: 15770751 [PubMed - indexed for MEDLINE]

If losing weight was one of your

New Year's resolutions and you

have already quit your diet, don't

despair. Many off-the-shelf diets come

with the seeds of failure —restriction,

deprivation, hunger, and cravings —al-

ready planted.

Finding an effective eating strategy

is serious business if you are consid-

erably overweight and are interested

in improving your long-term health.

Halting any further weight gain and

gradually shedding pounds can have

bene & #64257;cial effects on blood pressure,

cholesterol, diabetes, your risk of hav-

ing a heart attack or stroke, joint pain,

and the energy and ability to do every-

day activities.

What you really need is a plan you

can stick with for many, many moons.

It should be as good for your heart,

bones, colon, and psyche as it is for

your waistline. It should offer plenty

of tasty and healthy choices, banish

few foods, and not require an exten-

sive and expensive list of groceries or

supplements.

Let's use this yardstick as a way to

measure some of the popular diet books.

Low carbs

The most popular diets today are those

preaching the carbs-are-bad gospel.

Once seen as the go-to

foods for weight loss, car-

bohydrates such as bread,

pasta, and rice are now

reviled as dietary demons,

thanks to the Atkins,

South Beach, and other

low-carb diets. Avoiding

carbohydrates, so the

thinking goes, forces the

body to burn fat.

Does this theory translate into actual weight loss?

Yes and no — it depends on the individual and

the time period. Some people lose a

substantial amount of weight on a low-

carb diet, while others lose little and

some actually gain weight. And for

those who lose, the effects typically

aren't permanent. After a few months,

weight loss tends to slow and reverse,

just as happens with most other diet

types.

Bottom line: Low-carb diets work

for some people and not others. There's

no evidence that their short-term ef-

fects produce long-term weight loss,

while the added expense could lighten

your wallet. Equally important, we

know little about the long-term health

effects of high-protein, high-fat, low-

carb diets.

Low fat

Once the main strategy for losing

weight, low-fat diets have been el-

bowed aside by the low-

carb frenzy. That's not

necessarily a bad thing,

since neither of the two

foundations on which low-

fat diets were built — fat

makes you fat, and fat is bad for the

heart —are very solid. Healthy fats can

actually promote weight loss, while

some fats are good for the heart and

eliminating them from the diet can

cause problems.

Scores of low-fat diets have been pro-

moted over the years. One of the best

known is Dr. Dean Ornish's Eat More,

Weigh Less plan. Since fat contains 9

calories per gram while carbohydrates

contain 4, you can theoretically double

your food intake without taking in

more calories by cutting back on fatty

foods and eating more that are full

of carbohydrates, especially water-rich

fruits and vegetables.

Keep in mind that the Ornish plan

doesn't stop at a whole-grain, veg-

etarian, very-low-fat (less than 10%

of calories from fat) diet, but also

includes exercise, stress management,

and group support.

Bottom line: Low-fat diets have

unquestionably helped some people

lose weight and keep it off. They've

been dismal failures for others, in part

because they tend to be less & #64257;lling, less

& #64258;avorful, and all around less satisfying

than other eating strategies. They also

tend to be fairly restrictive about food

choices, which can limit your options

when dining out.

Correct carbs

Diets such as Sugar Busters! and the

Glucose Revolution don't ban carbo-

hydrates. Instead, they em-

brace " correct " carbs while

shunning " harmful " ones.

In a nutshell, this means

eating plenty of fruits, veg-

etables, and whole grains,

and cutting back or cutting

out re & #64257;ned sugars (white

sugar, high-fructose corn

syrup, honey, molasses,

etc.) and processed grains.

Right-carb diets rely

heavily on the glycemic index and

glycemic load (see the December 2002

Heart Letter ). In theory, foods with a

low glycemic load generate small but

steady increases in blood sugar that

help stave off hunger. In contrast, the

rapid increases in blood sugar and

insulin that follow consumption of

foods with a high glycemic load are

followed by equally steep drops that

soon get your internal hunger alarm

ringing.

Bottom line: In general, right-carb

diets promote healthy eating by focus-

ing on fruits, vegetables, and whole

grains. But you don't really need to rely

on the sometimes contradictory glyce-

mic index and glycemic load tables to

tell you that. Plans that prohibit re & #64257;ned

sugars also make dieting and healthy

eating more complicated than it needs

to be. Re & #64257;ned sugars aren't toxic;they

just add unnecessary calories.

Perfect proportions and careful combinations

Several popular diets sell the idea

that speci & #64257;c proportions of nutrients

or certain combinations

of foods are essential to

weight loss. If you want to

enter The Zone, you must

create meals and snacks

that contain 9 grams of

carbohydrate for every 7

grams of protein and 1.5

grams of fat (40% carbo-

hydrate, 30% fat, and 30%

protein).

The Eat Right 4 Your

Type diet promotes the wholly un-

scienti & #64257;c idea that your blood type

determines what you should eat, along

with how you should exercise, what

supplements you need, and what type

of personality you have. Following it

isn't easy, since you must remember

lists of good and bad foods. It isn't

balanced, something you can tell from

the long list of recommended supple-

ments. And it makes it hard to prepare

meals for a family with several differ-

ent blood types.

Bottom line: Proper proportions

or correct combinations force you to

focus on what you are eating, which

helps most people eat less each day.

That's where any weight loss from

these diets comes from, not from any

nutritional or physiologic secrets the

diet developers have uncovered.

Does density matter?

According to the Volumetrics plan,

focusing on foods that & #64257;ll the belly

without adding too many

calories will help you shed

pounds. Foods with a high

water content, such as

fruits, vegetables, low-fat

milk, cooked grains, beans,

soups, and stews, get the thumbs up,

while high-fat foods like potato chips

get the thumbs down, as do dry, calo-

rie-dense ones like pretzels, crackers,

and fat-free cookies.

Bottom line: This strategy helps

people lose weight the same way most

other diets do —it narrows your choic-

es so you take in fewer calories each

day. Whether it has a long-term role

for weight control isn't known.

Behavior change

Some people use food for comfort and

overeat in response to sadness, loneli-

ness, depression, or any number of

other triggers. Breaking an unhealthy

relationship with food can help such

individuals lose weight. That's where

Dr. Phil's Ultimate Weight Solution,

the Automatic Diet, and others come in.

Dr. Phil offers " seven keys to per-

manent weight loss " — right think-

ing, heali ng feel ings,

a no-fail environment,

mastery over food and

impulse eating, inten-

tional exercise, a circle

of support, and what Dr.

Phil calls high-response

cost, high-yield nutri-

tion. The plan offers little

advice about nutrition.

The Automatic Diet uses

behavior modif ication

techniques to reprogram the patterns

that work against healthy eating.

Bottom line: If you think that your

habits, behaviors, and relationships

with other people and with food pro-

mote poor eating habits or in & #64258;uence

your ability to lose weight or maintain

a steady weight, then a behavioral

approach makes sense. Combining it

with a healthy eating pattern based on

sound nutrition would be even better.

The evidence

Given the sheer number of diets pro-

moted over the years and Americans'

long-standing interest in losing weight,

it's appalling how little solid informa-

tion we have on effective strategies for

weight loss.

Surveys of people who have suc-

cessfully lost weight and kept it off,

conducted by the National Weight

Control Registry and Consumer

Reports, reveal that most did it on their

own without resorting to commercial

weight loss programs. They tend to

chalk up their successes to — drum-

roll, please — eating less and exercis-

ing more. The latest news from the

Registry indicates that participants

report taking in an average of 1,800

calories a day and burning an average

of 400 calories a day in physical activ-

ity, the equivalent of about an hour of

brisk walking.

Interestingly, the Registry partici-

pants tended to rely on low-fat diets,

while the Consumer Reports group

relied mostly on low-carb diets.

Another line of evidence about ef-

fective weight-loss strategies comes

from a few carefully controlled trials

in which obese volunteers were blindly

assigned to either a standard low-fat

diet or a low-carb, high-protein diet.

Overall, these trials showed that a

low-carb, high-protein diet leads to

quicker weight loss than a low-fat diet.

In the few studies that lasted for a

year, though, weight loss was about

the same regardless of diet type . These

studies focused primarily on weight,

and were too short to track other im-

portant consequences of diet, such as

heart disease, diabetes, bone strength,

and cancer.

The overall results mask some star-

tling individual differences. In one

trial, on both low-carb and low-fat

diets, some people lost weight while

others gained. In the low-fat group,

the range was from 53 pounds lost

to 31 pounds gained. In the low-carb

group, it was from 65 pounds lost to

18 gained.

The take-home lesson is that it is

okay to experiment on yourself. If

you give a diet your best shot and it

doesn't work, maybe it wasn't the right

one for you, your metabolism, or your

situation. Don't get too discouraged

or beat yourself up because a diet that

" worked for everybody " didn't pay off

for you. Try another.

Do it yourself

You could also strike out on your own,

like thousands of success-

ful dieters before you. You

can build your own plan by

choosing the smart parts of

the diets discussed here.

Or you could try a

healthy eating plan based on the best

science available, like the one that Dr.

Walter Willett, a member of the Heart

Letter editorial board, and his col-

leagues have developed. Its elements

include moderation (portion control);

eating more fruits and vegetables; cut-

ting back on unhealthy saturated and

trans fats and including more healthy

unsaturated fats;eating more whole

grains and less re & #64257;ned grain;and

choosing healthy sources of protein,

such as & #64257;sh, poultry, beans, and nuts.

An overall approach to healthy eating

like this one will do more for you in the

long term than a diet based on certain

foods. One problem with these is that

people often think they can eat all they

want of the " right foods. "

Dr. Willett's book, Eat, Drink, and

Be Healthy, offers a road map for this

strategy.

Al Pater.