By Martin Collis, Ph.D.

The origin of the word 'diet' is from the Greek word 'diaita' which means 'prescribed way of living' not just ruthless caloric restriction.

"Oh that this too, too solid flesh would melt, thaw and resolve itself into a dew." William Shakespeare.

North Americans are killing themselves with lousy lifestyle choices, they're getting fatter and fatter more quickly and at a younger age than at any time in history. As we enter the new millennium an increasing number of people seem numb and dumb and subsist on heavily advertised, non-nutritious pacifiers for much of their diet. Twelve companies with total sales in excess of 335 billion dominate the marketplace and often account for more than 50 percent of the items on supermarket shelves. The combination of poor food choices and an increasingly sedentary lifestyle has made weight gain inevitable unless people make a conscious decision to be physically active and to ignore the advertisements for convenient, packaged and fast foods in giant portions.

In a culture where an ideal body image is slim and the actual bodies are fat there is a tremendous sense of dissonance, and a huge potential market for any book or program that promises weight loss. Magazines are filled with pictures of models wearing size 2 or 4 outfits, but the most commonly sold dress size in North America is a 14. We're a society searching for a quick fix for our long term problems, always looking for that nutritional loophole, ready to give credence to any anecdotal evidence that suggests there's an easier way to shed weight than eating sensibly and exercising on a regular basis.

On July 7 the New York Times Magazine ran a cover story by Gary Taubes with the provocative title, "What if Fat Doesn't Make you Fat?" This was a brilliant piece of journalism, which was very carefully and cleverly researched. It was convincing enough to make me wonder whether it was possible that Dr. Atkins and his low-carb/high-fat acolytes could be right. I remembered the Woody Allen movie, 'Sleeper' in which the main character wakes up 200 years in the future and featured the following dialogue.

Head Researcher: "Any special requests now he's awake?" Assistant: "Yes, wheat germ and organic honey." Head Researcher: "Those were the charmed substances that years ago were thought to contain life-preserving properties". Assistant: "What do you mean, no deep fat, no steak, no cream pies or hot fudge?' Head researcher: 'Those were thought to be unhealthy, precisely the opposite to what we now know to be true.'

Taubes' provocative piece was too good to be dismissed out of hand and needed to be refuted by the big guns from the American Heart Association and by Dean Ornish representing the low-fat/high-carb. vegetarian leaning thinkers. Dean Ornish wrote an op. ed. column for the New York Times, and then sat down with Taubes and Dr. Barbara Howard of the American Heart Assn. in a head to head debate on the Charlie Rose show on PBS TV. Epidemiologist Barbara Howard was out of her league as a debater and Gary Taubes made her seem like an out of touch school marm. He knew her data better than she did and wouldn't let her get away with simply restating the party line. Dean Ornish battled hard, but he didn't look the part with his John Lennon glasses, laptop and general academic appearance. If this had been a debate the smooth, debonair, well-prepared Gary Taubes would have been declared the winner, as he was able to cast doubts on much of the bedrock data on which Ornish and Howard based their arguments. But when I watched the debate a second time it was clear that it was the health focussed Ornish that really had something of substance to say, while glossy Gary Taubes did a wonderful job of creating doubts and presenting an alternative hypothesis. As Bob Dylan told us, "Your debutante knows what you need but I know what you want." Gary Taubes knows what we want and so does Dr. Atkins.

The truth is that there is no one truth, and the answer is that there is more than one right answer. The debate cannot be reduced to high-fat/low-carb versus high-carb/low-fat. The complex carbohydrates in vegetables fruits and grains have sustained the human race since there was a human race, what we have difficulty in dealing with is the onslaught of simple carbohydrates found in white flour, sugar and fructose. Likewise we have been hunting and meat eating for eons, our incisors are not there by chance. None of the best-selling diets suggests that we can consume large quantities of doughnuts, soft drinks, candy, cookies, cake and other high calorie, low nutrient carbohydrates. [What I think of as 'carbage'] It isn't useful to think of 'carbohydrates' when what we need to specify is whether we are talking about natural, whole food, complex carbohydrates or simple, processed and refined carbohydrates (carbage). The same thinking applies to fat. There are hydrogenated fats and trans fats which are generally agreed to be negative, saturated fats from meat and dairy about which there is much debate and polyunsaturated fats in some plants and fish which most researchers feel are beneficial to the human body/mind. So, to reduce any argument to fats versus carbs is meaningless.

The essence of Taubes' hypotheses is that for the past 25 years the 'establishment' has been recommending that people cut back on the fat in their diet. During this 25 year time span overweight and obesity hit record levels, leading Taubes and Dr. Atkins to conclude that decreasing fat and increasing carbohydrate levels just made people fatter. However other dietary changes have occurred.

1. The number of calories consumed per person has increased significantly. Estimates range from an increase of 100 calories per day to 400 calories per day per person. Even if we take the lower of these two numbers this would mean an increase of about 10 lbs. per person per year. (N.B. The U.S.D.A.'s dietary intake survey showed an increase of 236 calories per day between 1987 and 1995.)
2. Following on from the above, although the percentage of fat calories might have decreased, the overall amount of fat consumed has stayed fairly constant because of the increase of the total number of calories consumed.
3. The consumption of unhealthy trans fats and hydrogenated fats has increased.
4. The consumption of 'carbage' (low nutrient, high calorie carbs) has increased.
5. We're eating more, we're eating worse and we're eating out.

top of the page

To watch Ornish and Taubes debate one would think that the major diets were wildly different, but the reality is that there are more similarities than differences between the best selling diets.

1. All diets recognize that if you are going to lose weight you must burn more calories than you consume (the second Law of Thermodynamics has not been repealed) So whether or not they specifically mention calories, all programs are designed to decrease your caloric intake.
2. All diets acknowledge that physical activity can help people lose weight and maintain weight loss.
3. All diets must include the 9 essential amino acids found in protein.
4. No diets suggest that you can lose weight while consuming large amounts of simple, non-nutritious, calorie-dense carbohydrates.
5. All major diets are aware of the dangers of hydrogenated fats and the benefits of omega 3 fatty acids.

Restating this, every major weight loss diet cuts calories, eliminates 'carbage', supports exercise and modifies the intake of unhealthy fat. This leaves only a few variables to play around with when designing a diet. Namely:

1. How many calories?
2. What percentage of complex carbohydrates in the diet?
3. How much fat and what sort of fat is acceptable?
4. What proportion of protein, complex carbohydrates and fats make up the diet?
5. How much exercise is desirable and what sort of exercise?

In their book, The Real Age Diet, the two MD's Roizon and La Puma estimated the average daily caloric intake (based on 10 days random sampling) of recipes from various popular diet books. When looking at their numbers, remember that many North Americans consume over 3000 calories a day with the average being in the 2500 to 2600 calorie range.

Daily Caloric Intake

Dr. Atkins (High Protein)	2000 (note: this would be less during the Induction phase)
The Protein Power Diet
(High Protein)	1800
The Carbohydrate Addicts' Diet
(High Protein)	2200
Sugar Buster's
(Moderate High Protein)	1400
Total Health Makeover Diet
(Complex Carbs.)	1000
Eat More, Weigh Less (Ornish)
(High Complex Carbs.)	1700
Pritikin Diet
(High Complex Carbs.)	1200
Eat Right For Your Blood Type Diet
Type A	1750
Type B	1900
Type AB	1700
Type O	1750
Get Skinny on Fabulous Foods
(Suzanne Somers)	1750
The Anti-Aging Zone Diet	1650
The Omega Diet	1350
Eating Well for Optimal Health Diet	1500
The Real Age Diet Plan	1650

The average of these diets is under 1600 calories a day. So whatever the name given to the diet e.g. Blood Type, Zone or Omega, the goal is to get you to consume fewer calories. If you've been consuming around 3000 calories a day and suddenly cut that consumption in half and maybe add some exercise, you are going to lose weight. It's not rocket science, and with many of the diets, it's not science at all. The high protein diets have the highest calorie consumption, but by removing most common carbohydrates from their lists of acceptable foods they make eating inconvenient and increase the likelihood of weight loss

In the world of high fashion and Hollywood, body-obsessed celebrities drop the name of their current diet the way they might talk about their favorite fashion designers. Whereas diets were once whispered about, they are now mainstream conversation. Zone followers include Jennifer Aniston, Cindy Crawford and Courtney Love who typically have little black boxes of Zone balanced meals delivered to them. Atkins followers include the super rich sisters Alexandra von Furstenburg and Princess Marie-Chantal of Greece. Rosie O'Donnell (taking a weight loss cue from Oprah) had her entire staff on a Weight Watchers program. Weight Watchers also has another celebrity, Sarah Ferguson, the Duchess of York, as their spokesperson who has written 4 diet and lifestyle books of her own. Men are now talking too, with Karl Lagerfeld losing a highly publicized 90 lbs. and even the fashionable New York Firefighters have 75 members working with weight loss guru Dr. Howard Shapiro.

Caloristas Princess Marie-Chantal of Greece and Alexandra Von Furstenburg

top of the page

Rating the Diets

On behalf of 'Well' readers I took a close look at some of the big selling diet programs of the past few years. First is a short form summary and grade for 4 high profile diets followed by and in depth look at whether they make sense in terms of health, physiology, psychology and overall lifestyle. No points were awarded on the basis of celebrity followers.

The Zone - Overall grade D

A balanced program of caloric restriction which will probably help you lose weight while maintaining adequate nutrition. The Zone loses all credibility by the utterly implausible claims it makes which do not stand up to any scrutiny. Alice Lichtenstein described it as "science fiction".

Dr. Atkins New Diet Revolution - Grade C+

This was the toughest grade to give. Atkins' way of getting people to cut calories is by initially cutting out nearly all carbohydrates including all breads, cereals and pastries plus virtually all fruits and many vegetables. He gradually reintroduces fruits and vegetables as you progress through the 4 stages of his diet. There is some very intriguing and provocative writing backed up by 25 pages of references. One of the most controversial aspects of the diet is Atkins' belief that eating fat leads to a greater rate of fat burning. He is selective in the studies he uses to support this claim but his claims are not without any foundation. My biggest concern is that a high fat diet, while it might help induce weight loss, is unhealthy, and the best study I could find indicates that an Atkins-like diet, when monitored for a year, led to an increase in coronary risk factors. The book includes a lot of thoughtful writing, strong support for physical activity and some very acceptable recipes. It is unlikely that people will remain on a high fat diet for an extended period and Atkins has published no research to support the success of his program.

Eat More, Weigh Less - Overall grade B+/A-

A health focussed, carefully constructed vegetarian, or low fat near vegetarian, diet with a wide choice of excellent menus and recipes from which to choose. I'd like to have seen more than 6 pages about exercise, including the 3 S's of stamina (cardiovascular), strength and suppleness (flexibility). The writing is friendly, intelligent and references are supplied in the back of the book. The overall packaging and presentation are probably not slick enough to gain mass acceptance. However, the content is solid and well researched which increases the likelihood that people will stay with the program. It is the only diet that I looked at which has followed people for 5 years and recorded their compliance, weight loss and health markers. The 10% of your calories from fat makes this a challenging diet for many North Americans.

Body for Life - Overall grade C

A reasonably strong training and exercise program with an acceptable food selection for the diet. If you follow the program for 12 weeks I'm sure you'll get stronger and lose weight. The book loses credibility by being presented like an infomercial with its dramatic before and after photos, dubious "scientific" statements and complete lack of experimental data. With its highly structured approach this will more likely be 'Body for 12 Weeks' rather than 'Body for Life'

top of the page

THE ZONE by Barry Sears

The sharp graphics on the cover inform you that when you, "enter the Zone" you will have a "dietary road map" which will enable you to:
1. Lose weight permanently
2. Reset your genetic code (whatever that means)
3. Prevent disease
4. Achieve maximal physical performance
5. Enhance mental productivity

These expansive claims set the tone for the Zone.

When I gave a cursory look at the Zone some years ago it looked quite intriguing with its method of balancing carbs, protein and fat (40/30/30) and maintaining a balanced intake throughout the day so that you stayed in "The Zone." I also liked the idea of matching food intake to body size and activity level. Sears focuses on "protein blocks" rather than calories, but the caloric cost of his protein blocks is low, as is the caloric content for his low glycemic carbohydrate blocks and very carefully selected fat blocks. In fact, when you do the calculations, this can be a very low calorie diet with intake ranging from around 1200 to 1700 calories per day. I feel the typical Zone diet is safe with its balanced intake of protein, quality carbs and fats. With a bit of exercise and a Zone diet you will probably lose weight, but not because of Sears' eating formula, you're simply cutting your calories.

An article Sears referenced to explain the significance of his carb/protein ratio was from the Journal of Clinical Nutrition by Golay et al. The authors of this article completely disagreed with Sears' interpretation of the importance of macronutrient ratios, stating that, "the results of this study showed that energy intake not nutrient composition determine weight loss in response to low energy diets."

Do you believe in miracles?

Barry Sears seems to. I think the biggest miracle is that Sears has sold so many books based on so little research and so many unsubstantiated claims.

The Stanford Swim Team

I'll begin by looking at something with which I'm very familiar, high level swimming. (I was an assistant coach at Stanford in '65-'66 and an assistant coach at Santa Clara Swim Club from '66-'69 working with numerous world record holders including Mark Spitz and Claudia Kolb.)

Sears claims that after convincing the Stanford women and men's swim coaches, Skip Kenny and Richard Quick, of the value of the Zone in 1992, the Stanford Swim program was transformed. He writes, "The Stanford women....finally wrested the NCAA title from Texas." What he doesn't mention, is that the Texas head coach, Richard Quick, had come to Stanford from Texas in 1988 bringing some of his swimmers with him. In Quick's very first year, Stanford won the National Championship in 1989 followed by two second place finishes in 1990 and 1991. The win in '92 had everything to do with Richard Quick and the fact that he had recruited three of the best women swimmers in the world: Summer Sanders (Olympic Champion 200 fly), Jenny Thompson (World Record Holder 100 free), and Lea Loveless (Olympic Champion 200 backstroke).

It was a similar story with the men. Sears boasts of the Stanford men's three straight National Championships from '92 - '94 under coach Skip Kenny after their introduction to the Zone. Again omitting to mention that Skip Kenny had already won three straight championships with Stanford from '85-'87 and had never been worse that third place.

To attribute the success of the team to the Zone is absolute fantasy. It would be like Martin Collis saying that because I was an assistant to the Stanford men's swim team in '65-'66 that this was the reason they won the NCAA Championships in 1967. Sears' claim was condemned in a joint statement from the American College of Sports Medicine, the American Dietetic Association, the Women's Sports Foundation and the Cooper Institute.

The Stanford team physician stated, "I am unaware of any evidence to support a correlation between those who follow the Zone diet and the athletes' performance. Since athletic performance is multi-factoral, any attempt to give credit for Stanford's athletic success is insulting to the coaches and the athletes, whose talent, incredible dedication and hard work are the primary factors in their success."

The International Journal of Sports Medicine states that the concepts in the Zone are "an appalling over simplification of complex physiological processes." I've detailed this section because it is so typical of Sears' claims of the wonders of the Zone diet. He makes these sorts of claims repeatedly. As a graduate supervisor I would flunk Sears on virtually every claim he makes. Experimental problems include:

1. Small number of subjects.
2. Lack of careful recording of dietary intake.
3. Lack of control groups.
4. No attempt to use cross over double blind designs.
5. No replication or validation of results.
6. Elimination and non-recording of drop outs and non-compliant subjects.
7. Inappropriate hypotheses.
8. Unjustified claims based on results.
9. Lack of control of random variables, which might affect the results.
10. The biggest. Lots and lots of anecdotal data.

continued on page two