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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.
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.
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.
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:
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
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.
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'
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:
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The Eicosanoid story Sears perceives the "almost invisible" eicosanoids as the keys to controlling disease. "Eicosanoids are the most powerful agents known to man." He sees the Zone diet as the way to control 'good' or 'bad' eicosanoids (without offering any proof). "Whether you want to move from illness to wellness or beyond wellness to optimal health, your only pathway is through the Zone. The balance of protein and carbohydrates controls the insulin-glucagon access, which in turn determines which eicosanoids your body makes are 'good' or 'bad.' Pretty simple actually". (not to say simplistic) Sears suggests that by using the Zone to control good and bad eicosanoids you can have a positive impact on almost every disease state, including heart disease, cancer, diabetes, depression, alcoholism, auto-immune diseases (including AIDS), reproductive disorders and many more. He stops short at promising eternal life but does promise "long life, increased vitality, and the greatest gift of all: good health. It's all possible in the Zone." Alice Lichtenstein, a senior researcher at the Jean Meyer Human Nutrition Research Centre at Tufts University, summed up the Zone as "science fiction." She went on to express concern that people would take Sears' words seriously that the Zone diet can fight diseases like AIDS and cancer and that he might be taking advantage of "vulnerable people." One of many examples of this is in his section on the Zone and cancer. He provides his usual anecdotal evidence to support the role of the Zone as a cancer cure with the story of Judy Jones. "Her next MRI brain scan left the doctors shaking their heads in astonishment. The tumor was not only shrinking, it appeared to be dead - a highly unexpected if not unheard of result." Sears seems to discount the possibility that the radiation treatments and surgery could have had an impact on the tumor. His closing sentence is this, "Living in the Zone is the very best revenge against cancer." In summary, the Zone is a reasonable low calorie weight loss diet that makes a series of preposterous and unsubstantiated claims. I recently read that, " Unethical advertising uses falsehoods to deceive the public. Ethical advertising uses truths or bits of truth to deceive the public". Surely they can't have been writing about the diet doctors?? DR. ATKIN'S NEW DIET REVOLUTION  'Dr. Atkin's New Diet Revolution' delivers the low carbohydrate/high fat message that Dr. Atkins has been preaching for 30 years. His books have been vilified by the medical, nutritional and dietary establishment, but purchased by more than 10 million people and presumably read by many more than that. I'm reminded of movies that get panned by the critics, but have huge success at the box office. The 'Dr. Atkins New Diet Revolution' has no illustrations, a couple of bar graphs and figures and more than 500 pages, so people are not buying it for its graphics and presentation or its brevity. My reading of Dr. Atkins is that he's not as bad as his reputation among dietary and medical professionals, and not as good as he likes to tell you in his book. His program is based on a shaky foundation, namely that the consumption of carbohydrates leads to insulin release, which in turn leads to fat storage, which ultimately leads to obesity. Atkins also believes that eating a high fat diet increases the body's tendency to burn fat as fuel. Like Gary Taubes and Barry Sears he points to the fact that despite North Americans being told for 25 years to cut back on fat, they have become fatter, ergo, carbohydrates are the problem. This is sloppy reasoning, which would give you a failing grade in Logic 101 and can lead to some strange conclusions. It is referred to in Latin as 'post hoc, ergo propter hoc' (assuming something has caused an event merely because it preceded it).
The above piece of humor is beginning to lose its point. With the spread of the North American fast food diet, obesity and heart disease are becoming global problems, affecting non-English speaking people of every race and colour. I noted when writing about the Zone, carbohydrates don't make you fat, the leanest and longest living people in the industrialized world are the Japanese whose diet is dominated by complex carbohydrates and is low in fat. Atkins knows this, he knows the problem lies in simple carbohydrates and junk food, but this does not make controversial copy. Atkins acknowledges a major debt to the work of British researchers Kekwick and Pawan who were conducting obesity related research in the 1950's and 60's. This is fairly obscure work which suggests that a high fat/low carb diet will promote more fat burning and weight loss than a calorically comparable diet high in carbohydrates. To Kekwick and Pawan, and by extension to Atkins, a calorie is not a calorie, because ingested fat calories lead to greater and faster losses of weight than do comparable carbohydrate calories. I went into the archives to check the references for this work, which was published in the July 28,1956 issue of The Lancet. The first thing I noticed was that we were dealing with very low numbers of subjects monitored over a very brief time span. Experiment 1 14 obese subjects were placed on 3 different 1000 calorie diets (high protein, high fat and high carbohydrate) for approximately one week. The high carbohydrate diet group gained 1.2 lbs. The high protein group lost 4.2 lbs. and the high fat group lost 6.3 lbs. The authors wrote, "When calorie intake was held constant at 1000/day, the rate of weight loss varied greatly on diets of different composition. It was most rapid with high fat diets while weight could be maintained for short periods on diets of 1000 calorie value given mainly in the form of carbohydrates. As this rate of weight loss varied so markedly with the composition of the diets on a constant calorie intake, it is suggested that obese patients must alter their metabolism in response to the contents of their diet. The rate of insensible water loss has been shown to rise with high fat and high protein diets and to fall with high carbohydrate diets. This supports the suggestion that an alteration in metabolism takes place." I was impressed with the care that the researchers took to control water intake (3000 ml) and the intake of sodium chloride, which totaled 10gms/day. This was not a classic experimental design with control and experimental groups, but rather was in the form of multiple case studies with the results of each subject averaged together. The researchers appeared to construct a rigorous protocol to control for any variables which might have affected the outcome of the results. But there were a few exceptions. There is some vagueness about how many days each patient followed each dietary protocol. The bar graph which shows results states, "Mean of 5-9 days on each diet." Two of the results require comment. In a carefully monitored group of subjects in a residential hospital setting where they were required to do some exercise it seems surprising that people would gain weight on the 1000 calorie high carbohydrate diet. Another statement which jumped out at me, was when these two authors reported the results of this study at an obesity symposium, "A striking resistance to ketosis was seen in the obese. Even on a 1000 calorie, 90% fat diet, blood sugar was maintained within normal limits and ketosis was not observed in any of the subjects studied." Both the above were possible and in her practice my wife has seen people on a 1000 calorie diet actually gain weight (usually associated with the menstrual cycle. She has also seen people on a very low carbohydrate diet of about 1000 calories who have not gone into ketosis. However, these are exceptions. I find it extra-ordinary that not one of the subjects was ketotic, when going into ketosis would be the norm. There was quite possibly some dietary contamination, in that one of the subjects subsequently reported that some food and alcohol were smuggled into the hospital by visiting friends. (This is hearsay and I debated whether to include the last sentence, so ignore it if you feel it's inappropriate, but it might help explain some surprising results). Experiment 2 Five obese subjects were placed on mixed diet of 2000 calories for 7 days. The same subjects were then placed on a high protein; high fat diet of 2600 calories for 7 days. Sure enough the mixed diet group gained 1.1 lbs. while 4 of the 5 high fat/high protein group lost an average of 2.8 lbs. In his book, Atkins does not mention the small number of subjects nor the short duration of the studies. The most likely explanation for the rapid loss of the high fat and high protein groups is water loss. When deprived of carbohydrates the body metabolizes glycogen from the muscle and liver. For every one gram of glycogen the body stores, it must store 3 grams of water. As glycogen gets broken down water is released and excreted. In describing a case study in his book Atkins writes, "She lost 21 lbs. in the first month and I surmise that 6 or 7 lbs. of that was water weight". However, Kekwick and Pawan felt that the weight loss could not be explained by fluid loss alone, although one wishes they had followed their subjects for a longer period. The researchers extracted a substance from the dieters' urine, which they creatively named Fat Mobilizing Substance (FMS). When they injected this into mice the experimental animals appeared to accelerate their fat burning. In his book Atkins writes "They attributed hormonal properties to FMS. Unfortunately, their findings on FMS have never been investigated by scientists. I am hopeful that research will be underwritten that will seek to duplicate and investigate further this phenomenon. I intend to do my part, through the newly formed Dr. Robert C. Atkins Foundation." The obvious question is this. Why hasn't Atkins funded this study long ago? He's a multi-millionaire and this would be easy work to replicate and improve. But instead, Atkins chooses to use small number, badly designed studies on which to build his theories. The 2nd obvious question is why haven't the groups such as AMA, and the American Dietetic Association replicated the research of Kekwick and Pawan and others that Atkins quotes to support his work? It would be easy to set up such studies and would show those organizations to be real truth seekers, and arm them with the data to either refute or, perhaps reluctantly, support Atkin's theories. Later work by Rabast, Vornberger and Ehl (Ann, Nutr. Metab 25: 341-349 1981), showed similar results to those of Kekwick and Pawan. Twenty-one obese subjects were put on 3 different dietary protocols of 1340 calories for 28 days. The protocols included a high carbohydrate diet and a high fat diet. The high carb group lost 9.5 kg while the high fat group lost 12.5 kg. In their discussion they state that, "differences in energy metabolism could provide a likely explanation for the different weight reduction observed". They suggest further research. They also report that the high fat diet had "failed to exert an adverse effort on lipid values".Clearly, Dr Atkins is not completely without suggestive scientific studies in designing his diet. One of the major criticisms and concerns about the Atkins diet is that, if followed as he prescribes, people will go into ketosis, which to a lot of people sounds like a problem. (Most words with the suffix 'osis' are not good news e.g. cirrhosis, scoliosis, halitosis, sarcoydosis, psychosis etc.) Without carbohydrates your body does not burn fat completely, and thus ketones are formed and released into the blood stream. One of the many unproven claims is that ketosis makes dieting easier as it depresses the appetite. Atkins refers to the ketosis associated with his diet as "benign dietary ketosis" as opposed to diabetic ketoacidosis, which is a medically dangerous condition. The preponderance of evidence suggests Atkins is right. Millions of people have followed his diet and become ketotic with no apparent side effects. The successful Bernstein Health and Diet Clinics in Canada have a diet designed to put all their clients into ketosis. The major concerns usually expressed are that ketosis puts a burden on the kidneys (Atkins counsels people with kidney problems not to do his diet) and might cause leaching of calcium from the bones leading to osteoporosis. Ketosis is actually used as a form of treatment for serious epileptics as it often eliminates, or greatly reduces, seizures. These epileptic patients are kept in a state of chronic ketosis with no apparent serious side effects.
The Atkins diet is psychologically very astute. The vision of someone on an Atkins diet is of a person stopping off at Burger King™ or McDonalds™ and tucking into a double cheeseburger but this is not the reality. The most rigorous restrictions come in the first 2-4 weeks of the Atkins regimen, the Induction Phase. This Phase is designed to put you into ketosis and to provoke rapid weight loss. During Induction you get 20 grams of carbohydrate, which comes in the form of salad and vegetables and no fruit, bread, pasta, grains, starchy vegetables, alcohol, sugar or junk. Atkins specifies no caffeine, no aspartamine and plenty of water. He also recommends wheat bran or psyllium, as constipation is a common problem of the Induction phase of his diet. A wide range of meats, fish and eggs are allowed. Although part of the hype about the diet is that one can have bacon cheeseburgers. Atkins is careful to tell people to avoid cured and processed meats, which often add sugar and nitrates. The cheese should not be processed, and if weight loss is slow Atkins suggests no cheese at all. He also specifies no bread and to take care with the special sauce, so you could be having a bacon cheeseburger with no bun, no sauce, possibly no cheese and, if the bacon is cured with nitrates, no bacon. Weight loss is designed to be rapid in the Induction Phase which is psychologically very important for someone who has restricted their diet and made major lifestyle changes. Atkins does not pretend the weight lost here is all fat and acknowledges that a percentage of lost weight will be water. Phase II of the diet is OWL (ongoing weight loss). This part of the diet is still very proscribed and specific, but there is a gradual increase in carbohydrates and a reintroduction of fruit and nuts. Your reward for staying on the diet (aside from the weight loss) is increased accessibility to a wider range of foods. If weight loss continues you move on to the Pre-Maintenance Phase in which you are allowed more starchy vegetables, a wider range of fruit, plus legumes and grains. If you graduate to Lifetime Maintenance you are able to have most things in moderation. Junk food and soft drinks are still off the list and your intake of carbohydrates depends on your exercise regularity and intensity. People envisage Atkins dieters engorging themselves on bacon, burgers and eggs benedict. He cleverly allows these on occasions so that dieters don't feel cut-off from some personal favorite, but most of his dietary recommendations for protein are for lean meat, fish and eggs. In order to lose weight you have to cut calories, which Atkins does by cutting out large amounts of carbohydrate. His entrée recipes are modest and the fifty recipes in his book average only 413 calories. Atkins is very clear about physical activity. "Exercise is non-negotiable. If you're not getting regular exercise, you aren't following the Atkins' Nutritional Approach. It's that simple. You must make a commitment to physical activity as well as change the way you eat". Somewhat surprisingly, the September 2002 issue of Active Living criticizes the Atkins diet for "its failure to advocate physical activity." The same sentiments are stated in Nutrition News Focus, "Also, Atkins does not recommend exercise...." If we are going to be critical of Dr. Atkins, let's make sure we have our facts right. He is likewise very clear about the value of vegetables. "Let us sing the song of veggies, such beautiful, health enhancing, varied foods. They are acceptable to every cuisine worldwide and nothing in the world of cooking has more variety of taste and texture. You can get high fiber and phytochemicals with relatively low numbers of calories". (This could be Dean Ornish writing.) I am always suspicious of people who sell their own line of vitamins and Dr. Atkins does. However, he lists what vitamins and minerals he considers important, "so you won't necessarily have to get them from Atkins Nutritionals". In Atkins' segment on 'Disease Prevention', he writes persuasively about the value of his diet in preventing diabetes, and in the prevention of cardiovascular disease, which is contentious, as many professionals believe his diet might increase cardiovascular disease risk factors. Dean Ornish believes that people on an Atkins type diet are "mortgaging their future". When I read the 'New Diet Revolution' I was prepared for some sensational and implausible writing. But in the context of a society struggling with obesity, the book might well have a place. Given a choice of someone staying 50 to 100 lbs. overweight or being on an Atkins diet, I'd probably go for the latter. This might not be the ideal diet in an ideal world, but it is one that seems to have appeal to many people and that works, if you stay with it. In a recent small scale Consumer Union Report, the Atkins diet was the most successful in achieving weight loss over a 6 month period. In its favor, the Atkins diet does provide structure which is absent from so much of the population's eating habits. After the Induction Phase, you are encouraged to eat a wide range of fruits and vegetables. Exercise is mandated throughout, as is supplementation. The diet is unbalanced and challenging to sustain, but is probably a great deal healthier than the high starch, high sugar, high fructose, high saturated and hydrogenated fat, high soft drinks, high caffeine, high preservative, high additive and high alcohol calorie intake typical of so many North Americans. Before I could confidently recommend the diet I would like answers to some of the following questions:
Dr. Atkins doesn't waver in his belief. As he notes in Time 2 Sept. 2002, "For over 30 years I've been a lone voice in the wilderness. I am grateful that the National Institute of Health is now examining controlled carbohydrate and low fat nutrition. These studies may end up showing that excessive carbohydrates are the true culprits, not fat. At what point am I allowed to say, " I told you so"? THE EFFECT OF HIGH, MODERATE AND LOW FAT DIETS ON WEIGHT LOSS AND CARDIOVASCULAR DISEASE RISK FACTORS. RICHARD FLEMING, M.D. The most interesting recent research I could find relating to the high fat/low fat debate was Dr. Richard Fleming's publication in Preventative Cardiology Summer 2002. While the study left some questions unanswered it is worth reporting in some detail. A total of 100 people (53 women and 47 men) were divided into 4 groups, each of which followed a different dietary protocol for one year. The 4 dietary regimens were as follows:
In my analysis I have focussed on the High Fat and the Low Fat groups with the Moderate Fat (Surgeon General type of diet) serving almost as a control or yardstick against which we can measure the more extreme protocols.
% Change in Possible Coronary Risk Factors
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Fleming's study suggests the following:
I had some questions about the results and methodology which I was able to discuss with Dr. Fleming. I asked why the High Fat group were more than 50 lb. lighter on average than the Low Fat group when the subjects were randomly assigned. He assured me that this was not by design and that the random group selection just happened to result in many of the heavier subjects finishing up in the Low Fat group. I inquired about drop-outs, and there were none. The subjects were highly motivated and although overweight, were free of any major disease. All 100 subjects who began the study were still participating at the end of the year. The High Fat group did not follow an Atkins protocol per se, but it was "very similar" to an Atkins' diet. Exercise was self-recorded which often results in hyperbole but, as Dr. Fleming pointed out, this was the same for all groups. The Low Fat group generally felt more energetic and "tended to exercise more frequently" although not significantly so. Insulin sensitivity was not measured. Dr. Fleming's study is the most comprehensive dietary study I have read that attempts to look at the sustained effects of different dietary protocols. The fact that some questions remain unanswered points out how important it is to generate major Federally funded and foundation funded studies to provide some definitive answers which will enable professionals to give recommendations without having to use terms such as "maybe", "might", and "will possibly" which sound weak when matched with the excessive claims of some best selling diets. (There is a phrase, "Often wrong, but never in doubt", which comes to mind in reading the assertions of some diet salespeople). Based on a previous study reported in Angiology, Dr. Fleming is completely convinced that an Atkins like high fat diet increases coronary risk factors, whereas he was able to show that a diet high in complex carbohydrates actually led to recovery of a viable myocardium. Dr. Fleming debated Dr. Atkins on the Today Show and came away singularly unimpressed with some of Dr. Atkins responses to specific medical questions. It will be interesting to see whether history is kinder to Dr. Atkins than two other high fat gurus, Dr. Tarnower and Dr. Stillman.
EAT MORE, WEIGH LESS What separates Ornish's program from most other diets is that it's a health first, weight loss second program. In an earlier book "Reversing Heart Disease" he showed that risk factors associated with heart disease could be reversed by making dietary and other lifestyle changes. The book included experiments to show that even blood flow to the coronary arteries could be increased in response to diet, exercise and psycho/social changes. Ornish followed this with a book entitled "Love and Survival" in which he looked closely at the role of such factors as loneliness, companionship, meditation, family and love and their impact on the health, self esteem and longevity. In other words, Ornish is about more than weight loss, although he has published more peer-reviewed articles on weight loss than most of the other diet doctors combined. In "Eat More, Weight Less" Ornish looks at weight loss in the context of the whole person. His approach is simple and he is able to compress the whole of his "Life Choice" program into the first 80 pages of the book. The remaining 300 pages are mostly made up of recipes, which is another area in which Ornish separates himself from the pack. He gave his dietary guidelines to some of America's finest chefs and asked them to create a full low fat menu. I can attest to the quality of some of the chefs that are featured, having recently eaten at Chez Panisse in Berkeley (Paul Bertolli) and Greens in San Francisco (Deborah Madison). Ornish counsels people to "eat like a gourmet" with modest portions of great food instead of supersized, 'biggie' portions of junk. The Life Choice Diet that Ornish suggests is not revolutionary; you can find similar ideas from Pritikin and John Robbins. He preaches a relentless low fat mantra. Ideally this would be vegetarian, but he tolerates some lean meat and dairy so as not to exclude too many people whose palate is accustomed to animal fats. Why eat a diet that is low in fat and high in complex carbohydrates?
In summary, the 'Life Choice' diet suggested in 'Eat More, Weigh Less' is healthy, has a measured track record of sustained weight loss, is inexpensive and is good for the environment. However, it runs counter to our massively advertised convenience food culture. In schools, hospitals, airplanes, barbecues and cafes there is a certain hassle factor about eating vegetarian and most people succumb to the 'get along, go along' school of thought. Doctors have a hard time getting their patients to take prescribed medications and vegetarian living involves a lot more thought than taking a few pills. Typically people don't change when they see the light, but when they feel the heat, and maybe with the massive increase in obesity and diabetes and the continuing toll of heart disease and cancer, it just might be getting hot enough for people to choose Dean Ornish and health when making dietary choices. One word of caution to Dean Ornish. He is 'consulting' with 3 of the top 12 global food giants as measured by 2001 gross income (Conagra, Pepsico and McDonalds). While it would be nice to think that some of the Ornish idealism would rub-off on corporate behemoths, it seems more likely that his input will be used to add a health related veneer to their product lines. (A visit to the Conagra web-site reveals that they have 4 major food categories to reflect the way "America eats" - Fun Foods, Comfort Foods, Favorite Foods and incongruously, Healthy Foods. Wouldn't it be better if all their foods were healthy?) Dean would do well to remember the old Chinese proverb, "He who lies down with dogs, wakes up with fleas." His long time accountant for the Preventative Medicine Research Institute is the Arthur Anderson organization.
'Body for Life' is another best selling diet and lifestyle package. The style of writing is friendly, folksy and very positive. The first thing that struck me on looking through the book was the gallery of 'before and after' photographs of clients of Bill Phillips. People are transformed from unsmiling, pasty, potbellied, scrawny individuals to grinning, tanned, flat-bellied, muscular body-beautifuls, with better haircuts. Many years ago Charles Atlas used the same sort of pictures to show how 'dynamic tension' (i.e. isometrics) could change 100 lb. weaklings into heavily muscled gods, who no longer tolerated sand being kicked on them by beach bullies. 'Body for Life' differs from other diet focussed programs in a number of significant ways:
So there you have 'Body for Life', which is a structured 12 week exercise program during which you are encouraged to eat 6 meals a day from Bill Phillips 'authorized' list of foods, or have meal replacements in the form of Phillips' Myoplex shakes. Phillips seems like a nice guy with almost Anthony Robbins-like motivational skills . I feel that 'Body for Life' is a decent exercise program upon which Bill Phillips has built a mountain of expectations. Anecdote is heaped on anecdote to describe the wonders of his 12 week program. The before and after pictures imply that in just 20 minutes a day you can have the physique of a competitive level body builder. Like Dr. Atkins he provides absolutely no statistical evidence for the success of his program and it would be such easy research to do. His "scientific" information cries out for some form of documentation. For instance, on page 65 of 'Body for Life' we see that 'Scientific studies indicate that fat is burned much faster - up to 300% faster - when you exercise in the morning as opposed to doing the same exercise in the afternoon" and "Research indicates.....the majority of calories will be used up after our workouts, provided we don't eat for one hour after our exercise sessions." No first year college student could get away with phrases like 'scientific studies indicate' and 'research indicates', nor would they want to, if they wished to retain any credibility. In many ways, 'Body for Life' is a misnomer as virtually the entire book is devoted to the 12 week program. There is lip service given to continued growth but little guidance. A program as regimented as this, with its 6 meals a day on authorized foods, tightly structured weight training and aerobic sessions and recording is probably not a program that people will do for life. There is nothing about flexibility exercises in 'Body for Life' and I feel that in general Bill Phillips' approach is inflexible and not suited to being integrated as part of an ongoing lifestyle. As I read the book, I felt as though a TV infomercial had been transformed into the medium of print. A Clinic Based Diet The Bernstein Health and Diet Clinics began in Ontario, Canada and quickly spread throughout the Province with over 40 locations. They have now moved to British Columbia and have recently opened 3 clinics in the Vancouver area. The Bernstein program is a nursing supported, medically supervised program aimed at rapid weight loss (at least 10 lbs. a month) and is particularly suitable for people who have large amounts of weight to lose. They had some great publicity when Canada's leading late night talk show host, Mike Bullard, who was a Bernstein client, changed shape before the nation's eyes, getting slimmer and lighter week by week. The diet is low carb., low fat, low calorie and uses controlled supplementation. The program is rigorous and disciplined and is designed to put people into ketosis. Clients who are careless and undisciplined in following the diet are not allowed to stay in the program. I have no long-term data on the success of the Bernstein program, but it has an impressive record in getting people to lose weight rapidly. One of the realizations that occurs when working with people who've lost a considerable amount of weight, is that our medical system is prepared to spend untold millions of dollars treating the side effects of obesity, but does little to address obesity itself. Our society typically sees a major role of a physician as prescribing medication, but the physicians at the Bernstein clinics often have to make decisions involving reducing or eliminating medications for such conditions as hyperlipidemia, hyperglycemia, hypertension and type II diabetes. A number of chronic conditions also respond positively to weight loss, including chronic fatigue, fibromyalgia, osteoarthritis and depression.
Dr. Bernstein devotes a separate booklet to his Maintenance Program once clients have reached their target weight. For a nominal fee they can still get input from the support team who supervised their weight loss. I wish data were available on the long-term success of Bernstein clients. It separates itself from other programs in the Low Carb/Low Fat debate in that it is low in both. In our permissive society it is interesting to see a program that has very clear expectations and reintroduces the concept of discipline to clients who have spent years of undisciplined consumption. Diets on the Internet eDiets.com There are hundreds of diet programs on the net, which, like the diet books, feature the good, the bad and the flat out ridiculous. They all promise weight loss and they nearly all want to sell you products, especially vitamins. I am going to mention but one, namely, eDiets.com which is the Amazon of the internet diets. eDiets earned Forbes Magazine "Best of the Web" designation for nutrition/fitness websites. In order to discuss eDiets with "Well" readers I had to pay $35.00 US to join and another $10.00 US for their fitness program. (There were many other ways to spend my money on the site, but I stopped at $45.00 US). I signed up in the afternoon and was the 2774th person to join that day. With almost a million members, one can see that diets are big business. eDiets is an awesome piece of interactive technology which customizes your diet and exercise program as fast as you can type in your information. Once you have entered data about your age, weight, fitness and goals you can then access your totally customized fitness program. You are asked what equipment you have access to, and up comes your daily program picturing your activities on your equipment.
eDiets has an excellent team of experts and I feel that their dietary suggestions are realistic and healthy. They make good use of the interactive capabilities of the net and you can get well-informed responses to all you questions. Modifying your diet or fitness program is easy. They offer support groups for your specific gender and age group, newsletters, coupons for obtaining groceries and health related products and a stream of reminders to keep your diet on track. The ubiquitous Dr. Andrew Weil offers a line of vitamins and supplements but I was happy to see that all the after tax profits from his Polaris products go to fund his non-profit Polaris Foundation dedicated to integrated medicine. eDiets has been built for the web and is way more than a book that you can access on your computer. It makes use of interactive technology to record, reinforce and inform. It is flexible and user friendly and can accommodate all age groups, fitness levels and dietary preferences. If you follow through on their dietary and exercise suggestions, I feel that you will get your money's worth.
So You Want to Lose Weight? «You know it don't come easy.» ~ Ringo Starr Over millions of years we have evolved as a vigorous active animal species who hunted and searched for food in the wild and, when it was available, ate to excess as a hedge against future shortages. In the 21st century our species with its design for physical activity and ability to survive famines has been dropped into an environment where minimal movement is the norm and massive amounts of prepared food is available at every turn. It is a formula for disaster and the disaster is happening before our eyes with men, women and children eating themselves into health threatening oblivion. This lifestyle is proving to be exportable beyond North America and I was recently speaking to a lawyer from the Arab Emirate, Qatar, where a remarkable 57% of the 200,000 plus Qataris are not just fat, but obese. Diabetes is rampant and perhaps the only good thing they have going for them is that they dress in flowing robes which hide their bodies from the world. Dr. Walter Willett of the Harvard School of Public Health says, "sedentary lifestyles and a cornucopia of food have transformed people into the equivalent of corn-fed cattle confined into pens. We have created the great American feedlot."
7 Steps To Lose Weight and Keep it Off For People who Really, Really want to be Slimmer I don't have space for a diet book and I'll focus this section on people who need to lose at least 25 lbs. and probably a whole lot more.
«I just left myself today Weight Loss Warning One of the reasons that people fail to maintain their weight loss is that they have unreasonable expectations of what will happen once they've lost weight. "When I lose these 40 lbs., I'll be happy, my spouse will like me more, work will be easier and the world will be a better place." But when your spouse is critical, (or, if you're single, no one asks you out), the promotion you expected does not happen and depression creeps back, it's easy to say, "why do I bother, I might as well eat whatever I like." You tell yourself, "things couldn't be worse" but, of course, they can.
«One thing they don't tell you 'bout It's a lot tougher to beat the blues when you're overweight and sick than when you are slim and healthy. Whatever else happens, or doesn't happen, eating well and exercising gives you a sense of being in charge and of doing your best to honor the gift of life that you've been given. You don't need a guru; you don't need to buy special foods or sign up for an Internet diet. More than half the successful people on the Weight Control Registry follow their own program. In my song, "Guru du jour" the last verse says it all.
«You are the trainer REBUILDING THE PYRAMID
The original USDA pyramid was modified by Dr. Walter Willett. Martin has added his own spin to the schematic. Fruits and vegetables form the foundation of the pyramid as they are the major source of health giving, cancer fighting antioxidants and nutrients and can assist in weight maintenance.
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by Dr. Martin Collis
I don't know who wrote the above, I found it in one of my files. I don't know whether I like his/ her (I think it's a him) hectoring style of writing. But I do sense the frustration and I can relate to the passion. It's a tragedy that given all our knowledge and resources, and our access to education that we're breeding a generation of children, many of whom will struggle to fulfill their potential because of their weight. It's sad that we have a global 'War on Terror' and yet millions of kids are driven to school because they and their parents feel that our own streets are unsafe. (It's worth noting that hundreds more children are killed or injured during their car commute to school than are ever kidnapped or mugged while walking to school.) Mixed Messages We are sending a very confusing message to our students. We tell them that we'd like them to eat well and exercise. We point out that there are medical dangers to being overweight. We teach these precepts in our Health classes and then send them out into a school full of vending machines selling junk from which the school profits. These same schools often make only a token effort to offer a meaningful physical education program, which impacts all the students. For example, in the US the minimum amount of PE required in the 4 years from grades 9 - 12 in order to graduate is as follows:
In the other 10 states individual school districts set the minimums. Now for the kicker, 21 states allow waivers or substitutions, for the PE requirement for religious reasons, ROTC, band and many other activities.
Even if children actually get a physical education class it doesn't guarantee a lot of activity. R.G. McMurray reporting in the August 2002 Journal of Adolescent Health watched 1140 kids aged 11 to 16 in Phys.Ed. Many classes contained less than 10 minutes of aerobic activity. I remember having my university students chart the activity of selected junior high students during a volleyball class and a gymnastics class. Some of the kids were so skilled at avoiding movement that they burned less than 100 calories. You're not going to impact obesity if a kid burns 100 to 200 calories per week in PE and then walks outside and has a 600 calorie Double Gulp. One would expect the Parent Teachers Associations and the Parent Advisory Councils would be militant about the indoctrination of their children with fast food products in school and the lack of meaningful physical activity in the school curriculum. However, parent groups are primarily fundraisers and some of the biggest profit margins come from low nutrient, calorie dense junk. (The Girl Guides with their cookies had this figured out long ago.) So, what was to be found at the National PTA Convention this summer in San Antonio? One would have expected the latest educational software, great new textbooks, numerous learning centered innovations, educational technology advances and a variety of booths to help inform parents how they could maximize their roles in supporting education. In reality, the exhibit hall was dominated by the confectioners like Mars, Nestle and Hershey. The Sugar Assn. was there to refute the "myths" that sugar could cause hyperactivity, obesity, diabetes or tooth decay. "If your child loves sweet treats, there's no need to worry" their literature stated.
Solutions I believe that solutions will emerge from a combination of grass roots programs and tough local and federal legislation. Everywhere I go I see examples of students, teachers and parents who are health focussed and do not want to see schools used as recruiting grounds for young consumers. They want the pop machines and corporate logos out of schools and do not want the drama program or marching band dependent on sales of Coke or Dr. Pepper.
The Los Angeles School Board has recently taken the courageous step of banning soft drink sales in their schools beginning January 1, 2004. Meanwhile, the soft drink giants are offering school districts ever increasing sums of money for exclusive "pouring rights" for extended periods. This can lead to absurd situations in which a student can be suspended for wearing the wrong logo. This happened to Mike Cameron at Greenbrier High in Georgia. Mike wore a Pepsi T-shirt for a publicity picture for "Coke in Education Day" at the school. The principal said Cameron could have been suspended from school for a week, but removed him from classes for just one day. "I don't consider this a prank," said the principal. In my own province of British Columbia, the students of Prince George Secondary School in the Northern town of Prince George have mounted a militant campaign to get the corporate logos out of their school. Administrators hoped that the protests would die out at the end of the last school year when the 'problem' students in grade 12 graduated, but this year's students are more vocal than ever. I'm reminded of the old rock song by Twisted Sister, "We're not gonna take it."
See accompanying story, 'No Corporate Logos in Our School' In the tiny town of Wells, parents will not allow any commercial junk food interests into their school. I believe that myriads of individual initiatives will lead to change. I know elementary school teachers who take their students on a daily walk to make sure they get at least some activity. Many parents are supporting and coordinating 'Walking school buses' where children are chaperoned to school in groups. The New York Times reports that the East Penn school district outside Allentown is sending letters to parents of overweight children that encourage them to change their children's eating habits and help them get more exercise. About 380 confidential letters have gone out since the fall, with more expected since high school screenings are completed, district officials said.
Legislation? Richard Rothstein of the New York Times writes, "Legislation perennially before Congress would authorize the Secretary of Agriculture to prohibit, on nutritional grounds, soft drink sales in schools. But the bills have been stymied. Lobbyists for soft drink and sugar producers have fought the bills, but so have the National School Boards Association and the National Association of Secondary School Principals, where members say that the harm done by underfinanced educational programs can be greater than that done to health." So much for our Great Society. Three US Senators, Frist, Bingaman and Dodd, currently have proposed legislation aimed at reducing obesity, particularly among children and adolescents. The 'Improved Nutrition and Physical Activity Act' or 'IMPACT' is 'aimed at giving young Americans the information necessary to make informed choices'. The Bill is in response to the Surgeon General's "Call to take action to prevent and reduce overweight and obesity". IMPACT has been referred to the Health, Education, Labour and Pensions (HELP) Committee. Committees are often where bills like this go to die. There are 3 major pieces of legislation I would like to see that already have a proven track record of success in some States and countries.
Government Funded Initiatives There is genuine concern among doctors, politicians and other professionals about child obesity. Recently, national initiatives have been developed in Canada and the USA to try and stimulate physical activity and healthy eating among children. In Canada, I know, respect and admire a number of friends and colleagues who produced Canada's Physical Activity Guide for Children and Youth. I am delighted that funding was made available for the project. I think we will learn a lot from the response of students and teachers to the guide. It's a step in the right direction, but an uncertain step.
When it comes to getting the Nation active it's hard to take anything the Canadian Federal Government does seriously, as it was they who cut the funding to Participaction, thus removing the most effective promotional organ for physical activity in the nation. On April 5th, 2002, Health Canada launched "Canada's Physical Activity Guides for Children and Youth". One of their primary goals is to get children to increase their physical activity by 30 minutes a day and decrease the time they spend on sedentary activities by a similar amount. They used some of the top human resources and organizations in the country, but I didn't find the Guide exciting. I did an informal survey with some children who looked at the Activity Guide on the Internet and it did not capture their imagination. It might be a currently fashionable word, but 3 different students described the site as "lame". A teacher described the site as being like a government brochure that was now on-line.
I truly acknowledge the effort made by some caring groups, and it seems churlish to be critical, but I feel the Guide has poor graphics and lacks energy and excitement, the very things it is trying to create.
Verb The Center for Disease Control has a well funded ($190 million US) program to promote physical activity to the 'tweens' (kids 9-13 years) called 'Verb'. I might be a bit slow, but it took me a minute or two to figure out the name. At first I thought it was an acronym, or some cool tween reference with which I was unfamiliar. Then it clicked, 'verb', a doing word. I feel that 'Slate' captured the essence of Verb in a recent article.
Conclusion We have gone so far, so fast in the wrong direction that it is going to take a massive, multi-faceted effort to reverse the trends that are diminishing the lives and expanding the bodies of our children. It remains to be seen whether governments and legislators will have the will and the courage to do what it takes. My feeling is that we're not going to do it with brochures and web sites. Don't look to corporate America for a solution, they're probably part of the problem. Kids have been fattened up with fast food and the hot designers/retailers like Tommy Hilfiger and Ralph Lauren merely offer more selection in the 14-20 size range. In November 2002, Seventeen magazine is launching a new section for larger girls called "Curvey Girl". I applaud all the efforts of concerned professionals to put health higher on the agenda of our children. But we can't wait for someone else to fix the problems. Ultimately, many of the solutions must come from passionate parents, turned on teachers and, best of all, from the children themselves. |
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I realize that it's not easy to produce kid friendly
materials that have the Government stamp of
approval. I wrote 'Moving into the Teens' for the old Ministry of Fitness and Amateur Sport.
The large majority of teachers and students never
knew of its existence.
The results of the 1999/2000 National Health and Nutrition Examination Survey are in and we flunked the test. NHANES is the real benchmark by which we gauge the changing shape of the American populace. It began in 1960 as the NHESI survey and has been repeated 5 times.
The current NHANES (1999-2000) is based on actual measurements of a representative sample of over 4000 American adults. This gives NHANES more power and validity than other surveys which often rely on self reporting in telephone interviews. As Dr. Stephen Blair and many other researchers have discovered, people have an enormous capacity for self deception when it comes to reporting their weight, caloric intake and exercise.
« Never believe what people say For example, the self reported Behavioral Risk Faction Surveillance System (BRFSS) showed a prevalence of obesity of 12% - 14% during the 1991 - 1994 period, the NHANES data for a similar period 1988 - 1994 showed an obesity level of 22.5%, more than 50% higher than the BRFSS. These are what the current NHANES figures show.
Those are huge percentage changes in a relatively | ||||||||||||||||||||||||||||||
