Lenore S. Greenstein: Why fad diets do, or don't , work

Tuesday, October 1, 2002

By LENORE S. GREENSTEIN, Special to the Daily News

The most common question I am asked still revolves around fad diets, and whether I approve of the Atkins plan and similar high-protein diets. Although I have written many times in the past about the dangers as well as limited efficacy of such quick roads to weight loss, the advocates of these programs are both vocal and vociferous.

Instead of listing all of my reasons not to engage in this, or any kind of dietary plan that restricts healthy food and important nutrients, I would like to quote many responses by esteemed researchers and health professionals.

In the New York Times recently, an article entitled "Stop Blaming Carbohydrates Or Fat, And Start Counting Calories," the author stated that the Atkins diet helped people lose weight because "If you cannot eat bread, bagels, cake, cookies, ice cream, candy, crackers, muffins, sugary soft drinks, pasta, rice, most fruits and many vegetables, you will almost certainly consume fewer calories. Any diet will result in weight loss if it eliminates calories that previously were overconsumed. This diet seems easy because it places no limits on the amounts of meats, fats, eggs, cheese and the like you can eat. These foods digest slowly, making you feel satisfied longer. Also, a diet without carbohydrates causes the body to make substances called ketones that may create a mild nausea, suppressing hunger."

A panel of 21 researchers from The Institute of Medicine of the National Academies of Science recently emphasized the importance of a balance of nutrients, with carbohydrates — starches and sugars — making up 45 to 65 percent of daily calories, while fats should only account for 20 to 35 percent. They also urged Americans to keep their consumption of saturated fats as low as possible. These saturated fats come from meats and full-fat dairy products, which are just the foods Atkins recommends as his diet's main components. With so few carbohydrates, the weight initially comes off in the form of body water, which accounts for the first 5 to 10 pounds of weight loss. After that, the going is much slower, and as soon as those missing carbohydrates are added back, so are some of the pounds.

In a study by Dr. Chia-Ying Wang at the University of Texas Southwestern Medical Center in Dallas, reported last August in The American Journal of Kidney Diseases, just six weeks of a low-carbohydrate, high-protein diet greatly increased the risk of developing kidney stones. "This study shows that this is not a healthy way to lose weight," Wang said.

In truth, the Atkins Diet has yet to be tested for its long-term safety and effectiveness. One reason that was cited for lack of government testing is because this type of high-fat-high protein diet is unlikely to be approved by any review committee. There are already many studies on the negative effects of animal fats and cholesterol on the risk of heart disease, strokes and some cancers. I have often cited evidence that diets unlike Atkins, which are rich in fruits and vegetables and moderate in protein and fat, can help prevent diseases like high blood pressure, prostate cancer, heart disease and diabetes.

The Atkins diet is also low in vital nutrients, including the B vitamins and vitamins A, C and D, antioxidants that slow the effects of aging. Calcium is also missing, and a diet rich in animal protein can draw calcium from the bones, increasing the risk of osteoporosis and hip fractures.

At the end of the day it is still calories that count. Eat more calories than you expend and you are sure to gain weight. A well-balanced dietary plan that includes a variety of foods, and has less calories taken in than calories out (or expended in physical activity), is the best way to ensure a slow but steady weight loss. The bottom line is always the same - cut calories or increase physical activity to achieve that equation, and you will be successful in dropping those extra pounds for good.

Lenore S. Greenstein is a registered and licensed dietitian in private practice in the Naples area, and can be reached online at naplesnutrition~aol.com


http://www.naplesnews.com/02/10/neapolitan/d805955a.htm

The study was posted here in the Research forum, and generated some good discussion. Check it out:

• Cutting carbohydrates risks health problems for some dieters
  
• Low-Carb Diets Tax Kidneys, May Weaken Bones

Basically, Wang's "study" consisted of only 10 subjects who followed a low-carb (20g), high protein diet for 2 weeks (the study was 6 weeks long, but the low-carb part was only 2 weeks). There was evidence of increased uric acid and calcium excretion in the urine. Based on those findings, the researchers suggested that a low-carb diet may lead to increased risk of developing kidney stones or weakened bones. No participant in the study actually got kidney stones or developed osteoporosis.
With the possible exception of the initial 14 days of Induction, Atkins' program, and other similarly carb-restricted plans are abundant in low-glycemic vegetables, greens and salads. There is some fruit, but truthfully, there's no nutrient in fruit that is not also found in vegetables, except sugar. In fact many low-carbers comment that they're eating way more vegetables now than they ever did before, when their diet consisted of bread, pasta, muffins, Special K with skim milk, mashed potatoes and bagels. Even limiting oneself to 20g digestible carbs per day, a person can still have great variety and generous servings of vegetables if they plan carefully. This was posted previously by Rosebud:

• Here's an example of what you can have:
  2 cups lettuce - remember iceberg lettuce has fewer nutrients than lettuces such as romaine - the ones with darker leaves are generally better.
  ½ cup peppers
  ½ cup cucumber
  1 cup cherry tomatoes
  1 cup broccoli
  1 cup asparagus
  1 cup cauliflower
  2 fluid ounces heavy cream
  
  According to Fitday, this gives you a total of 31g carbs, 12g fibre - making a total of only 19 useable carbs.

And, botanically speaking ... peppers, cucumbers and tomatoes are fruits.
Actually, there were several studies published earlier this year which showed the exact opposite ... increased protein intake actually improved bone density, and animal protein in particular.

• Calcium plus protein equals strong bones: study
  
• High-Protein Diet Won't Weaken Your Bones
  
• Animal Protein Consumption Associated With Bone Density in Elderly Women

Ms. Greenstein needs to do a little more reading before she starts writing

Doreen

This is a fantastic refutation. You've really addressed all of the points. Anyhoo the 6 month trial reported on the atkins site confirms there we're no ill effects over 6 months http://atkinscenter.com/Archive/2002/8/27-699825.html

But in any case there's no harm being totally upfront with your doctor and ask for blood tests in any area your concerned about.

The irony is you can even use these negative and somewhat tendencious pieces of research to your advantage and argue for a more extensive monitoring from your doctor. But its obviously better to have more rounded picture and anti LC people get a hold of one piece of speculation and then proclame atkins to be dangerous (they usually pick atkins).

Yes, the Duke University study was discussed here as well, even before it was published ... Finally: a peer-reviewed study of the Atkin's Diet - Duke University One thing about that study was the fact that it was funded by an unrestricted grant from the Atkins Center for Complementary Medicine.

More recently, at the Annual Meeting of the American Dietetic Association, researchers announced findings from an ongoing study that also shows favourable results with low-carbohydrate, high-protein diet over a 6 month term. This study is being funded by none other than the American Heart Association .. the great bastion of all things low fat, anti-Atkins .. so there can be no argument about the independence of the results This study is ongoing .. which means the official results won't be published for a while yet, but there will be opportunity to observe even longer-term results beyond 6 months. We discussed it here Low-carb diet deemed safe over short term.

Doreen