Feature
Eating By The Book
by Monika Klein, C.C.N.
A review of six popular diets offers food for thought
Weight loss is not the only reason people diet, but it is the most common. People also diet for freedom from chronic disease, to sustain energy and to encourage a positive attitude. Everyone wants to look and feel good for special occasions and special people, but Hollywood has created the most toxic reason to diet—false image. Unrealistic expectations can lead to serious conditions such as anorexia nervosa or bulimia.
Added to the mix is a multibillion-dollar diet industry that has many people feeling conned, confused or both. The pills, packaged foods and eating programs are alluring to our fast-food, instant-gratification culture. People want quick and easy ways to lose weight. Unfortunately, they attach so much importance to it that it leaves many to live in emotional, physical and spiritual pain. All my clients have stories about a diet that worked for a friend and they want it to work for them or, worse, it didn't work for them but worked for a friend.
The truth is many diets work for many people, but the ideal diet is tailor-made for an individual. Sensible diets contain fruits and vegetables, less saturated fats and fewer total calories. What differentiates most diets are the proportions of carbohydrates, protein and fat they contain. The body needs complex carbohydrates to sustain energy, and the preferable sources are fruits, legumes, vegetables and whole grains. Protein helps keep blood-sugar levels stable, which puts the body on an even keel emotionally and physically by balancing moods and extending energy. Good sources are fish, lean meat, poultry, tofu and whey. Fats also help balance blood-sugar levels; the best sources are fish, nuts and seeds and the natural oils derived from them, rather than meats and the hydrogenated oils found predominantly in fried foods.
The following six diets are among the more popular plans being sold in bookstores today. This summary will make it easier for you to explain each diet plan to your customers.
The "Balanced" Theories
Both the Blood-Type and the Zone diets advocate maintaining health by eating a balanced ratio of carbohydrates, proteins and fats. Overall, foods contained in the Blood-Type diet represent a balanced ratio but vary widely depending on one's blood type. The Zone popularized the 40/30/30 ratio of carbohydrates, protein and fat and is a good maintenance diet because it contains a variety of essential vitamins and minerals, with a macronutrient balance to stabilize blood sugar.
Blood-Type Diet
The diet popularized by naturopathic doctor Peter D'Adamo's book Eat Right 4 Your Type (G.P. Putnam's Sons, 1996) bases food choices on the blood types O, A, B and AB.
Type O blood is regarded by anthropologists as the oldest human blood type. People with type O blood, according to D'Adamo, had hunter-gatherer ancestors and do well eating meat. They have enough hydrochloric acid (HCl) in their stomachs to digest meat proteins.1 Because neither dairy products nor grains such as wheat and corn became staples until later in human evolution, D'Adamo theorizes the digestive systems of those with type O blood never adapted to them.
D'Adamo believes people with type A blood descended from those who developed agriculture and grain cultivation, and therefore are fine candidates for diets based on grains and vegetables. Unlike people with type O blood, D'Adamo says they do not have enough HCl to digest meats and are more suited to fish and tofu.
People with type B blood are descended from herdsmen, says D'Adamo, and they do well eating dairy—unlike both O and A types. The rarest type is AB, which he believes the human species will eventually evolve into. People with type AB blood can eat a bit of everything.2
D'Adamo says certain health conditions are blood-type specific—although blood type is more of a "meaningful refinement" than the sole determining factor in conditions. As an example, type A blood clots more easily than type O, a factor that can have an effect on heart disease. He surmises that type O blood is associated with arthritis and thyroid conditions; type A with cancers, diabetes and heart disease; B with more exotic illnesses such as lupus, multiple sclerosis, and chronic fatigue syndrome; and AB with parasites and bronchial infections.3
I have seen success with this diet in my practice: People have lost weight, cleared sinus conditions, improved bowel function, balanced blood sugar and, perhaps most importantly, they feel better.
As with any diet, however, compliance is always a problem. This diet can be difficult to adhere to and can get quite specific—for example, D'Adamo recommends staying away from certain types of onions and cabbage. Although some people lose weight on this diet, it is better suited to people interested in clearing up existing health conditions such as arthritis or allergies and maintaining their health.
The Zone
Barry Sears, Ph.D., introduced the balance concept several years ago when he published his book The Zone (ReganBooks, 1995) and put the term eicosanoid (a short-lived hormone) on the map. Although most readers never understood their meaning, let alone pronunciation, eicosanoids are believed by Sears and other researchers to control many hormones and every bodily function. They are affected by the nutrients the body absorbs from food.4
Sears proposes that excessive carbohydrates are to blame for the fattening of America, a theory unheard of at the time by most diet and nutrition experts and certainly the general population. It is commonly held that pasta, rice cakes and bagels are health foods, not high-glycemic foods that adversely affect health. Sears says otherwise, and studies have confirmed it.5
He advises people who wish to lose weight to balance carbohydrates, protein and fat intake to a 40/30/30 ratio. This is a significant change from the previous conventional wisdom of a 60/20/20 ratio, which minimized protein and fats because they are associated with some of the most debilitating diseases such as cancer and heart disease. As Sears points out, concurrent with the 20-year-old war on fat is a rise in diabetes and insulin resistance. He says this is primarily due to high-carbohydrate, low-fat diets which increase insulin.6,7 Unlike diets that restrict calories, the Zone balances hormones.8
Most of Sears' studies have been done with a large HMO patient base and results show the Zone's effectiveness. Sears claims the Zone is an anti-aging, calorie-restricted program. Countless animal studies show that calorie restriction—but not malnutrition—results in longer and healthier lives.9
One drawback is that, even though most people lose weight on this diet, its calorie restrictions leave people hungry, especially those who are physically active. This is a sound diet because it promotes balance, but some may find following the exact portions difficult. Also, since it advocates eating meat, it is problematic for vegetarians.
High Carbohydrate/Low Fat
Both the Life Choice program and the McDougall program qualify as low-fat, vegetarian diets. One small but potentially meaningful difference is that the Life Choice program recommends fish-oil supplements, while the McDougall program is strictly vegan—no animal products whatsoever.
The Life Choice Program
Developed by Dean Ornish, M.D., and explained in his book Eat More, Weigh Less (Harper Paperbacks, 1993), this plan could be classified as the fat-phobic diet. Many have lost weight with this diet,10 but it won't work for everyone.
It is low in protein and fat, including essential fatty acids, as well as low in several micronutrients such as vitamin B12 and zinc, which tend to come from animal products. Although the book does not specify ratios per se, I would estimate it as 75 to 85 percent carbohydrates from grains, legumes, fruits and vegetables; 5 to 10 percent fat; and 10 to 15 percent protein from grains, legumes, nuts and seeds.
Anyone following this diet long term should increase the fat amount, especially women because inadequate fat consumption can affect a woman's hormone levels. This is often the case with anorexics, who eliminate all fat and subsequently suffer from amenorrhea, or lack of menstrual flow.11 Ornish contends that the biggest nemesis in our diets is saturated fats.12 He does support the use of 2 g/day of fish oil—the exception to the vegetarian rule—and 2 g/day of flaxseed oil (a polyunsaturated fat) to provide essential omega-3 fatty aids.
This fiber-rich diet restores proper elimination and is a good cleansing diet. Many of Ornish's results have been published in the Journal of the American Medical Association, and his program has become the accepted way to treat weight loss and even serious illnesses such as heart disease, hypertension and cancer. An optimal diet certainly consists of plant-based whole foods. However, excessive carbohydrates may not be optimal. Complex carbohydrates are beneficial because they take longer to digest, but simple carbohydrates often wreak havoc on blood-sugar levels.
The mind/body aspect of this diet is quite valuable. Much of Ornish's program is lifestyle-enhancing whereby participants are encouraged not only to change eating habits but also to exercise, meditate, and become involved with group therapy and stress management. In my clinical experience, emotional support is often the most important aspect of dieting, yet is commonly overlooked.
McDougall Program
Popularized in the McDougall Program for Maximum Weight Loss (NAL/Dutton, 1995) by John A. McDougall, M.D., this short-term plan is high in some fruits as well as starches such as beans, corn, potatoes and rice.
The carbohydrate/protein/fat ratio is not itemized, but I would classify it as 80 to 90 percent carbohydrates and only 10 to 20 percent protein and fat. There is no doubt that anyone following this program will quickly lose weight. For most, this diet is a way to get off junk and highly processed foods. Like Ornish, McDougall also focuses on perceived toxic effects of animal products. Without these foods the diet becomes a cleansing diet as well.
I would call this extreme plan a food-phobic diet. Although most diets tout the benefits of calorie restriction, this program is severe and could lead to lean wasting and other complications. Endocrine-system dysfunction, for example, may occur because of the low amounts of essential fatty acids, which can create hormonal imbalances.13 Lean wasting occurs when lean muscle mass is lost rather than fat.
In addition, many people in my clinic who have tried the McDougall program became bored with the food restrictions, and gained the weight back shortly after discontinuing the program. The diet forbids all animal products including dairy and eggs; all oils including the heralded olive oil; and nuts, seeds, tofu and flour products such as pasta. Eliminating most protein sources as well as all fats is inadvisable because the body needs both for metabolic processes.14 This eating plan also lacks some essential amino acids and essential fatty acids.
This diet could be appropriate for five days to one week. It would enable a person to make smarter food choices and eliminate highly processed foods. Emphasizing vegetables and fruits is a good thing and has an added detoxifying benefit.
High Fat, High Protein, Low Carbs
A low-fat diet will shed body fat, right? Not so, according to the Atkins diet, which says obesity exists for metabolic reasons, and bypassing carbohydrates is the proper path to weight loss.
The Atkins Diet
Developed by Robert Atkins, M.D., and detailed in the book Dr. Atkins' New Diet Revolution (Avon Books, 1992), this program encourages weight loss and health gain through a process called ketosis which basically forces the body to use stored body fat as fuel rather than metabolized carbohydrates from the daily diet.
The premise of this diet is to eat a lot of fat and protein and very little carbohydrates, which puts the body in a state of ketosis and thereby increases metabolism, decreases hunger and balances blood sugar. Ketosis is often characterized by a fruity breath odor; sometimes the tongue may feel coated and thick.
Initially, protein and fat ratios are approximately 95 percent and carbohydrates are only five percent. This is called the induction phase and it lasts about two to four weeks. Once adequate weight loss is achieved, a maintenance level is begun and ratios change to 75 to 85 percent protein and fat and 15 to 25 percent carbohydrates.
Studies show a "significant" energy-level increase and weight decrease among people following the Atkins diet.15 The diet also seems to balance blood sugar in diabetics and hypoglycemics.16 The plan shows beneficial results with insulin and glucose balance by reducing carbohydrate consumption and increasing protein and fat consumption.
Some experts and practitioners, however, question the excessive amounts of fat and protein recommended. Most people, though, could benefit by eating fewer refined carbohydrates.17 Even so, high protein can cause its own set of problems such as impaired kidney function.18 Atkins believes the diet is safe as long as a person's creatinine blood levels (a measure of kidney disease) fall below 3.0 (1.2 is considered normal), but recommends anyone following the diet be monitored by a physician. Constipation often results from insufficient plant fiber from grains, fruits and vegetables, so a fiber supplement is suggested.
I disagree with Atkins' theory that "almost any fat will do," because healthier fats and oils do not increase the risk of chronic illnesses such as heart disease and arthritis. This diet does, notably, steer away from more artificial fats such as margarine. Finally, because the diet calls for large quantities of protein from meat, this is clearly not a plan for vegetarians.
Support-Oriented Diets
People often know exactly what they "need" to eat and yet refuse to follow through. Then they feel guilty. People who learn to believe in why they are making better choices are more likely to adhere to a lifetime eating plan.
The Solution
This diet, developed by Laurel Mellin, M.A., R.D., and popularized with the publication of The Solution (ReganBooks, 1997), focuses largely on the mental and emotional aspect of dieting.
The premise of this diet is why and when people in our culture eat rather than what is eaten. Oftentimes the why and when are the real reasons people put on weight, make poor food choices, and eat improper amounts at the wrong times—like before bed.
The Solution does not focus on ratios of carbohydrates, protein and fats per se, although the dietary recommendations are similar to those in the Ornish program. This diet is a step-by-step psychological program for breaking the addictive patterns of overeating. The six mind/body techniques in the plan focus on effective ways to increase awareness of feelings and events that trigger poor eating habits. For instance, it uses support groups, which have been shown effective for permanent weight loss.19 Support is a very important part of this program, but the Solution's support groups cost hundreds of dollars, posing another hurdle for dieters.
Other diets that offer support include Weight Watchers, Jenny Craig and NutriSystems. While not within the scope of this article to detail those programs, they do focus on weight, which often creates obsessiveness and discouragement.
Your Customers' Diets
In the next 20 years, baby boomers concerned about degenerative diseases and aging may start thinking about eating well and taking better care of themselves. Then what? Will they turn to the latest fad diet advertised on the Internet? More likely, they will turn to you.
Remember that all people are different. Bioindividuality is key in any diet plan and not all techniques work for everyone. Every diet has its success stories as well as its critics. Ultimately, the only thing that counts for a particular person is results. Perhaps the best advice for those who wish to eat well, especially those with specific health concerns, is to work with a qualified health care practitioner.
For your customers who are casting about for a diet plan, the basics still apply: Recommend they eat a balanced diet of fresh, wholesome foods including carbohydrates, protein and proper fats; supplement appropriately; and get plenty of daily exercise—something each person likes and even loves to do, so they'll stick with it. In the end, we need to eat and do what makes us feel good.
Monika Klein, C.C.N., runs a nutritional counseling practice in Malibu, Calif., and is the television host of Total Health Talk.
References
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13. Kretsch MJ, et al. Vitamin B-6 requirement and status assessment: young women fed a depletion diet followed by a plant- or animal-protein diet with graded amounts of vitamin B-6. J Am Clin Nutr 1995;61:1091-1101.
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