When all is said and done there are three dietary approaches to weight loss:
- General Calorie Restriction
- Low Fat Diet
- Low Carbohydrate Diet
I. General Calorie Restriction requires diligence and often some degree of will power. To many people this means that they will run into trouble two to six weeks down the road when some external stressor disturbs their concentration. This approach is most suitable for someone with a stable lifestyle, or for persons who only have to drop a dress size or 5 to 15 pounds.
General Calorie Restriction operates on the concept that if you eat even 300 calories less than you burn, then you will eventually lose weight. A general rule of thumb would be to create a calorie deficit of 20% less than what it takes to maintain your weight. For instance, if you weighed 200 pounds and maintained your weight with 3000 calories per day, you would need to decrease your calorie intake to 80% of 3000, or 2400 calories a day.
Increasing the number of hours per week of exercise will marginally increase the number of calories you burn over your basal metabolic rate (BMR); but more importantly it will increase your BMR for a period of 24 to 48 hours after a workout. Benefits of general calorie restriction approach are that no foods of food groups are excluded. Often, removal of daytime snacks or that evening pint of Haagen-Daaz are enough to tip the balance.
Drawbacks are that people will tend to eat their favorite foods and sacrifice more healthy choices in order to make their caloric limit. Other drawbacks are that you have to keep track of the number of calories or food units you have eaten as each day goes on- great if you tend to be on the compulsive end of the spectrum, but rough if you have to work to maintain focus and attention, and have major stressors or distractions in your life. Very low calorie diets with less than 1400 calories a day should not be attempted without the assistance of a physician.
INFORMATION SOURCES:
- Weight Watchers. For Meetings in your area call (800) 651-6000
- Jenny Craig: www.jennycraig.com
- overeaters anonymous: www.oa.org
II. A No Fat Diet, or one with less than 10% of its calories from fat, has recently been shown to reduce weight as well as reverse atherosclerosis when used in conjunction with meditation, regular exercise and group support.
Without a daily influx of cholesterol and fatty acids, the body is forced to make these substances from scratch in order to repair cell membranes and provide precursors for steroid hormones. This is energy intensive and so favorably increases BMR, which leads to weight loss.
Because this diet effectively removes animal proteins from the diet, many health benefits are gained if the person makes up the calorie deficit with fresh fruits and green vegetables. It is politically correct and fits perfectly with the vegetarian lifestyle.
Unfortunately, just moderate reduction in fat intake alone is not enough to cause weight reduction or to gain the cardiovascular benefits shown by Dean Ornish. In fact, during the period from 1980 to 1991, Americans reduced the proportion of fat in their diet from 36% to 34%, but gained an average of 10 pounds per person on an age adjusted basis. This is due in large part to the fact that reducing fat also reduces some of the inherent signals of satiety, and people ended up eating more calories in carbohydrates. This was true for men, women, blacks, whites, and especially children, who will continue to grow obese at younger ages unless the watching of television and computer games are reduced considerably. This however, is culturally unacceptable and any adult caught attempting this could be charged with some form of child abuse or sensory neglect.
For a person with daily angina and facing a coronary bypass, the Ornish program of yoga, exercise, very low fat diet, meditation, and group sessions with stress management techniques will often reduce chest pain within a period of days to weeks, and—yes—these persons do lose weight. In order to lose weight soley on a low fat diet, it is probably necessary to reduce fat consumption to below 20% of calories while maintaining the same caloric intake.
There is one group of overweight people for whom Low Fat Diets create a particular set of problems. These people are pre-diabetic with an elevated insulin response and elevated triglyceride levels. They crave candy, chocolate, soda or pasta (carbaholics), get cranky or shaky inside of hungry and may get drowsy after big meals. They gain weight from their teens to their 40s, develop diabetes10 years later, and then develop heart disease some 10 to 20 years after that, regardless of their cholesterol levels.
Their bodies are expert at converting carbohydrates into body fat and so a diet that allows cart blanche ingestion of carbohydrates guarantees weight gain. Propagation of this approach has been so successful that the prevalence of diabetes in the U.S. has more than tripled in the last 35 years from 1% to more than 3% of the population according to the National Institute of Diabetes and Digestive and Kidney Diseases.
A Low Fat Diet can be healthy, tasty, and will result in weight loss if fat as a percent of calories is kept at 20% or less and carbohydrate intake does not become excessive.
There is nothing biochemically or ethically evil about fat. It provides flavor, a sense of fullness and certain essential fatty acids that the body cannot make itself. Persons on a Low Fat Diet should try to include salmon or other cold water fish, or flaxseed oil in their diets to maintain Omega-3 fatty acid levels in their bodies. For the hard core vegetarians, a company named Neuromins has found a way to extract one of the two essential omega-3 fatty acids from algae. Omega-3 fatty acids are found in breast milk, and are necessary for nerve maturation in infants. Omega-3 fatty acids are especially important for strict Low Fat Diets, because the body, when forced to make its own fatty acids, cannot make the longer Omega-3 fatty acids it needs unless it receives the essential Omega-3 building blocks from the diet.
INFORMATON SOURCES:
- For information on Ornish’s Preventive Medicine Research Institute call (800) 775-7674, ext. 221. His book is titled Dr. Dean Ornish’s Program for Reversing Heart Disease, Random House, 1990.
- Pritikin Diet: www.pritikin.com
III. The Low Carbohydrate Diet was first suggested in nutritional circles by Carlton Fredrick, but was popularized by Robert Atkins beginning in the 1970’s. The Low Carbohydrate Diet takes advantage of the fact that most metabolic systems are not reversable, and so while the body is geared up for burning fat as in the survival or hibernation mode, it does not readily store fat or convert carbohydrates into fat as would occur in the Fall or the harvest season.
The body has a limited ability to store carbohydrates as glycogen. When marathon runners get to about the 20th mile, the experience of “hitting the white wall” is actually the body’s reaction to their dropping blood sugar as they convert from burning glycogen to burning fat stores. A carboholic getting cranky or shaky inside will avoid this by eating some sugar.
Once the body is burning fat as its primary energy source, complementary energy pathways are stimulated to enhance transfer of fatty acids into mitochondria for burning, and to build glucose from the byproducts of protein and fat metabolism. Some of the side effects of this metabolic shift are the production of ketones, increased thirst and increased water loss. Another is that eating fatty foods does not result in adding fat to cells, who cannot easily store and breakdown fat simultaneously. So a dieter is not limited by the amount of green vegetables, protein and fat that they can eat. They are restricted from eating any of a certain class of foods, the sugars and carbohydrates.
Carboholics who go on a Low Carbohydrate Diet find a smoothing of energy and mood, because they are not at the mercy of rapid shifts in their blood sugar. There is much less detail to remember, and issues of hunger and satiety are not a factor. Persons can monitor their progress by dipping a keto-stick through their urine to see if they have reduced ingestion of carbohydrates enough to maintain ketosis.
Drawbacks are that it is politically incorrect and that some heart disease and cancer risks of a high protein/fat diet may not be overcome by antioxidant intake. Robert Atkins M.D., recently put his money where his mouth is by sponsoring a study of his Low Carbohydrate Diet protocol. Published in the prestigious American Journal of Medicine (July 2002,p32-6), a six month trial of Low Carbohydrate intake and nutritional supplementation resulted in significant weight loss, lower Total cholesterol and higher HDL values.
Modifications of the Low Carbohydrate Diet include Ronald Hoffman, M.D.’s Salmon and Salad Diet, Richard and Rachael Heller's Carbohydrate Addicts Diet, Barry Sears’ The Zone Diet, the South Beach Diet, Low Glycemic Index diets and various strategies for simply reducing what for lack of a better word are called "mindless carbos".
INFORMATION SOURCES:
- Dr. Atkins Diet Revolution by Robert Atkins,
- The Carbohydrate Addicts Diet by Richard and Rachael Heller, Signet Books, 1993.
- Enter the Zone, by Barry Sears, Regan Books,1995.
- Lose the Weight You Hate, by Ritchie Shoemaker M.D., Gateway Press, Baltimore MD, 2001.
IV. Ultimately each person is different- their personality as well as their physiology. No one diet fits all, but there is a strategy that will work best for you. If you want to loose weight at this time, read through this pamphlet again and see if one particular approach makes sense for you. Then tell us and we will hook you up with the resources necessary to accomplish your goal. If you want to loose weight but you are uncertain about which path to proceed on, read on further about things to avoid.
Updated 8/2/02, 11/5/11
V. Things to avoid, Plus 17 refrains of that old and much repeated prayer,
“Lord, let there be five aces in the deck.”
Fat substitutes have hit the market, and 200 million in processing fees says that Olestra will be peaking out a you from the popcorn stand at your local movie house fairly soon. Only trouble is that this substance blocks the absorbtion of certain nutrients, and is in effect an antinutrient. Expect makers to pledge to add back some of the blocked nutrients in much the same way that breadmakers were forced to add back a few nutrients to make their “enriched” bread, after stripping it of most essential nutrients. Also expect cramps and loose stools with excessive amounts of Olestra.
Apart from a few squeals heard at the beginning of the New Year, don’t expect any researchers to commit funding suicide by publishing any negative studies on Olestra until it is firmly planted in the marketplace. The system is very unforgiving that way.
Olestra barely reaches the level of minor sin on the great scale of life. A given individual could compensate nutritionally and use Olestra reasonably in much the same way that millions of Americans utilize margarine. When they reviewed dietary diaries of 85,000 English nurses in the 1980’s, they found that those who had listened to their doctors and forswore all butter in favor of margarine had higher levels of heart disease than those unrepentant souls who continued to eat butter or those agnostics who knew they should be eating margarine but still ate some butter. The problem is on a societal level, where repetitious noncognizant use by undernourished persons can lead to selective malnutrition. Companies should be focusing on creating Smart Foods, but that is a story for another day.
From the German bunkers of World War II to the truck driver bennies of the 50's and 60's, to cocaine to coffee, Western culture has had an obsession with stimulant use. No less than five stimulant products have been promoted for appetite suppression or weight loss. Two of the neurotransmitter systems involved in appetite dynamics are the adrenalin and serotonin systems.
Most of the appetite suppressants on the market stimulate receptors of the adrenergic, or epinephrine based systems. Despite over 30 years of use for weight loss with dozens of reformulations, no study has convincingly shown that their use results in permanent weight loss.
The latest cultural apologists ignore America’s recent rapid increase in weight and diabetes, to argue that obesity is primarily genetically determined, and thus out of our control. So, temporary yo-yo weight loss, or a lifetime of medication should be acceptable choices. These arguments completely ignore the question of why, if this is primarily genetically determined, did the rate of obesity wait 40 million years to start increasing a decade ago.
The perfect person for an adrenergic appetite stimulant approach might be a person who is mild to moderately overweight, and who also has Attention Deficit Hyperactivity Disorder. Ritalin is a member of the adrenergic group. If one out of every 20 American kids is on Ritalin, is it fair to count them among the remaining 65% of the population who are normal weight?
The second neurotransmitter axis that has been used to suppress appetite is the tryptophan-serotonin-melatonin axis. In 1989 Prozac, the first of the Selective Serotonin Reuptake Inhibitors (SSRI’s) was introduced to the market. SSRIs are prescribed primarily for depression. Many people find their appetite reduced and food cravings diminished when starting a SSRI; some find as the dose is increased that their appetite returns or increases.
In 1997 sales of fen-phen were going strong. FDA approval two years before had occurred despite the fact that test animals’ brains had trouble resuming normal production of serotonin after stopping the drug. In 1998 studies published in the New England Journal found a high incidence of heart valve injuries in persons taking fen-phen and it was removed from the market.
The latest stimulant drug for weight loss approved by the FDA is Meridia. It works like the SSRI’s, but blocks the reuptake of both serotonin and adrenergic neurotransmitters. Side effects have included constipation, dry mouth, nervousness and increased heart rate. Blood pressure frequently rises, even with weight loss. Orlistat and Meridia are the only drugs approved for relatively long-term use. In the one study that showed sustained weight loss for a two year period, all patients were also on a 600- kcal-a-day deficit diet. As one expert put it, “ A likely scenario is that patients will have periods of intense treatment separated by periods of less intense treatment.” This is one disease that can virtually assure pharmaceutical industry profits for the next 30 years.
Your Basal Metabolic Rate, or BMR, is the amount of energy needed to run all your vital functions. Like the furnace in a house, increasing the temperature on the thermostat results in increased energy expenditure. The thyroid gland is like the thermostat for the body. People with overactive thyroids tend to be thin, nervous and shaky. So taking extra thyroid hormone can result in weight loss. The problem with this is that you wear your whole system out sooner if you are not simultaneously over- supplementing with various nutrients. People who are hyperthyroid have a higher incidence of heart arrythmias. Keep in mind that Iron supplements will inactivate thyroid supplements when taken at the same time, and that selenium deficiency will impair the enzyme in brown fat (type II T4- 5’ deiodinase) that converts your thyroid hormone into its active form. Growth hormone has also been reported to be thermogenic, but is very, very expensive.
One recent approach to weight loss involved research into the hormone Leptin that is involved in signaling the body to burn more fat. The set point, like the temperature setting on a thermostat, would be the body fat level that keeps the brain Leptin levels optimal. Since Leptin is produced in fat cells, a high level of Leptin would signal the brain to reduce body fat to normalize body Leptin levels.
Unfortunately, many overweight people seem to be resistant to their own Leptin, much in the way that adult onset diabetics are resistant to their own insulin. Time will tell whether there is some means for manipulating Leptin to benefit people with excess weight. What remains tantalizing is that stimulation could occur at Leptin receptors in brown fat cells , and weight loss would be a side effect of a mild increase in thermogenesis, akin to the tantric meditation technique Tibetan monks have been reported to use to stay warm in the winter.
So, what does tell us when we are hungry or when we are full?
Cows and horses will graze all or most of the day if given the opportunity. Omnivores and carnivores evolved brain-gut information systems to tell them when they needed to eat next. Not surprisingly, the information input for these systems comes in food. Tryptophan is an Essential Amino Acid mentioned earlier in connection with the serotonin pathway. It is the least common of the Essential Amino Acids. A drop in the availability of tryptophan in the blood stream leads to carbohydrate craving, presumably via lower serotonin levels in the brain. In a similar fashion deficiencies of the amino acid precursors of dopamine may also signal hunger.
Everyone knows that for most people “rich” foods that contain fat provide a feeling of satiety, or fullness. It is for this reason that Low Fat Diets feel so unrewarding to many people. The release of cholecystokinin from the stomach in response to the ingestion of fats or oils may be one of the messengers that transmits to the brain the feeling of satiety.
The latest entry in the appetite suppressor sweepstakes was described in a recent New York Times article (8/8/02) as Peptide YY3-36. This hormone is made in the cells of the small intestine in response to food and then circulates to the brain where it switches off the urge to eat. It has to be injected and costs about $250 per milligram. Best to wait a few years on this one.
A fifth approach to weight loss involves the use of various substances that will redistribute dietary nutrients. Conjugated Linolenic Acid, Carnitine, Testosterone, Dehydroepiandrosterone (DHEA), and Growth Hormone increase the body’s proportion of lean tissue and decrease fat without necessarily changing weight.
A number of products (Citrin, Citrimax) appeared about eight years ago that contain the fruit of the southern Indian trees Garcinia Cambogia and Indica. They have been found to contain as much as 50% (-) hydroxycitrate by weight, and this substance reportedly temporarily blocks an enzyme necessary for the synthesis of fatty acids. Although hydroxycitrate may block fatty acid synthesis, it is of no consequence unless a person is eating a Low Fat Diet, since humans can obtain most of their body fat from dietary lipids and use them whole cloth.
Cambogia must be taken before each meal to be effective, and would be expected to work best in the context of an overweight vegetarian who has gained weight on a low fat diet, but likes it.
In the chart below are a dozen or so substances reported to aid weight loss. None have been proven to cause stable long term weight loss, and some have not been formally shown to cause temporary weight loss. This brings us back to the question of whether then playing cards it makes sense to look for a fifth ace in the deck.
Each of these substances may benefit a particular person with a particular set of characteristics, but when used alone without regard to lifestyle changes of food intake and exercise, they are unlikely to be of benefit to most if not all the people who try them.
Finally we come full circle to the three basic dietary approaches to weight loss. Reread the first section on weight loss, and decide which approach you can live with. Conscious utilization of one or more of these approaches with regular physical activity is the cornerstone for a successful long term weight loss strategy.