What about the popular diets promoted to the general public over the 30 years since those guidelines were published? Initially, most programs followed the low-fat, high-carb orthodoxy. The most popular was the Pritikin Diet. This regimen requires severe total fat restriction. In recent years, Pritikin has liberalized its view of nonsaturated fats. I admire the Pritikin doctors for their commitment to prevention of heart disease, which has included the successful promotion of exercise. But the problem with the Pritikin Diet, which its proponents acknowledge, is that it is hard to follow and requires a tremendous commitment on the part of the patient. Also, the high carbohydrate content of the diet can worsen cholesterol and triglycerides in certain patients. It definitely is not a diet for the general public.
In the early 1970s, Dr. Robert Atkins wrote Dr. Atkins' Diet Revolution, which shocked all by advocating the exact opposite of the low-fat gospel. He called for a diet high in saturated fat and low in carbs and was immediately denounced by the medical and nutritional establishment. The criticism was undermined by the fact that the diet seemed to work much better than the low-fat, high-carb American Heart Association diet. It was also attacked in part because Dr. Atkins limited carbs so severely that body fat was broken down for fuel, causing a condition called ketosis. In otherwise healthy overweight or obese individuals, I am aware of no evidence that ke-tosis is a danger. But it is associated with a decrease of fluid volume and some dehydration, which can be a problem in patients with kidney disorders or those on antihypertensive medications. Overall, however, the specter of ketosis has been overstated.
The major problem I have with the Atkins Diet is the liberal intake of saturated fats. There is evidence now that immediately following a meal of saturated fats, there is dysfunction in the arteries, including those that supply the heart muscle with blood. As a result, the lining of the arteries (the endothelium) is predisposed to constriction and clotting. Imagine:
Under the right (or rather, wrong) circumstances, eating a meal that's high in saturated fat can trigger a heart attack! In addition, after a high-fat meal certain elements in the blood, called remnant particles, persist for longer than is healthy. These particles contribute to the buildup of plaque in the vessel walls. None of this was known at the time Dr. Atkins developed his diet. But we know it now.
These adverse effects do not occur when the unsaturated fats are consumed. This is why we have strongly encouraged the "right fats" in the South Beach Diet. They make the meals taste good while they actually contribute to healthy vessels.
The other major diet phenomenon of recent years has been Dr. Dean Ornish s plan. The Ornish approach is similar to Pritikin's. It calls for severe total fat restriction and liberal consumption of carbohydrates. He also emphasizes exercise and relaxation techniques. In several small studies, he has demonstrated improved vascular health as a result of his diet. The biggest problem that I see in the Ornish approach is one that he readily acknowledges: It is very difficult to follow. Another issue is its restriction of total fats. Most polyunsaturated and monounsaturated fats are good for you and your blood vessels. So why not use them for satiety and to make meals taste better? Also troubling is that in selected patients, the high carb intake can induce the prediabetes syndrome we'll discuss beginning on page 75. Since at least one-quarter of Americans are predisposed to this syndrome, and it is present in more than 50 percent of those who have had heart attacks, it is no small concern. Ornish developed his diet when the deleterious effect of refined carbs was virtually unknown. Today, Dr. Ornish is putting greater emphasis on high-fiber carbohydrates that will not induce prediabetes.
I know and admire Dr. Atkins and Dr. Ornish. They have successfully fought conventional wisdom and have both contributed to the country's growing focus on heart attack prevention via improved diet and lifestyle. They have been criticized for the commercial success of their programs but have persevered. Unless someone popularizes the science of nutrition, America will never get its difficulties with obesity and heart disease under control.
It is my purpose to teach neither low fat nor low carb. I want you to learn to choose the right fats and the right carbs. You will learn to enjoy foods that taste good, satisfy your appetite, and don't create hunger hours later. In this manner, you can develop the food plans that are best for you for short-term weight loss, long-term weight maintenance, and optimal health.
ELLEN P.: I LOST 20 POUNDS IN 21/2 MONTHS.
My oldest daughter's bat mitzvah was coming up, and I wanted to lose some weight—maybe 20 pounds or so.
My whole life I had always been able to eat anything and it never showed. I love sweets. Chocolates. My friends had always been jealous. They would say, "How can you eat so much and still be thin?"
So it was a real shock when I hit 40 and all of a sudden, I started gaining weight. My metabolism changed, I guess. Anyway, I didn't really know much about dieting because I never had to. But when I looked around and saw all the weight-loss plans, I said there's no way I'm going to be super-careful about everything I eat, or drink any of those diet shakes, or any of that. That's why this diet was perfect for me, because I never felt like I had to eat things I didn't like or leave the table hungry.
The hardest thing for me at the very beginning was cutting out all fruit. I love fruit and fruit juice. Plus, I'm home a lot with my three kids, and I'm always giving them snacks. At least twice a week my kids and I would buy slice-and-bake chocolate chip cookies. I used to buy a lot of ice cream, too. I'd sit and have a bowl in the middle of the day. Or I'd have cheesecake. Cookies.
At first I didn't know if I could do it. When someone tells me, 'You can't eat this," it's almost like I want it even more. But this diet was actually pretty good from the start. My husband went on it with me, and it became almost like a little competition between us. You're not supposed to, but we weighed ourselves every day.
What I liked about the diet was that you really do lose weight right away, and you feel good about that. You can have lobster and shrimp and steak if you're hungry, and vegetables, andyou don't have to limit yourself too much. It wasn't even that difficult giving up the sweets. After a while you don't even crave the stuff. And if I was hungry I'd go have a piece of turkey or something. Or cheese. I remember how my husband always had to have his bread. If we went to a restaurant, he would smell bread the second he walked in. Once he went on the diet he would tell the waiter, "Don't even bring it to our table. We don't want to be tempted."
I was on the diet for 2V2 months. And in that time I lost 20 pounds. I know you're supposed to stay on the strict phase for only 2 weeks, but I stayed on it a few weeks longer. I wanted to make sure I would lose the weight in time for the bat mitzvah. And even the strict phase wasn't so bad.
I guess I'm on the maintenance phase now. I'm not very strict about it, but I don't crave as much as I did before. I don't even look at ice cream when I go shopping, and I used to want it so much. I used to eat sandwiches all the time, and now I'll have turkey or whatever wrapped up in lettuce instead of bread. I'll cut up leftovers like steak and put them into a salad. Before, I used to skip breakfast most days, but now I always have it, and it seems like that makes it easier to stick with the diet. I'll have an egg with turkey bacon and it satisfies me until lunch. Before, I wouldn't have any breakfast, but if I found some doughnuts I'd have those. I still have cookies once in a while. But that's about it for sweets. •
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