News

"It's news that contradicts current healthy-eating advice — a diet heavy on meat and cheese and void of whole grains and fruit can help you lose weight and may even help reduce heart-disease risk, according a study released this week," Leslie Beck writes in her column Atkins bests three other diets in battle of the bulge in today's Globe

"The surprising findings suggest that dieters who lost faith in the low-carbohydrate regime out of concern for their health, might want to reconsider the weight-loss plan.

"Based on a comparison of four weight-loss diets, the low-carbohydrate diet was deemed most effective at helping overweight women shed pounds . . . "

"The A to Z Weight Loss Study, published in the Journal of the American Medical Association, demonstrated the low-carb diet was not only the most successful at promoting weight loss, it also did not raise blood pressure or significantly boost cholesterol. Following the diet was actually associated with greater improvements in blood triglycerides, HDL (good) cholesterol and blood pressure."

However, Ms. Beck concludes: "How successful you'll be at maintaining a lower weight [on any diet] depends on factors beyond the amount of carbohydrate, protein or fat in a diet.

"Permanent weight loss requires strategies for long-term structured guidance and support, and emphasis on expending more calories through exercise. That's something to keep in mind if you decide to follow the Atkins diet, or any other weight-loss diet."

Do you agree? Do you have questions about this report?

Ms. Beck took questions from readers of globeandmail.com today. Your questions and Ms. Beck's answers will appear at the bottom of this page when the discussion begins.

A leading Canadian nutritionist, Ms. Beck operates a private practice in Toronto. When she's not helping people achieve their nutrition and fitness goals, she's writing her weekly column for The Globe and making appearances on CTV as Canada AM's nutrition expert.

Ms. Beck is the author of seven books, including her most recent release, The No-Fail Diet (Penguin Canada, October 2006).

Born and raised in Vancouver, Ms. Beck obtained her Bachelor of Science (Dietetics) from the University of British Columbia and proceeded to complete the dietetic internship program at St. Michael's Hospital in Toronto. She studied a Masters in Epidemiology at the University of Toronto. She is a member of Dietitians of Canada and the College of Dietitians of Ontario.

Editor's Note: globeandmail.com editors will read and allow or reject each question/comment. Comments/questions may be edited for length or clarity. We will not publish questions/comments that include personal attacks on participants in these discussions, that make false or unsubstantiated allegations, that purport to quote people or reports where the purported quote or fact cannot be easily verified, or questions/comments that include vulgar language or libellous statements. Preference will be given to readers who submit questions/comments using their full name and home town, rather than a pseudonym.

Sasha Nagy, globeandmail.com writes: Hi Leslie: Thanks so much for doing this discussion. Our household has really taking steps to change our diet in the past year. Some of the changes we made included more fresh vegetables, lean meats, less pasta and carbs etc. In the end, the best way to describe these changes is less processed, more fresh produce and meats and vegetables.

Our diet now bears a strong resemblance to the way I used to eat as a child. Do you feel that food choices in the past 20 years have been overtly influenced by the food industry and their packaging foods and trying to market "convenience."

These new diets, like Atkins and South Beach seem to me to be full of common-sense choices. Is this a fair comment, or are these diets representative of more fundamental changes towards food and health?

Leslie Beck: It's my pleasure. Yes, I certainly do feel like today's diet has been influenced by the packaged foods industry as well as the fast food industry.

With our busy lifestyles, planning for healthy meals often takes a backseat to other demands. As a result, frozen and convenience foods become more common in the diet, as does take out food. I think this has had a negative effect on our calorie, fat, sugar and sodium intake. As well, many foods today are sold in jumbo-sized packages, which studies show encourage overeating. We really need to take the time to plan our meals so that we are organized and have the right foods on hands , either at home or at the office.

The Atkins and South Beach diets are low carbohydrate, higher protein diets. In my opinion the South Beach diet is a healthier version of a low carb diet because it emphasizes low fat protein foods and encourages followers to add in small portions of whole grains and fruit after the first few weeks. I would not say, however, these diets are "full" of common-sense choices. They are diets designed to help people lose weight and as a result they drastically limit, or ban, whole grains, legumes and fruits and dairy products. Whole grains, legumes and fruits are foods, that when eaten over the long term, are linked with a lower risk of certain diseases.

Alex Bell from Toronto writes: Is it true that eating a grapefruit before a meal is an effective appetite suppressant? And if so, do the high sugar levels in grapefruits counteract any previous benefit?

Leslie Beck: Grapefruit does not have a specific appetite suppressant effect due to any of it's natural ingredients. However, eating one whole grapefruit may help take the edge off your appetite before your meal just because it partly fills your stomach. This might enable you to eat smaller portions at the meal. One medium sized grapefruit contains 17 grams of natural sugar and 3 grams of fibre. These natural sugars will not counteract any of the benefits of eating a grapefruit. In fact, citrus fruits are considered low glycemic food choices, meaning they are digested slowly and their sugars are gradually released as glucose in the bloodstream. (High glycemic foods like refined sugar and white bread are more quickly digested and converted to blood sugar.) Interestingly, eating low glycemic foods as snacks or part of a meal can help you feel full longer.

Bill MacLean from Canada writes: Ms. Beck, This is an interesting study with interesting results, but I notice that of all the many diets out there, only four were compared. I realize that there have to be certain limits within a study like this, but I would like to know your opinions on the Weight Watchers program. My wife, and several of her friends and colleagues, have been in that program for a little over a year now - with dramatic results. My wife has lost well over 30 lbs., a male colleague of hers over 60, and another female friend 96 lbs.! And they all report that the easiest part of the program is the concept of portion control - versus the elimination of one or the other of carbs, fibre, or fat. Of all the ones in the study I would suspect the Weight Watchers program would come closest to the LEARN diet. Could you comment?

Leslie Beck: Hi Bill. Yes, only four diets were tested. They were chosen because of the level of carbohydrate each contained. Low (Atkins), moderate (Zone), high (LEARN) and very high (Ornish). Yes, Weight Watchers diet would most resemble the LEARN diet in its composition of carb, protein and fat. Both the LEARN diet and Weight Watchers are based on current healthy eating guidelines (e.g. the same principles Canada's Food Guide is based upon...55% or calories from carbohydrate, no more than 30% fat and no more than 10% saturated fat calories.)

I truly believe that one diet is not right for everyone. What works for one person may not work for another. While some people don't mind giving up carbs, other people feel more satisfied if they include them in a meal. You need to find a diet that will work with your food preferences, what you can see yourself doing long term, and one that teaches you behaviour modification strategies. You need to find a plan that fits into your lifestyle and you can stick to long term. And if you go off track, which is only natural to do from time to time on any diet plan, you cannot feel like it's the ruin of all your hard work. You need to stay positive and get right back on track. Another predictor of weight loss success is accountability and self monitoring (e.g. food records, weigh-ins). Many people find Weight Watchers helpful because it provides group support which is a motivator for some people. Again, there is no one diet - or weight-loss program - that suits everyone. Kudos to your wife and her colleague!

Murray Braithwaite from Canada writes: The study quoted seems to be too small to draw firm conclusions. Noetheless, given what we know about blood sugar and insulin, it makes sense to reduce intake of foods that drive up blood sugar. What I find curious is that people seem to favour Atkins (lots of animal protein and, as a result, animal saturated fats), or the opposite. Why does hardly anyone advoate lower-carbohydrate diets without the large amounts of animal protein and fat. For example, one might consume lots of nuts and salmon and non-starchy vegetables, instead of beef. Is there a reason not to get the best f both worlds, or is thre evidence that there is something specific to animal protein and facts that seems to be central to the Atkins diet?

Leslie Beck: Hi Murray. I agree with your comments. The study was small; only about 70-75 women on each diet. However, the results were statistically significant meaning they didn't occur by chance. Low carbohydrate diets do help people lose weight, no question. People find them easier to adhere to because they are simpler to follow. And the higher protein content very likely helps to reduce hunger. However, I do think it is important to include protein foods that are lower in saturated fat such as poultry breast, tofu, egg whites and lean cuts of meat. And of course fish is an excellent protein choice. And I also think it's important to add small portions of the healthy, whole grain, low glycemic index starchy foods in your diet.

The South Beach Diet, which was not tested in this study, does advocate lean protein foods, less animal fat and small portions of healthy carbohydrates.

The latest version of the Atkins diet also emphasizes including lower fat protein foods. (The original version did not.)

Abigale Miller from Toronto writes: You conclude that the Atkins diet is the most successful of the four that were studied, but it was the worst in terms of LDL cholesterol. The high carb diet (Ornish) was in fact the only one that provoked a decrease in LDL cholesterol. If you're evaluating the diets strictly based on health outcomes, shouldn't the Ornish diet be rated as better? I was under the impression that weight was a cursory indicator of health problems, while LDL cholesterol is a more reliable indicator of potential heart trouble. Why do you give the weight loss parameters so much importance? Thanks for your time.

Leslie Beck: Hi Abigale. The study's primary outcome measure was weight loss. That was the major purpose of the study - to find out which diet actually resulted in the greatest weight loss. That's why so much emphasis was placed on weight loss. The Ornish diet resulted in the a smaller amount of weight loss, even though it did lower LDL by roughly 3% by the end of the study.

The secondary outcome measure was the effect on metabolic risk factors including LDL cholesterol, blood triglycerides (a blood fat), HDL (good) cholesterol and blood pressure. In fact, what the researchers found was that, at the end of the 12 months, the Atkins diet had the most favorable effect on raising HDL cholesterol, lowering triglycerides, and reducing blood pressure -- effects which help reduce the risk for heart disease. While it did raise LDL by 2% after two months on the diet, this effect was gone by the end of the study There was no change in LDL on Atkins. The powerful effect of lowering triglycerides are also thought to result in larger, less atherogenic, LDL cholesterol particles. So in fact, a 2% increase may not be a negative effect - especially in light of the other positive effects of the Atkins diet.

Jay Wortman MD from West Vancouver writes: Hi Leslie. It is good to see a balanced article from you on this study. In the past you have been less than supportive of the low carb approach. In September 2004, under the headline, 'Good riddance to low-carb claims' you dismissed the accumulated evidence in support of this diet at that point, saying 'To date, there is no scientific evidence that low-carb diets reduce the risk of heart disease or diabetes. Nor is there any good evidence that following such a plan can prevent or treat obesity.' It is good to see that this new study may be causing you to shift that position. Can we expect you to include a low-carb approach in the dietary options you promote from this point on?

Leslie Beck: Hi Jay. I was waiting to hear from you today!! I think it is fair to say that there is still no proof that a low carb diet, if followed long term, will actually reduce the risk of developing heart disease or type 2 diabetes. But certainly by looking at the effects on metabolic risk factors in this study, and from others, it would seem logical to think so.

My dietary plans for clients have always been on the lower carb side (verses no starchy foods, no fruits, no dairy). Unless I have a vegan clients, I do not advocate or develop, high carb diets for my clients. The macro nutrient composition of my plans for clients have been somewhere between South Beach and Zone diets. But yes, I think it is safe to say that you can expect to see me include nutritionally-complete low carb diets more often in my approaches to treating overweight and obesity, especially if it suits a client's lifestyle and food preferences.

sav nan from Toronto writes: Hello Leslie: I am vegetarian, do not eat any eggs or fish, but eat dairy products. Do you have any diet recommendations for Vegetarian's, that work.

Leslie Beck: Hi there. Sounds like you are lacto-vegetarian. You will need to include vegetarian protein foods in your diet such as tofu, legumes, nuts and soy foods. I highly recommend that you pick up a copy of two excellent books called "Becoming Vegetarian" and "Cooking Vegetarian" both by Vasanto Melina. She is a Canadian nutritionist who specializes in vegetarian diets. You will learn a great deal about meeting your nutritional needs while following a vegetarian diet.

Mary from Ajax Canada writes: My husband and I dropped 40 pounds each through small changes in diet (increasing fruits and vegetables, eating more fish and chicken and less red meat and fats) and adding aerobic exercise a modest 20 minutes a day three days a week. It took eight months but we never felt hungry or denied. Why is there such a rush to 'take it off'? It took time to put it on, it's gonna take time to take it off…

Why is proper nutrition not promoted the way the Atkins diet is? It's not really that hard and it works!!!

Leslie Beck: Hi Mary. Excellent point. There should be no "rush" when it comes to losing weight. People need to accept the fact that losing weight at a rate of 1 to 3 pounds per week (rate of weight loss depends on gender, age, how much weight you have to lose, etc.) is safe and healthy. Weight taken off more slowly (vs. 5 pounds per week!) and steadily tends to stay off. Expecting the pounds to fall off rapidly usually leads to frustration and discouragement when you hit a natural plateau in the weight loss process ... and then abandonment of one's plan. Instead of focusing on "it's not working", we need to focus on all the positive changes you have made and how you feel.

Keep up the great work. You are an fantastic example of how small changes add up and pay off big time.

Sasha Nagy: Leslie: Thanks for your comments, and for making some time in your busy day to answer these questions. As a closing thought. I have been impressed with many of the questions that have come in. They display a knowledge about healthy eating that is clearly on the rise. Education is an important factor as Canadians strive to eat and live healthy lives. Do you feel that Canadians are becoming more knowledgeable in this area?

Leslie Beck: Yes. Canadians do consider themselves knowledgeable about nutrition and healthy eating. And the questions were fantastic! It's wonderful that health and nutrition are regularly featured in the news media - print, radio and television. Awareness and knowledge are key ingredients to behaviour change. I look forward to my continued work with readers and my private practice clients!