Bacon and eggs: The new diet food?

How low-carb diets are changing the way Americans lose weight When Bonnie Smith got ready to lose weight, she did what thousands of other Americans have done: She turned to

Wednesday, April 12th 2000, 12:00 am

By: News On 6

How low-carb diets are changing the way Americans lose weight

When Bonnie Smith got ready to lose weight, she did what thousands of other Americans have done: She turned to Oprah.

Taking her cue from the talk show host, she started the Carbohydrate Addict's Lifespan Diet, one of several hot-ticket low-carb weight-loss plans.

After years of being told to cut fat, dieters are suddenly getting a new message: Limit carbohydrates instead. And they're losing weight - even on plans that allow "unlimited" bacon, steak and cheese.

Since September, Ms. Smith has lost 23 pounds. "I'd say pretty painlessly," she adds.
Because her window-washing business keeps her on the go, the 52-year-old entrepreneur found herself eating lots of fried fast foods. "The old me ate all that stuff, snacked on sweets. I don't do that anymore."

The Carbohydrate Addict's Diet - which does not recommend unlimited fat - calls for two low-carbohydrate meals a day followed by one ''reward" meal, in which dieters can eat whatever they want.

"My typical breakfast might be eggs and bacon," Ms. Smith says. "I like to have a little cottage cheese and fresh tomatoes."

But most "white foods" - from pasta to potatoes, rice to bread - get the ax. For good.

"I don't eat any carbs at all for the first two meals," Ms. Smith says, adding: "It's not a diet, it's a lifetime change."

Ms. Smith's story is everything dieters love and health experts hate about the hugely popular low-carbohydrate/high-protein diets.

People do lose weight - whether it's on the Atkins Diet, the Zone Diet, Sugar Busters! or Protein Power. But perhaps not for the reasons they think, say experts.

Yet how can these same experts bad-mouth diets that help people drop pounds and get off of the fast-food-sugary-snack treadmill?

The tug-of-war turns on truths, half-truths, mistakes and vested interests. Who's right? Who's wrong? Read on for the good, the bad and, yes, the unknown.

The diets

Most of the low-carb diets, which are also high-protein, argue that Americans eat too much sugar and too many refined starch products. (Americans consumed 150 pounds of sugary sweeteners, such as sugar and high-fructose corn syrup, per capita in 1995, the most recent year for which the U.S. Department of Agriculture has figures.)

Good message! The diet authors rightfully point out that health organization guidelines to "eat less fat" may have unwittingly led people to consume more of these so-called empty calories, believing that if it's not fat, it's OK.

"In the drive to stick to the 'kiss' principle - keep it simple, stupid - the message has been so perverted and lost," says Dr. Kevin Vigilante, physician-coauthor of Low-Fat Lies (LifeLine Press. $19.95).

So when Dr. Richard Atkins, physician-author of the Atkins Diet, lambastes the American Heart Assocation for putting its heart-healthy seal of approval on Froot Loops, there's a ring of truth to the criticism. No one would confuse the sugary breakfast cereal with health food.
Like Dr. Atkins, many mainstream nutrition scientists also question whether Froot Loops are heart-healthy.

People listen to the low-carb/high-protein gurus because many are physicians - Dr. Atkins is a cardiologist, three of the Sugar Busters! authors are physicians, and Protein Power authors Michael and Mary Dan Eades are bariatric specialists. Those who aren't medical doctors are Ph.D.s, like Zone Diet creator Barry Sears, whose doctorate is in biochemistry.

But woven in with the truths in these diets are distortions that don't square with science or sound nutrition.

"Many give the message that all carbohydrates are bad," says Dr. Andrew Weil, physician and author of Eight Weeks to Optimum Health and the new Eating Well for Optimum Health (Knopf, $25) as well as a leading proponent of integrative medicine. His concerns echo those of many critics.

"Many of these diets breed unconsciousness about fat," he says, adding: "You can always spot the Atkins people at a buffet. Their plates are heaped with bacon.

"Then," he says, "I have long-term concerns about eating too much protein."

How do the diets work?

The low-carb/high-protein diets zero in on insulin.

"The theory is that if insulin is lowered or completely suppressed, fat storage will be limited or completely blocked," write Dr. Vigilante and Low-Fat Lies coauthor Mary Flynn in an article critical of the diets. In the January-February issue of the International Journal of Integrative Medicine, they go on to say: "Proponents of this theory state that because carbohydrates are the most potent stimulators of insulin release, then carbohydrates are responsible for causing fat storage and obesity."

"The problem is," says Dr. Vigilante from his office at Brown University in Providence, R.I."there's n
o or very little evidence to support it."
In diet studies where carbohydrate content was varied but total calories remained constant, no difference in weight loss occurred, he says.

And in the linchpin study cited in several of the LC/HP books - Kekwick and Pawan in The Lancet in 1956 - the authors themselves say the results are flawed: "The first and main hazard was that many of these patients had inadequate personalities. At worst, they would cheat and lie, obtaining food from visitors, from trolleys touring the wards, and from neighboring patients."

Dr. Weil also criticizes the diet book authors for their cause-effect conclusions.

"The worst distortions I see in Sears [Zone Diet] and Sugar Busters! is that eating high-glycemic foods makes you insulin-resistant.

And that's just wrong."

Insulin resistance occurs when the body builds up a resistance to the hormone insulin as it attempts to clear excess sugar from the blood stream. The glycemic index, a familiar fixture in many LC/HP diets, measures how carbohydrates affect blood sugar (see sidebar). Insulin, the diet authors say, prompts the body to store energy, while its counterpart, glucagon, tells cells to release energy.

By focusing on insulin - or, in the case of the Zone Diet, its effect on eicosanoids which are transient hormones - the diet authors overlook or minimize other important factors affecting weight loss, say critics.

Then why do people lose weight on these diets?

"I think these are another version of a crash diet," Dr. Weil says.

First, many of LC/HP diets are, by their authors' own admission, low in calories. In his newest book, Dr. Atkins New Diet Revolution (M. Evans & Co., $21.95), the author notes that people tend to eat fewer calories on his diet despite unlimited access to foods such as bacon, steak and cheese. Dr. Sears recommends eating no more than 1,700 calories a day, an amount on which most adults will lose weight, especially if they are exercising.

In diets that aren't calorie-restricted, "weight loss will occur initially as a result of water and carbohydrate losses, despite no significant calorie reduction," says Mitzi Dulan, an online registered dietitian and certified personal trainer who can be found on the cyberdiet.com Web site. Water is essential to carbohydrate metabolism; drastically reduce carbohydrates and the body lets go of a certain amount of water, too.

This loss can be very dramatic at first, says Dr. Vigilante, which can boost motivation to stick with the diet - a positive attribute of these weight-loss plans.

There may also be another important reason why these diets work: People do eat less because they feel fuller sooner and longer.

Foods rich in protein and fat "take longer to digest and increase the feeling of 'satiety' [or satisfaction] with meals," Ms. Dulan says.
But the bottom line is: People lose weight because they expend more calories than they consume.

So what's the problem?

Make that problems.

At their worst, some of these diets encourage unfettered comsumption of fatty, high-protein foods - usually meats and dairy products - that are loaded with saturated fat, which raises cholesterol. (Sugar Busters! and the Zone pointedly emphasize lean meats.) Many critics fear that the "eat all you want of high-protein (high-fat) foods" message will have serious long-term consequences for heart health.

But some authors claim that people on their diets improve their blood fat profiles - cholesterol and all.

It is possible. Weight loss alone, say scientists, can improve your blood fats. So if dieters are losing weight - by any means - their blood profile can improve.

Also, if dieters switch from a fast-food diet high in sugary snacks, fried foods and soft drinks to lean meats, fish and vegetables - as Ms. Smith did - theymay improve the content of their diets enough to improve their blood fats, too.

But experts warn that, over the long haul, eating unrestricted fats is likely to worsen blood lipids - including the so-called good HDL cholesterol and triglycerides - and increase heart disease risk.

People on an LC/HP diet who are physically active will tire more quickly during a workout, says Dr. Suzanne Nelson Steen, registered dietitian and head of the Huskies Sports Nutrition Service at the University of Washington, Seattle. She has devoted most of her career to helping young athletes achieve peak performance and good health.

Carbohydrates are the body's preferred fuel source, she says. And athletes who skimp on carbs may experience lack of energy, muscle fatigue and breakdown, confused thinking, lack of concentration and the inability to train at their optimum level.

Excess protein leaches calcium from the body.

"It is well known that high-protein diets promote calcium loss and so increase the risk of osteoporosis. . .," writes Dr. Weil in Eating Well for Optimum Health.

But he's also concerned about long-term damage to the liver and kidneys.

"Their workload is stepped up when you eat too much protein," he says.

Processing the byproducts of protein metabolism taxes the liver. And, Dr. Weil says, "We know perfectly well when you have reduced kidney function, you can't handle protein." What's unclear is how long you'd have to sustain a high-protein diet to damage these organs or see bone loss.

The American Institute for Cancer Research, among others, is critical of the diets for limiting or outright forbidding certain plant foods - such as corn, carrots, beets and potatoes.

Many of these, the organization says, are rich in vitamins, minerals and phytochemicals as well as fiber - all believed to decrease the long-term risk of heart disease and cancer.

High-protein diets may interfere with the immune response, Dr. Weil says. They seem to keep the immune system "in a state of irritation," especially if the protein is animal-based. "This is based upon my experience as a clinician," he adds, noting that there are few studies on this.

Too much protein (and too few carbohydrates) can cause mild dehydration, says Ms. Dulan, which can cause "headaches, fatigue and loss of appetite." Some of the diets recommend drinking extra fluids to compensate.

Severely carbohydrate-restricted diets, such as Atkins' Induction phase, intentionally induce mild ketosis - abnormal fat metabolism in the absence of carbs for fuel.

"The theory is that ketosis ensures that no fat will be stored in fat cells, and that the body will be forced to metabolize previously stored fat for energy," write Drs. Vigilante and Flynn in the Integrative Medicine article. "This hypothesis has not been proven."

Besides dehydration and lack of energy, ketosis can also cause bad breath and constipation, they note. And there's one other problem with ketosis, say Drs. Vigilante and Flynn: It increases the level of oxidized LDL cholesterol - the kind harmful to arteries - by 70 to 80 percent.

What's meant by carbohydrates, anyway?

One point of confusion is how these diets use the word "carbohydrate." Most don't mean all carbohydrates. Otherwise, virtually all vegetables and fruits would be eliminated from dieters' plates.

By and large, they refer broadly to starchy carbohydrates such as white bread, pasta, rice, corn, beans and potatoes. Blacklisted foods tend to have a high glycemic index - that is, they tend to raise blood sugar. By extension, the authors and some other health experts reason, they also increase insulin production.

But Dr. Vigilante points out that index "does not consistently predict insulin response." These foods may or may not actually stimulate greater insulin production.

Plus, you can slow the glycemic action by adding a little acid, such as vinegar or lemon juice, to these foods, Dr. Weil says. Or by cooking pasta al dente.

He gives the diets credit for making people aware that "carbohydrates are not created equal."

So while LC/HP dieters are eating fewer starchy carbohydrates, you still find huge salads, as well as many servings of broccoli, greens, asparagus, cabbage and other vegetables on most regimens. If a person is eating these instead of fast food or sugary snacks, they are improving their diets.

But after the initial water loss, the most likely reason they continue to drop pounds, experts say, is still the consumption of fewer calories.
Do we go back to high-carb/low-fat diets?

Perhaps not.

One reason the LC/HP diets have captured people's attention is the growing disenchantment with the low-fat/high-carbohydrate recommendation. Even health experts decry the way Americans have interpreted this message to mean unrestrained gorging on reduced- and low-fat sugary, calorie-dense foods like cookies, sweet rolls and frozen yogurt.

Indeed, the sugar problem and its health consequences were central to a 1997 clinical debate in the New England Journal of Medicine, where the cases were made for and against the low-fat/high-carb regimen.

All sides agreed that whether a diet is low-fat, high-fat or high-carb, the calorie sources make all the difference to health.

The authors, among them Dr. Scott Grundy, director of the Center for Human Nutrition at the University of Texas Southwestern Medical School, emphasized the need for carbohydrates in any healthful diet to come from plant foods - real foods, such as vegetables, fruits, nuts, beans and whole-grain products. And saturated fats (the kind found mainly in animal products) should be replaced by unsaturated fats, especially plant oils rich in monounsaturated fats, such as olive and walnut oil.

Finally, the authors acknowledge what the LC/HP diet authors have said all along: Clinical trials have not supported the theory that a high-fat diet causes weight gain.

So what's the answer?

Drs.Vigilante and Flynn urge Americans to adopt the Mediterranean diet - not just for weight loss but for better health. They're not alone. In Eating Well for Optimum Health, the Mediterranean diet also gets top billing.

One problem in our weight loss-food obssessed culture, Dr. Vigilante says, is the absence of a culinary heritage. France, Japan, Italy, Greece, China all have centuries-old ways of eating that have developed to match the culture and its needs. "Defining American cuisine is much more problematic," he says.
He and Dr. Flynn, as well as Dr. Weil, like the Mediterranean Diet because they believe it is accessible to Americans - unlike, say, the Japanese diet, which calls for too many unfamiliar ingredients.

Drs. Vigilante and Flynn also note that when you eliminate processed foods, you also eliminate many of the hidden sources of fat in the American diet. In the Mediterranean Diet, olive oil is visually obvious in foods; you see the fat you're eating.

Ms. Dulan, the online dietitian, suggests another approach: adopting a carbohydrate-managed diet.

"The object is not to over-restrict but rather to make wise selections of carbohydrate foods, both in starch and sugar forms, and to distribute it throughout the day," she says on her Web site. She integrates many of the positive attributes of the LC/HP weight-loss plans in her recommendations.

Add lean protein foods or cooked beans and peas to each meal to feel fuller longer.

Be a little more generous with the healthy fats, also to increase the feeling of fullness. Good sources are avocados, olives, nuts and nut oils such as walnut, sesame and olive.
Eat most of your carbohydrates as whole foods, such as rustic breads, whole-grain cereals, fruits and vegetables.

Why do people lose/gain weight?

"I don't think it's any mystery why people are fat," Dr. Weil says. "Too much food. Too much of the wrong food. And too little exercise."
But the LC/HP diets, however distorted or incomplete their message, have drawn attention to the fact that we all expend and store energy differently: Some people are carbohydrate-sensitive, says Dr. Weil, and some people's bodies are more efficient than others at storing energy as fat: They have ''thrifty genes."

"I think most people know what foods put weight on them," he adds.

For those who are carbohydrate-sensitive, "there's a family history of adult-onset diabetes, obesity . . . .You can predict where it's likely to happen." It is, he says, genetic.

"People who have that," he says, "should really work to inform themselves about the glycemic index." The Glucose Revolution by Jennie Brand-Miller, Ph.D, and others (Marlowe & Co., $14.95) is a book refers to in Optimum Health.

For the rest of us, he advises: "Eat the right kinds of fats. Eat the better kinds of carbohydrates. Increase your activity. Make sure you're eating plenty of good-quality fruits and vegetables."

The LC/HP diet trend may also spell doom for the simplistic low-fat/high-carb message.
"The point of our book is low-fat lies," Dr. Vigilante says. "That's the big lie: that the only way you can lose weight and be healthy is with low-fat foods and low-fat diets. That's based on very parochial research and a distorted message.

"People have to understand that they have to take control of what goes in their mouths," Dr. Vigilante adds. "Otherwise, they will be unhealthy, and they will die young."

GLOSSARY
Here are some basic nutrition terms:

Calorie: A unit of energy. The heat needed to raise 1 gram of water 1 degree Celsius.

Carbohydrates: Include sugars, starches and fiber. The body's primary source of energy.

Carbohydrates contain 4 calories per gram.

Fats: Part of a group called lipids used throughout the body. Fats that are solid at room temperature are usually of animal origin, such as butter. Those that are liquid at room temperature are called oils. Fats contain 9 calories per gram.

Protein: A major part of animal tissue made up of amino acids. Protein is part of most body structures. Protein contains 4 calories per gram.

Source: "The Dictionary of Nutrition and Dietetics"