Diets

Review by Del Meyer, MD

The other day at the nursing station, I observed the ward clerk reading "Weight Watchers" as she devoured a "Babe Ruth." ... I guess that keeps the scales balanced and the economy moving. It also contributes to the epidemic in America – 50-60% of the population are overweight with 25-33% affected with obesity. We consumed 15% more calories in 1994 than we did in 1970 and today we dine out twice as often. If obesity was an infectious disease, we would call it a national crisis.

Of all the books that cross my desk, there is at least one or two each month about dieting. The "diet industry" is flourishing. But is there really any new information? At one bookstore I counted 107 different diet books. At another there were over 200 titles. It is interesting that as this deluge of new books were filling up the shelves, some "dated" diet books that spoke of revolutionary new medical dietary evidence were now on sale at 10% of their initial listing.

There are number of diet books written by celebrities. These authors are obviously without credentials. However, some of these books are quite basic and meet a need because of a co-author with credentials, e.g., MS, PhD or MD, although the latter group may not always be as knowledgeable as the public assumes.

A brief review of some of these books will describe this self-perpetuating industry. The questions still remain. Are they of value to the overweight Americans? Are they helpful to those with other dietary problems such as hyperlipidemia, coronary artery disease, peripheral vascular disease, hypertension, or diabetes? Do they provide complete lifelong nutritional programs? Do they incorporate exercise and stress management? There are at least three that do.

The Pritikin Diet Programs of Nathan Pritikin have been continued by his son Robert, director of the Pritikin Longevity Center. The current volume, The New Pritikin Program by Robert Pritikin (Pocket Books, $7) is friendlier and more in tune with a lifetime commitment. The results of the first 893 people that participated in the 26-day Pritikin Longevity Center program was published in 1974 and provided a wealth of data which was evaluated by the Department of Biostatistics and Epidemiology at Loma Linda University. The results indicated that 83% of hypertensive people lowered their blood pressure to normal and left the program drug-free; 50% of adult-onset diabetics on insulin left the program free of insulin; 90% of diabetics on oral drugs left free of drugs; 62% of drug-taking angina patients left the center drug free; cholesterol and triglycerides were each lowered an average of 25%; overweight people lost an average of 13 pounds; of the 64 people who were recommended for bypass surgery, 80 % of them had not undergone surgery even five years later. I remember that when Nathan Pritikin presented his data to medical staffs in this community during the mid 1970s, he himself had severe coronary artery disease and was recommended for bypass surgery. He declined and developed this program instead, which reversed his own atherosclerosis. There now have been over 50,000 people treated at the Pritikin centers in the last 15 years. They feel that quick fixes simply don’t work in the long run and one may even worsen the problem. One must address all the factors of health. There is nothing magical. This is truly a proven formula for lifelong success and health.

A couple of years ago, my RN-NP introduced me to The Zone Diet by Barry Sears, PhD. Since then he has written additional volumes, including Mastering the Zone, which I received in the current package of audio tapes (Harper Audio, $25). Dr. Sears gives a very comprehensive nutritional program which is easily put into action. After a discussion of the ill effects of hyperinsulinism, he presents a system of balanced eating so one always remains "in the zone." If you’re "in the zone" of normal insulin levels one should not have postprandial lethargy. The current presentation seems more complete than what I have encountered in the past. He also states that only in America can one go to a gym and find valet parking. He advises that one should park at the most remote regions of a parking lot and walk. He even suggests that we park our cars about 15 minutes from work to provide at least 15 minutes of exercise every morning and every evening. He sees no need to buy exercise equipment or join a gym or pay to exercise. As physicians we have people run in place for a two minute exercise pulse in an eight foot exam room. Americans have a hard time thinking that anything happens unless they spend money. Much of the world feels we have too much of that. I found his system very easy to follow and quite effective.

Eating Well for Optimum Health by Andrew Weil, MD, (Knopf, $25) is a very comprehensive guide to food, diet, and nutrition. As a clinical professor of medicine at the University of Arizona, and director of the Program in Integrative Medicine, he speaks with authority and writes in textbook fashion. However, it is very readable. He presents the basic facts about human nutrition which allows us to make informed decisions about weight reduction. He gives us the pros and cons about a number of diets. He’s seen fad diets come and go and then, sometimes, come again and go again. He gives pointers on how to read labels on food products. He provides menu plans, recipes, and guidance for eating at home or in restaurants. In accord with his previous volumes, he gives dietary advice for a host of common ailments.

Eat More, Weigh Less by Dean Ornish, MD (Harper Paperbacks, $7) is the fourth book by Dr Ornish, an internist and researcher. It has been number one on The New York Times bestseller list and contains a very impressive list of researchers, physicians, angiographers, and faculty at UCSF and affiliated hospitals. Despite a title that fat people love, he makes a good case that conventional wisdom about losing weight is not working – in other words, "Most diets don’t work. Evidence suggests that weight-loss regimes do more harm than good." A front page story in The New York Times states, "A growing number of women are joining in an anti-diet movement. . . to make peace with their body size. . . forming support groups and ceasing to diet." The book is popularly written with a lot of name dropping and cliches that make you feel good. There are a lot of medical facts presented and, from the feedback, you may also lose some weight.

Dr. Atkins’ New Diet Revolution by Robert C. Atkins, MD, (Avon Books, $7.50) is a revision and updated version of the initial diet revolution by Dr Atkins. It also is a best seller with over 6 million copies in print. This is also very popularly written with all the right diet cliches that people who’ve been on numerous diets like to hear. Wouldn’t you rather be on a diet that sets no limit on the amount of food you consume, excludes hunger from the dieting experience, includes rich foods, gives you a metabolic edge, improves your health, and produces steady weight loss? Dr Atkins claims that 90% of his people have such an experience. He reports 15 criticisms of his diet and debunks them, with scientific evidence, as fallacies. He makes it seem that if just the other 150 million people that are overweight would just buy his book, he could cure this epidemic we have in America.

The Ultimate Fit or Fat by Covert Bailey (Houghton Mifflin, $11) is the eighth book by Bailey, sixth with "Fit or Fat" in the title. It too is a best seller with 5 million of his books in print. This is the update of his first book, Fit or Fat which sold 3 million copies in the mid 1970s, and allegedly is his final which he states "pulls together the whole problem of body fat and metabolism. . . gives people the final tools they need to get fit while lowering their fat . . . [and] it should put an end to the diet mania." Actually he gives us a lot of ordinary facts in a different and sometimes humorous vein and in a easily readable format that should appeal to a number of our patients.

Portion Savvy, The 30-day Smart Plan for Eating Well (Pocket Books, $24) was written by Carrie Latt Wiatt, who has a Master’s Degree in nutrition. She is Hollywood’s favorite nutritionist and feels that in 30 days she can inspire you to a healthier and happier body. She says her PS men and women don’t diet–they manage food wisely. She recognizes the struggles that are peculiar to our country since she has an international clientele. People moving here from other countries are amazed at the portions "they serve you here." She wonders if the custom officials should warn people about the overfeeding of America. No country in the world eats as much as we do or struggles with weight problems and nutritional diseases as we do. Recognizing that we are conditioned to over eat in America, she offers guidelines on changing our habits in a very readable and relatable format.

In a recent book (The False Fat Diet by Elson M Haas, MD, and Cameron Stauth, Ballantine Books, $24), Dr Haas, an integrative medicine expert feels he has the revolutionary 21-day program for losing the weight you think is fat. It begins with a "False Fat Week" during which "your puffiness" subsides and you lose 10 pounds. It has a strong allergy emphasis with the incentive from personal and family problems. Dr Haas lives on a farm in Sonoma County.

Hawaii has an epidemic of obese diabetics and diabetic researcher Dr Shintani outlines the first step in changing your life (Hawaii Diet by Terry Shintani, MD, JD, MPH, Pocket Books, $20). He cites medical histories of 425-pound diabetic Hawaiians who were insulin-free after losing 150 pounds. The orientation is a strict three-week program, but eating as much as you like, with an average of a 17-pound weight loss and a 14% drop in cholesterol. The myth that eating doesn’t cause weight gain lives on.

Two books with diets based on Chinese herbs (The Way of Herbs, 4^th edition & The Way of Chinese Herbs by Michael Tierra, OMD, Pocket Books, $14 each) by an herbalist and acupuncturist brings holistic remedies to the diet scene. As a non-physician, he has a large following in the treatment of many disorders that are in tune with America’s love affair with alternative medicine. For instance, in Chinese herbalism, phlegm has two general forms, visible and invisible. Visible phlegm is associated with the upper respiratory system of the lungs, bronchioles and sinuses, and it can be hot (inflamed) or cold. Invisible phlegm can have many serious manifestations, including enlarged thyroid, swollen glands, impaired consciousness, epilepsy, and stroke. That should give you a good idea of some of the things our patients read. Is it too far down the road before they will be demanding herbology consults covered by Medicare, Medicaid, and HMOs?

The Cholesterol Counter, by Annette B Natow, PhD, RD, and Jo-Ann Heslin, MA, RD, (Pocket Books, $7) is now in its fifth edition with 2.5 million copies in print. With only half of Americans knowing their cholesterol level, it focuses on coronary heart disease and other health problems with very practical advice. These two dieticians have published over a dozen books on nutrition, including The Protein Counter, The Sodium Counter, The Fat Counter and others, including pocket editions.

Overcoming Overeating, by Jane R Hirschmann and Carol H Munter, psychotherapists in New York City, (Fawcett/Ballantine, $7) was recently reissued as a promotion. The authors focus on how to overcome the compulsive reach for food, the diet/binge cycle, and the general obsession with food. They try to bring their patients from being controlled by others according to dietary rules and being cured. This involves the understanding that one no longer needs rules for food as one challenges his/her most deeply held convictions by dealing with much more basic psychodynamics.

There are books that relate diet to genetics. One has a diet for each blood type. Another, The Body Code by Jay Cooper, MS in Nutrition, and Kathryn Lance, a freelance writer of more than forty books on fitness, health, diet, and beauty (Pocket Books, $24), describes four genetic types and how to unlock your body code. Cooper draws on 25 years of experience starting when he received a wake-up call from his oncologist giving just a few months to live with his highly metastatic form of testicular cancer. He called this a blessing in disguise. He immediately set about writing this book recording his life work of exercise and balancing foods.

The Dictionary of Sodium, Fats, and Cholesterol by Barbara Kraus (Perigee Books, $13) is now in its second edition listing the amount of the above found in various foods in nearly 400 pages of tables. It is an excellent reference source, either on our desk as we try to figure out where our patients miscalculate or in our kitchens. Maybe even to carry in the shopping cart.

Reading these diet books reminds me of a recent Classic Peanuts strip in which Charlie Brown tells Snoopy that he had just read about a new diet. You can eat all you want, but you can’t swallow. After Snoopy throws the dog dish at Charlie Brown, he awakens from his concussion stating, "It’s no fun being a waiter if you can’t joke with the customers!" Obesity is not a laughing matter with the obese patients (unless you’re in the support group from New York). You better not try to joke with them. Sometimes it’s hard to be serious with them or even bring up the subject of their weight. But then, it is no wonder that people get confused reading diet books. The messages indeed are confusing. I hope this has been helpful. My thanks to all the publishers for having sent them.