While diet docs debate fats and carbs, weight loss still comes down to calories
By Linda Kulman
No food group was left unscathed last week when the authors of some of the nation's bestselling diet books squared off in Washington. At stake in "the great nutrition debate," sponsored by the Department of Agriculture, was who has divined the easy road to salvation for the nation's overweight masses. "We are in an era now where millions and millions of Americans are personally fascinated by diet and nutrition and they get a lot of conflicting information," says Agriculture Secretary Dan Glickman. "In fact, some of it is absolutely contradictory." Amen.
The battle lines were drawn between cardiologist Robert Atkins, whose high-protein, high-fat, low-carb plan is laid out in Dr. Atkins' New Diet Revolution, and internist Dean Ornish, author of five books including Eat More, Weigh Less, which outlines a spartan low-fat regime. They were joined by other diet gurus du jour who fall variously along the protein/carbohydrate spectrum, including biochemist Barry Sears, coauthor of The Zone, and cardiac surgeon Morrison Bethea, one of a passel of Sugar Busters! authors.
But for all the talk of insulin secretion and lipid profiles, nutritionists agree that no miracle was revealed. While Atkins and Ornish claim their strategies enable you to lose weight while eating more than traditional diets allow, nutritionists say both diets work in the time-tested manner: by cutting calories. "People need to find the diet that works for them," says Ronald Ruden, a New York internist. "Every single one of these practititioners is incorrect in thinking their diet is for everybody."
Atkins is often characterized as the most severe of the high-protein/low-carb school, and he does go whole hog, recommending dishes high in saturated fat like bacon and eggs, cheeseburgers, and rack of lamb. But it's the virtual absence of carbohydrates that creates what he calls "a metabolic advantage," enabling his followers to eat their fill yet strip away more pounds and fat. After two carbless days, insulin deprivation throws the body into a state called ketosis, he says, drawing on fat stores as fuel. "Ketosis is one of life's charmed gifts," Atkins writes. "It's as delightful as sex and sunshine"–although Atkins himself acknowledges it can cause bad breath.
Sears and the Sugar Busters! folks can be considered Atkins Lite. Sure, their meat is leaner and their lists of acceptable carbs longer. But they also tout some version of the idea that more carbohydrates produce more insulin, and it's the insulin, not the calories, that makes people fat. Opponents say, however, that while insulin levels are higher in obese people, it isn't the insulin that makes you fat. "Insulin is not the key to everything," Dean Ornish says, and other nutrition experts agree.
His diet reduces fat to a minuscule 10 percent or less, compared with 34 percent in the average American diet. Ornish's devotees are told to savor fruits, grains, and vegetables, while eschewing fish, meat, alcohol, and olive oil. Opponents say there's little inherently wrong with his regimen, which also includes other "life choice" changes like exercise and meditation. It's just that it is so rigorous few can make it stick.
The good news is that all the diets work for the short term. "They all do it the same way. They all cut calories. That is the only way anyone is ever going to lose weight," says Keith-Thomas Ayoob, a nutritionist with the Albert Einstein College of Medicine in New York, who participated in the debate. For all the bacon, a typical Atkins day amasses only 1,400 to 1,500 calories. It's hard to make up in steak what you gave up in baked potatoes.
Forever thin? How well either philosophy holds up in the long term is less clear. Ornish has published studies showing that his diet reverses heart disease–if dieters hew to the regimen. The Atkins diet, on the other hand, strikes some nutritionists as downright unhealthy. "The diet's only salvation is that people can't tolerate it for very long–not long enough for the increase in the risk of heart disease or cancer that long-term use of such a diet could bring," write Brown University professors Kevin Vigilante and Mary Flynn in Low-Fat Lies High-Fat Frauds. Atkins dismisses speculation about adverse health effects. "There's not a scintilla of evidence," he says.
The most practical tidbit–to eat what you like but to eat less–came from Ayoob. Of the nearly 3,000 people in the National Weight Control Registry, which lists people who lost at least 30 pounds and kept it off for at least a year, most followed a traditional low-calorie, low-fat diet. Limit portion size to what fits on the bottom of a dinner plate, recommends Sugar Busters! author Bethea. And, as one of the presenters reminded the audience, "Remember the pleasures of eating."