BY LENORE S. HODGES
T WORKED FOR ME! IT WAS JUST WONDERful, and I feel so much
better. If it worked for me, I'm sure it will work for you! You've been looking
a little tired lately. My supplement will help you have more energy—and
lose weight at the same time!"
We all know persons who almost sound believable as they perpetuate
their brand of snake oil or cure-all tonics. We're caught by their energy, their
enthusiasm, the promises, the so-called spectacular results. But if they were
required to testify under oath about the product they are pitching, would we
hear the same things? Or would the requirement of the "whole truth and
nothing but the truth" dramatically change the contours of their story?
We've all learned that we have to differentiate between salesmanship
and science, between those with such skill that they could probably sell microwave
ovens to sushi restaurants and sober-minded researchers who have nothing but
the public good in view. In no area is this need to differentiate more apparent
than in the conflicting claims of salespersons and science about healthy diets
and weight loss products.
Great Hope or Great Joke?
How does a modern consumer, bombarded with dozens of messages every day about
food and weight and lifestyle, know whom or what to trust? Should we place our
faith in testimonials offered by people who seem much like ourselves, or in
evidence-based medicine? How can we know which food and diet claims are true,
and which are simply modern snake oil? In societies where there is freedom of
speech and freedom of the press, persons can say or write anything they want
to—make any claim, however irresponsible—and it doesn't have to be
the truth. The freedom to hear all points of view assumes that we are responsible
enough to sort out the conflicting claims and make good decisions about matters
that affect us.
Many wonder why the medical profession is concerned about the
misinformation that abounds, and why it spends so much time and energy debunking
specious claims. It speaks out because it knows that misinformation can have
harmful effects on the health and economic status of consumers. If it remains
quiet, the "quacks" will woo the public to hand over $30 billion a
year in weight loss products and services—a sum that doesn't even include
the money spent on other nutritional products.
The truth, as always, is simple: If the amount of money spent
on scientifically unproven diets and supplements were spent on evidence-based
medical programs or for counseling from licensed physicians, dietitians, and
nurses, the overall health of the population might be significantly improved.
Somehow we have missed the point: We are willing to pay big prices for unscientific
products and spurious information, but we want free health care from licensed
professionals.
If not all nutrition information is accurate or trustworthy,
how can we differentiate between evidence and hype? In general, nutrition facts—conclusions
developed from research by reputable professionals—result from the application
of the scientific method and can withstand replication and peer review. This
is called evidence-based medicine. Misinformation consists of erroneous
statements—formulated with or without malicious intent—or misinterpretations
of food and nutrition science.1 Misinformation frequently
leads to food faddism, quackery, or health fraud, which may be harmful to the
body and the bank account.
Evaluating the Source2
In general, believe the information if it comes from:
The American Dietetic Association
The American Institute of Nutrition
The American Society for Clinical Nutrition
The U.S. Department of Agriculture and the Food and Drug Administration
State departments of health
University nutrition departments
Nutrition sections of the following scientific groups:
The American Diabetes Association
The American Medical Association
The American Public Health Association
The American Association of Family and Consumer Sciences (until 1994, known
as the American Home Economics Association)
Individuals who have an academically recognized degree in nutrition and dietetics,
such as registered dietitians.
Be wary of advice from:
Someone with something to sell, such as doorbell "doctors" or Internet
advertising
One posing under an authority title (doctor, professor, nutritionist, biochemist)
A person who is a professional in another field, but not nutrition.
A well-meaning but uninformed friend (who may be sincere, but sincerely wrong)
Popular books on nutrition (often a mixture of good science and misinformation)
Evaluating the Information3
Even if it is supported by numerous testimonials, don't believe information
that:
Guarantees a quick fix or exuberant, vital health and youth
forever
Blames all diseases and ill health on poor nutrition.
Urges that depleted soil or overprocessing has greatly diminished food quality
Recommends one food extract or several pills that will make you whole
Allows you to eat anything, and yet claims you can lose lots of weight quickly
Offers glaring misinformation, such as saying that almonds give you as much
calcium as milk
Claims that honey is healthful, but that sugar is poison and causes hyperactivity
What about Alternative Medicine?
A recent editorial in one of the most respected medical journals in the United
States offered this succinct discussion of the methodological problems of alternative
medicine:
"Under the rules of science, people who make the claims,
bear the burden of proof. It is their responsibility to conduct suitable studies
and report them in sufficient detail to permit evaluation and confirmation by
others. Instead of subjecting their work to scientific standards, promoters
of questionable 'alternatives' would like to change the rules by which they
are judged and regulated.
"'Alternative' promoters may give lip service to these
standards. However, they regard personal experience, subjective judgment, and
emotional satisfaction as preferable to objectivity and hard evidence. Instead
of conducting scientific studies, they use anecdotes and testimonials to promote
their practices and political maneuvering to keep regulatory agencies at bay."4
Many nutrition topics could be chosen to give examples of misinformation:
examples abound on every newsstand. But since obesity has become an epidemic
in the U.S., and more than $30 billion is spent annually on trying to lose weight,
it seems appropriate to review a few of the current diets in the context of
the criteria identified above.
"Quick fix" ads—those that offer instant or at
least rapid resolution of complex, long-term problems—are very appealing
to stressed, overweight persons. Our media is saturated with ads for diet pills,
vitamin supplements, Hollywood juices, and miracle potions. The social pressure
to be thin is contradicted by the easy availability of greasy fast food on every
corner. How is a person struggling with weight loss issues supposed to differentiate
between what is healthy or unhealthy? 5
Every few years since the early 1950s, someone has written a
book that preaches carbohydrate bashing. Even though nearly 50 years have passed
since the first of these appeared, we still have not seen hard scientific research
that supports this theory. There are actually more studies regarding the relationship
of animal fat to cancer than there are of carbohydrates causing weight gain.
1. The high-protein/fat, low-carbohydrate diet, marketed
as the Atkins Diet, the South Beach Diet, etc. This currently popular weight
loss approach is appealing to many people because they may eat as much fat and
protein as they like as long as they eat very few carbohydrates. The Atkins
diet works in weight loss because it reduces caloric intake, and the high-fat,
low-carbohydrate (low carb) diet causes a condition called ketosis, which
is an increased production of blood ketones that suppress hunger. Dieters never
go hungry nor deprive themselves, while the weight comes off, often at a rapid
pace. The diet is very low, however, in a number of basic nutrients, such as
calcium.
Maintaining a no-carb lifestyle is proving difficult for the
millions who have adopted some version of this diet during the past two years.
As long as one stays on the program, weight loss will occur, and the pounds
will stay off. But if the goal weight is reached and the dieter decides to indulge
in pizza, bread, or any other carbohydrates, the weight will be gained back.
2. The Sugar Busters Diet. This weight loss approach
has been advanced by H. Leighton Steward, and claims that sugar is the cause
of excessive weight because it increases the level of insulin in the body and
increases the likelihood of food being stored as fat. In this theory foods that
rank high on their glycemic index (the measure of how rapidly food appears in
the blood as glucose) should be avoided, such as white bread, pasta, and low-fiber
carbohydrates. This diet is also low in a variety of nutrients, including calcium.
There is no scientific evidence that high insulin levels cause
a person to store excess fat. But there is plenty of evidence showing that high
insulin levels cause heart disease. Carbohydrate consumption causes only a temporary
increase in insulin levels, which the body deals with easily. Obesity is not
a simple issue, and insulin is not the cause.
3. The Zone Diet, also known as the 40-30-30 Diet. Popularized
by Barry Sears, this diet is based on hormones, not calories. It claims that
most people are insulin resistant and carbohydrates have an effect on hormones
and insulin levels. Like the Atkins Diet and Sugar Busters, the Zone Diet claims
that the existence of excessive carbohydrates causes fat storage because it
creates bad eicosanoids. This diet also does not emphasize the use of calcium
foods to protect the body.
4. The vegetarian diet. The vegetarian diet has been
used for many centuries. In general, the lacto-ovovegetarian diet is balanced
and contains not only fiber, vitamins, and minerals but also the newly discovered
phytochemicals (fighter chemicals). These phytochemicals are found in unrefined
plant foods. Some of the well-known phytochemicals are carotenes, lycopenes,
isoflavones, and flavonoids. It appears that there are more than 7,000 of these
chemicals, and that they work in synergy. It's not possible, therefore, to extract
them and pack them in a pill. As antioxidants and pathway modulators, they assist
in protecting us from the long-term deteriorating diseases. They are stable
in foods, and so may be eaten fresh, frozen, canned, pureed, juiced, or dried.6
No discussion of weight loss or dieting would be complete without
noting the important role that exercise or activity plays in a successful weight
loss program. It is not only that exercise uses many calories, but that it also
helps to tighten muscles as we lose weight. The American Dietetic Association
reminds dieters that establishing and continuing an exercise routine after reaching
the goal weight is a marker of whether they will retain weight loss. The retention
of the weight loss is the most important goal. After all that work to get the
weight off, we certainly don't want to gain it back.
Conclusion
According to research, there is no one best diet for everyone. The main goal
is to eat fewer calories than we use, and that may be accomplished in a number
of ways. The best diet will be the one that allows us to get all of the nutrients
needed in the food that we eat, and the most balanced approaches are ones built
on the Healthy Eating Pyramid or ones that have a calorie pattern used by a
person who has diabetes. Good, solid, scientifically verifiable evidence still
points to a carefully chosen vegetarian diet as providing many of the natural
nutrients we need and the variety of kinds of food we crave.
_________________________
1 This is the position of the American Dietetic Association,
"Food and Nutrition Misinformation."
2 This list and the following one, "Evaluating the Information," are
drawn from About Nutrition, by the Seventh-day Adventist Dietetic Association
(Hagerstown, Md.: Review and Herald Publishing Assn., 1986), pp. 138-140.
3 Ibid., p. 137.
4 Editorial, New England Journal of Medicine, 2004.
5 A great source for evaluating fad diets is found at www.chasefreedom.com.
6 The Food and Nutrition Information Center (FNIC) at the National Agricultural
Library (NAL), www.nal.usda.gov/fnic/etext/000031.html.
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Lenore S. Hodges, Ph.D., L.D., R.D., is retired from Florida Hospital, Orlando,
Florida.
