Multitude of diets offer endless choices

Researchers in Thailand recently studied a low-calorie diet that purports to lower glucose levels in adults with obesity and diabetes.

Participants, according to findings published in the Journal of Diabetes Investigation, limited caloric intake for either two days or four days per week.

Reportedly, up to 30% of participants achieved “diabetes remission without the need for diabetes medication,” after 20 weeks in the trial.

Participants in this study followed a “very-low-calorie diet” consisting of only 600 kcal per day for 10 days as a “run-in period” before being randomized to continue the same restrictions for two days a week, or four days a week.

I am surprised that the four-day group did not stage an armed revolt, as they endured near starvation.

The only successful weight loss strategy, according to dieticians I know, is to alter one’s lifestyle. That includes portion control and increasing exercise.

Because that is difficult, physicians are remarkably unsuccessful in fostering long-term weight loss. Bariatric procedures, such as stomach banding or bypass surgery, may be helpful in some cases.

Beware of fad diets that promise extreme weight loss. They often rely upon eating single food groups, purchasing replacement products, fasting and other interventions purported to cause “detoxification.”

Some so-called “food-specific” diets that have achieved attention include the carnivore diet, the Paleolithic diet, macrobiotic diet, grapefruit diet, and the egg and wine diet, which sounds to me somewhat reminiscent of a champagne brunch.

Diets that are low in carbohydrates and high in fat include the Atkins diet, ketogenic diet, Scarsdale medical diet, South Beach diet, and Drinking Man’s Diet.

Perhaps there is nothing new under the sun. William the Conqueror attempted an alcohol-only diet after conquering England in 1066. The monarch died in a horse-riding accident but reportedly slimmed down before his demise.

Do you prefer a high-carbohydrate, low-fat diet? Dean Ornish’s diet approach purports to potentially reverse coronary artery disease when combined with stress reduction, exercise and lifestyle modification.

The Atkins diet is similar. Liquid food supplements, like Slim Fast, do not seem to address long-term lifestyle modification.

There are many vegetarian diets, including a strict vegan diet, lacto-vegetarianism (dairy is allowed), pescetarianism (eating fish), pollotarianism (eating chicken), and a plant-based diet with minimal meat consumption. Avoiding deficiencies of essential amino acids, iron and other nutrients may be challenging.

Diets free of “nightshade” plants (such as tomatoes) have been advocated for the prevention of arthritis, with anecdotal supporting evidence.

A low-purine diet does help prevent gout attacks. Patients on dialysis require a special diet. Gluten-free diets may be helpful for some gastrointestinal disorders.

Dietary advice, it appears, should be individually tailored.

Human beings, on the other hand, can survive eating a wide panoply of foodstuffs. The Inuit diet, for example, is historically based on meat and fish.

The Mediterranean Diet, by contrast, reflects a proclivity to consume olive oil, accompanied by wine, fish and grains. The Japanese diet, high in fish and lower in meat, seems to correlate with superb longevity.

Human dietary flexibility probably allowed our species to thrive in all habitats, from arctic to tropical. The idea of an “ideal” diet, therefore, may represent a mirage.

Consider, by contrast, the koala, a marsupial native to Australia. Koalas survive largely by eating eucalyptus leaves. They find themselves, therefore, in an evolutionary bottleneck, dependent on a single low-energy food source.

The question of what constitutes a “healthy” diet also varies based on religion, philosophical beliefs and even political outlook. These considerations deserve respect and recognition.

Moreover, a comprehensive approach to health maintenance requires considering your specific medical history, as noted above. Meeting with a dietician can be helpful for addressing specific concerns. This column is offered solely as food for thought.

Scott T. Anderson, M.D. ([email protected]), is a clinical professor at the University of California, Davis Medical School. This column is informational and does not constitute medical advice.

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