Low Carb Diets Increase in Popularity
More than one half of all people trying to lose weight in America have adopted a low carbohydrate intake. Low carbohydrate diets were once shunned by the conventional medical community. In fact, these diets were vilified by some physicians and national bodies of medical opinion. This situation has changed radically, as there is increasing recognition of the role of the dietary intake of simple sugars in the precipitation of weight gain and its associated problems. Refined carbohydrates are pivotal in the cause of the modern epidemics of the metabolic Syndrome X and Type 2 diabetes mellitus, but they are not the whole story.
The most popular, contemporary low carbohydrate diet was described by Dr. Robert C. Atkins, MD, but his initial dietary recommendations were selfmodified over a period of 30 years. Dr. Atkins' Diet was joined in recent years by other popular "low or lower carb diets," including but not limited to: "The Zone," "Carbohydrate Addict's Diet," "Sugar Busters Diet" and "The South Beach Diet."
Which Low Carb Diet Is Best?
Dr. Atkins has to be revered as the modern proponent of low carb diets. That said, carbohydrate restriction in the diet was recommended in England as long ago as 1860 by Mr. William Banting, a coffin maker to the Duke of Wellington. While arguments prevail that one low carb diet is "better" than the other, there is no real evidence that such differences exist. Certainly, recent studies published in the New England Journal of Medicine in 2003 served as a "wake-up call" for conventional medicine, when the Atkins' Diet was shown to be effective and reasonably healthy, at least in the short term.
Contrary to popular belief, recent scientific studies did not openly endorse the Atkins Diet. Weight regain with the Atkins Diet was noted to occur at six or 12 months or so in most people a "yo-yo effect In fact every diet
described in the history of weight management has suffered from a lack of effectiveness for long-term weight control. These circumstances lead to the rational proposal that modifications can be made to low carb diets that may make them more effective in the longer term. Of course, an important emerging issue is the need for weight control to be part of a global health initiative. There is a need to examine ways of enhancing all low carb diets and the "ideal carbohydrate-restricted diet" remains a matter of debate.
Obesity or Overweight Status: A Major Public Health Initiative
Many people are tired of being told that they are overweight and sedentary, but any complacency about weight gain must be dismissed. Modern medicine has shown us the serious increase in disability and death due to weight gain. The Office of the Surgeon General of the United States has made several "calls" to engage initiatives to prevent obesity and an overweight status. These proclamations culminated in the U.S. Surgeon General's Report in 2001, where Americans were told that more than 60% of adult U.S. citizens were overweight. Recent statistics and trends are even more alarming, especially in children. Some soothsayers tell us that by the year 2050, almost every American will become overweight, if the
occurrence of obesity increases at its current level. Perhaps we have tended to focus on the cosmetic aspects of obesity which may precipitate a degree of embarrassment or shame for some people. These are not constructive thoughts. The real significance of obesity to Western nations and some Third World countries is the occurrence of many obesityrelated diseases together with associated, mounting death rates. Most people are aware of the pandemic of weight gain in Western society, but fewer appreciate that obesity has gone "global." As many as 1.7 billion people worldwide may be overweight. According to the World Health Organization, lesser degrees of being overweight are associated with illness and death in Third World Countries. Perhaps one can see the emergence of American "nutritional colonialism" that contributes to the global epidemic of obesity.
Diets Are Not "Stand Alone" Interventions for Many People
Obesity does not usually present itself as a "single" medical problem, requiring focused management. Low carb diets are certainly effective for short term weight loss in people wishing to lose 5 or 10 pounds of body weight, but this initiative is not relevant to the elimination of the disability and premature death that results from obesity. National registers that keep information on people who have lost weight in a sustained manner imply that weight control occurred by means other than diet alone. Successful dieters undertook modification of eating behavior, positive lifestyle change and exercise. In other words, few people can achieve sustained weight loss by diet alone.
An Overall Healthy Weight Control Initiative
"Diets" cannot be eliminated as one of several important components of weight management. The metabolic status of tens of millions of Americans with Syndrome X favors the selection of carbohydrate restricted diets. A combat against the modern pandemic of obesity must involve positive lifestyle change with increased levels of exercise and modification of eating behavior, including but not limited to a selection of smaller meal-portion sizes. In other words, a diet with an altered ratio of macronutrient intake (e.g. a low carb diet or Atkins Diet) and the consumption of "low carb food" is just not enough to control weight, with any degree of consistency. However, there are many excellent low carb foods which are valuable in structuring a low carb diet.
Excess dietary intake of simple sugars, together with lack of physical exercise and poor lifestyle contribute to poor function of insulin. This provides a powerful incentive to adopt a diet that is controlled in its simple carbohydrate content (a low carb diet). However, low carb diets have not been shown to correct "insulin resistance," per se, but they are a step in the right direction.
Enhancing the effects of a low carb diet, such as the Atkins' Diet, must involve extended effort to combat or correct insulin resistance that is present in most, but not all,
overweight people. The current absence of a safe and universally effective pharmaceutical approach to combat insulin resistance and its principal associated diseases (high blood cholesterol, high blood pressure, etc.), together with side effect profiles of drugs, makes dietary supplement and "functional food" interventions "first line options" in the fight against obesity and its disease companions.
Overweight: Many Causes Requiring Multiple Interventions
The overweight status of Western nations is due to multifactorial causes that require multi-pronged interventions (See Table 2). A complete lifestyle and metabolic approach is required to address the most serious public health initiatives that threaten the future health of Western nations.
When Not to Use Low Carb Diets
Low carb diets are not indicated in the serious aerobic enthusiast. The primary fuel for all body movement is glucose. With exercise, stores of carbohydrates (glycogen) in muscles and the liver are used rapidly and carbohydrate is necessary to maintain the level of these body stores of readily utilizable fuel. The loss of glycogen from muscles is a big problem with routine exercise because this depletion will reduce physical performance and can cause premature fatigue. Potential interference between low carb diets and exercise is a key issue to overcome; and it makes recommendations for obligatory exercise with a low carb diet difficult for some people. Low carb diets are not recommended during pregnancy or in some people with certain diseases that can be aggravated by changes in macronutrient intake in their diet (e.g. excessive protein intake in people with gout).
TABLE 2 |
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| The most common form of obesity is "simple obesity," which is a lifestyle disorder. Insulin resistance is capitalized because it is a much more important and common cause of obesity than previously supposed. | |
Recognized Causes |
Medical Causes |
| Social gluttons (USA) | Drugs |
| Family predispositions | Surgery |
| Genetic obesity | Brain Disease |
| Diet composition | Endocrine causes |
| Eating patterns | Abnormal metabolism |
| Emotional factors | INSULIN RESISTANCE EXCESS |
Insulin and Blood Glucose
Insulin is known to push glucose into tissues of the body, where it is used as fuel for life. Insulin resistance occurs when the body does not take the command of insulin. When insulin resistance is present, the body reacts by making more insulin and so insulin levels become high in the blood. Insulin resistance is the underlying problem that generates the combination of problems found in the condition called the Metabolic Syndrome X. While all of us recognize the ability of insulin to help the body handle glucose, it is not quite as apparent to many individuals that insulin in excess can give signals to body organs to make them function in a negative manner for health.
Combating Insulin Resistance: A Key to Health
Understanding the role of insulin resistance in the development of disease within the "obesity diathesis" is a prerequisite for the understanding of my proposals. One can see how a low carb diet is a step in the right direction and how such diets may need to be modified to become more effective in their desired outcomes of weight loss and health promotion. Furthermore, it underlies my proposals that low carb diets can be changed to overcome insulin resistance that is not tackled effectively by a low carb diet alone. A reversal of insulin resistance benefits the management of weight gain and obesity-related diseases. Combatting insulin restistance help weight control.
Calorie Control Is Important
Many physicians are accepting the notion that there are "carbohydrate-sensitive individuals" who gain weight easily when sugar is a major component of their diet. This sugar sensitivity has started to make physicians and scientists rethink the simple idea or equation of "energy in and energy out" of the body. However, this is not an infallible equation that governs weight control.
Energy is taken into the body in the form of calories delivered by food. This energy is utilized by the body for day-to-day living and to support physical activity. However, this equation of "energy in and energy out" (the law of thermodynamics) does not fit perfectly with weight control tactics in humans. There are some people who can consume large amounts of energy (calories in food) and not gain weight, even though their level of exercise is not particularly high. That said, calorie control is generally a very important aspect of weight control and anyone who proposes that "calories do not count" is seriously misguided
Obesity, Syndrome X, Pre-Diabetes and Type 2 Diabetes
Before one starts to assess the overall negative effects of obesity and its related disorders, one must understand the relationship between obesity and the modern epidemics of Metabolic Syndrome X and Type 2 diabetes mellitus. There are 70 million Americans who have a condition called the Metabolic Syndrome or Syndrome X (Figure 1). Syndrome X requires careful definition and description, if the real advantages of carbohydrate restriction in the diet can be fully appreciated. Syndrome X is a combination of factors which are almost invariably associated with an overweight status. The simplest definition of Syndrome X is the variable combination of obesity, high blood pressure and high blood cholesterol, all linked by resistance to the hormone insulin (See Figure 1).
TABLE 1 |
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| Illness definitely associated with being overweight. Risks for these diseases tend to increase by degrees of obesity. Overlap of disease risk exists in the spectrum of being overweight ("degreess of fatness"), and the first four factors in the high risk column constitute the definition of Syndrome X. | ||
High Risk |
Moderate Risk |
Lower Risk |
| Diabetes mellitus | Heart Disease | Cancer of womb, breast, colon |
| Insulin Resistance | Periferal vascular disease | Hormonal disorders: especially sex hormones |
| Hypertension | Stroke | Infertility |
| High Blood Fats | Arthritus, osteoporosis, gout | Congenital defects in children of obese mothers |
| Gallstones | Polysystic Ovary Syndrome | Increased Accident Rates |
| Sleep Apnea | Low Back Pain | Depression |
| Decreases aerobic fitness potential | Fibromyalgia, medical risk in surgery | Social isolation |