Monday, January 15, 2007

Only the data are slim. Part 2.

As we saw last time, internal consistency isn't something that diet authors lose sleep over.

Item
: Though Sugar Busters rails against saturated fats, the book's list of "acceptable" foods variously includes butter, cream, cheese, eggs, milk, lamb and pork.

Item
: In the appendix of his Ultimate Weight Solution, Phil McGraw asserts that a health bar should contain no more than 140 calories. The bars he himself endorsed under the Shape Up! brand contained 210. (As I note in SHAM, writer Gregg Easterbook has convincingly pointed out* that, regardless of what you called it, McGraw's peanut-butter nutrition bar was, in fact, a candy bar.)

Item: Other diet books include recommendations for foods that either don't exist or would be awfully hard to find/quantify in the real world...such as the "lean bacon" that The Carbohydrate Addict's Diet urges its followers to buy.

Even the major health magazines, which generally cover their terrain with greater integrity and attention to detail, devote way too much copy to pandering to their audiences instead of dutifully informing them. This is true throughout mainstream publishing. "Every women's magazine runs cover lines telling readers they can lose weight by just walking," says a former editorial colleague of mine. "Granted, every bit of exercise is a plus. But walking takes so little effort that it's not going to change your body's metabolism in any significant way.** But editors know from surveys that that's what readers want to hear. So every month, at least one of the magazines runs a major feature that combines 'walking' and 'weight loss' in some direct—and thoroughly misleading—way." When the choice is between telling the truth—the whole truth—and losing readers, magazines go the pragmatic route.

One encounters this same mindset ("tell 'em what they wanna hear") at all levels of the weight-loss movement, from its big-picture issues right down to the tight-focus claims of individual players.

Big-picture: The industry persists in hyping the notion of targeted weight loss—"lose those ugly saddlebags by July!"—even though selective slenderizing of body parts has never been demonstrated clinically and is out of conformity with everything we do know about biophysics and nutrition. To be sure, says Quackwatch's Dr. Stephen Barrett, "There is nothing you can ingest, no pill or potion, that will spot-reduce a specific part of the body."

Tight focus: In Enter The Zone, Barry Sears writes, "I believe the hormonal benefits gained from a Zone-favorable diet will be considered the primary treatment for all chronic disease states, with drugs being used as secondary backup." He can believe it all he wants, but it's groundless fantasy, certainly at this juncture in medical science. Meanwhile, The South Beach Diet promises that you won't ever be hungry, despite menus averaging between 1200 and 1500 calories a day (erring towards the lesser number). Did Agatston ask any men?*** This would also be a good time to reiterate what's really going on with diet books as a class: If readers lose weight at all, it's because they're eating a lot less food. And do you really need a diet guru to lay that out for you? (Tellingly, when a Prevention reader of unspecified gender asked Agatston if his/her calorie intake was too low at between 950 and 1200 calories per day, the doctor effused, "It sounds like you are doing great." Though I concede that I lack the clinical research to back me up here, I strongly suspect that a man of normal activity levels could drop a fair amount of weight by consuming 950 calories a day in malt liquor, if that's all he ingested.)

What's more, I can't stress often enough that, while there's scant evidence that these products promote weight loss, they are not benign in their overall health impact. This became clear in the late 1990s when Redux and Fen-Phen, the once widely used appetite suppressants whose chemical formulas made them dieting's answer to
"speed," were banned after causing dozens of deaths due to soaring blood pressure and heart-valve abnormalities.****

Today, we have other "weight-loss aids" with precarious backgrounds:

Conjugated linoleic acid, an element of Dr. Phil's (since repudiated) line of nutraceuticals, does little for dieters but has been linked to liver damage and compromised insulin resistance. Leptin, the protein we mentioned last time around, which is now being positioned as a silver bullet for obesity, may also upset the body’s fragile insulin/sugar balance. Dried fucus vesiculosus extract, a seaweed derivative found in today's hottest anti-cellulite pills, won't help your cellulite, but contains up to twice the U.S. RDA of iodine per pill, posing a danger to people with compromised thyroid function. It also may affect the length, timing and overall predictability of women's menstrual cycles. The plethora of herbal teas that vow to catalyze quick weight loss contain potent laxatives and diuretics that often cause cramping, nausea, diarrhea, light-headedness, and uncomfortable sensations in the arms and legs; and, they play havoc with homeostasis (the body's attempt to maintain a steady state of biological function). As with other products that cause a dramatic water loss, the culprit is acute depletion of potassium reserves and other electrolytes. This can lead
has ledto heart-rhythm disturbances even in young, otherwise healthy people.

And so it ever goes. Untroubled by its shaky scientific foundations and marketing excesses, the soon-to-be-$60 billion weight-loss industry marches on, doing its business with impunity, beset by no apparent qualms about its fanciful claims, and seemingly beyond guilt or shame.

More soon....

* writing in The New Republic, October 2003.
** I should clarify here that the author of the linked article was not my source for this quote.
*** And what about dieters who are simultaneously exercising? A 1200-calorie menu is totally insufficient to supply the needs of a body (male or female) that's also engaged in vigorous physical activity.
**** and still without yielding the weight-loss results one might expect! One major review of data involving Redux users showed an average weight loss of just 3 percent. On a 200-pound man, that would be a rather underwhelming loss of just six pounds.

10 comments:

a/good/lysstener said...

Hey STeve, just wanted to let you know, one reason you don't seem to be getting as many comments could be that when you switched to the new look I noticed my old bookmarks for the blog didn't work anymore, even though the URL was the same. I had to find SHAMblog and bookmark it all over again; in fact I even had to erase my history before my browser would let me go to the new page! I wonder if anyone else has noticed this?

Lou Schuler said...

Great stuff, Steve.

Interestingly, the Zone Diet configuration -- which could be described as a "balanced macronutrient" plan -- has done well in some clinical weight-loss studies. So Sears may have been right about macronutrients, even if he had the wrong reasons why it would work.

Also, regarding calories in weight-loss plans, you're really on to something. You can't simply cut 1,000 or more calories out of your daily routine without suffering serious consequences.

The main one is metabolic -- the lack of food slows down your metabolic rate, you lose lots of muscle mass (along with fat, including visceral fat, which isn't necessarily an awful trade-off), and it becomes harder to maintain your new, lower weight.

For women, very-low-calorie diets are not only a metabolic train wreck, they're a hormonal horrorshow. With lower levels of estrogen and thyroid hormone, not only are women increasing their risk for osteoporosis, they're suffering the consequences of inadequate thyroid function, and all that implies.

This gets back to a point you've made in other posts: When medical doctors push diet plans, they're almost never doctors who actually specialize in weight loss or endocrinology.

Anonymous said...

I tried a 1200-calorie diet plan this fall, and was astounded by how little food 1200 calories adds up to. Given that most diets these days also insist that you eat "mini-meals" throughout the day, this basically means that you're condemned to a handful of low-fat food every two hours. If you don't know how that feels, I'd suggest that you try it. Ugh! I wish all those so-called "diet doctors" who blithely recommend these diets had to actually eat them themselves.

Anonymous said...

Steve, all due respect this is all old news to those who tried to diet and lose weight.

What is your solution?

As an aside the most success I ever had was on the phen/fen drugs, no heart damage and I did lose 60 pounds.

I feel the data on Redux may have been skewed by those who only wanting to lose 10 pounds getting the drug as it became popular and managing to get it easily.

Steve Salerno said...

Thanks for weighing in, Lou. For those who are unfamiliar with the name, Lou Schuler is a respected strength-and-conditioining coach--with appropriate certification of same--and author of several very successful books on fitness. His web site, unsurprisingly, is www.louschuler.com.

As for the comment about Sears "accidentally" getting it right, it's important to realize that I was criticizing Sears more for his hubris than for his diet plan, which may indeed--as Schuler suggests--turn out to provide some long-term benefit for weight management. But when Sears decides that positioning his diet as a diet isn't enough--i.e., when he presents it as the be-all-and-end-all solution to every physical ailment known to man--that's when I think we need to leave the zone, pronto. It's absurd to make such a statement, given the relative paucity of information on the topic and the many diseases whose true origins remain as-yet unknown to us.

Rodger said...

This is more for Lou, but for everyone else too...

At IU I was more active, and a fitness expert told me once that diet isn't as important as keeping active. Let me qualify that as he did.

It's okay to eat New York-style cheese cake (my personal favorite) if you're willing to exercise and balance your diet with healtier foods. He also said that eliminating soft drinks and fast food from your diet is good too.

On the subject of The Zone -- a friend of mine and I tried that diet to increase our energy levels during workouts in college. It worked pretty well.

Anonymous said...

Steve, first of all the guy who climbed all over you about the race thing in your memorial to Brecker is a wacko and an example of everyhting that's wrong with this country today. I'm a little surprised he didn't accuse you of dishonoring MLK by bringing this up today. I don't follow jazz as closely as you do obviously, but I know enough to know that Brecker was a heavy hitter.
But I do have a bone to pick with you myself about weight loss. As someone who's battled his waistline for many years I don't see how you can blame people for trying something new when the things they tried before didn't work! That almost sounds like you're against progress. So are we supposed to just keep trying the same old things and reject something new just because it's new?
-Carl

acd said...

Carl, I don't think Steve is critical of these weight loss methods just because they're new. The problem is that people use these methods just because they're new. That is the attraction. There is always that hope that the next new thing will be the perfect solution. However, only the beneficial properties are advertised (and even these claims may be false). The potential negative effects are either unknown or not revealed until later. Whether it is a diet plan or some herbal supplement, it needs to be tested long-term to see the true effects, both good and bad, before people commit to it. Otherwise, they can end up doing serious harm to themselves.

And if maintaining a healthy lifestyle--that is, eating less and exercising more--is what you mean by "the same old things," then yes, by all means, I would encourage you to keep trying that. It is a concept that may not be new and may not be easy, but at least it has been proven to help people lead healthier lives.

Steve Salerno said...

That nicely covers it, acd. I would only add that every time I do a call-in show, and we get into the topic of alternative medicine, somebody says some version of the following: "Hey, look at all the people who have been damaged by so-called legitimate drugs. Look at the drugs that have had to be taken off the market, even though they were rigorously tested for years. What do you say to that??" What I say to that is: Nobody's perfect. Every once in a while, a bad drug will sneak through, either because of some fluke results in the formal testing, or some after-effects (or idiosyncratic reaction) that no one could've predicted, or--and I truly believe this is the extreme exception--because of hanky-panky on the part of the drug companies. Yes, what happened in the case of Vioxx sounds unforgivable; it appears that people covered things up with tragic results, and there is no excusing that. Period. But all available evidence suggests that such events are rare. For the most part, the drug approval process is long and painstaking; if anything, it has been attacked (notably by AIDS activists) for precisely that: for being TOO cautious.

So. Would you really rather take your chances with some obscure herbal potion that's distributed from a post-office box in the Ukraine, and whose actual ingredients are a mystery to everyone but the person or persons selling it?

Anonymous said...

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