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—page 11— JANUARY/FEBRUARY 2004 VOLUME 31 / NUMBER 1 —page 13— CENTER FOR SCIENCE IN THE PUBLIC INTEREST $2.50

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HEALTH LETTER

By Bonnie Liebman

nd then there were three. For years, Dr. Atkins’ New Diet Revolution Ahas dominated best-seller lists. But by last November, Atkins had company. Dr. Phil’s The Ultimate Weight Solution had cracked the top ten. And The South Beach Diet sat comfortably at number one. Where it should be.

South Beach isn’t perfect. Its rationale has some flaws. And just because people buy a self-help book, you can’t assume that they’ll follow its advice (or we’d all be trim, sculpted, happily married, wealthy, and living a purpose-driven life).

But for the first time in a long time, one of the most popular weight-loss books is recommending a healthy diet. Whether it helps those unwanted pounds disappear any better than other

Design: Barbara Quinn. Illustrations: Loel Barr. diets is another question.

(Continued on (Continued on page 3) page 3) Illustration: Annie Gusman. COVER STORY

fter all these slower is better.” How years, pub- do you know which lishers know foods are which? what sells. “In the early 1980s, And, with a few excep- Dr. David Jenkins led a tions, what’s selling now team of Canadian are books about “good researchers who carbs.” devised a scale to mea- Books like The South sure the rapidity and Beach Diet, The Zone, and degree with which a Good Carbs, Bad Carbs fixed quantity of food argue that “bad” carbs increases your blood are making us . Even sugar,” writes South the Atkins diet, which Beach author Arthur has urged dieters to limit Agatston. “They called all carbs since the 1970s, it the .” has modeled its recent In fact, the index is advice (especially for much more compli- Phase 2) after the “good- cated than most books carb” books. In a nut- pretend. shell, here’s what they “People think that a claim: food has a definitive glycemic index, but it 1. Bad carbs cause a quick “Lose weight! Increase energy! Look great! This book will depends on how the rise in blood sugar. ...show you how to change your life once and for all.” food is processed, 2. High blood sugar raises stored, ripened, cut, blood insulin levels. “I’m not exaggerating when I say that this diet can, as a fringe and cooked,” says 3. Insulin leads to weight benefit, save your life.” Xavier Pi-Sunyer, an gain (either by making “...learn to live a healthier, expert at Columbia University the body store fat or by fuller life from this point forward.” lowering blood sugar lev- College of Physicians els so much that it causes and Surgeons in New Guess which of those promises come from which of the three top-sell- hunger). York. ing diet books, Dr. Atkins’ New Diet Revolution, The South Beach Diet, Furthermore, diet The solution? Simple, say and Dr. Phil’s The Ultimate Weight Solution. (Answer: they’re in order.) books imply that the books. All dieters have Most diet books follow a formula. Amid the dispelled myths, tips, and “good” carbs like to do is eat “good” carbs whole grains have a (like whole grains, vegeta- personal success stories, nearly all promise that: low glycemic index bles, and beans) instead of ■ it’s not a diet but a way of life, (GI, for short), while “bad” carbs (like sugar, ■ the food is delicious and you won’t be hungry, “bad” carbs like sugars, white , and pota- ■ you’re overweight because you ate the wrong (not too much) food, white flour, and other toes). ■ you’ll lose weight because you’ll eat the right (not less) food, and refined grains have a Yet most obesity ex- ■ high GI. In fact: perts, including those who the diet will prevent either the major—or virtually all—diseases. believe in that advice, If you believe all that, we’ve got some old Enron stock for you. ■ Bread is typically agree that the research high-GI, whether cupboard is bare. “It’s whole-wheat or white, amazing how few good studies have Glycemic Confusion because it’s made from finely ground looked at how different flour. affect ,” says Walter Willett, The South Beach Diet calls them “slow ■ is low-GI, whether whole- chair of the nutrition department at sugar” and “fast sugar.” To Good Carbs, wheat or white, but there are varia- the Harvard School of Public Health. Bad Carbs, they’re “tricklers” and tions. “Thin linguine has a higher GI “So far, the long-term evidence on “gushers.” than thick linguine,” notes Pi-Sunyer. weight loss is meager. We need bigger But the message is the same: “As far “How would we advise the public and longer randomized trials.” as obesity is concerned,” says South about this major difference?” Photo: Nick Waring. Beach, “fast sugar is worse for you; ››››

NUTRITION ACTION HEALTHLETTER ■ JANUARY/FEBRUARY 2004 3 COVER STORY

■ ranges from high-GI (instant the Atkins’ white) to low-GI (Uncle Ben’s con- verted white), with brown and long- grain white rice in the middle. “Are low-evidence we going to specify for the public which kind of rice they should eat revolution and which kind they shouldn’t?” asks Pi-Sunyer. ■ obert Atkins died last spring after falling on the icy Sugars range from high-GI (glucose) to low-GI (fructose). Sucrose (table rpavement outside his New York City office. A few sugar) is smack in the middle. What’s months later, his clinic closed its doors for good. more, “researchers have found no rela- tion between the sugar content of But his work lives on, not only in the diet books that continue to sell like hot- foods and their glycemic index,” says cakes (low-carb, of course), but in the more than 100 snack bars, frozen dinners, Pi-Sunyer. muffin mixes, ice creams, and other foods and supplements that carry his name. And it’s not even clear that the rise in The pitch: Atkins-brand foods have fewer “net” carbohydrates than conventional blood sugar that comes from eating foods. What are net carbs? They’re what’s left after Atkins Nutritionals replaces high-GI foods leads to high blood insu- lin levels, or that higher insulin leads some of the foods’ carbs with from soy and wheat, and after it deducts people to overeat, says Pi-Sunyer.1 other carbs that, according to the company, have “a minimal impact on blood “The glycemic index may account for less than a quarter of the insulin re- sugar.” (The list includes fiber, glycerin, sugar alcohols, and polydextrose.) sponse to a food,” he suggests. “And The remaining carbohydrates appear in the “Net Atkins Count” circle on the there is no evidence that the typical package. Creative accounting? You bet. Good science? Hardly. post-meal levels of insulin increase food intake or body weight.” ■ Atkins Nutritionals won’t say whether it has tested its foods to make sure that Which leads to the question: how they don’t raise blood sugar. Just because a food is sweetened with glycerin, good is the evidence that low-glycemic- sugar alcohols, or other sugar substitutes doesn’t necessarily mean that it’s index foods promote weight loss? gentler on your blood sugar. For example, a sugar-free apple muffin or banana cake raises blood sugar as much as its sugar-sweetened counterpart.1 No Magic Bullet ■ Atkins’ books claim that only carbs that raise blood sugar cause weight gain, You’ll find a glycemic-index ranking of but the evidence is scanty. foods in The Zone; Dr. Atkins; Good What’s more, low-carb foods aren’t cheap. A 12-ounce box of pasta costs Carbs, Bad Carbs; and The New Glucose $5.99. Four cups of instant soup run $12. Fifteen brownies will set you back $32. Revolution. But unlike the other books, The Supplements New Glucose Revolution was written by scientists who have actually studied the Atkins Nutritionals also sells pills to “help break up a weight loss logjam.” Among glycemic index. In fact, one of its the ones Atkins recommends: authors, Thomas Wolever of the ■ Coenzyme Q10: Take 100 mg a day, since an “exploratory” study two decades University of Toronto, was one of the researchers who helped devise the ago found that people who took CoQ10 lost more weight than people who didn’t. scale. Reality check: The study, which was never published in a peer-reviewed scien- The glycemic index is no magic tific journal, was never followed up. bullet for dieters, says Wolever. ■ Carnitine: Take 1,500 mg a day, just in case you have a deficiency of the “I’ve yet to see evidence that a low- amino-acid derivative. GI diet aids weight loss,” he explains. Reality check: No good research shows that overweight people are deficient in “One or two studies show it and a number of others don’t.” carnitine, or that taking 1,500 mg a day helps people lose weight.2 Despite the “Lose Weight” claim on ■ Chromium: Take up to 1,000 micrograms a day, because preliminary research the cover of Wolever’s The New Glucose 15 years ago suggested that it helped build muscle and burn fat. Revolution, “it’s not really a diet book,” Reality check: Better studies since then have come up empty. he says. “It’s information about the glycemic index and how to use it for —David Schardt health.” Wolever’s research uses a low- glycemic-index diet to lower the risk of 1 Amer. J. Clin. Nutr. 76: 5, 2002. heart disease and to control diabetes. 2 Int. J. Sport Nutr. Exer. Metab. 10: 199, 2000. “The chapter on weight says that a low-GI diet may be helpful for people

4 NUTRITION ACTION HEALTHLETTER ■ JANUARY/FEBRUARY 2004 COVER STORY

who want to lose weight,” he says. “But the best way to do that is to Dr. Phil’s pills reduce calorie intake and increase activ- ity level.” When Wolever put people on low-GI f you hit it right, a popular diet book can be a diets to control their diabetes, the igold mine. But the big players know how to dig pounds didn’t melt away. “People tended to lose a little weight, but it even deeper. Dr. Phil—who at 6’4” and 240 pounds wasn’t significant,” he explains. “And is clearly overweight—wants fans to pay $120 for his we found no differences in how full vitamins and up to $90 for his bars and drink mixes they felt on low-GI foods.” In fact, in one study of 35 people every month. Here’s the scoop: with diabetes, those who were given Weight Management Supplements high-GI (corn flakes, puffed rice, or crispy rice) lost two pounds after six If you’ve got a waist smaller than 35 inches (women) or 40 inches (men), Dr. Phil weeks, while those who got low-GI wants you to buy his Weight Management Supplement & Complete Multivitamin cereals (Bran Buds or a Cheerios-type for Pear Body Types. If you have a larger waist, you need his supplement for Apple , plus an added fiber called psyl- Body Types. Either way, it’s 12 pills a day, 60 bucks a month. lium) lost no weight.2 What’s the difference? Very little. Both contain the same 23 vitamins and miner- Others agree that the research is in its als, plus carnitine (an amino-acid derivative) and four herbs. The “pear” pills also infancy. have a speck of soy isoflavones, green tea, and Rhodiola rosea root. In contrast, the “A low-GI diet may suppress hunger. “apple” pills contain Gymnema sylvestre leaves, vanadium, and white kidney bean But until there is research over the long extract. term, we just don’t know,” says Susan Never mind that there are no studies showing that the supplements promote Roberts of the Jean Mayer U.S. Depart- weight loss in anyone, pear or apple. No matter what fruit your body looks like, ment of Agriculture Human Nutrition Dr. Phil thinks you need to “take your weight management efforts to the next Research Center on Aging at Tufts level” by plunking down an additional $60 a month on 10 “Intensifier” pills a day. University in Boston. The Intensifiers contain: A recent review of the evidence ■ reached this conclusion:3 “The ideal Coenzyme Q10: “Required for the production of energy in the body.” human intervention study on low-GI Reality check: May help with congestive , not excess weight. vs high-GI diets has not yet been ■ Conjugated linoleic acid (CLA): “May reduce the deposit of excess body fat conducted.” and increase the ratio of lean body mass to fat, when combined with a low- For example, in many studies, the calorie diet and exercise.” diets differ in fiber or protein content, Reality check: May also cause liver damage and worsen insulin resistance. not just in the glycemic index of their foods. “A lot of articles hypothesize ■ EPA and DHA: “Support healthy body membranes and heart health.” about the glycemic index, but there are Reality check: These omega-3 , which are found in fish oil, may help prevent not a lot of controlled studies to see sudden cardiac death, but have nothing to do with weight loss. whether a low-GI diet works,” says ■ Tyrosine and L-theanine: “May help reduce every day stress.” Bonnie Brehm, an obesity researcher at Reality check: No good studies back up the benefits of theanine or the trivial the University of Cincinnati. amount of tyrosine in Dr. Phil’s Intensifier pills. ■ Vitamin C: “Protects your body against the damaging effects of free radicals.” Beyond the Index Reality check: There is no evidence that vitamin C has any impact on weight. If a low-GI diet is no guarantee that we’ll Nutrition Shakes all look like Demi Moore and what’s-his- name, so what? Maybe it’s not a low You’re nobody in the weight-loss game unless you sell a meal replacement shake. glycemic index, but more whole grains Shape Up! Shakes contain “scientifically researched levels of ingredients that can or fiber, that can keep us slim. help you change your behavior to take control of your weight,” says Dr. Phil. “It’s hard to draw conclusions In fact, they’re just a run-of-the-mill powder made from milk, eight kinds of fiber, because the studies on fiber are all too and added vitamins (which you don’t need if you’re already taking his 22 pills a different—some use supplements, some day...or your own inexpensive multi). use real food, some have a small fiber Nutrition Bars increase, some have a modestly big increase,” says Tufts’ Susan Roberts. Dr. Phil’s Shape Up! bars are concoctions of sugars, oil, soy protein, fiber, and still Studies on whole grains and weight more added vitamins. So much for his advice to keep sugars and fats “off-limits if are even scarcer. “Our study found you want to successfully control your weight.” that diets higher in whole grains and —David Schardt fiber slow weight gain compared to ›››› (continued on p. 8)

NUTRITION ACTION HEALTHLETTER ■ JANUARY/FEBRUARY 2004 5 COVER STORY

s it the title? Is it the promises? Is it word of mouth? It’s not clear how people pick a diet book, but one thing’s for sure: the decision is rarely based on good science. Here’s our take on the most popular diet books. Since no large long-term studies have pitted them head-to-head, we can’t evaluate the diets’ ability to make you skinnier. Instead, we’ve graded each book’s scientific credibility (“Is the Science Solid?”) and whether the diet it recommends is healthy. (In “What You Eat,” “Yes” means frequently, “Less” means rarely, if ever.) The books are listed in order according to Amazon.com’s top-selling “Diet and Weight Loss” books in mid-November. We added ’s Eat More, Weigh Less and the cookbook because a recent study tested both diets. We excluded other cookbooks and how-to spin-offs of the top-sellers. The chart gives only thumbnail sketches. See the books for more details.

MOST NAME CLAIM WHAT IS THE IS THE DIET WORST PREPOSTEROUS YOU EAT SCIENCE SOLID? HEALTHY? FEATURE CLAIM Switching to Yes: Seafood, Healthy version of Mostly Restricts car- You won’t ever good carbs stops chicken breast, lean Atkins diet that’s healthy foods. rots, bananas, be hungry insulin resistance, , low-fat , backed by solid evi- pineapple, and (despite menus cures cravings, most veggies, nuts, dence on fats and watermelon. that average just The South and causes oils; (later) whole heart disease. 1,200 calories a Beach Diet weight loss. grains, most fruits, day). By Arthur Good fats protect low-fat milk or Agatston the heart and yogurt, beans. prevent hunger. Less: Fatty , full-fat cheese, re- fined grains, sweets, juice, potatoes.

Foods that take Yes: Seafood, poul- Tough-love manual Mostly Readers may “Each of these time to prepare try, meat, low-fat that relies more on healthy foods. buy Dr. Phil’s nutrients [in his and chew lead to dairy, whole grains, Dr. Phil’s opinion expensive, supplements] Gives no weight loss. Other most veggies, fruits, than on science. questionable has solid clinical The Ultimate “Keys to Weight (limited) oils. menus, recipes, supplements, evidence (and a Weight Loss Freedom” or advice on how bars, and record of safety) Solution include “no-fail Less: Fatty meats, much of what to shakes (see behind it.” By Phil environment,” sweets, refined eat. “Dr. Phil’s McGraw “right thinking,” grains, full-fat dairy, Pills,” p. 5). “healing feelings,” microwaveable and “circle of entrées, fried foods. support.”

A low-carb diet is Yes: Seafood, poul- Low-carb “bible” Too much red Long-term “Only by doing the key to weight try, meat, eggs, overstates the results meat may raise safety not Atkins can you loss (and good cheese, salad veg- of weak studies and risk of colon or established. lose weight eat- health) because gies, oils, , the evidence on prostate cancer. ing the same Dr. Atkins’ carbs cause high cream; (later) limited supplements. (How- number of calo- New Diet insulin levels. amounts of nuts, ever, in recent small Lack of fiber, ries on which Revolution fruits, wine, beans, studies, people lost vegetables, and you used to gain By Robert veggies, whole more weight after fruits may raise weight.” C. Atkins grains. 6—but not 12— risk of heart dis- months on Atkins ease, stroke, can- Less: Sweets, refined than on a typical cer, diverticulosis, grains, milk, yogurt. diet.) and constipation.

Switching from Yes: Sourdough Dumbed-down, Mostly Dieters may “…in spite of the high-glycemic- bread, beans, most sloppy version of healthy foods. assume that title Good Carbs, index foods fruits, low-fat dairy, they can eat as Bad Carbs, there Good The New Glucose Few recipes, (“gushers”) to most veggies, chips, Revolution that many “trick- are no bad Carbs, low-glycemic- pasta, Special K, menus, or spe- lers” as they carbs.” Bad Carbs index foods pudding, pound inflates the impor- cifics. want and not By Johanna (“tricklers”) aids cake. tance of the Some low- gain weight. Burani & weight loss. glycemic index. Linda Rao glycemic-index Less: White bread, foods are un- sweets, Raisin Bran, healthy (e.g., potatoes, water- sponge cake, melon. chips, chocolate bars).

6 NUTRITION ACTION HEALTHLETTER ■ JANUARY/FEBRUARY 2004 MOST NAME CLAIM WHAT IS THE IS THE DIET WORST PREPOSTEROUS YOU EAT SCIENCE SOLID? HEALTHY? FEATURE CLAIM Your blood type Yes: About as scientific as Not applicable May convince “If you are a determines your Type O: Meat, sea- a horoscope. (diet varies people to use Type A woman diet, supple- food, fruits, veggies. according to these diets to with a family ments, and per- (Less: Wheat, beans.) blood type, treat cancer, history of breast Eat Right 4 sonality because it ancestry, etc.). asthma, infec- cancer, consider Your Type is “the key to your Type A: Fruits, veg- tions, diabetes, introducing By Peter J. body’s entire gies, beans, most arthritis, hyper- snails into your D’Adamo & immune system.” seafood. (Less: tension, and diet.” Catherine Meat, dairy, wheat.) infertility. Whitney Type B: Meat, beans, fruits, veggies. (Less: Chicken, wheat.) Type AB: Seafood, dairy, fruits, veggies. (Less: Red meat.)

Following a point Yes: Fruits, veggies, No science cited, Mostly Some Not applicable system helps low-fat dairy, poul- but its sensible healthy foods. packaged (cookbook). Weight dieters cut calories try, seafood, lean advice is used by Weight Watchers and lose weight. meats, grains. millions. Watchers foods New (none are men- Complete Less: None. tioned in the Cookbook cookbook) aren’t exactly nutritious.

Low-glycemic- Yes: Beans, pasta, Reasonable interpre- Mostly Advice is diffi- Low-glycemic- The New index foods keep most fruits, veggies, tation of the sci- healthy foods. cult to follow index diets are Glucose you satisfied low-fat dairy, poul- ence, though because gly- easy to teach Revolution longer and help try, lean meat, stronger for heart Fuzzy limits cemic index and easy to By Jennie you burn more seafood. disease and diabetes on low-glycemic- varies so much learn. Brand-Miller, body fat and less than for weight loss. index foods, for each food Thomas muscle. Less: Potatoes, including pasta, (e.g., bananas Wolever, Kaye white bread, fatty sourdough range from 30 Foster-Powell, meats, full-fat dairy, bread, honey, to 70). and Stephen watermelon. some sugary Colagiuri cereals, and some dried fruits.

Eating the right Yes: Seafood, poul- Exaggerates evi- Mostly May convince “I believe that mix of the right try, lean meat, fruits, dence that the Zone healthy foods. people to use the hormonal fats, carbs, and most veggies, low- diet is the key to the diet to treat benefits gained protein keeps you fat dairy, nuts. weight loss and Few recipes cancer, AIDS, from a Zone- Enter trim and healthy implies that the diet or menus. chronic pain, favorable diet will The Zone by lowering Less: Fatty meats, can cure virtually impotence, be considered By Barry Sears insulin. full-fat dairy, butter, every disease. alcoholism, the primary shortening, (limited) depression, treatment for all grains, sweets, and arthritis. chronic disease potatoes, carrots, states, with drugs bananas. being used as secondary backup.”

Detoxifying the Yes: Eggs, meat, Kooky mishmash of Mostly Useless fat- “The best way to liver and lymph poultry, seafood, old detox lore and healthy foods. flush kit costs give those fatty system, taking most veggies, fruits, new good-carb $68 per month deposits [in your omega-3 fats that organic coffee, nuts, theory. Too much red for vitamins, thighs and arms] The Fat burn calories, and cranberry juice; meat and eggs. omega-3 fats, the old heave-ho Flush Plan avoiding insulin- (later) beans, whole etc., that “trig- is by cleansing By Ann raising carbs pro- grains, cheese. ger fat burn- your lymphatic Louise mote weight loss. ing...and nour- system with a Gittleman Less: Sweets, butter, ish our tired bouncing action margarine, refined and over- or by moving grains, caffeine, milk, worked livers.” your arms while yogurt, yeast. walking briskly.”

Slashing fat is the Yes: Beans, fruits, Diet worked (when Mostly Unnecessarily Eating a very- key to weight loss. veggies, grains, (lim- combined with healthy foods. restricts sea- low-fat vegetar- ited) non-fat dairy. exercise and stress food, turkey ian diet is easy. reduction) in a Too many and chicken Eat More, Less: Meat, seafood, small-but-long-term carbs may raise breast, oils, Weigh Less poultry, oils, nuts, study. triglycerides and nuts, and fat- By Dean butter, dairy (except lower HDL free dairy. Ornish non-fat), sweets, (“good”) choles- alcohol. terol if people don’t exercise, lose weight, and reduce stress.

NUTRITION ACTION HEALTHLETTER ■ JANUARY/FEBRUARY 2004 7 COVER STORY

diets high in refined carbohydrates,” “The Atkins diet is potentially related ference in weight loss on four diets— says Eric Rimm of the Harvard School to a long-term risk of cancer” if people Atkins, The Zone, Dean Ornish, and of Public Health. stay on it long enough, says Harvard’s Weight Watchers. But until the study But the difference in weight was Eric Rimm. has been vetted and published, it’s too small—only a few pounds over 12 A few months on Atkins may not early to weigh its conclusions. years—and it’s impossible to know cause problems. “But two years on a Ornish’s book, Eat More, Weigh Less, whether whole-grain eaters did other red meat diet could initiate a cancer,” resurrects an old question: should things to avoid obesity.4 he adds. “It could show up as a polyp dieters eat a very-low-fat diet, which “Would I like to see trials that ran- in seven years and as colon cancer in gets 70 to 75 percent of its calories domly assign people to eat whole ten.” from carbohydrates? grains or refined grains for a year?” asks And Brehm worries about too little Carbs shouldn’t exceed 60 or 65 Rimm. “Sure.” In the meantime, he fiber, fruits, and vegetables on an percent of calories, say the National recommends whole grains for every- Atkins-type low-carb diet. Heart, Lung, and Blood Institute, the one, overweight or not. American Heart Association, and the “There’s a growing body of evidence National Academy of Sciences. that whole grains are more beneficial “Too many carbs may raise triglyc- than refined grains to reduce the risk of erides and lower HDL [good] choles- heart disease, diabetes, and obesity.” terol,” says Alice Lichtenstein of Tufts’ Human Nutrition Research Center on Aging, who coauthored the American Diet vs Diet Heart Association’s guidelines on very- low-fat diets. After years of ignoring popular diet That didn’t happen when Ornish put books, researchers recently started test- 35 people with heart disease in his Life- ing Dr. Atkins head-to-head against style Heart Trial for five years. (Their “conventional diets,” which cut calo- arteries became less clogged.) Was it all ries mostly from fat. Three research the fiber they were eating? Possibly. teams released preliminary results last “It’s also possible that other parts of year.5-7 Ornish’s program—vigorous exercise, “Our study, as well as the two others, stress reduction, and weight loss—pro- were all relatively small and short-term, tected them,” says Lichtenstein. “If but the results of all three were consis- people don’t follow his diet and other tent,” says the University of Cincin- advice closely, too many carbs could nati’s Bonnie Brehm. “The healthy cause trouble.” obese women in our study lost more Ornish aside, people who think they weight on the Atkins diet than on the “The women in our study averaged can eat any and all carbs without con- American Heart Association’s diet.” only five grams of fiber a day,” she sequences are wrong. Brehm’s study lasted only six notes. (That’s one-sixth of what “When the pendulum swung as far as months. In another study, the Atkins experts recommend.) And despite it could to low-fat diets in the 1980s, dieters also lost more weight, but the what Atkins claims, “they did have we may have gone too far recommend- difference between the two groups dis- constipation problems.” ing higher carbs,” says Brehm. “People appeared after a year. Still, what dieter Phase 2 of the Atkins diet allows may have lost sight of the fact that wouldn’t jump at the chance to lose more fruits and vegetables, she carbs have calories.” extra weight for six months? acknowledges. “But if you don’t lose Now they know better. What’s more, “we don’t have as enough weight in Phase 2, you have to “We’re saying that you need to cut much reservation as we used to about move back to Phase 1, so you’re on back on carbs, and you can eat more the cardiovascular risk factors of an that restricted diet longer than the unsaturated fat,” Brehm explains. Atkins diet,” adds Brehm. “The weight book says. “People may be ready for a more loss seems to override the high satu- “I don’t see the medical community refined tool that separates good carbs rated fat content of the diet.” recommending Atkins as a healthy diet and fats from bad.” Sound familiar? But what happens to LDL (“bad”) because it’s so restricted,” says Brehm. “The South Beach Diet teaches you and other risk factors for “You miss out on fiber and any phyto- to rely on the right carbs and the right heart disease once weight stabilizes is chemicals in fruits and vegetables that fats,” says the book’s first page. an open question, she adds. Also, her we may not even know about yet.” study tested women with normal, not high, cholesterol. 1 Amer. J. Clin. Nutr. 76: 290S, 2002. “Is the Atkins diet effective?” asks The Bottom Line 2 Amer. J. Clin. Nutr. 72: 439, 2000. Brehm. “Yes. But I still wouldn’t rec- 3 Obesity Reviews 3: 245, 2002. 4 ommend it until we have more Where does that leave the ever-expand- Amer. J. Clin. Nutr. 78: 920, 2003. 5 research on its safety.” ing legions of dieters? J. Clin. Endocrinol. Metab. 88: 1617, 2003. 6 New Eng. J. Med. 348: 2074, 2003. Others are also hesitant to endorse a According to media reports last 7 New Eng. J. Med. 348: 2082, 2003.

Illustration: Loel Barr. diet that’s loaded with red meat. November, a new study found no dif-

8 NUTRITION ACTION HEALTHLETTER ■ JANUARY/FEBRUARY 2004