E R U M J H U M R A , M S C . R D .

P A K I S T A N N U T R I T I O N A N D D I E T E T I C S O C I E T Y

C O N T I N U I N G N U T R I T I O N E D U C A T I O N S E M I N A R

F E B R U A R Y 2 3 , 2 0 1 3

Demystifying Fad Diets 1

“There is more misinformation pretending to be fact in this field than

any other I can think of”

Dr. Jeffery M. Friedman Rockerfeller University Obesity Researcher

New England Journal of Medicine Jan 31, 2013

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Body Composition

Fat

Fat Free Mass

Fat Mass

Total

weight

Total Body

weight

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MALES MALES FEMALES FEMALES

Total fat 8 to 24%

Storage fat 5-21%

Essential fat 3%

Muscle 44.8%

Bone 14.9%

Remaining 16.3-32.3%

Total fat 21-35%

Storage fat 9-23%

Essential fat 12%

Muscle 38%

Bone 12%

Remaining 15-29%

Krause’s Food and Nutrition Therapy 2008

Distribution of Weight 4

What Regulates our Body Weight?

Resting Metabolic Rate: 60 – 70% of total energy used. energy restriction and age (2-3% per decade)

Energy used in voluntary activity: 15 – 30%

includes AT and NEAT

Regulatory Systems: e.g. hormones and neurotransmitters

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Factors Affecting Weight Gain

Obesity

Genes, Metabolism, Physiology, Disease

Diet, Quality and Quantity

Physical Activity and Exercise

Sleep and Stress

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A Fad Diet

Short term diet plans. List can vary.

Claims are too good to be true - weight loss at an unrealistic pace.

Refers to foods as “good” or “bad.”

Recommendations are extreme.

Personal testimonials used to “sell” the diet.

Recommendations based on a single study – or no research at all.

Statements are refuted by reputable organizations.

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The HCG Diet

MODE OF ACTION

Regular injections of HCG (human chorionic gonadotropin) derived from pregnant women's urine.

Simultaneously follow diet

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The HCG Diet - Reality

Cortisol and insulin

ovarian stimulation & testosterone produced

Immunity against pregnancy?

Risk of headaches, blood clots and fatigue

Discredited by FDA & researchers in 1970’s.

Near starvation, 500 kcal for 6 weeks

Placebo

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MODE OF ACTION MODE OF ACTION ANALYSIS ANALYSIS

Drink for a week to several weeks: juice/water or green smoothies

Detoxification?

Intake of fruits and vegetables.

Detox /Master Cleanse/ Green Smoothies

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CLAIM CLAIM REALITY REALITY

Flushes toxic chemicals

Body functions better

Metabolism soars and sheds pounds

Might include pills, powders, enemas, colon cleansers e.g. sea salt

Liver, kidneys and colon detoxify

Extreme low calorie

Detox, Master Cleanse, Green Smoothies

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General Motors* Diet, 7 Day Diet

MODE OF ACTION

No alcohol, 10 glass water a must, only black tea/coffee allowed

1. All fruits, no banana

2. Start with a potato, but rest all vegs day

3. Veg & fruits – no banana or potato

4. Upto 8 bananas and 3 glasses LF milk

5. Upto 20 oz beef and 6 tomatoes

6. All beef & veg

7. Brown rice, veg & fruit

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CLAIM CLAIM REALITY REALITY

Unlimited wonder soup

Lose 10-17lbs/week

Cleansing effects

Emotional fulfillment

Vegetarian version

Optional exercise 10 mins

Repeat at intervals to maintain

low cal veggies for filler

Quick result– repeat

Sudden muscle weakness, headache, irritability, malaise, hunger.

Restricted choice, nutritionally def.

General Motors* Diet, 7 Day Diet 14

What is wrong with semi starvation?

“When the body is suddenly deprived of adequate energy, such as with involuntary or deliberate starvation or semistarvation,the RMR adapts to conserve energy against an unpredictable future by dropping rapidly, by as much as 15% in 2 weeks. When adequate food intake is restored, the RMR returns to baseline levels”

Krause’s Food and Nutrition Therapy 2008

Page 535

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CASE STUDY

Your client, Rizwan’s details are as follows: •Age: 40 years •Height: 5’ 10” Weight: 200 lbs •Body fat: 28% of total weight (56 lbs. of fat) •Daily intake: 3,000 calories (2 big meals, lunch & dinner) •Reduces his intake to 2,000/day through lots of meat, eggs & milk, no carbs. •Drops to 190 lbs. in 2 weeks and only feels slightly sluggish.

After three weeks: •Weight loss stops •Cuts calories to 1,500/day •Weight drops to 180 lbs •Needs more sleep, has occasional headaches and craves sugars

and bread. •After 10 weeks:

•Achieved his goal weight of 170 lbs. & has a body fat of 27%. Calculate his fat in lbs and fat free mass in lbs. What’s wrong with these results?

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CASE STUDY

Post diet: •Total weight: 170 lbs. •Body fat: 27% (46 lbs. of fat) •Weight lost: 30 lbs (20 lbs. of lean tissue and 10 lbs. fat)

• Primary loss = Lean mass, metabolism. • Poorly balanced diet = immune suppressed. • Difficult to follow same pattern for long

•What will happen when he goes back to usual eating pattern?

After 1 year (Now 41 years old): •Weight: 203 pounds •Body fat: 32% (70 lbs.of fat) •Intake: Approx. 2,000 calories (2 big meals, lunch & dinner •Remembers he lost weight on that diet and plans to do it again. •About to become a yo-yo dieter.

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The Dukan Diet

MODE OF ACTION: Different phases

Attack : 1-10 days unlimited lean protein/dairy

Cruise : alternate pure protein – veg and protein. Introduce unlimited (allowed) vegetables

Consolidation: add 1 fruit, 2 slice bread, 1 piece cheese. 2 free meals allowed in a weak

Stabilization: eat what you like, but protein only thursdays – forever.

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“The Atkins Nutritional Approach”

An evolving approach. Has been around since 1972.

The New Atkins For a New You (2010)

Phases:

2 week Induction: high protein, high fat, low carb

Ongoing Weight loss: tiny increase in carbs

Pre maintenance: 10 gms increase/week (identify optimum)

Life time maintenance: with option to drop back

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OVERVIEW OVERVIEW ANALYSIS ANALYSIS

Low carb diet

after about 48 hours,

ketones are burnt for energy.

Glucose is reserved only for absolute need.

Hunger is controlled by less changes in blood sugar levels.

Not sustainable long term.

Protein should be lean

High fat a concern

Lower triglycerides

The Atkins and Dukan Diets 20

Low CHO & High Protein

Restricting all CHO is unhealthy 1

Ketosis is a biochemical process in fat burning state 2

Systematic Review of data 3:

n= 229 hunter-gatherer societies

Information on Anthropological and nutritional data

Results: 76% of the societies derived >50% of their subsistence from animal foods. The rest gathered plant foods

1. Karra,C ; Shape Up America’ Reveals The Truth About

Dieters, 2003 2. Volek, J.; Stephen D.(2011). Beyond Obesity. pp. 302, 2011 3. Cordain, L., J. B. Miller, S. B. Eaton, N. Mann, S. H. Holt, and

J.D. Speth. American Journal of Clinical Nutrition, 2000

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The Good and the Bad Carbohydrate

Is there such a thing as a good CHO ?

For weight loss, a good CHO is one with lower calorie density

Fruits and vegetables have lesser calories per bite as opposed to other CHO

Healthy intake of CHO between 45% to 65%

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OVERVIEW OVERVIEW ANALYSIS ANALYSIS

Includes only things you can hunt, gather and grow e.g. fish, meat, veg, fruits and nuts.

No dairy

Restricts most grains.

sugar, refined CHO, processed foods.

risk of heart disease, due to better fat metabolism.

Calcium deficiency.

The Paleo Diet 23

OVERVIEW OVERVIEW ANALYSIS ANALYSIS

Use of grains, supplemented by vegs.

Avoid processed foods

Avoid red meat

Fish, seafood, nuts, fruits allowed 2-3 times/wk

Not a cure for cancer as advocated

Severe forms very restrictive

The Macrobiotic Diet 24

Why Conventional Weight Loss Diets Fail

They focus on weight loss not fat loss.

Starvation lowers energy expenditure

Don't encourage lifestyle modification or exercise.

Demand drastic changes in eating patterns

Most often result in weight regain plus more

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Nutritionally Sound Diets That Work

The DASH Diet

The Mediterranean Eating Pattern

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Which Weight Loss Diet Works Best?

You can choose any diet for weight loss as long as you take in fewer calories than you burn. 1

n= 800 volunteers

Assigned to one of four diets : average protein, low fat; high protein, low fat; average protein, high fat; high protein, high fat.

Results: At 2 years, weight loss across the four plans was similar (7 to 9 lbs) There was no difference in feelings of hunger, satiety, satisfaction or other markers of cardiovascular risk.

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1. Sacks, FM, Bray GA, Carey VJ, et al. Comparison of Weight-Loss Diets with Different Compositions of Fat, Protein, and Carbohydrates. N Engl. J Med.2009

Which Weight loss Diet Should I Choose?

4 Simple Questions

1. Will this diet teach you to eat right in the long term?

2. Does it involve modification of behavior that caused weight gain to begin with?

3. Can you follow this diet for an extended period of time?

4. Does this diet offer sensible advice on exercise?

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Successful Weight loss

Behavior

Diet

Exercise

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The Qur’an: Al Ma’idah ayah 87

“ O you who believe! Make not unlawful the good things which Allah has made lawful for you, but commit no excess; for Allah loves not those given to excess”

ها الذين آمنوا ال يا أي

بات ما موا طي تحر

لكم وال أحل للاه

ال تعتدوا إن للاه

يحب المعتدين

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A Balanced Diet –

Still the Best Approach

clients' history.docx

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