Right-Food-Combination Diabetes Diets

The right-food-combination diets do not focus on emphasizing or avoiding one type of food, such as fat or carbohydrates. Rather, they are based on other theories. Some of the popular right-food-combination diets are the Zone Diet, the Eat Right for Your Type Diet, and Dr. Phil’s Ultimate Weight Solution.

The Zone Diet

The Zone Diet promises that if you eat small meals with the correct ratio of protein, carbohydrate, and fat, then you will balance your hormones and insulin so that your body works at peak performance. According to its developer, being in the “zone” leads to decreased hunger, increased weight loss, increased energy, and the ability to burn fat and fight heart disease, diabetes, depression, and cancer (and possibly facilitate world peace).

The Zone Diet treats food as if it were a drug: “You must eat food in a controlled fashion and in the proper portions as if it were an intravenous drip.” The recommended diet is 40 percent carbohydrate, 30 percent protein (based on lean body mass), and 30 percent fat. The book aims to convince people that they need to eat foods in “blocks,” with a final ratio of 1:1:1 for protein, carbohydrate, and fat blocks at each meal. It is true that if people with diabetes eat a consistent amount of carbohydrate in each meal and snack from day to day, their blood-sugar levels will be more stable and predictable. However, asking people to follow rigid rules such as eating seven grams of protein for every nine grams of carbohydrate and one and a half grams of fat to meet this 1:1:1 ratio is cumbersome and can reduce the pleasure in planning meals and eating food.

The Zone Diet suggests that you eat a Zone breakfast within one hour of waking, have a Zone-favorable snack thirty minutes before exercise, and eat a small Zone snack before bed. Such a regimented eating plan can help you lose weight. But it can also lead to discouragement and giving up. All that is really necessary

to lose weight is to lower calorie intake and increase activity level. Changing lifestyle habits is hard enough without complicating the process with unnecessary rules! Finally, the high protein intake of the Zone Diet is also of concern for people with diabetes because they are at higher risk for kidney failure.

The Eat Right for Your Type Diet

The Eat Right for Your Type Diet claims that your blood type is the key to determining what for you is the right diet, the right exercise program, and the right supplements for staying healthy, living longer, and achieving your ideal body weight. The diet implies that if you don’t eat correctly according to your blood type and ancestry, you will be susceptible to certain diseases.

The truth is that eating a healthy, low-calorie diet to lose weight has nothing to do with your blood type. The Eat Right for Your Type diet may lead people to restrict certain foods and food groups unnecessarily and thus limit their enjoyment of food. What is most worrisome is that some people may use this diet to treat serious medical conditions.

Dr. Phil’s Ultimate Weight Solution

Dr. Phil’s Weight Solution promises, “You will learn about food in a completely dif ferent context, in a way that no diet book has ever discussed or previously put into widespread practice.” Dr. Phil suggests that if you eat the right foods—he calls them “high- response cost, high-yield foods”—and minimize or avoid the wrong foods —“the low-response cost, low-yield foods”—then you will lose weight.

As Dr. Phil defines them, “high-response cost, high-yield foods” take a long t ime to prepare and chew and are lower in calories; allegedly, they are “hunger suppressors.” “Low-response cost, low-yield foods” are easy to grab and eat, require little chewing, and provide an excess of calories for little nutritional value; allegedly, they are “hunger drivers.”

There is an important measure of truth in the advice that you

should eat more slowly. It takes about twenty minutes for your stomach to generate and send “stop eating”— or satiety— signals to your brain, so slowing the pace of eating is important. This is also why portion control is so important and why “supersized” meals are such a problem. If you eat a supersized meal very slowly, you might feel full by the time you are only halfway through it. But if you eat it fast, you’ve taken in way more calories than you need before your “stop eating” signals kick in—and then it’s too late.

Another part of Dr. Phil’s advice also is sound. Planning meals and snacks no more than four hours apart and including foods with more fiber in your diet will help you feel more satisfied and full with fewer calories. However, it is not true that the low- response cost, low-yield foods drive your hunger.

In summary, people with diabetes could benefit from Dr. Phil’s plan. At the same time, however, if you have diabetes you will need to monitor your blood-sugar levels closely and work with your diabetes team to adjust medications as needed to pre- vent hypoglycemia. There is another reason to be careful. The high-response cost, high-yield foods and the low-response cost, low-yield foods do not reflect food choice recommendations for people with diabetes and may in fact limit food choices more than is necessary to lose weight and control blood-sugar levels.

All of these diets can produce weight loss not because of their specific macronutrient composition but because they all have one common denominator: they are each low in calories. Table 11.1 shows a sample daily menu for the low-carbohydrate diets, the right-food-combination diets, and the very-low-fat diets. Each of the diets restricts calories by restricting the consumption of specific food groups or one of the macronutrients (carbohydrate, protein, or fat). Each of the diets works because, in general, Americans eat too much food and too much of each of these macronutrients.

Table 11.1 also shows the nutritional composition of each of the diets. As you can see, the Atkins Diet is high in fat, saturated fat, and cholesterol and low in fiber. The South Beach Diet does emphasize healthier fat choices. However, the Phase 1 diet pro- file is more similar to an Atkins-type diet and is high in percent total fat, exceeds recommendations for percent saturated fat intake, and does not meet dietary fiber—intake recommendations. The Phase 2 diet is more moderate in percent total fat, is lower in percent saturated fat, and contains more fiber yet does not meet fiber-intake recommendations. The very-low-fat diets are very low in saturated fat and cholesterol and high in dietary fiber but may be too high in carbohydrates for people with type 2 diabetes. As you can see, just because a diet produces weight loss does not necessarily mean that it is nutritionally adequate or healthy.

How Well Do They Really Work?

Research comparing the low-carb, high-fat Atkins Diet; the high-protein, moderate-carb Zone Diet; the very-low-fat, high- carb Ornish diet; and the low-fat Weight Watchers diet has shown that each of these helps people lose weight. Why? Because each one helps people take in fewer calories.

In a one-year study conducted by researchers from Tufts University in Boston, 160 overweight men and women (average weight, 220 pounds) were randomly assigned (by chance alone) to follow one of the four diets as best as they could. Within just two months, 22 percent of the volunteers had given up. At the end of the year, 35 percent had dropped out of Weight Watchers and the Zone Diet, and 50 percent had quit the Atkins and Ornish Diets, arguably the two more radical diets—although at opposite sides of the carbohydrate/fat spectrum.

Although volunteers in each group lost weight, not surprisingly those who followed their assigned diet most closely lost the most weight —between nine and thirteen pounds, on average. (This is less than the average of fifteen pounds lost with the DPP program.) In this study, all of the diets lowered cholesterol levels; however, the Ornish diet reduced the LDL cholesterol (bad cholesterol) by 10 percent, whereas the Atkins Diet reduced LDL cholesterol by 2 to 3 percent.

TA BL E 1 1 .1 One-Day Menu Comparisons of Popular Diets(1,2)

1. Nutrition information in this chart represents a sample one-day menu for each of the diets. Other daily menus for these diets can range from 1,000 calories to 1,700 calories per day. This range of calorie intake is sufficient to produce weight loss in most people who are overweight. The American Heart Association recommends no more than 30 percent of calories from fat, less than 10 percent of calories from saturated fat, and less than 300 milligrams of cholesterol per day. The American Dietetic Association recommends 20—35 grams of dietary fiber each day. The recommended dietary allowance (RDA) for protein is 46—50 grams of protein per day for women and 58—63 grams per day for men.

2. Abbreviations as follows: p = protein, c = carbohydrates, f = fat

In another study, one hundred people were randomly assigned to follow one of four diets for one year: an Atkins-type, 55 to 65 percent fat diet (high-fat); a 20 to 30 percent fat diet ( low-fat); a  15 percent fat calorie-controlled diet (350- to 500-calorie deficit); or a 10 percent fat, whole foods, high-complex-carbohydrate diet (75 percent carbohydrate). Weight loss was initially one pound per week on the 10 percent fat diet and about one-half pound per week on the Atkins-type diet. After one year, those on the  10 percent fat diet had a 52 percent decrease in LDL (bad) cholesterol, whereas those on the Atkins-type diet had a 6 percent increase.

Other recent studies have compared the low-carb, high-fat Atkins Diet (20 to 30 grams carbohydrates per day) to a moderately low-fat diet (25 to 30 percent fat and 500-calorie-per-day deficit). The results may remind you of the story of the tortoise and the hare. At six months, those assigned to the Atkins Diet had lost more weight than those assigned to the low-fat diet. Yet at one year, there was no significant difference in the weight loss between those on the Atkins Diet and those on the low-fat, low- calorie diet. In another recent study comparing different popular diets, more moderate diets, such as Weight Watchers, achieved similar weight loss as more radical diets (Atkins or Ornish) over one year. Adherence to the Weight Watchers diet was superior.

The fear that high-fat diets will inevitably worsen cholesterol and other lipid levels has not proved to be the case, at least when weight loss is achieved in the short term. After one year, there was no significant difference in the reductions in total cholesterol or LDL cholesterol levels between the Atkins Diet and a low-fat diet. However, triglyceride levels decreased more and HDL (good) cholesterol levels increased more in those assigned to the Atkins Diet compared with those on the low-fat diet.

The research to date suggests that the primary reason that people on the Atkins Diet lose more weight initially is that they eat fewer calories. The diet may facilitate cutting back in calories in two ways—by the limited variety of foods to choose from and by the greater satiety and reduction in appetite that can occur with low-carbohydrate, high-fat “ketogenic” diets. The increased water loss that occurs during the first two weeks of the Atkins Diet also contributes.

The Atkins and other low-carb diets aren’t for everyone. In the rigorous one-year trials conducted so far, one-third to one- half of volunteers assigned to the Atkins Diet dropped out, and others had trouble strictly sticking with the diet. This may be due in part to the requirements of the diet and the eventual lack of variation. Side effects are another reason. Constipation, headaches, bad breath, muscle cramps, diarrhea, and general weakness are reported more often by people who “do Atkins” than those who follow low-fat diets.

The research thus far suggests that the Atkins Diet may pro- duce better short-term (six-month) weight loss than a low-fat diet, but it is difficult to maintain that pace after six months. Larger, longer studies are needed to pin down the impact of different popular diets on weight loss patterns. We also need to know more about how they affect kidney function, bone density, and cardiovascular function. This is best studied when: (1) we measure how well people stick with each of the diets; (2) weight loss and side effects are compared over time; and (3) indicators of health such as cholesterol levels or bone density are studied not only after weight loss but also once weight is stabilized, so that the acute weight loss effect is no longer trumping the effect of the macronutrient composition on health. For example, in the first six months of some clinical trials, LDL cholesterol (bad cholesterol) increased more than 10 percent in 30 percent of volunteers assigned to an Atkins Diet but in only 16 percent of low-fat dieters. Some experts believe that the reason that HDL cholesterol increases on the high-fat Atkins Diet is because the body needs to produce more HDL cholesterol so that it can remove the proportionately higher amounts of unhealthy fats being absorbed into the bloodstream. It is possible that when people following the Atkins Diet are no longer losing weight and are in the weight-maintenance phase, the higher total fat and saturated fat intakes will cause more dramatic increases in total cholesterol and LDL cholesterol levels and ultimately increase the risk for heart disease.

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