FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

["LOW CARB" DIET NOT A GOOD LONG-TERM WEIGHT LOSS STRATEGY ]

Question: Several of my friends are on a new diet that eliminates carbohydrates. They eat meat, eggs, cheese and butter while avoiding fruits, vegetables, breads and pasta. Some of them have lost weight and have had their cholesterol go down too. This plan seems in conflict with everything I've previously heard about good nutrition, particularly the high-fat diet for those of us with high cholesterol. Will this diet work, and is it safe?

Answer: Dieting is an all-American pastime. One out of every three of us is dieting at any given time. This high rate of dieting has several causes. One of those is the preponderance of very slender individuals in advertisements and on television. These images help shift our perception of normal and desirable body size and proportions. Another cause is reality itself. One third of Americans are more than 20 percent above a healthy weight. This level of obesity is associated with serious health risks and is one of the most important undertreated health problems today.

The high-protein and low-carbohydrate diet your friends are trying isn't really new, but it is new to some people. Its logic is based upon the premise that sugars and starches - a class of chemical compounds called carbohydrates - are the cause of overeating. Examples of carbohydrate-rich food are bread, flour, pasta, sugar, honey and fruit.

The body produces the hormone insulin to improve the efficiency of carbohydrate metabolism. Insulin does have some role in stimulating the appetite, so reducing it should reduce the urge to eat. In addition, carbohydrates are metabolized into glucose, the type of sugar the body uses for fuel, and the glucose level in the blood does in turn also have impact upon appetite. As you would expect, dramatically limiting carbohydrate content of the diet will subsequently reduce the craving to eat.

The human body is efficient. Consuming more calories than you use up over the course of a day, regardless of the type of food, will cause a weight gain. Any diet that provides less calories than are needed for your day's activities will cause a loss of weight. Unfortunately, we all need certain nutrients on a regular basis to stay healthy, so we can't just stop eating until we reach a desired weight without paying a high price in terms of health problems.

A high-protein diet can help bring about weight loss. It has been a perennial favorite among wrestlers and weight lifters, and it episodically becomes popular with the general public. Its greatest risk is in bringing on gout, a type of arthritis. There have also been rare reports of serious electrolyte imbalances or kidney problems.

I can think of no redeeming features for a high-fat diet. Fat is very high in calories, containing nine calories per gram. This is more than twice the calorie content of carbohydrates or protein (4 calories per gram). Fat is also the raw material from which cholesterol is made, and we all know about the problems high cholesterol causes.

Your friends are on a silly diet. Those individuals who already have high cholesterol should certainly not consider it. Others may lose weight on it because they eat fewer calories than they were previously, but I don't think they can stay on this eating plan forever. When they stop, and hopefully they won't have had any complications, their weight will go right back up to where it was before they started on their diet.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.