Diets - Intermountain Healthcare

DietsThe Good, the Bad, and the Ugly

Lindsay Park RD CD CNSC

"Patients often are attracted to diets and programs that promise magical, no-stress weight loss. Although these programs have no metabolic validity, their promises are appealing. This has led to a weight loss industry in this

country in excess of $30 billion per year. It must be acknowledged that such programs do modify food intake and produce weight loss not

because of the claims given, but because of the energy deficit. Although many have short-term success, these diets are often unbalanced and

deficient in certain nutrients and may be excessive in others."

The Position of the American Dietetic Association on Weight Management:

Statistics• Nearly 70% of American adults are overweight or obese

• Nearly 50% of American adults say they want to lose weight

• Nearly 25% of American Adults say they are actively trying to lose weight

The Atkin’s Diet• Decrease carbohydrate intake (the body’s usual fuel source) to burn fat

stores for energy and lose weight. • Phase 1 - (induction) Limits carbs to 20 gm/day to jump start weight loss. • Phase 2 - carbs are gradually increased (5gm daily per week - 20 g a day

to 25 g a day for a week, then to 30 g a day for a week, etc.). You can keep increasing carbs until you see weight-loss slow or stop. At that point, you can move on to Phase 3 or cut back on carbohydrates if weight-loss slows too much. Because protein and fats are more filling, you actually tend to eat less quantity, yet feel full at each stage.• Phase 3 - pre-maintenance; add more healthy carbs.• Phase 4 - maintenance; about 100 carb grams a day.

The Atkin’s Diet - Pros

• The diet is easy to stick to in that it is black and white. No carbohydrates and all the protein you want. • You don’t have to watch portions.• Glycemic control – limiting carbohydrates helps regulate insulin and ease

metabolic syndrome, pre-diabetes, and diabetes.

The Atkin’s Diet - Cons

• Not a well-balanced diet – eliminating food groups eliminates vitamins, minerals, fiber, phytochemicals, anti-oxidants.• Calcium is lacking – new research indicates that people who get enough

calcium (1,200 mg a day) lose weight and maintain the weight loss. Supplements are not as effective. • Dehydration – carbs hold onto water, so when you don’t eat carbs, you

lose water weight. This can raise uric acid levels and cause gout, increase calcium loss through urine, and overwork your kidneys and liver. • Bowel obstructions and kidney failure

The Paleolithic (Paleo) Diet• Not created for weight loss• Allows only those foods that man ate when he first roamed the planet

millions of years ago.• Eliminates high-fat, high-sodium, high-sugar processed foods that have

little nutritional value. • Emphasizes lean proteins, fruits, and vegetables • Weight loss is the result of restricting food groups.

The Paleolithic (Paleo) DietFoods to eat on the Paleo Diet:• Lean cuts of beef, pork, and poultry,

preferably grass-fed, organic, or free-range.

• Game animals (quail, venison, bison).• Eggs (no more than six a week).• Fish and shellfish.• Fruit.• Non-starchy vegetables.• Nuts and seeds.• Olive oil, flaxseed oil, and walnut oil (in

moderation).

Foods to avoid on the Paleo Diet:• All dairy products.• Cereal grains (wheat, rye, rice, barley).• Legumes (beans, peanuts, peas).• Starchy vegetables (potatoes, sweet

potatoes, corn).• Sweets — all forms of candy, honey, sugar.• Soda and fruit juices.• Processed and cured meats, such as

bacon, deli meats, and hot dogs.

The Paleolithic (Paleo) Diet - Pros• Relatively healthy - focuses on lean meats and fruits and veggies (high in

fiber, vitamins, minerals, anti-oxidants).• The diet is simple. You eat the foods that are acceptable and avoid those

that are not — there’s no prepacked meal plan or diet cycles to stick to.• The diet also emphasizes exercise, which is an important part of a healthy

lifestyle and can further help with weight loss.

The Paleolithic (Paleo) Diet - Cons• It might get boring – most foods are eaten plain.• It can be expensive — organic foods and/or grass-fed beef, etc. cost more.• Eliminates healthy food groups unnecessarily (dairy, legumes, cereal

grains, starchy veggies)• low in certain nutrients (calcium).

• There’s no scientific proof that the Paleo diet prevents disease or facilitates weight loss.

The Ketogenic Diet• Not originally designed for weight loss• Created in the 1920’s and used until the development of anti-convulsant

medications• High-fat, adequate-protein, low-carbohydrate diet to treat epilepsy in

children.• 70% fat, 25% protein, and 5% carbohydrate.

The Ketogenic Diet

Do Not Eat• Grains• Sugar or sweeteners• Fruit• Tubers (potato, yams, etc.)

Do Eat• Meats – fish, beef, lamb, poultry, eggs• Leafy Greens• Above ground vegetables• High Fat Dairy –cheese, cream, butter• Nuts and seeds• Avocado and berries • Sweeteners – stevia, erythritol, monk

fruit, and other low carb sweeteners• Fats and oils

The Ketogenic Diet - Pros• Nearly half of children with epilepsy who tried some form of a ketogenic

diet saw the number of seizures drop by at about half, and the effect persists even after discontinuing the diet.

• Weight loss results are similar to an Atkin’s type diet• Very filling due to fat and protein = eat less• Lowered blood sugar levels may improve insulin sensitivity

Ketogenic Diet - Cons

• Constipation (affecting about 30% of patients)• Kidney stones• High fat – could potentially have a negative affect on cholesterol levels

and heart health• Excludes food groups necessary for growth and overall health (fruits,

veggies, whole grains)• Deficient in vitamins, minerals, fiber, and potentially protein

The Ketogenic Diet - Cons

• The ‘keto flu” • Poor energy and mental function• Increased hunger• Sleep issues• Digestive discomfort (nausea)• Decreased exercise performance.

The Mediterranean Diet• Heart-healthy diet based on typical intakes of people living in the

Mediterranean region (Greece, Italy, parts of France, etc.).• The diet emphasizes healthy fats, seafood, fruits, vegetables, whole

grains, nuts and legumes.• Low in red meat, and includes some dairy products (yogurt and cheese).• Red wine in moderation • Exercise is included• Discovered due to it’s heart healthy benefits, not necessarily it’s weight

loss or insulin moderating ability.

The Mediterranean Diet - Pros

• Easy to stick with - offers varied flavors and food options, and it covers all major food groups.• Heart healthy (low in saturated and trans fats, high in unsaturated fats)• Decreases the risk of heart attacks, strokes, certain cancers, Parkinson’s

and Alzheimer’s disease (high anti-oxidant content)• Improves glucose control

The Mediterranean Diet - Cons

• Does not include a lot of dairy products, other than some cheese and yogurt – may need to increase calcium intake.• Watch the wine – don’t drink more than 1-2 glasses per day (too much

alcohol is linked to breast, esophageal, oral, laryngeal, and liver cancers)• Watch the fat – it may be a healthy fat, but it is still calories • The ability to cook is preferred.• Too much garlic?!!

The DASH Diet (Dietary Approaches to Stop Hypertension)• Developed to lower blood pressure, not necessary for weight loss• Similar to Mediterranean Diet – except less fat, more dairy• Emphasizes fruits, vegetables, whole grains, nuts and seeds, legumes,

healthy fats, and low fat dairy• Low in red meat and processed, high sodium foods.• Also provides antioxidants that may help protect against certain

cancers, reduce the risk of strokes, heart attack, improve blood glucose.

The DASH Diet - Pros

• Well balanced and nutritionally adequate• Low in saturated fat and cholesterol• Moderate amount of protein (lean meat, poultry, fish, nuts, beans)• High in fiber/low glycemic• All foods can fit in moderation

The DASH Diet - Cons

• None?• Lots of fruits, veggies, unprocessed foods – expensive? May go bad if not

consumed?

The MIND Diet – Mediterranean-DASH Intervention for Neurodegenerative Delay

• Designed to promote a healthy mind and lower the risk of Alzheimer's disease. • A mash-up of the Mediterranean and DASH diets.

The MIND Diet – Mediterranean-DASH Intervention for Neurodegenerative Delay

10 foods to eat daily:• Vegetables (esp. green leafy ones)• Berries• Nuts• Beans• Wine• Whole grains• Fish• Poultry• Olive oil

5 foods to avoid:• Fried or fast food• Red meats• Cheeses• Butter and stick margarine• Pastries and sweets

The MIND Diet – Mediterranean-DASH Intervention for Neurodegenerative Delay

Diet Guidelines:• Get at least three servings of whole grains per day• Eat a salad each day• Eat one other vegetable every day• Drink a glass of wine each day• Snack almost every day on nuts• Eat beans every other day• Consume poultry and berries at least twice a week• Consume fish at least once a week• Unhealthy foods are allowed, but less than one serving per week• Less than 1 tablespoon a day of butter is allowed

The MIND Diet – Mediterranean-DASH Intervention for Neurodegenerative Delay - Pros

• Lowered the risk of Alzheimer's by about 53% in those who strictly followed the diet; 35% for those who followed the diet moderately.

• Weight loss, reduced blood pressure, improved blood glucose, and decreased risk of heart disease are other benefits of the diet

The MIND Diet – Mediterranean-DASH Intervention for Neurodegenerative Delay - Cons

• Potential risk: increased seafood consumption – increased mercury?• Wine daily – be cautious!

Intermittent Fasting

• Fasting may improve health by influencing circadian rhythms and other body systems. • Circadian rhythms (controlled by the hypothalamus) can be reset by

fasting.• Weight loss can result from calorie restriction and a temporary increase in

resting energy expenditure (REE). • During the first days of starvation, REE increases by about 5%.

Intermittent Fasting

“Fasting, as with any other lifestyle change, requires discipline, but reducing intake a few days per month may be more acceptable than chronic, [daily] calorie reduction.”

Two Options: 5:2 Fasting Regimen/Whole Day Fasting: 1-2 nonconsecutive days a week, eat only one meal, and the other five days eat normally

Extended Overnight Fasting/Time-restricted: Five days each week, don't eat between the hours of 6 PM and 10 AM.

Intermittent Fasting - Pros

Studies show that fasting may result in: • Weight loss• Decreases in body fat percentage• Lowered triglycerides and LDL cholesterol• Reduction in blood pressure• Can improve cells ability to remove damaged proteins and organelles

Intermittent Fasting - Cons

• Extreme hunger, headaches, and a possible drop in blood sugar.

• High ketone levels (ex: type 1 diabetes, DKA - life threatening).

• Get physician’s approval before starting, especially if there are any pre-existing health conditions

**The American Heart Association concluded that while there's evidence that both alternate-day and periodic fasting may be effective for short-term weight loss, there isn't enough evidence to determine whether it's effective long term.

So Which Diet Will Help You Lose Weight?

• It seems like there are as many ways to lose weight as there are people trying to lose it! • Named diets (Atkins, South Beach, Zone, Weight Watchers)• Generic diets (low fat, low carb, paleo)• Fad diets (grapefruits, cabbage soup, blood type)• Essentially, all of them work the same way: • decrease caloric intake = weight loss.

So Which Diet Will Help You Lose Weight?

So Which Diet Will Help You Lose Weight?

So Which Diet Will Help You Lose Weight?

• At 6 mon, the greatest weight loss occurred with low-carb (Atkins) at 22lb• At 1yr the weight loss for low-carb and low-fat diets is similar, about 16 lb.• Diets are hard to maintain

• The particular diet you choose is likely less important than choosing one you can actually stick to.

Conclusion

• Diet meals ‘way of life.’• Weight is just a number on a scale• Look at overall health• Can you maintain it? Do you enjoy it? • All foods can fit into a healthy ‘diet’

References• G. A. Colditz (2016). "Healthy diet in adults." UpToDate.

• R. Estruch et al. (2013). "Primary prevention of cardiovascular disease with a Mediterranean diet." The New England Journal of Medicine.

• L. Schwingshacki and G. Hoffman (2014). "Adherence to Mediterranean diet and risk of cancer: a systematic review and meta-analysis of observational studies." International Journal of Cancer.

• J. G. Mancini et al. (2016). "Systematic review of the Mediterranean diet for long-term weight loss." The American Journal of Medicine.

• Mediterranean Diet; American Heart Association.

• https://www.nutritioncaremanual.org/topic.cfm?ncm_toc_id=104997.

• Ostler. E (2014). “Which Diet Will Help You Lose the Most Weight.” https://fivethirtyeight.com/features/which-diet-will-help-you-lose-the-most-weight/. Accessed 1/17/17

• D. Webb (2018). “Fasting Regimens for Weight Loss.” Today’s Dietitian; Vol. 20, No. 2 Pg. 34. http://www.todaysdietitian.com/newarchives/0218p34.shtml. Accessed 5/14/18