You can eat all you want and lose lots of weight
And tone up your muscles with machines that vibrate
And if you pay me by the 15th of June
I'll throw in a T-shirt and land on the moon
Who wants a deal? Who wants a deal?

Martin Collis from the song, "Who Wants A Deal?"

Recently the top spots of the New York Times best selling non-fiction books have been Pearl Harboured by books on professional wrestling and low carbohydrate diets. Although a case might be made that both categories above could also be listed in the fiction section. In North America, more books are sold relating to food and diet than sex, which gives us an idea of the importance associated with eating well and weight loss. There is certainly a need for some sort of caloric control as study after study informs us that Americans and Canadians have never been fatter. If you want to lose weight you can follow various paths, which go in radically different directions.

The Talking Heads did a song called "Too Much Information" and when it come to diets, vitamins, minerals, phytochemicals, eicosanoids, and calories, there is a Niagara of information that can overwhelm expert and layperson alike. Currently low carbohydrate diets are fashionable, but that will probably change. So which direction do we go if we want to eat well and lose weight?

• Low carbohydrate, with authors such as Dr. Atkins and Rachel and Richard Heller?
• Low fat, with Dean Ornish, Oprah, and McDougall?
• High protein, with Barry Sears and The Zone?
• The Goldilocks programs of Health Canada (not too much, not too little, etc.), and the USDA?
• A behaviour modification approach, to increase movement and decrease calories. Reflected in my own book "The Phacts of Life," where people are rewarded for small increases in activity and decreasing the intake of high calorie snacks?
• Prescribed food combinations as in Fit For Life and Suzanne Somers', "Eat Great, Lose Weight"?

There are plenty of choices.

One of the most useful newsletters to which I subscribe is called "Nutrition Action Health Letter", which is published by the Center for Science in the Public Interest. The current issue included an interview with Gerald Reaven M.D., who has served as the Director of the Division of Endocrinology and Metabolism at my alma mater Stanford University, where he is currently professor of medicine. Dr. Reaven has published over 500 scientific papers, and it is some of his research relating to insulin sensitivity that influenced the thinking behind books such as "Dr. Atkins' New Diet Revolution", "Protein Power", and "The Zone". Dr. Reaven feels his work has often been misinterpreted and has written his own book, "Syndrome X: Overcoming The Silent Killer That Can Give You A Heart Attack". He says, "I wrote this book because I got so upset about the misinformation in other books."

Here are a few of Dr. Reaven's responses in the Nutrition Action interview.^**

Causes of Insulin Resistance

Q: What causes insulin resistance?
A: We know that the ability of insulin to do its job varies about tenfold in healthy populations – not counting diabetics. Probably half of that is genetic. The other half – the other two major players – are how heavy you are and how fit you are. Obesity has been overplayed because most studies haven't taken into consideration that obese individuals are often sedentary. If you take objective measures of fitness versus obesity, you end up getting roughly equal impact. So maybe 20 to 25 per cent of your risk of insulin resistance depends on how heavy you are and maybe another 20 to 25 per cent depends on how fit you are.

Q: Does insulin resistance cause obesity, as many diet books claim?
A: Absolutely not. Years ago, we put people with different degrees of insulin resistance on dramatically different diets – in one study, carbohydrates were either 85 or 17 per cent of calories (J. Clin Invest, 45: 1648, 1966). The only thing that affected their weight was how many calories they ate. More recently, we've published long-term studies showing that weight gain is unrelated to how insulin-resistant people were when the studies began (J. Clin. Endocrin. Metab. 83:3498, 1998). And weight loss with low-calorie diets is also unrelated to the degree of insulin resistance (J. Crin. Endocrin. Metab. 84: 578, 1999).

Q: Would you expect it to?
A: No. If you think about it, the notion that insulin resistance causes obesity in unreasonable. Insulin resistance means that insulin isn't acting correctly. So if you don't have enough insulin or if your cells aren't responding to insulin, you can't deposit glucose into cells. If anything, you would lose weight.

Q: Which lifestyle changes are most important?
A: The most powerful are how much you weigh and how fit you are. If you're insulin-resistant and overweight and you lose weight, you become less insulin-resistant. And you stay that way as long as you keep the weight off. The average overweight person would benefit by losing only ten or fifteen pounds.

Diet Books

Q: How does your diet compare to the Dr. Atkins diet?
A: The Atkins diet is dangerous because Atkins doesn't care how much saturated fat you eat. There's no doubt that the major determinant of LDL cholesterol – other than genes – is the amount of saturated fat in your diet. So it doesn't make much sense to have anybody eating large amounts of meat, cheese, butter, and other sources of saturated fat.

Q: What do you think about The Zone diet?
A: Carbs don't make you fat, and insulin doesn't make you fat, as the book claims. Calories make you fat. It's like a bankbook. It's a matter of how much you put in and how much you take out. The more you eat and the fewer calories you burn up, the heavier you'll get. The law of thermodynamics, to the best of my knowledge, hasn't been repealed recently. What's more, the physiology behind The Zone's good and bad eicosanoids has no scientific basis.

Q: How is your diet different from The Zone diet?
A: The fundamental difference is that we substitute unsaturated fat for the carbs you give up. The Zone substitutes protein for carbohydrate. That's inappropriate because protein stimulates insulin secretion, and the protein is often accompanied by saturated fat and cholesterol. Fat doesn't stimulate insulin secretion.

Q: What about a very-low-fat diet like Dean Ornish's?
A: Ornish's program puts people on a very-low-fat diet, but it also includes exercise and weight loss. So his diet lowers LDL and, if you get active and lose weight, it's going to improve insulin resistance. But I think people who are insulin-resistant would do even better if they exercised, lost weight, and followed my diet, because mine raises HDL and lowers triglycerides.

^**Copyright © 2000 Center For Science in the Public Interest. Reprinted/Adapted from Nutrition Action Health Letter (1875 Connecticut Ave., N.W., Suite 300, Washington, DC 20009-5728. $24.00 for 10 issues)

Few people calculate the percentage of calories they get from protein, carbs, or fat, but this chart should give you some idea of how several diets vary.

*This diet makes no specific recommendation; recommended menu plans were used to calculate proportions.
Source: Nutrition Action – Syndrome X: Overcoming the Silent Killer That Can Give You a Heart Attack

I don't know enough about eicosanoids to comment on that aspect of Barry Sears' writing in The Zone, but I do give him credit for some creative thinking and for doing some standardized research on the effectiveness of The Zone with diabetics and others. Of the various popular diet books I've read, I found this most interesting and thought provoking.

Dean Ornish deserves plenty of credit for his dietary suggestions which came out of his research into 'reversing heart disease' (the title of his best-selling book), and which form part of an overall lifestyle. It's a challenging diet, but it is measurably effective in weight loss and decreasing LDLs, and literally reversing heart disease.

At a conference titled "Living Well With Cancer" I attended this month, nutritionist Donna Weihorn of Wisconsin said that Suzanne Somers' best-selling book was essentially based on a scientific myth. I looked through "Eat Great, Lose Weight" in vain to find anything other than anecdotal evidence of its effectiveness. (eg. "Alan's daughter, Leslie, lost those last 10 'hard to lose' pounds on this program.")

Actually there are many similarities between Suzanne Somers' suggestions and those of Michael Montignac, the French guru who wrote "Eat Yourself Slim." If you'd like to see how someone fares on Montignac's diet, beginning March 20th, you can follow the progress of one Julia McKinnel at National Post Online . (I've just read the first 4 days of her reporting and I don't know how effective the diet will be, but her writing is certainly lightweight.)

In our instant culture, there is a tendency to look for the quick fix and the magic bullet. I can sometimes sense the resistance of an audience when I tell them that the key to weight control is calories in/calories out. "But what about the obesity gene?" I'm asked. Of course genetics is a factor, but I sometimes wonder what happened to the obesity gene in some developing countries I've visited. Recently in Bali, I saw little evidence of obesity among the population, which has a lot to do with the fact that the average caloric intake is 2,200 cals, and they live a lifestyle with plenty of caloric expenditure as a part of their activities of daily living.

It's like the story of the man hanging onto a branch above a chasm. He prays for help to his God and back comes God's answers. "Let go of the branch," to which the man says, "Is there anybody else up there?"

Is there another book? Another guru who will give me hope without asking me to exercise and modify my caloric intake? What about those fat burning pills I see on late-night infomercials?

I don't think for a moment that the government "experts" have all the answers. National dietary recommendations can be influenced by cultural, political, fiscal, and other factors. Breakthroughs come from independent thinkers who will always be criticized before they're accepted.

However, I think an author owes his/her readers more than speculation. What I look for when I study best selling diet books are some large number prospective studies, which document over a period of years the statistically significant improvement of participants compared with control subjects. Sounds boring, but if you really have a breakthrough diet surely you want to prove to the world how good it is by testing it scientifically and not by saying how Mrs. Conclusion of Moose Jaw lost 30 kg and won back the love of her husband.

So why do diet books continue to outsell all other self-help books? One reason, as I noted earlier, is that more than half the population is overweight. We are surrounded by tempting calories and can literally eat like the aristocracy of other eras, with food choices from all over the world. At the same time, we burn fewer and fewer calories in our activities of daily living, it's a toxic environment for weight control.

Not surprisingly we turn to people who promise us help. What a diet can do is provide structure in our often unstructured gastronomic lives. It is a map to guide our food choices. But we have to try and ensure that it's the appropriate map. You could become hopelessly lost in Seattle if you're trying to get around using a map of Vancouver. No matter how hard you try, you'll still get lost.

In my lectures, I tell people to "eat as though your life depended on it, because it does." Five of the top 10 causes of death in our culture are associated with diet. Surely your health, your appearance, and well-being are worth some time and thought on your part.

My suggestion for taking control is to create your own diet (way of living). You know your food preferences, budget, schedules, kitchen, weight, and weaknesses. Do some reading, being careful of anyone who promises a quick fix, and make your own map. Keep a journal, accept setbacks, and enjoy the journey. "Beer and franks with cheer and thanks. Beats sprouts and bread with fear and dread."

Reading

In the words of Susan Powter, "read everything." But if you don't have time, here's a few suggestions:

• Check your National publications, such as The Canada Food Guide and the USDA recommendations, with its Eating Right Food Pyramid. According to authors such as Ornish and McDougall, they suggest too much fat, especially in the form of dairy and meat. But they reflect some sort of consensus.
  
  
• The McDougall Plan – John McDougall M.D.
  Eat More, Weigh Less – Dean Ornish M.D.
  Choices for a Healthy Heart – Joe Piscatella
  The three authors above belong to the low-fat thinkers.
  
  
• Stop The Insanity! and Food – Susan Powter
  She's loud, has an odd haircut, but this woman has done her homework and has some excellent observations and practical tips.
  
  
• Negotiated Peace: How To Win The War Over Weight – Wayne Miller
  A good look at the psychological aspects of weight control.
  
  
• The Zone – Barry Sears
  I'm not Zoned Out myself, but know a number of people who are. Barry makes a lot of assertions and has some controversial interpretations of biochemistry, and it's an interesting read.
  
  
• Diet For a New America – John Robbins
  I like John Robbins who created this book on the Gulf Islands near Victoria. This is the strongest case for vegetarianism you will read.
  
  
• The New Nutrition – Michael Colgan
  Strongly worded, well referenced book by Dr. Colgan. Michael created the Colgan Institute of Nutritional Science in San Diego, but now works mostly on nearby Salt Spring Island. There must be something about these West Coast islands that attracts food conscious writers.
  
  
• The Phacts of Life – Martin Collis Ph.D.
  This is a behavior modification book that I wrote for the Federal Government. It works on the principle that little things mean a lot and provides numerous ways (for those who want to lose weight) to make a 250 calorie a day difference in their lives. (In old think this adds up to 1/2 lb per week or about 1 kilogram per month.)