Tuesday, January 22, 2019

Sonoma Medicine

The magazine of the Sonoma County Medical Association

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The D-Diet

Sanjay Dhar, MD

There are several hundred different types of diets out there, so I figured why not add one more to the list, the Dhar Diet, or D-Diet. How difficult can it be to come up with a diet? All I need to do is read a few books, adopt some basic ideas, tweak the concept and present it with a new “designer” name.

Diets range from A (Atkins) to Z (Zone), and there is no shortage of advice regarding the different diet plans. You may decide to choose one and stick with it or seamlessly switch from one diet to another. However, with all the diets out there and the endless advice offered, why then are Americans getting heavier at a faster pace than ever before? It seems that it’s a never-ending battle between the food industry pushing processed products that make us gain weight, and the diet industry, which has convinced us that we can never be satisfied with the way we are.

Is the truth somewhere in between? We do know that both these sectors are reaping billions of dollars in profits. Let us also not forget the consumer, who is the most important member in this complex relationship. Ultimately we have to be responsible for our actions, even though we know that we live in a free country where we can eat and drink whatever we want.

As a cardiologist, I have been giving dietary advice to my patients over the last 25 years. Diets come in various shapes and forms, with each having a tailored approach or a certain niche. My focus has been on preventing and hopefully reversing heart disease. I try to evaluate dietary habits rather than just giving a blanket order to “lose weight.”

Patients often have difficulty following guidelines because of poor food labeling. The label on a jar of peanuts may report 200 calories, for example, but you have to read the fine print to realize that the calorie amount mentioned is per serving, and that there are several servings per package. Unless patients take the time to read the label in detail, they often consume many more calories in a single sitting than they think. (A cup of peanuts actually contains 830 calories). The same concept is also true for salt and corn syrup content in processed foods. Unfortunately, we don’t have a fuel-gauge sensor in our body that tells us to stop eating when we have reached sustenance levels in calorie intake.

Why do people diet? Most do so to lose weight, to jumpstart the summer season, or to keep up with their new year’s resolution. Some are forced to lose a lot of weight because they have become morbidly obese and it’s affecting their health. Some diet to help their medical conditions, such as diabetes, hypertension, heart disease, arthritis of lower extremity joints, swelling of legs, reduced aerobic and functional capacity, exertional shortness of breath, easy fatigability, sleep apnea and abnormal cholesterol panels, to name a few. Some people have to change their diet because they have developed food intolerances, whether it’s gluten, dairy, nuts or other food ingredients. Then there are some disease states that demand special attention to food choices, such as chronic kidney disease, gout or other metabolic conditions.

For my patients, I recommend a drawn-up plan, any plan that has a chance of being successful. Ultimately losing weight is simple mathematics: calories in vs. calories out … or is it? We know that under extreme starvation, everyone will lose weight. However, since starvation is not practical or sustainable, weight loss should occur without extreme effort or significant time consumption. A good diet plan should be effortless and simple and yet not boring.

Why do some people try their best and still not lose weight? The answer in part may be related to differences in metabolism. The difference might explain why two individuals eating the same food over a specified period of time may have major differences in either weight gain or weight loss. Currently we don’t have a method or an app that can tell us exactly what a particular individual requires for sustenance. During the Ice Age, our human ancestors ate only when hungry and often consumed no food for days at a time. It is thus surprising that some current diets advise 5-7 meals throughout the day. Perhaps thousands of years in future we will have undergone such tremendous genetic change that skipping breakfast and lunch might result in death by dinner.

Certain well-established programs, including a vegetarian diet, exercise and meditation, have been shown in studies to reduce arterial plaque. According to some people, however, eating cabbage soup three times a day might not be sustainable or make life worthwhile. The key to success for any diet is that it should be palatable, consist of locally available healthy food options (as opposed to hamburgers, pizza, etc.) and should not be time-consuming. Americans, for example, probably should not choose diets that require extracts from a rare Himalayan bush, seeds from an African fruit or South American root extract to help them lose weight. People from these regions may be of ideal weight in part because they consume these extracts, but perhaps more importantly because they don’t eat a typical American diet and don’t lead a typical American life.

Established and vetted diets are not without their uncertainties. Does a vegan diet make you less prone to heart attacks and cancer? Does changing to a gluten-free diet cure diabetes? If the Atkins diet reduces cholesterol and blood pressure, does it also reduce the risk of heart attacks? Controversies also result from diets that exclude essential nutrients, proteins, minerals and supplements. For example, some people swear by the Paleo diet. To them I say that we have left the Paleolithic ages far behind.

I would be remiss if I didn’t consider an alternative point of view with regard to obesity, encompassing both cost and health. Treating obesity costs money and takes a financial toll on healthcare utilization. But what about the cost incurred by our society trying to combat the obesity epidemic? What if the amount spent to combat obesity from all sources (consumers, healthcare providers, advertisers) is greater than the cost of treatment? What if, as some maintain, it is possible to stay obese and healthy at the same time? In that case, it may be better to let people be obese as long as they adopt healthy eating habits and lifestyle. As in the Lady Gaga song, maybe they were “Born this Way.”

Providers and corporations have a financial incentive to treat obesity, and they market this concept everywhere. There are billboards (10 days and 10 pounds or your money back) and TV programs (The Biggest Loser), along with ads of all kinds for gyms, diet plans, weight-loss centers, fat farms and so on. Some of them do present compelling messages, but some sound too good to be true. How can you lose weight by eating more? When all else fails, there is always bariatric surgery. Although complications are rare, mortality is not 0%, and some patients do end up having lifelong morbidities.

In a nutshell, it is for us as physicians to decide what is appropriate, how far to promote weight-loss strategies, and what reasonable goals are. It also is up to patients to find a mandate of their own choice and not be driven by outward pressure to look a certain way.

What we do know is that if you consume fresh fruits and vegetables (Mediterranean diet) and reduce intake of highly processed foods, deep-fried foods, artificial sweeteners, foods high in corn syrup, sodas, and saturated fats, you will most likely reduce the probability of becoming obese and/or developing chronic disease conditions linked to heart disease, diabetes and cancer.

So what is the D-Diet? It is simply an ideal diet (heart healthy), made fresh every day from local ingredients. It’s not a liquid diet and it doesn’t come in small containers, cans or cardboard boxes. It’s effortless to follow, quick and easy to make, and is loaded with all kinds of flavors, colors and textures to take you on a pleasing gastronomic cruise. It doesn’t affect your bodily systems in any way, and there are new food choices every day. There are no worries about how much to eat and when to eat. It doesn’t cost a whole paycheck. And by the way, I am still working on it.

Dr. Dhar is a Santa Rosa cardiologist.

Email: santarosadoc@aol.com

SONOMA MEDICINE | Spring 2014 | Sonoma County Medical Association

Emerging Concepts of Obesity
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