The End of Dieting: How to Live for Life (11 page)

A person’s history of dieting and weight fluctuation not only leads to the accumulation of visceral fat, it may also change the type of fatty acids the body stores. Fad diets like the Paleo or Atkins diet, for instance,
often increase the amount of saturated fats in the body’s tissues, which raises your cholesterol and puts you more at risk for getting cancer.

We know this from animal experiments and human clinical trials. For example, one study put rats on a diet that caused them to lose weight and then regain the lost weight over and over. When the rats died, scientists examined the fatty acid composition of their tissues and found that the more times the rats lost and gained weight, the more saturated fats collected in their tissues. At the same time, their levels of the essential omega-3 fatty acid ALA decreased accordingly. What this means is the rats burned through their healthy essential fatty acids for energy but then couldn’t replace them once they put weight back on. Without enough ALA in our adipose tissue (literally, body fat), the higher saturated fats take over, which can lead to coronary heart disease. People with a history of weight cycling demonstrate similar problems. The fluctuation in weight lowers their high-density lipoprotein (HDL) (good cholesterol), raises their low-density lipoprotein (LDL) (bad cholesterol), and increases their risk of high blood pressure and the likelihood of triggering ischemic events, such as heart attacks and strokes.
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Weight gain is associated with high blood pressure, especially when the weight settles in as visceral fat. Not surprisingly, then, your blood pressure increases as your body mass index increases, even when you’re well within the normal BMI range for your particular height.
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A history of weight cycling also leads to higher fasting insulin levels. Insulin is the chief hormone responsible for increasing lipogenesis (fat storage), while simultaneously suppressing lipolysis (fat removal). For example, even as far back as 1932 a study showed that men with the longest history of weight fluctuations exhibited higher fasting insulin levels, even if their BMI was within the normal range for their height. If a man achieved a more favorable weight, his high fasting insulin level still increased, which put a tremendous amount of stress on the pancreas to balance out the increase in insulin—the
first step toward diabetes. The beta cells in the pancreas that produce insulin become overworked because they’re trying to keep up with the high insulin demands. Ongoing demand continuing for years causes these beta cells to fail more and more, which is when diabetes rears its ugly head.

Not only does weight cycling increase the risk of diabetes, it also lowers your good cholesterol and raises your bad cholesterol. And it raises your blood pressure in later life. A constant fluctuation in weight places significant stress on the entire cardiovascular system, increasing overall cardiovascular morbidity and premature death. Interestingly, the increased risk of cardiovascular disease isn’t limited to people who are overweight. Weight cycling has an equally adverse effect in people of normal weight too.

Every time you “diet” by eating a smaller number of calories than your body would normally require to maintain a favorable weight, your body activates the enzymes that promote fat storage that can make weight loss more difficult. Some of these enzymes include fatty acid synthase, acetyl-CoA-carboxylase, ATP citrate lyase, and glucose-6-phosphate dehydrogenase. When calories are scarce, the body holds on to calories in its tissues. Activity of these enzymes inhibits the loss of fat from the body, and once these enzymes get going, it takes a long time to slow them down. Which means that once you return to eating the appropriate number or, even worse, the same number of calories you were previously eating, your body is more prone to store these calories as fat, making it more likely that you’ll end up fatter than you were before you started to diet.

Self-Destruction Never Tasted So Good

Let’s take a closer look at the Dukan diet, one of the most dangerous—and popular—yo-yo diets ever devised. Another rehash of the Atkins and South Beach diets, Pierre Dukan’s book
The Dukan Diet
has sold
more than 7 million copies since its publication in France in 2000 (it was published in the United States in 2011). The fact that this dangerous diet, cycling a person in and out of
ketosis
, became so popular demonstrates profound nutritional confusion among our population and the need for tremendous education about dieting. The first step in this diet is cutting out carbohydrates completely and eating a diet of almost all animal products.

Like Atkins, the diet lets you lose weight quickly through episodic ketosis. When you go on a very-high-protein, severely carbohydrate-restricted diet, your body becomes starved for glucose, the fuel that typically runs your body’s cells and is the primary fuel for the brain. Ketosis is your body’s way of making up for this lack of fuel. Since the brain and other tissues aren’t getting sufficient glucose, the brain gradually accommodates to accept ketones as an emergency fuel. Ketones are a product of fat breakdown.

But ketosis doesn’t come without a price. It increases acids in your bloodstream and leaches calcium from your bones. And as these acids flood your body, your body burns through stored minerals in an attempt to stop or reduce the rising acidity in your blood. Then, to purge acid from your urine, your body excretes from your system even more calcium, as well as potassium and magnesium, which creates mineral deficiencies and electrolyte imbalances that can lead to cardiac arrhythmias, or irregular heartbeats. Episodic ketosis can also lead to kidney damage.
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High-protein, low-carbohydrate diets are also associated in scientific studies with increased risk of cardiovascular disease and premature death.
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More frightening is they may cause many more deaths than we know about. At the height of the Atkins craze, for instance, sudden cardiac death, which is generally caused by an irregular heartbeat, spiked dramatically in young women. Typically a danger to the middle-aged and elderly, sudden cardiac death increased by 30 percent in young women from 1990 to 2000, according to a report released by the CDC and
first reported at the American Heart Association’s Forty-First Annual Conference on Cardiovascular Disease Epidemiology and Prevention. This increase in death due to cardiac arrhythmia in young women is striking because it happened during a time when the overall risk of cardiac death was decreasing in our society. These unexplained anomalies could be the result of the popularity of diets that rely on high-protein ketosis. We saw similar problems related to the liquid protein fad in the 1970s.
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A striking example of this heightened risk of death was a medical journal report documenting the details of one of the many thousands of sudden cardiac deaths in young people, where the potential causative factors were never investigated and detailed like they were in this case:
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The medical journal report describes a sixteen-year-old girl who had sudden onset of cardiorespiratory arrest while at school. The investigators reported:

She had recently attempted weight loss using a low-carbohydrate/high-protein, calorie-restricted dietary regimen that she had initiated on her own. During resuscitation, severe hypokalemia (low potassium) was noted. At postmortem examination, no other causes for the cardiac arrest were identified. Laboratory evaluation during resuscitation revealed severe hypokalemia (low potassium). Other potential causes for the condition were ruled out by parental history, autopsy findings, and postmortem toxicology evaluation
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Bloom and Azar (published study) reported that postural hypotension can develop in subjects on low-carbohydrate diets. Using an isolated, perfused rat heart model, Russell and Taegtmeyer (published study) showed that the beating heart loses contractile function (more than 50 percent in sixty minutes) when oxidizing acetoacetate alone. Elevated levels of free fatty acids may promote both vascular thrombosis and cardiac arrhythmias. More importantly, deaths associated with other specialized diets have been reported. Our patient’s sudden onset of cardiorespiratory arrest occurred without an underlying cause identified by history or on postmortem examination. Initial electrocardiogram revealed ventricular fibrillation, an unusual presenting arrhythmia in a sixteen-year-old adolescent without underlying cardiac disease or electrolyte disturbance. When considering the potential causes of these electrolyte disturbances in an otherwise healthy female adolescent, questions arise regarding the potential role of the low-carbohydrate/high-protein diet compounded by a period of inadequate caloric intake and the resultant catabolic state
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That’s one serious side effect that we must consider as a strong possibility. Sudden death is obviously not the most common risk factor here. The most critical risk is the risk later in life of cancer from eating this way. However, are dieters warned about this potentially deadly risk from these popular diets? Imagine if they placed a sticker right across the front page of those books:

NEW YORK TIMES
BESTSELLER. OVER 5 MILLION SOLD. BE AWARE, THIS DIET MAY CAUSE CONSTIPATION, REFLUX, BONE LOSS, AND SUDDEN CARDIAC DEATH, AND IF YOU LIVE LONG ENOUGH, CANCER.

I guess there are no authorities looking to protect the public from diet books. Yet, these authors will claim their diet is healthful and safe from a two-year study with a relatively limited number of participants. This is demonstrative of one of the problems. People do not consider long-term effects of their actions and do not realize that looking at a study that lasts for one or two years is not sufficient to ascertain risks. It would take twenty to thirty years to see pertinent findings of increased risk of cancer.

When the atomic bomb was exploded in Hiroshima and Nagasaki, Japan, in the 1940s, it took forty years to see the peak in cancer occur
from that increased radiation exposure. In general, there is a significant lag time between cause and effect when we are looking at cancer. It takes many years of observation to state an intervention is safe. Even increased risks of heart disease generally would take many, many years to observe and document. Just viewing changes in lipid profile is not adequate, as that is merely one of many risk factors and promoters of atherosclerosis. The link between high-protein diets and breast cancer has not been investigated; however, the vast majority of the studies examining this issue conducted over longer periods of time show a clear link with higher meat consumption.
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To fully appreciate the link between diet and breast cancer, you have to examine early-life diets in detail, not later-life diet, right before the diagnosis is made. This is why epidemiologic studies show a strong relationship with animal products and cancer and cohort studies on later-life adults do not. For example, in the Shanghai Breast Cancer study, they compared the high vegetable and soy diet pattern to women eating a higher meat and sweet diet pattern and found a 60 percent increased risk of breast cancer in the meat and sweet diet group.
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The concern that this brings up is that many of these low-carb, high-protein dieters are younger and they are maintaining these extreme high-meat diets for many years.

Another serious concern I have regarding the Dukan diet and other similar diets that require you to cycle in and out of various levels of intensity with episodic ketosis is that they cycle fat as you progress through the different stages of the diet. You wind up losing subcutaneous fat and end up adding visceral fat to your body, where it gathers in and around your heart—the last place you want to store any kind of fat. These kinds of diets are dangerous to both your short-term and long-term health.

It’s important to remember, though, that you do need to keep your weight down. Losing weight, if done correctly, is not dangerous—as
long as you keep it off. Scientific research has shown again and again that overall and abdominal obesity are strongly associated with coronary heart disease, and the severity of heart disease correlates with the number of years a person remains obese. Every year a person is obese increases the risk of death.
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How
you lose weight is critical. Which brings us to the three basic principles of dieting:

1. If you lose weight, don’t gain it back.
   
2. If you change your diet, change it forever.
   
3. The longer you remain overweight, the higher your risk of heart disease and cancer.
   

Don’t make any changes to your diet that don’t support your long-term health, and don’t make any changes to your diet that you don’t believe you can maintain for the rest of your life
.

I have changed my diet too in recent years. In the past five years, for instance, I learned more about the disease-protective and immune-strengthening power of raw onion and cooked mushrooms, so I now eat more onions and mushrooms than I ever did before. I’ve never even liked raw onions as much as I do now, but you learn to like the foods you regularly eat. When you do something to benefit your long-term health, you do it for the long term. It’s not dieting; it’s eating for optimal health and for a more pleasurable life.

I’m lobbying for a diet change that is stable, not one that is in constant flux. Episodic periods of weight loss are unsustainable and too often result in binge eating or a gradual return to the SAD and its vicious cycle of food addiction, toxic hunger, and overeating.

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