I have had the opportunity to have another look at a very successful diet program recently. I will reflect on what have been the elements of that success, but, first the more important stuff.
Isabelle is thriving. She is all of 22 months now and still eating little in the way of carbs and virtually zero sugar. There are times that she might eat a strawberry or chew on a piece of apple but her food preferences are for protein and fat. We don’t limit fruit, it is just her preference. She has always been a chatterbox but recently she has begun to speak english. And, even at this early stage of language development, she is starting to tease her dad. We had a little incident a few weeks ago where a large latte was left on the roof of my freshly washed white car. Of course, as I began to drive it splashed all down the side leaving a mess not unlike that of a seagull in gastric distress. Everyone had a laugh at Dad’s expense, including Isabelle. From that point on she started to tease me with “car so bad”. From first thing in the morning to when I arrive home from work, her first words for me are “car so bad”, to which I reply, “nooo, daddy’s car is good”. She is a delightful little girl and cute as all get out, too. She brings a huge amount of joy into all our lives. And, she still has not had a fever or a rash. I am more convinced than ever that the absence of sugar has a huge positive impact on her immune system function. There has been scientific work in this area. Here are some references that I got from Barry Grove’s website (www.second-opinions.co.uk ) that make the case for increased starch and sugar consumption causing a significant reduction in the ability of immune system cells to neutralize bacteria:
Kijak E, Foust G, Steinman R.R. Relationship of Blood Sugar Level and Leukocytic Phagacytosis. South Calif Dent Assn 1964; 32: 349-351
Sanchez A, et al. Role of sugars in human neutrophilic phagocytosis. Am J Clin Nutr 1973; 26: 1180-84.
Ringsdorf WM jr, Cheraskin E and Ramsey RR jr. Sucrose, Neutrophilic Phagocytosis, and Resistance to Disease. Dent Surv 1976; 52: 46-48
I have just returned from a visit to two small towns in southern British Columbia, Midway and Grand Forks. Firstly, I have to say that this is a beautiful part of the country and is well worth a visit just for the surroundings. However, my time there was not for tourism but related to, what else, diet.
Something interesting is happening. You will recall that I was recently in Valemount, BC where Dr Stefan DuToit has been running a highly successful diet program for the local population (see my earlier post: Village(s) on a Diet). Although the diet he is using is more restrictive than what I would recommend in terms of calories and fat, and although it is not as low in carbs, his dieters routinely achieve significant weight loss and usually correct their metabolic problems while getting off their meds. I recall one gentlemen telling me he is saving $500 per month on meds. Another woman showed me her before photos and told me she had lost half her body weight. One of the most remarkable aspects of Dr. DuToit’s approach is that he gets very high rates of compliance on a diet that I think is not that easy to follow. In my discussions with other physicians and public health types about this, the common observations are that this is a flash in the pan, that it will prove to be unsustainable and that the initial success is likely due to Dr Du Toit’s charisma and is therefore not reproducible.
Well, it turns out that this may not be true at all. The longest running Valemount dieters are now at about 18 months. There has been some attrition but the majority appear to be sticking with it. We have been helping Dr DuToit manage the transition to a diet that will be sustainable for the long-term by adding fat back in once maximum weight loss has been achieved. He thinks this will be the key to long-term success. We will continue to monitor the data from his groups and, hopefully, will have something he can publish so that others can benefit, too.
In the meantime, however, some other sites have started using Dr DuToit’s diet and are also demonstrating excellent results. A group has started in McBride, BC, a small town about an hour’s drive from Valemount. The physician there tried the diet, lost weight and has now recruited a bunch of local people who are losing weight and getting off their meds just like their neighbours in Valemount. And, since then, another project has sprung up in Midway, BC, a southern town smaller than Valemount. In that case, a local public health nurse who learned about Dr DuToit from the CBC news coverage a few months ago, travelled up to Valemount to join one of his groups. Both she and her husband did very well on the diet and now she has started a group in Midway. This is not led by a physician but the local doc is open-minded and supportive. Again, the results are startlingly good.
What does all this mean? For starters, it means that there is some validity to the approach that goes beyond the effect of a charismatic doctor (not to suggest the doctors mentioned here are not charismatic; they are). It also means that the results are reproducible. Not only is this a model that can be implemented in a family practice setting by a doctor, it can also succeed when it is led by a non-physician. This is pretty exciting.
Until now, my physician colleagues have not had a stellar track record in terms of getting their patients to lose weight. I think this is largely because we haven’t developed a quick and ready approach that is amenable to the real-life realities of general practice medicine. If it were as simple as writing a prescription, they would be all over it. Since it is not, and since the failure rate of the currently accepted approach (eat less, exercise more) is so abysmal, I think it is completely understandable that my colleagues have, for the most part, abandoned the field. And this is why I think it is so fascinating to figure out what is the secret of the huge success of Dr DuToit’s approach.
We are hard at work analyzing the data but I don’t think that is where the answer necessarily lies. I think the initial diet is so significantly lower in carbohydrates that the subjects do benefit from de facto carb restriction more than the calorie restriction. And, you can restrict fat early on as you are burning off your stored body fat. So the diet he has been using, in the early stages, makes sense from a low-carb diet perspective even if it is not quite as low as I would recommend. In addition, however, I am very impressed with the effect of the group dynamics. He has his dieters meet together once a week for an hour. I have attended a couple of these sessions and they remind me a little of what an AA meeting might be like (I have never attended one of those). There appears to be something compelling to be part of, and accountable to, a group of others who are engaging in the same struggle. There has been research that supports this idea and certainly there are examples in the commercial diet industry that incorporate the concept of group support.
Having said that, there are other elements of this success that need to be considered. For instance, is there something unique about a small community that contributes to better compliance? As someone pointed out to me, “everybody knows your business”. Perhaps one is more determined to succeed if there is the perception that everyone is watching. If this is the case, the anonymity of a large city would make it easier to relapse. It would be interesting to test that idea (not that I need any more research questions at the moment).
I will continue to study Dr DuToit’s diet and perhaps we will eventually publish something. If he has solved the problem of what a physician in a general practice setting can do about reversing obesity, he will have done everyone a huge service. I will keep you posted as I find out more.
Nice to see you back Dr. Jay!
I’ve been on again off again low carb for the last 6 years. I’ve been able to maintain a 30lb loss, but I still have 50 more to go. I’m also hypothyroid, on synthyroid and Cytomel. When I stay strickly low carb I loose weight but very very slow. Do you think it would be better for me to eat low fat/low carb as in Dr DuToits diet? If so is there anyway to get any info on Dr DuToits diet?
Dr Jay’s Reply:
When you have hypothyroid problems, it can stall the weight loss a bit. I have heard that dessicated thyroid is sometimes better for some people but I do not have direct experience with this.
If you cut the fat you will drop the amount of calories you are eating and this may lead to more rapid weight loss. Or it may not and may lead to feelings of hunger and difficulty staying on the diet. One thing to keep in mind is that it is not just about weight. Your main goal should be to achieve and maintain healthy cardiometabolic markers – high HDL, low triglycerides, healthy ApoB, low CRP and a HbA1c in the 5’s if you are diabetic. Some people achieve this long before they shed all their excess fat and some will remain technically obese even though their markers have returned to normal healthy values.
Dr DuToit’s diet plan is not being made generally available. As I said in my post, I think a big part of its success lies in the group dynamics and mutual support from fellow dieters. If you are frustrated with the pace of your weight loss, even if you have really knuckled down and eliminated the carbs, you can try calorie restriction, as well, but that is a tough diet to maintain without the support of a group, IMHO.
If your markers are healthy and even if the weight loss is slow, take comfort in knowing that carb restriction is doing you a world of good and stick with it.
Thank you Dr Jay, your right I should be looking to have good health rather than just weight loss. Since starting low carb my blood work has always been very good. I’ll just have to accept the very slow weight loss.
Thanks, keep up the good work!
No doubt Dr DuToit’s plan is a step in the right direction and well received.
I don’t think anything is much possible without the addiction factor and the addiction approach, AA or otherwise, being dealt with.
I prefer individual or “open” group setting to deal with these addictions rather than the AA model simply because the AA “foundation”, is that we are unable to beat this addiction without resorting to a higher power. “God as you know him”.
I believe we are that higher power ourselves and that we can lick this addiction by first “acknowledging it” and then doing something about.
No different than the other drugs, as well as alcohol, caffeine, tobacco and gambling.
All genuine addictions.
Congratulations on your daughter and I’m sure wife. The best life has to offer, an immense gift.
My grandchildren are the same.
Can you imagine this little crown jewel bringing you babies like her in about fifteen years or so.
Paradise revisited.
They are my whole entire driving force as well as yours, I’m sure.
It’s too bad that everybody doesn’t know or care that everybody’s babies are as important to them and equally the same.
Best to you.
Tom
Dr Jay’s Reply:
There is some evidence that carbohydrates, especially sweets, have an addictive quality. It is an area that deserves more attention. So much to do and so little time!
If we were to discover two identical planets just like the earth in every way and very visible to us because they just magically appeared in the sky one day and were closer than the moon to us, so we could visit and walk around these earths because they are mirror images of our planet earth except that one had developed farming and hybreeding and processing of sugars and carbohydrates and alcohols and the other one didn’t..
That’s what you got going on here folks.
One is before white mans invasions and the other one, after!
A pristine earth.
I’ve been obese – and hungry all my life. As a child my weight equalled my age – luckily stopping when I was 16. Since then I’ve always hovered between 16 & 19 stone (224 & 266 lbs). I’ve been following low carb since the end of May and have lost 22 lbs – and not felt hungry – except at the proper times.
The weight isn’t coming off as fast as I’d like, but I do have other health problems. It’s a brilliant way of eating – thanks to you Dr J and Jimmy Moore for introducing me to it.
Presumably you saw the Lim & Hollingsworth paper on the ludicrous 600 kcal diet?
Strangely a lot of people seem to obtain the same results with the same sort of quantity of carbs only without cutting back on the fats and proteins. I’ve always been skinny, except for briefly while following a low fat high carb diet which really piled on the pounds, but I’ve always had the metabolic factors of an obese person (it’s familial).
Simply by eating the exact opposite of what I was told by the dietician I brought my BG into normal range, reduced my BP, doubled my HDL and reduced my trigs to 1/10 of what they were.
I never actually found it that difficult, except for eating out. I mean, you don’t have to eat those bland starches and you get to replace them with nice tasty things like meat, fish and veggies, what’s not to like?
It is a bit weird stuffing your face with Forbidden items like butter and cheese, but you soon get used to it. I’m privileged to live in an agricultural area near the coast so we get a lot of high quality local produce. We also have a lot of fit healthy elderly people. This is no coincidence. Someone should study what they eat “none of that low fat rubbish for a start!” as one told me, before they all die off due to a surfeit of carbs.
I’m glad the recent forum crap resulted in my finding your blog. I’ll add it to my list, er, eventually, I’ve been in read-only mode for a long time.
Possibly off-topic, but anyway – reading the current low-carb and paleo books, it would seem to be a slam dunk, closed case that Type2 diabetes is mostly a dietary phenomenon. So I wondered why, with all the (hundreds?) of millions being pumped into diabetes research, no one had done the science to “prove” this, it should be an easily proved/disproved hypothesis. Well, maybe this is it?
http://www.diabetologia-journal.org/Lim.pdf
Hi, Dr. Jay. I’m part of an active support group for Cushing’s Disease/Syndrome. I have had Cushing’s Disease for over 27 years, one pituitary tumor removal and 3 years later (last summer), a bilateral adrenalectomy to finally control it. I am 53 years old and used to be very slim. I put on quite a bit of weight during the years of Cushing’s with no one believing me about eating correctly except my immediate family members who saw that I did.
During the 90’s, I tried Dr. Atkins diet and actually gained weight. Of course, I gained weight on just about any diet at that time. However, my cholesterol and H1AC were excellent which is something most of us have difficulty controlling with this endocrine “malfunction”. I also have Hashimoto’s and am on large doses of thyroid hormones. Due to the tumor I was panhypopit except for excess ACTH prior to surgery and remain that way.
I have remained on a low-carb diet since that time, but not “no-carb”. Since my BLA a year ago, I’ve lost over 80 pounds, but I need to lose that much again. It is getting much harder. My question to you is “Do you think going no-carb will help?”
Thank you so much for your response.
Dr Jay’s Reply:
Your hormonal problems complicate things to a degree that I hesitate to offer specific dietary advice and it is my policy to avoid practicing medicine via the web. For those reasons, I cannot suggest what dietary course of action might serve you best.
Having said that, it is my opinion that in the usual course of events we have zero requirement for carbohydrates in our diet. Unless you have a disorder that prevents you from converting protein to glucose (gluconeogenesis) or from generating ketones from fat (ketogenesis), there is no reason to eat carbohydrates. Whether you have an impairment in these capacities is not something I can determine from the information available but I suspect you do not. If your liver can produce glucose and ketones, I would expect there would be no harm in severely restricting carbohydrates. As to whether this would produce the results you desire, I cannot say, unfortunately.
IMO there’s little doubt that current dietary dogmas are causal to a lot of metabolic derangement
http://high-fat-nutrition.blogspot.com/2009/02/cholesterol-presentation-between.html
demonstrates the lack of basis to low fat diets.
Genetics determine how each individual responds to the same environmental insult. When a thyroid or pituitary is broken the results may differ just as someone with a broken pancreas may become diabetic whereas someone with an intact one may “just” become fat and get CVD. Tweaking things to see what happens is really the only plan.
Dr Jay’s Reply:
Thanks for the helpful advice.