Succeeding at long-term weight management

Townsend Letter for Doctors and Patients, June, 2006 by Katherine Duff

Enhancing Low Carb Diets

by Stephen Holt MD

Wellness Publishing, 105 Lock Street, Suite 405, Enterprise Development Center, NJIT, Newark, New Jersey 07103 USA

Quality paperback, 210 pp, c. 2004, $19.95

There is a reason for the dieter's lament, "I've tried everything and nothing works," and "I lost weight but gained it all back." According to Stephen Holt, MD, in his book, Enhancing Low Carb Diets, every diet in the history of weight management has suffered from lack of effectiveness for long-term weight control. In this book, Holt offers his suggestions for breaking that chain of failure with a more global understanding of weight control and the metabolic factors that may be influencing it.

The metabolic factor affecting weight and health in many people is what is known as Syndrome X. This condition, which is marked by high blood pressure and high cholesterol, is the cause of insulin resistance. Insulin resistance is a consequence of excess consumption of refined carbohydrates, insufficient nutrition, lack of exercise, and genetic tendencies. The ingestion of too many refined carbohydrates causes a spike in glucose levels in the body, and this results in excess insulin, which then leads to major changes in the body's chemistry. The results of insulin run amok in the body are linked to some of our most prevalent diseases such as cardiovascular disease, Type 2 diabetes, and inflammatory diseases, to name just a few. Syndrome X places dieters in the middle of a vicious cycle that must be broken if there is any hope of long-term diet success. The way out of this cycle is through weight loss itself, not just reduction of carbohydrate intake.

To achieve weight loss, the author prefers the low-carbohydrate diet, specifically the Atkins Diet, but with modifications. One of those modifications centers on a better understanding of carbohydrates. Having witnessed his patients experience weight gain at six moths to a year, he has identified the point at which carbohydrates are reintroduced into the diet as the culprit. For patients with insulin resistance, this could be the point where the patient re-enters the cycle of excess insulin due to the resumption of eating simple sugars. Holt recommends the dieter learn the difference between good and bad carbohydrates, using the Glycemic Index. The Glycemic Index is the measure of food's ability to increase blood glucose levels. Foods lower on the index would be preferable for maintaining consistent insulin levels, whereas those high on the index would promote the cycle of insulin resistance. Consuming soluble fiber is another way to avoid the rapid rise in blood glucose.

Learning that all fats are not equal is another detour from the low-carbohydrate diets that do not attempt to limit saturated fats in the diet. The author makes the case for consuming less of those fats and more of the omega 3 and omega 6 fatty acids. Other general modifications to the low carbohydrate diet would include behavior modifications and dietary supplements. Behavior modifications should address eating disorders, exercise, and lifestyle changes.

Holt also has some blunt advice to dieters about believing in the fairy-tale diets that offer such gems as "eat anything you want and lose weight." He urges them to face the reality that calories do matter. The need for dietary supplements is discussed in terms of managing Syndrome X, obesity, and weight loss. The recommended supplements and their dosages appear on a list from a proprietary product Holt has found helpful.

The Atkins Diet serves as more than a basis for Holt's modified diet in this book. The author delves into the history of the Atkins Diet, the response from the medical/nutrition community, and the evolution of the diet itself. He lists the features of the diet that are unsatisfactory without the modifications he writes about in the book. Sometimes, though, the personal accounts of his disagreements with Dr. Atkins over the diet only serve as a distraction to the message in this book.

Enhancing Low Carb Diets has valuable information for the frustrated dieter, but the author's writing style often looses focus as he alternates between conveying information and proposing arguments to Dr. Atkins and others. In fact, tighter overall editing would have made reading this book a little more pleasurable.

review by Katherine Duff