DIETARY CHOICES FOR BETTER METABOLIC HEALTH AND WEIGHT CONTROL

Most people appreciate that an appropriate diet is crucial to developing a healthy eating pattern designed to lose and then maintain weight. Yet they can be confused about how to achieve that goal. Patients are often confronted with conflicting and confusing nutrition information from multiple sources, some of which offer dubious advice. Low carb, High Protein, South Beach, Atkins, 21-day, Lions and Tigers, and Bears, oh My!!! How do you make sense of it all?

Many nutritionists tells you to limit total fat content and/or total calories, with much less regard to the food source of the fat and calories. Yes it is easy to recommend calorie counting and restricting fat as “a one-size-fits-all” approach. However, in this oversimplified approach, they assume that dieting is merely an issue of willpower rather than paying attention to the science of physiology.

You have been told this before and know that this conventional focus on limiting calories and restricting fat has been unsuccessful at curbing the obesity, not just yours, but both in the United States and globally. Growing scientific evidence suggests that while calorie counting helps you lose weight in the short term, maintaining an ideal weight is an altogether different battle. The influence of dietary quality on glucose and insulin responses, brain reward and craving, the fat synthesis, adipocyte function, and possibly even metabolic rate are all too complicated that the “one-size-fits-all” to be successful.

In the long term, quality of the food you eat appears to drive both how much you need to eat and your energy level. Researchers now know that the percentage of calories from total protein, fat, or carbohydrate—is much less important than the types of foods containing these macronutrients. Minimally processed foods should be emphasized (eg, fruits, nuts, and seeds, non-starchy vegetables; legumes; whole grains; seafood; yogurt; and vegetable oils). Red meat consumption should be limited and processed meats, refined grains, and refined sugars should be avoided as much as possible.  For optimal results, replacing foods high in refined carbohydrates with foods rich in healthy fats and protein is a good simple rule of thumb. Such a diet is consistent with a high-fat, low-starch/low-sugar Mediterranean-type diet or, similarly, the high-fat DASH (Dietary Approaches to Stop Hypertension) diet. Originally designed to lower blood pressure, the DASH diet is also very effective for weight loss, lowering cholesterol, and managing or preventing diabetes. It was developed after research sponsored by U.S. National Institutes of Health (NIH), not by someone trying make a quick buck selling fad diets. The following picture, worth a thousand words is taken from the research articles published by the scholars who did the studies.

Another tool to help figure out this maze is the determination of glycemic index and glycemic load (see Image). Ideally, glucose from dietary starch and sugar should be released into the bloodstream slowly and steadily—as seen with foods having a low glycemic load. Patients with type 2 Diabetes and insulin-resistant patients may do especially well with a low refined carbohydrate/low glycemic load diet.

THE LOW-FAT VS LOW-CARB CONTROVERSY

For decades, low-fat diets have been the standard for weight reduction; indeed, fat reduction remains a major component. Yet lot of research has demonstrated that calorie-restricted, low-fat diets are not superior for weight loss when compared with low-carbohydrate, low-calorie diets, particularly for long-term maintenance of weight.

Given the overall CV and metabolic benefits of many foods rich in fat—such as nuts, fish, and oils from fruits (eg, olive, avocado), beans (eg, soybean, canola), and seeds (eg, safflower, grapeseed)—consuming a dietary pattern higher in healthy fats and lower in refined starch and sugars appears to be the most evidence-based option for both weight control and overall cardiometabolic health.

Such diets may prevent weight gain or even induce gradual loss of fat storing cells without intention for weight loss. For instance, a large randomized trial showed that diets high in fat from nuts and extra virgin olive oil in place of carbohydrate, demonstrated smaller waist circumference after 5 years even without any guidance or focus on weight loss.

Keep visiting us for discussion of the DASH diets, and what can you do to keep the weight loss for years after your treatment.

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