Dieting should be viewed as a way of life -- a pattern of eating for proper nourishment. Popular dietary lifestyles maintained for long periods of time include the Mediterranean Diet, Weight Watchers, vegetarianism, Jenny Craig, Ornish, Atkins, and the Paleolithic Diet.1
This column explores the likelihood of following a low-carbohydrate, high-protein approach for the long term. It is a common question patients ask of their healthcare providers.
Food contains three main types of carbohydrate: starches (also known as complex carbohydrates), sugars and fiber.2 Carbohydrates alone-not fat-increase body weight. Carbohydrates are rapidly digested and quickly converted to blood glucose. After carbohydrates are consumed, insulin is produced to manage the carbohydrates, and if excess carbohydrates are consumed, they are stored as fat.3
Once the body's cells have had their fill of glucose, the liver stores some of the excess for distribution between meals should blood glucose levels fall below a certain threshold. If there is leftover glucose beyond what the liver can hold, it can be turned into fat for long-term storage, so that none is wasted. When carbohydrates are scarce, the body runs mainly on fats. If energy needs exceed those provided by fats in the diet, the body liquidates some of its fat tissue for energy,4 and eating fat doesn't produce weight gain.5-7
Studies examining the effects of low-carbohydrate diet on weight loss and cardiovascular health and the effects of low-carbohydrate diet on type 2 diabetes conclude that the low-fat diet does not improve cardiovascular health.8-15 Evidence shows that the low-fat diet has no scientific support, while the low-carbohydrate diet improves both triglycerides and high-density lipoproteins.8-15
Maintenance of Control
In spite of the health benefits of the low-carb lifestyle,8 it is a challenge to maintain.16 Many overweight and obese people acknowledge that their carbohydrate eating habits meet most of the seven diagnostic criteria for substance dependence.17 Recovery and relapse occur, as with any addiction. Addiction to carbohydrates makes it more difficult to sustain the low-carb lifestyle compared to other dietary lifestyles, just as an alcoholic or drug addict struggles to stay sober.
Mechanisms of addiction have been extensively studied.18-21 According to Koob and Zorilla,20 addiction is a chronically relapsing disorder characterized by compulsion to take or use a substance as well as a loss of control in limiting intake.21
Some diagnostic criteria for substance dependence include the inability to abstain; use despite negative consequences; eating more for longer periods of time than anticipated; and avoiding social events where the food of choice will not be available (or more often when on a low-carbohydrate diet, apprehension about attending events where high-carb foods are the only foods available).22
SEE ALSO: T2DM Patients Ready to Reach A1C Target Faster
Additionally, pervasive advertisement of high-calorie foods, as well as advertisement of high-carbohydrate foods as healthy, makes it difficult to sustain a low-carb lifestyle. Further complicating patients' efforts is continuing promotion of a low-fat diet when science shows that only carbs are converted to fat, and fat doesn't metabolize to fat in the human body.
Resources are available to help patients maintain the low-carbohydrate lifestyle. Examples are Low-Carb Dieting for Dummies (For Dummies; 2003) and the website http://carbloaded.com/. Healthcare providers can gain expertise in this area by learning about metabolic coaching at cutthekillercarbs.com.
Additionally, help can be found through healthcare professionals and clinics that specialize in weight loss. Many such professionals are members of the Obesity Medicine Association. The organization's website is http://obesitymedicine.org/.
Cynthia Hodgins owns TLC Medical Weight Loss Clinic in Austin, Texas. Learn more at www.tlcweightlossclinic.com).
1. Top 10 Most Popular Alternative Dietary Lifestyles. http://nutritionsciencedegree.org/popular-alternative-dietary-lifestyles/
2. American Diabetes Association. Types of Carbohydrates. http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/understanding-carbohydrates/types-of-carbohydrates.html?referrer=https://www.google.com/
3. Groves B. Why Eating Too Many Carbs Makes You Fat. https://www.diabeteshealth.com/why-eating-too-many-carbs-makes-you-fat/
4. Gebel E. How the Body Uses Carbohydrates, Proteins, and Fats. http://www.diabetesforecast.org/2011/mar/how-the-body-uses-carbohydrates-proteins-and-fats.html?referrer=https://www.google.com/
5. Eenfeldt A. How Carbs Make You Fat. http://www.dietdoctor.com/how-carbs-make-you-fat
6. Taubes G. What really makes us fat? Article questions our understanding of the cause of obesity. http://www.sciencedaily.com/releases/2013/04/130416214734.htm
7. Voorhes A. Why Are We So Fat? The Multimillion-Dollar Scientific Quest to Find Out. http://www.wired.com/2014/08/what-makes-us-fat
8. Brehm B, et al. A randomized trial comparing a very low carbohydrate diet and a calorie-restricted low fat diet on body weight and cardiovascular risk factors in healthy women. J Endocrinol Metab. 2003;88(4):1617-1623. http://press.endocrine.org/doi/10.1210/jc.2002-021480?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed
9. Brinkworth G, et al. Long-term effects of a very-low-carbohydrate weight loss diet compared with an isocaloric low-fat diet after 12 mo. Am J Clin Nutr. 2009;90(1):23-32. http://ajcn.nutrition.org/content/90/1/23.long
10. Howard BV, et al. Low-fat dietary pattern and risk of cardiovascular disease: The Women's Health Initiative Randomized Controlled Dietary Modification Trial. JAMA. 2006;295(6):655-666.
11. Meckling K, et al. Comparison of a low-fat diet to a low-carbohydrate diet on weight loss, body composition, and risk factors for diabetes and cardiovascular disease in free-living, overweight men and women. J Clin Endocrinol Metab. 2004;89(6):2717-2723.
12. Volek J, et al. Comparison of energy-restricted very low-carbohydrate and low-fat diets on weight loss and body composition in overweight men and women. Nutr Metab. 2004;1(1):13.
13. Volek J, et al. Carbohydrate restriction has a more favorable impact on the metabolic syndrome than a low fat diet. Lipids. 2013;44(4):297-309.
14. Wadden T, et al. Four-year weight losses in the Look AHEAD Study: factors associated with long-term success. Obesity. 2011;19(10):1987-1998.
15. Yancy WS, et al. A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia: a randomized, controlled trial. Ann Intern Med. 2004;140(10):769-777.
16. Tate J. Treating overweight as carbohydrate addiction. Amer J Bariatr Med. 2010;25(2): 13-15.
17. Gearhardt AN, et al. Food Addiction: An examination of the diagnostic criteria for dependence. J Addict Med. 2009;3(1):1-7.
18. American Society of Addiction Medicine. Definition of Addiction. http://www.asam.org/for-the-public/definition-of-addiction
19. Heller R, Heller R. Carbohydrate Addiction Defined:What is it? Where does it come from? http://www.carbohydrateaddicts.com: http://www.carbohydrateaddicts.com/cadfnd.html
20. Koob G, Zorilla E. Neurobiological mechanisms of addiction on corticotropin-releasing factor. Curr Opin Investig Drugs. 2010;11(1):63-71.
21. Mathes W, et al. The biology of binge eating. Appetite. 2009;52(3):545-553.
22. American Psychiatric Publishing. Diagnostic and Statistical Manual of Psychiatric Disorders, Edition 5 (DSM-5). Feeding and Eating Disorders.