The Diet Revolution

Copyright © 2007

 

 

All interventions to solve human problems are subject to the verdict of natural laws; dietary practices are no exception. If they should violate natural laws, either they would fail to deliver the promises, or they could backfire. During the first half of the 20th century, nutritionists were more concerned about malnutrition than about the sins of dietary excess. After World War II, however, a coronary heart disease epidemic swept across the U.S. "Middle-aged men, seemingly healthy, were dropping dead," wrote biochemist Ancel Keys of the University of Minnesota, who was among the first to suggest that dietary fats might be the cause. By 1952, Keys was arguing that Americans should reduce their fat intake to less than 30% of total calories. In the famous and very controversial Seven Countries Study, Keys and his colleagues reported that the amount of fat consumed seemed to be the salient difference between populations such as those in Japan and Crete that had little heart disease and those, as in Finland, that were plagued by it. Rates of cancer at various sites also differ enormously--up to 100-fold-in different populations. The rapid changes in rates of many of these diseases over time and studies that show increases in chronic disease rates among migrants from traditional to Westernized cultures demonstrate that relatively swift changes in disease rates cannot be attributed solely to genetic differences between populations. Instead, they are likely due to differences in lifestyle, of which dietary factors play a very important role (Rimm 04). In 1961, the Framingham Heart Study linked cholesterol levels to heart disease, and Keys made the cover of Time magazine. The American Heart Association (AHA) also began advocating low-fat diets as a prescription for men with high cholesterol levels (Taubes 01). The U.S. Department of Agriculture's (USDA) dietary guidelines and Food Guide Pyramid, which recommend 6 to 11 servings of bread, cereal, rice, and pasta daily, while fats and oils are to be used "sparingly", further shaped beliefs. As a result, during most of the past 30 years, the concept of eating healthy in America has become synonymous with avoiding dietary fat. The low-fat obsession spreads through multiple channels, while being continuously reinforced by physicians, nutritionists, journalists, health organizations, and consumer groups that refer to fat as the "greasy killer."

 

The fat-reduction gospel has encouraged a shift to low-fat but high-carb diets, which may actually be worse than high-fat diets. Since early 1970s, Americans' average fat intake has dropped from over 40% of total calories to 34%; average serum cholesterol levels have dropped too. But no compelling evidence suggests that these decreases have improved health. Although heart disease death rates have dropped--and public health officials insist low-fat diets are partly responsible--the incidence of heart disease does not seem to be declining, as would be expected if lower fat diets made a difference. This was the conclusion, for instance, of a 10-year study of heart disease mortality published in The New England Journal of Medicine in 1998, which suggested that death rates are declining largely because doctors are treating the disease more successfully. Meanwhile, obesity in America, which remained constant from the early 1960s through 1980, has surged upward since then--from 14% of the population to over 30% (Anon 04a). Diabetes has increased apace. A century ago type-2 diabetes was never seen in humans younger than 40 years. Even two decades ago it was routinely called "adult-onset diabetes." Today, physicians are seeing "adult" diabetes in 10-year-olds (Booth 05). Both obesity and diabetes increase heart disease risk, which could explain why heart disease incidence is not decreasing. In the latter half of last century, the developed world has become more affluent, food abundantly inexpensive, dietary carbohydrates more refined, and lifestyle more sedentary with the advent of widespread labor-saving mechanization and the TV, PC and Internet culture. The emphasis on low-fat has spurred the popularity of low-fat but high-carb eating, often over-sized too. Refined, high-GI carbs spike up insulin responses often and stress up the pancreas, especially when insulin resistance has become so prevalent. Cutting down on fat should help to cut down on calories, but high-GI carbs elicit low satiety and more hunger responses conducive to the over-consumption of food. Excessive calories accumulate as body fat. As a result, two-thirds of Americans are overweight or obese. Cardiovascular disease remains the top cause of death, accounting for 41% of all fatalities (O'Keefe 04). Given that 90% of diabetics are obese (Anon 98), and obesity has become an epidemic affecting psychological, physical, and social well-being, the widespread focus on obesity negatives has created a fertile breeding ground for an anti-thesis to the obesity-prone, low-fat, high-carb diet. Hence the world witnessed the shock of low-carbmania spearheaded by Dr. Robert Atkins and his diet that swept the obesity-plagued U.S. and Europe in the past few years.

 

Dr. Robert Atkins' rise and fall mirrored the general fear of obesity (with the concomitant risks of diabetes, heart disease, and low self-esteem), strong desire for good health and good looks (Hobsbawn-Smith 05), and ready willingness to buy into the promise of a painless, risk-free, magic bullet. He pioneered the low-carb Atkins Diet since the 1970s, considered rebellious and unorthodox by many scientists. Atkins followers are told they can lose weight by tucking into unlimited fatty meat, butter and other high-fat dairy products - items severely restricted in classic diets - provided they keep carbohydrates to initially less than 20 grams per day (Anon 04d). By spinning the USDA Food Guide Pyramid (Herbert 95) on its head and throwing the American Heart Association Dietary Guidelines (Brown 95) out the window, he almost single-handedly, with some help from celebrities and food companies jumping on his bandwagon (Anon 04c), discredited the low-fat regiment embraced for so long by food and nutritional professionals. In making low-fat products, many food makers pumped products with starch and sugar. But in the new-found low-carb world, it is insulin-spiking carbohydrates, starch and sugar included, that gets whipped. Almost everyone in carbohydrate-rich sectors like cereals, baked goods, juices, desserts, confectionery, and zero-fat "white foods" such as flour, rice, pasta and potatoes suffered (Reitman 04, Roberts Jr. 05). According to a survey of 1,182 people conducted in December 2003 for LowCarbiz, 8.3% of respondents said they were on low-carb diets and 20% said they were not on diets but had been cutting back on high-carb foods.

 

The promise of munching through so many once-forbidden things to lose weight fast has made the Atkins diet enormously successful (Anon 04c). Why Atkin's regimen apparently worked in rapid weight loss could be explained by reduced caloric intake, satiety of high-protein meals, and massive loss of body water. Looking closely at low-carb diets, Andrea Miller, a Canadian dietitian, discovered that in the initial phase they provide only 800 to 1,200 calories per day, while the typical adult woman eats 1,800 to 2,500 when not dieting. "The same weight loss would occur if we simply ate half of everything we normally eat," Miller says (MacKinnon 05). Limiting carbohydrates means fewer calories are consumed, which leads to weight loss. Eating lots of protein food, which tends to be high in fat too, makes people feel full so they may eat fewer calories overall (Daniels 04). And by lowering the intake of carbohydrate-rich foods such as breads and pastas, the body will begin to burn stored fat for energy -- a process called ketosis. Studies have shown that this type of diet does indeed result in fast and often significant weight loss. But "Ketosis is a toxic effect and that's why you have the rapid weight loss, because your body is purging a lot of water to get the toxins out -- up to 10 pounds initially," says Toronto food-trends expert Dana McCauley. "It's not a meaningful weight loss, and it's very hard on your body." (George 05). Also more danger comes because the process pulls calcium and potassium from the blood, very important electrolytes in regulating heartbeat. Leah McLaughlin, nutrition director for Fitness magazine, also explained: "When you're not eating carbs, the body pulls glycogen - a stored carbohydrate - out of your muscles to use as fuel. Every molecule of glycogen has 4 molecules of water attached to it. So when you first go on a diet like Atkins you lose weight quickly because you're pulling all this water out of the muscle cells. When you add carbs back, your body starts restoring glycogen, and you regain the water weight." (Leichman 05). Studies were conducted, by the Philadelphia Veteran Affairs Medical Centre and the University of Pennsylvania School of Medicine (published in the New England Journal of Medicine) to find out what happens to people who stay on Atkins-style diets for six months and for a year. In both studies, researchers found Atkins dieters lost more weight than low-fat dieters in the first six months. But over an extended period (a year), some people lost lots of weight, some lost a little and some actually gained. In other words, in the long haul, weight loss results were the same as for any traditional lower fat diet that calls for moderate eating.

 

If Atkins' effects were neutral on the weight-loss front, it negatively impacts the dieter's long-term health. Atkins' focus was a quick-fix way to help people lose weight, but he lost sight of the compatibility of his proposition with natural laws. In January 2001, the U.S. Department of Agriculture (USDA) released a report detailing that high-protein, low-carbohydrate diets are nutritionally inadequate and are low in micronutrients including magnesium, iron, zinc, calcium, and potassium. They are also deficient in vitamins A, E, B1, B6, vitamin D, and folate. These eating plans are low in fiber but high in saturated fat and cholesterol (Miller 02). An overly high protein intake may strain the kidneys' ability to deal with the extra load of waste products of protein metabolism. A 2002 Harvard study published in the Annals of Internal Medicine showed that 30% (489 of 1,624) of the women whose high-protein diets were monitored for 11 years showed some deterioration in their kidney function (Ho 03). Excessive protein intake also can boost uric acid production, which can cause gout and kidney stones (Daniels 04). Then negative publicity about the health of dieters surfaced and Atkins' reputation suffered (Fox 03).

 

Atkins' untimely death in April 2003, with rumors that he died of obesity-related heart disease, accentuated questions of safety in many-a-follower's mind (Lawrence 05). Specifically, half of the 801 adults surveyed in a national poll by the Dole Nutrition Institute say that no amount of weight loss from a low-carb diet is worth the potential negative health impact (Anon 04f). The report cited a variety of risks from the low-carb diets: high cholesterol, constipation, kidney stones and increased risks of some cancers. Other side effects mentioned in a survey published in The Lancet medical journal: headaches, fatigue and foul breath.

 

The Achilles' heel of the original Atkins diet, and paradoxically its differentiated selling point, is its condemnation of all carbs and condonement of saturated fat. Yet bad interventions that contravene natural laws lead to bad consequences. One of Atkins' rival diets that rides on a modified approach is Dr. Arthur Agatston's South Beach diet. Agatston is a cardiologist whose motivation was to improve the cholesterol and insulin levels of his patients who had heart disease. His diet teaches participants to rely on the right carbohydrates and the right fats - the good ones. He just couldn't conscience urging his at-risk patients to indulge in artery-clogging saturated fats such as butter, fatty steaks and Brie (Reitman 04). Rather than referring to his South Beach diet as "low-carb"--even though it is-- Agatston prefers to refer to "good carbs" (such as the ones that come from non-starchy vegetables, some fruits and beans) and "bad carbs" (those that come from flour, sugar and non-whole grains). Agatston credits Atkins with having the right idea--that high-glycemic carbohydrates, particularly refined sugar and flour--cause big swings in blood sugar that lead people to crave more carbohydrates, and lead them to eat more. Although data from long-term studies are lacking, short-term investigations indicate that consumption of low-glycemic-index (low-GI) carbs may delay the return of hunger and reduce subsequent energy intake relative to consumption of higher-GI carbohydrates (Roberts 03). In contrast, proteins and fats, according to Agatston, tend to keep diners more satisfied. As a result, participants lose weight, lower cholesterol, reduce risk of heart disease and diabetes, and eliminate cravings without feeling hungry. It sounds scientifically based, is rich in vegetables, fruits, whole grains, and lean protein, and doesn't omit any major food group (Anon 04h).

 

Agatston is good at borrowing ideas from the opposition, like discouraging high-glycemic fruit juice consumption as in Atkins, or encouraging moderate olive oil consumption like in the Mediterranean diet Also he touches the pleasure button, by encouraging followers to "Say Yes to Smart Dessert". Dessert and diets rarely go hand in hand, but Dr. Agatston cites that a big reason other diets fail is because they forbid sweet stuff. The key is to keep desserts sugar-free and under 100 calories. His diet is so easy to follow that you do not need to keep track of calories or portion control. (According to Dr. Agatston, "when you're eating the right things, portion control takes care of itself." In other words, once you start eating more protein and fewer carbs, you'll start to feel fuller faster and you will want to eat much less.) (Goober 04)

 

There is also a striking similarity between the much-hyped Mediterranean Diet and what is allowed on the South Beach menu (Reitman 04). The Mediterranean diet has been described as a model from a nutritional point of view due to the proportion in which it includes all the food groups (Ortega 04). There is, however, no standard Mediterranean diet, which varies from country to country bordering the Mediterranean and evolves over time. But it is generally defined as one rich in vegetables and fruits, whole grains, nuts, unsaturated vegetable oils and protein derived from fish, beans and chicken, not red meat (Brody 02). Ancel Keys sparked interest in the Mediterranean diet in his seven-country study including Crete and was one of the first to link high-fat diets to higher concentrations of blood cholesterol and a subsequent increased risk of heart disease. To help people reduce their risks for coronary heart disease, he wrote a cookbook in which he summarized his findings and provided advice for a healthy lifestyle. The Mediterranean diet of the 1960s was the prototype for the low-fat dietary guidance policy previously adopted in the U.S. because the Dietary Guidelines for Americans reflect the advice Keys outlined in his cookbook (Zizza 99). Although there were praises about the efficacy of the Mediterranean diet in improving healthy longevity and preventing metabolic syndrome (Nuttall 04), studies in Italy have revealed that an excess of energy intake, particularly from refined bread and pasta, can be an unfavorable feature of the Mediterranean diet with respect to colorectal cancer risk, especially for a sedentary lifestyle (Franceschi 99). In a study involving 6,000 people, those on the highest-percentile glycemic diets had almost double the colorectal cancer risk of those in the lowest percentiles (Anon 00).

 

The new food guidelines promulgated by the U.S. government in January 2005 actually incorporated many of the South Beach and Mediterranean diet ideas to help Americans lead a healthier lifestyle to respond to the phenomenal onslaught of obesity and diabetes. The Standard American Diet, nicknamed "SAD", must be revamped. Agatston did his part through a congressional testimony (Agatston 04), elucidating the etiology and remedy of the obesity and diabetes epidemic. He summarized the failure of the low-fat, high-carb experiment in 4 causes: First, the type of carbohydrate consumed in the low-fat countries was high in fiber and low in glycemic index while that adopted in the U.S.A. was low in fiber and high in glycemic index. Secondly, the consumption of unprecedented amounts of processed carbs produced swings in our blood sugars that resulted in frequent cravings, increased caloric intake, obesity, pre-diabetes and diabetes. Currently, over 40% of Americans over the age of 40 are pre-diabetic. Thirdly, because the animal protein in our diets is from corn-fed cattle and poultry that do not run free, it has high levels of saturated fat and insignificant levels of omega-3 healthy fat. Finally, in an attempt to lessen our intake of saturated fat, trans fats were developed and became ubiquitous in our commercial baked goods and in our fast foods. We now know that trans fats are worse than saturated fats for our waistlines and for our blood vessels. His prescriptions for counter-measures were straight-forward: Because counting calories alone could not work, carbohydrate choices are made on the basis of the glycemic index. His hypothesis was that, when proper food choices were made, hunger and cravings would diminish and fewer calories would be consumed. His clinical experience indicates that South Beach Diet can truly become a lifestyle. Weight loss can be sustained and symptoms of pre-diabetes and, often, of type-2 diabetes, can be reversed.

 

The new federal dietary guidelines put emphasis on counting calories (Layton 05) and call for lots more fruits, vegetables and whole grains and less saturated and trans fats, cholesterol, added sugars and salt. And they call for all Americans to exercise more (Anon 05d). The guidelines warn, "Major causes of morbidity and mortality in the United States are related to poor diet and a sedentary lifestyle. Some specific diseases linked to poor diet and physical inactivity include cardiovascular disease, type 2 diabetes, hypertension, osteoporosis, and certain cancers." But all is not perfect. The most obvious political posture was the position on glycemic index. The 13-member federal advisory panel advised that those considering dieting should not be distracted by a currently fashionable concept: the glycemic index. The index shows the speed at which foods are converted into sugars in the body. Carbohydrates are converted faster than proteins, and backers of high-protein diets and foods have promoted their products as having better scores on the index. Although some research has suggested a lower glycemic index indicates a lower risk of diabetes, the panel has concluded that the evidence is not solid enough to serve as a basis for eating plans (Anon 04g). The fact that the panel had to single out low-GI as a distractor meant one of two things. Either it saw low-GI as a competitive viable alternative to the new guidelines, or low-GI is too similar to the new guidelines. The latter is particularly plausible if we add the exercise component that is central to counteracting the sedentary habit of modern city folks. Both diet schemes emphasize essentially the same food choices and fiber sources, such as whole fruits and vegetables instead of juices, whole grains instead of refined white foods, low-fat instead of regular-fat dairy foods, going for fish and lean meats, and trimming saturated and trans fats. They sound like twin brothers carrying different names and each demanding the credit.

 

The updated guidelines, at 71 pages, offering 41 recommendations on what to eat and how often to exercise, can be intimidating to busy people (Curtis, M. C. 05). To common folks, the guidelines sound quite complicated and not easy to follow. Following the guidelines strictly takes a lot of time -- writing down everything we ate, figuring out cups and servings -- and exercising. And constantly calculating the nutritional content of meals takes a lot of the fun out of eating (Ness 05). The guidelines, transformed into the new food pyramid, could be even more problematic. The old food pyramid, despite taught in classrooms across the country, has done little to curb Americans' appetites. "It's become quite familiar," said Mike Johanns, USDA secretary, "but few Americans follow the recommendations." Now the new food pyramid is even less user-friendly than the old version. Unlike the original pyramid, health officials say that its meaning is not immediately understood (Anon 05bd). That really puts a limit on its ultimate usefulness in inspiring action. "To know and not to do, is really not to know." (Covey 04).

 

The glycemic approach, on the other hand, has the advantage of relative simplicity, and the GI table is an easy-to-understand-and-follow objective standard. It is a much more marketable and user-friendly guide because low-GI provides a common thread to tie eating activities firmly to a position in the consumer's mind. It does not contradict the U.S. new food guidelines, is compatible with a high variety of food choices for nutrients and antioxidants, and yet provides an actionable single-minded message for consumers to develop healthier habits. In its annual report on "What American Eats", Parade magazine (New York) found that, while carbohydrate-cutting diets may be fading, consumers have learned important lessons from Atkins' inspirations. For that matter, more than a third (38%) of Americans say that "reducing carb" is a permanent change in their eating habits. Moreover, U.S. consumers are paying more attention to total fat and saturated fat, 45% have reduced portion sizes in their meals, 40% are eating low-fat foods, and 31% are reducing overall calories--despite the fact that only one in five Americans is dieting to lose weight, a decrease from the one in three in 2004's survey (Anon 05c). Perhaps the message is getting across that healthy eating is preferable to fad dieting, which, like Atkins, may not be compatible with health, and which, once stopped, reverses the weight loss. According to the USB 11th consumer attitude survey (USB 05), in regard to dieting, only 17% said they participated in a weight loss program, while 51% looked for foods low in carbs. Nothing beats actual consumer behavior. ACNielsen says that the dollar sales of fresh potatoes, instant rice, orange juice, white bread and cereal have dropped. It's not only perennial dieters who are cutting back on carbs. Many people who aren't overweight have been incorporating low-carb eating habits, forgoing bread, pasta and potatoes for more protein, olive oils, beans and nuts (Reitman 04). Cookie sales were down 3.5% in 2004. It's not that people don't love cookies. Many worry more about what's in cookies. They don't like the carbs, sugar, and trans fats. Dieters worldwide are moving toward a more moderate lifestyle that is easy to maintain. According to David Jago, director of Mintel's Global New Products Database (GNPD), the Glycemic Index, which has already gained much favor in Australia and UK, appears to be the answer to the consumer demand for a more 'moderate' approach to diet. Germany is set to be the next biggest market, suggests Jago (Anon 05b). So after the low-fat thesis and low-carb antithesis, the low-glycemic synthesis has evolved as a paradigm moving towards global consensus to guide food choices compatible with a healthy lifestyle and our genetic predisposition. Between the low-carb and non-low-carb camps, once we shift the focus away from reducing or allowing carbs to low glycemic and good carbs, we remove much of the controversy and begin to see the light of consensus.

 

Adopting a diet, changing a lifestyle, or following an exercise program is like an intervention testing natural law. Whether the intervention is compatible with natural law or not, the results will speak for themselves. Obviously a super-sized, high-or low-fat, high refined carbohydrate, low-fiber, high-glycemic diet as part of a sedentary lifestyle is not compatible with the natural law governing good health and weight control. Neither is a high-fat, high-protein, low-carb, low-fiber diet in the same lifestyle context a panacea for healthy weight loss. In fact it can backfire so badly as to cause regrettable health troubles. The type of intervention that holds the most promise, so far not implicated in any negative news, is the low-glycemic approach first introduced by Dr. David Jenkins, MD, professor of nutrition at the University of Toronto in 1981. Supported by common-sense moderation (which limits calories) and an active lifestyle, it appears compatible with the goals of good health and weight control in the modern era. This era of low physical activity and high-calorie, high-glycemic food (super-sized fast food in particular) has sneaked upon us and is spreading a worldwide epidemic of obesity, diabetes, cancer and heart disease in post-industrial, industrialized and industrializing economies. The time for a paradigm shift in lifestyle is long overdue.

 

The glycemic index (GI) was initially designed to help diabetics manage their insulin response to foods. At that time, the diet for people with diabetes was based on a system of carbohydrate exchanges or portions, which was complicated and not very logical, being based on the assumption that all starchy foods produce the same effect on blood sugar levels. Jenkins was one of the first researchers to question this assumption and to investigate how real foods behave in the bodies of real people (Brand-Miller 04). Now the influence of GI extends far beyond diabetic management. Research published in Nutrition Review in May 2003 suggests that low-GI diets may also protect against colon and breast cancers. Harvard University's Nurses Health Study, reported in the June 2000 issue of The American Journal of Clinical Nutrition, provides the best evidence to support the role of the glycemic index in heart disease. This ongoing study of more than 65,000 nurses showed that those who ate more high-GI foods had nearly twice the risk of having a heart attack over a 10-year period compared to those who followed low-GI diets. And a low-GI regimen helps people drop pounds. High-GI meals cause such a flood of insulin to cope with all the glucose that blood sugar levels wind up lower than if you'd never eaten. And low blood sugar may send out hunger alarms. In one study, overweight children (average age 10) at Children's Hospital in Boston spent 4 months on either a low-GI diet or a low-fat diet of equal calories. The clear winner was the low-GI diet, with an average weight loss of 4.5 lb compared to 2.8 lb on the low-fat diet (Jibrin 01). "Following the glycemic index is about maintaining your energy level, controlling your hunger and, most importantly, staying-or getting-healthy," says Thomas Wolever, who understudied Jenkins in Toronto (Tunick 04). The glycemic index system for rating carbs sounds complicated, but it isn't. What it is, some health experts believe, is the most exciting nutrition breakthrough on the horizon (Jibrin 01). The biggest surprise of all seems to be that the glycemic index may offer dramatic health benefits not just for diabetics but for almost everyone. The glycemic index (GI) assigns carbohydrate-containing foods a number based on how they affect your blood sugar, or blood glucose, after you eat them. Foods with a GI less than 55 cause only a little blip in blood sugar; those in the 55 to 70 range raise it a little higher; and carbs with GIs more than 70 send blood sugar soaring. We're learning that low-GI carbs are healthy; high-GI carbs, in excess, are not. The longer your body has to wrestle with the carb to break it down into glucose, the slower the rise in blood glucose and the lower the GI. Dr. Simin Liu, M.D., director of nutrition research and assistant professor of medicine at Harvard Medical School, believes that there are just two basic ideas we need to remember. First, carbohydrates, such as potatoes, white bread, white rice and other refined or highly starchy foods register highest on the glycemic index. So eat these sparingly. Opt for their whole-grain counterparts instead, like whole-wheat bread and brown rice. Second, rely on fruits, legumes and vegetables for the greater part of your carbohydrate intake. Although the glycemic numbers among fruits and vegetables vary, most are at the lower end of the scale. Fruits, vegetables and whole grains simply supply more vitamins, minerals, phytochemicals and fiber that contribute to heart health. Following a GI chart actually gives people a feeling of control, feeling good even though they are voluntarily foregoing some choices. It is similar to a moral sense of making sacrifices to do good, not evil. Some educated common sense, though, is in place to help better grasp GI impact. Often, fiber-rich foods have lower GIs. Fiber, especially the soluble type in oats and beans, creates a web in the intestines that traps carb particles. Not surprisingly, beans have low GI numbers. The miracle food, soybean, for example, has a GI value of 15, relative to glucose's 100. But when fiber is ground finely as it often is in whole-wheat flour, it doesn't present enough of a digestive challenge to lower the GI of these foods. That explains why whole-wheat bread has a GI number nearly identical to white bread. But whole-wheat bread is still a healthier choice than white bread because of its extra fiber and other nutrients. The GI of bananas increases with ripeness, and that of rice increases inversely with grain length (short grain higher in GI than long grain). Also, some foods with high GIs are worth eating because they are rich in nutrients--carrots, for example. Besides, there are only so many carrots one can consume in a sitting. Whereas some foods with low GIs are bad choices because they are high in fat and low in nutrients, such as pork rind and side bacon. And low GI may not be appropriate under all circumstances for everyone. Someone who needs quick energy or replenishment immediately before or after exercise may want to opt for high GI input, although you have greater endurance when you exercise, say 2 hours after a low-GI meal compared to a high-GI meal (Jibrin 01). The glycemic load (GL) is another concept to help GI decisions and resolve dilemmas when they arise. It is defined as the food's GI multiplied by the grams of carbohydrates per serving of the food, and dividing by 100. Under the GL system the "avoid" foods score 16 and over, while the "eat all you want" are 10 and below (Burne 05). Yet GL is counter-habit because few people will actually physically measure how much of a food they have consumed. Brian Wansink, director of the Food and Brand Lab at the University of Illinois, observed that many of us are reasonably diligent about what we eat but we don't put that much thought into how much we eat. People may decide to eat Chinese food instead of pizza or fruit instead of potato chips because they're healthier. But once they make that initial choice, they tend to not monitor how much they eat (Wansink 04). GL also involves more work than GI because it entails calculations that consider serving sizes, which can also be arbitrary. Some nutritionists argue that GL is an improvement over the GI, because it provides an estimate of both the amount (the serving size) and the quality of carbohydrate (its GI value). Why not consider only the glycemic load of a food when making food choices? If you consider only the GL, you may end up eating a diet with very little carbohydrate, but lots of fat, especially saturated fat, which is not heart-friendly, and excessive amount of protein, which is not kidney-friendly--essentially, you'd be eliminating most carb foods from your diet, which is not recommendable. The low risk of disease associated with the lowest glycemic load, evidently supported by large, long-term studies out of Harvard University, was associated with the consumption of low-GI foods--not with a low-carbohydrate intake.

 

People in modern societies are living with a genes-lifestyle gap. Human have come a long way since prehistoric days of hunting and gathering. But about 99% of our genome was defined long before our forebears evolved into Homo sapiens some 50,000 years ago. Our genes are still equipped for the Ice Ages, not the current warm period in which agriculture dominates. During the past 2 million years of human evolution--except for the last 10,000 years when agriculture was developing--we have been hunter-gatherers rather than farmers. Prehistoric hunting for meat and foraging for vegetables may well have provided the optimum exercise and dietary regime for human survival! Although the Paleolithic diet was more protein- than carbohydrate-based, the protein came from lean meats and legumes, and the carbohydrates were unrefined, so these diets most probably had low GI values. Unlike the saturated-fat-laden grain-fed livestock that provides the meats that we eat today, game meat was low in saturated fat and had a good balance of omega-3 to omega-6 fatty acids to suggest favorable blood cholesterol and lipid profiles. And before the agricultural age, carbohydrates were derived almost exclusively from nuts, legumes, fruits and vegetables, which would have had low GI values too. The industrial revolution changed the quality of dietary carbohydrate. The milling of cereals made starch more digestible and postprandial insulin responses increased 2-3 fold compared with coarsely ground flour or whole grains (Colagiuri 02). Carbohydrate stimulates the pancreatic secretion of insulin more than any other component of food. The slow absorption of the low-GI carbs in our food means that the pancreas doesn't have to work as hard, so it needs to produce less insulin. If the pancreas is overstimulated over a long period of time, it may become "exhausted", and genetically susceptible people may develop type-2 diabetes. The better controlled our blood-sugar levels, the less likely we are to experience reactive hypoglycemia (and hunger response) -when blood-sugar levels fall below normal after a high GI food hit has produced a lot of insulin. Insulin also promotes the storage, in fat cells, of fatty acids from the blood, so overloading on "bad" carbs can lead to weight gain not needed in times of abundance (Clarke 05). U.S. and Korean researchers who tracked over 1 million Koreans for a decade showed that high blood sugar levels could be a risk factor in developing several types of cancer. The group with the highest fasting glucose levels (greater than 140 mg/dL) had higher death rates from all cancers combined (Anon 05a). In addition, increasing evidence indicates that variations in the levels of insulin and insulin-like growth factors could account for many risk factors of colon cancer and for its high incidence in Western countries (Giovannucci 01). Indeed, our ancestors would have had low rates of diabetes and colon cancer. In contrast, Native Americans, who have gone directly from hunter-gatherer low-glycemic diets to present-day high-glycemic meals, currently suffer high rates of diabetes and heart disease (Brand-Miller 04). Statistics show that Native Americans, with a 15% diabetic rate (more than double the current U.S. rate) are 420% more likely to die from diabetes than the rest of the U.S. population (Anon 05h). The "problem" in such individuals is their genetic structure, with a "thrifty gene" or "fat gene" responsible for insulin resistance, which was a double-edged sword. Insulin resistance means the liver makes more sugar from protein, the muscles use less glucose for immediate energy and store less glucose as glycogen. But the persistently high level of circulating insulin also maximizes the storage of excess energy as fat (Anthony 04). Insulin resistance is a survival mechanism that conveys an advantage to the bearer when food, especially carbohydrates, are scarce. But today, food, particularly refined carbs, is abundant and inexpensive. For example, Brazil can produce sugar at 4 cents U.S. a pound, so that US$1 can make almost 50,000 kilocalories! (Brody 05). However, it becomes a killer liability when we get hooked on high-GI foods, because our fat-making machinery has already been built in place (Jeejeebhoy 00). Leading a sedentary lifestyle in our high-GI environment, our genes-lifestyle mismatch easily overtaxes our pancreatic insulin capacity. In 1985, around 30 million people worldwide had diabetes. But today in Europe alone, 48 million people--7.8% of the population--are living with it. In Singapore, the number of diabetic adults has risen 5 times from 2% to 10% over the last 20 years (Anon 03b). Diabetes is the 4th main cause of death in developed countries, the leading cause of blindness and the most common cause of amputation. It greatly increases the risk of suffering a heart attack, a stroke, or kidney disease. And the fact that more and more children are getting "adult-onset" type-2 diabetes is a grave warning sign that the modern lifestyle is, in some way, terribly wrong (Gorman 04). Over the last 50 years, the explosion of convenience and takeaway 'fast foods' has exposed most populations to caloric intakes far in excess of daily energy requirements and the resulting obesity has been a major factor in increasing the prevalence of insulin resistance (Colagiuri 02). Obesity is characterized by a chronic, systemic low-grade state of inflammation (Lee 05). Fat tissues produce pro-inflammatory markers that predict type-2 diabetes and cardiovascular disease (Tallmadge 05). Compound that with the frequent intake of ubiquitous trans fats, no wonder we are seeing the current epidemic of diabetes, obesity and heart disease.

 

Living organisms thrive best in the environment and on the diet to which they were evolutionarily adapted; this is a fundamental axiom of biology. When former hunter-gatherers adopt Western lifestyles, obesity, type-2 diabetes, atherosclerosis, and other diseases of civilization become commonplace. At least for today, the genes we are born with are those that we will live and die with. Thus, the most practical solution for reducing the incidence of chronic degenerative diseases such as atherosclerosis is to realign our current maladaptive diet and lifestyle to simulate the milieu for which we are genetically designed (O'Keefe 04). The hunter-gatherer diet and lifestyle are the milieu for which we remain genetically adapted. This in part accounts for the success of the Atkins diet in inducing weight loss, but its high levels of saturated fat, low levels of fiber and antioxidants, and the stress on kidneys make this a suboptimal eating style. A growing consensus indicates that a diet containing moderate amounts of beneficial fat and protein in addition to carbs coming from low-GI foods in conjunction with daily exercise is the most effective way to achieve and maintain ideal body weight and prevent heart disease. This approach mimics the eating pattern and lifestyle of prehistoric humans. Such a diet does not peak insulin levels, which, in turn, assists in control of tissue inflammation believed to be related to Western diseases such as cardiovascular, arthritis, Alzheimer's and type-2 diabetes (O'Donnell 05). And Rick Gallop, author of "The G.I.: Glycemic Index Diet" and "Living the G.I. Diet", has made such an approach actionable, simple to follow and easy to stick to for life.

 

According to Rick Gallop, a 68-year-old Canadian and past president of the Heart and Stroke Foundation of Ontario, Canada, diet programs like Atkins, the Zone, South Beach, Weight Watchers, and Jenny Craig don't work long-term for many people (Fiedelholtz 04). "Anyone can lose weight on a fad diet, but the difficulty is maintaining the weight loss," Gallop says. "People fail on diets for two reasons: One, they feel hungry and food-deprived. Two, the diets are too complicated." For example, a study, reported in the Journal of American Medical Association (JAMA), randomly assigned 160 participants to 4 popular diets on the market: Atkins, Ornish, Weight Watchers or the Zone diet. The Atkins diet restricts carbohydrates, the Ornish diet restricts fat, Weight Watchers restricts portions and the Zone restricts balance of carbohydrates, protein and fat. Only half of the participants who started the study were still attempting to follow their diet at one year. Those who dropped out complained the diets were too restrictive or too hard to follow (Smith 05). Gallop said our obsession with the latest diet is because of a fundamental misunderstanding. "Diet really means a way of eating. When people are eating to lose weight that is the weight-loss phase. After they've been successful, they then create a diet that allows them to maintain the loss," he adds. "If you can understand a traffic light," the cover of his diet book boasts, "you'll understand this diet." "Red-light foods - don't eat those if you want to lose weight." "Yellow-light foods - only eat those once you've gotten to your desired weight level." "Green-light foods - eat as much as you like." Atkins bacon or the South Beach eggs all hit a "red light" with Gallop. But he does allow lean meats and whole-grain breads, pastas and oatmeal; rice (not white); low-fat dairy; and lots of fruit. And, of course, most vegetables - even carrots - get a green light. When you get right down to it, much of the GI Diet sounds suspiciously - and reassuringly - like common-sense nutritional advice. But that is exactly why it is suited for the job of synthesis, after the low-fat thesis and low-carb antithesis, having the ability to provide a variety of choices while resolving differences of opposing views in a common-sense way. Gallop's formula for what makes a food good or bad is more complex than in many popular diets. For example, it distinguishes between good and bad carbs, between good and bad fats (saturated and trans fats). But his strength is that he assigns most foods a color, removing guesswork and counting. The book has been a best-seller in Canada, where it was published in 2002, and England, where it appeared in 2003. It was published in the U.S. in 2004 and made the New York Times expanded miscellaneous best-seller list. (Parks 04).

 

Gallop understood the critical nature of adherence, and made the GI Diet successful by boiling things down to the core principle (low-GI and low-calorie, which automatically point to high-fiber and low-fat), making food selection simple to follow (traffic light system), and still allowing a wide choice to defeat monotony (lenient on whole foods with fiber). We may even include some high GI foods if we eat a mixed meal with substantial protein and some good-fats, or with substantial fiber component, to delay stomach emptying. Both approaches reduce glycemic impact. The former is found in a Mediterranean diet in which nuts, olive oil, fish and meat are consumed alongside pasta, whereas the latter is found in a traditional southern Chinese diet in which lots of vegetables are consumed not with high-GI potato but with much lower GI, long-grain, high-amylose rice (Anon 03a). We can even say that the fish- and plant-rich Mediterranean diet and the traditional soy- and vegetable-rich southern Chinese diet are compatible with the low-GI concept. Low-GI satiety helps cut calorie intake, without sacrificing essential nutrients or unduly restricting choices, and without loading up on unhealthy things. No wonder the new U.S. federal food guidelines read like a twin of the GI Diet. The fact that the low GI approach is endorsed so quickly and widely by the common public and the trade suggests that it resonates with easy-to-follow common sense with minimal hurdle. Considering that in the USB 2004-2005 national consumer attitude survey, 56% of respondents say health and nutrition information (on the Nutrition Facts Label) is too confusing (USB 05), it is imperative that the GI scheme be as simple as it can be. Anything more complicated, like GL and glycemic glucose equivalent (GGE) (Anon 05e, Anon 05g), are unlikely to work for the majority of consumers.

 

Reducing circulating levels of insulin help people manage appetite, spare the stress on the pancreas, burn more fat, and reduce the incidence of colorectal cancer and skin wrinkles (Dowden 05). And helping people lose some weight goes a long way towards reducing the risks of type-2 diabetes and heart disease. Besides being a principled way to help people live a healthier life, the potential relief on public health spending can be astronomical. Considering diabetes alone, from the year 2000 to 2050, the number of persons with diagnosed diabetes is projected to increase by 165%. The lifetime risk for developing diabetes is estimated to be 32.8% for a man and 38.5% for a woman born in the U.S. in the year 2000 (Curtis, J. 05). According to a study by the U.S. Department of Health and Human Services' (HHS) Diabetes Prevention Program involving Americans from all over the country, type-2 diabetes can be delayed or even prevented by losing a small amount of weight and getting 30 minutes of physical activity 5 times per week. These lifestyle interventions worked particularly well in people aged 60 and older, reducing the development of diabetes by 71% (Anon 05f). This alone is enough to encourage lifestyle intervention to improve overall well-being.

 

However, Gallop's critical flaw was his bias against processed foods in general, putting them all in the high-GI, therefore "red-light" category. According to him, high-GI foods include items that are processed --doughnuts, granola bars, white bread, fruit juices and sweetened juices; you should definitely stay away from anything processed ... anything that comes from a manufacturer; it is always better to eat the fruit than drink the juice. But low-GI and processed foods are not necessarily mutually exclusive. Diet books teach people what to choose, but physical products show people what real-life innovative choices are. Lowering the GI of products (and removing trans fats) could be one of the biggest steps the food industry can take to improve public health (Anon 04b). Several countries have already adopted formal approaches to labeling foods according to their glycemic impact properties, with the Australian system most highly developed.

 

In the power vacuum after the demise of both the low-fat thesis and low-carb antithesis, if GI is not the new paradigm, then what? At a time of paradigm shift, there will not be a shortage of critics and nitpickers. The question to ask is: Do they make sense? Can they come up with more sensible alternatives? If not, they cannot be taken too seriously. Like playing good basketball, tuning into GI is like learning to play good defense, choosing whole grain, nuts and whole fruit over potato, white flour cookies and sugary fruit drink. And good defense jump-starts good offense, providing a launching platform upon which to proactively build whole-soy, fish, nuts, dark chocolate and green tea into the diet. There is definitely a place for the traditional Mediterranean diet and the southern Chinese diet, which, despite being more qualitative than quantitative in concept, work well in practice in controlling the onset of type-2 diabetes. They are both mixed diets not exclusive of medium- or even high-GI carbohydrates, but they are well balanced with low-GI whole vegetables and fruits that they even out the overall impact on blood sugar. Their true traditional versions are also moderate in calories and fat, and therefore compatible with weight and diabetic control. In fact, researchers at the University of California, San Diego School of Medicine have identified a single gene linking the high-fat diet common in the West and type-2 diabetes. This gene is responsible for encoding an enzyme key to enabling beta cells in the pancreas to detect blood glucose levels and trigger the production of insulin when appropriate. The researchers demonstrated in tests on mice that this enzyme is suppressed by a high-fat diet. Without enough of the active enzyme, pancreatic cell failure occurs, resulting in type-2 diabetes (Lister 05). Hence a low-GI approach, supported by moderate calorie and fat intakes, is friendly to people concerned about the metabolic syndrome. The syndrome, comprising dyslipidemia (high blood lipids and low HDL-cholesterol), elevated blood pressure, impaired glucose tolerance, central obesity (Anon 04e), and now also fatty liver (Anon 05j), is linked to resultant elevated risks of diabetes, kidney disease, heart disease, cancer and dysfunctional liver. About 32% of U.S. adults, or 50 million people, now have metabolic syndrome (Anon 05i), a likely result of poor diet habits and sedentary lifestyle over time.

 

For the average consumer, the low-GI concept is compatible with natural law to confer tangible benefits, simple enough to understand and easy enough to follow. The more informed will augment low-GI with conscious wise choices such as moderate calorie and fat intakes and an active lifestyle. They are also likely to eat more fruits and vegetables, whole-soy, whole grains and develop enjoyable food habits. Once good habits are formed on sound values, beliefs and assumptions, we improve our odds for health and happiness.

 

 

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