Sunday, June 10, 2012

The phenomenally successful NSRF diet

This month's CMAJ arrived in the mail on Friday, and we were intrigued to read an academic review titled "Managing obesity in adults in primary care" by Gilles Plourde MD Phd and Denis Prud'homme MD MSc.

This peer-reviewed article examines the statistics surrounding obesity in Canada, methods of determining obesity, and models for treating it.  The authors note that:
   ... trials suggest that dietary adherence and caloric restriction are more important than macronutrient composition in determining weight loss... Canadian guidelines on obesity recommend a high protein or low-fat diet as a reasonable short term (6-12 mo) treatment option ...
prescribing .. diets in clinical practice can be challenging because physicians may not have the time or expertise to provide appropriate advice on dietary composition...  importance of providing long-term counselling to patients.
Regarding pharmacologic treatment of obesity, the review notes that: the only available long-term drug therapy for obesity in Canada.  A Cochrane meta-analysis of 16 randomized controlled trials involving 10 631 patients has shown that ...Orlistat reduces weight by 2.9 (95% CI 2.5 to 3.2) kg. 
Did you see that?  Would you be satisfied with a weight loss of under 3kg?  I certainly wouldn't.  So let's stick to a nutritional approach, shall we?

In the tables accompanying the article, recommendations for successful weight loss include following Canada's Food guide, reading food labels, limiting the number of restaurant meals, consuming more fruits and vegetables, and eating foods with low energy density.

I was intrigued to see the reference to high protein dieting.  To me this is a better-late-than-never recognition of Atkins-style diets.  There are also references to low glycemic choices.  Slowly, very slowly, the world of peer-reviewed studies is beginning to hint at the acceptability of lower carb eating.

There are several references that specifically mention that low fat consumption is necessary to lose weight successfully.   Fat in the diet is still a no-no according to the literature.

It's a funny thing that just as "high protein" is beginning to gain some acceptance, it seems that "high fat" is gaining more traction among those of us who are skeptical of the official nutritional party line.

What I didn't see is language specifically addressing sugar consumption.  It's one thing to tell people to choose products that contain "less fat, sugar and sodium", but it doesn't pinpoint sugars as the main culprit. By sugars, I mean refined sugar, grains, and anything else that results in the  speedy delivery of a shot of insulin to your system.  

What I don't pick up is a sense that people should be eating more natural food.  By this I mean foods that come in their natural state and which haven't been processed in any way.  Advising people to read food labels is an implied admission that most of us will consider a diet comprised mainly of foods in their natural form to be a non-starter.  It tacitly allows processed foods in a diet designed for weight loss.  However, if you have ever spent any time reading food labels, you will know that most foods that come with labels, also come with additives of one kind or another, and the vast majority of the resulting concoctions no longer resemble natural foods.

Worst of all are the high carbohydrate counts of many of the foods that came to the stores via food processing plants.  They may have bold labels on them promising "low fat" or "multi-grain", but it makes no difference:  they are not natural foods and chances are, they are filled with sugars.

I also wonder about the references to time. The study mentions diets in the short term (6 to 12 months). Obesity and related health problems don't just happen overnight.  They are a result of many years of suboptimal food choices.  It is absurd to think this can be permanently overturned by a couple of months of dieting.  Again, to get back to natural food, I find it hard to believe that people can possibly achieve any kind of lasting weight loss without embracing a real food diet. 

To me, this just shows how it's not just weight that most of us want to lose.  Our weight is inextricably linked to our state of health (and our future state of health).  It makes no sense to lose weight over a period of 6 to 12 months, only to revert to the poor choices that -- perhaps ever so slowly -- put us in that weight-filled position in the first place.

That's the beauty of the paleo approach to nutrition.  It's not just a diet; it starts with knowledge.

Without a good understanding of why it's a good idea to cut out sugars, you're not likely to hold out longer than a couple of days at most.  But, as most of us who have done this have found out, once we understood why sugars and processed foods are a bad idea, it became possible to embrace a totally new approach to food. 

Take my friend Karen, for example: She is currently down an impressive 17 kg (that's 37 lb!) in the past 7 months.  I remember her telling me about a year ago how impossible it was to lose weight, and in the next breath, how she could never give up eating candies and sweets.  Then she started reading  Mark's Daily Apple, Dr. Eades' Protein Power, Andreas Eenfeldt's Diet Doctor and even this blog.  And she's succeeding without caloric restriction, cravings or deprivation.  What a difference her new-found knowledge made!

As these blogs make more inroads into the public consciousness, I have to wonder if we're going to see an explosion of evidence in the next few years that completely destroys the prevailing orthodox wisdom on managing obesity.

After all, many of us have lost weight and, at the same time, gained health using methods that had nothing to do with the recommendations in Plourde's and Prud-homme's peer reviewed literature review.

And the acronym for the title of this post?  Can you guess what NSRF stands for?  No, it doesn't actually exist as an established diet.  How could it, when the official literature doesn't recognize or even support its most important premises?

But I am convinced that No Sugar, Real Food is the way to go, in spite of what is written in this month's Canadian Medical Association Journal.

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