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The risk of ischemic heart disease with low-fat, high-carbohydrate diets
by: Michal R. Pijak
There is convincing scientific evidence that type of fat have a more important role in determining the risk of coronary heart disease(CHD) than total amount of fat in the diet.(1) However, because of misleading presentation of epidemiological data by some authors(1), the readers might be left with the impression that low-fat, high- carbohydrate diet is the best option for patients with CHD risk.
In fact, high- carbohydrate diets, in the absence of weight loss, can lead to both elevated triglyceride and reduced HDL cholesterol, effects that may be associated with increased risk for CHD.(2) Although these effects may be lessened with dietary fiber and moderate physical activity, they appear to be worse among individuals with insulin resistance.(3)
As reviewed by Kris-Etherton(4) adverse metabolic effects of low fat diet do not occur with substitution of monounsaturated (MUFA) or polyunsaturated (PUFA) fatty acids for saturated and trans-fatty acids. This is also the case for individuals with diabetes, with the added benefit of better glycaemic control.(5)
As predicted by metabolic studies, replacement of saturated fat, and even more so trans fatty acids with either PUFA or MUFA was associated with a larger reduction in risk of CHD than simple reduction of total fat consumption.(6) With respect to weight control, a moderate-fat diet can be as, or even more, effective that lower-fat diet. (6)
References
1. Hu FB, Manson JE, Willet WC. Types of dietary fat and risk of coronary heart disease: a critical review. J Am Coll Nutr 2001;20:5-19.
2. Fung MA, Frohlich JJ. Common problems in the management of hypertriglyceridemia. CMAJ 2002;167:1261-6.
3. Jeppesen J, Schaaf P, Jones G, Zhou MY, Chen YD, Reaven GM. Effects of low-fat, high-carbohydrate diets on risk factors for ischemic heart disease in postmenopausal women. Am J Clin Nutr 1997;65:1027-33.
4. Kris-Etherton PM, Kris-Etherton PM, Binkoski AE, Zhao G, Coval SM, Clemmer KF, et al. Dietary fat: assessing the evidence in support of a moderate-fat diet; the benchmark based on lipoprotein metabolism. Proc Nutr Soc 2002;61:287-98.
5. Rivellese AA, De Natale C, Lilli S. Type of dietary fat and insulin resistance. Ann N Y Acad Sci 2002;967:329-35.
6. Krauss RM, Eckel RH, Howard B, Appel LJ, Daniels SR, Deckelbaum RJ et al. AHA Dietary Guidelines: revision 2000: A statement for healthcare professionals from the Nutrition Committee of the American Heart Association. Circulation. 2000;102:2284-99.



About the author:
Dr. Michal R. Pijak is a consultant in rheumatology, allergy and clinical immunology at the University Hospital in Bratislava, Slovakia


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Why Your Diet May Not Be Working!
 by: Nishanth Reddy

Jennifer, a middle-aged single mother with one six-year-old daughter, has been skipping sweets for a few weeks now. She’s also become a stickler for portion control. She feels as if she’s eating less than ever, and she’s been diligently exercising for an hour at a time at least four days a week. Yet, she hasn’t lost a single pound. The question is, “Why?”

This is a dilemma which affects dieters the world over. They think they are taking the steps necessary to lose weight, but nothing seems to be happening. In essence, they are trapped in a dieting rut and they don’t know how to free themselves. As a result, they become frustrated and depressed and may then engage in binge eating.

One of the problems with diets is that they are often standardized. As a result, they don’t take into consideration your individual physiology and metabolism. They provide a cookie-cutter approach to weight loss—an approach which may not work in your individual case. As a result, an increasing number of people are turning to dieticians to formulate a person weight loss strategy for them. This process has been made easier through the Internet, where you can correspond with a dietician any time of the day or night via e-mail. The dietician can also act as your personal coach, helping you through your dieting dilemmas.

Another reason that you may be failing at your diet is because of a lack of support. You may have family members who can eat whatever they want and seemingly not gain a pound. As a result, they may fill your refrigerator with junk food, leading you into temptation. Also, you may feel as if you have no one to turn to in order to discuss your weight problems. In order to solve this problem, many individuals look to psychotherapists to help them with their food-related issues. This can be particularly important if an individual has turned to purging in an effort to combat their weight problems. Bulimia is a serious disease which must be treated in order to ensure the good health of the patient. Thankfully, there are a number of treatment programs throughout the U.S. specifically focusing on bulimia.

Yet another reason for diet failure is hidden calories. You may literally be consuming calories and not even realize it. For instance, the frappucinos that are so popular today are loaded with calories—as many as 600 in a single serving! You may also be indulging in sugary sodas—another source of extra calories. By taking a few simple steps, such as eliminating the exotic coffee drinks from your diet and substituting skim milk for whole milk, you may be able to eliminate the hidden calories that are denying you dieting success.

Lack of consistency can also be a diet-killer. You might go on a diet for a while, then quit before you’ve made any measurable progress. It’s only natural to want to see quick results. The problem is that healthy weight loss involves losing only a couple of pounds a week. That means you’ll have to stay on your diet for months before you see appreciable weight loss. Discouraging? It can be, but if you keep a positive attitude you can achieve your ideal weight.

You may also be more successful in your dieting if you consider it to be a lifestyle change. Therefore, your diet becomes a meal plan for life. This means that you must change the way you look at food. It is designed to be fuel for your body, and nothing more. As a result, you should not turn to food to make you feel better or to provide you with a sense of comfort. A lifestyle change implies commitment; it means that you are prepared to follow the plan for the long haul. If you feel as if you cannot be on your diet for any appreciable length of time, perhaps it’s time to consider a different diet. Your aim ultimately should be not simply to lose weight, but to become healthier. A fad diet will not allow you to reach that milestone. Therefore, you must choose your diet carefully.


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