Sandeep Chandra, MD FACC is board certified in Cardiovascular Diseases along with Internal Medicine and Nuclear Cardiology. He is an Asst. Clinical Professor of medicine at Emory University Hospital. He received his medical degree in Tennessee and received his training in Cardiology at Brown University in Rhode Island. His practice is currently located in Tucker/Norcross & Alpharetta, GA.
Email , Phone 770-638-1400
Diet: A Growing Dilemma

Is there a ‘right diet’? Dr Sandeep Chandra examines the different diets that have sparked a burgeoning ‘weight loss’ industry.

It is a well known fact that prevalence of obesity is increasing steadily in the United States, and recently has been classified as a major health concern. Despite years of low fat diet recommendations, Americans continue to grow heavier. Most disturbing is the alarming rate of childhood obesity and diabetes. There has never been more confusion about “The Right Diet” than in recent months. This has sparked a burgeoning industry labeled as “The Weight Loss Market”. This includes a myriad of diet recommendations as well as supplements. Given the recent information explosion in this area, it is imperative to review the supporting data and understand the pros and cons of the various commercially available diets.

First and foremost, the correlation between nutrition, health and weight needs to be understood. There is a direct correlation between calories and weight, just as there is a correlation between nutrition and health. Nutrition implies choices of high quality foods, whereas amount of calories, either high or low does not imply good nutrition. It is incorrect to assume that losing weight equates to better health. Weight loss can be healthy or not so healthy based on the approach.

Most people pursue diets for one of two reasons: either for aesthetic reasons, or for health reasons. It is important to be clear on the goal as it will affect the choice of diet. Several high protein/high fat diets such as Atkins will help in losing weight, but may not help prevent heart attacks. Similarly, very low fat diets may reduce total cholesterol, but may induce diabetes.

Weight loss clearly can only be achieved by consuming less calories than what is being burned. This is irrespective of the diet you choose. This is the basic tenet for most commercially available supplements which tend to curb appetite. Some of them come with significant risks including elevation in blood pressure, heart attacks and occasionally damage to the heart valves as in the case of Phen-Phen. Extending this concept to the diet scene will help clarify the matter.

Low carbohydrate diets turn out to be low calorie diets. Relying on simple carbohydrates to achieve a state of satiety (satisfaction (how about use the word “fullness” here)) could rack up the calories rapidly. High fat and protein diets have a high satiety index. Meaning small amounts of food go a long way. Given this, along with a catabolic state, where the body learns to use fat as a source of energy when it cannot find sugar, causes fairly rapid weight loss. Some of the weight loss is also the diuretic effect of ketones, which are the byproducts of fat metabolism. This can also induce “ketosis breath” which can be unpleasant. A summary of the pros and cons are as follows:


· Weight loss within the first few weeks which is highly motivating
· Palatable, requires less discipline for most
· Easy way to curb calories

*Can leach calcium off the bones, leading to weak bones
*Can be atherogenic, hardening of arteries/plaque buildup
*Usually low in antioxidants and fiber, which can increase risk of cancer
*Long term weight loss no different than traditional low fat diet.

We believe that this diet may have a role in people needing quick weight loss as well as individuals with diabetes and metabolic syndrome.

To achieve healthy weight loss, one needs to restrict the number of calories, engage in moderate intensity exercise and follow nutritionally sound principles that have been medically proven to reduce the incidence of disease. There is an inverse correlation between the number of calories and longevity. 

Stress reduction is also felt to be a critical component in managing weight. High stress leads to secretion of “stress hormones” which coach the body to store energy as “fat”. The body interprets stress as a natural disaster, goes into survival mode (as if there is famine), and tries to conserve energy by hiding the glucose as fat.

Diet that has been medically proven to reduce heart attacks and achieve weight loss is the Mediterranean Style diet. Principles of this diet have been incorporated in the recommendations of the American Heart Association. In some trials, they have shown up to a 40% reduction in risk of heart attack.

Basic principles include eating high satiety index foods (most of which are also the low glycemic index foods), and predefining portions based on your caloric needs. Your physician may be able to help you determine your caloric needs. General guidelines for the Mediterranean diet are as follows:

*Preponderance of nuts, beans, fruits, vegetables and whole grain cereal and breads.
*Olive oil as the principle source of fat
*Low to moderate consumption of fish and poultry
*Low consumption of eggs, sweets and meats
*Moderate daily exercise

Due to the increasing complexity of various diets, there have been a great number of patients who have given up trying to eat healthy. A prevalent attitude has been to enjoy life and “live to eat”. One cannot argue with this approach, except to recognize that part of the enjoyment may require future trips to a medical facility of your choice and a laundry list of medications for diabetes, high blood pressure, and high cholesterol.

There are always exceptions to every rule. Any major changes to your diet and exercise regimen should be approved by your physician. Appropriate blood chemistry analysis is an important component of following a healthy program. Needless to say, a little effort and will power now, can significantly reduce the risk of developing future diseases, enhance longevity and improve quality of life.

*Disclaimer: The contents are meant for informative, educational purposes only. Formal recommendations can only be made by physicians involved in your care. Please check with your physician before acting on any part of this article.