Physicians recommendations for and personal use of low-fat and low-carbohydrate diets

Puma, John La; Szapary, Philippe; Maki, Kevin C.

doi:10.1038/sj.ijo.0802840

Cited by 4 publications

(3 citation statements)

References 7 publications

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“…Only 6 % of responders indicated that "they were discouraging even after I showed good results," which may be a surprising result depending on one's relative expectations of evidence-based medicine vs. prejudice against the Atkins diet [ 19 - 21 ]. The results bear on a recent paper indicating that physicians were more likely to use a carbohydrate-restricted diet (CRD) themselves and recommend a LF diet for their patients [ 22 ].…”

Section: Resultssupporting

confidence: 56%

Low carbohydrate diets in family practice: what can we learn from an internet-based support group

Feinman

Vernon

Westman

2006

Nutr J

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The Active Low-Carber Forums (ALCF) is an on-line support group started in 2000 which currently has more than 86,000 members. Data collected from posts to the forum and from an online survey were used to determine the behavior and attitudes of people on low carbohydrate diets. Members were asked to complete a voluntary 27-item questionnaire over the internet. Our major findings are as follows: survey respondents, like the membership at large, were mostly women and mostly significantly overweight, a significant number intending to and, in many cases, succeeding at losing more than 100 lbs. The great majority of members of ALCF identify themselves as following the Atkins diet or some variation of it. Although individual posts on the forum and in the narrative part of our survey are critical of professional help, we found that more than half of respondents saw a physician before or during dieting and, of those who did, about half received support from the physician. Another 28 % found the physician initially neutral but supportive after positive results were produced. Using the same criteria as the National Weight Registry (without follow-up) -30 lbs or more lost and maintained for more than one year -it was found that more than 1400 people had successfully used low carb methods. In terms of food consumed, the perception of more than half of respondents were that they ate less than before the diet and whereas high protein, high fat sources replaced carbohydrate to some extent, the major change indicated by survey-takers is a large increase in green vegetables and a large decrease in fruit intake. Government or health agencies were not sources of information for dieters in this group and a collection of narrative comments indicates a high level of satisfaction, indeed enthusiasm for low carbohydrate dieting.The results provide both a tabulation of the perceived behavior of a significant number of dieters using low carbohydrate strategies as well as a collection of narratives that provide a human perspective on what it is like to be on such a diet. An important conclusion for the family physician is that it becomes possible to identify a diet that is used by many people where the primary principle is replacement of starch and sugar-containing foods with non-starchy vegetables, with little addition of fat or protein. Used by many people who identify themselves as being on the Atkins diet, such a strategy provides the advantages of carbohydrate-restricted diets but is less iconoclastic than the popular perception and therefore more acceptable to traditional nutritionists. It is reasonable for family practitioners to turn this observation into a recommendation for patients for weight control and other health problems.

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Section: Resultssupporting

confidence: 56%

Low carbohydrate diets in family practice: what can we learn from an internet-based support group

Feinman

Vernon

Westman

2006

Nutr J

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“…Although proponents of LoCHO diets recommend ad libitum fat intake, we do not endorse this and instead favor use of MUFA and PUFA which have been demonstrated in various studies to reduce the risk of CVD [3,4,41,84]. A final irony is the report that physicians frequently choose LoCHO diets for themselves while recommending low fat for their patients[87]. …”

Section: The Case For a Low Carbohydrate Dietmentioning

confidence: 89%

The case for low carbohydrate diets in diabetes management

Arora

McFarlane

2005

Nutr Metab (Lond)

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A low fat, high carbohydrate diet in combination with regular exercise is the traditional recommendation for treating diabetes. Compliance with these lifestyle modifications is less than satisfactory, however, and a high carbohydrate diet raises postprandial plasma glucose and insulin secretion, thereby increasing risk of CVD, hypertension, dyslipidemia, obesity and diabetes. Moreover, the current epidemic of diabetes and obesity has been, over the past three decades, accompanied by a significant decrease in fat consumption and an increase in carbohydrate consumption. This apparent failure of the traditional diet, from a public health point of view, indicates that alternative dietary approaches are needed. Because carbohydrate is the major secretagogue of insulin, some form of carbohydrate restriction is a prima facie candidate for dietary control of diabetes. Evidence from various randomized controlled trials in recent years has convinced us that such diets are safe and effective, at least in short-term. These data show low carbohydrate diets to be comparable or better than traditional low fat high carbohydrate diets for weight reduction, improvement in the dyslipidemia of diabetes and metabolic syndrome as well as control of blood pressure, postprandial glycemia and insulin secretion. Furthermore, the ability of low carbohydrate diets to reduce triglycerides and to increase HDL is of particular importance. Resistance to such strategies has been due, in part, to equating it with the popular Atkins diet. However, there are many variations and room for individual physician planning. Some form of low carbohydrate diet, in combination with exercise, is a viable option for patients with diabetes. However, the extreme reduction of carbohydrate of popular diets (<30 g/day) cannot be recommended for a diabetic population at this time without further study. On the other hand, the dire objections continually raised in the literature appear to have very little scientific basis. Whereas it is traditional to say that more work needs to be done, the same is true of the assumed standard low fat diets which have an ambiguous record at best. We see current trends in the national dietary recommendations as a positive sign and an appropriate move in the right direction.

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“…Choices for meals would seem readily amenable to the preferences of physicians and their staff, who themselves may conflict about which foods are preferred and delivered. To the best of our knowledge, the nutritional content of food provided in the medical office has not been studied, though data show that eating outside the home is associated with overweight and obesity French (2000); Guthri et al (2002).…”

Section: Discussionmentioning

confidence: 99%

Predictors of physician overweight and obesity in the USA: an empiric analysis

Puma¹,

Szapary

Maki

2005

Nutrition &Amp; Food Science

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Purpose -Because patients are more likely to follow advice from healthy weight rather than overweight physicians, seeks to determine whether physician overweight could be predicted by selfreported physician eating behaviors. Design methodology/approach -An anonymous, written, self-administered, pre-tested, confidential survey of practicing physicians in the Midwestern USA was undertaken. Findings -Most surveyed physicians (394 or 74 per cent) completed the survey. The results indicate that stress at home (OR 2.62, CI 1.35-5.08) was most significantly and strongly predictive of physician overweight (BMI > 25 kg/m 2 ), as were particular eating behaviors, including eating food provided at the medical office. Assessment of overall health was significantly and strongly inversely proportionally predictive (OR 0.43, CI 0.30-0.62) of physician overweight as well.Research limitations/implications -The research implies that, like patients, practicing US physicians are susceptible to feelings other than hunger which prompt over-eating and weight gain. Limitations include study of a single, specific sample of physicians, and an exclusive focus on food and nutrition. Future research may wish to include measures of fitness and exercise. Originality/value -Physicians are susceptible to predictable, particular feelings other than hunger which prompt over-eating and overweight. Physician ability to respond to these feelings and to ameliorate the stresses and factors associated with them may help improve physician overweight and, in turn, physician ability to facilitate patient weight loss.

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Physicians recommendations for and personal use of low-fat and low-carbohydrate diets

Cited by 4 publications

References 7 publications

Low carbohydrate diets in family practice: what can we learn from an internet-based support group

Low carbohydrate diets in family practice: what can we learn from an internet-based support group

The case for low carbohydrate diets in diabetes management

Predictors of physician overweight and obesity in the USA: an empiric analysis

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