I have had the opportunity to have another look at a very successful diet program recently. I will reflect on what have been the elements of that success, but, first the more important stuff.
Isabelle is thriving. She is all of 22 months now and still eating little in the way of carbs and virtually zero sugar. There are times that she might eat a strawberry or chew on a piece of apple but her food preferences are for protein and fat. We don’t limit fruit, it is just her preference. She has always been a chatterbox but recently she has begun to speak english. And, even at this early stage of language development, she is starting to tease her dad. We had a little incident a few weeks ago where a large latte was left on the roof of my freshly washed white car. Of course, as I began to drive it splashed all down the side leaving a mess not unlike that of a seagull in gastric distress. Everyone had a laugh at Dad’s expense, including Isabelle. From that point on she started to tease me with “car so bad”. From first thing in the morning to when I arrive home from work, her first words for me are “car so bad”, to which I reply, “nooo, daddy’s car is good”. She is a delightful little girl and cute as all get out, too. She brings a huge amount of joy into all our lives. And, she still has not had a fever or a rash. I am more convinced than ever that the absence of sugar has a huge positive impact on her immune system function. There has been scientific work in this area. Here are some references that I got from Barry Grove’s website (www.second-opinions.co.uk ) that make the case for increased starch and sugar consumption causing a significant reduction in the ability of immune system cells to neutralize bacteria:
Kijak E, Foust G, Steinman R.R. Relationship of Blood Sugar Level and Leukocytic Phagacytosis. South Calif Dent Assn 1964; 32: 349-351
Sanchez A, et al. Role of sugars in human neutrophilic phagocytosis. Am J Clin Nutr 1973; 26: 1180-84.
Ringsdorf WM jr, Cheraskin E and Ramsey RR jr. Sucrose, Neutrophilic Phagocytosis, and Resistance to Disease. Dent Surv 1976; 52: 46-48
I have just returned from a visit to two small towns in southern British Columbia, Midway and Grand Forks. Firstly, I have to say that this is a beautiful part of the country and is well worth a visit just for the surroundings. However, my time there was not for tourism but related to, what else, diet.
Something interesting is happening. You will recall that I was recently in Valemount, BC where Dr Stefan DuToit has been running a highly successful diet program for the local population (see my earlier post: Village(s) on a Diet). Although the diet he is using is more restrictive than what I would recommend in terms of calories and fat, and although it is not as low in carbs, his dieters routinely achieve significant weight loss and usually correct their metabolic problems while getting off their meds. I recall one gentlemen telling me he is saving $500 per month on meds. Another woman showed me her before photos and told me she had lost half her body weight. One of the most remarkable aspects of Dr. DuToit’s approach is that he gets very high rates of compliance on a diet that I think is not that easy to follow. In my discussions with other physicians and public health types about this, the common observations are that this is a flash in the pan, that it will prove to be unsustainable and that the initial success is likely due to Dr Du Toit’s charisma and is therefore not reproducible.
Well, it turns out that this may not be true at all. The longest running Valemount dieters are now at about 18 months. There has been some attrition but the majority appear to be sticking with it. We have been helping Dr DuToit manage the transition to a diet that will be sustainable for the long-term by adding fat back in once maximum weight loss has been achieved. He thinks this will be the key to long-term success. We will continue to monitor the data from his groups and, hopefully, will have something he can publish so that others can benefit, too.
In the meantime, however, some other sites have started using Dr DuToit’s diet and are also demonstrating excellent results. A group has started in McBride, BC, a small town about an hour’s drive from Valemount. The physician there tried the diet, lost weight and has now recruited a bunch of local people who are losing weight and getting off their meds just like their neighbours in Valemount. And, since then, another project has sprung up in Midway, BC, a southern town smaller than Valemount. In that case, a local public health nurse who learned about Dr DuToit from the CBC news coverage a few months ago, travelled up to Valemount to join one of his groups. Both she and her husband did very well on the diet and now she has started a group in Midway. This is not led by a physician but the local doc is open-minded and supportive. Again, the results are startlingly good.
What does all this mean? For starters, it means that there is some validity to the approach that goes beyond the effect of a charismatic doctor (not to suggest the doctors mentioned here are not charismatic; they are). It also means that the results are reproducible. Not only is this a model that can be implemented in a family practice setting by a doctor, it can also succeed when it is led by a non-physician. This is pretty exciting.
Until now, my physician colleagues have not had a stellar track record in terms of getting their patients to lose weight. I think this is largely because we haven’t developed a quick and ready approach that is amenable to the real-life realities of general practice medicine. If it were as simple as writing a prescription, they would be all over it. Since it is not, and since the failure rate of the currently accepted approach (eat less, exercise more) is so abysmal, I think it is completely understandable that my colleagues have, for the most part, abandoned the field. And this is why I think it is so fascinating to figure out what is the secret of the huge success of Dr DuToit’s approach.
We are hard at work analyzing the data but I don’t think that is where the answer necessarily lies. I think the initial diet is so significantly lower in carbohydrates that the subjects do benefit from de facto carb restriction more than the calorie restriction. And, you can restrict fat early on as you are burning off your stored body fat. So the diet he has been using, in the early stages, makes sense from a low-carb diet perspective even if it is not quite as low as I would recommend. In addition, however, I am very impressed with the effect of the group dynamics. He has his dieters meet together once a week for an hour. I have attended a couple of these sessions and they remind me a little of what an AA meeting might be like (I have never attended one of those). There appears to be something compelling to be part of, and accountable to, a group of others who are engaging in the same struggle. There has been research that supports this idea and certainly there are examples in the commercial diet industry that incorporate the concept of group support.
Having said that, there are other elements of this success that need to be considered. For instance, is there something unique about a small community that contributes to better compliance? As someone pointed out to me, “everybody knows your business”. Perhaps one is more determined to succeed if there is the perception that everyone is watching. If this is the case, the anonymity of a large city would make it easier to relapse. It would be interesting to test that idea (not that I need any more research questions at the moment).
I will continue to study Dr DuToit’s diet and perhaps we will eventually publish something. If he has solved the problem of what a physician in a general practice setting can do about reversing obesity, he will have done everyone a huge service. I will keep you posted as I find out more.