PE 9A Information

Section 6: The Diet Industry

Tracey Kobayashi

50 Phelan Ave, NGYM
San Francisco, CA 94112
(415)452-7311
tkobayas@ccsf.edu

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Intro | Facts
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Nutrition | Diet Industry
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The diet industry thrives on the quick fix, promising lifelong leanness and happiness in the form of a pill, powder or drink. Yes, herbs and old-fashioned remedies can be effective healing agents, of wich drug companies have no interest in because they cannot patent an herb. However, the supplement industry on the whole thrives on people's insecurities, often making promises they cannot keep. In addition, the people selling these products often don't have the background necessary to provide sound advice to consumers. This means the consumer not only needs to be well-educated in the potential benefits AND dangers of specific products, but may also need to research specific companies. In general, the best rule of thumb is to beware...if it sounds too good to be true, it probably is!

Safety and effectiveness of dietary products range a wide spectrum. Under current law, products labeled as Òfood supplementsÓ may claim to affect body structure or function without prior FDA review. In addition, the manufacturer is responsible for insuring their products' safety and don't have to pass FDA review before going on the market. In other words, dietary products DON'T have to meet claims made on their packages, AND there are no guarantees that the manufacturer tested them for safety. The FDA wont pull a product until presented with evidence it is harmful.

Some ads employ customer Testimonials or professional Endorsements. Before and After testimonial ads are often "doctored" in terms of picture quality and even subjects -- healthy actors are filmed for the After portion and then overfed so they will be larger for the Before shots. Professional endorsements are similar in that they use an actual "person" to guarantee a product's efficacy. However, the companies rarely provide real information on any research that may have been conducted on their products, or they use someone's name without permission OR fabricate a fictitious authority. Even if a professional actually endorses a product, there is no guarantee that person even reviewed any scientific evidence or used acceptable review standards but you can bet they received compensation for the endorsement!

Supplements may or may not contain the claimed active ingredient and even if they do, may not contain the ingredients in the amounts specified. In a study of ma huang (ephedra) supplements (Gurley et al, 2000), 50% of the products tested varied in amounts listed on the labels by as much as 20%. Lot-to-lot differences were as much as 1000%. One product contained no ma huang. Given the potential health risks of ephedra, which is linked to heart failure, this is a serious concern. For more information on rules for dietary supplements, you can read the following releases at the FDA web site:

Supplementation Rules
Rules for Supplement Claims

Forms of Dietary Aids

Let's look at basic forms of diet aids: appetite suppressants; fat replacers; and Òfat-burners.Ó

Appetite suppressants are perhaps the most effective products at achieving their goal: suppressing the body's natural urge to eat. Although they can be effective in the short-term, appetite suppressants by themselves don't enforce long-term good habits. If appetite suppressants must be used, they should be taken under a doctor's guidance and with proper nutritional counseling. Appetite suppressants tend to include stimulants, which can cause restlessness and possible heart problems. In addition, the appetite suppressants themselves often have dubious side effects. Always consult with your physician before considering the use of appetite suppressants and NEVER use them if you have a history of high blood pressure or heart disease in your family.

Fat-free foods and fat replacements are used primarily in snack foods, resulting in a lower-calorie product. Snackwells are a popular brand of ÒdietÓ snack food, which are fat-free. WOW is a brand name for snack foods containing Olean, an indigestible fat. Most of these foods, in addition to lacking fat, also lack many essential nutrients, and don't enforce healthy eating habits -- people who eat them tend to eat more and end up consuming more calories than they would with the full-fat product. In addition, foods containing olean actually deplete the body of fat-soluble nutrients. People should treat these foods as they would other sweets Ð eat them occasionally in small quantities.

Fat-burners/muscle enhancers include ingested supplements as well as topical lotions or creams, which claim to absorb or melt away fat. There has been no valid research that supports the claims of these products. Some fat burners, often marketed as thermogenic agents, are stimulants in disguise. Use caution: some stimulants have caused cardiac disfunction in people with no prior heart problems.

Some Terms You Might See

Marketers will try to influence you to buy their product using some terms that may be technically correct... but misleading.

• No Sugar/Sugar-Free: contains no sugar. May be sweetened with chemical sweeteners or sugar alcohols (sorbitol, xylitol, malitol), which can have adverse effects on the digestive system if consumed in large quantities.
• Fat-Free: contains minimal (.5g or less) or no fat. Often made up for by adding sugar or sugar substitutes. Often when people see this or the previous term, they feel the need to consume larger quantities than they would of the full sugar and fat versions.
• Pesticide Free: produce grown without pesticides or animals raised on pesticide-free produce. This is actually a good thing, but for some reason, the average person assumes fewer calories when told something is pesticide free.

Popular Dietary Supplements

The following list is a run-down of popular diet aids. Inconclusive research generally means there is no strong evidence to support the claim.

• Beta-Carotene: An antioxidant thought to reduce risk of cancer and heart disease. However, beta-carotene's helpful effects seem to lessen when removed from the foods in which it naturally occur, so it's difficult to determine whether the substance itself, or some combination of nutrients provides the benefit.
• Blue-Green Algae: A life form marketed to ÒpurifyÓ blood and cure disease. Blue-Green Algae is not a medicine or a good source of nutrients, and depending on where it's harvested, has been known to contain certain toxins.
• Carnitine: The body manufactures carnitine, which transports fatty acids to the mitochondria for energy breakdown. Excess carnitine is excreted. Has been used to treat patients with congenital carnitine deficiency. Proponents of carnitine claim it aids fat reduction, however, there is no evidence to support this claim. Ingestion is safe, however most over-the-couner brands are poorly manufactured, and contain little, or even no, carnitine.
• Chitosan: Chitosan has been shown to be effective in regulating serum cholesterol and atherosclerosis in rats. The diet industry recently marketed it as a Òfat blocker,Ó which prevents fat from being digested. Studies done on chitosan's fat-blocking claim have shown that chitosan alone is ineffective for reducing body fat or weight (Pittler et al, 1999).
• Chromium (Cr): Cr is a mineral which helps insulin transfer glucose and other nutrients into the cells. It has caused modest improvements in glucose intolerance, however there are no studies to determine its long-term effect. Health claims include decreasing fat, increasing muscle, decreasing cholesterol, and increasing lifespan. Research on chromium has been inconclusive, and chromium neither burns fat nor increases muscle mass. For glucose intolerance, 200mcg of Cr per day may help control blood sugar levels. Form is not important: picolinate and polynicotinate are no better than types found in foods and most supplements. Best sources: whole grains; fruits; veggies.
• Coenzyme Q10 (CoQ10): The body manufactures CoQ10, which assists in bioenergetics. It has been used to treat congestive heart failure resulting from deficiency, although research in this area is inconclusive thus far. CoQ10 proponents claim anti-aging properties due to free radical activation, and AIDS treatment in that it increases the cd4:cd8 ratio (cd4 attacks intruders, cd8 suppresses cd4). CoQ10's free radical deactivation is relatively minor, although research on both of these fronts is inconclusive. Claims that CoQ10 enhances athletic performance are wrong. CoQ10 is safe to take and is best absorbed in softgel form -- it is not well absorbed in dry (tablet, powder in capsule) form.
• DHEA: The adrenal gland releases a form of DHEA (dehydroepiandrosterone), which is converted into testosterone and estrogen in the body's tissues. DHEA levels decline steadily with age, which is the basis of the supplement industry's interest in the hormone. DHEA has been touted as cure for heart disease, and cancer, a fat-burner, life extender, and libido enhancer. It is, however, ineffective for all of these. In fact, DHEA may be associated with some ovarian and breast cancers and possibly decrease life span. DHEA might possibly relieve joint pain and other symptoms of lupus. Because DHEA levels decline with age, many believed its paucity led to many age-related disorders. Initial studies showed encouraging results to some claims made by DHEA marketers, but just about all follow-up studies refuted initial results, with the exception of the lupus research.
• Growth Hormone: Originally used to treat patients with Growth Hormone deficiency, growth hormone enablers are now popping up all over the market, promising a fitter, leaner body, enhanced sexual performance, and a full head of hair! Let's be clear here: growth hormone is a controlled substance available only with a doctor's prescription, and for good reason. ou don't want to mess with your hormone levels are something yunless you really know what you're doing. Growth hormone levels, like DHEA, also decrease with age, partly to balance other age-related changes. For example, growth hormone promotes growth in adolescents. If the hormone is still present in large amounts, when the epiphyses seal, bones and soft tissues like the tongue can grow abnormally. The good news is that the HGH enabling products sold in the spam emails I receive daily most likely are ineffective, so you have nothing to worry about, except maybe a lighter wallet.
• Olean/Olestra: Olestra is an ÒoilÓ developed by Proctor & Gamble manufactured into large molecules the body can't digest, so it can't be absorbed and stored. As with all foods, you still need to watch serving size -- people tend to eat more. Olean also depletes the body of fat-soluble vitamins (A, D, & E), and carotenoids (plant pigments associated with prevention of some cancers, heart disease, and macular degeneration. P&G is required to fortify olestra with the vitamins, in an effort to replete what the product takes away, but not the carotenoids. There have been many cases of EXTREME gastrointestinal distress (cramps; gas; diarrhea) related to olean intake, with symptoms lasting as long as one week. T
• Fen-Phen: A combination of Pondamin (fenfluramine) and phentermine (a stimulant), Fen-Phen is an appetite suppressant. Especially when combined with Redux (dexfenfluramine), fenfluramine promotes heart disease.
• Herbal Fen-Phen: Combination of St John's Wort (an anti-depressant) and Ephedra (ma huang). No conclusive research. Contraindications: St. John's wort shouldn't be taken with other anti-depressants; ephedra is dangerous for those with high blood pressure, heart disease, and diabetes, and has serious side effects in large doses (more than 18 deaths have been associated with ephedra). A recent study also showed ma huang to have variable effects on blood pressure and increased heart rate in healthy, normotensive adults (White et al, 1997), so even apparently healthy individuals need to exercise care in using ma huang.

Fad Diets

Many diets cycle in and out of popularity, each with a slightly different twist and each touted by a new author, eager to sell a lot of copies of his or her book. Past diets have included those that: touted the benefits of eating a single food; prescribed specific food combinations; high protein diets; and severe caloric restriction. Let's explore some of the ramifications of fad dieting.

The body needs a variety of nutrients in order to perform optimally. With certain elements lacking and an overabundance of others, the body not only needs to deal with disposing of the excess constituents, but also developing some kind of work-around for the missing nutrients. This means resources must be diverted from the body's normal functions in order to deal with the imbalance. Let's say you discover a wonderful diet the author says helped 175,000 people to lose weight. What the author doesn't tell you is that MOST diets yield some kind of short-term weight loss, not necessarily because it's effective for the long-term, but because subjects are generally only monitored for a certain length of time. By the time they revert to old habits and weights, monitoring has usually ceased). For the first few weeks, you think it's the most wonderful thing on the face of this earth. You lose weight, and possibly inches, and these positive signs are enough to make you feel Òmore energeticÓ and Òless sluggish.Ó After the novelty wears off, you discover you're tired of eating only pickles with artichokes, and you really miss chocolate chip cookies. So you go back to what you know Ð- the habits you developed over your lifetime Ð- and the weight creeps back up.

I said most diets are successful in the short-term. This is because in the end, all diets, regardless of its methods, decrease total caloric intake, and for the most part, weight change relies primarily on caloric balance (calories in vs. calories burned). However, these diets are not necessarily good for and in fact, could be detrimental in the long-term. The best plans are based on sound dietary guidelines, recommending a variety of foods eaten in moderate amounts.

Lets look at two popular diets: Atkins and the Zone. Both diets refute standard thinking by disagreeing that a large percent of caloric intake should be carbohydrate. They differ in that the Atkins diet goes to the extreme in limiting carbohydrate intake, while allowing dieters to eat all the fat and protein they want, while the Zone gives dieters a more structured program.

The Atkins diet is based on the belief that most weight problems arise from how the body processes carbohydrates. Atkins believes that in overweight people, insulin, a hormone responsible for facilitating carbohydrate usage and storage, promotes excess body fat. Without carbohydrates, the body enters a state of ketosis, which Atkins believes makes the body burn fat and food cravings disappear. He neglects to tell you that Ketosis can interfere with the body's ability to transport oxygen and cause nasty-smelling breath. As discussed in the Nutrition section, long-term carbohydrate depletion can result in kidney problems, weakened bones, and arteriosclerosis, and as mentioned in the above paragraph, this extreme approach is nearly impossible to follow for a long time. In addition, there are no limits to saturated fat and cholesterol intake, and fiber intake is minimal, while foods known to reduce the risk of heart disease and some cancers are eliminated or drastically reduced, all of which could mean serious health consequences in the long haul.

The Zone diet is based on a similar take on carbohydrates. However, it's a more structured program that directs certain proportions and amounts of carbohydrate, fat and protein at certain times of the day. In addition, Zone author Barry Sears believes that ÒsuperhormonesÓ regulate weight loss. Although the superhormone theory has little scientific support, the Zone diet is more varied than Atkins, and probably doesn't have as many health risks waiting to happen as with Atkins.

Caveats to Atkins and Zone: Due to the strain on the filtering organs, these diets are dangerous to those with liver or kidney disease. Those with heart disease or diabetes risk should check with their doctors before trying them -- don't even think about these diets if you already have heart disease or diabetes. Although these diets have been touted as magical cures for diabetes, they can exacerbate the blood lipid problems which are a side-effect of the disease. In previous sections, I mentioned that strained glucose levels result in abnormal fat metabolism, which contributes to circulating LDLs. The combination of diabetes and low-carbohydrate diet compounds this effect. Anyone at risk for gout should avoid these diets. Gout outbreaks are unpredictable, but have been associated with high protein intake, and there have been several cases of gout that have been exacerbated by these diets.

Surgical Procedures

Cosmetic surgery is not tecnhically in the diet industry, but it is big business and is worth a mention here. While few people will admit to having cosmetic surgery, Jim Morelli reports that 60% of women and 43% of men polled by telephone would do it if it were free, safe and well-concealed. Tops on the lists: tummy tuck/liposuction for women, and hair transplants (followed by tummy tuck/liposuction) for men. As with any surgical procedure, cosmetic surgery carries the risk of accidental death. Fortunately, deaths have decreased in recent years, mainly due to better surgeon education. An article by Denise Mann outlines some of the ways surgical techniques have improved, and some caveats to surgery. Risk factors for death include: operating on someone in poor health; removing too much fat; and combining liposuction with other procedures (this last one increases death risk 14 times). Now that you've spent a considerable amount of time with me, you probably know I'm not a fan of cosmetic surgery. However, if you MUST, thoroughly research potential surgeons -- find out about their education and experience in the procedure you're considering, their certifications, and any other dirt you can dig up. WebMD has a guide to choosing a cosmetic surgeon. The following groups have listings of surgeons certified for plastic surgery (certification is not a guarantee of skill):

• American Academy of Cosmetic Surgery
• American Academy of Facial Plastic and Reconstructive Surgery
• American Society of Plastic Surgeons

Liposuction is probably the most widespread surgical procedure for fat removal at this point: it uses small incisions and is typically an outpatient procedure, with minimal downtime. Caveats: removing fat from one part of the body without siginificant lifestyle changes will cause fat storage somewhere else. Since most people have fat removed from their lower bodies, fat stores in the torso can increase, straining the heart.

Mesotherapy for fat removal is a relatively new procedure in the U.S., and there is not much research I could find on it. Mesotherapy in general is a treatment method utilizing subcutaneous microinjections, and has traditionally been used for pain syndromes and certain diseases. Unfortunately, I can't tell you much about this therapy at this point -- not even the contents of the injection. I do know that mycobacterium infection is a risk in any mesotherapy treatment, so it is probably also a risk here.

Intro | Facts
Cardio | Strength
Nutrition | Diet Industry
Resources
References