The Diet Fix: A Science-Based Weight Loss Guide

Diets fail. Not just often, but almost always—90% of the time. If diets worked we wouldn’t have a worldwide obesity problem. And obesity is a problem that needs to be solved. The prevalence of obesity has doubled since 1980. As a public health issue, there are few determinants of illness that are more destructive, as obesity contributes to the growing rates of diabetes, heart disease, and even cancer. There’s no “one true cause” of all illness, but obesity comes pretty close. When people ask me for the single most important thing they can do for their health, my advice (after quitting smoking) is to (1) ensure you keep your weight under control and (2) exercise in any way possible.

Despite its tremendous impact on health, I’ve only blogged about obesity in an indirect way—by pointing out what doesn’t work. Dr. Oz is my perpetual source of bad health information with his regular promotion of bogus “weight loss” supplements like the green coffee bean “miracle”. I’ve also criticized eating programs like the fads of “Eating Clean”, gluten “intolerance”, or harmful diet delusions like “detox”. It’s the typical skeptical science blogger approach—spot pseudoscience, debunk it, and hope you did something good. But none of my posts have focused on what one should do—just what you shouldn’t. Over at Science-Based Medicine (where I also blog) Dr. Mark Crislip recently commented that what science-based medicine advocates support manifests in what we oppose. He’s right, because that’s the easy approach. Using the principles of science-based medicine, there’s an awful lot to oppose in the current writing and popular opinion on how to treat obesity. And my professional advice in the role of a pharmacist has been limited to steering people away from supplements, and then giving some basic advice about dietary planning. Anecdotes and platitudes. I admit that I’ve told patients to “eat less and exercise more”. I haven’t seen pharmacists do much more, though I like to think that pharmacists can and should be playing a much larger part in obesity management and treatment.

Should you “Eat Clean”?

Like many of you I’m interested in the science of good nutrition. In general, I’ve come to be pretty skeptical of the nutritional literature, as so many studies seem to follow the same trajectory that we see with drug studies: Trivial changes in non-relevant outcomes, a failure to consider the results in the context of the accumulated scientific evidence and often, significant conflicts of interest. What’s worse, you can’t blind a dietary evaluation. So we’re left to dig through observational studies and try to sort out correlation from causation. It’s little wonder that so many consumers are confused about the basics of healthy eating. It isn’t helped with the plethora of gurus offering their own solution. Many believe that vitamins supplements are both beneficial and routinely necessary (they are not) and that the latest “superfood” is all that’s standing between themselves and immortality. But nutritional science is important, and I’m always pleased when patients initiate discussions about weight loss, or just improving their dietary habits. After all, obesity is a significant risk factor for an array of chronic illnesses. Improving our dietary patterns should pay off with improved health.. A regular challenge I face is that my patient that has already decided to use a highly restrictive weight loss plan in order to achieve a specific weight loss goal. I always caution them to take a long-term view. Weight loss is easy. Maintaining that loss is the challenge. Most “diets” fail. So I’m critical of useless interventions (like food intolerance blood tests) or faddy diets (like going gluten-free) with the hope of easy weight loss. At its core, weight loss and weight maintenance comes down to caloric balance. Permanent weight loss requires permanent dietary changes. And how we spend our “calories” matters.

Over the past few months I’ve seen a few friends and colleagues announce that they’ve decided to transform their diet, lose weight, and “eat clean”. When I asked what was “clean” food, no-one seems to have a consistent answer. The most common response was that “eating clean” meant cutting out processed foods. But to others, eating clean meant avoiding meat, anything with GMOs, wheat and sometimes milk. It seemed to mean something different to everyone. It reminds me a bit of Humpty Dumpty in Through the Looking Glass:

‘When I use a word,’ Humpty Dumpty said, in rather a scornful tone, ‘it means just what I choose it to mean — neither more nor less.’

Is “eating clean” just a faddish buzzword? There are a number of personalities competing in the “eating clean” dietary space. The pioneer seems to be Tosca Reno, who has the Eat-Clean Diet and about a dozen related books based on the same idea. But she’s not alone, as there are several other books with related names, including Terry Walters with her “Clean Food” books. Success breeds competition, it seems. Given Reno’s book appears to be the most popular, I’ll take her plan as the template. She outlines the principles of how she defines eating clean in her 2007 book. I’ve added my comments after each principle.

Green Coffee Beans for weight loss: Dr. Oz loves it, but where’s the evidence?

I can’t keep up with Dr. Oz. Just when I thought the latest weight loss miracle was raspberry ketone, along comes another panacea promising results with no effort. This time, it’s green coffee beans.

Everyone knows Dr. Oz, now. Formerly a guest on Oprah, he’s got his own show which he’s built into what’s probably the biggest platform for health pseudoscience and medical quackery on daytime television. In addition to promoting homeopathy, he’s hosted supplement marketer Joe Mercola several times to promote unproven supplements. He has been called out before for promoting ridiculous diet plans, and giving bad advice to diabetics. And don’t forget his failed attempt to actually demonstrate some science on his show, when he tested apple juice for arsenic which prompted a letter from the FDA about his shoddy methodology. His extensive track record of terrible health advice is your caution not to accept anything he suggests at face value. Yet it continues to frustrate me that pharmacies see his endorsements as a boon for sales of supplements, rather than what they really are  – an obstacle to science-based health care. So when the sign in front of my local pharmacy started advertising “Green coffee beans – as seen on Dr. Oz”, I tracked down the clip in question. The last time I saw Dr. Oz in action when when he had Steven Novella from the Science-Based Medicine blog as a guest, where there was actually a exchange (albeit brief) about the scientific evidence for alternative medicine. Replace Dr. Novella with a naturopath, and you get this:

Mulberry Zuccarin Side Effects

The Science-Based Pharmacy post about Mulberry Zuccarin has become the most read article, by a big margin.  We’re pleased this evidence review has found a wide audience. However, it’s concerning that many consumers seem to be searching for information about mulberry leaf extract side effects, and adverse events associated with Mulberry Zuccarin. Some have posted their concerns in the comments, or have contacted this blog directly.

Please report any potential  adverse effects from Mulberry Zuccarin, or any other mulberry extract you take, to regulators in the country where you live. Only by reporting adverse events can cause and effect be properly evaluated. In general, natural health products are poorly evaluated, with few even undergoing randomized controlled trial evaluation. Consequently, the side effect profile may not be understood.  It is very difficult to establish a causal relationship from any product based on individual casse reports. Only with multiple reports can possible safety signals be identified.

Chili Burn: Can Green Tea and Chili Pepper Burn Fat?

Diet products are common in most pharmacies. Consumer demand is one factor, with obesity proliferating to the point where the majority of Canadian adults are now overweight or obese. Compounded with the reality that there are no easy solutions when it comes to weight loss, the weight loss industry is working overtime developing new products. Some healthy skepticism is called for, on the part of both consumers and pharmacists. Given the prevalence and accessibility of pharmacies, pharmacists are well positioned to play an important role in helping the overweight and obese.

Let’s review one product advertised widely in Canada: Chili Burn from the manufacturer New Nordic. The ad has the headline “I hated the extra pounds on my body!” “I’m am really surprised how well the Chili Burn tablets worked!” The ad then makes the following claim:

The product increases the amount of calories your body uses in a day, without any needed dietary changes or added exercises. As your body burns and wastes more calories, you steadily but surely, lose weight.

It sounds too good to be true.

Mulberry for Weight Loss: Not just unproven, but implausible

I don’t normally read the freebie newspapers in Toronto as their content is the journalistic equivalent of the lead in the Toronto water supply: both slowly sap your intellect away.

But I ride public transit and those papers are littered everywhere, rolling around the TTC. So against my better judgment I picked up the paper on May 20,  skipped past the article from the “holistic nutritionist” (a topic for another day) and stumbled across this advertisement:

“The Man Who Made the Whole Town Lose Weight”

Impressive headline.  Reading further it turns out that “Johnny Petterson”, a local health food store owner in Alesund, Norway, had started selling mulberry leaf tablets to his customers, and they lost weight – after only 10 days.  According to the advertising copy, Johnny has helped over 1500 customers lose weight. Apparently this product is for sale at major pharmacies in Canada. So it’s time to do a bit of digging into this scientific breakthrough unearthed by a health food store owner.

Here’s excerpts from the ad (here is a similar PDF) – and my comments.