Do Diets Really Work?

Yes and no. They certainly can! But not long term.. What?!

A breakfast salad of arugula, tomatoes, cucumbers, avocado, eggs and hummus made by yours truly

There is a lot to consider when we talk about diets. The first and foremost important question is, “What we are trying to accomplish with a diet?” So now you are probably thinking… “Ummm that is obvious, weight loss.” Well it isn’t that obvious! Diets aren’t just for weight loss and the art of losing weight is complicated.

What is a Typical Diet?

Most diets tend to be around weight loss that are typically calorie restrictive diets. Companies like Weight Watchers do this in a simpler and more consumer friendly method by allotting points to the various foods they provide or the foods you put into their app calculator. They inform you of a max amount of points you can spend which are basically just calories. The ‘calories-in-and-calories-out” is the easiest implemented approach to weight loss that shows great effectiveness short term. No matter how a company presents it, it is very likely just a calories-in-calories-out diet but hidden with fancy terminology or pathology (even keto diets are shown to be indirectly calorie restrictive due to it’s high satiety profile). Overall, 6 months of calorie restrictive dieting showed great improvement in weight loss and cardiovascular health but, after 1 year the majority of individuals are close to their previous pre-diet weight and cardiovascular health markers. (1) Why does this happen?

Why do they fail?

Lifestyle. Changing diet routines, implementing exercise, meditating, incorporating healthy foods, reducing alcohol intake… these are ALL different lifestyle changes. The way we eat, exercise, enjoy life are part of our day to day routines and how an individual lives their life. The moment someone restricts their calorie intake and gets their desired weight off they normally will go back to their original cravings and dietary intake. The best way to create permanent change is to implement new eating habits instead of treating it as a temporary diet. These include eating proper food portions, following the 50/25/25 vegetable, grains and proteins plate ratio, incorporating high fibre foods, and increasing proteins that keep you full and reduce snacking.

It isn’t just calories-in-calories-out. “What!? But you said!.. I give up..” There are many factors that can complicate weight loss that need to be considered first. That and restricting your calories too much will cause your metabolism to slow.

• Digestive Health. This is incredibly important as poor digestion, lack of nutrient absorption and improper bowel movements can dampen your ability to lose weight. Good bacteria in the gut also influence the ability to properly lose weight. (2) Also, who doesn’t have a great day after a good poop?

• Nutrient Status. Having adequate nutrition allows for properly functioning metabolic pathways and energy levels. A fatigued individual will also have a lack of motivation for lifestyle changes and cooking healthy meals at home.

• Hormones. These don’t just involve female reproductive hormones but your thyroid, testosterone, insulin, vitamin D (yes it is a hormone) and cortisol. These all are good markers on how your body will utilize and store glucose and fats in the body. As well as being decent indicators of mental health status.

• Sleep. Proper sleep improves metabolism, insulin sensitivity, glucose tolerance, decreases appetite and allows for proper daytime and nighttime cortisol hormone levels. Lack of sleep will throw a lot of that out the window including the hormones mentioned above. (3)

• Mental Health. This is a bit of a what came first, cyclical in nature factor. Poor mental health status will create bad dieting and over/under eating or malnutrition. And poor nutrition also effects the mood of an individual as it alters hormonal and metabolic pathways. But in general, someone who isn’t in a great mood will have a more difficult time sticking to a new routine such as a diet.

• Inflammation. Inflammatory processes when we have an injury are important. But abnormal inflammatory processes in the body common in dysfunction digestion, autoimmune disorders, diabetes, cardiovascular disease, chronic stress and obesity in itself are shown to be influential on each other. (4,5) A little bit of a chicken and the egg situation here too, between high weight profile and these other disorders. A lot of this comes from pro-inflammatory foods highly prevalent in Western diets.

Common “Naturopathic Diets”

So why do I have the above in quotations? It’s because many Naturopathic Doctors commonly prescribed these diets to improve the health of those in chronic conditions like diabetes, heart disease, lupus, asthma, arthritis and others. A big focus is also improving digestive health through diet interventions as a dysfunctional gut can be the root of many conditions and diseases. So these diets are less about weight loss and more about creating lifestyle changes and eating habits that improve overall quality of life and health. Some of these can be considered as “restrictive dieting” which must be monitored and not necessarily done long term (but to promote that lifelong healthy eating practice post diet). Cibophobia; fear of certain foods is a condition that is becoming more prevalent. The aim of health diets are to improve symptoms and heal, then slowly go into a balanced overall healthy diet as a lifestyle change, not to fear food. Also these diets were not necessarily created by Naturopathic Doctors but are often prescribed by them.

Here are some of the most common and most studied non-weight loss related “diets.”

• Low FODMAP Diet: Mainly used for IBS (irritable bowel syndrome), SIBO (small intestinal bacterial overgrowth) and bloating related digestive concerns. It consists of foods that are low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols. This allows less bacteria to ferment those foods in the gut and cause distress, while reducing the amount of bacterial overgrowth in the digestive tract. (6)

• DASH Diet: Around for 20+ years it is a diet to reduce high blood pressure but now also used in obesity and type 2 diabetes. Its aim is to try to incorporate healthy eating practices with high intakes of vegetables, fruits and whole grains while drastically reducing sodium and saturated fats in the diet. The improvements in lowering high blood pressure are incredible, adherence to the diet is not. (7,8).

• Mediterranean Diet: This diet also has been around for quite some time. With well over 3000 citations in various publications of various health conditions, the mediterranean diet has become somewhat the standard for a healthy diet. From diabetes to neurological disorders to breast cancer, this diet compared to the western diet shows much improvements and lowered mortality risks. (9) So much of the time you will see a practitioner start with this recommendation of healthy fats, fish, low red meat intake, moderate grains, high amounts of fruit and vegetables and even regular consumption of wine with meals.

• AIP Diet: Stands for Autoimmune Protocol Diet, it aims to remove inflammatory, gut irritant and immunostimulant foods for a minimum of 30 days. Aimed to treat those with autoimmune diseases such as Lupus, Arthritis and Ulcerative Colitis. Not much research is to be had of this diet, and not much standardization is implemented. BUT there has been promising results in digestive autoimmune disorders as well as many patient cases that have been shared by practitioners. (10)

• Intermittent Fasting: A huge fad with some pretty decent research, and must be done correctly. Intermittent fasting puts your body through a daily self preservation phase by creating a period of minimum 12 hours without food consumption. We have drugs in our body that trick our cells into doing such things as well, such as metformin. This improves insulin sensitivity, helps with blood sugar regulation and overall better metabolism in the body. (11,12) Research shows that intermittent fasting may help with aging, diabetes, cardiovascular disease, weight loss, hormonal balance and more. And in combination with proper meal planning and supplementation, it could be a great addition to a plan.

• Elimination Diet: When I refer to this I am referring to the elimination and reintroduction of foods to discover sensitivities that is used by Dieticians and Naturopaths alike. It consists of eliminating common food sensitivities for a period of time and then reintroduced to see if a reaction results, pointing out foods that deem sensitive. (13) It is a great tool to find problematic foods and then proceed with a plan to heal and support the digestive tract, resulting in many symptoms being resolved.

• Naturopathic Diet: Not really an official diet, but an important one to note. Naturopaths such as myself will adjust or create new recommendations for meal planning based on a lot of these researched diets. And much of the time it can be influenced by lab results as well, from hormone levels to nutrient deficiencies to inflammatory markers. In this way, it is trying to create a food/diet plan that works with your unique health and lifestyle.

The Bottom Line

In a way of diets it is best to treat it more like a modification and lifestyle change. Following extremely strict diets that are way out of what you traditionally eat will set you up for long term failure. Forming new habits take time, and depend on the individual and what habit is being formed, it can take anywhere from 21 to 210 days. (14) A change in habit such as quitting smoking can be much more difficult than say stopping to use your phone before bed. So in nutritional modifications there are some that are more challenging than others too; like cutting out sugar or alcohol versus introducing more vegetables.

Remember diet modifications are not just for losing weight but are also created for certain health conditions too. A trained practitioner or nutritionist can look at your diet diary and make changes that will benefit your health or put you on a more strict regiment short term to help with healing and recovery alongside other treatments. Then get you back to eating your favourite foods, with some in moderation.

So do diets really work? Yes, if done properly and are implemented slowly as a lifestyle change, with more restrictive diets being used for certain health conditions and short term.

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References:

1) Ge L, Sadeghirad B, Ball GDC, et al. Comparison of dietary macronutrient patterns of 14 popular named dietary programmes for weight and cardiovascular risk factor reduction in adults: systematic review and network meta-analysis of randomised trials [published correction appears in BMJ. 2020 Aug 5;370:m3095]. BMJ. 2020;369:m696. Published 2020 Apr 1. doi:10.1136/bmj.m696
2) John GK, Wang L, Nanavati J, Twose C, Singh R, Mullin G. Dietary Alteration of the Gut Microbiome and Its Impact on Weight and Fat Mass: A Systematic Review and Meta-Analysis. Genes (Basel). 2018;9(3):167. Published 2018 Mar 16. doi:10.3390/genes9030167
3) Beccuti G, Pannain S. Sleep and obesity. Curr Opin Clin Nutr Metab Care. 2011;14(4):402-412. doi:10.1097/MCO.0b013e3283479109
4) Ellulu MS, Patimah I, Khaza'ai H, Rahmat A, Abed Y. Obesity and inflammation: the linking mechanism and the complications. Arch Med Sci. 2017;13(4):851-863. doi:10.5114/aoms.2016.58928
5) Ramallal R, Toledo E, Martínez JA, et al. Inflammatory potential of diet, weight gain, and incidence of overweight/obesity: The SUN cohort. Obesity (Silver Spring). 2017;25(6):997-1005. doi:10.1002/oby.21833
6) Magge S, Lembo A. Low-FODMAP Diet for Treatment of Irritable Bowel Syndrome. Gastroenterol Hepatol (N Y). 2012;8(11):739-745.
7) Challa HJ, Ameer MA, Uppaluri KR. DASH Diet To Stop Hypertension. [Updated 2021 May 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482514/
8) Steinberg D, Bennett GG, Svetkey L. The DASH Diet, 20 Years Later. JAMA. 2017;317(15):1529-1530. doi:10.1001/jama.2017.1628
9) Romagnolo DF, Selmin OI. Mediterranean Diet and Prevention of Chronic Diseases. Nutr Today. 2017;52(5):208-222.
10) Konijeti GG, Kim N, Lewis JD, et al. Efficacy of the Autoimmune Protocol Diet for Inflammatory Bowel Disease. Inflamm Bowel Dis. 2017;23(11):2054-2060.
11) Cuyàs E, Fernández-Arroyo S, Buxó M, et al. Metformin induces a fasting- and antifolate-mimicking modification of systemic host metabolism in breast cancer patients. Aging (Albany NY). 2019;11(9):2874-2888.
12) Stockman MC, Thomas D, Burke J, Apovian CM. Intermittent Fasting: Is the Wait Worth the Weight?. Curr Obes Rep. 2018;7(2):172-185.
13) Tuck CJ, Biesiekierski JR, Schmid-Grendelmeier P, Pohl D. Food Intolerances. Nutrients. 2019;11(7):1684. Published 2019 Jul 22. doi:10.3390/nu11071684
14) Gardner B, Lally P, Wardle J. Making health habitual: the psychology of 'habit-formation' and general practice. Br J Gen Pract. 2012;62(605):664-666. doi:10.3399/bjgp12X659466