By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.
Of all the diets and weight loss strategies out there – low-fat, vegan, gluten-free, Mediterranean, Paleo… which ones are truly best for long-term health and weight loss? If you have been following my recommendations on this website, you have a pretty good idea of the kinds of foods that a cardiologist certified in nutrition likes and doesn’t like. Just to make it clear, here’s a short roundup.
The Best Diets in the World
What I like, and which has worked for my heart patients over the years and for patients seeking to improve their health, is adopting a diet that combines the best of traditional Mediterranean and Asian diets – what I call the Pan-Asian Modified Mediterranean (PAMM) diet. Basically, this diet features an abundance of plant-based foods with about 20 percent from animal proteins like lamb, fish, chicken and eggs, and a good amount of healthy fats.
The PAMM diet is both a healthy diet and a weight loss diet – a true win-win: with lots of fresh vegetables and fruits, complemented by legumes, fermented soy, eggs, fish and seafood, extra-virgin olive oil, fresh garlic, nuts and seeds, and seaweed – you’re feeding your body low-glycemic, unprocessed, nutrient-dense fuel that is both satisfying and helps keep excess weight off, and promotes health and longevity. Of all the diets out there, I think this one brings us closest to the fountain of youth.
Now, I do feel the need to stress the modified in PAMM, as not all aspects of traditional Mediterranean and Asian diets are healthy. Whether they are artificial ingredients or high-carb (high glycemic) no-nos, you’ll learn below why I’ve picked and chosen only the best of each.
My Take on Other Popular Diets and Weight Loss Strategies
A High-Carb Diet
The typical American diet is based on processed, quick-to-prepare meals that involve an excess of refined carbohydrates and sugar like bread, bagels, macaroni, and plain pasta – high-glycemic foods, which break down quickly to sugars in the digestive tract and cause lots of insulin to be released so you can digest all that sugar.
Once in a while, a lot of insulin floating around in your blood isn’t going to hurt you, but if you regularly fill up on high-glycemic carbs, you’re setting yourself up for a situation where your cells say, “thanks, but no thanks, insulin, take it somewhere else” – in other words, they become insulin resistant. You DON’T want to become insulin resistant: it sets the stage for weight gain, atherosclerosis, diabetes and all the problems these conditions lead to – you’ve got to limit your carbs!
Now – just for the sake of splitting hairs – a high-carb diet can be a healthy diet and good weight loss strategy, but only if the carbs you eat are low-glycemic and high in fiber; that is, they are broken down into sugar slowly and don’t require much insulin for digestion. Most fresh fruits and vegetables are best bets as low-glycemic carbs.
Very Low-fat or Non-fat Diets
Remember the fat-free diet craze in the 1990s, which sparked a whole new industry of non-fat and low-fat foods? Fat – especially saturated fat – was unnecessarily vilified, and people started substituting carbs – mostly processed carbs with lots of sugar and other added sweeteners – for the fat they were cutting out.
Unfortunately, it became clear a decade or two later that the carb-, grain- and sugar-heavy “solution” to our fat problem was actually contributing to obesity and diabetes rates….It made sense at the time to assume that a fat-heavy diet would cause weight gain because fat has more than twice the amount of calories per gram than carbs or proteins, and it seemed logical that foods with cholesterol would raise the amount of cholesterol in your body…. Hindsight is always 20-20. Research has since shown that a low-carb diet is better for weight loss than a low-fat diet.
I recommend in my PAMM diet that you get 35 to 40 percent of your daily calories from healthy fats like nuts, extra virgin olive oil, avocados, and even organic cheese. A very low-fat or non-fat diet – one that is less than 15 percent fat – is simply not a good weight loss diet… First, if you’re eating more sugar and processed carbohydrates to make up for the fat loss, you’re increasing your risk of weight gain and diabetes, not to mention atherosclerosis, or artery disease. Second, fat gives you a feeling of satiety, so depriving yourself of it too much may leave you constantly hungry. A very low fat diet is not a healthy diet either … Your body needs fat for a variety of functions and limiting fat can seriously impact your intake of omega-3 fatty acids – found in fish, nuts, and seeds – that are so important for health. A diet with plenty of healthy fats, protein, fiber, antioxidants, and key nutrients is the best weight loss strategy, and will also help keep you out of the cardiologist’s office.
A Vegan Diet
A vegan diet – which means you don’t eat any animal products whatsoever – is a double-edged sword. On the one hand, if you eat mostly fresh fruits and veggies, legumes, nuts, fermented soy and seeds, you’re doing your heart good. On the other hand, if you eat a diet full of high-glycemic and processed carbs, you’re not doing your heart or waistline any favors.
Either way, vegans risk ending up deficient in a few vital nutrients which are found primarily in animal food sources: Vitamin B12 (found in eggs), Coenzyme Q10 (CoQ10 – found in fish like salmon), and L-carnitine (found in lamb). We need Vitamin B12 to keep our arteries healthy, among other things. CoQ10 – which I wouldn’t dream of practicing cardiology without – is absolutely vital for heart health. Many of my younger patients who were vegans often complained of fatigue, which makes sense since CoQ10 and L-carnitine are necessary for the production of cellular energy – Adenosine triphosphate (ATP).
To make vegan a healthy diet, you need skip the processed carbs and take vitamin B12, CoQ10, and L-carnitine supplements.
A Gluten-Free Diet
The trendy gluten-free diet doesn’t make a lot of sense to me, but is certainly a money-maker for the food industry. Gluten is a protein in wheat, rye, and barley, which means it’s in just about everything in the American diet – breads, pastas, cereals, etc. Grocery stores are now filled with gluten-free versions of all our American favorites, but are these gluten-free foods really any healthier or better for weight loss? The short answer is, no.
For about 1 percent of population with celiac disease, gluten can cause serious health issues. Among the rest of us, there may be some people with an allergy or sensitivity to foods with gluten, but for the vast majority drawn to gluten-free processed foods, there’s probably no benefit: a (high glycemic) carb is a carb is a carb.
Many gluten-free foods are processed and full of sugar, with processed rice and corn substituted for wheat. So if you’re munching away on gluten-free crackers and eating bowls of gluten-free pasta, you’re not really doing much for yourself other than to be part of a questionable fad (somewhat like the fat-free fad of the 1990s… you see where I’m going with this).
The bottom line? Unless you really have a problem with gluten, a diet where you’re just substituting gluten-free carbs for gluten-filled ones, isn’t going to help you lose weight or improve your health. Gluten-free can be a healthy weight loss diet, but only if you cut out the high-glycemic gluten-free carbs, and fill up on fresh fruits and veggies, nuts, seeds, etc. – healthy PAMM foods.
A Paleo Diet
The Paleolithic diet – I like to call it a caveman diet – consists of what you could hunt and gather if you didn’t have the supermarkets, bodegas and the restaurants we take for granted: meat, fish and seafood, fresh fruits and vegetables, eggs, nuts and seeds, and good fats from olive and coconut oils, avocado, and walnuts. It means avoiding modern conveniences like cereal grains, dairy, refined sugar, and processed foods.
Generally, I think Paleo is a healthy diet, as the Paleo diet can help improve symptoms of metabolic syndrome (a condition caused by a carb-heavy diet), but I’m wary of the overemphasis on meat and the recommendation to eat meat on a daily basis. A few times a week is OK in my book, but not more. Meat-heavy diets are linked to colon cancer, cardiovascular disease, and diabetes. If you go Paleo, make it mostly about the fresh fruits and vegetables and go easy on the meat; vary it up with fish, chicken, eggs, and even fermented tofu.
Fast Food Diet
Let me start by saying that, I don’t suggest that anyone eat a diet of fast food. I do recognize, though, that – for a variety of reasons – fast food may be a part of daily life for some people. For these folks, the key to not ruining their health is to be smart about it. Smart is not hamburgers, fried anything – fish, chicken, or French fries – sodas or “milkshakes” two or even three times a day. A greasy cheeseburger with mayonnaise-based sauce sandwiched between a white flour bun (sometimes with 3 buns, like a club sandwich) with French fries and a soda, contains the equivalent of 40 teaspoons of sugar! That’s a sure ticket for overweight and obesity and health problems.
Here are some dieting tips if fast food is – for whatever reason – in your everyday cards:
- Eat as many raw vegetables as possible – think onions, tomatoes, lettuce, fruit, salad, salsa, and even pickles.
- Choose mustard instead of fatty mayonnaise or sugary catsup. Eat smaller portions.
- Eat one-half of the bun only, or skip the bun altogether.
- Pass on the sodas. Drink water or seltzer instead.
- Don’t even think about ordering French fries.
- Choose grilled chicken over fried.
For more information on how to make the best of a fast food diet, check out my book, The Fast Food Diet.
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