by Barbara Berkeley, MD
I was struck today by an opinion piece by Dr. Yoni Freedhoff on Medscape, an educational physician website. Dr. Freedhoff, a thoughtful commentator on the diet and obesity scene, contends that the stridency of the Low Carb Community is turning people off. Many Low Carb advocates have gone over the top, he says. They are unable to see any other viewpoint. In fact, they often appear to arrogantly assert that there is no other viewpoint.
Perhaps Freedhoff's article hit home for me because it was a painful reminder of the many times my husband has scolded me for dietary arrogance. He gets particularly annoyed when I start preaching my Low Carb gospel to people when we are out to dinner with them. Granted, I only do this when someone at the table has asked me for advice about eating. But while it is a friend who opens the door, I am the one who barges through it with my soapbox.
It seems that everyone who is trying to live healthily has his or her strong position (belief system about eating, exercise, healthy habits). As our current political climate makes only too obvious, human beings are tribal. We are wired to identify with a group. Unfortunately, we often see those in other tribes as wrong, misguided, or even as enemies.
I have been observing and working in the world of obesity for 30 years. While it is clear to me that carbohydrate consumption is a major problem in the American diet, I've also come to realize that we know very little about what has caused us to fatten so quickly and so globally.
The emergence of the gut microbiome was a major eye opener. The importance of this major system (which processes and disposes of our food) was not even considered until recently. And we are just beginning to think about how the 100 TRILLION (imagine!) bacteria that share our lives as inhabitants of our intestines are changed by what we eat, the drugs we take, and how we live. We know that changes in these bacteria impact health and may even cause obesity. But the larger picture remains a mystery. Without doubt, huge areas of the obesity puzzle remain obscure, unknown. The best we can do right now is to try to work out empirical solutions, in other words....figure out what works by trial and error
These solutions may look somewhat different for each of us.
To be sure, there are certain themes that repeat when we look at the eating styles of those who have successfully lost weight and are maintaining it. Many people cite a return to food without additives and in its natural state. Many are on primal style diets that are lower in carbohydrate and which focus more on vegetables and proteins with the addition of some fruits. Most rely on exercise to some degree control weight. A growing number of people credit alternate periods of fasting or controlled eating hours with helping them lose and maintain.
Despite all the science and speculation, diet still remains guesswork. When I was in practice, I always encouraged my patients to think of themselves as scientists who were doing an experiment. But they needed to be both the scientist and the subject of study. Learning what diet works best for each of us involves reading, observing and yes....experimenting. Where to begin? It's not unlike looking at product reviews on the internet. If tons of people are giving something five stars, it's probably a better bet than the product that is constantly panned. If the same dietary themes seem to be working for the majority of people, those are a good place to start.
But do beware of becoming a dietary fundamentalist. Once you've figured out your own algorithm it's easy to fall into the trap of dietary arrogance. What works for you may not fit someone else. Always remember that we know so little. Celebrate yourself if you are able to figure our your own experiment in weight loss and maintenance. What an achievement!!! But don't fall prey to the temptation of insisting that everyone live the same way.