Monday, July 21, 2008


It is a routine in my clinic to advice my patients on dieting and exercise as many of the patients are overweight with a BMI in excess of 25. I always advice a low calorie, low salt diet, especially if they are above 50years of age and also a low fat diet. Dieting forms an important part of our strategy of primary prevention against coronary artery disease and diabetes. Further evidence of these was published in the July 15 edition of the New England J of Medicine. Dr I Shai of Israel, published a 2 year study of 322 Israelis ( there was a 85% followup rate after 2 years ) who were split into 3 groups. One group receiving a low fat diet, one group a Mediteranean diet rich in olive oil with some calorie restriction and the third group a low carb diet. After two years, they found that the group on Mediteranean diet and the group on low carb diet, lost more weight and had better lipid profile, than the group on low fat diet. Their sugar profile was also better. This study is interesting from several points of view. I was relieve to know that the investigators did not go on a food specific diet by rather on a strategy of the general composition of the diet. Very often, we are taken up by what we can and cannot eat. That may be missing half the point. There must be some give and take in the food items, as long as we have a food consisting mainly of low calories and if possible, fish and vege base. The second think that I learn is that a two year outcome ( if possible 5-10 years ) is better than many of the previous study, which sometimes study subjects over 1 year. Thirdly, this Israeli study was carried out in a nuclear research center where the subjects were working and where the meals could be standardised and monitored. Most of the subjects will take their main meal, which is lunch, at the facility and return home for dinner and breakfast. How much will the fact that there was constant peer encouragement and supervision, and how much will the fact that it is a regimented nuclear facility, have on the outcome is open for discussion. The point is that we all should diet, to prevent heart disease. We should adopt a diet, rich in veges, fruits, if possible olive oil or at least vegetable oil and also limit the number of calories. If we can also do low fat, that is fine. It would appear from this study that low carb may be more important than low fat. It is nice to know that we have been doing the right thing all along.

No comments: