Can't lose weight? You could have Syndrome X. (Book Reviews).

Cabot S, WHAS, Cobbity NSW, 2001, 348 pages, $25.00, ISBN 0-958-61379-2

Syndrome X is another low-carbohydrate high-protein diet book which dietitians will certainly be asked to comment on.

It tantalises the reader with the longish title 'Can't Lose Weight? You could have Syndrome X--the chemical imbalance that makes men and women store fat'. Like the common excuse of an 'underactive thyroid' for overweight, here is the newest one-'I can't lose weight I have Syndrome X'.

Its 348 pages are divided into 23 chapters, starting with a rundown on the Metabolic Syndrome (the term now accepted for Syndrome X) followed by chapters on diabetes, types of diets, insulin, ketosis, carbohydrates, glycaemic index, sweeteners, fats, labels, obstacles to weight loss and protein. There are plenty of practical tips on food selection.

The book offers 70 pages of attractive recipes contributed by 'recipe tester' Audrey Tea. They range from breakfast, salads, lunches, mains to sweets, including 'Syndrome X energy cookies' and 'Syndrome X energy slices' which are not especially low in carbohydrate but nice wholemeal cakes baked with nuts and dried fruit, None of the recipes are analysed--some are asterisked as being lower in carbohydrate.

Cabot's earlier bestsellers are all worked into this book via sections on how to work our your body type (The Body Shaping Diet), hormonal imbalances (Don't Let Hormones Ruin Your Life) and why 'incorrect diet is the major cause of fatty liver' (The Liver Cleansing Diet).

The actual Syndrome X Diet is described as a '12-week metabolic weight loss eating plan'. It begins with a first stage of six weeks of very low carbohydrate intake where no bread, pasta, rice, lollies, desserts or starchy vegetables are allowed. The only carbohydrates permitted are legumes 'in moderation' (no quantities given) and two serves of fruit a day (but not the 'high sugar' types such as banana, mango, pears, pineapple and papaya). Milk should be avoided.

No exact quantity of carbohydrate is offered nor is there a meal plan to guide you, which is frustrating. Those who want more rapid weight loss or are 'metabolically resistant' are counselled to consume only 18 to 30 grams daily with the cautionary note 'under the supervision of a health care professional'.

Stage Two comprises a further six weeks of low carbohydrate intake where the dieter is now allowed one slice of bread, one serve of starchy vegetables plus two to three fresh fruit daily but no desserts. Again no specific quantity of carbohydrate is given.

The final Stage Three is a maintenance eating plan once desired weight is achieved, set at 40 to 45% of calories from carbohydrate, but it would be hard for the reader to work out how much carbohydrate this means. Professionals will find lots of things irritating:

* Frequent advertisements are dotted throughout the text for Dr Cabot's practices, products, web sites and books.

* Many of the studies, tables of figures and statements of opinion from 'experts; are not referenced.

* When references are given, they are not numbered individually in the usual convention. Often three or four references are grouped together under the one number.

* Food labels used as examples are presented in the US format (Chapter 14) although the book is clearly Australian.

* Weights of foods are inconsistent, sometimes given in grams, in ounces and in household measures or a mixture of all three.

* Food lists are not equivalent--in a list of carbohydrate portions (p.247), two cups of raw leafy vegetables is supposed to equal to one slice of bread or to one cup raw muesli, which is incorrect.

Like her other books, there are 'food gimmicks' and in this one it's the promotion of stevia as a 'safe non-caloric herbal sweetener' in place of sugar, along with 'Syndrome X juice' made by juicing beans, broccoli and Brussels sprouts which is 'effective in lowering blood sugar and improving liver function' (p.70). Her 'Syndrome X Snack Pack' (p.223) is another and consists of nuts and dried fruit which you can order directly from her. A long list of supplements is also suggested such as milk thistle, taurine, psyllium and dandelion for liver or chromium picolinate for slimming or gymnema sylvestre, bitter melon and lipoic acid for modifying insulin.

But the biggest annoyance is that Cabot makes the fundamental error of lumping all refined carbohydrates together as 'high glycaemic index (GI)' and still divides carbohydrates into 'simple' and 'complex' (pp.104-6), a notion now discarded by nutritionists.

Sugar is supposed to 'cause a rapid rise in blood sugar and insulin'. The book is violently anti-sugar, echoing the diet books of the 1970s. Sugar (sucrose) is not even included in a table of GI values (p.128), which would show it to have only a moderate GI, although honey, fructose, maltose, glucose and lactose all appear.

Trans and hydrogenated fats cop a hiding. The author does not seem to have caught up with the fact that almost all margarines are now free of trans fats in Australia and our fast food industry does not use hydrogenated oils but prefers palm oil and beef tallow.

Cabot does not recommend any dairy and declares 'it is easy to get all the calcium you need without eating dairy products' (p.221). A table of calcium values gives surprisingly high figures until you realise that the standard serve sizes have been inflated e.g. one cup (no weight given) of canned salmon is supposed to have 431 mg calcium and one cup wakame seaweed comes in at 520 mg compared to one cup skim milk at 300 mg.

Overall, the Syndrome X diet is nutritionally 'better' than a straight Dr Atkin's high-fat high-protein diet because it is not high in saturates, but rather promotes healthy fats like cold-pressed oils, avocados, nuts and seeds.

The book appears scientific and has enough of the usual nutrition terms like BMI, GI, etc. to win over readers. But the incorrect GI information and the vagueness of the diet plan make it hard to recommend. However anyone cooking the recipes will still consume a healthy diet with plenty of vegetables and legumes.