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Treat syndrome X with whole foods eating plan. (Easy for Patients to Follow).

FORT LAUDERDALE, FLA. -- A modified low-carbohydrate diet that focuses on fruits, vegetables, and low-fat protein can improve glucose tolerance and lipid profiles in patients with insulin resistance syndrome, or syndrome X.

The diet can also facilitate weight loss in these patients, who often have a high level of abdominal obesity--a significant risk factor for heart disease, Katherine Chauncey, Ph.D., said at a conference on patient education sponsored by the Society of Teachers of Family Medicine.

The "whole foods" diet, which Dr. Chauncey, a registered dietician, developed for use at Texas Tech University Medical Center, Lubbock, is directed first at improving the lipid profile and lowering insulin resistance. Weight loss is a secondary benefit.

The diet can be part of the lifestyle changes recommended by the National Cholesterol Education Program's Adult Treatment Protocol III, which notes that high carbohydrate consumption (more than 60% of the daily energy intake) can contribute to high triglyceride levels and low HDL cholesterol levels.

Patients who followed the diet not only commented on its ease and the satiety level that they experienced, but saw improved blood lipids and a decreased risk of developing heart disease, Dr. Chauncey explained at the meeting, also sponsored by the American Academy of Family Physicians.

Dr. Chauncey cited the case of one extremely overweight patient with a very poor lipid profile, who followed the diet for 1 year. The patient's total cholesterol level decreased by 17.4%; LDL cholesterol decreased 21%, while HDL cholesterol increased 33%. She experienced a 41% risk reduction for developing cardiovascular disease and lost 90 pounds.

"She was still obese, but she was much healthier," Dr. Chauncey said.

Syndrome X is defined as a cluster of pathologies that predispose a patient to ischemic heart disease and type 2 diabetes. The syndrome is present in patients who have at least three of the following characteristics:

* Abdominal obesity (waist circumference of more than 35 inches in women and more than 40 inches in men).

* Fasting glucose level of 100 mg/dL or greater.

* Triglyceride level of 150 mg/dL or greater.

* HDL cholesterol level of less than 50 mg/dL in women and less than 40 mg/dL in men.

* Blood pressure of 130/85 mm Hg or greater.

The whole foods diet limits carbohydrate servings to five per day but encourages patients to eat to satiety of nonstarchy vegetables and fruits, nonfat cheese, and lean protein. Other than the five carbohydrate servings, the diet allows no breads, cereals, sweets, soft drinks, or fruit juices.

The diet divides foods into three categories. "Green-light" foods can be consumed in unlimited quantities. These options include nonstarchy vegetables; all fruit except bananas; lean meat, poultry, and fish; low- or nonfat cheese; condiments; and noncaloric beverages.

"Yellow-light" foods are those to be used with caution. They include lowfat milk, monounsaturated fats, and the five carbohydrate choices a day. "Redlight" foods are those to be avoided: additional carbohydrate foods above the five servings, soft drinks, and sweets.

Some substitutions are allowed, Dr. Chauncey noted. This lets patients control their food choices to avoid a feeling of deprivation but still limits their carbohydrate consumption to an acceptable level.

"You want to aim for 75 grams of carbohydrate a day," she said. "You can have a 12-ounce can of soft drink, but you have to realize that's half of your daily allotment and substitute accordingly. This teaches them a trade-off system to choose what they want but still stay in control."

Patients are encouraged to eat three or four meals per day, drink a total of 64 ounces of water each day, and draw snack foods from the green-light list only. The diet also includes a recommendation to increase exercise according to medical advice.

While the diet includes many foods with a low glycemic index, it is not a strict, low-glycemic plan. Constructing a day-to-day eating plan around glycemic indexes is too complicated for most patients, Dr. Chauncey said.

The whole foods diet is easier to follow and concentrates on healthy, everyday eating over special rules about choosing and cooking foods.

"This diet emphasizes low-glycemic-index foods and encourages the consumption of phytochemical-rich fruits and vegetables. It also includes protective fats and high-quality protein, while it discourages the consumption of junk foods. It's healthy eating."

Dr. Chauncey added that the whole foods diet is not "fully embraced" as a patient education tool by the American Diabetes Association, which continues to endorse carbohydrate counting as the preferred method of meal planning for diabetic patients.

Copies of the diet can be obtained by e-mailing Dr. Chauncey at
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Author:Sullivan, Michele G.
Publication:Family Practice News
Geographic Code:1USA
Date:Jan 15, 2003
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