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Weighing the diet books.

And then there were three.

For years, Dr. Atkins' New Diet Revolution has dominated best-seller lists. But by last November, Atkins had company. Dr. Phil's The Ultimate Weight Solution had cracked the top ten. And The South Beach Diet sat comfortably at number one. Where it should be.

South Beach isn't perfect. Its rationale has some flaws. And just because people buy a self-help book, you can't assume that they'll follow its advice (or we'd all be trim, sculpted, happily married, wealthy, and living a purpose-driven life).

But for the first time in a long time, one of the most popular weight-loss books is recommending a healthy diet. Whether it helps those unwanted pounds disappear any better than other diets is another question.

After all these years, publishers know what sells. And, with a few exceptions, what's selling now are books about "good carbs."

Books like The South Beach Diet, The Zone, and Good Carbs, Bad Carbs argue that "bad" carbs are making us fat. Even the Atkins diet, which has urged dieters to limit all carbs since the 1970s, has modeled its recent advice (especially for Phase 2) after the "good-carb" books. In a nutshell, here's what they claim:

1. Bad carbs cause a quick rise in blood sugar.

2. High blood sugar raises blood insulin levels.

3. Insulin leads to weight gain (either by making the body store fat or by lowering blood sugar levels so much that it causes hunger).

The solution? Simple, say the books. All dieters have to do is eat "good" carbs (like whole grains, vegetables, and beans) instead of "bad" carbs (like sugar, white bread, and potatoes).

Yet most obesity experts, including those who believe in that advice, agree that the research cupboard is bare. "It's amazing how few good studies have looked at how different carbohydrates affect weight loss," says Walter Willett, chair of the nutrition department at the Harvard School of Public Health.

"So far, the long-term evidence on weight loss is meager. We need bigger and longer randomized trials."

Glycemic Confusion

The South Beach Diet calls them "slow sugar" and "fast sugar." To Good Carbs, Bad Carbs, they're "tricklers" and "gushers."

But the message is the same: "As far as obesity is concerned," says South Beach, "fast sugar is worse for you; slower is better." How do you know which foods are which?

"In the early 1980s, Dr. David Jenkins led a team of Canadian researchers who devised a scale to measure the rapidity and degree with which a fixed quantity of food increases your blood sugar," writes South Beach author Arthur Agatston. "They called it the glycemic index."

In fact, the index is much more complicated than most books pretend.

"People think that a food has a definitive glycemic index, but it depends on how the food is processed, stored, ripened, cut, and cooked," says Xavier Pi-Sunyer, an obesity expert at Columbia University College of Physicians and Surgeons in New York.

Furthermore, diet books imply that "good" carbs like whole grains have a low glycemic index (GI, for short), while "bad" carbs like sugars, white flour, and other refined grains have a high GI. In fact:

* Bread is typically high-GI, whether whole-wheat or white, because it's made from finely ground flour.

* Pasta is low-GI, whether whole-wheat or white, but there are variations. "Thin linguine has a higher GI than thick linguine," notes Pi-Sunyer. "How would we advise the public about this major difference?"

* Rice ranges from high-GI (instant white) to low-GI (Uncle Ben's converted white), with brown and long-grain white rice in the middle. "Are we going to specify for the public which kind of rice they should eat and which kind they shouldn't?" asks Pi-Sunyer.

* Sugars range from high-GI (glucose) to low-GI (fructose). Sucrose (table sugar) is smack in the middle. What's more, "researchers have found no relation between the sugar content of foods and their glycemic index," says Pi-Sunyer.

And it's not even clear that the rise in blood sugar that comes from eating high-GI foods leads to high blood insulin levels, or that higher insulin leads people to overeat, says Pi-Sunyer. (1)

"The glycemic index may account for less than a quarter of the insulin response to a food," he suggests. "And there is no evidence that the typical post-meal levels of insulin increase food intake or body weight."

Which leads to the question: how good is the evidence that low-glycemic-index foods promote weight loss?

No Magic Bullet

You'll find a glycemic-index ranking of foods in The Zone; Dr. Atkins; Good Carbs, Bad Carbs; and The New Glucose Revolution.

But unlike the other books, The New Glucose Revolution was written by scientists who have actually studied the glycemic index. In fact, one of its authors, Thomas Wolever of the University of Toronto, was one of the researchers who helped devise the scale.

The glycemic index is no magic bullet for dieters, says Wolever.

"I've yet to see evidence that a low-GI diet aids weight loss," he explains. "One or two studies show it and a number of others don't."

Despite the "Lose Weight" claim on the cover of Wolever's The New Glucose Revolution, "it's not really a diet book," he says. "It's information about the glycemic index and how to use it for health." Wolever's research uses a low-glycemic-index diet to lower the risk of heart disease and to control diabetes. "The chapter on weight says that a low-GI diet may be helpful for people who want to lose weight," he says. "But the best way to do that is to reduce calorie intake and increase activity level."

When Wolever put people on low-GI diets to control their diabetes, the pounds didn't melt away. "People tended to lose a little weight, but it wasn't significant," he explains. "And we found no differences in how full they felt on low-GI foods."

In fact, in one study of 35 people with diabetes, those who were given high-GI cereals (corn flakes, puffed rice, or crispy rice) lost two pounds after six weeks, while those who got low-GI cereals (Bran Buds or a Cheerios-type cereal, plus an added fiber called psyllium) lost no weight. (2)

Others agree that the research is in its infancy.

"A low-GI diet may suppress hunger. But until there is research over the long term, we just don't know," says Susan Roberts of the Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging at Tufts University in Boston.

A recent review of the evidence reached this conclusion: (3) "The ideal human intervention study on low-GI vs high-GI diets has not yet been conducted."

For example, in many studies, the diets differ in fiber or protein content, not just in the glycemic index of their foods. "A lot of articles hypothesize about the glycemic index, but there are not a lot of controlled studies to see whether a low-GI diet works," says Bonnie Brehm, an obesity researcher at the University of Cincinnati.

Beyond the Index

If a low-GI diet is no guarantee that we'll all look like Demi Moore and what's-his-name, so what? Maybe it's not a low glycemic index, but more whole grains or fiber, that can keep us slim.

"It's hard to draw conclusions because the studies on fiber are all too different--some use supplements, some use real food, some have a small fiber increase, some have a modestly big increase," says Tufts' Susan Roberts.

Studies on whole grains and weight are even scarcer. "Our study found that diets higher in whole grains and fiber slow weight gain compared to diets high in refined carbohydrates," says Eric Rimm of the Harvard School of Public Health.

But the difference in weight was small--only a few pounds over 12 years--and it's impossible to know whether whole-grain eaters did other things to avoid obesity. (4)

"Would I like to see trials that randomly assign people to eat whole grains or refined grains for a year?" asks Rimm. "Sure." In the meantime, he recommends whole grains for everyone, overweight or not.

"There's a growing body of evidence that whole grains are more beneficial than refined grains to reduce the risk of heart disease, diabetes, and obesity."

Diet vs Diet

After years of ignoring popular diet books, researchers recently started testing Dr. Atkins head-to-head against "conventional diets," which cut calories mostly from fat. Three research teams released preliminary results last year. (5-7)

"Our study, as well as the two others, were all relatively small and short-term, but the results of all three were consistent," says the University of Cincinnati's Bonnie Brehm. "The healthy obese women in our study lost more weight on the Atkins diet than on the American Heart Association's diet."

Brehm's study lasted only six months. In another study, the Atkins dieters also lost more weight, but the difference between the two groups disappeared after a year. Still, what dieter wouldn't jump at the chance to lose extra weight for six months?

What's more, "we don't have as much reservation as we used to about the cardiovascular risk factors of an Atkins diet," adds Brehm. "The weight loss seems to override the high saturated fat content of the diet."

But what happens to LDL ("bad") cholesterol and other risk factors for heart disease once weight stabilizes is an open question, she adds. Also, her study tested women with normal, not high, cholesterol.

"Is the Atkins diet effective?" asks Brehm. "Yes. But I still wouldn't recommend it until we have more research on its safety."

Others are also hesitant to endorse a diet that's loaded with red meat.

"The Atkins diet is potentially related to a long-term risk of cancer" if people stay on it long enough, says Harvard's Eric Rimm.

A few months on Atkins may not cause problems. "But two years on a red meat diet could initiate a cancer," he adds. "It could show up as a polyp in seven years and as colon cancer in ten."

And Brehm worries about too little fiber, fruits, and vegetables on an Atkins-type low-carb diet.

"The women in our study averaged only five grams of fiber a day," she notes. (That's one-sixth of what experts recommend.) And despite what Atkins claims, "they did have constipation problems."

Phase 2 of the Atkins diet allows more fruits and vegetables, she acknowledges. "But if you don't lose enough weight in Phase 2, you have to move back to Phase 1, so you're on that restricted diet longer than the book says.

"I don't see the medical community recommending Atkins as a healthy diet because it's so restricted," says Brehm. "You miss out on fiber and any phytochemicals in fruits and vegetables that we may not even know about yet."

The Bottom Line

Where does that leave the ever-expanding legions of dieters?

According to media reports last November, a new study found no difference in weight loss, on four diets--Atkins, The Zone, Dean Ornish, and Weight Watchers. But until the study has been vetted and published, it's too early to weigh its conclusions.

Ornish's book, Eat More, Weigh Less, resurrects an old question: should dieters eat a very-low-fat diet, which gets 70 to 75 percent of its calories from carbohydrates?

Carbs shouldn't exceed 60 or 65 percent of calories, say the National Heart, Lung, and Blood Institute, the American Heart Association, and the National Academy of Sciences.

"Too many carbs may raise triglycerides and lower HDL [good] cholesterol," says Alice Lichtenstein of Tufts' Human Nutrition Research Center on Aging, who coauthored the American Heart Association's guidelines on very-low-fat diets.

That didn't happen when Ornish put 35 people with heart disease in his Lifestyle Heart Trial for five years. (Their arteries became less clogged.) Was it all the fiber they were eating? Possibly.

"It's also possible that other parts of Ornish's program--vigorous exercise, stress reduction, and weight loss--protected them," says Lichtenstein. "If people don't follow his diet and other advice closely, too many carbs could cause trouble."

Ornish aside, people who think they can eat any and all carbs without consequences are wrong.

"When the pendulum swung as far as it could to low-fat diets in the 1980s, we may have gone too far recommending higher carbs," says Brehm. "People may have lost sight of the fact that carbs have calories."

Now they know better.

"We're saying that you need to cut back on carbs, and you can eat more unsaturated fat," Brehm explains. "People may be ready for a more refined tool that separates good carbs and fats from bad." Sound familiar?

"The South Beach Diet teaches you to rely on the right carbs and the right fats," says the book's first page.

Guess which of those promises come from which of the three top-selling diet books, Dr. Atkins' New Diet Revolution, The South Beach Diet, and Dr. Phil's The Ultimate Weight Solution. (Answer: they're in order.) Most diet books follow a formula. Amid the dispelled myths, tips, and personal success stories, nearly all promise that:

* it's not a diet but a way of life,

* the food is delicious and you won't be hungry,

* you're overweight because you ate the wrong (not too much) food,

* you'll lose weight because you'll eat the right (not less) food, and

* the diet will prevent either the major--or virtually all--diseases.

If you believe all that, we've got some old Enron stock for you.

battle of the diet books

is it the title? Is it the promises? Is it word of mouth? It's not clear how people pick a diet book, but one thing's for sure: the decision is rarely based on good science. Here's our take on the most popular diet books. Since no large long-term studies have pitted them head-to-head, we can't evaluate the diets' ability to make you skinnier. Instead, we've graded each book's scientific credibility ("Is the Science Solid?") and whether the diet it recommends is healthy. (In "What You Eat," "Yes" means frequently, "Less" means rarely, if ever.)

The books are listed in order according to Amazon.com's top-selling "Diet and Weight Loss" books in mid-November. We added Dean Ornish's Eat More, Weigh Less and the Weight Watchers cookbook because a recent study tested both diets. We excluded other cookbooks and how-to spin-offs of the top-sellers.

The chart gives only thumbnail sketches. See the books for more details.
 WHAT
 NAME CLAIM YOU EAT

The South Switching to Yes: Seafood,
Beach Diet good carbs stops chicken breast, lean
By Arthur insulin resistance, meat, low-fat cheese,
Agatston cures cravings, most veggies, nuts,
 and causes oils; (later) whole
[ILLUSTRATION weight loss. grains, most fruits,
OMITTED] Good fats protect low-fat milk or
 the heart and yogurt, beans.
 prevent hunger.

 Less: Fatty meats,
 full-fat cheese,
 refined grains, sweets,
 juice, potatoes.

The Ultimate Foods that take Yes: Seafood, poultry,
Weight time to prepare meat, low-fat
Solution and chew lead to dairy, whole grains,
By Phil weight loss. Other most veggies, fruits,
McGraw "Keys to Weight (limited) oils.
 Loss Freedom"
[ILLUSTRATION include "no-fail Less: Fatty meats,
OMITTED] environment," sweets, refined
 "right thinking," grains, full-fat dairy,
 "healing feelings," microwaveable
 and "circle of entrees, fried foods.
 support."

Dr. Atkins' A low-carb diet is Yes: Seafood,
New Diet the key to weight poultry, meat, eggs,
Revolution loss (and good cheese, salad
By Robert health) because veggies, oils, butter,
C. Atkins carbs cause high cream; (later) limited
 insulin levels. amounts of nuts,
[ILLUSTRATION fruits, wine, beans,
OMITTED] veggies, whole
 grains.

 Less: Sweets, refined
 grains, milk, yogurt.

Good Switching from Yes: Sourdough
Carbs, high-glycemic- bread, beans, most
Bad Carbs index foods fruits, low-fat dairy,
By Johanna ("gushers") to most veggies, chips,
Burani & low-glycemic- pasta, Special K,
Linda Rao index foods pudding, pound
 ("tricklers") aids cake.
[ILLUSTRATION weight loss.
OMITTED] Less: White bread,
 sweets, Raisin Bran,
 potatoes, watermelon.

Eat Right 4 Your blood type Yes:
Your Type determines your
By Peter J. diet, supple- Type O: Meat, seafood,
D'Adamo & ments, and per- fruits, veggies.
Catherine sonality because it (Less: Wheat, beans.)
Whitney is "the key to your
 body's entire Type A: Fruits,
[ILLUSTRATION immune system." veggies, beans, most
OMITTED] seafood. (Less:
 Meat, dairy, wheat.)

 Type B: Meat, beans,
 fruits, veggies. (Less:
 Chicken, wheat.)

 Type AB: Seafood,
 dairy, fruits, veggies.
 (Less: Red meat.)

Weight Following a point Yes: Fruits, veggies,
Watchers system helps low-fat dairy, poultry,
New dieters cut calories seafood, lean
Complete and lose weight. meats, grains.
Cookbook
 Less: None.
[ILLUSTRATION
OMITTED]

The New Low-glycemic- Yes: Beans, pasta,
Glucose index foods keep most fruits, veggies,
Revolution you satisfied low-fat dairy, poultry,
By Jennie longer and help lean meat, seafood.
Brand-Miller, you burn more
Thomas body fat and less Less: Potatoes,
Wolever, Kaye muscle. white bread, fatty
Foster-Powell, meats, full-fat dairy,
and Stephen watermelon.
Colagiuri

[ILLUSTRATION
OMITTED]

Enter Eating the right Yes: Seafood, poultry,
The Zone mix of the right lean meat, fruits,
By Barry Sears fats, carbs, and most veggies, low-fat
 protein keeps you dairy, nuts.
[ILLUSTRATION trim and healthy
OMITTED] by lowering Less: Fatty meats,
 insulin. full-fat dairy, butter,
 shortening, (limited)
 grains, sweets,
 potatoes, carrots,
 bananas.

The Fat Detoxifying the Yes: Eggs, meat,
Flush Plan liver and lymph poultry, seafood,
By Ann system, taking most veggies, fruits,
Louise omega-3 fats that organic coffee, nuts,
Gittleman burn calories, and cranberry juice;
 avoiding insulin- (later) beans, whole
[ILLUSTRATION raising carbs pro- grains, cheese.
OMITTED] mote weight loss.
 Less: Sweets, butter,
 margarine, refined
 grains, caffeine, milk,
 yogurt, yeast.

Eat More, Slashing fat is the Yes: Beans, fruits,
Weigh Less key to weight loss. veggies, grains, (limited)
By Dean non-fat dairy.
Ornish
 Less: Meat, seafood,
[ILLUSTRATION poultry, oils, nuts,
OMITTED] butter, dairy (except
 non-fat), sweets,
 alcohol.

 IS THE IS THE DIET
 NAME SCIENCE SOLID? HEALTHY?

The South Healthy version of [??] Mostly
Beach Diet Atkins diet that's healthy foods.
By Arthur backed by solid
Agatston evidence on fats
 and heart disease.
[ILLUSTRATION
OMITTED]

The Ultimate Tough-love manual [??] Mostly
Weight that relies more on healthy foods.
Solution Dr. Phil's opinion
By Phil than on science. [??] Gives no
McGraw menus, recipes,
 or advice on how
[ILLUSTRATION much of what to
OMITTED] eat.

Dr. Atkins' Low-carb "bible" [??] Too much red
New Diet overstates the results meat may raise
Revolution of weak studies and risk of colon or
By Robert the evidence on prostate cancer.
C. Atkins supplements. (How-
 ever, in recent small [??] Lack of fiber,
[ILLUSTRATION studies, people lost vegetables, and
OMITTED] more weight after fruits may raise
 6--but not 12-- risk of heart
 months on Atkins disease, stroke,
 than on a typical cancer, diverticulosis,
 diet.) and constipation.

Good Dumbed-down, [??] Mostly
Carbs, sloppy version of healthy foods.
Bad Carbs The New Glucose
By Johanna Revolution that [??] Few recipes,
Burani & inflates the impor- menus, or specifics.
Linda Rao tance of the
 glycemic index. [??] Some
[ILLUSTRATION low-glycemic-index
OMITTED] foods are
 unhealthy (e.g.,
 sponge cake,
 chips, chocolate
 bars).

Eat Right 4 About as scientific as Not applicable
Your Type a horoscope. (diet varies
By Peter J. according to
D'Adamo & blood type,
Catherine ancestry, etc.).
Whitney

[ILLUSTRATION
OMITTED]

Weight No science cited, [??] Mostly
Watchers but its sensible healthy foods.
New advice is used by
Complete millions.
Cookbook

[ILLUSTRATION
OMITTED]

The New Reasonable interpre- [??] Mostly
Glucose tation of the sci- healthy foods.
Revolution ence, though
By Jennie stronger for heart [??] Fuzzy limits
Brand-Miller, disease and diabetes on low-glycemic-index
Thomas than for weight loss. foods, including
Wolever, Kaye pasta, sourdough
Foster-Powell, bread, honey,
and Stephen some sugary
Colagiuri cereals, and
 some dried fruits.
[ILLUSTRATION
OMITTED]

Enter Exaggerates evi- [??] Mostly
The Zone dence that the Zone healthy foods.
By Barry Sears diet is the key to
 weight loss and [??] Few recipes
[ILLUSTRATION implies that the diet or menus.
OMITTED] can cure virtually
 every disease.

The Fat Kooky mishmash of [??] Mostly
Flush Plan old detox lore and healthy foods.
By Ann new good-carb
Louise theory. [??] Too much red
Gittleman meat and eggs.

[ILLUSTRATION
OMITTED]

Eat More, Diet worked (when [??] Mostly
Weigh Less combined with healthy foods.
By Dean exercise and stress
Ornish reduction) in a [??] Too many
 small-but-long-term carbs may raise
[ILLUSTRATION study. triglycerides and
OMITTED] lower HDL
 ("good") cholesterol
 if people
 don't exercise,
 lose weight, and
 reduce stress.

 MOST
 WORST PREPOSTEROUS
 NAME FEATURE CLAIM

The South Restricts car- You won't ever
Beach Diet rots, bananas, be hungry
By Arthur pineapple, and (despite menus
Agatston watermelon. that average just
 1,200 calories a
[ILLUSTRATION day).
OMITTED]

The Ultimate Readers may "Each of these
Weight buy Dr. Phil's nutrients [in his
Solution expensive, supplements]
By Phil questionable has solid clinical
McGraw supplements, evidence (and a
 bars, and record of safety)
[ILLUSTRATION shakes (see behind it."
OMITTED] "Dr. Phil's
 Pills," p. 5).

Dr. Atkins' Long-term "Only by doing
New Diet safety not Atkins can you
Revolution established. lose weight eating
By Robert the same
C. Atkins number of calories
 on which
[ILLUSTRATION you used to gain
OMITTED] weight."

Good Dieters may "... in spite of the
Carbs, assume that title Good Carbs,
Bad Carbs they can eat as Bad Carbs, there
By Johanna many "trick- are no bad
Burani & lers" as they carbs."
Linda Rao want and not
 gain weight.
[ILLUSTRATION
OMITTED]

Eat Right 4 May convince "If you are a
Your Type people to use Type A woman
By Peter J. these diets to with a family
D'Adamo & treat cancer, history of breast
Catherine asthma, infec- cancer, consider
Whitney tions, diabetes, introducing
 arthritis, hyper- snails into your
[ILLUSTRATION tension, and diet."
OMITTED] infertility.

Weight Some Not applicable
Watchers packaged (cookbook).
New Weight
Complete Watchers foods
Cookbook (none are
 mentioned in
[ILLUSTRATION the cookbook)
OMITTED] aren't exactly
 nutritious.

The New Advice is diffi- Low-glycemic-index
Glucose cult to follow diets are
Revolution because gly- easy to teach
By Jennie cemic index and easy to
Brand-Miller, varies so much learn.
Thomas for each food
Wolever, Kaye (e.g., bananas
Foster-Powell, range from 30
and Stephen to 70).
Colagiuri

[ILLUSTRATION
OMITTED]

Enter May convince "I believe that
The Zone people to use the hormonal
By Barry Sears the diet to treat benefits gained
 cancer, AIDS, from a Zone-favorable
[ILLUSTRATION chronic pain, diet will
OMITTED] impotence, be considered
 alcoholism, the primary
 depression, treatment for all
 and arthritis. chronic disease
 states, with drugs
 being used as
 secondary
 backup."

The Fat Useless fat- "The best way to
Flush Plan flush kit costs give those fatty
By Ann $68 per month deposits [in your
Louise for vitamins, thighs and arms]
Gittleman omega-3 fats, the old heave-ho
 etc., that "trig- is by cleansing
[ILLUSTRATION ger fat burn- your lymphatic
OMITTED] ing ... and nour- system with a
 ish our tired bouncing action
 and over- or by moving
 worked livers." your arms while
 walking briskly."

Eat More, Unnecessarily Eating a very-low-fat
Weigh Less restricts sea- vegetarian diet is
By Dean food, turkey easy.
Ornish and chicken
 breast, oils,
[ILLUSTRATION nuts, and
OMITTED] fat-free dairy.


(1) Amer. J. Clin. Nutr. 76: 290S, 2002.

(2) Amer. J. Clin. Nutr. 72: 439, 2000.

(3) Obesity Reviews 3: 245, 2002.

(4) Amer. J. Clin. Nutr. 78: 920, 2003.

(5) J. Clin. Endocrinol. Metab. 88: 1617, 2003.

(6) New Eng. J. Med. 348: 2074, 2003.

(7) New Eng. J. Med. 348: 2082, 2003.

RELATED ARTICLE: The Atkins' low-evidence revolution.

Robert Atkins died last spring after falling on the icy pavement outside his New York City office. A few months later, his clinic closed its doors for good.

But his work lives on, not only in the diet books that continue to sell like hot-cakes (low-carb, of course), but in the more than 100 snack bars, frozen dinners, muffin mixes, ice creams, and other foods and supplements that carry his name.

The pitch: Atkins-brand foods have fewer "net" carbohydrates than conventional foods. What are net carbs? They're what's left after Atkins Nutritionals replaces some of the foods' carbs with protein from soy and wheat, and after it deducts other carbs that, according to the company, have "a minimal impact on blood sugar." (The list includes fiber, glycerin, sugar alcohols, and polydextrose.)

The remaining carbohydrates appear in the "Net Atkins Count" circle on the package. Creative accounting? You bet. Good science? Hardly.

* Atkins Nutritionals won't say whether it has tested its foods to make sure that they don't raise blood sugar. Just because a food is sweetened with glycerin, sugar alcohols, or other sugar substitutes doesn't necessarily mean that it's gentler on your blood sugar. For example, a sugar-free apple muffin or banana cake raises blood sugar as much as its sugar-sweetened counterpart. (1)

* Atkins' books claim that only carbs that raise blood sugar cause weight gain, but the evidence is scanty.

What's more, low-carb foods aren't cheap. A 12-ounce box of pasta costs $5.99. Four cups of instant soup run $12. Fifteen brownies will set you back $32.

Supplements

Atkins Nutritionals also sells pills to "help break up a weight loss logjam." Among the ones Atkins recommends:

* Coenzyme Q10: Take 100 mg a day, since an "exploratory" study two decades ago found that people who took CoQ10 lost more weight than people who didn't.

Reality check: The study, which was never published in a peer-reviewed scientific journal, was never followed up.

* Carnitine: Take 1,500 mg a day, just in case you have a deficiency of the amino-acid derivative.

Reality check: No good research shows that overweight people are deficient in carnitine, or that taking 1,500 mg a day helps people lose weight. (2)

* Chromium: Take up to 1,000 micrograms a day, because preliminary research 15 years ago suggested that it helped build muscle and burn fat.

Reality check: Better studies since then have come up empty.

(1) Amer. J. Clin. Nutr. 76: 5, 2002.

(2) Int. J. Sport Nutr. Exer. Metab. 10: 199, 2000.

--David Schardt

RELATED ARTICLE: Dr. Phil's pills.

If you hit it right, a popular diet book can be a gold mine. But the big players know how to dig even deeper. Dr. Phil--who at 6'4" and 240 pounds is clearly overweight--wants fans to pay $120 for his vitamins and up to $90 for his bars and drink mixes every month. Here's the scoop:

Weight Management Supplements

If you've got a waist smaller than 35 inches (women) or 40 inches (men), Dr. Phil wants you to buy his Weight Management Supplement & Complete Multivitamin for Pear Body Types. If you have a larger waist, you need his supplement for Apple Body Types. Either way, it's 12 pills a day, 60 bucks a month.

What's the difference? Very little. Both contain the same 23 vitamins and minerals, plus carnitine (an amino-acid derivative) and four herbs. The "pear" pills also have a speck of soy isoflavones, green tea, and Rhodiola rosea root. In contrast, the "apple" pills contain Gymnema sylvestre leaves, vanadium, and white kidney bean extract.

Never mind that there are no studies showing that the supplements promote weight loss in anyone, pear or apple. No matter what fruit your body looks like, Dr. Phil thinks you need to "take your weight management efforts to the next level" by plunking down an additional $60 a month on 10 "Intensifier" pills a day. The Intensifiers contain:

* Coenzyme Q10: "Required for the production of energy in the body."

Reality check: May help with congestive heart failure, not excess weight.

* Conjugated linoleic acid (CLA): "May reduce the deposit of excess body fat and increase the ratio of lean body mass to fat, when combined with a low-calorie diet and exercise."

Reality check: May also cause liver damage and worsen insulin resistance.

* EPA and DHA: "Support healthy body membranes and heart health."

Reality check: These omega-3 fats, which are found in fish oil, may help prevent sudden cardiac death, but have nothing to do with weight loss.

* Tyrosine and L-theanine: "May help reduce every day stress."

Reality check: No good studies back up the benefits of theanine or the trivial amount of tyrosine in Dr. Phil's Intensifier pills.

* Vitamin C: "Protects your body against the damaging effects of free radicals."

Reality check: There is no evidence that vitamin C has any impact on weight.

Nutrition Shakes

You're nobody in the weight-loss game unless you sell a meal replacement shake. Shape Up! Shakes contain "scientifically researched levels of ingredients that can help you change your behavior to take control of your weight," says Dr. Phil.

In fact, they're just a run-of-the-mill powder made from milk, eight kinds of fiber, and added vitamins (which you don't need if you're already taking his 22 pills a day ... or your own inexpensive multi).

Nutrition Bars

Dr. Phil's Shape Up! bars are concoctions of sugars, oil, soy protein, fiber, and still more added vitamins. So much for his advice to keep sugars and fats "off-limits if you want to successfully control your weight."

--David Schardt
COPYRIGHT 2004 Center for Science in the Public Interest
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Author:Liebman, Bonnie
Publication:Nutrition Action Healthletter
Article Type:Cover Story
Geographic Code:1USA
Date:Jan 1, 2004
Words:4756
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