Endocrinology - Hellerman

 

January 15 2003 • Volume 36 • Number 2

 

Clinical Rounds

 

Facilitates weight loss
Treat Syndrome X With A Low-Carbohydrate Diet

Michele G. Sullivan
Mid-Atlantic Bureau
 

A clarification of this article appears in the April 1, 2003, issue of Internal Medicine News.

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 also can facilitate weight loss in these patients, who often have a high level of abdominal obesity—a 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 commented on its ease and the satiety level they experienced, and they had improved blood lipids and a decreased risk of heart disease, Dr. Chauncey said at the meeting, also sponsored by the American Academy of Family Physicians.

Dr. Chauncey described 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%; HDL cholesterol rose 33%. She had 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 these 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 include nonstarchy vegetables; all fruit except bananas; lean meat, poultry, and fish; low- or nonfat cheese; condiments; and noncaloric beverages. “Yellow-light” foods are to be used with caution. They include low-fat milk, monounsaturated fats, and the five carbohydrate choices a day. “Red-light” foods are to be avoided: carbohydrate foods (beyond the five servings), soft drinks, and sweets.

Some substitutions are allowed, letting patients avoid a feeling of deprivation while limiting their carbohydrate consumption. “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.

Although 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, Ms. 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,” she said.

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


 

Last Modified: Monday April 07 2003

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