Searching for the Right Weight-Loss Plan

My journey to disease prevention through diet actually began when my education as a cardiologist did, 30 years ago. During my training in the late 1970s, I looked forward to treating patients with heart disease—despite the fact that we didn’t have many preventive weapons in our arsenal. I asked the most respected cardiologist I knew this question: “What is the best way to prevent heart disease?” His answer: “Pick the right parents.” If you inherited the gene for cardiac longevity, you were likely to live to a ripe old age. If heart disease struck early in your family, there was not much you could do to change your destiny.

Then, in 1984, I attended a course at the Heart House in Bethesda, Maryland, the national headquarters of the American College of Cardiology. There, I heard a lecture by a brilliant researcher and charismatic teacher, Bill Castelli, who headed the world-famous Framingham Heart Study. Dr. Castelli told us about the results of the recently completed National Institutes of Health (NIH)-sponsored Lipid Research Clinics Primary Prevention Trial (LRCPPT). This was the very first study to prove that lowering cholesterol could reduce heart attacks. At the time, the only known treatment for high cholesterol was an unpleasant, grainy powder known as a resin, which was taken several times a day before meals. Therefore, we were all very excited when Dr. Castelli told the conference that if we put patients on the very first American Heart Association diet, we could lower their cholesterol and end the scourge of heart disease in America.

We all returned home filled with fervor, ready to guide our patients to restored cardiac health and dietary wisdom. I came back to Miami confident in my new found knowledge of how to save my patients’ lives. My wife and I even joked that with heart disease out of the picture, I might be better off switching to a growth specialty, like plastic surgery. It wasn’t long before I learned that unemployment as a cardiologist was going to be unlikely.

I began counseling my patients on the low-fat, high-carbohydrate diet advocated by the American Heart Association, but the results fell far below my expectations. Often, there was an initial modest improvement in total cholesterol with mild weight loss. This invariably was followed by a return of cholesterol to its previous level or higher, along with a return of the lost weight. This scenario was not only my experience but also that of my colleagues. It was reflected in the many diet-cholesterol trials documented in the literature: we were unable to sustain cholesterol and/or weight reductions using low-fat, high-carbohydrate diets. There were no convincing studies showing that the American Heart Association diet saved lives.

Over the years I had suggested most of the highly respected diets out there—going back to Pritikin and then through the various, more recent, heart-healthy low-fat regimens, including the Ornish plan and several American Heart Association diets. Each of them, for different reasons, failed miserably. Either the diets were too difficult to stick with, or the promise of improved blood chemistry and cardiac health remained just that—a promise. Discouraged, I had all but given up on advising my patients about nutrition, because I was unable to suggest anything that actually helped. Like most cardiologists in that period, I turned instead to the statin drugs that were just entering the market, medications that had proven extremely effective in lowering total cholesterol, if not weight.

But I also decided, as a last-ditch effort, that I would devote some serious study of my own to diet and obesity. Like most physicians, I was not particularly knowledgeable in the science of nutrition. So my first task was to research all the weight-loss programs out there, the serious scientific ones as well as the trendy attempts that topped the best-seller lists. As I acquired that education, I was also reading in the cardiology literature about the prevalence of something called the insulin resistance syndrome and its effect on obesity

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