The remarkable success of The Carbohydrate Addict's Diet -- by Rachael Heller, MD, and Richard Heller, MD, and first published in 1993 -- led to a handful of best-selling books. Each is based on a single theory: Many overweight people are "carbohydrate addicts." Among these people, biological processes that convert food into energy fail to perform as they are supposed to and, the Hellers say, "for reasons that are not yet clearly understood, sustained high levels of insulin in the blood result." The elevated insulin, according to their theory, makes carbohydrate addicts crave food throughout the day. But a big question -- why does this condition create carbohydrate craving? -- is not answered.
Given the premise, the Hellers claim that this is not a diet for everybody -- only for those with this metabolic imbalance that they call "carbohydrate addiction." However, their "documented research" shows that 75% of overweight adults identify themselves as "carbohydrate addicts," but they maintain that the actual figure may be as high as 85%. Alas, these theories on addiction and the related figures are not founded on scientific research.
The diet is based on the Hellers' own theories about controlling fat-storing insulin in the body. And insulin, they claim, can be controlled by drastically reducing carbohydrate consumption during most of the day.
For the first two weeks, you eat two small Complimentary Meals daily, consisting of a portion (three to four ounces) of meat, fish, or fowl or two ounces of cheese, and roughly two cups of vegetables or salad. The third meal is your Reward Meal, which can be anything you want, in any quantity -- though it should be nourishing and well balanced. You can have wine or a cocktail or a glass of beer, promise the Hellers. This meal can be breakfast, lunch, or dinner. But there's a time limit. The Reward Meal -- from cocktail to dessert -- must be consumed within an hour.
After the first two weeks, the regimen splits into several eating plans, depending on how much weight you still want to lose, or on whether you just want to maintain what you've already lost. Some will choose a plan that allows one prescribed snack a day, made up of the same low-carb foods that you eat at the Complimentary Meals. You may never choose carbohydrate-rich foods such as fruits, fruit juices, breads, pasta, snack foods, or sweets as your snacks. Never. And these snacks are limited to half the size of a meal.
The book gives an extensive list of food to chose from, which covers five pages, and urges you not to deviate: "If the food is not listed here, don't eat it during your Complimentary Meals or Snacks. ... When in doubt, save the food for your Reward Meal."
Other rules: Drink plenty of water. If you have milk or cream with your coffee, you can have one cup a day the way you like it. Keep to the rules, say the Hellers, and you will improve your metabolism and miraculously lose weight, and all the time you'll feel great.
The Hellers claim that by restricting carbohydrates drastically during most of the day, the body releases far less insulin than if you had been eating a high-carb diet at each meal. They say that the entire chain of metabolic events is altered: Less insulin is released, less fat is stored, and more fat is burned up. Because the body is releasing less insulin, the brain regulates the appetite better with a release of serotonin, a biochemical that gives that nice, complete feeling of satiety.
The time limit on the Reward Meal, when you are eating and drinking carbs to your heart's content, controls the insulin release, which the Hellers say occurs about one-and-a-quarter to one-and-a-half hours after you begin eating. If you are still polishing off that apple pie, your body will compensate for the initial low release of insulin with a big blast of it. But if you've stopped eating within an hour, "this second phase appears to be kept low," they write.
High insulin in the blood leads to a decrease in the number and activity of receptor sites in the muscles and fatty tissue that absorb insulin and glucose. This is called insulin resistance. Only one carbohydrate-rich meal a day, the Hellers say, lowers insulin production and leads to an increase in receptor sites, which then gobble up the insulin and glucose more quickly, removing it from the blood. This in turn allows the "carbohydrate addict" to feel less intensely hungry throughout the day, have fewer cravings, and lose more weight.
This diet is hardly a favorite of nutritionists or specialists with a medical background. It is well known that many individuals have abnormally high insulin levels and insulin resistance, but this is a part of the medical condition known as the metabolic syndrome, which has a variety of causes -- notably obesity itself. "Carbohydrate addiction" has never been shown to be among them.
"The whole premise that we are carbohydrate addicts makes about as much sense as telling people they are oxygen or water addicts," says John McDougall, MD, one of the participants in the debate on fad diets last spring in Washington, D.C., an event sponsored by the U.S. Department of Agriculture. He is the head of the McDougall Program, a center for the rehabilitation of dietary diseases at St. Helena Hospital in the Napa Valley of California, and a lecturer in nutrition. "We are designed to be seekers of carbohydrates," he says. "The tip of the tongue has one kind of calorie-seeking taste bud, and that is for carbohydrates."
McDougall explains that the Hellers' science is unsupported and as proof points to a 1997 article in the American Journal of Clinical Nutrition, which demonstrates that many animal protein foods produce more insulin than carbohydrates -- the reverse of their claims. Their diet, he says, "is a way of tricking people into restricting food intake," and for that reason it probably works in the short term.
Neal Barnard, MD, president of the Physicians Committee for Responsible Medicine, is likewise unconvinced by the Hellers' premise: "This diet addresses a problem that is not even remotely the problem for most overweight people," he comments. "It would be much more effective to repair the body's ability to handle carbohydrates rather than demonizing them, and this is done by cutting fat out of the diet, boosting fiber, and choosing those carbohydrates such as whole grains and vegetables that release glucose slowly -- and, finally, by adding exercise to your routine."
Barnard believes it would be easier to break poor eating habits than tease yourself with the one Reward Meal a day. "The problem is not the carbohydrate in the potato, it is the butter on the potato." He concedes that some people would find the diet helpful, but he insists that it is a "Band-Aid approach" to generally poor eating habits in this country. "In Asian countries people have consumed huge amounts of carbohydrates -- rice, vegetables, noodles -- and they are the slimmest people on the planet." Until of course, he adds, "They swap that healthy rice for KFC, Burger King, and other Western, meaty, cheesy choices."
Though popular, this diet does not receive the support of nutrition experts, who have a particularly hard time swallowing the Hellers' claim that most overweight people are "carbohydrate addicts." In addition, the Reward Meal is an aspect of the diet that merely rewards unhealthy eating habits.
Reviewed By Charlotte E. Grayson, MD February 2004.
SOURCES: Heller, R. The Carbohydrate Addict's Diet, 1999, Signet Books. John
McDougall, MD, director, the McDougall Program, St. Helena Hospital, St. Helena,
CA. Neal Barnard, MD, president, the Physicians Committee for Responsible
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