July 17, 2008 -- Laura from Grays River, Wash., asked: I have a strong family history of diabetes and I believe that I am a beginning-stages diabetic myself. What diet should I think about following? I have tried the Atkins diet in the past and remained on it for about one year, but could not remain on it because it was too strict. I did lose around 25 lbs on it, but gained it all back with interest. I really need to lose around 50 lbs now. I have changed my diet considerably and have been trying to eat more veggies and fruit and less sugar and breads, pasta etc. I love meat and eat a fair amount of it.
Dr. Shai answered: It would be better for you to set moderate goals to reduce 5 percent of your body weight, where you can still achieve significant improvements in some of your health indicators. You may want to try the Mediterranean diet, which is between the extreme low-fat and low-carb diets, but rich with olive oil. Combine this with physical activity.
Jo from Miami asked: What is an "average" complex carbohydrate daily range? To completely knock carbs out of my diet will defeat me. Considering that I'm at 40 lbs overweight and 65 years old, I'd like to know about how many carbs I can eat daily so that I don't get frustrated. I'm a post-gastric bypass patient by 3 years and still have a lot of problems eating protein, so carbs are important to me. Thanks.
Dr. Shai answered: If you are post-gastric bypass patient and carbs are important for you, don't adopt the low-carb diet, but restrict your beverages/milkshakes/ice cream that are probably well digested and keep a moderate low-calorie diet. You may need to take nutritional supplements. People can consume 400 grams of carbs per day, which equals 1,600 calories. It is impossible and undesirable to completely "knock out" carbs for your body, as it is one of the ingredients of vegetables and milk products, for example. Individuals can live with 40-100 grams of carbs.
Michele from Elizabethtown, Pa., asked: It appears from the study, if you have blood sugar problems (diabetes or hypoglycemia), you should follow the Mediterranean diet rather than low-carb. Is this true?
Dr. Shai answered: Yes, although the low-carb diet was favorable to diabetics as well, the results weren't that significant.
Jim from Denver asked: What online or print sources can you recommend for low-carb diet plans, and Mediterranean diet plans? Any books or authors to recommend?
Dr. Shai answered: Dr. Walter Willett, professor of epidemiology and nutrition at Harvard School of Public Health and professor of medicine at Harvard Medical School, wrote books and provides good diet information on the Mediterranean diet. Dr. Atkins also has a number of books with good information online on low-carb diets.
Ashlee from Austin, Tex., asked: Which is the best Low Carb diet to follow and which one should be avoided?
Dr. Shai answered: If you choose to adopt the low-carb regime, you need to consult with your doctor or nutritionist. Avoid trans fats (margarine, etc.) and keep consuming olive oil, fish and almonds within your high protein diet. I'd also recommend you get your blood tested regularly and be physically active.
JB from Oxnard, Calif., asked: My one concern is the lack of information on how a low carb diet can impact someone with depression. Why is that? Research shows that the amino acid typtophan, which is the precursor of 5htp which affects serotin levels, needs carbs to get across the blood-brain barrier. I lost 70 pound on a low carb diet but fell into the deepest depression I had experienced in my 45 years. I ended up taking 300 mg of Effexor a day to counter the depression. I went off the low-carb diet and unfortunately gained all my weight and more back. But I was able to drop down to only 75 mg of Effexor a day. Prior to going on the diet I had not been on medication for depression for 8 years. Without having to take high dosages of anti-depression meds how can I stay on a low-carb diet? It was the most effective diet for me.
Dr. Shai answered: Our study suggests that there are some alternative diet strategies that each individual can tailor according to his individual diet history, specific preferences and metabolic goals. You already experienced the feeling of successes in dieting. But if you feel that the low-carb diet was the reason for your mood change, you may switch to Mediterannean diet and keep eating more than two two fish portions a week or consume omega 3 supplements along with physical activity to improve your mood.
Joanne from San Jose, Calif., asked: I have tried every kind of diet -- low carb, low calorie and low fat. None of them seem to work for me. I need to lose a lot of weight. I do not eat a huge amount of anything. Sweets are only occasional. My diet is basically, whole grains, fruits & veggies and lean meats. Why does nothing work? I also go to the gym and exercise 3 times a week. What do I do? I am pear shaped and in good health.
Dr. Shai answered: I would suggest you try testing your hormonal levels. However, If you are in good health, exercising and eating well, and if you keep a stable weight, maybe you don't need to diet and just keep going with your healthy lifestyle. In your case, cycling might be worse than stability.
Aaron, asked: I'm someone who isn't trying to lose weight at all, but rather trying to control my cholesterol, triglycerides and sugar levels. I would say I'm on a mix between the low-fat and Mediterranean diets. I've cut my saturated fat intake, have lowered my cholesterol intake, avoid all trans fats, and have significantly cut down on refined sugars. On the other hand, I have increased my poly and monounsaturated fat intake because I've been told and done research that says they're good fats, and I have been eating much more fruit and vegetables. I guess my question is -- is slashing carb intake the best way to lower cholesterol and sugar levels or is the diet I'm on good? Also, I have read conflicting articles regarding these new findings that say the "Atkins" diet used in the study was plant-based, as opposed to the "meat and butter" diet that generally springs to mind when one thinks of the Atkins diet. Could you clarify?
Dr. Shai answered: I understand your confusion. There isn't a single "best" diet for everyone. Between low-fat to low-carb, it seems you are doing very well. You may want to follow your lipids and sugar and if it doesn't improve, to try omitting from your plate the carbs (bread, rice, potatoes, pasta, etc.) and see if this affects your specific blood profile.
Ramesh from Naperville, Ill., asked: What is the best option for vegetarians? I do not eat meat or fish of any kind. So is the low-fat diet my only option? Can I do better?
Dr. Shai answered: If you keep having legumes, nuts, cheese, eggs, vegetables and olive oil, it is not necessarily low-fat diet. Being a vegetarian is kind of another strategy.
Nancy from Cumming, Ga., asked: My husband and myself both need to loose 30lbs per doctor. We have high blood pressure and high cholesterol. We have started walking for exercise and lifting 5 lbs weights. We are in our 50's. What would you recommend as the best diet for us? We both work from 8 to 5.
Dr. Shai answered: Working as a couple has a great potential of success. You both have the freedom to choose the low-fat, Mediterranean or low-carb strategy, according your special preferences and goals, and go for it with the joy of physical activity. Once you choose the strategy, stick to it.