MIRACLE DIETS When eating guidelines cause health problems

Abstract

Globally, 1.9 billion adults are overweight, 650 million of which are obese, which in turn impacts both health and the economy. Treating obesity involves strategies such as physical activity and dietary planning, always under the supervision of healthcare professionals. Recent decades have brought many fad diets, although they originated at the beginning of the twentieth century. However, these can lead to health problems among their users. A practical way to detect them is that they promise rapid weight loss (more than 1 kg per week), are allegedly effortless, impose excessive energy restrictions, and exclude food or nutrients from the diet.

Full text

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ISSN: 21 74-3 487. eISSN: 2174-9221.
M  S S  J, 11 (2021): 147–1 53. Universit y of Valenc ia.
Submitted: 02/12/2019. Approved: 12/06/2020
https://doi.org/10.7203/metode.11.16193
MIRACLE DIETS
When eating guidelines cause health problems
José miguel soriano del castillo and mª inmaculada ZarZo llobellJosé miguel soriano del castillo and mª inmaculada ZarZo llobell
Globally, 1.9 billion adults are overweight, 650 million of which are obese, which in turn impacts
both health and the economy. Treating obesity involves strategies such as physical activity and
dietary planning, always under the supervision of healthcare professionals. Recent decades
have brought many fad diets, although they originated at the beginning of the twentieth century.
However, these can lead to health problems among their users. A practical way to detect them
is that they promise rapid weight loss (more than 1 kg per week), are allegedly eortless, impose
excessive energy restrictions, and exclude food or nutrients from the diet.
Keywords: fad diets, mono diets, Atkins diet, health, obesity.
At the end of the twentieth century, obesity, a
multifactorial chronic disease characterised by an
excessive accumulation of fat, was already considered
a pandemic: more than 300 million adults and around
25 million children and adolescents were overweight
(WHO, 2000). This situation was not solved even with
global, national, and local food policies, and is now
even more alarming (WHO, 2016) with over 1.9 billion
adults currently overweight, 650 million of which are
obese, and more than 340 million overweight or obese
children and adolescents.
In Spain, this exponential change
is evident in the fact that one in
ten children and adolescents are
obese, according to the information
provided in the National Health
Survey (Ministerio de Sanidad,
Consumo y Bienestar Social, 2018).
In addition to the effect this has
on the healthcare system, it also
has a powerful economic impact
because almost 2 billion euros
from the Spanish National Health
System (2016) are devoted to mitigate the direct cost of
treating excess weight, to which we must add a similar
amount in costs related to work incapacity and the loss
of productivity (Hernáez et al., 2019). This is certainly
interesting, because this is the same amount Spanish
citizens spend on miracle products or weight loss books,
even though 67 % of the nutritional information they
include has no scientic basis (FESNAD, 2008).
In the eld of health, and according to the
International Agency for Research on Cancer (IARC,
2018), obesity can increase the predisposition to suffer
several types of cancer (colon and rectum, oesophagus,
kidney – renal cell carcinoma –, liver, gallbladder,
pancreas, ovary, thyroid, uterine lining, prostate, breast –
in postmenopausal women and men –, stomach tumours,
and meningioma and multiple myeloma). It can also
increase the prevalence of pathologies related to the
cardiovascular system (heart failure and arrhythmias,
among others), gastrointestinal
system (such as gastroesophageal
reux disease and fatty liver),
endocrine system (diabetes),
renal and genitourinary system
(like erectile dysfunction and
chronic kidney failure), obstetric
system (foetal distress), dermal
system (stretch marks, acanthosis
nigricans, and cellulitis), muscle
and skeletal system (predisposition
to gout, osteoarthritis, and back
pain), neurological system (stroke
and meralgia paresthetica), and respiratory system
(dyspnoea, obstructive sleep apnoea, and asthma), as
well as psychological disorders (depression and low
self-esteem).
The tools available to ght obesity are physical
activity and energy intake restriction, as well as
cognitive-behavioural treatment, pharmacological
treatment, and bariatric surgery (National Institute for
«At the end
of the 20th century, obesity,
a multifactorial chronic
disease characterised
by an excessive accumulation
of fat, was already considered
a pandemic»

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Health and Care Excellence, 2014) – although
the two latter options should only be used when
the rest have failed. The objective of dietary
plans to restrict energy intake and guidelines
to increase physical activity is to achieve a
negative energy balance. Thus, the body must
obtain energy from the reserves of fat stored
in its adipose tissue, constituting the largest
energy reserve of the body. However, a great
variety of diets are now available that, based
on different principles, seek a rapid decrease
in weight without a proper evaluation of their
effectiveness and impact on health.
There is no place today for the so-called
drawer diets, which were given to patients
without considering their tastes, total energy
consumption, lifestyle, or food dislikes. Only
the intervention of a personalised nutrition plan
established by a dietitian-nutritionist will allow
patients to achieve a healthy goal and keep
them from falling into so-called fad diets (also
known as magical or miracle diets).
■ THE DIET, THE GREAT UNKNOWN
If we search for diets on Google, we get over 85
million results, and although the relationship
between obesity and diet is already clear in
the minds of the population, the concept of a diet as a
whole does not seem to be so clear. The term comes
from the Latin word diaeta, which in turn comes from
Greek diaita, meaning “way of life”. The dictionary
of the Royal Spanish Academy (RAE, in its Spanish
acronym) offers three denitions. First, as an «eating
and drinking regime that patients or convalescent
people must follow and, by extension, the foods and
drinks in that regime»; second, as a «set of substances
that are regularly ingested as food»; and, lastly, as
the «complete deprivation of eating». On the other
hand, the UN Food and Agriculture Organization
(FAO, n.d., p. 128) denes diet as the «Mix of solid and
liquid foods consumed by an individual or group. Its
composition depends on the availability and cost of
food, as well as the eating habits and cultural value of
certain foods».
All these denitions present several problems. In
the case of the rst denition in the RAE, including
only patients or convalescent individuals is a mistake.
A diet can, for instance, be considered for several
physiological situations such as a pregnancy or
childhood, not just for pathological situations. The
second denition is the closest to reality, although the
intended goal to prescribe those substances should be
specied. The third entry focuses more on fasting. On
a practical level, it would now be more appropriate to
use a denition closer to the following: «liquid or solid
foods established by a dietitian-nutritionist for users
or patients in a particular physiological or pathological
situation to help them establish the best possible
lifestyle regime».
The rst diet in history was found in the Ebers
Papyrus, dates back around 1,550 BCE, and was
acquired in 1872 by the Egyptologist George Ebers in
Luxor. It includes around 250 clinical proles. A diet
is described for one of them, based on a mixture of
wheat semolina, dates, and Nubian ochre, presented
in an aqueous preparation, which should be taken for
four days for patients with symptoms similar to those of
diabetes (Ebers, 1873).
However, the rst weight-loss diet did not
appear until the early twentieth century, thanks to
an entrepreneur, Horace Fletcher. He praised the
effectiveness of a treatment that allowed him to
chew each bite up to one hundred times in the loss
of 18 kg, which earned him the nickname «the great
Obesity can increase the probability of suering from several
types of cancer, as well as the prevalence of some other
pathologies.
jcomp–Freepik

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masticator». He decided to publish a book
that became a best seller (Fletcher, 1903)
and coined two new terms: etcherism
(a diet following Horace Fletcher’s
principles) and etcherising (the action of
chewing according to etcherism). One
of the greatest advocates for this new
technique, which he put into practice
at the Battle Creek Sanatorium, was Dr.
John Harvey Kellogg, the inventor of
the breakfast cereals. But Fletcher was
touting something a little more extreme:
he believed we should chew each bite
without swallowing it until the food is
liquid (which is somewhat complicated for
many foods).
It is true that today, due to the stress
in our lives, among other reasons, we do
not masticate food properly. Rather than chewing,
we just swallow. If we chew properly, slowly,
and for an adequate time, one of the effects we
would observe is that we would become satiated
earlier, so we would consume less food, leading
to a lower energy intake and, therefore, to weight
loss. This data was reected in a 2011 study by
researchers at Oxford Brookes University, which
compared two groups of participants. One of the
groups masticated each bite 35 times, while the
other chewed it ten times; food intake was reduced
in the rst group (Smit et al., 2011).
■ FAKE, MAGICAL, MIRACLE, AND
UNHEALTHY DIETS
From Fletcher’s writing to the present day, it is
estimated that more than a thousand diets have
appeared, most of them dangerous due to their
associated risks to our health. In Spain, the rst
ineffective diets were collected in the 1994 Vitoria
meeting, where Professor Arnold Bender indicated
that millions of people follow the most absurd diets
and that these diets were scamming people. It was the
rst recorded use of the concept of a «magical diet»
(Bender, 1994). The term was recovered three years
later by Varela, Núñez, Moreiras, and Grande Covián
(1998) in their technical public health document for
the region of Madrid (Documento técnico de salud
pública de la Comunidad de Madrid). They referred
to diets claiming to result in weight loss, increased
lifespan, and the curation of several pathologies based
on unveried virtues attributed to «natural» foods or
products. The document was expanded upon eleven
years later by the Spanish Nutrition Foundation and
The objective of a dietary plan that restricts energy intake
and oers guidelines to increase physical activity is to reach a
negative energy balance.
Bruno Nascimento – Unsplash
Fat lad at the back–Unsplash
«There is no place today for the so-called
drawer diets, which were given to patients
without considering their tastes, total
energy consumption, lifestyle, or food
dislikes»

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Nutrition and Eating Disorders Institute of the Region
of Madrid (FEN & INUTCAM, 2009).
In 2008, following the Nutrition Day, the Spanish
Federation of Nutrition, Food and Dietetics (FESNAD)
launched the campaign «Tu dieta es tu vida. ¡Cuídala!
Las dietas milagro no existen» (“Your diet is your
life. Take care of it! Miracle diets don’t exist”), which
thoroughly described and classied these diets (Table
1). In the following, we will describe an instance of each
of these diet types.
Dr. Shelton’s diet was created
by Herbert McGoln Shelton, who
had studied at the American School
of Chiropractice and graduated as
a doctor in naturopathy from the
American School of Naturopathy.
His diet was based on the concept of
dissociation and although it focused
on vegetarians at rst, it was later
modied to incorporate more non-
vegetarian patients. He promised
weight loss of up to 1.5 kg per week. After 1927, and
during the following three decades, he was arrested,
imprisoned, and ned for practicing medicine without
a license. He was also charged with negligent homicide
after one patient starved to death and another one died
of a heart attack, and this sentence led him to bankruptcy
(Varela et al., 1998).
The Gayelord diet was developed in the 1920s by
Benjamin Gayelord Hauser, a graduate in
naturopathy and chiropractice (Carstairs,
2014). It was based on a seven-day
elimination diet with a fasting day which
only allowed the consumption of juice.
Together with his brother-in-law, he
started marketing products for use in
patients. At the same time, the diet spread
in Hollywood because some great stars
of the time, such as Fred Astaire, Ingrid
Bergman, Marlene Dietrich, Greta Garbo,
Paulette Goddard, Grace Kelly, Jeanne
Moreau, Gloria Swanson, and the Duchess
of Windsor, used it. He called himself a
«nutrition advisor» because he had not
completed any medical studies and was not
a doctor. He promised weight loss of up to
1.5 kg per week, but following this diet can
lead to insufcient intake of vitamins and
minerals (Drouard, 1998).
The Atkins diet was proposed in the
1960s by the US cardiologist Robert Coleman Atkins.
After reading a scientic article supporting the idea
that the restriction of carbohydrate-rich foods led to
weight loss, he decided to try it and observed that the
effect was indeed real. Later, he published a book
titled Dr. Atkins’ Diet Revolution (Atkins, 1972), in
which he advised against the consumption of milk,
fruit, almost all vegetables, bread, pasta, cereals, sugar,
and pastries. Conversely, he imposed no limits on the
consumption of meat, sh, eggs, cured meats, some
cheeses, fats, and oils, offal, and seafood. He promised
weight loss of up to 2 kg per week. Christman (2002)
indicated that more interventions
or studies were necessary to be
able to discuss the benets and
adverse effects of the Atkins
diet, because the available results
were short term and used very
small sample sizes. The book was
reissued in 1992 under the title Dr.
Atkins’ New Diet Revolution. Its
precepts had relaxed to allow the
consumption of more vegetables
to increase the bre intake, and
slightly increased carbohydrate consumption.
At the end of the twentieth century, a number of
experiments showed that patients on the Atkins diet
consume fewer calories. It is believed that, because
so few carbohydrates are available to them, fats
actually control their appetite, causing a satiating
effect (Christman, 2002; Rolls et al., 1994). This
last study indicated that, even though fat’s satiating
«A great variety of diets
are now available that seek
a rapid decrease in weight
without a proper evaluation
of their effectiveness
and impact on health»
Miracle diets promise rapid weight loss and their advocates
claim that they can be followed eortlessly. These diets impose
excessive energy restrictions and exclude foods or nutrients that
are important for our bodies.
James Farmer–Freeimages

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Table 1. Fad diet classications.
Diet type Characteristics Examples Problems
Diets with a low
or very low caloric
value
800–1,000 and 400–800
kcal/day, respectively
• Dissociated
• Triple-factor
• Open
• Shelton
• Gastrointestinal, gynaecological,
and dermal problems, sleep
disorders, depression
Hypoenergetic
diets
1,000–1,200 kcal/day • Gayelord
• Carrot-only diet
• Asparagus diet
• Artichoke diet
• Inadequate vitamin and mineral
intake
Low carbohydrates,
with high protein
and fat
Low intake of
carbohydrates and high
intake of foods with
signicant protein and fat
content
• Dr. Atkins diet
• Scardale diet
• Mayo Clinic diet
• Montignac diet
• Increased cholesterol,
triglycerides, and uric acid
• Loss of muscle and visceral
protein
• Gastrointestinal disorders
• Bad breath, nausea, dizziness,
lack of appetite, fatigue, and
decalcication
• Without dietary planning, it can
lead to kidney and brain damage
Rich in
carbohydrates
Low protein (0.5g/kg/day)
and fat (10 % or less of the
total energy intake)
• Lemonade cleanse
and maple syrup diet
• Pineapple diet
• Brown rice diet
• Potential lack of some nutrients
such as essential fatty acids, fat-
soluble vitamins, and proteins
• Gastrointestinal problems
(lower absorption of minerals,
abdominal cramps, diarrhoea,
and gas)
Mono diet Based on consuming one
particular food
• Grapefruit diet
• Soup diet
• Grape diet
• Ice cream diet
• Monotonous, boring, and
unbalanced, both energetically
and nutritionally
• They can potentially cause
digestive and psychological
disorders
Eccentric Diets that use some
kind of quirk to convince
people that they are easy
to follow
• Garlic diet
• Calendar diet
• Mental diet
• Colour diet
• Beverly Hills diet
• Nutritional imbalances
Source: Developed by the authors from FESNAD (2008) and Lesmes (2016).

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effect was signicantly lower than that
of carbohydrates for some individuals,
it would lead to an increase in energy
consumption. Atkins died without
understanding the actual biological
mechanism of his own diet. On a
different note, doctor Arne Vernon
Astrup, a researcher in the Department
of Human Nutrition of RVA University
in Copenhagen, carried out a review
analysing 107 papers and noted that there
was no evidence that the Atkins diet was
useful for long-term weight loss, although
it might be safe for short periods up to six
months (Astrup et al., 2004). The Atkins
diet achieves weight loss during the rst
few days, due to the use of glycogen and
body water. However, it has been shown
that it can increase the amount of plasma
cholesterol and uric acid (leading to gout),
and patients who have stopped this diet have rapidly
gained weight when their glycogen and body water
stores were replenished (Christman, 2002).
The lemonade diet and the maple syrup diet
were developed by naturopath Stanley Burroughs
who published a book describing this diet in 1976.
It consisted of fasting for ten days or more while
consuming only a drink made with lemon juice,
maple syrup, and cayenne pepper, together with a
laxative tea and water with sea
salt. After these days, some
foods such as vegetables,
vegetable soup, and fruits could
be gradually incorporated. He
promised weight loss of up to 5
kg per week (Burroughs, 1976).
This diet causes protein, vitamin,
and mineral deciencies, as well
as halitosis (bad breath), fatigue,
insomnia, dizziness, and drops in
blood pressure, among other
effects. In 1984, Burroughs was
convicted of unlawfully selling
treatments against cancer, practicing without a license,
and for the second-degree murder of Lee Swatsenbarg
– a cancer patient who followed his treatment – by the
Supreme Court of California (Trimble, 1985).
The grapefruit diet, also known as the Hollywood
diet, became popular in the early 1930s, claiming
that fruit contains avonoids that stimulate the
body to burn fat and speed up metabolism. It was
proposed as an eighteen-day diet associated with a
low-calorie intake (between 800 and 1,000 kcal). The
fact is that this association (low energy intake and
bre consumption from fruit) would be the reason
for the weight loss. It is discouraged for patients
medicated with immunosuppressants, some statins,
benzodiazepines, most calcium channel blockers,
indinavir, and carbamazepine, because grapefruit juice
inhibits CYP3A4, the isoenzyme
of cytochrome P450, which is
involved in the metabolisation of
these medicines (Modi & Priefer,
2020).
Lastly, we would like to
mention the garlic diet, which, in
the words of Varela et al. (1998),
«consists of placing a peeled
garlic clove on the bellybutton,
which will feel uncomfortable
when the individual snacks»
(pp. 29–30).
These and other similar
diets are still present in our everyday lives. However,
resources are available to detect them: all of them
promise rapid weight loss (more than 1 kg per week),
their advocates claim they can be followed effortlessly,
they impose excessive energy restrictions, and the
diet excludes foods or nutrients that are important for
our bodies. These diets can endanger the health of
individuals because they do not incorporate balanced
and sufcient amounts of the nutrients necessary for
normal body functioning.
At the beginning of the twentieth century, the rst weight loss
diet was presented by the entrepreneur Horace Fletcher, who
claimed to have lost 18 kg by chewing every bite of food up to one
hundred times.
«Only the intervention of a
personalised nutrition plan
established by a dietitian-
nutritionist will allow patients
to achieve a healthy goal
and keep them from falling
into so-called fad diets»
Bearfotos – Freepik

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In a world where health information abounds but it
is sometimes difcult to tell evidence-based messages
apart from the rest, it might be best to remember the
following Hippocratic principle: «Let food be thy
medicine, and let medicine be thy food», to which
we would add that any dietary treatment should be
monitored by dietitians and nutritionists.
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JOSÉ MIGUEL SORIANO DEL CASTILLO. Full Professor of Nutrition
and Bromatology at the University of Valencia (Spain) and director of the
Food & Health Lab and Gastrolab-Fernando Sapiña, at the Institute of
Material Science in the same university. He is director of the University Clinic
of Nutrition, Physical Activity, and Physiotherapy, of the Lluís Alcanyís
Foundation, and co-director of the Joint Research Unit in Endocrinology,
Nutrition, and Clinical Dietetics of the University of Valencia–Health
Research Institute Hospital La Fe.  jose.soriano@uv.es
Mª INMACULADA ZARZO LLOBELL. Predoctoral researcher at the Food
& Health Lab of the Institute of Material Science at the University of Valencia
and is an Adjunct Professor within the Ofcial Master’s Degree in Personal
and Community Nutrition at the University of Valencia (Spain).
 farmarzar@hotmail.com
The Atkins diet achieves weight loss in the rst few days by using
up glycogen and body water. However, it has been shown that it
can increase the amount of plasma cholesterol and uric acid, and
patients who have stopped this diet have rapidly gained weight
again.
I. Yunmai - Unsplash