"Impossible Advice"
A Rebuttal to the Zone Diet


ENTER THE ZONE by Dr. Barry Sears - the book that launched a dietary revolution in the U.S. On June 9, 1997, I met Barry Sears, the author of the number one national best seller, Enter the Zone, at Bally's in Las Vegas for the first of our 3 debates (see page 7 for more information). After telling a crowd of nearly 4,000 people the virtues of his diet for controlling insulin and eicosanoid levels with resulting weight loss and improved health, I proceeded to explain why his diet is merely a semi-starvation diet and like all such diets it is impossible to follow for any length of time. I used Barry Sears as an example:
Barry Sears weighs 210 pounds and is 6'5" according to information from his book. His diet is based on 30% of the calories from protein, 30% fat, and 40% carbohydrate. He says he eats 100 grams of protein a day. He has been following his diet for 4-5 years. He says he is still on his diet because he still needs to lose more weight.
If Barry Sears eats 100 grams of protein that translates into 400 calories of protein (1 gram of protein = 4 calories). Since the proportions of the diet are 30/30/40, this means he also consumes 400 calories of fat, and about 500 calories of carbohydrate. His total calorie intake is, therefore, 1,300 calories per day. A conservative estimate of his actual needs would be over 2,300 calories a day, with only sedentary activity. This means every day he is 1,000 calories short of his needs. Every week he comes up 7000 calories short, which must be made up from his fat stores. One pound of fat amounts to 3,500 calories. Therefore, Barry Sears must lose 2 pounds of fat a week on his diet. Every year by calculation he loses 104 pounds. Since he says he has been on his diet for 4 to 5 years this means he has lost over 400 pounds. At this point in the debate I asked him, "Barry Sears: A) Did you start your diet at over 600 pounds? B) Do you defy the laws of nature? or C) Is it thatyou cannot and do not follow your own diet?"
Like all calorie restricted diets, the Zone diet is next to impossible to follow for very long because it hurts to be hungry. His program is also impossible because the dietary rules are complicated and foods recommended are unhealthy and unappealing. Coincidentally the June issue (6/2000) of Prevention Magazine came to the same conclusions. They made up a day in the Zone for their article. The meals consisted of 6 egg whites, ½ cantaloupe, 1 kiwifruit, and 3 macadamia nuts for breakfast, Lunch served 3 oz. of skinless white chicken, 1 cup each of steamed asparagus, broccoli, green beans, and 1 tsp of olive oil. Dinner was 3 oz. of turkey breast salad, 4 cups of spinach, 3 cups of cucumber slices, 2 tomatoes, and 1 tsp. of olive oil. Afternoon snack was ¼ cup of low-fat cottage cheese, ½ medium pear, and 3 olives. Evening snack was ¼ cup egg substitute (scrambled), 1 medium plum, ½ tsp. natural peanut butter. This provided 1,209 calories, 110 grams of protein (37%), and 646 mg of calcium. The authors of this article asked "How long could you eat this way?"
During the next round of the debate I pointed out that Barry Sears had not answered my question. Therefore, I must assume he cannot and does not follow his own diet. He admits to only 35 pounds of weight loss over the past 4 years (less than 9 pounds a year), therefore, he must be consuming at least 2300 calories a day. This leaves two possibilities: If he is following his rule that to be in "the zone" you must adhere to proportions of 30/30/40; then based on a 2300 calorie intake he must be eating 173 grams of protein and 77 grams of fat daily (1 gram of protein = 4 calories and 1 gram of fat = 9 calories). Therefore, he must be in a high-protein, high-fat zone. However, he admits to eating only 44 grams of fat a day, so the next possibility is more likely.
If he follows his rule that he eats a specific amount of protein daily to be in "the zone" and for him that's 100 grams of protein a day; then based on 2,300 calories of a day his diet would be 17% protein, 17% fat and 66% carbohydrate, which would place him in a high-carbohydrate zone.
My next question to him was, "Barry ... please tell us -- are you on a high-protein (Atkins-Type) diet or are you on a high-carbohydrate (McDougall-Type) diet?" He still wouldn't answer. He finally said something about not being interested in weight loss, but was really trying to protect himself from heart disease, since he has a strong family history.

The Heart Disease Zone

Seems kind of strange to think of a diet centered around beef, pork, lamb, chicken, eggs, bacon shrimp, lobster, and cheese as preventing heart disease. But, Sears reasons that too much insulin production by the body is the primary culprit for causing heart disease, and the Zone diet will control insulin and prevent heart disease. He feels so strongly about this that he claims in his book that a very low-cholesterol, low-fat diet will actually cause heart disease. After looking over Dr. Dean Ornish's research he concludes, "My guess is that the people who stay on his (Ornish's) program will ultimately have more heart attacks, more strokes, and a higher cardiovascular death rate than the dropouts." He bases this on the fact that "good" HDL-cholesterol went down in Ornish's patients and triglycerides went up. During the debate I pointed out to him that Ornish had corrected him over a year ago, by providing him the data showing his patients on a high-carbohydrate diet had a 50% decrease in risk of cardiovascular deaths. Sears admitted his error to Dr. Ornish and promised to make corrections in his book, but has not. On a healthy low-fat, low-cholesterol diet "good" HDL-cholesterol goes down because all fractions of cholesterol go down. Worldwide the lowest incidence of heart disease is found where people eat the lowest cholesterol diets and also have the lowest HDL-cholesterol levels (2:367, 1981).
Feeding cholesterol raises HDL-cholesterol (N Engl J med 325:1704, 1991). A long-term study of patients on a high-carbohydrate diet showed less risk of death from heart disease compared to those on the American diet (JAMA 173:884, 1960).
More Zone Nonsense

Barry Sears makes numerous statements in his books and at public appearances that are incorrect, and I believe he is well aware of the inaccuracies, but refuses to correct them. Much of this same misinformation is used by promoters of other high-protein diets.
Examples include: Fat Doesn't Cause Obesity. Sears: Eating fat doesn't make you fat. We are consuming less fat than 10 years ago and getting fatter, therefore dietary fat cannot be the culprit. Truth: We are consuming the same amount (actually a little more) of fat now than before. But, in addition, we are consuming over 250 more calories of refined flours and sugars over the past 15 years. Because of the added refined carbohydrates, the percent of fat in the diet has gone down between 1980 and 1990 (men 38% to 34%, women 37% to 34%), but the actual amount (grams) of fat consumed has remained the same (men 99.8 to 98.8, women 62.6 to 67.8), and the diet American diet now has more calories (men 2,457 to 2,684, women 1,531 to 1,805). The reason for the rise in obesity is no mystery--Americans eat a high-calorie, high-fat diet.

Carbohydrates Increase Heart Disease. Sears: A high-carbohydrate diet for cardiovascular patients may be dangerous to their health. Experiments show high carbohydrate diets increase the risk factors for heart disease, by raising cholesterol and triglycerides, and lowering HDL-cholesterol. Truth: You can design such experiments to show triglycerides go up by feeding refined carbohydrates to subjects, and by overfeeding subjects (cholesterol still goes down and I explained the effect on HDL-cholesterol above). When subjects are allowed to eat only until they are full (not force-fed) their cholesterol level falls, their triglyceride levels don't go up significantly, and they lose weight (JAMA 274:1450, 1995). A study of 1250 of my patients shows triglyceride levels decrease an average of 10 mg/dl, and people who start with levels over 600 mg/dl have a 311 mg/dl reduction in 11 days. Therefore, eating as much as you want (but not more than you want) of a healthy low-fat, no-cholesterol diet lowers three important risk factors for heart disease--cholesterol, triglycerides and body weight.
Rice Means More Heart Disease. Sears: The Chinese are an example of how people on a high carbohydrate diet (rice) are as likely to have heart disease as Americans. Using the American Heart Association data, he points out, Urban Chinese have almost as much cardiovascular disease as in the U.S. Truth: Cardiovascular disease is not the same as heart disease. In China, half of this cardiovascular disease is represented by strokes (from old age and high-salt diets), less than one-third is due to heart attacks (ischemic heart disease). In the U.S. nearly two-thirds of the cardiovascular disease is due to heart attacks (and one-sixth is due to strokes). Besides, the 1993 figures he uses reflects the modern Chinese diet, which much higher in fat and cholesterol than a few years back, especially for those people in the cities (urban).
Fat Improves Athletic Performance. Sears: Athletes perform better on a high-fat diet. A high carbohydrate diet is overrated for elite athletes. A high-carbohydrate diet actually limits the performance of highly trained endurance athletes. Truth: Carbohydrate, not fat, is the primary fuel for exercise at or above 70% of aerobic capacity, the intensity at which most people train and compete. Fat only becomes available for fuel after 20 minutes of exercise; therefore most people never exercise enough to lose body fat. Almost every study of trained athletes shows carbohydrate fed before and during the event improves an athlete's performance. Carbohydrate fed after the event replenishes the athlete's glycogen stores for the next race.
Keeping Correct Insulin Levels. Sears: Reaching "the Zone" requires precise control of the protein-to-carbohydrate ratio. Protein counteracts the carbohydrates you eat to keep insulin levels in balance. High levels of insulin generated by too much carbohydrate drive you out of "the Zone." Truth: There is no evidence that eating equal amounts of protein and carbohydrate at every meal, as Sears suggests, lowers insulin. According to Dr. Gerald Raven from Stanford University, "Protein--when eaten alone--increases insulin secretion. I see no reason in the world why it would be any different if protein were eaten with carbohydrate" (Nutrition Action Newsletter Jul/Aug 1996). A study from the Lancet found beef fed with glucose raised insulin levels twice as high as glucose alone and four-times as high as beef alone. The authors concluded, "Ingestion of glucose plus protein is followed by a very large increment in plasma-insulin, of such a magnitude as to suggest synergism between glucose with aminoacid (protein) with respect to insulin release." (Lancet 2:454, 1966). The diet fed these subjects met the zone specifications of 30/30/40 for ideal an protein-to-carbohydrate ratio: 27% protein / 30% fat / 43% carbohydrate.
A study of adult-type diabetics, people with insulin resistance, and normal people found 3-weeks of a high-carbohydrate, low-fat diet and exercise lowered insulin levels significantly (Am J Cardiol 69:440, 1992).
Ecosanoids are the Key. Sears: Eicosanoids are the body's super-hormones. Virtually every disease state--whether it be heart disease, cancer, obesity or autoimmune diseases, like arthritis and multiple sclerosis--can be viewed as an imbalance of eicosanoids. To keep the eicosanoids in a healthy balance you need to eat three grams of protein for every four grams of carbohydrate. Truth: Sears bases his whole diet theory on these hormones, yet he has never measured the eicosanoid levels in people--so he really doesn't know the response to his diet. Gerald Raven of Stanford says, "I find it hard to swallow that anyone could really believe eicosanoids are the key to all health and disease" (Tufts U Diet & Nutrition Newsletter, May 1996).
William Evans, Ph.D, director of the Noll Physiological Research Center at Penn State University says, "There aren't any studies that I'm familiar with that suggest they're dangerous in any way. Anyone who tries to sell diet as the key to stemming 'bad' eicosanoids is capitalizing on an unfounded idea" - (same Tufts Newsletter).
What to Tell Your Friends. "You can burn more fat watching TV than by exercising" and "...many people following high-carbohydrate diets might just as well be eating candy bars" are some of the ridiculous statements found in Sears' book and people still want to believe him; therefore, it seems like an impossible task to try to help those friends and family members who are attracted by "high-protein diet preachers." Try to get them see the big picture. If carbohydrates were bad for people then the Japanese living in Japan on a rice-based diet would be fat and sickly. When they moved to the U.S. and switched to a lower-carbohydrate, higher-fat and -protein diet they would become thinner and healthier.
The truth is the Japanese are among the slimmest, most energetic, longest lived, healthiest people on earth. Furthermore, they take on common American diseases when they change to the American diet. If high-protein diets, which means meat, egg, and dairy products, were so good for us then people who subsist on these foods (most Americans) would be the thin and healthy, and vegetarians would be fat and sick. In general, the opposite is the case.
Along this same line of thinking, ask your friends to closely observe the personal appearance of these experts making all these dietary recommendations. You will be struck by how fat and sickly most of them look. From where I stand, I must conclude that they do eat high-protein foods and lots of them. In the long run these controversial diets are extremely important (even though some people get hurt along the way). The worst thing that can happen to the truth is for people to show no interest. This high-protein craze has made the country's top doctors, dietitians, nutritionists, sports experts, and other scientists closely examine the scientific research on nutrition and health. Almost every article on the subject these days brings up the damaging effects of protein on bone health leading to osteoporosis. Before this controversy all they would talk about is the need for calcium. The harm from eating refined foods, and sugars in all forms of the very popular nonfat cookies and cakes is now being emphasized. Soon the pendulum will swing back to a high carbohydrate, vegetarian diet and hopefully more people will make this their lifestyle as the truth becomes more widespread.