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Food replacement diets

From: Va Voom Health,

10
February
2010
Food replacement diets

As featured in the Daily Mail

It’s the controversial diet that’s been quietly sweeping the nation. There’ve been no splashy TV ads, no mega poster campaign. Indeed, those who don’t have a serious weight problem – you need to be on the Johnny Vegas side of plump to be medically allowed to go on it – may never have heard of LighterLife. Yet, to devotees, who report losses of four, five, even six stone in as many months, it’s a diet that can be completely life changing.

One such is Lawrence Llewelyn-Bowen’s wife Jackie, who recently revealed that she used LighterLife to shed an amazing five stone in just five months. ‘I’m not Lawrence’s dumpy wife any more,’ she declared, as she was snapped in a slinky little red frock.

There have been less PR-friendly stories too. Jacqueline Henson, a mother-of-five from Huddersfield who was on LighterLife, died after drinking too much water. Jacqueline, 40, consumed four litres of water in less than two hours and died from swelling of the brain. The coroner was satisfied that LighterLife was not to blame and recorded a verdict of accidental death.

Go on any of the many internet dieting forums and opinion is divided right down the middle between those who are evangelical about LighterLife, having lost jaw-dropping amounts of weight, and others who complain not just of the kind of hunger that would see you raiding the cat’s bowl at four in the morning, but of side effects, such as hair loss, headaches, depression, feeling cold and gall stones.

Della David has used her own experience of 20 years of yo-yo dieting to become a diet coach. Three years ago, she managed to lose four stone in three months on LighterLife. ‘I was thrilled,’ she explains. What she was less pleased about was the hair loss she suffered while on the diet. ‘If I was washing my hair, I was pulling it out in clumps,’ she says. David didn’t stop the diet, though. ‘Oh, no, I could start to feel my ribs and that was far more exciting than losing my hair,’ she say.

So what is LighterLife? LighterLife is a food replacement plan. Like better known rivals Slim Fast and The Cambridge Diet and newer British-owned Exante, conventional meals are replaced by low calorie soups and shakes, with snack bars as an optional extra.

What has created the buzz about LighterLife is that there not only does it make you lose weight, there is an attempt to address the emotional reasons why someone might be overweight through a weekly group meeting. Small groups of dieters are taught Transactional Analysis and Cognitive Behavioural Therapy techniques. It’s worthy stuff, but it sounds a tad heavy, especially when the audience may not have seen a sandwich in three months.

LighterLife is not cheap. A week’s supply of three ‘meals’ can cost £66, next to Exante’s £49.98 and £37 to follow the Cambridge plan. OK, you’re not going to be nipping to the corner shop for a bar of Dairy Milk every five minutes and the weekly takeaway bill will obviously be reduced, but £66.00 is a lot of money for what nutritionist Anita Bean, author of ‘Slim Secrets’ calls ‘a glass of pink goo’.

Bean is appalled by the popularity of LighterLife and other meal replacement diets. ‘This is artificially created, engineered food,’ she declares. This is a fact that Dr Tony Leeds, an obesity specialist at The Central Middlesex Hospital and Medical Director of The Cambridge Health and Weight Plan, does not dispute. However, he says: ‘There is no way that you can achieve the energy deficits necessary to achieve such significant weight losses on whole foods and get all the needed micronutrients’. And he’s got a point. No one ever lost a stone a month eating avocados.

LighterLife, Cambridge and the others do produce ‘food’ that looks a bit weird, but compared to the diet many obese people have existed on – what exactly is in a burger van hot dog, anyway? – it is massively nutritionally superior. The soups, shakes and bars have been engineered deliberately to provide a balance of macronutrients (protein, carbs and good fats) as well as fortified with the sort of vitamins and minerals many doughnut monsters haven’t seen in years.

What they have also been engineered to do, of course, is restrict calorie intake. LighterLife, Cambridge et al are all what are referred to medically as Very Low Calorie Diets (VLCDs). The initial, most strict phase of LighterLife is just 530kcals a day, less than half most conventional diets. No wonder some dieters report feeling so darn hungry.

Given the incredibly low calorie intake, LighterLife insists that only those who have a Body Mass Index of over 30, medically classifying them as obese, should attempt the foundation stage where all meals are replaced. Dieters are advised to contact their GP to get the all-clear before they start and they are monitored weekly by LighterLife counsellors during the diet. NICE also issued guidance in 2006, stipulating that no one should stay on a VCLD for more than 12 weeks and that energy intake should be increased every 3-4 weeks.

Many doctors are in favour of VCLDs. Dr David Haslam, clinical director of the National Obesity Forum and on the Medical Advisory Board for LighterLife, says: ‘The benefits of VCLDs in terms of redressing diabetes for example, outweigh the risks’. He points out that VCLDs are for people ‘Who’ve tried everything else and it hasn’t worked’.

Dr Carel Le Roux is a consultant in metabolic medicine at Imperial College, London and The Bupa Cromwell Weight Management Centre. He puts his patients on a 1000 calorie-a-day food replacement diet for between two and six weeks before gastric bypass surgery. ‘VCLDs reduce the size of the liver, which, in the obese, is infiltrated with fat,’ he explains. A large liver makes surgery more difficult. ‘Males do particularly well on VLCDs. They don’t mind the monotony,’ he says.

So, what about the supposed side effects of LighterLife and other VCLDs? Are these just the whinges of those who want to find a reason to raid the fridge? Apparently not. There was a famous piece of research conducted in America after WW11, called The Minnesota Men’s Health Study. Participants were put on a 1200 calorie diet (double that of LighterLife). Many reported feeling cold, lethargic and depressed, just as many of those on modern VCLDs do. Many of the Minnesota men pigged-out afterwards too, just as some of today’s dieters do.

‘It is very characteristic for people to complain of feeling cold when on a VCLD. It affects women more than men, we don’t know why,’ says Dr Tony Leeds. One reason may be ‘thermogeneneration’ or rather the lack of it. Dr Le Roux explains: ‘If you starve people, their basal metabolic rate (BMR) slows down and thermogenesis, the heat produced by the body after a meal, reduces’. Dr Le Roux also says that Non Exercise Activity Thermogenesis (NEAT), the creation of body heat through the imperceptible twitching of muscles, also falls, contributing to the feeling of coldness.

Depression is also linked to VLCDs. This has been explained as due to a shortage of the feelgood brain chemical serotonin, which is released when someone eats protein, but can only be carried into the brain if there is sufficient carbohydrate in the diet.

A more general reason for feeling low may simply be hunger. ‘People are incredibly hungry on VCLDs. They don’t feel satisfied,’ explains Dr Le Roux. Fat cells produce a hormone called Leptin which sends a signal of satiety to the brain. But, if you go on a diet and begin to lose fat, less Leptin is produced. ‘You go into starvation mode and your brain activates a search for food,’ Dr Le Roux explains.

The low fibre content of most VCLDs contributes to this ‘empty’ feeling, but so does their largely liquid nature. Dr Le Roux explains: ‘A liquid diet can exacerbate a feeling of hunger because chewing food begins to activate natural gut hormones which signal fullness’.

The headaches many complain of on LighterLife may be explained by caffeine withdrawal, as dieters eschew their usual coffees, teas and diet drinks. As for the hair loss, that too is par for the course on all diets. It’s do with the slowing down of the BMR. Dr Tony Leeds says: ‘The body “switches-off” hair follicles. A change in hormone levels as a result of a calorie restriction, including a fall in Thyroid hormone T3, may also have a direct effect on hair growth’.

As to gall stones, Dr Tony Leeds says: ‘They are a risk with all weight loss programmes due to lithogenenicity of the bile’. This means a tendency to form crystals. A diet where less food is eaten may result in decreased bile flow from the gall bladder, so that the salts in the bile crystallise in the gall bladder and form stones.

Dieters are also at greater risk of gout because: ‘Any form of weight restriction means that the concentration of uric acid in the blood goes up,’ says Dr Tony Leeds. The uric acid may crystallise in the joints, causing the pain of gout.

That some people are willing to put themselves through all of this is testament to their desperation to lose weight. The frustration when, a year or two later, some find they have put all the flab back on and more is immense. Indeed, many of those on website dieting forums complain that while the weight falls off on LighterLife, Cambridge etc. it is nigh on impossible to keep it off.

After losing a total of seven stone on LighterLife and then The Cambridge Diet three years ago, Della David put three stone back on. ‘That was breaking point for me. I’d done five to six months of this horrific diet and the weight was going back on,’ she says. David insists she was only eating 1200 calories a day and exercising, so why did the spare tyre reappear so easily?

‘Some adaption does take place which can result in changes that mean the body becomes more energy conscious,’ explains Dr Tony Leeds. The ‘adaption’ is a slowing down of the BMR. A major factor in BMR is the amount of lean tissue (muscle) you carry on your body. Unfortunately, when you diet, you lose lean tissue as well as fat. For every pound of weight lost, about three quarters is fat and a quarter is muscle. Less muscle mass means a lower BMR.

The news gets worse says Dr Le Roux. ‘If you lose weight, you lose fat and muscle but when you gain it back, the body puts back fat preferentially. You end up being fatter’. Plus, your BMR may be difficult to rev-up again. ‘It is true that with rapid weight loss the BMR is turned down and it doesn’t turn back up,’ declares Dr le Roux. What never? ‘We don’t know,’ he says. ‘Yo-yo dieters end up saying “Listen, I’m eating almost nothing but I’m putting on weight”. We now know that these patients are telling the truth’.

Dr Tony Leeds thinks that it may be a case of a dieter not adjusting to their new slimmer body. ‘As someone’s body weight comes down, so their need for energy is also reduced. They don’t have so much weight to carry around. If someone goes back to their normal eating, they will gain weight’. This is how the figures stack-up: If you lose 10kg in weight, you need 250 kcals less a day to maintain this new weight. You cannot continue to pile your plate high.

The reason that some others may gain weight when they come off LighterLife may be simpler. They could control their appetite when existing on soups and shakes, but things go to pot (not least their belly) once they're in the land of pasta and pizza. Dr Tony Leeds says: ‘’People have behaviour problems in relation to food. There is a view that for some people there is a benefit in having a period when they do not have to face food’. It is true that it can be an immense relief not to have to make healthy choices in the office canteen, however, you may still face an uphill struggle with real food.

Amanda Hamilton, author of ‘Life Changing Weight Loss’ and star of Channel four’s Spa of Embarrassing Illnesses, thinks food replacement plans, far from helping dieters, can actually lead to disordered eating. She explains: ‘I interviewed a major international celebrity recently who was so scared of food she couldn’t even stand close to a cake. She had been on a meal replacement plan for 30 days’.

Fellow nutritionist Anita Bean agrees: ‘These diets take away the requirement to change your relationship with food’. LighterLife counters this argument by stressing the importance of the weekly group meetings. Even so, Ann Moulder, director of rival company Exante, thinks this is unnecessary and may put dieters off. Exante doesn’t offer group meetings. ‘Not everyone wants to spend two hours listening to other people go on about their past,’ Moulder says, dryly.

Whatever approach a dieter takes, the bottom line with all food replacement plans may not be what happens on the diet, but what happens afterwards. Dr Le Roux comments: ‘My concern is that people will regain the weight quickly afterwards. VCLDs are not a permanent solution’. Jackie Llewelyn-Bowen and the 15000 other dieters currently using LighterLife will be praying that he’s wrong.

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Lowri is a journalist, nutritionist and hypnotherapist, specialising in weight loss, skin and anti-ageing. Her business, Va Voom Health, offers a rare and unique service using both hypnotherapy and nutritional advice to get you the body you want. Whether you're trying to lose weight with one diet after the next or your skin is crying out for help, Lowri has a personalised approach that can help you reach the right balance.

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