Fad Diets
Facts for Dental Professionals
Connie Mobley, PhD, RD
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ABSTRACT
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Background. The author examined fad diet practices associated with oral health status and the role of the dental practitioner in addressing relevant issues.
Conclusions. The author reviewed the literature regarding overweight and obesity in the United States to interpret issues that might arise in reviewing fad diet practices among dental patients. The author provides suggestions for assisting patients in choosing dietary and lifestyle behaviors that are based on current public health evidence in support of achieving and maintaining a healthy body weight.
Clinical Implications. Dental professionals are well-positioned to guide patients toward dietary choices that support dental health and the attainment of a healthy weight associated with a decreased risk of developing chronic diseases.
Key Words: Fad diets; overweight; obesity
Fad diet is a subjective term used to label dietary regimens that restrict food choices and dietary patterns. A fad diet promises to prevent or cure cancer, cleanse the body, enhance human performance or stimulate quick, effective weight loss. These regimens frequently become popular and then fall out of favor with the majority of people because anticipated results are not realized. Often, these approaches list foods as being "good" or "bad" and make simplistic conclusive claims on the basis of a single study or anecdotal evidence. Elimination of important food groups or a suggestion of unusual or ritualistic eating patterns is characteristic of fad diets.
The purpose of this article is to examine the fad diet practices associated with oral health status and the role of the dental practitioner in addressing these issues.
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WEIGHT LOSS PRACTICES
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Approximately 50 million people in the United States seek weight loss products and services, and they cost more than $50 billion annually.1 Obesity continues to be a leading public health concern. Between 1999 and 2004, the prevalence of overweight/obesity increased in children and men but remained constant among women.2 Weight loss practices reported in the 2001–2002 National Health and Nutrition Examination Survey included eating less food/restricting calories, exercising, eating less fat, switching to foods with fewer calories, drinking more water, skipping meals, eating only diet foods or products, taking weight loss supplements, using liquid diet formulas, taking prescription diet pills or laxatives, and vomiting.3 The National Weight Control Registry of people who have maintained weight loss for one to five years reported that most successful people consume low-calorie low-fat diets and eat breakfast and exercise daily.4
Associations between fad diet practices and oral health status can alter dental care and treatment outcomes.
Fad diets are designed to highlight one facet of eating behaviors or food choices. However, caloric intake equal to caloric or energy output at a constant body weight is the essence of energy balance. Inherent in fad diets are beliefs that specific energy sources (such as protein, carbohydrates, fats, alcohol) can alter this biological principle of energy balance. Higher-protein diets may increase satiety, but no data exist to show that they achieve sustained weight loss.5 The ratio of protein to carbohydrate to fat within a dietary pattern does not alter the energy balance equation. Total caloric intake is the ultimate determinant of any successful program. Calories do count.
Fad diets place extreme importance on food components such as vitamins, minerals, herbs, spices and dietary fiber. To modulate the effectiveness of fad diets, those who develop them also consider rules for dietary patterns, such as the number of meals per day, food combinations and frequency of consumption.
Diets based on a philosophy of "detoxification" include the use of coffee enemas, consumption of gallons of fruit juices and raw calves’ liver, intake of potentially toxic herbal/vitamin combinations and macrobiotic diets for the prevention or treatment of cancer. The U.S. Preventive Services Task Force reported that inadequate evidence exists to suggest that when vitamins are taken to supplement a healthy diet, they prevent heart disease and cancer.6 The strongest evidence in support of the role of diet in cancer prevention and treatment points to a well-balanced diet high in whole grains, vegetables, fruits and beans. These foods contain fiber, are believed to reduce the risk of rectum and colon cancer and are rich in antioxidant vitamins, minerals and phyto-chemicals that play a role in reducing overall cancer risk. In the absence of controlled clinical trials that define a dietary regimen for cancer prevention, there are no special diets that have proven to be unequivocally effective mediators of cancer control.
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FAD DIETS AND ORAL HEALTH
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Associations between fad diet practices and oral health status can alter dental care and treatment outcomes. The dental professional can screen patients as follows.
- –If you are following a special diet to achieve weight loss or maintenance, or to manage a chronic disease or condition, can you describe your program?
- –Describe any oral symptoms or conditions you have noticed while following the dietary regimen.
Below are some possible interactions between fad diets and oral health that dental practitioners can use to guide their responses to issues raised by patients.
- –High-protein diets increase body water excretion and may be associated with xerostomia.7
- –Restricting dietary intake to one or two meals a day interferes with salivary flow unless chewing gum or other stimulants are included in the diet.8
- –High-carbohydrate, low-fiber diets, including nutritional bars rich in highly concentrated and formulated fermentable carbohydrates, can increase caries risk.9
- –Fad diets that recommend the intake of caffeine-rich calorie-free drinks or herbal supplements might cause dehydration of oral tissues and dental erosion.10,11
- –Diets that restrict the intake of foods such as fruits, vegetables and grains that provide essential nutrients for the maintenance of tissue integrity and immune response may indirectly affect a patient’s response to dental restorative treatment.12
- –Severe dieting can lead to eating disorders such as anorexia nervosa or bulimia nervosa, both of which are associated with alterations in dental soft- and hard-tissue health.13
- –Diets based on herbal, megavitamin or pharmaceutical therapies may interfere with or alter prescribed drug therapies through undesirable interactions. Following the U.S. Food and Drug Administration’s removal of dexfenfluramine (fen-phen) from the diet drug market in 1997, the Centers for Disease Control and Prevention and the American Heart Association advised antibiotic prophylaxis for all dental patients who reported having used these drugs because of their association with the development of valvular heart disease.14
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HEALTHY DIETS
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Finally, dentists can assist patients by promoting guidelines for healthy dietary behaviors. Guidelines for appropriate weight loss strategies are similar to those for decreasing the risk of developing chronic diseases. Dental practitioners can suggest to patients that they focus on making modest positive changes in daily routines.5 A balanced, healthy diet and sensible, regular exercise are the keys to maintaining an acceptable body weight and health status. Although the field of nutrition science is evolving constantly, below are some generally accepted guidelines for losing weight or maintaining a healthy weight based on a high-quality diet.12
- –Consult with a physician, a registered dietitian or another qualified health care professional to determine a healthy body weight.
- –Eat smaller portions throughout the day and choose from a wide variety of foods.
- –Increase the intake of foods naturally high in fiber, such as fruits, vegetables, legumes and whole grains.
- –Limit portions of foods high in fat, including dairy products such as cheese, butter and whole milk; red meat; and cakes and pastries.
- –Exercise for at least 30 minutes per day at a moderate intensity.15
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CONCLUSION
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Fad diets include the unusual and possibly restrictive approaches to eating that can lead to potential harm and negative health outcomes. The dental professional is well-positioned to guide patients toward dietary choices that support dental and overall health.
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FOOTNOTES
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Dr. Mobley is the acting associate dean of research and a professor, Department of Professional Studies, University of Nevada Las Vegas, School of Dental Medicine, 1001 Shadow Lane, MS-7410, Las Vegas, Nev. 89106, e-mail "connie.mobley{at}unlv.edu". Address reprint requests to Dr. Mobley.
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REFERENCES
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- Weiss EC, Galuska DA, Khan LK, Serdula MK. Weight-control practices among U.S. adults, 2001–2002. Am J Prev Med 2006;31(1):18–24.[Medline]
- Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA 2006;295(13):1549–55.[Abstract/Free Full Text]
- Weight-control Information Network: An information service of the National Institute of Diabetes and Digestive and Kidney Diseases. Available at: "win.niddk.nih.gov/publications/choosing.htm". Accessed Nov. 13, 2007.
- The National Weight Control Registry. Available at: "www.nwcr.ws/". Accessed Nov. 13, 2007.
- Halton TL, Hu FB. The effects of high protein diets on thermogenesis, satiety and weight loss: a critical review. J Am Coll Nutr 2004;23(5):373–85.[Abstract/Free Full Text]
- U.S. Preventive Services Task Force. Recommendations and rationale. Routine vitamin supplementation to prevent cancer and cardiovascular disease. Rockville, Md.: Agency for Healthcare Research and Quality; June 2003. Available at: "www.ahrq.gov/clinic/3rduspstf/vitamins/vitaminsrr.htm". Accessed Nov. 13, 2007.
- St. Jeor ST, Howard BV, Prewitt TE, Bovee V, Bazzarre T, Eckel RH; Nutrition Committee of the Council on Nutrition, Physical Activity, and Metabolism of the American Heart Association. Dietary protein and weight reduction: a statement for healthcare professionals from the Nutrition Committee of the Council on Nutrition, Physical Activity, and Metabolism of the American Heart Association. Circulation 2001;104(15):1869–74.[Abstract/Free Full Text]
- Mobley CC. Dietary analysis in a restorative practice. In: Duke ES, ed. The changing practice of restorative dentistry. Indianapolis: Indiana University School of Dentistry; 2002:139–56.
- Zaura E, ten Cate JM. Dental plaque as a biofilm: a pilot study of the effects of nutrients on plaque pH and dentin demineralization. Caries Res 2004(38 supplement 1):9–15.
- Armstrong LE, Casa DJ, Maresh CM, Ganio MS. Caffeine, fluid-electrolyte balance, temperature regulation, and exercise-heat tolerance. Exerc Sport Sci Rev 2007;35(3):135–40.[Medline]
- Abebe W. An overview of herbal supplement utilization with particular emphasis on possible interactions with dental drugs and oral manifestations. J Dent Hyg 2003;77(1):37–46.[Medline]
- Mobley CC. Nutritional risk assessment. In: Cappelli DP, Mobley CC, eds. Prevention in clinical oral health care. St. Louis: Elsevier; 2008:92–110.
- Fairburn CG, Cooper Z, Doll HA, Davies BA. Identifying dieters who will develop an eating disorder: a prospective, population-based study. Am J Psychiatry 2005;162(12):2249–55.[Abstract/Free Full Text]
- Barasch A, Safford MM. Diet medications and valvular heart disease: the current evidence. Spec Care Dentist 2002;22(3):108–14.[Medline]
- U.S. Department of Health and Human Services, U.S. Department of Agriculture. Dietary guidelines for Americans, 2005. 6th ed. Washington: U.S. Department of Health and Human Services; January 2005. Available at: "www.health.gov/dietaryguidelines/dga2005/document/default.htm". Accessed Nov. 27, 2007.
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ABSTRACT
WEIGHT LOSS PRACTICES
