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July 31, 2000

Weight and Weight Loss

Question from San Jose, California, USA:

My twin daughters, aged 25, have had diabetes for 22 years and have never been in very good control. They are eating only protein for the most part, in an attempt to lose weight. They plan to do this for a month. I wonder if this short time of eating excessive protein can do permanent damage to their kidneys or cause kidney failure now.

Answer:

I can imagine that you’re very concerned about your girls. First, a word of reassurance, rapidly followed by a caution. A short period of time on a low carbohydrate/high protein diet is unlikely to cause any serious or permanent health problems unless they already have signs of developing kidney disease. If your girls have been found to have protein in the urine or an elevated creatinine value, then even a short time on such a diet has the potential, in my opinion, to further damage the kidneys. The lower the amount of carbohydrate eaten with the protein, the more potential for damage that exists. Both the excess protein eaten and the ketones that such diets usually produce are hard on the kidneys. It’s an extra burden, and especially worrisome if there is already existing kidney trouble due to the diabetes.

There is a long list of other potential problems related to the high protein diets as well — bone loss, skin changes, dehydration, kidneys stones, and others. Most people don’t stay on the diet long enough for these problems to become apparent. Besides, at 25 most young people feel pretty invincible, not to mention immortal, and are perhaps more interested in appearance than in putting their kidneys through their paces or weakening their bones. With that in mind, perhaps you like to share the following information.

No temporary diet — whether good or bad from a nutritional standpoint — is going to help keep the body in shape. Losing weight is not hard. People do it all the time in a variety of ways. But keeping weight off is a different story. Two years after losing weight, around 95% of people have regained every ounce they lost and then some. Whether your daughters’ focus on their weight is related to health or appearance issues, their best chance for meeting their goals is to stop dieting, start paying attention to exercise, and become aware of what they eat. It’s boring but true. There is no “magic bullet” or “hidden secret.” The message of focusing on health, instead of some anorectic model of beauty is a hard sell these days, but if your girls want to keep strong, fit, healthy bodies for a lifetime, it’s important to stop dieting and start living. The vast majority of people who diet end up watching their weight cycle higher and higher after each short term effort. It wasn’t the outcome they had in mind.

Since your girls have type 1 diabetes, it’s particularly important that they’re working with someone who can help them confirm that they’re on the right insulin doses and regimens. Taking too much insulin — and then having to eat to prevent or treat lows — can lead to inappropriate weight gain. Their blood sugars may have actually become more stable on the high protein diet. If so, this is a sign that they did not have good way to keep insulin balanced with changing food intake before they began the diet.

Weight loss — often to extreme levels that have no relationship to what women’s body’s are actually supposed to look like — are an American obsession and a huge business. I hope your daughters don’t stay on that merry-go-round for very long. It’s harmful to the body and the spirit.

BB