The Cleveland Clinic three-day diet is a very low-calorie diet (VLCD) or quick weight loss program intended to be followed, as the name indicates, for three days. There are certain foods (e.g., specific vegetables, hot dogs, vanilla ice cream, and saltine crackers) that the dieter must eat on specific days during the three-day period, although some versions of the diet allow substitutions. Most Internet versions of this diet promise a 10 lb (4.5 kg) weight loss over the first three days, or 40 lb (18 kg) if the diet is followed for a month. The Cleveland Clinic diet plan is primarily available on the Internet.

A number of other three-day diets share similar concepts as the Cleveland Clinic version, some of which are derived from other healthcare institutions or the military:

Cardiac diet
Birmingham Hospital cardiac unit diet
American Heart Association (AHA) diet
Three-day Army diet
Three-day Navy diet
Hot dog diet (or hot dog and ice cream diet)
Kaiser three-day diet

KEY TERMS

Urban legend—A story, anecdote, or piece of advice based on hearsay and circulated by person-to-person transmission, often by e-mail.

Very low-calorie diet (VLCD)—A term used by nutritionists to classify weight-reduction diets that allow around 800 or fewer calories a day.

Dr. Perricone’s three-day diet
Dr. Christopher’s three-day cleansing program
Bubba’s three-day diet
Oregon Health and Science University (OHSU) diet

Origins

The Cleveland Clinic diet development is attributed to the Cleveland Clinic located in Cleveland, Ohio. However, there is no official record of the diet’s use in the facility. In fact, the origins of the diet have become somewhat of an urban legend. Many variations of the diet and stories of its development can be found posted by anonymous sources on Web sites and blogs. It is possible that the diet became associated with the Cleveland Clinic because the clinic does publish specialized cookbooks and nutrition guides for persons with kidney disorders or diabetes.

There are no books or privately published versions of the Cleveland Clinic diet in print, which makes it difficult to date this diet let alone trace it back to its original source. Although some accounts maintain that the Cleveland Clinic diet first began to circulate around 1985, the Oregon Health and Science University’s disclaimer about this diet states that an early form of it called the University of Oregon Medical School diet has been passed around the Pacific Northwest since 1975. The Cleveland Clinic diet has been attributed to the cardiology departments of various hospitals and medical centers. Supposedly these facilities have overweight patients scheduled for heart surgery use the diet to help them lose weight before the operation.

Description

Most versions of the Cleveland Clinic diet begin with the claim that the dieter will lose weight by means of a chemical breakdown. In fact, weight loss on this diet results from simple calorie restriction; the diet allows between 600 and 1,100 calories per day.

Basic three-day diet plan.

Day One:

Breakfast: Black coffee, water, or tea; half of a grapefruit or pink grapefruit juice; and one slice of toast with 1 or 2 tbl of peanut butter
Lunch: Black coffee, water, or tea; 1/2 cup of water-packed tuna; and one slice of dry toast
Dinner: Black coffee, water, or tea; 3 oz lean meat; 1 cup green beans; 1 cup beets; 1 cup vanilla ice cream; and one small apple

Day Two:

Breakfast: Black coffee, water, or tea; one egg, any style; one banana (some versions say 1/2 banana); and one slice of dry toast
Lunch: Black coffee, water, or tea; 1 cup of cottage cheese; and five saltine crackers
Dinner: Black coffee, water, or tea; two hot dogs; 1/2 cup carrots; 1 cup broccoli (or cabbage); one banana (some versions say 1/2 banana); and 1/2 cup vanilla ice cream

Day Three:

Breakfast: Black coffee, water, or tea; five saltine crackers; one egg (or one slice cheddar cheese); and one 4-oz glass of apple juice
Lunch: Black coffee, water, or tea; one hard-boiled egg; one small apple; and one slice of dry toast
Dinner: Black coffee, water, or tea; 1 cup tuna, chicken, or turkey; 1 cup cauliflower or green beans; 1 cup beets; 1 cup cantaloupe or one small apple; and 1/2 cup vanilla ice cream

Instructions

Some Internet versions of the Cleveland Clinic diet include tips and instructions for the dieter:
Do not alter amounts or make substitutions on the diet menu
Drink at least four glasses of water or diet soda each day
Salt and pepper may be used but no other seasonings
No snacks allowed
Use this diet for three consecutive days each week
After three days of dieting, resume eating as usual but avoid binging
After four days of normal eating, repeat the three-day diet
Cheating on the diet will make it ineffective
Strictly follow the rules of the diet

Variations of the three-day diet.

Some versions of the Cleveland Clinic diet allow herbs, lemon juice, vinegar, soy sauce, mustard, catsup, and Worcestershire sauce to add spice or flavor foods.

Versions of this diet that allow food substitutions do so on the basis that it is a calorie based diet. As long as food substitutions have equivalent calorie amounts, the diet will remain effective. Other versions provide specific lists of permitted substitutions:

An orange instead of grapefruit
Tuna instead of cottage cheese and vice versa
Frozen yogurt instead of ice cream
Cauliflower instead of broccoli and vice versa
Green beans instead of broccoli or cauliflower
Beets instead of carrots
A slice of toast instead of five crackers or vice versa

Function

The primary function of the Cleveland Clinic three-day diet is rapid short-term weight loss. Most variations of the diet imply that the diet can be used indefinitely, following a three-days on and four-days off pattern. Some online versions of this diet claim that it is a detoxification and weight regulation diet. The Cleveland Clinic three-day diet is also claimed to reduce the dieter’s risk of heart disease by lowering blood pressure and cholesterol levels.

Benefits

There are no benefits to health from the Cleveland Clinic diet other than a few pounds of temporary weight loss. Some dieters like the simple menu and no requirements for over-the-counter appetite suppressants.

Precautions

The so-called Cleveland Clinic three-day diet or any of its three-day variations cannot be recommended for anyone who needs to lose weight; in particular, it poses risks to health for anyone with a history of heart disease or an eating disorder. In addition to avoiding fad diets such as this one, a general precaution for anyone seeking to lose weight is to consult a physician before trying any specific diet. This precaution is particularly important for adolescents, women who are pregnant or nursing, people with kidney or liver disorders, people with eating disorders, anyone who has had recent surgery, and anyone who needs to lose more than 30 lb (13.5 kg).

QUESTIONS TO ASK YOUR DOCTOR

Have any of your other patients actual ly tried the Cleveland Clinic Diet or any other three-day diet? If so, did they experience any side effects?
Why or why wouldn’t you recommend this diet to anyone even for a three-day trial period?
What types of food substitutions would be acceptable?
What is your opinion on cycling the program each week (three days on, four days off)?

Risks

The Cleveland Clinic three-day diet is touted on some websites as a regimen that will lower blood cholesterol levels and the risk of heart disease. On the contrary, the diet requires foods that are high in fat, saturated fat, and cholesterol; all of which have been linked to heart disease.

The rigid rules associated with this diet as well as its calorie restriction place individuals diagnosed with eating disorders at risk of a relapse. A study at the University of Minnesota reported in 2007 that adolescent girls are at particularly high risk of developing or retaining disordered eating patterns with frequent exposure to magazine or online articles recommending diets, including such fad diets as the Cleveland Clinic diet.

Very restrictive diets such as the Cleveland Clinic diet may have an effect on dieter’s morale. Some nutritionists have expressed concern that when dieters fail to lose weight on these diets, the dieters see themselves as weak or lacking willpower rather than recognizing that the diet is unsustainable.

Research and general acceptance

The Cleveland Clinic diet is rejected by mainstream physicians and dietitians. The American Heart Association (AHA) and the hospitals whose names have been associated with the cabbage soup diet have issued formal disclaimers warning the public that they do not endorse this diet. The Oregon Health and Science University stated in 2003 that the “hot dog and ice cream diet . . . has been a thorn in our side for years. . . . We will not publish the entire meal plan for fear that someone might take it seriously.”

The UAB Health System not only disowns the three-day diet, but notes its specific nutritional inadequacies,.

including not providing adequate iron and calcium needed for a healthy diet.

Other critics of the Cleveland Clinic diet note its association with yo-yo dieting or weight cycling Yoyo dieting is a phrase coined in the early 1980s by Kelly Brownell, an obesity specialist at Yale University, to describe a repetitive pattern of weight loss and regaining in which the dieter’s weight goes up and down like a yo-yo. The weight cycle may be as small as 5–10 lb (2–5 kg) or as large as 50 lb (22 kg). Weight cycling is no longer thought to affect metabolism but it does appear to increase a dieter’s risk of gallstones, high cholesterol levels, and high blood pressure. Therefore, it is healthier to lose weight slowly through lifestyle changes (including more exercise) and keep it off than to use fad diets like the Cleveland Clinic diet as part of a weight cycling pattern.

Resources

BOOKS

Christopher, John R. Dr. Christopher’s Three-Day Cleansing Program and Mucusless Diet, Rev. ed. Springville, UT: Christopher Publications, 1978.

Perricone, Nicholas, MD. The Perricone Weight-Loss Diet: A Simple 3-Part Plan to Lose the Fat, the Wrinkles, and the Years. New York: Ballantine Books, 2005.

PERIODICALS

Brownell, Kelly B. “The Central Role of Lifestyle Change in Long-term Weight Management.” Clinical Cornerstone 2 (1999): 43–51.

Judge, B. S., and B. H. Eisenga. “Disorders of Fuel Metabolism: Medical Complications Associated with Starvation, Eating Disorders, Dietary Fads, and Supplements.” Emergency Medicine Clinics of North America 23 (August 2005): 789–813.

Katz, D. L. “Pandemic Obesity and the Contagion of Nutritional Nonsense.”Public Health Review 31 (2003): 33–44.

Roberts, D. C. “Quick Weight Loss: Sorting Fad from Fact.” Medical Journal of Australia 175 (December 3–17, 2001): 637–640.

van den Berg P., D. Neumark-Sztainer, P. J. Hannan, and J. Haines. “Is Dieting Advice from Magazines Helpful or Harmful? Five-Year Associations with Weight-Control Behaviors and Psychological Outcomes in Adolescents.” Pediatrics 119 (January 2007): 30–37.

OTHER

Cleveland Clinic Diet Cleveland Clinic. 2007. [cited May 2, 2007]. <http://cms.clevelandclinic.org/body.cfm?id=606>

“‘Heart Diet’ Not Affiliated with Hospital, Potentially Harmful” Dear Doctor Column University of Alabama at Birmingham (UAB) Health System. December 8, 2003. [cited May 2, 2007]. <http://www.health.uab.edu/>

“‘The OSHU Diet‘—NOT from OSHU.” Ed. Cindy Francois. Lipid Clinic News Oregon Health & Science University. 18, no. 1 (March 2003). [cited May 2, 2007]. <http://www.ohsuhealth.com/news/lipid/articles/lipid_news1.cfm>

Phony American Heart Association Diets: Seeking the AHA 3-Day, 7-Day, or Cabbage Soup Diet? American Heart Association (AHA). [cited May 2, 2007]. <http://www.americanheart.org/presenter.jhtml?identifier=507>

Zelman, Kathleen M., RD, MPH. “The 3 Day Diet.” WebMD February 8, 2007. [cited May 2, 2007]. <http://www.webmd.com/diet/features/the-3-day-diet>

ORGANIZATIONS

American Dietetic Association (ADA). 120 South Riverside Plaza, Suite 2000, Chicago, IL 60606-6995. Telephone: (800): 877-1600. Website: <http://www.eatright.org>

Cleveland Clinic. 9500 Euclid Avenue, Cleveland, OH 44195. Telephone: (216) 444-2200. Website: <http://www.clevelandclinic.org/>

Dietitians of Canada/Les dietetistes du Canada (DC). 480 University Avenue, Suite 604, Toronto, Ontario, Canada M5G 1V2. Telephone: (416) 596-0857. Website: <http://www.dietitians.ca>

Partnership for Healthy Weight Management (PHWM), c/o Federal Trade Commission (FTC), Bureau of Consumer Protection. 601 Pennsylvania Avenue, NW, Room 4302, Washington, DC. 20580. Website: <http://www.consumer.gov/weightloss/>

Rudd Center for Food Policy and Obesity. 309 Edwards Street, Yale University, New Haven, CT 06520-8369. Telephone: (203) 432-6700. Website: <http://www.yaleruddcenter.org/home.aspx>

Rebecca J. Frey, PhD