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Scarsdale Diet

Definition

The Scarsdale diet is a rapid weight loss regimen classified as a very low-calorie diet, or VLCD. It is also one of the oldest low-carbohydrate diets still followed by some dieters. Although the first edition of The Complete Scarsdale Medical Diet was published in 1978, over a quarter-century ago, the book is still in print as of early 2007. It is reported to be particularly popular in France in the early 2000s.

Origins

The Scarsdale diet began as a two-page typewritten office handout drawn up in the 1950s by Dr. Herman Tarnower, a cardiologist who had built a medical center in Scarsdale, a middle- to upper middle-class community in Westchester County, New York. Tarnower had written the short reducing guide for patients who needed to lose weight for the sake of their hearts; he was not a professional nutritionist or dietitian. The two articles that he published in medical journals have to do with fever as a symptom of a heart attack and with management of congestive heart failure. His primary motive in writing down his diet plan was impatience; he disliked having to spend time explaining nutrition or other health issues to his patients and so chose to make up a weight-reduction handout. Tarnower gave an interview shortly before his death to the journal Behavioral Medicine, in which he stated, ‘‘If you don’t have a routine written out that you can give to patients with common disorders, it will destroy you. You try to go over all the instructions with each patient, but no physician has that much patience.’’

Tarnower’s patients often copied the diet for their friends, who in turn sent photocopies to other friends. At some point in the mid-1970s, following the early success of the Atkins diet, one of Tarnower’s friends, Oscar Dystel, suggested that he expand his office handout into a full-length book. Tarnower hired a writer, Samm Sinclair Baker, who had published other books in the field of nutrition, and the first edition of The Complete Scarsdale Medical Diet was printed in 1978. It became an immediate bestseller, going through 21 printings in its first ten months in hardcover format. Tarnower’s book became the choice of four book clubs; it sold the second-highest number of copies (over 642,000) of hardcover books published in 1979, outdone only by a humorous book by Erma Bombeck. According to Time magazine, Tarnower’s diet book grossed more than $11 million by the spring of 1980. Sinclair Baker’s most important contribution to the book was to suggest four new programs that represented variations on the basic diet: the Scarsdale Diet for Epicurean Tastes, the Scarsdale International Diet, the Scarsdale Vegetarian Diet, and the Scarsdale Money-Saver Diet. These will be described more fully below.

Tarnower’s book received an initial surge in sales when it was featured in such prestigious fashion magazines as Vogue, which ran an article on ‘‘the Scarsdale-diet rage’’ in 1979. It received an even bigger boost when Dr. Tarnower was shot and killed in March 1980 by Jean Harris, a long-term lover who was then the headmistress of a prestigious private school for girls in Virginia. The made-for-media aspects of the murder and the trial that followed guaranteed that the diet book would receive its share of attention from the press and the public.

Description

The Scarsdale diet can be summarized as a very low-calorie low-carbohydrate diet with a slightly different ratio of carbohydrates, proteins, and fats. An adult woman who follows the diet exactly will consume between 650 and 1000 calories per day. The nutrient ratio, which is unusual for a low-carbohydrate diet, is 43% protein, 22.5% fat, and 34.5% carbohydrate.

KEY TERMS

Ketone bodies— A group of three compounds (ace-toacetic acid, acetone, and beta-hydroxybutyric acid) that are formed in an intermediate stage of fat metabolism and excreted in the urine.

Ketosis— An abnormal increase in the number of ketone bodies in the body, produced when the liver breaks down fat into fatty acids and ketone bodies. Ketosis is a common side effect of low-carbohydrate diets like the Scarsdale diet. If continued over too long a period of time, ketosis can cause serious damage to the kidneys and liver.

Porphyria— A hereditary metabolic disorder characterized by the excretion in the urine of porphyrins, which are molecules that normally combine with iron atoms to form heme-a protein found in hemoglobin, the red pigment that gives blood its color. Some types of porphyria can be triggered by fasting or diets with severe calorie restriction like the Scarsdale diet.

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

Basic Scarsdale diet

The basic Scarsdale diet is to be followed for either seven to 14 days, alternating with two weeks off. The dieter is instructed to drink at least 4 glasses of water, tea, or diet soda every day in order to flush waste products from the body. The dieter may add the following seasonings to her foods: herbs, salt, pepper, lemon, vinegar, Worcestershire sauce, soy sauce, mustard, or ketchup.

An important feature of the basic Scarsdale diet is its rigidity. Although calories are not counted, the dieter is restricted to the three meal plans for each day; snacking is not allowed. When the diet was still in its office-handout stage, some of Dr. Tarnower’s patients asked him whether they might substitute other fruits in season for the grapefruit that forms the centerpiece of the basic plan (18 servings in the course of the two-week regimen, 14 for breakfast and 4 for dessert at lunch or dinner), or substitute raw radishes and cauliflower for carrots and celery sticks. Tarnower invariably told his patients that they had to stick to the plan exactly as written. It was not until the basic diet was expanded into the book-length edition of 1978 that Tarnower seems to have realized that the meal plans could incorporate a greater variety of foods without requiring alterations in the nutrient balance or calorie count.

Sample menus from the basic diet

Day 1

  • Breakfast: coffee or tea with sugar substitute plus 1/2 grapefruit (the breakfast menu is the same for all 7 or 14 days of the diet)
  • Lunch: any amount of lean beef, chicken, or fish plus tomato salad plus coffee or tea
  • Dinner: broiled fish plus tomato and lettuce salad plus 1/2 grapefruit

Day 3

  • Breakfast: coffee or tea with sugar substitute plus 1/2 grapefruit
  • Lunch: tuna salad plus 1/2 grapefruit
  • Dinner: 2 lean pork chops plus mixed green salad plus coffee

Day 5

  • Breakfast: coffee or tea with sugar substitute plus 1/2 grapefruit
  • Lunch: all the dry cheese you want plus raw or cooked spinach plus 1 slice of dry toast
  • Dinner: broiled fish plus green salad plus 1 slice dry toast

Variations on the basic diet

As was noted earlier, Dr. Tarnower’s co-author was instrumental in expanding the basic diet into four additional options that offered the dieter a bit more variety. For purposes of comparison, here are the Day 5 menus from three of these 1978 additions:

Day 5, Gourmet Diet for Epicurean Tastes

  • Breakfast: coffee or tea with sugar substitute plus 1/2 grapefruit or 1/2 cup diced fresh pineapple, 1/2 fresh mango, 1/2 papaya, 1/2 canteloupe, or ‘‘a generous slice of honeydew, casaba, or other available melon.’’
  • Lunch: eggs and chicken livers, farm style; plus tomatoes, lettuce, celery, olives, or endives; plus 1 slice of protein toast; plus coffee, tea, or demitasse
  • Dinner: consomme madrilene; plus baked chicken breasts; plus spinach delight; plus a fresh peach with raspberries; plus coffee or tea

Day 5, International Diet

  • Lunch: pickled eggplant and cheese sticks; plus salad greens, ‘‘all you want,’’ with vinegar and lemon dressing; plus a fresh peach with raspberry sauce; plus coffee, tea, or espresso
  • Dinner: baked stuffed mushrooms; plus veal Napolitaine; plus 1/4 cup boiled white rice; plus zucchni stew; plus coffee, tea, or espresso

Day 5, Money-Saver Diet

  • Breakfast: 1/2 grapefruit or canteloupe, plus coffee or tea with artificial sweetener
  • Lunch: 2 eggs, any style, but prepared without fat; zucchni; 1 slice dry protein bread, no spread;
  • Dinner: broiled, boiled, roasted, or barbecued chicken, ‘‘all you want,’’ with skin and visible fat removed before cooking; plus ‘‘plenty of spinach’’ plus coffee or tea

Function

The basic purpose of the Scarsdale diet is rapid weight loss. It is not intended as a lifetime regimen of sensible weight control; one of its distinctive features, in fact, is that the dieter is supposed to alternate one or two weeks on the diet with two weeks off.

Benefits

The only benefit of the Scarsdale diet appears to be rapid initial weight loss. Most persons who have tried it and reported on their experiences found it unpleasant because of its lack of flexibility and the boring meal plans prescribed in the basic diet. One British reporter described the Scarsdale diet as ‘‘Bad news ... A raw vegetable nightmare so extreme that Bugs Bunny would have revolted.’’

Precautions

The Scarsdale diet has been criticized by nutritionists for a number of health-related deficiencies:

  • Nothing is said in the 1978 edition of the diet about the importance of physical exercise in a weight-reduction regimen. Many nutritionists point out that the 700-1000 calories allowed each day are inadequate for a healthy woman who is even moderately active, let alone one who participates in sports or other forms of physical exercise.
  • The exclusion of milk from the Scarsdale diet means that the dieter’s calcium intake will be too low. This low level of calcium intake poses risks for women who are postmenopausal or over 50.
  • The dieter does not learn how to choose foods wisely during the two weeks off the diet or in real-world situations like restaurants or meals shared with family or friends.
  • Most of the weight lost is in the form of water, and is quickly regained when the dieter resumes normal eating.
  • The Scarsdale diet demands more than the usual amount of will power from the dieter because of its rigidity and low-calorie structure.

Because of these deficiencies and drawbacks, anyone considering the Scarsdale diet in order to lose weight rapidly should consult their physician and a professional dietitian

Risks

The Scarsdale diet does not allow enough calories for women with active life styles or for adolescents who are still growing. It is completely inappropriate for children. It carries the same risks for the dieter associated with other VLCDs, namely fatigue, constipation or diarrhea, irritability, and an increased risk of gallstone formation. The Scarsdale diet has also been reported to trigger episodes of porphyria, an inherited metabolic disorder, in patients with a genetic susceptibility to the disease. Porphyria, which is characterized by the excretion of excessive numbers of porphyrins (molecules used in the formation of the red pigment that gives blood its color) can be brought on by fasting or by long-term use of a VLCD.

The low-carbohydrate profile of the Scarsdale diet also poses the risk of potential kidney or liver damage resulting from ketosis. Ketosis is a metabolic process that occurs when the carbohydrates that serve the body as its basic fuel drop below a certain level. The body must then burn protein and fats to maintain its energy level. When fats are broken down, fatty acids are released into the bloodstream. There they are converted to ketone bodies, which are mild acids excreted in the urine. Excretion of the ketone bodies, however, places an additional burden on the kidneys. If ketosis continues for long periods of time without medical supervision, the kidneys may eventually fail. The health risks associated with ketosis are one reason why the Scarsdale diet should never be used for more than 14 days at a time. In addition, pregnant women, alcoholics, and persons already diagnosed with kidney or liver disease should not use the Scarsdale or any other low-carbohydrate diet for weight control.

QUESTIONS TO ASK YOUR DOCTOR

  • Considering that the Scarsdale diet does not reflect recent advances in the science of nutrition, would you recommend this diet?
  • Have any of your patients ever tried the Scarsdale Diet?
  • If so, were they able to keep off any weight they lost?
  • If so, did they develop any health problems while following it?

Research and general acceptance

The Scarsdale diet has not been the subject of extensive medical research, possibly because of its association with a notorious legal case. There is only one article in the medical literature that reported on the diet’s usefulness as a means to rapid initial weight reduction for people who were then placed on less restrictive weight-loss regimens. The article, however, was published in 1982 and its findings would require reevaluation a quarter-century later. Dr. Tarnower himself never tested the diet in a clinical trial or published any outcome studies of his patients. Although the cover of the 1978 edition of The Complete Scarsdale Medical Diet promises a weight loss of ‘‘up to 20 pounds in 14 days’’ the only evidence provided to support this claim is anecdotal quotations from some of the doctor’s patients.

Although the Scarsdale diet was popular when it was first published in book form, it is considered a fad diet as of the early 2000s, and listed as such by the American Dietetic Association (ADA). Although the publication on fad diets published by the American Academy of Family Physicians (AAFP) does not mention the Scarsdale diet by name, it would clearly come under the heading of controlled carbohydrates diets, which the AAFP does not recommend. Much of the early popularity of the Scarsdale diet may have been due to snob appeal. Dr. Tarnower was disliked as a person by many of his patients as well as by others who knew him for his pretentiousness and open social climbing. The association of the diet with the town of Scarsdale, which was a symbol of prosperity to people in the New York area, may well have encouraged some readers to think of weight loss as a path to economic or social success. Dr. Tarnower was obsessed with his own trim figure as evidence of his professional stature, reportedly dieting whenever his weight went even slightly over 174 pounds. One measure of the Scarsdale diet’s loss of popularity is that the upscale fashion magazines that touted it in the late 1970s described it less than a decade later as one of the ‘‘diets that don’t work.’’

In general, researchers in the United States and Canada maintain that VLCDs are not superior in any way to conventional low-calorie diets (LCDs). The first report of the National Task Force on the Prevention and Treatment of Obesity on these diets, which was published in the Journal of the American Medical Association in 1993, noted that ‘‘:Current VLCDs are generally safe when used under proper medical supervision in moderately and severely obese patients (body mass index > 30) and are usually effective in promoting significant short-term weight loss . . . . [but] long-term maintenance of weight loss with VLCDs is not very satisfactory and is no better than with other forms of obesity treatment.’’

One Canadian study reported in 2005 that a history of weight cycling tended to lower the health benefits that obese patients could receive from VLCDs, while a 2006 study carried out at the University of Pennsylvania in Philadelphia found that the use of liquid meal replacement diets (LMRs) with a daily calorie level of 1000–1500 calories ‘‘provide[d] an effective and less expensive alternative to VLCDs.’’ The only study that reported that VLCDs are ‘‘one of the better treatment modalities related to long-term weight-maintenance success’’ was completed in the Netherlands in 2001. The Dutch researchers added, however, that an active follow-up program, including behavior modification therapy and exercise, is essential to the long-term success that they reported.

BOOKS

Bowden, Jonny. Living the Low Carb Life: From Atkins to the Zone: Choosing the Diet That’s Right for You. New York: Barnes & Noble Publishing, 2004. Compares the Scarsdale diet to some other well-known low-carbohydrate regimens.

Tarnower, Herman, MD, and Samm Sinclair Baker. The Complete Scarsdale Medical Diet Plus Dr. Tarnower’s Lifetime Keep-Slim Program. New York: Rawson, Wade Publishers, 1978.

Trilling, Diana. Mrs. Harris: The Death of the Scarsdale Diet Doctor. New York: Penguin Books, 1982. Contains some background information on the Scarsdale diet as well as an account of Dr. Tarnower’s death and the subsequent murder trial.

PERIODICALS

‘‘Death of the Diet Doctor.’’ Time, March 24, 1980. Fortino, Denise. ‘‘Famous Diets That Don’t Work.’’ Harper’s Bazaar 120 (October 1987): 94–96.

Gilden Tsai, A., and T. A. Wadden. ‘‘The Evolution of Very-Low-Calorie Diets: An Update and Meta-Analysis.’’ Obesity (Silver Spring) 14 (August 2006): 1283–1293.

Hart, K. E., and E. M. Warriner. ‘Weight Loss and Biomedical Health Improvement on a Very Low Calorie Diet: The Moderating Role of History of Weight Cycling.‘ Behavioral Medicine 30 (Winter 2005): 161–170.

Maxted, Anna. ‘Slimmer after 16 Years of Diets? Huh, Fat Chance.‘ The Independent (London), July 16, 1995.

National Task Force on the Prevention and Treatment of Obesity, National Institutes of Health. ‘Very Low-Calorie Diets.‘ Journal of the American Medical Association 270 (August 25, 1993): 967–974.

Quiroz-Kendall, E., F. A. Wilson, and L. E. King, Jr. ‘Acute Variegate Porphyria Following a Scarsdale Gourmet Diet.‘ Journal of the American Academy of Dermatology 8 (January 1983): 46-49.

Saris,W. H. ‘Very-Low-Calorie Diets and Sustained Weight Loss.‘ Obesity Research 9 (Suppl. 4): 295S–301S.

‘Top 25 Best-Selling Hardcovers of 1979.‘ Time Capsule, Home Textiles Today, September 6, 2004, 36.

Weber, Melva. ‘The Scarsdale-diet Rage.‘ Vogue 169 (January 1979): 139-140.

Wing, R. R., L. H. Epstein, and B. Shapira. ‘The Effect of Increasing Initial Weight Loss with the Scarsdale Diet on Subsequent Weight Loss in a Behavioral Treatment Program.‘ Journal of Consulting and Clinical Psychology. 50 (June 1982): 446-447.

OTHER

American Dietetic Association (ADA). Fad Diet Timeline— Fad Diets throughout the Years. Press release, February 1, 2007. Available online at http://www.eatright.org/cps/rde/xchg/ada/hs.xsl/media_11092_ENU_HTML.htm.

ORGANIZATIONS

American Academy of Family Physicians (AAFP). P.O. Box 11210, Shawnee Mission, KS 66207-1210. Telephone: (800) 274-2237 or (913) 906-6000. Website: http://www.aafp.org.

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

Rebecca J Frey, Ph.D.


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