“Trim Healthy Mama” diet book review

THMbook“All of us are sick of the word d-i-e-t.” This is the context with which sisters Serene Allison and Pearl Barrett introduce their plan for healthy eating and weight loss, in the book Trim Healthy Mama. Both are stay at home moms with long histories of stumbling through the confusing mess of dietary plans and philosophies. They set out on a five-year mission of personal research to clear up the confusion and write out a new plan that claims to be the end of fad dieting. Now the sisters have a book published in 2012, a website full of success stories, an online store for plan-approved products, a Pinterest page, a set of how-to YouTube videos, and an exercise dvd in progress. This diet plan continues to gain a growing group of followers, who are affectionately called “THM-ers.”

The Basic Physiology of THM

According to Allison and Barett, any extra padding around the waistline is related to an excess of carbs, creating a problem with the hormone insulin. Excess insulin is directly responsible for excess fat, by promoting the storage of fat in the body. The cause of excess insulin is eating too many carbohydrates which are converted into blood glucose more quickly than fat and protein. The safe zone for blood glucose is 80-100, and when levels in the blood exceed this, the pancreas must produce more insulin to clear out the surplus. The problem worsens when insulin can no longer deliver glucose to the “full” muscle cells and stores the excess in fat cells. Eating too little protein furthers the problem because protein causes the body to release glucagon, a hormone that helps stop insulin’s promotion of fat synthesis.

In general terms, the authors’ theory of insulin action is correct. When we consume carbohydrates, insulin works to convert glucose to glycogen for storage in liver and muscle, decrease the breakdown of glucose from stored glycogen in the liver, and activate the transportation of glucose into muscle and adipose cells. In regards to fat metabolism, insulin inhibits the breakdown of fat (lipolysis) and aids in the conversion of dietary fat into free fatty acids and glycerol, causing lipogenesis. Part of this fat storage is the activation of lipoprotein lipase, which takes triglycerides into adipose tissue.

Now, glucose routinely exits the liver into the bloodstream for transport by insulin to tissues such as adipose and muscle, but a problem arises when a high-carbohydrate diet is consumed. The more carbohydrates to metabolize, the more insulin is required to carry out the necessary responses that include glucose uptake by muscle or fat and synthesis of glycogen and fat. Under normal conditions, minimum amounts of dietary carbohydrate would be utilized to make adipose tissue, as this process takes three times the energy of lipogenesis from dietary fat. This heightened insulin response only occurs under the conditions of excess dietary carbohydrate. The authors are thus correct in their statements that insulin is fat-promoting, and its action increases in response to excess carbohydrate intake.

As far as protein’s relation to insulin action, its metabolites are building blocks for glucagon, which functions with insulin to regulate blood glucose levels. It has been suggested by the authors and researchers that glucagon counteracts fat synthesis through the promotion of lipolysis; however the research base is inconclusive and lacks current examinations of this proposed process. One study performed in 2001, found that glucagon did not significantly stimulate lipolysis of adipose tissue. Alternatively previous studies on mice, such as the research the authors present, have shown a significant effect.  However this was a concentrated injection of glucagon and exceeds the physiological amount attainable by humans via the diet. The authors’ explanation for weight gain is also simplistic, and does not take into account any environmental, genetic, or physical activity factors.

The THM Plan

On this premise the authors present their eating plan that separates the two primary fuels of fats and glucose into distinct “satisfying” and “energizing” meals, so that the body can burn through one fuel source at a time and then switch to burning the body’s own adipose tissue for fuel. Protein is the foundationfor each meal because it is not a primary fuel source and will promote glucagon action.

Satisfying meal: Higher in fat and lower in carbohydrates, consists of protein, butter, oils, cheeses, non-starchy vegetables, berries, nuts, and seeds. Cook only with saturated oils and use nut and seed flours for making “S” baked goods.

Energizing meal: Higher in carbohydrates and lower in fat, consists of protein, whole grains, beans, certain root vegetables, and fruits. Carbohydrates are not refined or processed, and do not go over the 45 gram limit. Fat is still allowed, but only in a 1-2 teaspoon amount of oil, butter, or nut butter.

“S Helpers,” “Crossovers,” and “Fuel Pulls

S Helpers: Basically adding in a little carbohydrate to the “S” meal. Protein-based meals with fats and a small amount of starch or fruit, with the purpose of giving the body a small amount of glucose first and then moving to fat as the primary fuel. The S Helper will allow for slower weight loss.

Crossovers: Protein-based meals with fats and medium-carbohydrate amounts for tandem fueling and weight maintenance.

Fuel Pulls: Protein-based meals low in carbohydrates and fats that use the body’s own fat for fuel. The Fuel Pull allows for fast weight loss. Research has shown that intermittent calorie restriction days will prevent the usual drop in resting metabolic rate and promote weight loss; however research is still required to assess the long-term safety and effectiveness of this diet approach.

In practice the authors recommend a “freestyling” approach with the alternative fuel source meals, allowing three hours between meals and switching between satisfying or energizing, and adding in S Helpers, Crossovers, and Fuel Pulls as it suits the mama’s preferences and weight loss needs (fast, slow, or maintenance). The final pieces of the THM plan are foundation foods, supplements, and exercise.

THMplanFoundation foods: Salmon, berries, omega-3 eggs, fermented dairy and vegetables, nuts and seeds, coconut and red palm oils, chana dahl, nutritional yeast, konjac noodles, and xanthan gum. Serene and Pearl also have their own THM brand of three foundation foods: stevia, defatted peanut flour, and whey protein.

Supplements: Cod liver oil, vitamin D3, green supplements (alfalfa tablets, green powders, etc.), vitamin C, and magnesium. Extra supplements recommended for those with extra cash are curcumin, selenium, tart cherry extract, resveratrol, multivitamins, cholesterol, niacin, red yeast rice, and blood pressure supplements.

Exercise: THM-ers should forgo the long workout and choose short, high-intensity workouts, about 20-30 minutes maximum. Once again, supplements and protein such as whey protein powder are recommended to supplement these exercise sessions.

Not recommended: Honey, agave, artificial sweeteners, and cow’s milk are not recommended, the latter because it is considered carbohydrates and fats in liquid form.

How Does it Measure Up?

The Pros

  • THM-ers are eating less calories overall and will likely lose weight on the plan.
  • Eating more protein and fat, and less carbohydrate, may increase satiety while improving some metabolic values such as HDL cholesterol and blood glucose.
  • The plan provides an established, routine strategy with a set of rules to follow.
  • The amount of processed foods and added sugars in the diet will be significantly reduced.

The Cons

  • Exclusion of cow’s milk and non-fermented dairy products is concerning for vitamin D and calcium intake.
  • The diet removes cereal and grain products such as bread that are fortified with nutrients such as protein and folic acid, which are both essential for pregnant “mamas.”
  • The majority of supplements endorsed by THM contain nutrients whose recommended amounts are attainable through dietary sources.
  • The complexity of the diet plan makes it difficult to understand and follow.
  • There are lots of rules and “good” and “bad” food categories.
  • The sustainability of this diet long-term is uncertain, and lacks emphasis on exercise and other lifestyle factors.
  • The diet welcomes saturated fats, which are less beneficial to lipid profile values than unsaturated fats, and if unlimited may have negative effects on weight and chronic disease risk.
  • They sell products highly recommended for their diet, and some of the supplements don’t have evidence to back them up.

In review, the Trim Healthy Mama plan is supported by evidence for weight loss but lacks conclusive, supportive evidence in the areas of nutritional adequacy and long-term maintenance. A potential THM-er should:

  • Prepare for the complexity of the plan, and be aware of the nutrients that may be lacking from their new diet.
  • Consult with their healthcare provider before starting any of the supplements, especially if they are pregnant or breastfeeding.
  • Know that most of the nutrients they would be supplementing are available to them in a normal, healthy diet.

As far as the claim of THM to be the end of all fad diets, the plan described in the book is in fact just the opposite. THM combines multiple diet approaches of varied effectiveness to form an adjusted calorie diet that will help weight loss, but may not improve overall health. With insufficient evidence to support all of their claims, Trim Healthy Mama is not the cure to diet sickness but only another symptom.

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