Book Review: The Dukan Diet

With a suspicion that the Dukan Diet may be the next diet fad in the U.S., I reviewed The Dukan Diet: 2 Steps to Lose the Weight, 2 Steps to Keep It Off Forever by Pierre Dukan (2011, first American edition). On Amazon.com’s rating system, I give it two stars.

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Think of Dukan as a Low-Fat Atkins Diet.

The Dukan Diet is apparently very popular in Europe. It’s comprised of four phases. The Attack Phase, also called “Pure Protein,” lasts usually two to seven days. Eat all you want from the protein-rich food list, mostly skinless chicken, low-fat meat, fish, and nonfat dairy. No carbs at all except for the dairy. The Cruise Phase is next: Alternate Pure Protein days with proteins and non-starchy vegetables until you’re at your goal weight. Eat all you want from the low-carb veggie list. Consolidation Phase lasts five days for every pound lost. Eat more variety but limited quantities: two slices of whole grain bread, one portion each of fruit and cheese daily, one or two servings of starchy carbs (e.g., legumes, flour, cereals), plus two “celebration meals” a week, carefully defined. Proteins and low-carb veggies are still unlimited. Finally, the Permanent Stabilization Phase is lifelong and similar to Consolidation Phase, but requires one Pure Protein day per week, such as Thursdays. Also, take no stairs or elevators. All phases include prescribed servings of oat bran.

During the active weight loss phases, this diet is low-fat, low-carb, and high-protein. You don’t have to count carb grams, fat grams, or calories. Presumably, Dr. Dukan has done all that for you, although he never shares the average calories consumed nor the macronutrient breakdown (i.e., what percentage of calories are derived from protein, fat, or carbs). The latter two phases are still very low-fat but allow a bit more carbs.

I liked this book more than I expected. It’s obvious the author has copious experience with dieters, especially women. The writing is clear. He’s a serious, earnest man, not a charlatan. Although some will criticize the book’s repetitiveness, it’s a proven educational technique. For weight management, Dr. Dukan and I agree that 1) weighing daily is good, 2) abstinence from sugar rarely eliminates the longing for sweets, 3) artificial no-calorie sweeteners are OK, 4) the 4-7 pound weight loss in Attack Phase is mostly water, not fat, 5) discipline and willpower are important, 6) after losing weight, you’ll regain it if you ever return to your old ways, and 7) a realistic weight goal is essential.

Dr. Dukan recommends at least 20-30 minutes a day of walking. He provides little information on resistance training, although increasing evidence supports it as a great weight control measure. I wish he’d mentioned high intensity interval training (HIIT).

The book contains numerous recipes, including a week of menus for the Attack Phase. Disappointingly, none of the recipes include nutritional analysis.

You’ll find an index. It doesn’t list glycogen. Insulin, a primary fat-storage hormone, is mentioned on only one page, one sentence.

This is one fat-phobic diet. In Dr. Dukan’s view, “fat in food is the overweight person’s most deadly enemy.” All fat consumption contributes to fatness, and animal fats “pose a potential threat to the heart.” It seems Dr. Dukan never got the memo that total and saturated fat content of foods have little, if anything, to do with heart or other cardiovascular disease. While criticizing Dr. Atkins’ diet for demonizing carbohydrates, Dr. Dukan demonizes fats. Yet Dr. Dukan does all he can to banish both carbohydrates and fats from his weight loss phases.

Dr. Dukan makes several erroneous statements, including 1) all food is made up of only three nutrients, 2) all alcoholic beverages are high in carbohydrates, 3) all shellfish are carbohydrate-free, 4) he implies that when dieting or fasting, we convert much of our fat into glucose, 5) there are no indispensable fats, 6) fat is bad for the cardiovascular system, 7) vinegar is the only food containing sour taste, 8) fruit is the only natural food containing rapid-assimilation sugars, 9) “Anyone who loses and regains weight several times becomes immune to dieting,” 10) weight loss releases into the bloodstream artery-toxic fat and cholesterol, 11) many overweight folks are unusually good at extracting calories from food, 12) some people can gain weight even while they sleep, 13) exercise is vitally important for losing weight, and 14) the Atkins diet raises triglycerides and cholesterol levels dangerously.

Will the diet work? I’m sure many have lost weight with it and kept it off. It does, after all, limit two of the major causes of excess weight: sugars and refined starches.

In considering rating this book two or three stars, I asked myself if I’d recommend it to one of my patients looking to lose weight. Initially I had concern that the diet may be deficient in essential fatty acids since it’s so fat-phobic. “Essential” means necessary for life and health. Then I figured that the body’s own fat stores would provide adequate essential fatty acids, at least in the first two phases. The later stages, I’m not so sure. Carefully choosing specific foods would eliminate the risk, but how many people know how to do that? Separate from that potential drawback, there are other diets that are better, such as The New Atkins Diet for a New You, Protein Power, The Advanced Mediterranean Diet, the Ketogenic Mediterranean Diet (free on the Internet), and The New Sonoma Diet. You’ll have no risk of fatty acid deficiency with those.

If you limit carbs, there’s just no need for fat-phobia.

Steve Parker, M.D.