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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. It was 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 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, and 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.

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 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 1,000 calories per day. The nutrient ratio, which is unusual for a low-carbohydrate diet, is 43% protein, 22.5% fat, and 34.5% carbohydrate.

Basic Scarsdale diet

The basic Scarsdale diet is to be followed for either 7 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 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 that Tarnower seemed 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: unlimited dry cheese 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 cantaloupe, 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: consommé madrilène; plus baked chicken breasts; plus spinach delight; plus a fresh peach with raspberries; plus coffee or tea

Day 5, International Diet

• 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 cantaloupe, or “a generous slice of honeydew, casaba, or other available melon”
• 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 zucchini stew; plus coffee, tea, or espresso

Day 5, Money-Saver Diet

• Breakfast: 1/2 grapefruit or cantaloupe, plus coffee or tea with artificial sweetener
• Lunch: 2 eggs, any style, but prepared without fat; zucchini; 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 people who have tried it and reported on their experiences found it unpleasant because of its lack of flexibility and the plain meal plans prescribed in the basic diet.

Precautions

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

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 people with active lifestyles 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 people already diagnosed with kidney or liver disease should not use the Scarsdale or any other low-carbohydrate diet for weight control.

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 require reevaluation. 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, and is listed as such by the Academy of Nutrition and Dietetics. 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 fall under the category of controlled-carbohydrates diets, which the AAFP does not recommend. Much of the early popularity of the Scarsdale diet may have been due to its association with the town of Scarsdale, which was a symbol of prosperity to people in the New York area, and 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 1,000–1,500 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, was essential to the long-term success that they reported.

Resources

BOOKS

Bowden, Jonny. Living the Low Carb Life: From Atkins to the Zone: Choosing the Diet That's Right for You. New York: Sterling, 2005.

Tarnower, Herman, 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.

PERIODICALS

“Death of the Diet Doctor.” Time, March 24, 1980.

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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): 1283–93.

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): 161–70.

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): 967–74.

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.

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

Weber, Melva. “The Scarsdale-Diet Rage.” Vogue 169 (January 1979): 139–40.

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): 446–47.

WEBSITES

Academy of Nutrition and Dietetics. “Fad Diet Timeline.” http://www.eatright.org/nnm/games/timeline/index.html (accessed August 10, 2012).

“The Scarsdale Diet (official website).” http://www.scarsdalediet.com (accessed August 10, 2012).

Rebecca J Frey, PhD