понеделник, 12 май 2008 г.

Therapeutic weight loss techniques

The least intrusive weight loss methods, and those most often recommended by physicians, are adjustments to eating patterns and increased physical exercise. Usually, health professionals will recommend that their overweight patients combine a reduction of the caloric content of the diet with an increase in physical activity.

Other methods of losing weight include use of drugs and supplements that decrease appetite, block fat absorption, or reduce stomach volume. Surgery is another method. Bariatric surgery artificially reduces the size of the stomach, limiting the intake of food energy. Some of these treatments may have serious side-effects.

"Crash Dieting"

A crash diet (also known as "fasting") is where a person willfully restricts themselves of all nourishment (except water) for more than 12 hours. The desired result is to have the body burn fat for energy with the goal of losing a significant amount of weight in a short time. Crash dieting is not the same as flexible intermittent fasting, where dieters fast for 2 days each week and calories are cycled. Generally the weight lost in a crash diet returns when normal eating resumes.

Weight loss industry

In the developed world, there is a substantial market for products which promise to make weight loss easier, quicker, cheaper, more reliable, or less painful. These include books, CDs, cremes, lotions, pills, rings and earrings, body wraps, body belts and other materials, fitness centers, personal coaches, weight loss groups and food products and supplements. US residents in 1992 spent an estimated $30 billion a year on all types of diet programs and products, including diet foods and drinks.

Between $33 billion and $55 billion is spent annually on weight loss products and services, including medical procedures and pharmaceuticals, with weight loss centers garnering between six percent and 12 percent of total annual expenditure. About 70 percent of American's dieting attempts are of a self-help nature. Although often short-lived, these diet fads are a positive trend for this sector as Americans ultimately turn to professionals to help them meet their weight loss goals

Intentional weight loss

Weight loss may refer to the loss of total body mass in an effort to improve fitness, health, and/or appearance.

Therapeutic weight loss, in individuals who are overweight, can decrease the likelihood of developing diseases such as diabetes. Overweight and obese individuals face a greater risk of health conditions such as type 2 diabetes, heart disease, high blood pressure, stroke, osteoarthritis and certain types of cancer. For healthy weight loss, a physician should be consulted to develop a weight loss plan that is tailored to the individual.

Weight loss occurs when an individual is in a state of negative energy balance. When the human body is spending more energy in work and heat than it is gaining from food or other nutritional supplements, it will catabolise stored reserves of fat or muscle.

Although weight loss may involve loss of fat, muscle or fluid, weight loss for the purposes of maintaining health should aim to lose fat while conserving muscle and fluid.[citation needed]

It is not uncommon for people who are already at a medically healthy weight to intentionally lose weight. In some cases it is with the goal of improving athletic performance or to meet weight classifications in a sport. In other cases, the goal is to attain a more attractively shaped body. Being underweight is associated with health risks. Health problems can include difficulty fighting off infection, osteoporosis, decreased muscle strength, trouble regulating body temperature and even increased risk of death.

неделя, 13 април 2008 г.

Blood type diet

Blood type diet

From Wikipedia, the free encyclopedia

The blood type diet is a diet advocated by Peter D'Adamo and outlined in his book Eat Right 4 Your Type. Its basic premise is that ABO blood type is the most important factor in determining a healthy diet. The diet is widely derided by dieticians, physicians, and nutritional scientists as having no scientific basis.

The cornerstone of his theory is D’Adamo’s premise that lectins in foods react differently with each ABO blood type. Throughout his books he cites the works of various biochemists and glycobiologists who have researched blood groups, claiming or implying that their research supports this theory. In his book, Eat Right 4 Your Type, "Lectins: The Diet Connection", and in following chapters, "lectins" which interact with the different ABO type "antigens" are described as incompatible and harmful, therefore the selection of different foods for A, AB, B, and O types to minimize reactions with these lectins.

D'Adamo bases his ideas on the ABO classification of Karl Landsteiner and Jan Janský, and some of the many other tissue surface antigens and classification systems, in particular the Lewis antigen system for ABH secretor status. [2]

The evolutionary theory of blood groups, which is also used by D'Adamo, stems from work by William C. Boyd, an immunochemist and blood type anthropologist who made a worldwide survey of the distribution of blood groups. In his book Genetics and the races of man: An introduction to modern physical anthropology, published in 1950, Boyd describes how by genetic analysis of blood groups, human races are populations that differ according to their alleles. On this basis, Boyd divided the world population into 13 geographically distinct races with slightly different frequency distributions of blood group genes.

D'Adamo groups those thirteen races together by ABO blood group, each type within this group having unique dietary recommendations:

  • Blood group O is believed by D'Adamo to be the hunter, the earliest human blood group. The diet recommends that these supposedly muscular, active people eat a meat-rich diet.
  • Blood group A is called the cultivator by D'Adamo, who believes it to be a more recently evolved blood type, dating back from the dawn of agriculture. The diet recommends that individuals of blood group A eat a diet emphasizing vegetables and free of red meat, a more vegetarian food intake.
  • Blood group B is, according to D'Adamo, the nomad, associated with a strong immune system and a flexible digestive system. The blood type diet claims that people of blood type B are the only ones who can thrive on dairy products.
  • Blood group AB, per D'Adamo, the enigma, the most recently evolved type. In terms of dietary needs, his blood type diet treats this group as an intermediate between blood types A and B.

Criticism

D'Adamo's Blood Type Diet has met with several criticisms. The fundamental criticisms are, for one, that none of his hundreds of citations to others' research on blood groups directly support his claims of differential food tolerances and, secondly, that he provides no comparative clinical trials demonstrating efficacy of his diet.

Evidence

One criticism of D'Adamo's hypotheses and recommendations claims that he provided inadequate evidence. For example, his first book, Eat Right 4 Your Type, published in 1997, contains only a bibliography. Most of his subsequent books, however, have been thoroughly referenced as far as his general theory. However, despite his providing general reasons for the classifications of various foods within his established categories of "beneficials", "neutrals" and "avoids", his specific process for reaching these conclusions of classification remain undocumented.

Although D'Adamo claims there are many ABO specific lectins in foods, this claim is, for a number of his cited cases, unsubstantied by established biochemical research, which has not found differences in how the lectins react with a given human ABO type. A common criticism is that lectins which are preferential for a particular ABO type are not found in foods (except for one or two rare exceptions, e.g. lima bean), and that lectins with ABO specificity are more frequently found in non-food plants or animals.

Another criticism is that there are no clinical trials of the Blood Type Diet. In his first book Eat Right 4 Your Type, D'Adamo mentions being in the eighth year of a 10 year cancer trial, but no results of this trial have ever been published. In his book Arthritis: Fight It With the Blood type Diet, D'Adamo mentions an impending clinical trial of the Blood Type Diet in order to determine its effects on the outcomes of patients with rheumatoid arthritis, but no results of this trial have yet been published.

Blood type evolution

In the article "Genetic of the ABO blood system and its link with the immune system", Luiz C. de Mattos and Haroldo W. Moreira point out that D'Adamo's assertion that the O blood type was the first human blood type requires that the O gene evolved before the A and B genes in the ABO locus. Instead, phylogenetic networks of human and non-human ABO alleles show that the A gene was the first to evolve. The authors argue that, in the evolutionary sense, it would be extraordinary for normal genes (those for types A and B) to have evolved from abnormal genes (for type O).

Yamamoto et al. further note:

Although the O blood type is common in all populations around the world, there is no evidence that the O gene represents the ancestral gene at the ABO locus. Nor is it reasonable to suppose that a defective gene would arise spontaneously and then evolve into normal genes.

In May 2004, Transfusion published a study which concluded that: "Assuming constancy of evolutionary rate, diversification of the representative alleles of the three human ABO lineages (A101, B101, and O02) was estimated at 4.5 to 6 million years ago." This finding declares that ABO did not evolve in the near past, essentially contradicting that which D'Adamo suggests.

Inedia

Inedia

From Wikipedia, the free encyclopedia


Jasmuheen

Jasmuheen (born Ellen Greve) was probably the most famous advocate of Breatharianism during the 1990s. She claimed "I can go for months and months without having anything at all other than a cup of tea. My body runs on a different kind of nourishment."Several interviewers found her house full of food, but she claimed the food was for her husband. In 1999, she volunteered to be monitored closely by the Australian television program 60 Minutes for one week without eating to demonstrate her methods Greve claimed that she failed because on the first day of the test she had been confined in a hotel room near a busy road, saying that the stress and pollution kept her from getting the nutrients she needed from the air. “I asked for fresh air. Seventy percent of my nutrients come from fresh air. I couldn’t even breathe,” she said. On the third day the test moved to a mountainside retreat where she could get plenty of fresh air and live happily. After Greve had fasted for four days, Dr. Berris Wink, president of the Queensland branch of the Australian Medical Association, urged her to stop the test.

According to the doctor, Greve’s pupils were dilated, her speech was slow, she was "quite dehydrated, probably over 10%, getting up to 11%." Towards the end of the test, he said, "Her pulse is about double what it was when she started. The risks if she goes any further are kidney failure. 60 Minutes would be culpable if they encouraged her to continue. She should stop now." The test was stopped. Dr. Wink said, "Unfortunately there are a few people who may believe what she says, and I'm sure it's only a few, but I think it's quite irresponsible for somebody to be trying to encourage others to do something that is so detrimental to their health She challenged the results of the program, saying, "Look, 6,000 people have done this around the world without any problem." [4] Though she claims thousands of followers,mostly in Germany,there is no evidence that any have lived for long periods of time without any food at all.

Jasmuheen was awarded the Bent Spoon Award by Australian Skeptics in 2000 ("presented to the perpetrator of the most preposterous piece of paranormal or pseudoscientific piffle"). She also won the 2000 Ig Nobel Prize for Literature for Living on Light. Jasmuheen claims that their beliefs are based on the writings and "more recent channelled material" of the Count of St Germain. She claims that her DNA has expanded from 2 to 12 strands, to "absorb more hydrogen". When offered $30,000 to prove her claim with a blood test, she said that she didn't understand the relevance

Deaths

The well-publicized deaths of 49-year-old Australian-born Scotland resident Verity Linn, 31-year-old Munich kindergarten teacher Timo Degen, and 53-year-old Melbourne resident Lani Marcia Roslyn Morris, while attempting to enter the Breatharian "diet," have drawn further criticism of the idea.[1][2] Jim Vadim Pesnak, 63, and his wife Eugenia, 60, went to jail for three years on charges of manslaughter for their involvement in the death of Morris. Verity Lynn, the Scottish woman who inadvertently killed herself by choosing the Breatharian "diet" was a nominee for the 1999 Darwin Awards. She "took to the highlands", the article says, "with only a tent and her grit and determination." She died of hypothermia and dehydration, aggravated by lack of food. Jasmuheen claimed that her death was brought on by a psycho-spiritual problem, rather than a physiological one.

Jasmuheen has denied any involvement with the three deaths and claims she cannot be held responsible for the actions of her followers. In reference to the death of Lani Morris, she said that perhaps Morris was "not coming from a place of integrity and did not have the right motivation

Wiley Brooks

Wiley Brooks is a purported breatharian, and founder of the Breatharian Institute of America. He was first introduced to the public in 1981, when he appeared on the TV show That's Incredible!. Wiley has stopped teaching in recent years, so he can "devote 100% of his time on solving the problem as to why he needed to eat some type of food to keep his physical body alive and allow his light body to manifest completely." This comes after much controversy over the years. In 1983 he was allegedly spotted leaving a Santa Cruz 7-Eleven with a Slurpee, hot dog and Twinkies.

He told Colors magazine in 2003 that he periodically breaks his fasting with a Big Mac and Coke, explaining that when he's surrounded by junk culture and foods, consuming them adds balance. On his website Brooks goes on to explain that his future followers must first prepare by combining the junk food diet with the meditative incantation of the five magic fifth-dimensional words which appear on his website.Prospective disciples are asked after some time on this junk food/magic word preparation to revisit his website in order to test if they can feel the magic.[5] He further mentions that those interested can call him on his fifth-dimensional phone number in order to get the correct pronunciation of the five magic words.[5] In case the line is busy prospective recruits are asked to meditate on the five magic words for a few minutes and then try calling again.[5] However he does not explain how anyone can meditate with words they cannot yet pronounce. Wiley Brooks' Breatharian Institute of America charges $15,000,000 US (minimum) to learn how to live without food.[6] This charge is a limited time offer and it is scheduled to go up in November 2007 to 20,000,000 and in January 2008 it will reach 25,000,000 US dollars.[6] A payment plan can be arranged but no refunds are offered currently.[6] In addition all applicants must be pre-qualified by the Breatharian Institute.[7]

Hira Ratan Manek

Hira Ratan Manek (born September 12, 1937) claims that since June 18th, 1995, he has lived exclusively on water, and occasional tea, coffee, and buttermilk. He says sunlight is the key to his health, citing the Jainist Tirthankara Mahavira, ancient Egyptians, Greeks, and Native Americans as his inspiration.

According to his website, three extended periods of his fasting have been observed under control of scientific and medical teams: the first lasting 211 days in 1995-96 in Calicut, India, under the direction of Dr C. K. Ramachandran. During that period he is reported to have lost 41 kg.[14]

The second study lasted 411 days in 2000-2001 in Ahmedabad, India, under the direction of a 21 member team of medical doctors and scientists led by Dr Sudhir Shah and Dr K. K. Shah, a past President of the Indian Medical Association and current Chairman of the Jainist Doctors' Federation. The latter group aims to "Promote scientific research and medical education based on principles of Jainism"[15]. Dr K. K. Shah said "Fasting is a method of curing the meditation of mind and body which has been proved by great jain monks, sanyasis and munis of ancient times. There is a need to propagate these methods during this age of increasing diseases of the body and mind due to overconsumptions and increasing with fasting would help maintain perfection."[16]. Dr Sudhir Shah was also involved in the study of Prahlad Jani.[17]

The paper[18] published by Dr Sudhir Shah makes it clear that dozens of people had access to Hira Ratan Manek during the study and he went on at least one excursion: "Most surprisingly, he had himself climbed the famous Shatrunjay mountain (Palitana hill) on 4.4.01, on 401st day of his legendary fasting along with 500 fellowmen without anybody’s help, within 1.5 Hrs. only". The paper reports that the subject lost 19 kg of weight during the study period. Neither the experiment, as described in the paper, nor the paper itself have been validated by any well-known Western scientific or medical journal.

The third study lasted 130 days in Philadelphia, Pennsylvania, at Thomas Jefferson University and the University of Pennsylvania under the direction of Dr. Andrew Newberg and Dr. George C. Brainard. Dr Sudhir Shah, who led the previous study, acted as an advisor and consultant to the USA team.[19]

However, Dr. Andrew Newberg said that Hira stayed at the University of Pennsylvania only for brain scans on studies of meditation, not his ability to fast indefinitely[citation needed]. Newberg denied ever undertaking the 130-day study.[citation needed]

Buddhism and vegetarianism

Buddhism and vegetarianism

Buddhism, along with Jainism, recognizes that even eating vegetables could contribute to the indirect killing of living beings as animal life is destroyed as farmers plough land. Jainism consequently considers death by starvation as the ultimate practice of non violence, while Buddhism considers extreme self-mortification to be undesirable for attaining enlightenment.

Both Mahayana and Theravada theology generally hold that meat eating in and of itself does not constitute a violation of the Five Precepts which prohibit one from directly harming life. Pali/Sanskrit term for monks and nuns means one who seek alms. However, when monks and nuns who follow the Theravada feed themselves by alms, they must eat whatever leftover foods which are given to them including meat. Exception to this alms rule is when monks and nuns have seen, heard or known that animal(s) have been specifically killed to feed the alm seeker or guest, in which case, consumption of such meat would be karmically negative. This is also followed by lay Buddhists; and is known as the consumption of the 'triply-clean meat' (三净肉 sanjingrou). On the other hand, when lay communities specifically purchase meat for consumption of monks and nuns, permissibility of meat eating differ among different Buddhist sects. Theravada Pali Canon records instances of Buddha eating meat which were specifically purchased for Buddha. This act was deliberately performed by the Buddha to demonstrate that if need be, a Buddhist can bend the rules in times of emergency or inconvenience. Obstinately observing vegetarianism or Buddhist rules in times when you cannot, conflicts with Mahayana philosophy because obstinacy or attachment for anything, is considered to be 'stubborness' (执著 zhizhuo) which will become an obstacle to nirvana or enlightenment. However even then, if one undertakes a vow to be a Buddhist vegetarian, one is expected to follow this vow until it is humanly impossible to continue one's vegetarian diet.

Acceptance of authenticity of the Pali Suttas differ within Mahayana sects and Mahayana sutras do not record Buddha eating meat. While no Mahayana sects consider Pali sutras to be inauthentic, Chinese Buddhist sects tend to consider this particular part of writing in Pali suttas to be false. Japanese Buddhist sects generally accept that Buddha ate meat[1].

Still, both Mahayana and Theravada Buddhists consider that one may practice vegetarianism as part of cultivating Bodhisattvas's paramita. Since Mahayana Buddhists recognise the consumption of meat to be cruel and devoid of compassion, many Mahayana Buddhists are vegetarians. Numbers of Mahayana sutra record Buddha praising the virtue of avoiding meat. However, Tibetan Buddhism believes that tantric practice makes vegetarianism unnecessary. All Japanese Kamakura sects of Buddhism (Zen, Nichiren, Jodo) have relaxed Mahayana vinaya, and as a consequence, do not practice vegetarianism but rather pescetarianism. Chinese Buddhism and part of Korean Buddhism strictly adhere to vegetarianism.

Buddhism and other food considerations

East Asian "Buddhist" cuisine differ from Western vegetarian cuisine in one aspect, that is avoidance of killing plant life. Buddhist vinaya for monks and nuns prohibit harming of plant. Therefore, strictly speaking, no root vegetables (such as potatoes, carrots or onion) are to be used as this will result in death of vegetables. Instead, vegetables such as beans or fruits are used. However, this stricter version of diet is often practiced only on special occasion. Some Mahayana Buddhists in China and Vietnam specifically avoid eating strong-smelling plants, traditionally garlic, Allium chinense, asafoetida, shallot, and Allium victorialis (victory onion or mountain leek), and refer to these as 五荤 'Five Acrid And Strong Smelling Vegetables' or 五辛 'Five Spices' as they tend to excite senses. This is based on teachings found in the Brahma Net Sutra, the Surangama Sutra and the Lankavatara Sutra (chapter 8). In modern times this rule is often interpreted to include other vegetables of the onion genus, as well as coriander.

An example of shōjin-ryōri taken in Kyoto, Japan at the zen temple of Ryuanji.
An example of shōjin-ryōri taken in Kyoto, Japan at the zen temple of Ryuanji.

The food that a strict Buddhist takes, even if he/she is not a vegetarian is also specific. For many Chinese Buddhists, beef and the consumption of large animals and exotic species is avoided. Then there would be the aforementioned sanjingrou rule. One restriction on food that is not known to many is the abstinence from eating animal innards and organs. This is known as 下水 (xiashui), and is a Chinese term and is not to be confused with the Japanese term gesui (sewage).

Alcohol and/or other drugs are also avoided by many Buddhists because of their effects on the mind and "mindfulness". It is part of the Five Precepts which dictate that one is not to consume "addictive materials". The definition of "addictive" depends on each individual but most Buddhists consider alcohol and contraband drugs to be addictive. Stricter Buddhists consider tobacco to be addictive as well.

Common sources for Buddhist foods

Vegetarian restaurant buffet, Taipei, Taiwan. July 2003
Vegetarian restaurant buffet, Taipei, Taiwan. July 2003

Buddhist vegetarian chefs have become extremely creative in imitating meat using prepared wheat gluten, also known as "seitan" or "wheat meat", soy (such as tofu or tempeh), agar, and other plant products. Some of their recipes are the oldest and most-refined meat analogues in the world. Soy and wheat gluten are very versatile materials, because they can be manufactured into various shapes and textures, and they absorb flavourings (including, but not limited to, meat-like flavourings), whilst having very little flavour of their own. With the proper seasonings, they can mimic various kinds of meat quite closely.

Some of these Buddhist vegetarian chefs are in the many monasteries which serve wu hun and mock-meat (also known as 'meat analogues') dishes to the monks and visitors (including non-Buddhists who often stay for a few hours or days, to Buddhists who are not monks, but staying overnight for anywhere up to weeks or months). Many Buddhist restaurants also serve vegetarian, vegan, non-alcoholic, and/or wu hun dishes. Some Buddhists eat vegetarian only once per week or month, or on special occasions such as annual visits to an ancestor's grave. To cater to this type of customer, as well as full-time vegetarians, the menu of a Buddhist vegetarian restaurant usually shows no difference from a typical Chinese or far-Eastern restaurant, except that in recipes originally made to contain meat, a chicken flavoured soy or wheat gluten might be served instead (e.g. "General Tso's chicken" made with flavoured wheat gluten).

сряда, 9 април 2008 г.

Mediterranean diet

Mediterranean diet

From Wikipedia, the free encyclopedia

The Mediterranean diet is a modern nutritional model originally inspired by the traditional dietary patterns of some of the countries of the Mediterranean Basin. The most commonly-understood version of the Mediterranean diet was presented by Dr. Walter Willett of Harvard University's School of Public Health in the mid-1990's. Based on "food patterns typical of Crete, much of the rest of Greece, and southern Italy in the early 1960s", this diet, in addition to "regular physical activity" (e.g. farm labor), emphasizes "abundant plant foods, fresh fruit as the typical daily dessert, olive oil as the principal source of fat, dairy products (principally cheese and yogurt), and fish and poultry consumed in low to moderate amounts, zero to four eggs consumed weekly, red meat consumed in low amounts, and wine consumed in low to moderate amounts". Total fat in this diet is "<> 35%" of calories, with saturated fat at 8% or less of calories. The diet is often cited as beneficial for being low in saturated fat and high in monounsaturated fat and dietary fiber.

This diet is not typical of all part of the Mediterranean basin. In central Italy, for instance, lard and butter are commonly used in cooking, and olive oil is reserved for dressing salads and cooked vegetables. In North Africa, wine was traditionally not consumed by Muslims. In both North Africa and the Levant, sheep's tail fat and rendered butter (samna) are the traditional staple fats. In inland areas before refrigeration, fish was largely unknown, even in Greece and Southern Italy.

Although it was first publicized in 1945 by the American doctor Ancel Keys stationed in Salerno, Italy, the Mediterranean diet failed to gain widespread recognition until the 1990s. It is based on what from the point of view of mainstream nutrition is considered a paradox: that although the people living in Mediterranean countries tend to consume relatively high amounts of fat, they have far lower rates of cardiovascular disease than in countries like the United States, where similar levels of fat consumption are found. A parallel phenomenon is known as the French Paradox.

One of the main explanations is thought to be the large amount of olive oil used in the Mediterranean diet. Unlike the high amount of animal fats typical to the American diet, olive oil lowers cholesterol levels in the blood. It is also known to lower blood sugar levels and blood pressure. Research indicates olive oil prevents peptic ulcers and is effective in treatment of peptic ulcer disease, and may be a factor in preventing cancer. In addition, the consumption of red wine is considered a possible factor, as it contains flavonoids with powerful antioxidant properties.

Michael Pollan in his book "In Defense of Food" suggests the explanation is not any particular nutrient, but the combination of nutrients found in unprocessed food.[citation needed]

Dietary factors may be only part of the reason for the health benefits enjoyed by these cultures. Genetics, lifestyle (notably heavy physical labor), and environment may also be involved.

Although green vegetables, a good source of calcium and iron, as well as goat cheese, a good source of calcium, are dommon in the Mediterranean diet, concerns remain whether the diet provides adequate amounts of all nutrients, particularly calcium and iron.[citation needed]


Medical research

The Seven Countries Study found that Cretan men had exceptionally low death rates from heart disease, despite moderate to high intake of fat. The Cretan diet is similar to other traditional Mediterranean diets: consisting mostly of olive oil, bread, abundant fruit and vegetables, fish, and a moderate amount of dairy foods and wine.

The Lyon Diet Heart Study set out to mimic the Cretan diet, but adopted a pragmatic approach. Realizing that some of the people in the study (all of whom had survived a first heart attack) would be reluctant to move from butter to olive oil, they used a margarine based on rapeseed (canola) oil. The dietary change also included 20% increases in vitamin C rich fruit and bread and decreases in processed and red meat. On this diet, mortality from all causes was reduced by 70%. This study was so successful that the ethics committee decided to stop the study prematurely so that the results of the study could be made available to the public immediately.

Diet food

Diet food

From Wikipedia, the free encyclopedia

Diet food (or dietetic food) refers to any food or drink whose recipe has been altered in some way to make it part of a body modification diet. Although the usual intention is weight loss and change in body type, sometimes the intention is to aid in gaining weight or muscle as in bodybuilding supplements.


Terminology

In addition to diet other words or phrases are used to identify and describe these foods including light or lite, low calorie, low fat, no fat, fat free, no sugar, sugar free, and zero calorie. In some areas use of these terms may be regulated by law. For example in the U.S. a product labeled low fat must not contain more than 3 grams of fat per serving; and to be labeled fat free it must contain less than 0.5 grams of fat per serving.

Process

The process of making a diet version of a food usually requires finding an acceptable low calorie substitute for some high calorie ingredient. This can be as simple as replacing some or all of the food's sugar with a sugar substitute as is common with diet soft drinks such as Coca-Cola. In some snacks, the food may be baked instead of fried thus reducing the calories. In other cases, low fat ingredients may be used as replacements.

Controversy

In diet foods which replace the sugar with lower-calorie substitutes, there is some controversy based around the possibility that the sugar substitutes used to replace sugar are themselves harmful. Even if this question is satisfactorily resolved (which remains unlikely at this time), the question still remains as to whether the benefits of caloric reduction would outweigh the potential harm.

In many low-fat and fat-free foods the fat is replaced with sugar, flour, or other full-calorie ingredients, and the reduction in caloric value is small, if any.

Detox diet

Detox diet

From Wikipedia, the free encyclopedia

A detox diet is a dietary regimen involving a change in consumption habits in an attempt to "detoxify" the body, by removal of "toxins" or other contaminants. Proponents claim it improves health, energy, resistance to disease, mental state, digestion, as well as aiding in weight loss. Many scientists, dietitians, and doctors, however, regard 'detox diets' as less effective than drinking a glass of water, and view 'detox diets' as generally harmless but a waste of money.[1]

"Detox" diets usually suggest that fruits and vegetables compose a majority of one's food intake. Limiting this to unprocessed (and sometimes also non-GM) foods is often advocated. Limiting or eliminating alcohol is also a major factor, and drinking more water is similarly recommended.


Detox diets

An incomplete list of methods to modify the diet for the purpose of detoxification includes:

  • Eliminating foods that are hard on metabolism, such as caffeine, alcohol, processed food (incl. any bread), pre-made or canned food, salt, sugar, wheat, red meat, pork, fried and deep fried food, yellow cheese, cream, butter and margarine, shortening, etc., while focusing on pure foods such as raw fruits and vegetables, whole grains (excluding white rice), legumes, raw nuts and seeds, fish, vegetable oils, herbs and herbal teas, water, etc.
  • Raw foodism
  • Fasting, including water fasting and juice fasting
  • Increased consumption of fish such as salmon
  • Food combining
  • Calorie restriction
  • Herbal detox
  • Master Cleanse also known as the lemonade diet, terms coined to refer to the fasting paradigm penned by Stanley Burroughs

Some proponents of detox diets would emphasize it as a lifestyle, rather than a diet. Literary references include "Ultimate Lifetime Diet" by Gary Null advocating veganism as a (lifestyle) method of detoxification.

Criticism

Professor Alan Boobis OBE, Toxicologist, Division of Medicine, Imperial College London states that "The body’s own detoxification systems are remarkably sophisticated and versatile. They have to be, as the natural environment that we evolved in is hostile. It is remarkable that people are prepared to risk seriously disrupting these systems with unproven ‘detox’ diets, which could well do more harm than good."

There is also criticism that detox diets in general are unhealthy due to the possibility of a greater amount of natural toxic chemicals in fruits and vegetables than in animal products.[citation needed] It is argued by advocates of this perspective that the liver has evolved to do its job without assistance from such diets. However, this argument does not take into account the main focus of most detox diets, which is the sheer excess of difficult to metabolize foods that is consumed in the present day. Thus, this argument does not consider the resulting larger quantity of toxic metabolic by-products that the liver and other body systems must process.[citation needed]

The potentially high mercury content in some fish is cited to argue against increased fish consumption. If one is considering eating more fish, it is therefore important to choose fish that have low mercury levels.

Sudden changes in diet have been linked to fainting and other medical issues. It is therefore of utmost importance to gradually introduce the dietary changes, especially if they are extreme compared to the present diet. Fasting should never be undertaken without a proper understanding of its procedures, and long-term changes to the diet should always include a balance of the nutrients needed for the sustenance of the human body - carbohydrates, protein, unsaturated fat, vitamins, minerals and water. The same is adviseable for any diet, cleansing or otherwise, in order to maintain optimal health.

Highly restrictive detox diets such as Water fasting or the Master Cleanse are not the safest form of weight loss. These diets, if done improperly or for too long, may result in nutrient deficiencies. Of particular concern is lack of protein, which may result in wasting of muscle tissue, due to insufficient amino acids for repair. With less lean muscle tissue, the body's metabolic needs decrease, which hampers weight loss efforts unless calories are lessened further in the diet.

While many people have provided testimonials to their health improvements in following a "detox" diet lifestyle, some of these people may have started the detox diet after coming off an unhealthy diet high in sugar and processed food that may lack nutrients. Any improvements cited from such people would only prove the effectiveness of a detox diet over an average diet, and not that it is the ideal diet that doesn't carry its own unique health risks. It is therefore necessary to investigate whether or not the diets advocated provide sufficient nutritional value for optimal physical functioning.

Some of the changes recommended in certain "detox" lifestyles are ones that agree with mainstream medical advice, such as consuming a diet high in fruits and vegetables. Separating the beneficial effects of such changes from the rest of the recommendations made in a "detoxifying" diet is difficult.

Diet of Finland

Diet of Finland

From Wikipedia, the free encyclopedia


The Diet of Finland (Finnish Suomen maapäivät, later valtiopäivät; Swedish Finlands Lantdagar), was the legislative assembly of the Grand Duchy of Finland from 1809 to 1906 and the heir of the powers of the Swedish Riksdag of the Estates.


Åbo Lantdag

The first States of Finland were held in Helsinki in 1616.[1] Other assemblies (Åbo lantdag) where held in Turku for example in 1676. The assembly was called together by Axel Julius De la Gardie. The estate of peasants was chaired by Heikki Heikinpoika Vaanila.

The Porvoo Diet

Main article: Diet of Porvoo

During the Finnish War between Sweden and Russia, the four Estates of occupied Finland (Nobility, Clergy, Burghers and Peasants) were assembled at Porvoo (Borgå) by Tsar Alexander I, the new Grand Duke of Finland, between March 25 and July 19, 1809. The central event at Porvoo was the sovereign pledge and the oaths of the Estates in Porvoo Cathedral on March 29. Each of the Estates swore their oaths of allegiance, committing themselves to accepting the Emperor and Grand Duke of Finland as the true authority, and to keeping the constitution and the form of government unchanged. Alexander I subsequently promised to govern Finland in accordance with its laws. This was thought to essentially mean that the emperor confirmed the Swedish Instrument of Government from 1772 as the constitution of Finland, although it was also interpreted to mean respecting the existing codes and statutes. The diet had required that it would be convened again after the Finnish War, which separated Finland from Sweden, had been concluded. On September 17 of the same year, the conflict was settled by the Treaty of Fredrikshamn, but it would be another five decades until the Finnish Estates would be called again.

The Estates convene again


Not until June 1863, after the Crimean War had taken place, did Alexander II call the Estates again. On September 18 the opening ceremony was held and the Emperor made his declaration where he promised to introduce changes to the constitution. The changes included making the diet a regularly convening body, a promise which was kept by the Emperor when the diet convened again in January 1867, where it established an act on the working order of the diet. The diet was to convene at least every fifth year but in practice it would come to convene every third year. The act on Freedom of the Press was seen to have been rejected by the diet in 1867, and as a consequence censorship was introduced. The diets of the 1860s created a working and regularly convening Finnish parliament, but it also spelled an end to further promised constitutional reforms.

In the elections for the diet of 1872, members of the two language-based parties, the Fennomans and Svecomans, gained more ground at the expense of the liberals. After the assassination of Alexander II the special position of Finland in the Russian empire was in danger. Alexander III announced that the Finnish monetary, customs and postal systems were to be incorporated into their imperial counterparts. At the diet of 1882 the Governor-General gave the Emperors announcement that the diet would have the right to submit bills, but he would be the only one to initiate changes regarding the constitution and military issues.

The first period of oppression

Main article: Russification of Finland

In 1899 Emperor Nicholas II signed what was come to be known as the February Manifesto. The powers of the diet regarding Finland's internal affairs were weakened and transferred to the Russian ministers. The legal committee of the diet of 1899 adopted the opinion that the manifesto was not legally valid in Finland.

Reform

The unrest during the Russo-Japanese War resulted in a general strike in Finland in October 1905. The most immediate result was the Emperor's manifesto that cancelled all illegal regulations. A parliament based on universal and equal suffrage was also promised. An extraordinary session of the diet in December 1905 was called to implement the parliamentary reforms. The proposal was presented to the Emperor on 15 March 1906 and after his approval it was submitted to the estates on 9 May. The reforms came to force on 1 October 1906. The diet was reformed from a legislative assembly of four Estates into a unicameral parliament of 200 members. At the same time universal suffrage was introduced, which gave all men and women, 24 years or older, the right to vote and stand for election. Acts on the right of parliament to monitor members of the government, on the Freedom of Speech, Assembly and Association, and Freedom of the Press were also introduced. These reforms established the hallmarks of today's Parliament of Finland.

Composition in 1869–1906

From 1869 to 1906 the Diet of Finland was composed as follows:

  • Nobility: 201 seats; the heads of noble families had the right to sit in person or name a family member as a representative.
  • Clergy: 40 seats; included priests, university personnel and other senior teachers who elected their representatives.
  • Burghers: 30–70 seats; these were the representatives of the people living in cities, only men with taxable wealth were eligible to vote. The number of seats rose when the population of the cities grew.
  • Peasants: 70 seats; elected through indirect election in which only peasants that owned their own land (4.5% of the rural population in early 1900s) could vote.

All chambers debated separately and there were no joint sessions. Three chambers had to pass the bill before it could be approved by the Emperor.

South Beach diet

South Beach diet

From Wikipedia, the free encyclopedia

The South Beach diet is a diet plan started by Miami, Florida, area cardiologist Arthur Agatston which emphasizes the consumption of "good carbohydrates" and "good fats". Dr. Agatston developed this diet for his cardiac patients based upon his study of scientific dieting research. The diet first appeared in a book of the same name published by Rodale Press.

Dr. Agatston believes that excess consumption of so-called "bad carbohydrates", such as the rapidly-absorbed carbohydrates found in foods with a high glycemic index, creates an insulin resistance syndrome—an impairment of the hormone insulin's ability to properly process fat or sugar. In addition, he believes along with many physicians that excess consumption of "bad fats", such as saturated fat and trans fat, contributes to an increase in cardiovascular disease. To prevent these two conditions, Agatston's diet minimizes consumption of bad fats and bad carbohydrates and encourages increased consumption of good fats and good carbohydrates.

The diet has three phases. In all phases of the diet, Dr. Agatston recommends minimizing consumption of bad fats.


Phase I

The diet begins with Phase 1, which lasts two weeks. Dieters attempt to eliminate insulin resistance by avoiding high or moderately high-glycemic carbohydrates, such as dairy, sugar, candy, bread, potatoes, fruit, cereals, and grains. During this phase, Dr. Agatston claims the body will lose its insulin resistance, and begin to use excess body fat, causing many dieters to lose between 8 and 13 pounds. For the first two weeks, dieters eat normal-size helpings of meat, fish, vegetables, eggs, cheese, and nuts. This phase includes three meals a day, plus snacks, encouraging the dieter to eat until their hunger is satisfied. No alcohol is allowed (though red wine will be introduced later in small amounts). The dieter loses weight, changes body chemistry, and ends cravings for sugars and starches.

Phase I: Authorized foods

  • Beef: Lean cuts, such as sirloin (including ground), tenderloin, top round
  • Poultry: Cornish hen, turkey bacon (two slices per day), turkey and chicken breast
  • Seafood: All types of fish and shellfish (Shrimp,clams,oysters)
  • Pork: Broiled ham, Canadian Bacon, Tenderloin
  • Veal: Chop, cutlet, leg; top round
  • Lunchmeat: Fat-free or low-fat only
  • Cheese (fat-free or low fat): American, cheddar, cottage cheese (1–2% or fat-free), cream cheese substitute (dairy free), feta, mozzarella, Parmesan, provolone, ricotta, string
  • Nuts: Almonds (15), peanut butter (2 tbsp), peanuts (20 small), pecan halves (15), pistachios (30)
  • Eggs: The use of eggs is not restricted unless otherwise noted by your physician. Use egg whites and egg substitute as desired
  • Tofu: Use soft, low-fat or lite varieties
  • Vegetables: Artichokes, asparagus, beans (black, butter, chickpeas, green, Italian, kidney, lentils, lima, pigeon, soy, split peas, wax), broccoli, cabbage, cauliflower, celery, collard greens, cucumbers, pickles (dill, or those sweetened with Splenda), eggplant, lettuce (all varieties), mushrooms (all varieties), snow peas, spinach, sprouts (alfalfa), turnips, water chestnuts, zucchini, radishes
  • Fats: Canola oil, olive oil
  • Dairy: Two cups of nonfat milk or nonfat or lowfat plain yogurt are to be consumed daily
  • Spices and seasonings: All spices that contain no added sugar, broth, extracts (almond, vanilla, or others), horseradish sauce, I can't Believe It's Not Butter! spray, pepper (black, cayenne, red, white)
  • Sweet treats (limit to 75 calories per day): Candies (hard, sugar-free), chocolate powder (no-sugar-added), cocoa powder (baking type), sugar-free fudgsicles, sugar-free gelatin, sugar-free gum, sugar-free popsicles, sugar substitute.
  • Hot Sauce
  • Salsa - Limit to 2 TBS during phase 1
  • Soy Sauce - 1/2 TBS
  • Steak Sauce - 1/2 TBS
  • Worcestershire Sauce - 1 TBS
  • Whipped Topping (Light) - 2 TBS

Phase I: No-No foods

  • Beef: Brisket, Liver, other fatty cuts
  • Poultry: Chicken wings and legs, duck, goose, poultry products (processed)
  • Pork: honey-baked ham
  • Veal: breast
  • Cheese: Brie, edam, non-reduced fat
  • Vegetables: beets, carrots, corn, potatoes (white),potatoes (sweet),
  • Fruit: Avoid all fruits and fruit juices in Phase 1 including: Apples, apricots, berries, cantaloupe, grapefruit, peaches, pears
  • Starches and Carbohydrates: avoid all starchy foods in Phase 1 including: bread (all types), cereal, matzo, oatmeal, rice (all types), pasta (all types), pastry and baked goods (all types)
  • Alcohol of any kind, including beer and wine
  • No regular ketchup or cocktail sauce
  • No pork rinds - too high in saturated fat
  • No jerky - too high in sugar content
  • Limit Caffeine-Containing Beverages to 1-2 servings per day

Phase II

After two weeks, Phase II begins. Whole grain foods, fruits and dairy products are gradually returned to the diet, although in smaller amounts than were likely eaten before beginning the diet, and with a continued emphasis on foods with a low glycemic index. Sweet potatoes are also now permissible, as is red wine, both in moderate amounts.

Phase III

After the desired weight is obtained, the diet calls to move into Phase III, a maintenance phase. In Phase III the diet expands to include three servings of whole grains and three servings of fruit a day.

The diet distinguishes between good and bad carbohydrates, and good and bad fats.

  • "Good carbohydrates" are high in fiber or high in good fats, and have a low glycemic index, that is, they are digested and absorbed slowly. Other preferred carbohydrates are those with more nutritional value than the alternatives. For instance, brown rice is allowed in moderation, but white rice is discouraged. When eating any carbohydrates, Dr. Agatston recommends also eating fiber or fat to slow digestion of the carbohydrates.
  • "Good fats" are polyunsaturated and monounsaturated fats, especially those with omega-3 fatty acids. Saturated and trans fats are bad fats.

The diet emphasizes (1) a permanent change in one's way of eating, (2) a variety of foods, and (3) ease and flexibility. Eating whole grains and large amounts of vegetables is encouraged, along with adequate amounts of mono- and polyunsaturated fats, including omega-3 fatty acids, such as are contained in fish. It discourages the eating of overly refined processed foods (particularly refined flours and sugars), high-fat meats, and saturated fats in general.

The diet does not require counting calories or limiting servings; Agatston suggests dieters eat until they are satisfied. Dieters are told to eat 6 meals a day: breakfast, lunch, and dinner, with small snacks between each meal. This is different from The Zone diet in that The Zone recommends (1) a proper ratio of carbohydrates, proteins, and fats, (2) "good" carbohydrates, proteins, and fats over "bad" ones, and (3) eating portion sizes that are right for your body.[1]

South Beach Living packaged foods

Main article: South Beach Living

In 2004, Kraft Foods licensed the South Beach Diet trademark for use on a low-carb line of packaged foods called South Beach Diet. These have been renamed South Beach Living. These products are designed to meet the requirements of the diet.

Scientific studies

A 2004 study of the South Beach Diet by Agatston, et al., reviewed a 1998–1999 trial completed by 54 participants over the course of a year. A 2005 study of the South Beach Diet conducted by Kraft Foods was completed by 69 subjects over the course of just under three months. Both studies showed favorable results for the groups using the South Beach Diet.

Ketogenic diet

Ketogenic diet

From Wikipedia, the free encyclopedia


The ketogenic diet is a high fat, adequate protein, low carbohydrate diet, primarily used in the treatment of difficult-to-control (refractory) epilepsy in children. The diet mimics aspects of starvation by forcing the body to use fat rather than carbohydrate as an energy source. The body produces excess ketone bodies, a state known as ketosis. The "classic" ketogenic diet contains a 4:1 ratio by weight of fat to combined protein and carbohydrate. To achieve this, a number of foods are effectively eliminated (for example, starchy fruits and vegetables, bread, pasta, grains and sugar). A variant known as the MCT diet uses a form of coconut oil that is very high in medium-chain triglycerides (MCT; most dietry fat contains long chain triglycerides). This oil has a strong ketogenic effect, which allows some relaxation of the regime.

Developed in the 1920s, its popularity waned with the introduction of effective anticonvulsant drugs. In the mid 1990s the Hollywood producer Jim Abrahams, whose son's severe epilepsy was effectively controlled by the diet, created the Charlie Foundation to promote it. Publicity included an appearance on NBC's Dateline programme and ...First Do No Harm (1997), a TV movie starring Meryl Streep. The foundation funded a multicentre study that was published in 1996, which marked the beginning of renewed scientific interest in the diet.

The efficacy of the diet has not been tested in a large, double-blind, randomised controlled trial. Such a trial is regarded as unfeasible and possibly unethical as meta-analysis of the many uncontrolled prospective and retrospective trials provides sufficient evidence to recommend clinical use. In children with refractory epilepsy, the ketogenic diet is more likely to be effective than trying an alternative anticonvulsant drug. There is some evidence that adults may benefit too, and that a less strict diet (such as a modified Atkins) might be effective.


History

The ketogenic diet is a mainstream therapy that was scientifically developed to improve on the success and limitations of the non-mainstream use of fasting to treat epilepsy. Discarded as irrelevant in a world with numerous anticonvulsant drugs, the diet has once again found a role in the effective treatment of refractory epilepsy (epilepsy that cannot be brought under control after adequate trials of different drugs) in children.

The ancient Greek physicians employed dietetic regimens to treat disease, including epilepsy, but the treatment of seizures by fasting was not a popular therapy. In the Hippocratic collection, the author of On the Sacred Disease recommends diet and drugs over supernatural therapies. In the same collection, the author of Epidemics describes the case of a man whose epilepsy is cured as quickly as it had appeared, through complete abstinence of food and drink. Galen wrote, "one inclining to epilepsy should be made to fast without mercy and be put on short rations". He believed an "attenuating diet" might afford a cure in mild cases and be helpful in others.[8]

The first modern study into fasting as a treatment for seizures was in France in 1911.[9] Around this time, the exponent of physical culture, Bernarr Macfadden, popularised the use of fasting as a means of restoring health. His disciple, the osteopath physician Hugh Conklin, of Battle Creek, Michigan, began to treat his epilepsy patients by fasting. Conklin believed that epileptic seizures were caused when a toxin, secreted from the Peyer's patches in the intestines, was discharged into the bloodstream. A fast would allow this toxin to dissipate and typically lasted for 18 to 25 days. Conklin probably treated hundreds of epilepsy patients with his "water diet" and boasted of a 90% cure rate in children (a rate that steadily declined with patient age). Later analysis of Conklin's records show 20% achieved seizure freedom and 50% had improvement.

Conklin's ideas were adopted by neurologists in mainstream practice. In 1916, a Dr McMurray wrote to the New York Medical Journal claiming to have successfully treated epilepsy patients, since 1912, with a fast and then a starch- and sugar-free diet. In 1921, prominent endocrinologist H. Rawle Geyelin reported his experiences to the American Medical Association convention. He had seen Conklin's success first-hand and attempted to reproduce the results in 36 of his own patients. He had similar results, but there was no long-term follow-up. Further studies in the 1920s indicated that seizures generally returned after the fast. John Howland, professor of paediatrics at Johns Hopkins Hospital, received a gift of $5000 from his brother Charles, whose son had been successfully treated by Conklin. The money was to be used to scientifically study "the ketosis of starvation", a task undertaken by neurologist Stanley Cobb and his assistant William G. Lennox.

Diet

Rollin Woodyatt, reviewing the current research on diet and diabetes, reported in 1921 that "acetone, acetic acid and beta-hydroxybutyric acid appear … in a normal subject by starvation, or a diet containing too low a proportion of carbohydrate and too high a proportion of fat." Russel Wilder, at the Mayo Clinic, built on this research and coined the term ketogenic diet to describe a diet designed to produce ketonemia through an excess of fat and lack of carbohydrate. The idea was to maintain the benefits of fasting over a much longer period. His trial, in 1921, on a few epilepsy patients was the first use of the ketogenic diet as a treatment for epilepsy. Wilder's colleague, paediatrician Mynie Peterman, formulated the "classic" diet, with a ratio of one gram of protein per kg of body weight in children, 10–15 g of carbohydrate per day, and the remainder of calories from fat. Peterman's work, in the 1920s, established the techniques for induction and maintenance of the diet, as well as documenting both positive and negative side-effects. Meanwhile, the Massachusetts General Hospital, under Fritz Talbot, established their own ketogenic diet programme, which is very similar to the current one at Johns Hopkins Hospital. Talbot discovered that the ideal therapeutic ratio of fat to combined protein and carbohydrate was 4:1 and first used urine testing to monitor the level of ketosis.

Anticonvulsants

In the 1920s and 1930s, the only anticonvulsant drugs were the sedative bromides (1857) and phenobarbital (1912). The ketogenic diet was seen as an important and mainstream therapy, and widely used. This changed in 1938 when H. Houston Merritt and Tracy Putnam discovered phenytoin (Dilatin), and the focus of research shifted to discovering new drugs. With the introduction of sodium valproate in the 1970s, neurologists had drugs that were effective across a broad range of epileptic syndromes and seizure types. The use of the ketogenic diet, already restricted to difficult cases such as Lennox-Gastaut syndrome, declined further.

The ketogenic diet's severe carbohydrate restrictions made it difficult to produce palatable meals, leading to problems with compliance. During the 1960s, the properties of medium-chain triglycerides (MCT) were discovered: these oils are are considerably more ketogenic than normal dietary fats (which are mostly long-chain triglycerides); they are rapidly absorbed and have a high caloric value. In 1971, Peter Huttenlocher devised a diet with sufficient MCT oil to induce ketonuria and tested it on a dozen children and adolescents with intractable seizures. The oil was mixed with at least twice its volume of skimmed milk, chilled, and sipped during the meal or incorporated into food. About 60% of the diet's calories came from the MCT oil, and this allowed more protein and up to three times as much carbohydrate as a 3:1 classic diet. Most children improved both in seizure control and alertness; results were similar to the classic ketogenic diet. Gastrointestinal side-effects were a problem, which led one patient to abandon the diet, but meal preparation was easier and compliance generally good. The MCT diet replaced the classic ketogenic diet in many hospitals, though some devised diets that were a combination of the two.

Revival

The ketogenic diet achieved national media exposure in October 1994 when NBC's Dateline television programme reported the case of Charlie Abrahams, son of Hollywood producer Jim Abrahams. The 2-year-old had intractable epilepsy that remained undefeated by mainstream and alternative therapies. Abrahams discovered a reference to the ketogenic diet in an epilepsy guide for parents and brought Charlie to the Johns Hopkins Hospital, which was one of the few institutions to still offer the therapy. Under the diet, Charlie's epilepsy was rapidly controlled and his developmental progress resumed. This inspired Abrahams to create the Charlie Foundation to promote the diet and fund research. A multicentre prospective study began in 1994 and was presented to the American Epilepsy Society in 1996. There followed an explosion of scientific interest in the diet. In 1997, Abrahams produced a TV movie, ...First Do No Harm, starring Meryl Streep, in which a young boy's intractable epilepsy is successfully treated by the ketogenic diet.

As of 2007, the ketogenic diet is available from around 75 centres in 45 countries. The form of classic or MCT ketogenic diet offered varies with the hospital and also culturally. Less restrictive variants, such as the modified Atkins diet, have emerged as alternatives, particularly among older children and adults. The ketogenic diet is also under investigation for the treatment of a wide variety of disorders other than epilepsy.

Efficacy

Early studies showed high success rates: in one study in 1925, 60% of patients became seizure free, 35% had a greater than 50% decrease in seizure frequency. These were retrospective studies, that only report on patients who stuck with the diet. Recent studies show that patients and their carers give up if the diet is not effective. Therefore, even modern retrospective studies show a high success of around 29% seizure freedom. The patient group in older studies is also different; modern patient groups tend to study children with refractory epilepsy. Older protocols generally had a much longer initial fast (with the aim of losing 5–10% body weight) and had restricted calorie intake.

The biggest modern study with intent-to-treat prospective design was published in 1998. The Johns Hopkins Hospital studied 150 children for at least 12 months. By three months, 25 patients had dropped out, 26% had a good reduction in seizures (50–90% reduction), 31% had an excellent reduction (90–99% reduction) and 3% became seizure free. By twelve months, 67 patients had dropped out, 23% had a good reduction, 20% had an excellent reduction and 7% were seizure free. In the same year, a multicentre study of 51 children showed similar efficacy, proving that the results could be repeated by other institutions.

A meta-analysis of studies for the Blue Cross and Blue Shield Association in 2000confirmed that about half the children starting the diet will achieve at least a 50% reduction in seizure frequency. About half drop out by twelve months, and these are overwhelmingly patients who had less than 50% reduction.

The success of the diet is measured clinically by reported seizure reduction. Although urinary ketone levels are checked daily, the levels do not correlate with seizure effect. They are useful in detecting that ketosis has been achieved, and for spotting issues with compliance. Electroencephalogram (EEG) changes are also not a reliable indicator of seizure protection. There is no relationship between outcome and age, sex, principle seizure type or initial EEG. Adults can benefit too, though adherence to the regime becomes more difficult with adolescence. Despite this, if the patient achieves a good reduction in seizure frequency, they will stick with it. For patients who benefit, half will achieve a seizure reduction within five days (if the diet starts with an initial fast of one to two days), three quarters achieve a reduction within a fortnight and 90% achieve a reduction within 23 days. If the diet does not begin with a fast, the time for half of the patients to achieve an improvement is longer (a fortnight) but the long-term seizure reduction rates are unaffected. The initial fast has been likened to an intravenous loading dose of anticonvulsant, and may be particularly beneficial where there is some medical urgency that outweighs the increased risk of acidosis and hypoglycemia. If no improvement is seen within two months, it is likely that the diet has failed.

The lack of randomised controlled trials meant that a Cochrane review in 2003 concluded that the diet was merely "a possible option" in the treatment of intractable epilepsy. Long-term blinding is made difficult by to the nature of the diet. However, a short-term blinded study is possible, by spoiling the ketogenic diet with the use of a glucose-sweetened drink. Children may be randomised to receive a drink containing glucose or one containing an artificial sweetener. Other study options being trialled include a controlled parallel-group where patients are randomised to receive the diet after a short interval (4 weeks) or a long interval (16 weeks). A long-term randomised placebo-controlled trial is not feasible and may be unethical, as meta-analysis of the many uncontrolled prospective and retrospective trials indicates sufficient evidence to recommend clinical use. Children with refractory epilepsy are more likely to find the ketogenic diet to be effective than trying an alternative anticonvulsant drug.

Indications and contra-indications

The ketogenic diet is indicated as an adjunctive treatment in children with drug-resistant epilepsy.[16][17][18] The ketogenic diet is endorsed by national guidelines in Scotland,[18] England and Wales[16] and by US insurance companies.[14][19][20] The ketogenic diet is a first-line therapy for patients with seizures due to pyruvate dehydrogenase (E1) deficiency and glucose transporter 1 deficiency syndrome. Both these disorders prevent the body using carbohydrate as fuel, resulting in a dependency on ketone bodies.

In the UK, the National Institute for Health and Clinical Excellence state that the diet should not be recommended for adults with epilepsy due to insufficient evidence of efficacy. The conditions pyruvate carboxylase deficiency and porphyria are absolute contraindications to the ketogenic diet. Other conditions that generally contraindicate are defects in fatty acid oxidation, certain mitochondrial cytopathies, and known carnitine deficiencies.

Interactions

Most children who start the ketogenic diet have already tried six or seven anticonvulsants and are typically taking two. There are no harmful or beneficial interactions between anticonvulsant drugs and the ketogenic diet. A trial in 2007 of 30 children studied the combination of ketogenic diet and the vagus nerve stimulator (VNS). About half the children were already on the ketogenic diet and had the VNS added to their therapy; the other half had the opposite sequence. About two thirds of the children had a greater than 50% reduction in their seizures as a result of combining these therapies. Those who responded well, generally did so within a month. No significant side effects were noted and as with other studies, the children who did not respond well tended to be the ones who subsequently discontinued the diet.

Adverse effects

The ketogenic is not a benign holistic or natural treatment for epilepsy; as with any serious medical therapy, there may complications. These are generally less severe and less frequent than with anticonvulsant medication or surgery. Common but easily treatable side effects include constipation, lack of appropriate weight gain for age, low-grade acidosis, and hypoglycemia if there is an initial fast. Cholesterol may increase by around 30%.

About 1 in 20 children on the ketogenic diet will develop kidney stones (compared with 1 in several thousand for the general population). A class of anticonvulsants known as carbonic anhydrase inhibitors (topiramate, zonisamide) are known to increase the risk of kidney stones, but the combination of these anticonvulsants and the ketogenic diet does not appear to elevate that risk. The stones are treatable and do not lead to discontinuation of the diet. Oral potassium citrate is preventative and had no clear disadvantages; its routine use is under investigation. Kidney stone formation (nephrolithiasis) occurs on the diet for four reasons. Excess calcium in the urine (hypercalciuria) occurs due to increased bone demineralisation with acidosis (bone phosphate acts as an acid buffer) as well as increased calcium excretion by the kidney. There is an abnormally low concentration of citrate in the urine (hypocitraturia), which normally helps to dissolve free calcium. The urine has a low pH, which stops uric acid from dissolving, leading to crystals that act as a nidus for calcium stone formation. Many institutions restrict fluids on the diet to 80% of normal daily needs.

Initiation


The best documented protocol for initiating the diet is the one practised at the Johns Hopkins Hospital (JHH). At initial consultation, patients are screened for conditions that may contraindicate the diet. Dietary history is obtained and the parameters of the diet selected: the ketogenic ratio, the calorie requirements, and the fluid intake. The day before admission to hospital, carbohydrates are decreased and the patient begins fasting after their evening meal. On admission, they may drink but not eat until dinner, which consists of an "eggnog" restricted to one-third of the usual calories for a meal. The following breakfast and lunch are similar, and on the second day, the dinner is increased to an "eggnog" with two-thirds of the usual calories. By the third day, dinner contains the full calorie quota and is a standard ketogenic meal (not "eggnog"). After a ketogenic breakfast on the fourth day, the patient is discharged.

During their stay in hospital, the patient has their glucose levels checked and is monitored for signs of symptomatic ketosis (which can be treated with a small quantity of orange juice). Lack of energy and lethargy are common but disappear by two weeks. The parents attend classes over the first three full days, covering nutrition, managing the diet, preparing meals, avoiding sugar and handling illness. Medicines are exchanged for carbohydrate-free formulations, where possible.

Deviations from the Johns Hopkins protocol are common. If there is no initial fast, the time to reach ketosis is longer (but still achieved within five days), and there were fewer initial complications. The initiation can be performed using outpatient clinics rather than requiring a stay in hospital. Fluid restriction may be relaxed, leading to fewer cases of dehydration. Rather than increasing meal sizes over the three day initiation, some institutions maintain meal size but alter the ketogenic ratio from 2:1 to 4:1.

Maintenance

At Johns Hopkins Hospital, outpatient clinics are held at 3, 6, 12, 18 and 24 months. Throughout the diet, telephone contact with the nutritionist helps with fine tuning. A short-lived increase in seizure frequency may occur during illness or if ketone levels fluctuate. The diet may be modified if seizure frequency remains high, or the child is losing weight.

Discontinuation

About 10% of children on the ketogenic diet achieve seizure freedom and many of them also manage to reduce or discontinue anticonvulsant drugs. At around two years on the diet, or after six months of seizure freedom, the diet may be gradually discontinued over a two to three month period. This is done by lowering the ketogenic ratio until urinary ketosis is no longer detected, and then lifting all calorie restrictions. Children who discontinue after achieving seizure freedom have about 20% recurrence risk of seizures. The length of time until recurrence is highly variable but averages two years. This recurrence risk compares with 10% for resective surgery (where part of the brain is removed) and 30–50% for anticonvulsant therapy. Of those that have a recurrence, just over half regain their seizure freedom either with anticonvulsants or by returning to the ketogenic diet. Recurrence is more likely if, despite seizure freedom, an EEG shows epileptiform spikes, or if an MRI shows focal abnormalities (for example, children with tuberous sclerosis). Such children may remain on the diet longer than normal, and it has been suggested that children with tuberous sclerosis who achieve seizure freedom could remain on the ketogenic diet indefinitely.

Variants

Classic

The ketogenic diet is calculated by a dietician for each child; age, weight, activity levels, culture and food preferences all affect the meal plan. A computer program may be used to help generate meals. A typical day of food for a child on a 4:1 ratio, 1500 calorie ketogenic diet:

  • Breakfast: egg with bacon
28 g egg, 11 g bacon, 37 g of 36% heavy whipping cream, 23 g butter, 9 g apple.
  • Snack: peanut butter ball
6 g peanut butter, 9 g butter.
  • Lunch: tuna salad
28 g tuna fish, 30 g mayonnaise, 10 g celery, 36 g of 36% heavy whipping cream and 15 g lettuce.
  • Snack: keto yogurt
18 g of 36% heavy whipping cream, 17 g sour cream, 4 g strawberries and artificial sweetener (e.g., Splenda).
  • Dinner: cheeseburger
22 g minced (ground) beef, 10 g American cheese, 26 g butter, 38 g cream, 10 g lettuce and 11 g green beans.
  • Snack: keto custard
25 g of 36% heavy whipping cream, 9 g egg and pure vanilla flavouring.

A ketogenic "eggnog" is used during induction and is a drink with the required ketogenic ratio. For example, a 4:1 ratio eggnog would contain 60 g of 36% heavy whipping cream, 25 g egg, vanilla and saccharin flavour. This contains 245 calories, 4 g protein, 2 g carbohydrate and 24 g fat (24:6 = 4:1).

MCT oil

Normal dietary fat contains long-chain triglycerides (LCT). Medium-chain triglycerides are more ketogenic than LCTs. Their use allows the fat content to be lowered and consequently greater protein and carbohydrate intake. The MCT ketogenic diet is identical in efficacy to the classic diet; abdominal bloating and diarrhoea are more common, but constipation is less of a problem. A combination of the classical and MCT diet may be used, which aims to avoid the disadvantages of either.

Modified Atkins

A modified Atkins diet is effective in children and adults. The diet consists of 60% fat, 30% protein and 10% carbohydrate by weight; calories are not restricted. Carbohydrate is limited to 10 g per day for at least one month, and gradually increased to 10% if this limitation is not tolerated. Consistently strong ketosis is more difficult to achieve than on the ketogenic diet; patients with wildly fluctuating urinary ketones have unfavourable seizure outcomes. Achieving the balance of fat, protein and carbohydrate can be difficult; patients may consume the appetising protein (meat) and leave or vomit the fat. Older children and adolescents who refuse the ketogenic diet's restrictions may tolerate the modified Atkins diet.

Prescribed formulations

Infants, or patients fed via a gastrostomy tube can also be fed a ketogenic diet. A prescribed powdered formula, such as KetoCal, can be made up into a feed that has none of the palatability issues. KetoCal is a nutritionally complete feed containing milk protein and supplemented with amino acids, fat, carbohydrate, vitamins, minerals and trace elements. It is used to administer the 4:1 ratio classical ketogenic diet in children over 1 year. Each 100 g of powder contains 73 g fat, 15 g protein and 3 g carbohydrate, and is typically diluted 1:5 with water. The formula is available unflavoured or in an artificially sweetened vanilla flavour and is suitable for tube or sip feeding.

Mechanism of action

Many hypotheses have been put forward to explain how the ketogenic diet works; it remains a mystery. Disproven hypotheses include systemic acidosis, electrolyte changes and hypoglycemia. Changes in neurotransmitter levels occur and cerebral energy state is improved. Although many biochemical changes are known to occur in the brain of a patient on the ketogenic diet, it is not known which of these has an anticonvulsant effect. The lack of understanding in this area is not dissimilar to the situation with anticonvulsant drugs.

On the ketogenic diet, carbohydrates are severely restricted so cannot provide for all the metabolic needs of the body. Most energy is instead produced by a high rate of fatty-acid oxidation in the cell mitochondria. This produces large amounts of acetyl-CoA, which the liver uses to synthesize the three ketone bodies ß-hydroxybutyrate, acetoacetate and acetone. The brain is normally fueled solely by glucose; fatty acids do not cross the blood-brain barrier. Ketone bodies can enter the brain but they are not used preferentially to glucose. The ketone bodies are converted to acetyl-CoA and subsequently to adenosine triphosphate (ATP) as part of the Krebs cycle within brain mitochondria.

The ketone bodies are possibly anticonvlusant in themselves; acetoacetate and acetone protect against seizures in animal models. The ketogenic diet results in adaptive changes to brain energy metabolism that increases the energy reserves; ketone bodies are a more efficient fuel than glucose, and the number of mitrochondria is increased. This may help the neurons to remain stable in the face of increased energy demand, and may also confer a neuroprotective effect.

The ketogenic diet has been studied in at least 14 rodent animal models of seizures. It is protective in many of these models and has a different protection profile to any known anticonvulsant. This, together with studies showing its efficacy in patients who have failed to achieve seizure control on half a dozen drugs, suggests a unique mechanism of action.

Anticonvulsants suppress epileptic seizures but they neither cure nor prevent the development of the inherent seizure susceptibility. The developement of epilepsy (epileptogenesis) is a process that is poorly understood. A few anticonvulsants (valproate, levetiracetam and benzodiazepines) have shown antiepileptogenic abilities in animal models of epileptogenesis. However, no anticonvulsant has ever achieved this in clinical trial in humans. The ketogenic diet has been found to have antiepileptogenic properties in rats.

Other applications

A number of rare metabolic disease may benefit directly from the ketogenic diet. Case reports on indicate a possible use in treating brain tumours (astrocytomas). Migraine headaches, autism and depression have been shown to benefit in small case studies. Animal models of Alzheimer's disease and amyotrophic lateral sclerosis (ALS) show benefit.

Diet Pepsi

Diet Pepsi

From Wikipedia, the free encyclopedia

Diet Pepsi is a low-calorie carbonated cola, introduced in 1964 as a variant of Pepsi-Cola with no sugar. Its current formula in the United States contains only the artificial sweetener aspartame. The current Canadian formulation contains both aspartame (124mg/355ml) and acesulfame potassium (32mg/355ml)[citation needed]. Pepsi does not list on its United States labeling the exact amount of aspartame/Nutrasweet present.

In some countries, Diet Pepsi is known as Pepsi Light. This is not to be confused with an earlier U.S. product of the same name which was essentially 1970s Diet Pepsi with lemon flavoring.

Although Diet Pepsi contains caffeine, another version is available without caffeine. Additional variations of Diet Pepsi have been introduced over the years, wherein other flavors (such as wild cherry, vanilla, lemon, and lime) have been added to the cola. Their availability and brand identification vary by country.

Diet Pepsi's current slogan is "Light.Crisp.Refreshing."


Test Marketing

Diet Pepsi was first introduced as Patio Diet Cola in 1963. After the drink received positive reviews, it was re-introduced as Diet Pepsi in 1964.

Marketing

In the United States Diet Pepsi is marketed as calorie-free, as FDA guidelines allow products with less than five calories per serving to be labeled as containing zero calories.

PepsiCo also markets low-calorie colas known as Pepsi Max and Pepsi ONE.

When Diet Pepsi was introduced, it originally contained one calorie (just like Pepsi ONE) until the late 90's. Then it was marked to having zero calories.

Diet Pepsi in popular culture

In 1985, immediately following Super Bowl XIX, the game's respective quarterbacks, Joe Montana and Dan Marino, meet in a hallway of what appears to be a football stadium. Montana of the winning team, buys Marino a Diet Pepsi, and Marino promises to buy the drink the next year[citation needed].

During the early-1990s, blues singer Ray Charles was featured in a series of Diet Pepsi ads featuring the jingle, "You Got the Right One, Baby" followed by "Uh huh!".

In the United States a Diet Pepsi commercial features a Diet Pepsi Machine (simply called Machine) being drafted into the NFL by the 3-time Super Bowl champion New England Patriots. The machine cannot be tackled because of its size compared to the human players, therefore leading to many touchdown catches as a wide receiver. In a recent commercial, Machine now plays for the New Orleans Saints, competing with running back Reggie Bush. Other commercials feature Diet Pepsi (the can) as an entertainer, represented by "agent" Jay Mohr, in a music video produced by Diddy ("Brown and Bubbly"), and an action film featuring Jackie Chan (Diet Pepsi is replaced by a "stunt double", a rival Diet Coke can, which is squashed by the villains)[citation needed]. Diet Pepsi (the can) has also been portrayed as a great poker player winning hand after hand against Poker Champs Daniel Negreanu, Phil Hellmuth, and Scotty Nguyen.

A futuristic diet Pepsi bottle can be seen in the background of the Cafe '80s in Back to the Future Part II.

Health concerns

Diet Pepsi contains the artificial sweetener aspartame, which has been the subject of a vigorous public controversy regarding its safety and the circumstances around its approval. A few studies have recommended further investigation into the possible connection between aspartame and diseases such as brain tumors, brain lesions, and lymphoma. These findings, combined with alleged conflicts of interest in the approval process, have engendered vocal activism regarding the possible risks of aspartame.


Diet Pepsi is acidic; drinking acidic drinks over a long period of time can erode the tooth enamel, particularly when they are sipped throughout the day rather than consumed with food. Drinking through a straw is often advised by dentists as the drink is then swallowed from the back of the mouth and does not come into contact with the teeth. It has also been suggested that brushing teeth right after drinking soft drinks should be avoided as this can result in additional erosion to the teeth due to the presence of acid.