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.

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

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.

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.

Low-carbohydrate diet

From Wikipedia, the free encyclopedia

Low-carbohydrate diets or low-carb diets are dietary programs that restrict carbohydrate consumption usually for weight control. Foods high in digestible carbohydrates are limited or replaced with foods containing a higher percentage of proteins and fats.

The precise definition of low-carbohydrate diets varies greatly. The term is most commonly used to refer to ketogenic diets, i.e. diets that restrict carbohydrate intake sufficiently to cause ketosis like the Atkins diet, but some sources consider less restrictive variants to be low-carbohydrate as well.

Apart from obesity low-carbohydrate diets are often discussed as treatments for some other conditions, most notably diabetes and epilepsy, although these treatments still remain controversial and lack widespread support.

History

Beginnings

In 1863 William Banting, an obese English undertaker and coffin maker, published "Letter on Corpulence Addressed to the Public" in which he described a diet for weight control giving up bread, butter, milk, sugar, beer and potatoes. His booklet was widely read, so much so that some people used the term "Banting" for the activity usually called "dieting."

In 1967, Dr. Irwin Stillman published The Doctor's Quick Weight Loss Diet. The "Stillman Diet" is a high-protein, low-carbohydrate and low-fat diet. It is regarded as one of the first low-carbohydrate diets to become popular in the US. Other low-carbohydrate diets in the 1960's included Air Force Diet^[ and the Drinking Man’s Diet Austrian physician Dr Wolfgang Lutz published his book 'Leben Ohne Brot' (Life Without Bread) in 1967.However it was hardly noticed in the English speaking world.

In 1972, Dr. Robert Atkins published Dr. Atkins Diet Revolution which advocated a low-carbohydrate diet he had successfully used in treating patients in the 1960s (having himself developed the diet from an unspecified article published in JAMA)The book met with some success but, because of research at that time suggesting risk factors associated with excess fat and protein, it was widely criticized by the mainstream medical community as being dangerous and misleading, thereby limiting its appeal at the time. Among other things critics pointed out that Dr. Atkins had done little real research into his theories and based them mostly on anecdotal evidence.

The concept of the glycemic index was invented in 1981 by Dr. David Jenkins. This concept evaluates foods according to their insulin demand -- with fast digesting simple carbohydrates having a high insulin demand and slower digesting complex carbohydrates such as grains having a lower insulin demand

Low carb craze

In the 1990s Dr. Atkins published Dr. Atkins New Diet Revolution and other doctors began to publish books based on the same principles. This has been said to be the beginning of the "low carb craze."During the late 1990s and early 2000s low-carbohydrate diets became some of the most popular diets in the U.S. (by some accounts as much as 18% of the population was using a low-carbohydrate diet at its peak and spread to many countries. These were, in fact, noted by some food manufacturers and restaurant chains as substantially affecting their businesses (notably Krispy Kreme^[22]). This was in spite of the fact that the mainstream medical community continued to denounce low-carbohydrate diets as being a dangerous trend. It is, however, valuable to note that many of these same doctors and institutions at the same time quietly began altering their own advice to be closer to the low-carbohydrate recommendations (e.g. eating more protein, eating more fiber/less starch, reducing consumption of juices by children) The low-carbohydrate advocates did some adjustments of their own increasingly advocating controlling fat and eliminating trans fat. Many of the diet guides and gurus that appeared at this time intentionally distanced themselves from Atkins and the term low carb (because of the controversies) even though their recommendations were based on largely the same principles (e.g. the Zone diet). As such it is often a matter of debate which diets are really low-carbohydrate and which are not. The 1990s and 2000s also saw the publication of an increased number of clinical studies regarding the effectiveness and safety (pro and con) of low-carbohydrate diets (notably a 2006 NEJM paper by Halton et al. describing a 20-year study).

After 2004 the popularity of this diet trend began to wane significantly although it still remains quite popular. In spite of the decline in popuarlity this diet trend has continued to quietly garner attention in the medical and nutritional science communities.

Practices and theories

The term low-carbohydrate diet today is most strongly associated with the Atkins Diet. However, there is an array of other diets that share to varying degrees the same principles (e.g. the Zone Diet, the Protein Power Lifeplan, and the South Beach Diet). Therefore, there is no widely accepted definition of what precisely consistutes a low-carbohydrate diet. It is important to note that the level of carbohydrate consumption defined as low-carbohydrate by medical researchers may be different than the level of carbohydrate defined by diet advisors. For the purposes of this discussion, we focus on diets that reduce (nutritive) carbohydrate intake sufficiently to dramatically reduce or eliminate insulin production in the body and to encourage ketosis (production of ketones to be used as energy in place of glucose).

Although originally low-carbohydrate diets were created based on anecdotal evidence of their effectiveness, today there is a much greater theoretical basis on which these diets rest. The key scientific principle which forms the basis for these diets is the relationship between consumption of carbohydrates and their effects on blood sugar (i.e. blood glucose) and hormone production. Blood sugar levels in the human body must be maintained in a fairly narrow range to maintain health. The two primary hormones related to regulating blood sugar levels, produced in the pancreas, are insulin, which lowers blood sugar levels, and glucagon, which raises blood sugar levels. In general, most western diets (and many others) are sufficiently high in nutritive carbohydrates that virtually every meal causes substantial insulin production and avoids ketosis, thus causing excess energy in the diet to be stored as fat (discussed in the next section). By contrast, low-carbohydrate diets, or more properly, diets that are very low in nutritive carbohydrates, discourage insulin production and tend to cause ketosis. Some researchers suggest that this causes excess dietary energy and body fat to be eliminated from the body. Although these diets remain controversial, clinical studies show that "Participants on a low-carbohydrate diet had more favorable overall outcomes at 1 year than did those on a conventional diet."

Low-carbohydrate diet advocates in general recommend reducing nutritive carbohydrates (commonly referred to as "net carbs," i.e. grams of total carbohydrates reduced by the non-nutritive carbohydrates)to very low levels. This means sharply reducing consumption of desserts, breads, pastas, potatoes, rice, and other sweet or starchy foods. Some recommend levels as low as 20-30 grams of "net carbs" per day, at least in the early stages of dieting (for comparison, a single slice of white bread typically contains 15 grams of carbohydrate, almost entirely starch). By contrast, more standard nutrition guides typically recommend consumption levels in the neighborhood of 225-325 grams of carbohydrate per day (based on a 2000 calorie a day diet).Low-carbohydrate diets often differ in the specific amount of carbohydrates allowed, whether certain types of foods are preferred, whether occasional exceptions are allowed, etc. Generally they all agree that processed sugar should be eliminated, or at the very least greatly reduced, and similarly generally discourage heavily processed grains (white bread, etc.). They vary greatly in their recommendations as to the amount of fat allowed in the diet although the most popular versions today (including Atkins) generally recommend at most a moderate fat intake.

As a related note, there is a set of diets known as low-glycemic-index diets (low-GI diets) or low-glycemic-load diets (low-GL diets), in particular the Low GI Diet by Brand-Miller et al. In reality, low-carbohydrate diets are, literally speaking, low-GL diets (and vice versa) in that they specifically limit what contributes to the glycemic load in foods. In practice, though, "low-GI"/"low-GL" diets differ from "low-carb" diets in the following ways. First, low-carbohydrate diets treat all nutritive carbohydrates as having the same effect on metabolism and generally assume that their effect is independent of other nutrients in food. Low-GI/low-GL diets base their recommendations on the actual measured metabolic (glycemic) effects of the foods eaten. Second, as a practical matter, low-GI/low-GL diets generally do not recommend diets with glycemic loads low enough to minimize insulin production and induce ketosis, whereas low-carbohydrate diets generally do.

Another related diet type, the low-insulin-index diet, is very similar except that it is based on measurements of direct insulemic responses (i.e. the amount of insulin in the bloodstream) to food rather than glycemic response (the amount of glucose in the bloodstream). Although the diet recommendations mostly involve lowering nutritive carbohydrates, there are some low-carbohydrate foods that are discouraged as well (e.g. beef).

In contrast to these diets, based on evidence for risk of heart disease and obesity, the Institute of Medicine recommends that American and Canadian adults get between 40-65% of dietary energy from carbohydrates.The Food and Agriculture Organization and World Health Organization jointly recommend that national dietary guidelines set a goal of 55-75% of total energy from carbohydrates, but only 10% should be from Free sugars (their definition of simple carbohydrates).

Ketosis and insulin synthesis: what is normal?

At the heart of the debate about most low carbohydrate diets are fundamental questions about what is a "normal" diet and how the human body is supposed to operate. These questions can be summarized as follows. Nutritive carbohydrates (starches and sugars) in the diet tend to break down very easily into glucose in the bloodstream (blood sugar) when consumed. Glucose in the blood is used by the cells in the body for energy for their basic function. Excessive amounts of glucose in the blood are toxic to the human body (the reason diabetes causes such serious health problems). In general, unless a meal is very low in starches and sugars the level of glucose will tend to rise to potentially dangerous levels. When this occurs, the pancreas automatically produces insulin to cause the liver to convert glucose into glycogen (glycogenesis) and triglycerides (which can become body fat), thus reducing the blood sugars to safe levels.Diets with a high starch/sugar content, therefore, cause sharp spikes in insulin production. As such the blood sugar levels are highly variable with every meal.

By contrast, if the diet is very low in starches and sugars (low-carbohydrate diets) the blood sugar level can fall so low that there is insufficient glucose to fuel the cells in the body. This state causes the pancreas to produce glucagon.Glucagon causes the conversion of stored glycogen to glucose and, once the glycogen stores are exhausted, causes the liver to synthesize ketones (ketosis) and glucose (gluconeogenesis) from fats and proteins, respectively. Most cells in the body can use ketones for energy instead of glucose, and since ketones are easier to produce, only a small amount of glucose is created (in other words, ketosis is the more significant process in this case). Because diets low in starches and sugars do not tend to directly affect blood sugar levels significantly, meals tend to have little direct effect on insulin levels (and so such diets tend to discourage insulin production in general).

The diets of most people in modern, so-called western nations, especially the United States contain significant amounts of starches (and, frequently, significant amounts of sugars). As such, the metabolisms of most westerners tend to operate outside of ketosis and tend to involve significant insulin production. This has been regarded by medical science in the last century as being "normal." Ketosis has generally been regarded as a dangerous (potentially life-threatening) state which unnecessarily stresses the liver and causes destruction of muscle tissues. The view that has been developed is that getting energy more from protein than carbohydrates causes liver damage and that getting energy more from fats than carbohydrates causes heart disease and other health problems. This view is still the view of the majority in the medical and nutritional science communities.

Most advocates of low-carbohydrate diets (specifically those that recommend diets similar to the Atkins Diet) argue that this metabolic state (using primarily blood glucose for energy) is not normal at all and that the human body is, in fact, supposed to function primarily in ketosis.They argue that high insulin levels can, in fact, cause many health problems, most significantly, fat storage and weight gain. They argue that the purported dangers of ketosis are unsubstantiated (some of the arguments against ketosis result from confusion between ketosis and ketoacidosis which is a related but very different process). They also argue that fat in the diet only contributes to heart disease in the presence of high insulin levels and that if the diet is instead adjusted to induce ketosis, fat and cholesterol in the diet are not a major concern (although most do not advocate unrestricted fat intake and do advocate avoiding trans fat). Further, whereas insulin in the bloodstream causes storage of food energy, when the body is in ketosis, excess ketones (which contain excess energy) are excreted in the urine and the breath.

This debate is on-going and no consensus currently exists.

Scientific research

Main article: Medical research related to low-carbohydrate diets

Because of the substantial controversy regarding low-carbohydrate diets and even disagreements in interpreting the results of specific studies it is difficult to objectively summarize the research in a way that reflects scientific consensus.Although there has been some research done throughout the twentieth century, most directly relevant scientific studies have occurred in the 1990s and early 2000s and, as such, are relatively new. Contrary to popular belief that low-carbohydrate diets damage the heart, one study found that women eating low-carbohydrate, high-fat/protein diets had the same or slightly less risk of coronary heart disease, compared to women eating high-carbohydrate, low-fat diets. Other studies have found possible benefits to individuals with diabetes, cancerand autism. The ketogenic diet, with 90% of energy from fat and much of the remaining from protein, has been used since the 1920s to treat epilepsy. The introduction of modern anticonvulsant drugs, however, substantially restricted its use. Interestingly, there has very recently been renewed interest in use of the diet, especially in children.

A study conducted in 1965 at the Oakland (California) Naval Hospital used a diet of 1000 calories per day, high in fat and limiting carbohydrates to 10 grams (40 calories) daily. Over a ten-day period, subjects on this diet lost more body fat than did a group who fasted completely. (Benoit et. al. 1965). Some subsequent studies have shown similar results. Many advocates of low-carbohydrate diets have termed this the metabolic advantage of such diets although many experts dispute whether this is truly a general phenomenon. Among others, recent studies from Stanford University (2007) and Duke University (2005) comparing various diets seem to favor low-carbohydrate diets for both weight loss and health indicators.

Criticism and controversies

Water-related weight loss

In the first week or two of a low-carbohydrate diet a great deal of the weight loss comes from eliminating water retained in the body (many doctors say that the presence of high levels of insulin in the blood causes unnecessary water retention in the body. However, this is a short-term effect and is entirely separate from the general weight loss that these diets can produce through eliminating excess body fat.

Exercise

Some critics argue that low-carbohydrate diets can inherently cause weakness or fatigue giving rise to the occasional assumption that low-carbohydrate dieting cannot involve an exercise regimen. Advocates of low-carbohydrate diets generally dispute any suggestion that such diets cause weakness or exhaustion (except in the first several days as the body adjusts) and indeed most highly recommend exercise as part of a healthy lifestyle.

Micronutrients and vitamins

The major low-carbohydrate diet guides generally recommend multi-vitamin and mineral supplements as part of the diet regimen which may lead some to believe that these diets are nutritionally deficient. The primary reason for this recommendation is that if the switch from a high-carbohydrate to a low-carbohydrate, ketogenic diet is rapid, the body can temporarily go through a period of adjustment during which the body may require extra vitamins and minerals (the reasons have to do with the body's releasing excess fluids that were stored during high-carbohydrate eating). In other words, the body goes through a temporary "shock" if the diet is changed to low-carbohydrate dieting quickly just as it would changing to a high-carbohydrate diet quickly. This does not, in and of itself, indicate that either type of diet is nutritionally deficient. Some critics have argued or implied that "carbohydrates contain vitamins" and mineralsbut this suggestion is strictly false (by definition). While it is true that many foods that are rich in carbohydrates are also rich in vitamins and minerals, there are many low-carbohydrate foods that are similarly rich in vitamins and minerals.Also, the important vitamin B12 is only available in significant quantities from animal sources and not from vegetable sources.

It should be noted that, contrary to the recommendations of most diet guides, some individuals may choose to avoid vegetables altogether in order to minimize carbohydrates. It is more likely that such a diet could be nutritionally deficient (some would dispute this based on cases like Vilhjalmur Stefansson).

Other controversies

In 2004, the Canadian government ruled that foods sold in Canada could not be marketed with reduced or eliminated carbohydrate content as a selling point because reduced carbohydrate content was not determined to be a health benefit, and that existing "low carb" and "no carb" packaging would have to be phased out by 2006.

Some variants of low carbohydrate diets involve substantially lowered intake of dietary fiber which can result in constipation if not supplemented. For example, this has been a criticism of the Induction stage of the Atkins diet (note that today the Atkins diet is more clear about recommending a fiber supplement during Induction). Most advocates today argue that fiber is a "good" carbohydrate and in fact encourage a high-fiber diet.

It has been hypothesized that a diet related change in blood acidity can lead to bone loss through a process called ketoacidosis, as mentioned earlier in this article. However ketoacidosis, which is often confused with ketosis, is an acute medical condition caused by extreme fasting or as a symptom of untreated diabetes, and is not likely to be induced by a proper low-carbohydrate diet.

One of the occasional side effects of a ketogenic diet is a noticeable smell of ketones in the urine, perspiration, and breath. This is caused by the temporary metabolism of fatty-acid derived acetyl-coa into the ketone form, so that it may be released from the liver into the blood stream. The ketones are then re-assembled when they reach various body tissues to form acetyl-coa again, which is used as the precursor to energy.

Diet of Japan

From Wikipedia, the free encyclopedia

The National Diet of Japan (国会, kokkai^?) is Japan's bicameral legislature. It is composed of a lower house, called the House of Representatives, and an upper house, called the House of Councillors. Both houses of the Diet are directly elected under a parallel voting system. As well as passing laws, the Diet is formally responsible for selecting the Prime Minister. The Diet was first convened as the Imperial Diet in 1889 as a result from adopting the Meiji constitution. The Diet took its current form in 1947 upon the adoption of the postwar constitution and is considered by the Constitution to be the highest organ of state power. The National Diet Building is located in Nagatachō, Chiyoda-ku, Toky

Composition

See also: Elections in Japan and List of members of the Diet of Japan

Both houses of the Diet are elected under a parallel voting system. This means that the seats to be filled in any given election are divided into two groups, each elected by a different method; the main difference between the houses are in the sizes of the two groups and how they are elected. Voters are also asked to cast two votes: one for an individual candidate in a constituency, and one for a party list. Any citizen of Japan at least twenty years of age (the age of majority in Japan) may vote in these elections. Japan's parallel voting system is not to be confused with the Additional Member System used in many other nations.

• House of Representatives: Of 480 members, 300 are elected from single seat constituencies under the Single Member Plurality ('First-past-the-post') system, and 180 are elected from eleven separate electoral blocs under the party list system of proportional representation (PR).
• House of Councillors: Of 242 members, 146 are elected from 47 prefectural constituencies by means of the Single Non-Transferable Vote. The remaining 96 are elected by party list PR from a single national list.

The Constitution of Japan does not specify the number of members of each house of the Diet, the voting system, or the necessary qualifications of those who may vote or be returned in parliamentary elections, thus allowing all of these things to be determined by law. However it does guarantee universal adult suffrage and a secret ballot. It also insists that the electoral law must not discriminate in terms of "race, creed, sex, social status, family origin, education, property or income".

Generally, the election of Diet members is controlled by statutes passed by the Diet. Because the Liberal Democratic Party has controlled Japan for most of its postwar history, and gains much of its support from rural areas, rural areas generally have more representation in the Diet than do urban areas. The Supreme Court of Japan began exercising judicial review of apportionment laws following the Kurokawa decision of 1976, invalidating an election in which one district in Hyōgo Prefecture received five times the representation of another district in Osaka Prefecture. The Supreme Court has since indicated that the highest electoral imbalance permissible under Japanese law is 3:1, and that any greater imbalance between any two districts is a violation of Article 14 of the Constitution.

Powers

Article 41 of the Constitution describes the National Diet as "the highest organ of state power" and "the sole law-making organ of the State". This statement is in forceful contrast to the Meiji Constitution, which described the emperor as the one who exercised legislative power with the consent of the Diet. The Diet's responsibilities include not only the making of laws but also the approval of the annual national budget that the government submits and the ratification of treaties. It can also initiate draft constitutional amendments, which, if approved, must be presented to the people in a referendum. The Diet may conduct "investigations in relation to government" (Article 62). The prime minister must be designated by Diet resolution, establishing the principle of legislative supremacy over executive government agencies (Article 67). The government can also be dissolved by the Diet if it passes a motion of no confidence introduced by fifty members of the House of Representatives. Government officials, including the prime minister and cabinet members, are required to appear before Diet investigative committees and answer inquiries. The Diet also has the power to impeach judges convicted of criminal or irregular conduct.

In most circumstances, in order to become law a bill must be first be passed by both houses of the Diet and then promulgated by the Emperor. This role of the Emperor is similar to the Royal Assent in some other nations, however the Emperor cannot refuse to promulgate a law and therefore his legislative role is merely a formality.

The House of Representatives is the more powerful chamber of the Diet.While the House of Representatives cannot usually overrule the House of Councillors on a bill, the House of Councillors can only delay the adoption of a budget or a treaty that has been approved by the House of Representatives, and the House of Councillors has almost no power at all to prevent the lower house from selecting any Prime Minister it wishes. Furthermore, once appointed it is the confidence of the House of Representatives alone that the Prime Minister must enjoy in order to continue in office. The House of Representatives can overrule the upper house in the following circumstances:

• If a bill is adopted by the House of Representatives and then either rejected, amended or not approved within 60 days by the House of Councillors, then the bill will become law if again adopted by the House of Representatives by a majority of at least two-thirds of members present.
• If both houses cannot agree on a budget or a treaty, even through the appointment of a joint committee of the Diet, or if the House of Councillors fails to take final action on a proposed budget or treaty within 30 days of its approval by the House of Representatives, then the decision of the lower house is deemed to be that of the Diet.
• If both houses cannot agree on a candidate for Prime Minister, even through a joint committee, or if the House of Councillors fails to designate a candidate within 10 days of House of Representatives' decision, then the nominee of the lower house is deemed to be that of the Diet.

Activities

Under the constitution at least one session of the Diet must be convened each year. Technically only the House of Representatives is dissolved before an election but while the lower house is in dissolution the House of Councillors is usually 'closed'. The Emperor both convokes the Diet and dissolves the House of Representatives but in doing must act on the advice of the Cabinet. In an emergency the Cabinet can convoke the Diet for an extraordinary session, and an extraordinary session may be requested by one quarter of the members of either house.^[8] At the beginning of each parliamentary session the Emperor reads a special speech outlining the government's plans for the coming year from his throne in the chamber of the House of Councillors.^[9]

The presence of one third of the membership of either house constitutes a quorum^[8] and deliberations are in public unless at least two-thirds of those present agree otherwise. Each house elects its own presiding officer who exercises the casting vote in the event of a tie. Members of each house have certain protections against arrest while the Diet is in session and words spoken and votes cast in the Diet enjoy parliamentary privilege. Each house of the Diet determines its own standing orders and has responsibility for disciplining its own members. A member may be expelled, but only by a two-thirds majority vote. Every member of the Cabinet has the right to appear in either house of the Diet for the purpose of speaking on bills, and each house has the right to compel the appearance of Cabinet members.

History

Japan's first modern legislature was the Imperial Diet (帝國議会; Teikoku Gikai) established by the Meiji constitution in force from 1889 to 1947. The Meiji Constitution was adopted on February 11, 1889 and the Imperial Diet first met on November 29, 1890 when the document entered into operation. The Diet consisted of a House of Representatives and a House of Peers (貴族院; Kizokuin). The House of Representatives was directly elected, if on a limited franchise; universal adult male suffrage was introduced in 1925. The House of Peers, much like the British House of Lords, consisted of high ranking nobles.

The word diet derives from Latin and was a common name for an assembly in medieval Germany. The Meiji constitution was largely based on the form of constitutional monarchy found in nineteenth century Prussia and the new Diet was modeled partly on the German Reichstag and partly on the British Westminster system. Unlike Japan's modern constitution, the Meiji constitution granted a real political role to the Emperor, although in practice the Emperor's powers were largely directed by a group of oligarchs called the genrō.^[11]

To become law or bill, a constitutional amendment had to have the assent of both the Diet and the Emperor. This meant that while the Emperor could no longer legislate by decree he still had a veto over the Diet. The Emperor also had complete freedom in choosing the Prime Minister and the Cabinet, and so, under the Meiji constitution, Prime Ministers often were not chosen from and did not enjoy the confidence of the Diet. The Imperial Diet was also limited in its control over the budget. While the Diet could veto the annual budget, if no budget was approved the budget of the previous year continued in force.

The postwar Constitution of Japan, adopted in 1947, created a more democratic system and renamed the legislature the National Diet. Under the document the franchise was extended to women for the first time and the House of Peers was abolished and replaced with the directly elected House of Councillors. The Emperor was reduced to his current, purely ceremonial role, and the Diet declared the "highest organ of the state power" (Article 41). All Diet elections occurred under the single non-transferable vote system.

The proportional representation system for the House of Councillors, introduced in 1982, was the first major electoral reform under the postwar constitution. Instead of choosing national constituency candidates as individuals, as had previously been the case, voters cast ballots for parties. Individual councillors, listed officially by the parties before the election, are selected on the basis of the parties' proportions of the total national constituency vote. The system was introduced to reduce the excessive money spent by candidates for the national constituencies. Critics charged, however, that this new system benefited the two largest parties, the LDP and the Japan Socialist Party, which in fact had sponsored the reform

Dieting

From Wikipedia, the free encyclopedia

Dieting is the practice of ingesting food in a regulated fashion to achieve or maintain a controlled weight. In many cases the goal is weight loss, but some athletes aspire to gain weight (usually in the form of muscle) and diets can also be used to maintain a stable body weight.

Types of dieting

There are several kinds of diets:

• Weight-loss diets restrict the intake of specific foods, or food in general, to reduce body weight. What works to reduce body weight for one person will not necessarily work for another, due to metabolic differences and lifestyle factors. Also, for a variety of reasons, most people find it difficult to maintain significant weight loss over time — among individuals that have lost 10% or more of body weight, only 20% are able to maintain that weight loss for a full year.

• Many professional athletes impose weight-gain diets on themselves. American football players may try to "bulk up" through weight-gain diets in order to gain an advantage on the field with a higher mass.

• Individuals who are underweight, such as those recovering from anorexia nervosa or from starvation, may undergo weight-gain diets which, unlike those of athletes, has the goal of restoring normal levels of body fat, muscle, and stores of essential nutrients.

Many people in the acting industry may choose to lose or gain weight depending on the role they're given.

As more cultures scrutinize their diets, many parents consider putting their children on restricted diets that actually do more harm than good. This is extremely deleterious to a young child's health because a full and balanced diet (fats, carbohydrates, protein, vitamins, minerals, fiber, etc.) is needed for growth. A doctor should be consulted before putting any child on a specialized diet.

Research also shows that putting children on diet foods can be harmful. The brain is unable to learn how to correlate taste with nutritional value, which is why such children may consistently overeat later in life despite adequate nutritional intake. ^[2]

In children and young adults

Receiving adequate nutrition through a well-balanced diet is critical during childhood and adolescence. Unless a doctor says otherwise, low-carb, low-fat, or other specialty diets for children who are not heavily obese are unhealthy because they deprive the body of the building blocks of cells (namely energy and lipids in the above examples).

Children who diet could actually be doing worse things for themselves and their bodies. Alison Field from Harvard Medical School stated that "Our study found that dieting was counterproductive- children who dieted gained more, not less, weight than non-dieters." Scott,R.,Jennifer "Dieting Kids May Gain Weight" 12,July,2006 [1] Children who diet tend to develop habits of overeating, or binge eating as a result of attempting to casually diet. It is suggested that children should just attempt to eat healthy instead of trying to casually diet.

Thermoregulation

According to the principles of thermoregulation, humans are endotherms. We expend energy to maintain our blood temperature at body temperature, which is about 37 °C (98.6 °F). This is accomplished by metabolism and blood circulation, by shivering to stay warm, and by sweating to stay cool.

In addition to thermoregulation, humans expend energy keeping the vital organs (especially the lungs, heart and brain) functioning. Except when sleeping, our skeletal muscles are working, typically to maintain upright posture. The average work done just to stay alive is the basal metabolic rate, which (for humans) is about 1 watt per kilogram of body mass (0.45 W/lb). Thus, an average man of 75 kilograms (165 lb) who just rests (or only walks a few steps) burns about 75 watts (continuously), or about 6,500 kilojoules (1,440 calories) per day or 1 calorie each minute.

Physical exercise

Physical exercise is an important complement to dieting in securing weight loss. Aerobic exercise is also an important part of maintaining normal good health, especially the muscular strength of the heart. To be useful, aerobic exercise requires maintaining a target heart rate of above 50 percent of one's resting heart rate for 30 minutes, at least 3 times a week.^{[citation needed]} Brisk walking can accomplish this.

The ability of a few hours a week of exercise to contribute to weight loss can be somewhat overestimated. To illustrate, consider a 100-kilogram (220 lb) man who wants to lose 10 kilograms (22 lb) and assume that he eats just enough to maintain his weight (at rest), so that weight loss can only come from exercise. Those 10 kilograms (22 lb) converted to work are equivalent to about 350 megajoules (84,000 calories). (We use an approximation of the standard 37 kilojoules or 9 calories per gram of fat.) Now assume that his chosen exercise is stairclimbing and that he is 20 percent efficient at converting chemical energy into mechanical work (this is within measured ranges). To lose the weight, he must ascend 70 kilometers. A man of normal fitness (like him) will be tired after 500 meters of climbing (about 150 flights of stairs), so he needs to exercise every day for 140 days (to reach his target). However, exercise (both aerobic and anaerobic) would increase the Basal Metabolic Rate (BMR) for some time after the workout. This ensures more calorific loss than otherwise estimated.

The minimum safe dietary energy intake (without medical supervision) is 75 percent of that needed to maintain basal metabolism. For our hypothetical 100-kilogram man, that minimum is about 5,700 kilojoules (1,300 calories) per day. By combining daily aerobic exercise with a weight-loss diet, he would be able to lose 10 kilograms in half the time (70 days). Of course, the described regime is more rigorous than would be desirable or advisable for many persons. Therefore, under an effective but more manageable weight-loss program, losing 10 kilograms (about 20 pounds) may take as long as 6 months.

There are also some easy ways for people to exercise, such as walking rather than driving, climbing stairs instead of taking elevators, doing more housework with fewer power tools, or parking their cars farther and walking to school or the office.

Fat loss versus muscle loss

Weight loss typically involves the loss of fat, water and muscle. A dieter can lose weight without losing much fat. Ideally, overweight people should seek to lose fat and preserve muscle, since muscle burns more calories than fat. Generally, the more muscle mass one has, the higher one's metabolism is, resulting in more calories being burned. The exact figure is 14 calories burned per pound of muscle at rest. Since muscles are more dense than fat, muscle loss results in little loss of physical bulk compared with fat loss. To determine whether weight loss is due to fat, various methods of measuring body fat percentage have been developed.

Muscle loss during weight loss can be restricted by regularly lifting weights (or doing push-ups and other strength-oriented calisthenics) and by maintaining sufficient protein intake. According to the National Academy of Sciences, the Dietary Reference Intake for protein is "0.8 grams per kilogram of body weight for adults."

Those on low-carbohydrate diets, and those doing particularly strenuous exercise, may wish to increase their protein intake which is necessary. However, there may be risks involved. According to the American Heart Association, excessive protein intake may cause liver and kidney problems and may be a risk factor for heart disease.^[4] There is no conclusive evidence that moderately high protein diets in healthy individuals are dangerous, however; it has only been shown that these diets are dangerous in individuals who already have kidney and liver problems.

Energy obtained from food

The energy humans get from food is limited by the efficiency of digestion and the efficiency of utilization. The efficiency of digestion is largely dependent on the type of food being eaten. Poorly chewed seeds are poorly digested. Refined sugars and fats are absorbed almost completely. Chewing does not compensate for the calorie content of a food that is eaten; even celery, which is primarily indigestible cellulose, contains enough sugars to easily compensate for the cost of chewing it.^{[citation needed]}

Proper nutrition

Food provides nutrients from six broad classes: proteins, fats, carbohydrates, vitamins, dietary minerals, and water. Carbohydrates are metabolized to provide energy. Proteins provide amino acids, which are required for cell, especially muscle, construction. Essential fatty acids are required for brain and cell membrane construction. Vitamins and trace minerals help maintain proper electrolyte balance and are required for many metabolic processes. Dietary fiber is another food component which influences health even though it is not actually absorbed into the body.

Any diet that fails to meet minimum nutritional requirements can threaten general health (and physical fitness in particular). If a person is not well enough to be active, weight loss and good quality of life will be unlikely.

The National Academy of Sciences and the World Health Organization publish guidelines for dietary intakes of all known essential nutrients.

Sometimes dieters will ingest excessive amounts of vitamin and mineral supplements. While this is usually harmless, some nutrients are dangerous. Men (and women who don't menstruate) need to be wary of iron poisoning. Retinol (oil-soluble vitamin A) is toxic in large doses. As a general rule, most people can get the nutrition they need from foods (there are specific exceptions; vegans often need to supplement vitamin B12). In any event, a multivitamin taken once a day will suffice for the majority of the population.

A sensible weight-loss diet is a normal balanced diet; it just comes with smaller portions and perhaps some substitutions (e.g. low-fat milk, or less salad dressing). Extreme diets may lead to malnutrition, and are less likely to be effective at long-term weight loss in any event.

How the body gets rid of fat

All body processes require energy to run properly. When the body is expending more energy than it is taking in (e.g. when exercising), the body's cells rely on internally stored energy sources, like complex carbohydrates and fats, for energy. The first source the body turns to is glycogen (by glycogenolysis). Glycogen is a complex carbohydrate (in total about 2000 kcal). 65% is stored in skeletal muscles and the rest in the liver. It is created from the excess of injested makronutrients, mainly carbohydrates. When those sources are nearly depleted, the body begins lipolysis, the mobilization and catabolism of fat stores for energy. In this process, fats, obtained from adipose tissue, or fat cells, are broken down into glycerol and fatty acids, which can be used to make energy. The primary by-products of metabolism are carbon dioxide and water; carbon dioxide is expelled through the respiratory system.

Fats are also secreted by the sebaceous glands (in the skin). When losing weight one must be careful as to not begin to burn muscle. When the body runs of out of fats and carbohydrates to burn, it will begin to burn muscle which will be harmful for the body.

Psychological aspects of weight-loss dieting

Diets affect the "energy in" component of the energy balance by limiting or altering the distribution of foods. Techniques that affect the appetite can limit energy intake by affecting the desire to overeat.

Consumption of low-energy, fiber-rich foods, such as non-starchy vegetables, is effective in obtaining satiation (the feeling of "fullness"). Exercise is also useful in controlling appetite as is drinking water and sleeping. (Extreme physical fatigue, such as that experienced by soldiers and mountain climbers, can make eating a difficult chore.)

The use of drugs to control appetite is also common. Stimulants are often taken as a means to suppress (normal, healthy) hunger by people who are dieting. Ephedrine (through facilitating the release of adrenaline and noradrenaline) stimulates the alpha(1)-adrenoreceptor subtype, which is known to act as an anorectic. L-Phenylalanine, an amino acid found in whey protein powders also has the ability to suppress appetite by increasing the hormone cholecystokinin (CCK) which sends a satiety signal to the brain.

Weight loss groups

There exist both profit-oriented and non-profit weight loss organizations who assist people in their weight loss efforts. An example of the former is Weight Watchers; examples of the latter include Overeaters Anonymous, as well as a multitude of non-branded support groups run by local churches, hospitals, and like-minded individuals.

These organizations' customs and practices differ widely. Some groups are modelled on twelve-step programs, while others are quite informal. Some groups advocate certain prepared foods or special menus, while others train dieters to make healthy choices from restaurant menus and while grocery-shopping and cooking.

Most groups leverage the power of group meetings to provide counseling, emotional support, problem-solving, and useful information.

Dangers

Extreme calorie restriction, medication or unusual patterns of eating (i.e. restricting food consumption to a single fruit or meal) can be dangerous. This can indicate Anorexia Nervosa and/or Bulimia which are common eating disorders and can even be fatal.

Medications

Certain medications can be prescribed to assist in weight loss. Some, like amphetamines, are dangerous and are now banned for casual weight loss. Some supplements, including those containing vitamins and minerals, may not be effective for losing weight.

Diuretics

Diuretics induce weight loss through the excretion of water. These medication or herbs will reduce the amount that a body weighs, but will have no effect on an individual's body fat. Diuretics can thicken the blood, cause cramping, kidney and liver damage.

Stimulants

Stimulants such as ephedrine (now illegal in the United States due to an FDA ban) or synephrine work to increase the basal metabolic rate and reduce appetite.

Dangers of fasting

Lengthy fasting can be dangerous due to the risk of malnutrition and should be carried out under medical supervision. During fasting, low-carbohydrate or very low calorie diets lack blood glucose, the preferred energy source of the brain, causing the body to metabolize sugars from protein, which over a prolonged fast can lead to muscle wasting.

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