1 per cent Successful Long Term Weight Loss

-Robert Jeffrey and colleagues

"dieting may be the major cause of obesity"

-Jean-Paul Deslypere, University of Ghent Professor of human nutrition

EXECUT !E SU""#$%
#diposity is the result of an e&cessi'e number or si(e of )hite adipose cells* #diposity is caused by genetics and the en'ironment* +e) chromosome 'ariations causing obesity are constantly added to the list* dentical t)ins reared apart ha'e the same )eight, -unless one has been e&posed to a fattening 'irus./* "aternal diabetes, smo0ing, and malnutrition predispose the unborn to gro) up fat* Early )ithdra)l of breast feeding, early introduction of a high carbohydrate diet predispose the child to gro) up fat* E&posure to at least one 'irus causes permament )eight gain* +ormal adults do not retain )eight brought on by a period of o'ereating* Con'ersely, indi'iduals )hose )eight gain )as not caused by o'ereating are rarely successful at long term )eight loss* The )eight they lose usually comes bac0 )ith considerable "interest" -rebound/* This rebound may be mediated by diet induced increase in fat cell numbers*
High carbohydrate low fat diets for weight loss have been recommended for three millennia !ow fat diets have been e"tensively studied for the last # decades $n the last decade %mericans have reduced their fat inta&e only to get fatter than ever 'or the first time in history, a ma(ority of males are overweight Previously reported assocations between higher fat consumption and obesity have not held up to careful study Previously reported associations between higher fat consumption and breast cancer have been refuted % )*-year study of nearly +,,--- women found no evidence that a high-fat diet promotes breast cancer or that a low-fat diet protects against it .omen who ate the least fat appeared to have a )# percent higher rate of breast cancer /Journal of the %merican 0edical %ssociation 12)-2,,3 4he low fat2low cholesterol diet is ineffective 5ome researchers now thin& low-fat high carbohydrate diets are ma&ing us fat 0eanwhile, traditional nutritionists have ignored the lowering of female puberty from )6 to )1 years in the last century, revealing a tremendous increase in bioavailable dietary carbohydrate $n the future, drugs, antibodies to fat cells, and2or cellular removal will control adiposity $n the meantime, people at ris& of adiposity would be wise to chec& with a competent endocrinologist to prevent the early rise in insulin levels that triggers adiposity and related diseases %diposity )-) surveys the rapidly evolving field of adiposity research

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Compound C34, de'eloped for cancer treatment, inhibits feeding, but does not allo) the metabolism to shut do)n* t tric0s the animal into thin0ing it5s )ell fed* t drops )eight li0e a stone* C34 treated mice lost )eight 64 per cent faster than untreated fasting mice. C34 also re'ersed a fat7related form of diabetes* C34 bloc0s 1atty #cid Synthase, a po)erful fat ma0ing en(yme* "This is the en(yme that turns your pasta into fat," 8r* 1ran0 9uhajda told United :ress nternational* 1#S is the last en(yme on an assembly line of about ;4 en(ymes that builds fat molecules to store energy* 9uhajda says that in a test tube, purified 1#S )ill "ma0e fat before your eyes" if gi'en the right building bloc0s* This may ha'e been 'ery useful )hen primiti'e humans had to sprint across the sa'anna and 0ill an animal for supper* t has become a curse in the age of carbohydrate* " t ma0es us fat," 9uhajda says*

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+EW %<$9, 1eb 1= ;>>> -$euters 2ealth/ 77 The e&tremely carbohydrate7restricted #t0ins diet is a safe, effecti'e )ay to lose )eight, according to studies presented at the Southern Society of ?eneral nternal "edicine in +e) <rleans* $n a press release, the researchers also say that their study did not find any of the safety concerns voiced by the %merican Dietetic %ssociation, such as potentially dangerous effects on liver and &idney function 7$n four short months on the %t&ins Diet, we were able to confirm scientifically what Dr %t&ins states he has seen in his practice over the past decades 4he diet lowers cholesterol and triglycerides and raises HD! which may represent an entirely new approach to the control and prevention of heart disease,7 said lead researcher Dr 8ric 9 .estman, assistant professor of medicine at :orth 9arolina;s Du&e University

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=besity ruins the >uality of life for more than )-- million %mericans 0edical advances have circumvented the natural eugenic selection that previously limited the diabetic2obese to less than )-? of the population $ncreases in obesity prone minorities and high carbohydrate gestation and suc&ling environments add to the weight 4raditional weight control technology has changed little since Gree& anti>uity 1- years of applied research into traditional weight control technology and the resulting recommendations have only made %mericans fatter :o study has ever shown dieting to e"tend the life of fat people, but more than twenty have reported ill effects from dietary weight cycling 'or years dieters have complained that weight loss regimes made them fatter, but these observations fell on deaf ears Recent research has shown that dieting is a ma(or cause of obesity .hile the long term success rate from dieting is less than one per cent, about 1- per cent of dieters regain more than they lose as a direct result of their dieting

" n the last ;4 years there has been no progress in treatment for obesity and the long7term results are miserable*" /0arian %pfelbaum, University of Paris Professor of :utrition3 "dieting may be the major cause of obesity" /Jean-Paul Deslypere, University of Ghent Professor of human nutrition3 Recent obesity research has disproven public stereotypes and the conventional wisdom of most health professionals $dentical twins grow up with virtually the same body fatness, even when raised by different families, /those that don;t may have been e"posed to a virus that causes obesity3 while adopted children raised by fat parents are no fatter than those raised by thin parents 4he opposite would be true if adiposity were environmental instead of inborn 4his evidence has yet to register on diet promoters and e"ercise gurus who continue to claim obesity is mostly environmental .hen all you have is a hammer every problem loo&s li&e a nail 'or the first time in history, research has placed true cures for human obesity within sight @ut before this can happen, the public must first be weaned from its belief that the obese eat much more than other people, that this is the cause of their obesity, and that they could become lean and remain slender simply by eating normal amounts of food 4his belief is particularly resistant to change since it was the accepted scientific position until recently 0isleading weight loss advertising perpetuates this belief, and the sheer volume of this commerce discourages the media from educating the public !ess than one research dollar is spent for each overweight %merican compared to a thousand dollars for each H$A positive %merican $t is high time overweight %mericans got their fair share of the billions and billions of ta" dollars they pay for medical research $n addition, we should add a chec&off to income ta" forms allowing ta"payers to earmar& money for the research and deployment of new weight control technology $n the meantime, the protections of the %mericans with Disabilities %ct should be e"tended to those %mericans whose diligence in dieting has only made them fatter 4he purpose of this paper is to set out the case for new weight loss technology and thereby give hope to the millions of fat %mericans for whom conventional weight loss technology has been ineffective or worse 4his paper is a summary of recent progress in obesity research $t identifies topics and issues concerning obesity 4he reader should study the references given below if >uestions or doubts remain 0any of the topics related to adiposity are interrelated 5ince this document was only recently converted to hyperte"t, few lin&s are available 4he reader must carefully study the entirety of this document to understand adiposity

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8:8RGB @%5$95 4H8 @$=!=GB =' %D$P=5$4B 5et Point =besity Airus Rats, Pigs and @limps @rown %dipose 4issue /@%43 .hite %dipose 4issue /.%43 5iCe and :umber of 'at 9ells 'at 9ell Receptors 'at and 9arbohydrate ="idation 0uscle 'ibre 4ype '=R4U:8 =' @$R4H 4ypes of %diposity G8:84$95 or 8:A$R=:08:4D 5yndrome E 0aternal 8nvironment Precocious Puberty @aby;s Diet 8''8945 =' =@85$4B Personality Problems Health Problems 4R%D$4$=:%! 4R8%408:4 8E8R9$58 D$845 5low vs Rapid .eight !oss @ehavior 0odification Diet 5ide 8ffects 8at 0ore to !ose 'at %rtificial 5weeteners High 'iber Diet !ow 'at Diets 4he 9ornell !ow 'at 5tudy Dieting Gourmets 4he !opeC Diet 2 8at li&e a .arrior !ow 9arbohydrate Diets =rnish and %t&ins 9ompared Diets - the @=44=0 !$:8 .8$GH4 9B9!$:G '!%.8D R858%R9H 9orrelation vs 9ause and 8ffect 'lawed 5ample 5election2Distribution $mproper use of Ratios to %d(ust Data 4RU4H $: R858%R9H P%P8R5 08D$% D$54=R4$=: :8. 489H:=!=GB 'ood %llergy %voidance 5timulation of 4hermogenesis Growth Hormone 4reatment Growth Hormone 5timulation DH8% 4reatment RU-*+F 4reatment 9oPP 4reatment @romocriptine 4reatment 9ircadian !ipostat 0anipulation D=P%0$:8 %G=:$545

4estosterone 4reatment @eta1-%drenoceptor %gonists 5erotonin Reupta&e $nhibitors '%4 98!! R80=A%! 'at 9ell Removal by 5urgery 'at 9ell Removal by $mmunological 0anipulation PR8D$94$=:5 R89=008:D%4$=:5 '=R %94$=: R8GU$R8D R8%D$:G R89=008:D8D R8%D$:G $:48R854$:G .8@ P%G85

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%norecticH appetite suppression %nore"iantH substance that suppresses appetite %dipocyte HyperplasiaH 8"cessive number of fat cells, as much as ten times normalI an increase in the number of fat cells caused by diet induced weight cycling %dipose 9ellH 4here are two types of adipose /fat3 cells, .hite %dipose 4issue /.%43 and @rown %dipose 4issue /@%43 4he body uses .%4 to store energy for use in faminesI @%4 burns energy to maintain body temperature 5evere obesity is caused by too many .hite %dipose 9ells Human adipose tissue in vivo does not have the simple metabolic pattern that might be e"pected from studies of adipocytes in vitro $t is engaged in a variety of metabolic e"changes 4%G, glucose, o"ygen, acetoacetate, and 1-hydro"ybutyrate and acetate are all e"tracted from from the blood :8'%, glycerol, lactate, and carbon dio"ide are released /Proceedings of the :utrition 5ociety ),,JH #), *-,-*)+3 @ioavailability refers to the e"tent to which a medication or nutrient can actually be used by the body !aboratory measurements of the protein, fat, and carbohydrate content of foodstuffs do not necessarily predict their effect on humans 0easurements of human response to foodstuffs indicate the bioavailability of dietary carbohydrate is greater in modern foods than in their traditional counterparts @ody 0ass $nde" /@0$3 is a measure of the percentage of fat to total body mass @0$ is weight in &ilograms divided by height in meters, s>uared /0ultiply by 6-* if using inches and pounds 3 @0$ is a relatively height and bone-density independent measure of adiposity /fatness3 @0$ is more highly correlated with body fat than other indices of height and weight @0$ tends to overstate the fatness of mesomorphs and to understate the fatness of sub(ects whose lean tissue has been diminished by diet induced weight cycling 9%R8'U! R858%R9H8R5 a code phrase suggesting researchers reporting contrary results made errors in e"perimental design or deduction DH8% is a hormone that reduces fat tissue siCe and serum cholesterol in men DH8% increases resting metabolism, directing dietary inta&e into heat instead of fat stores $ncreased DH8% allows migration into colder environments Results vary in women depending on their age 8:D=0=RPH a person with a heavy body build, in contrast to mesomorph /muscular3 and ectomorph /s&inny3 'at 'ree 0ass /''03 is everything that is not fat .ater constitutes about 61 per cent of ''0 G!B9=G8:, another constituent of ''0, is stored in the liver and muscle as a reservoir of glucose for metabolic energy 0any papers do not distinguish between ''0 and muscle tissue 4o complicate the issue, obesity tissue contains significant protein and other substances in addition to fat ''0 measurements must be used with caution as controversy remains about its definition and measurement techni>ues G!U9=58 /de"trose3, found in fruits and other foods, is the end product of carbohydrate digestion @lood glucose is the primary source of energy in animals Glucose is converted to glycogen and stored in the liver, muscles, and fat tissues @lood glucose levels are of great interest in adiposity and diabetes !ow blood glucose from fasting or other dietary restriction can induce headaches, low spirits, and an innate compulsion to restore normal glucose levels by eating 0etabolic needs of the body are provided by the

degradation of glucose and free fatty acids K''%L 0ost tissues can use both glucose and ''% for their energy needs, but the brain and nervous system can only use glucose /or &etones3, but not fats .hen dietary inta&e or fat stores do not permit sufficient production of glucose, body protein /lean tissue3 is sacrificed to ma&e it 4o convert from the mmol2! 5$ units found in research papers to the familiar mg2dl used by %merican doctors, multiply by )+ HyperphagiaH overeating $n vitroH in a test tube $n vivoH in the body $:5U!$: has been called 7the fattening hormone7 $nsulin promotes differentiation of white fat cells, fat deposition, lipoprotein lipase /!P!3, inhibits growth hormone release, and inhibits the fat releasing action of catecholamines $nsulin inhibits the hormone-sensitive lipase that releases stored fat from adipose tissue $n normal individuals, insulin primarily increases glucose upta&e by muscle tissue and lowers glucose production by the liver $n 5yndrome E, the liver and muscles are resistant to insulin, forcing the production of more insulin to control blood glucose 4his causes hyperinsulinaemia /too much insulin3, shunting dietary energy to fat stores % high level of insulin precedes obesity and hypertension in 5yndrome E 4ight control in 4ype $ diabetics increases average insulin concentration and causes weight gain 5ince obesity is associated with resistance to insulin action, a vicious cycle of insulin-Mweight gainMmore insulin is possible High insulin levels appear to be a factor in development of high blood pressure, abnormal lipid levels and artherosclerosis $t is &nown that insulin induces the growth of human vascular smooth muscle and stimulates the proto-oncogene c-myc through the $G'-$ receptor !ow levels of insulin caused by untreated type $ diabetes can lead to lipoatrophy /loss of fat tissue3 Dietary carbohydrate, but not fat or protein, increases plasma insulin levels N$!=J=U!8 some papers use &ilo Joules /&J3 to measure food energy instead of &ilocalories /&cal3, or 7calories7 as used by the lay press and food labels 4o convert from &J to &cal /7calories73, multiply by - J* !8P4$: is a hormone /name derived from the Gree& word for 7thin73 normally produced by the 7ob7 gene =b mice in(ected with shots of leptin >uic&ly began losing fat cells, ate less food, spent more time e"ercising and generally became healthier =besity may be caused by insufficient leptin or an insensitivity to leptin !eptin also plays a role in starvation Rats fasted for *+ hours decreased leptin levels, delayed ovulation, decreased testosterone, decreased thyroid and increased stress hormones 4hese responses are thought to aid in surviving famine 4his may e"plain some of the metabolic slowdowns seen in dieting humans 'asted rats in(ected with leptin did not have these slowdowns $n humans, obesity may be caused by an insensitivity to leptin :onetheless, it may be possible to induce weight loss by adding enough leptin to overcome the insensitivity !$P=G8:85$5 5toring of energy in fat tissue !$P=!B5$5 Draining energy from fat tissue !P! !$P=PR=48$: !$P%58 4wo ma(or enCymes involved in the regulation of upta&e and egress of fatty acids from fat cells are !ipoProtein !ipase /!P!3 /repartitions energy into fat3 and Hormone 5ensitive !ipase /H5!3 /mobiliCes fat3 0orbid obesity =besity severe enough to directly affect the victim;s health or >uality of life :$DD0 :on $nsulin Dependent Diabetes 0ellitus, or $nsulin Resistance, a disease caused by a defect in insulin mediated glucose consumption P%::$9U!U5 %D$P=5U5 overhanging belly PR=$:5U!$: is one of many metabolically defective insulin- li&e substances produced by the pancreas in addition to insulin 4he ability to distinguish insulin from the other substances is new and not widespread 5ome now thin& most 4ype $$ diabetics are in fact insulin deficient because much of their 7insulin7 is actually proinsulin /4he !ancet, 'eb )) ),+,, J,1--#3 5everal lines of evidence suggest proinsulin is not merely a wea& insulin, but a uni>ue hormone of its own specific target receptors, functions, and diseases Proinsulin preferentially binds at proliferative target cells /lymphocytes, arterial smooth muscle cells, small gut crypt cells3 $t is thought to be an important cardiovascular ris& factor Predominately released already in small for date babies, aging, obesity, and type $$ diabetes, it may be an early mar&er if not pathogenic principle of 5yndrome E /> v 3 Proinsulin is a potent ris& factor in obesity /#th 8uropean 9ongress on =besity )--)J June ),,J3

P$4U$4%RB G!%:D releases Human Growth Hormone /HGH3 in bursts, mostly during the early hours of sleep Human Growth Hormone promotes muscle growth and fat loss HGH is also called somatropin PR=GR%00$:G % permanent change in the structure or function of an organism resulting from a stimulus or insult acting at a critical period of early life R8'%94=RB %d(ective indicating the condition reasserts itself, precluding long term relief A!9DH Aery !ow 9alorie Diet A!8DH Aery !ow 8nergy Diet @oth terms apply to diets severely restricted in energy content 4he term 7!ow 9alorie7 is more popular than 7!ow 8nergy7 because the latter has negative associations with tiredness and other diet related complaints .8$GH4 R8@=U:D a net adiposity increase in a diet-regain cycle, sometimes confounded by loss of lean tissue B00AH Bour 0ileage /results3 0ay Aary

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nteresting :arameters for 8ietary "acronutrients

:arameter :rotein 1at Carbohydrate Ethanol Gross energy &cal2g ## ,J 1, 6) Digestibility ? ,J ,# ,, )-0etabolic energy &cal2g * , * 9ost of storage &cal2g F )* 1* .eight change g2&cal DD J) to )J 1nil :utritionists often compare the gross energy of fat, protein, and carbohydrate when selecting foods Gross energy is the heat of combustion, useful information for investigating spontaneous combustion of humans 'or the body to use these nutrients, they must be digested /an imperfect process3 5ome energy is re>uired to convert carbohydrate to triglycerides in fat storage 8nergy is also re>uired to store dietary fat in adipose cells, and to store protein in lean tissue /=besity and !eanness - @asic %spects3 $n the human body, dietary macronutrients affect fat stores /body weight3 in individual ways =n a high-fat diet, *6-1 to +*6) e"cess calories were re>uired for each &ilogram of added weight /Department of H8. Pub :$H 6#6-+ Government Printing =ffice, )F#-+F3 =n a low carbohydrate A!9D, replacing fat calories with + g2day of e>uivalent carbohydrate calories reduced weight loss by ) F+ &g, corresponding to 11-- calories of carbohydrate2&ilogram, possibly J#-- calories per &ilogram for carbohydrate alone /%m J of 9lin :utr ),,JI#FHJ)65-J153 4he action of insulin and other hormones may account for the contradiction between the gross energy content of fat and carbohydrate compared with their dietary effects on human weight 8thanol is another energy-providing substrate, at least in so far as energy is released when it is burnt in a bomb calorimeter 5ome dietary studies show that increased ethanol consumption is not accompanied by the e"pected change in body weight Pathways have been suggested by which ethanol may be o"idiCed without generation of useful energy 'rom a biochemical point of view, ethanol demonstrates the inapplicability of lin&ing the 7energy value7 of a nutrient /&ilocalories3 with storage of lipids in fat tissue %fter an overnight fast, there was no tendency for fat storage after a )*-- &J ethanol load, in mar&ed contrast to fat storage from a ))F- &J monohydrate load /Proc of the :ut 5oc ),,J #), *-,-)+3

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=ne cannot understand current obesity research without some essential &nowledge of human energy metabolism and how it is regulated 4he body gets its energy from dietary protein, carbohydrate and fat 4he body stores energy as glycerol, lean tissue and fat 4he partitioning of available energy sources between energy output /wor&3, muscle and fat storage vary greatly between individuals 4hese differences are primarily genetic in origin, but are also caused by metabolic and nutritional abnormalities during gestation and infancy 0uscle tissues burn carbohydrate and fat for energy .hen energy e"penditure e"ceeds dietary input, stored glycogen, fat stored in adipose cells, and lean tissue are cannibaliCed to ma&e good the energy shortfall %nimals regulate their body fat stores within fairly narrow limits 4his regulation is automatic, not re>uiring conscious intervention 9hanges in energy balance are compensated for by changes in appetite and metabolism % bout of flu reduces energy inta&e at the same time the body;s fever increases energy e"penditureI the lost weight is regained afterwards !i&ewise a large 4han&sgiving meal raises metabolism /that;s why one feels warmer3 and depresses appetite for a while 4he usual body weight that a person maintains automatically is called the 584 P=$:4 weight 4he 584 P=$:4 4H8=RB of body weight regulation postulates that a biological servo system affects energy e"penditure, hormones, fat cell receptors, appetite, and other metabolic parameters to maintain a constant body weight /set point3 resistant to changes in energy input or e"ertion 'or many obese individuals, their set point is the stable weight to which they repeatedly return to after dieting 5et point theory e"plains why the calorie loss of moderate e"ercise provo&es an increase in appetite and2or slowing of metabolism, preventing ma(or weight loss 70aintenance of a reduced or elevated body weight is associated with compensatory changes in energy e"penditure, which oppose the maintenance of body weight that is different from the usual weight 4hese compensatory changes may account for the poor long-term efficacy of treatments for obesity 7 /:8J0 ),,#I11JIFJ)-+3 4he reduction in energy e"penditure to a level )# per cent below that predicted for the body composition, as a result of a )- per cent /or larger3 decrease in body weight, is large compared to the level of overeating resported in some studies Healthy male sub(ects who have no history of dieting or weight concerns have a strong caloric compensation /%merican Journal of 9linical Research sub(ects reduced inta&e of other foods after re>uired eating of food containing JJ?-#J? of their baseline energy inta&e 5ub(ects compensated for the covert caloric dilution of one third of the available items by increasing inta&e of non diluted items :utrition ),,JI##I11)-*J3 4he !P! study mentioned below supports the much-debated 7set point7 theory, which holds that inner mechanisms set a person;s weight at a predetermined level and if anything is done to change the weight, the body will ad(ust to restore fat content to the set point 7$ regard body temperature, which stays around ,+ F degrees ', to be a set point .eight doesn;t have a set point in that sense,7 says Eavier Pi-5unyer, 0 D , director of the =besity Research 9enter at 5t !u&e;s-Roosevelt Hospital 9enter in :ew Bor& $f there is a set point for weight, it generally seems to move in one direction--that is, the body will not ma&e ad(ustments to counteract a large weight gain but will fight efforts to lose the weight 7.hen a person gains weight and stays at that weight a while, the body will defend that weight $t becomes the new ;set point;,7 e"plains Pi-5unyer %side from the action of !P!, the body uses other adaptive mechanisms when food inta&e is reduced 4o cite (ust two of themH Dieting depresses the metabolic rate so that calories are burned more slowly, and as fat cells shrin&, they become more responsive to the action of insulin and do not release their contents as readily /'D% 9=:5U08R3 4he set point theory of body weight regulation is based on a large body of evidence /.eigle D5I Human obesity 8"ploding the myths .estern Journal of 0edicine ),,- =ctI )#1I*J)-*J+3 % remar&able demonstration of the set point can be seen in the 7Guru .alla7 fattening session in the 0assas ethnic group in :orthern 9ameroon 4he sub(ects were fattened on a F61F calorie /per dayO3 high carbohydrate diet %fter the fattening session, the sub(ects; eating was entirely spontaneous %verage mean inta&e was 1-+) calories :o dietary advice was provided %fter 1F months the men returned to their starting body weights /%m J of 9lin :ut ),,*IF-H+F)-13 4his suggests one;s set point is misset if one cannot reach and maintain normal weight on 1--- calories per day

s there an <besity !irusA

% preliminary study indicates )# percent of obese people show signs of having caught obesity from a virus :i&hil Dhurandhar at the University of .isconsin at 0adison claimed discovery of antibodies to this virus among the obese is the first significant finding in the field for years U. endocrinologist Richard %t&inson admitted the idea of obesity as a viral disease is unconventional but noted that the idea of ulcers being caused by bacteria was (ust as outrageous )# years ago 4he study involved adenovirus 1F, one of #- adenoviruses, several of which are &nown to cause the common cold Researchers at the University of .isconsin in 0adison have found that mice and chic&ens infected with a common human virus put on much more fat than uninfected animals 4hey have also discovered that the same virus is more prevalent among overweight people, a strong indication that it may also cause obesity in humans $n four e"periments, the .isconsin researchers inoculated chic&ens and mice with adenovirus-1F, a member of a viral family that includes about #- strains 0ost adenoviruses cause colds, diarrhea or pin&eye %fter several months, animals infected with adenovirus-1F weighed only 6 percent more on average than those without the virus, but their bodies contained more than twice as much fat %side from a day or two of cold-li&e symptoms, %t&inson said, the virus produced no observable effects besides obesity 9lic& here for longer articleO

$ats, :igs and @limps

0ice, rats and pigs are commonly used in adiposity research because their metabolisms resemble those of humans .ild rats never e"ceed )-? body fat, even when fed high fat diets 5ome strains have been bred to mimic the metabolism of obese humans 4he best &nown strains are the obese ob2ob mouse and the fatty fa2fa Puc&er rat 4hese strains become obese even when restricted by pair-feeding to the caloric inta&e of lean littermates 4he genetically-obese rodents demonstrate the problems of the obeseI they die easily in the cold, are often infertile, lac& mobility, and will mobiliCe muscle in preference to fat when food is scarce 4he ob2ob mouse fails to survive in the cold because it cannot generate sufficient heat by burning fat 4he 4ubby 0ouse interests researchers because it models the course of human obesity more closely than other strains, in which the rodents overeat from birth 4ubby mice don;t overeatI they gain weight slowly, as they age 4ubby mice also have imparied insulin metabolism :itrogen balance studies have shown that the obese Puc&er rat tends to deposit amino acid carbon s&eletons in the form of fat, rather than muscle protein 4heir muscles are smaller and contain less protein than those of lean counterparts 4he obese rat also has less lean body mass, a reduced rate of protein deposition, and a reduced rate of protein synthesis in s&eletal muscleI the decreased rate of protein synthesis is already present in the obese rat before weaning /$nt J of =bes ),,J,)FH J)1-+3 =besity in Puc&er fa2fa rats is thought to result from the combination of two recessive genes /fa2fa3 Puc&er rats can survive in the cold, yet they attain the obese state with normal diet and e"ercise 74he obesity of the Puc&er rat is inherited as an autosomal recessive mutation $t is thought to be the initiated by a single gene defect /fa3 the nature of which remains totally un&nown 4hese rats develop a syndrome that closely resembles human obesity Hyperphagia, hyperinsulinemia and normoglycemia, hypertriglycemia, hypertrophy and hyperplasia of fat cells as well as the development of type $$ diabetes and renal complications are common features to both Krat and humanL species 7 p F6,, Journal of !ipid Research, ),,J % J#- fold increase in the amounts of the enCyme adipose tissue 'atty %cid 5ynthetase /'%53 apparently causes this obesity 0ature adipocytes from genetically obese Puc&er rats maintain their hyperactive lipid storage capacity when withdrawn from their in vivo environment, indicating an intrinsic alteration in these cells High protein re>uirements could provide a partial e"planation for the hyperphagia of genetically-obese Puc&er rats 4hese mutants o"idiCe amino acids in preference to fats and therefore growth of lean body mass is limited $n order to obtain sufficient protein for normal growth the Puc&er overeats, and the e"cess energy ends up as fat $t is claimed that the hyperphagia is almost completely abolished when these animals are fed very high protein diets, and weight gain is then diminished /p 11, =besity and !eanness - @asic %spects3 7'%5 overactivity will act as a metabolic drive, channeling dietary substrates Kfood energyL into adipose tissue fat storesI this would happen whatever the food inta&e level of the rats, in good &eeping with the well-established observation that hyperphagia KovereatingL is not a necessary precondition for the development of Puc&er rat obesity 4he shunting of nutrients into adipose tissue would entail two physiological conse>uences, a compensatory hyperphagia and a secondary hyperinsulinemia 7 Human '%5 activity was higher in obese sub(ects than in lean controls /0etabolism ),,)I*-I1HJ+-- #3

4he sand rat /Psammoys obesus3 becomes obese, hyperinsulinaemic, and insulin resistant when shifted to a high energy diet, a syndrome which also affects %boriginal %ustralians and Pima $ndians 4he choice of animal strain is important to obesity e"periments Results obtained with obese rats are more relevant to obese humans than results obtained with .istar or 5prague-Dawley /genetically thin3 rats

@ro)n #dipose Tissue -@#T/

@rown %dipose 4issue /@%43 generates heat with :on 5hivering 4hermogenesis /:543 by burning calories without physical motion $n humans, brown adipose tissue siCe decreases with age, while in small mammals, the siCe remains constant or increases in preparation for hibernation

White #dipose Tissue -W#T/

=besity results from an e"cess of white adipose tissue /.%43 .%4 cells are not simple storage tan&s 4hey are active, living cells 4hey destroy DH8% and Growth Hormone 4hey convert steroids that promote muscle development to estrogen .hite 'at cells compete with lean tissue for nutrients, impeding muscle development Reduction of fat cell numbers /see below3 causes permanent fat loss while weight loss techni>ues that do not reduce the number of fat cells are temporary 4his suggests that fat cells themselves enforce the elevated set point in many individuals 74he evidence is strong that the defense of body weight against a reduction in diet palatability is much stronger in animals and humans with normal siCe or small fat cells than in individuals with enlarged fat cells 4his seems to be the case regardless of fat cell number =ne wonders, therefore, whether reduction in fat cell siCe might be the event that normally gives rise to the food hoarding response in food-deprived rats 7 /9linical :europharmacology Aol )) 5uppl ) p 5)-563 not accounted for by the loss of muscle tissue H J 7Preadipocytes M 'at 9ells7 .hite fat cells begin life as PR8%D$P=94B85 4he human body contains a vast reserve of preadipocytes, but these cells are so tiny they only cause a problem when they differentiate /mutate3 into the much larger adipocytes Human adipose tissue contains a pool of tiny precursor cells /preadipocytes3 which can be converted to adipocytes /fat cells3 in the presence of glucocorticoids and insulin /Journal of 9linical 8ndocrinology and 0etabolism, ),+63 4he role of insulin in fat cell proliferation, reported in many papers, e"plains the effect of dietary sugar and carbohydrate on the development of obesity 4his would also e"plain why e"cessive insulin levels in the gestating human baby induce obesity that appears after several years 4he future adiposity of suc&ling pigs can be predicted by measuring the ability of the suc&ling;s blood to differentiate preadipocytes into full siCe fat cells in a test tube 4he preobese suc&lings had low levels of growth hormone 8pidermal Growth 'actor /8G'3 dramatically inhibits differentiation of preadipocytes into fat cells =bese mice have 8G' levels as much as +-? less than their lean littermates 'at pads of 8G' treated rats weighed only half as much as untreated rats, contained only J# percent as many mature adipocytes, and accumulated only J- per cent as much lipid Preadipocytes isolated from fat deposits in different parts of the anatomy appear to be different 4his could e"plain the strong heritability of body fat distribution Preadipocytes isolated from obese rat strains change into fat cells more easily than normal

Si(e and +umber of 1at Cells

$s obesity caused by an e"cess number of fat cells or by gross enlargement of a normal number of fat cellsD 4he answer to this >uestion has heavy implications for the possible success of various weight loss strategies !ean individuals have J- to *- billion fat cells 'at cells can e"pand to no more than twice normal siCe 5ome obese sub(ects have ten times as many fat cells as normal @(orntorp and 5(ostrom /084%@=!$50 AJ-I6I6-13 have observed an association between high fat cell numbers /hyperplasia3, more severe obesity, and childhood onset obesity % number of studies have found that sub(ects with childhood onset obesity have more difficulty losing weight and are more li&ely to regain more weight than they lose dieting, putting them at ris& of hyperobesity from diet induced weight cycling

% study published in the Proceedings of the #th $nternational 9ongress on =besity showed that obese sub(ects who had lost weight had fat cells J# per cent smaller than those of marathon runners who had half the total body fat 4he dieters had twice as many fat cells as the athletes 4he defense of body weight against a reduction in diet palatability is much stronger in animals and humans with normal siCe or small fat cells than in individuals with enlarged fat cells /9linical :europharmacology Aol )) 5uppl ) 5)-63 4his would e"plain why it is much more difficult for obese individuals to reach and maintain ideal weight 5ee 7.eight 9ycling7 below for more information on how diets actually increase fat cell numbers

1at Cell $eceptors

'at cells gain and lose weight by passing lipids through receptors =ne type of receptor removes lipids from the blood stream and another type allows the body to access the energy stored in the fat cells with a resulting loss of weight Geographic distribution of fat, including 7love handles7 that do not respond to e"treme dieting, is believed to result from local variations in these receptors 4he numbers and efficiencies of fat cell receptor types change with repeated dieting, slowing weight loss on successive diets and promoting weight gain

1at and Carbohydrate <&idation

% low metabolic rate is a ris& factor for subse>uent weight gain % low ratio of fat to carbohydrate o"idation independent of energy e"penditure is also a ris& factor for weight gain $n response to weight gain, both the metabolic rate and fuel mi" o"idation become 7normal7 for the new body weight /Progress in =besity Research ),,-, p )+-3 4he lower thermic effect of food in the obese is uncorrected by weight loss, and thus it is a contributor to obesity rather than a conse>uence of obesity /%m J of 9lin :utr ),,JI##H,J*-113

"uscle 1ibre Type

4he %pril ), ),,- !ancet reports that s&eletal muscle fibre type is directly correlated with body fatness !ean sub(ects have more 7slow fibres7 well endowed with mitochondria that use fatty acids as energy source 9orpulent sub(ects have fewer 7slow fibres7 but more 7fast fibres7 that only burn glucoseI they cannot burn fat for energy /5ee 8E8R9$58, below 3 4he proportion of fibre types is a nearly linear function of @0$ %ll of the sub(ects were sedentary, ruling out any effect from endurance training /)D-#3 /)D-63 % low ratio of fat to carbohydrate o"idation independent of energy e"penditure is a ris& factor for weight gain /p )+-, Progress in =besity Research ),,-3 $t is now recogniCed that obese trauma patients re>uire special dietary intervention because their bodies cannot use the energy stored in their fat for healing the way thin people do /Journal of 9linical $nvestigations, Jan ),,)3 Growth Hormone treatment allows the obese patient;s body to mobiliCe and utiliCe its fat stores /084%@=!$50 ),,1 *JHJ )+#-),-3

1<$TU+E <1 @ $T2

Types of #diposity
Research over the last decade has shown that most fat people did not get fat because they ate too much, ate the wrong things, or e"ercised too little Rather, they became fat because their bodies put too great a fraction of their food energy into fat 4his research is discussed in later chapters 8"periments with controlled overfeeding of lean sub(ects demonstrate an increase in body metabolism that restores normal weight when overfeeding ceases $n a ),+F Dutch study, men who e"perienced many life events in a short period showed a gain in body mass % year later this weight gain had disappeared in almost all subgroups of these men 4he e"ception was the subgroup that tried to lose weight by dietingI those who dieted gained yet more weight /$nternational Journal of =besity /),++3, )J, J,-1, 3

!ean individuals; self-recovery from overeating is e"ploited in ads from Jennie 9raig and other diet providers that claim long term weight loss :one of the well &nown 7before2after7 diet celebrities such as %rt 0c0ahon had childhood onset obesity 0uch remains to be learned about human genetics, but it has already been learned that individuals with the H!% %w1- allele have a J F) relative ris& for obesity /Human Heredity ),+,I1,/13H)#F-F*3 8"periments by 0eier, 9incotta and !ovell suggest obesity and associated type $$ diabetes are the result of defective circadian Kdaily cycleL neuroendocrine rhythms

?E+ET CS or E+! $<+"E+TA

4he conclusion of current research is that individual differences in @ody 0ass $nde" /@0$3 are mostly the result of genetic factors Discoveries of 7obesity genes7 continues at a fast pace, with the discovery of a fifth /the 7tubby gene73 reported in %pril ),,F =besity is now thought to be the result of a pairing of normally recessive genes /fa2fa3 7Previously, researchers at the University of $owa found evidence of a recessive obesity gene /the child needs one copy of the gene from each parent to have the tendency towards overweight3 % study of J66 school children and their families showed a pattern of obesity that followed the classic model for recessive inheritance $n December ),,* scientists from :ew Bor&;s Roc&efeller University reported molecular identification of an obese gene in mice % similar gene was also found in humans 4he first identification of an obesity gene in both animal and humans e"cited obesity researchers and the lay public, if not nutritionists and e"ercise promoters $t is li&ely that a number of genetic mechanisms e"ert influence on weight, among them genes that dictate metabolism and appetite =ne that is being investigated actively is the gene that codes for lipoprotein lipase /!P!3, an enCyme produced by fat cells to help store calories as fat $f too much !P! is produced, the body will be especially efficient at storing calories Kas fatL !P! is partly controlled by reproductive hormones /estrogen in women, testosterone in men3, so gender-based differences in the activity of the enCyme also factor into obesity $n women, fat cells in the hips, thighs and breasts secrete !P!, while in men the enCyme is produced by fat cells in the midriff region 'at cells in the abdominal area release their contents for >uic& energy, while fat in the thighs and buttoc&s are used for long-term energy storage 4hus, a man can often pare his paunch more readily than a woman can shed her saddlebags !P! also ma&es it easier to regain lost weight, according to a study conducted at 9edars-5inai 0edical 9enter in !os %ngeles and reported in the %pril )J, ),,-, issue of the :ew 8ngland Journal of 0edicine :ine people who lost an average of ,- pounds had their !P! levels measured before dieting and after maintaining their new weights for three months 4he researchers found that levels of the enCyme rose after weight loss, and that the fatter the person was to start with, the higher the !P! levels were--as though the body was fighting to regain the weight 4hey believe that weight loss activated the gene producing the enCyme 4his may be one reason why it is easier for a dieter to regain lost weight than for someone who has never been obese to put weight on 7 /'D% 9=:5U08R3 !P! plays a ma(or role in the production of low density lipoproteinsI this may partly e"plain the increased mortality associated with repetitive diet induced weight cycling /Progress in =besity Research ),,-, JJ#3 4wo studies published in the :ew 8ngland Journal of 0edicine illustrate the point $n 74he body-mass inde" of twins who have been reared apart7, the rearing environment was shown to have no effect on @0$ %doptees of fat parents were no fatter then adoptees of s&inny parents $n other words, if you;re fat, it wasn;t because your mother fed you too many coo&ies and it wasn;t because your father didn;t ma&e you e"ercise $n a followup paper given at the Fth $nternational 9ongress of =besity, p F6-, the heritability estimate for obesity at age *# comes to - +* 9ompare this to some other commonly accepted heritability estimatesH 9oronary, *,, 5chiCophrenia, F+, Hypertension, #6, %lcoholism, #6, 9irrhosis, #1, 8pilepsy, - #4he plots of parent2offspring weights in the above study bear close inspection 4he plot of biological parents and adoptees shows the /by now3 well &nown nearly straight line relationship between parents; adiposity and that of their children 4he plot of adoptive parent weight and adoptee weight shows a slight negative trend for females, and no trend for males 5o much for fat mothers passing bad habits on to their children 7the genetic relationship fully accounts for the familial resemblance in body mass inde" among adults 7 Ki e , nothing to do with passing on bad eating habits or sedentary lifestyleL /$nt J of =besity ),,JH)F,JJ6-1F3 % study of lean and overweight male %rmy personnel was designed to prove that the overweight valued good health less than normalweights, and practiced less healthy lifestyles 4o the researchers; surprise, there were no significant differences between overweight and normalweights on these attitudes

7environmental effects shared among family members are irrelevant in the determination of weight and obesity 7 /$nternational Journal of =besity ),,J )F F#6-FFF3 $n 74he response to long-term overfeeding in identical twins7, )J pairs of identical male twins were overfed and &ept sedentary under close supervision 4hose who gained the most fat gained less muscle than those who gained the least fat :otwithstanding the wide differences in weight gain between pairs, among )- of the )J pairs weight gain was almost identical 4here was a 1 to ) ratio in weight gain between the easiest gainer and the slowest gainer 4he overfeeding study is interesting because of its sample selection :one of the sub(ects had any history of obesity whatsoever, not even in their families =ne can but imagine what that 1 to ) difference in weight gain and )F to ) difference of lean2fat gain would have been if overweight sub(ects had been included 4he appearance of these papers in the 0ay J* ),,- :ew 8ngland Journal of 0edicine prompted several submissions >uestioning the papers; findings 4hese letters and the authors; rebuttals were printed in the =ct )) ),,edition 4he 5ep ),,- 5cience :ews reported a very wide difference in the amounts and types of tissues added in response to overfeeding $n this study, thin people actually added more weight than fat people did, but the thin people added weight mainly as lean tissue instead of fat Data from 7lean hungry7 types that gained little weight were e"cludedO 4he obese /and pre-obese3 differ from lean persons in other ways 4heir muscle cells do not burn fat well DH8% and growth hormone levels are low 4heir fat cells spontaneously multiply under conditions when those of of lean persons do not 0etabolic differences are evident even before birth 4hese factors are described elsewhere in this document $nsulin resistance is a survival advantage in famine, evidenced by the high prevalence of 5yndrome E in populations that have e"perienced recent famines 4he inhabitants of the Pacific $slet of :auru have provided a practical ob(ect lesson in the genetics of obesity 4he :auruans were selected for the 7thrifty genotype7 when their ancestors reached the islands by long canoe voyages when fatter individuals escaped death by starvation Droughts and crop failures were common in the past, and many died of starvation during the harsh Japanese occupation of ),*J-# 5ince then mining has made :auru wealthy =besity and :$DD0 became endemic after ),#-, affecting two thirds of adults by age ##-F* :$DD0 pea&ed in ),6#-6F but has since decreased mar&edly as obesity and :$DD0 prone people failed to reproduce Diabetic women in :auru had more stillbirths and less than half as many live births as healthy controls 5imilar natural selection has reduced the prevalence of :$DD0 in the .est to about +? /:%4UR8 A=! 1#6 * June ,J 1F1-13 =bese and lean persons do not share the same genetic heritage 0edical advances in managing gestational diabetes in the last few decades counteracting this natural selection have fattened the gene pool

S%+8$<"E X
75yndrome E7 or 7insulin resistance syndrome7 is defined asH resistance to insulin-mediated glucose upta&e 'at cells release a hormone resistin that causes insulin resistance J glucose intolerance 1 hyperinsulinemia * increased very low density triglycerides /A!D!3 # decreased high-density lipoprotein cholesterol /HD!3 F hypertension 6 elevated systolic @P during subma"imal e"ercise + adiposity 5cientists used D:% samples from JJ-- overweight volunteers to locate a section on chromosome 1 that may be the source of 5yndrome E Genes on those chromosomes probably control whether the body burns fat or stores it /'o"news com Dec ), J---3 4he inherited defect is insulin resistance in s&eletal muscles, the other abnormalities are conse>uences /%merican J of =bstet Gynecol July ),,- J,J-#3 5ince the differences in insulin resistance between Pima $ndians and 9aucasians remains even after matching for obesity, the increased insulin resistance could not be blamed on their obesity /Progress in =besity Research ),,-H 1F)3 $n genetically prone individuals, insulin resistance is the earliest detectable defect 4his defect may occur )#-J# years before the clinical onset of the disease $nsulin resistance constitutes an 7intervening phenotype7 as well as a mar&er for the disease $nitially the body attempts to compensate for this insulin resistance, but eventually the increased insulin secretion fails to compensate and type $$ diabetes )

results /Diabetes ,2,* *1H)-FF-+13 4his defect in insulin resistance in s&eletal muscles may e"plain why fat people are less tolerant of e"tended e"posure to coldI their bodies cannot burn energy >uic&ly enough to maintain warmth % study by teams in %ustralia and the United 5tates confirms a genetic defect in certain populations with a high ris& of developing obesity-lin&ed disease such as diabetes 4he research defined the defect in a critical metabolic step in the body;s capacity to metabolise sugar 7this discovery is classed as a ma(or brea&through in that it has identified a genetic tendency which causes the disorder 7 Professor Paul Pimmet, director of the $nternational Diabetes $nstitute /Reuter, July J ),,J3 5ome types of 4ype $$ diabetes in human were lin&ed to gene locations in ),,J % connection between a gene and one type of diabetes with implications for hundreds of thousands of %mericans was reported in 'ebruary, ),,1 74his is the first clear definition of a genetic cause of 4ype $$ diabetes,7 said Dr 5imon Pil&is, chairman of the Department of Physiology and @iophysics at the 5tony @roo& Health 5ciences 9enter in :ew Bor& 70oreover, it may be one of the largest single-gene disorders described to date 7 74ools are now available to screen for gene mutations, and it is only a matter of time before other genes implicated in 4ype $$ diabetes are identified,7 Pil&is said 7.e will be able to screen different diabetic populations or the general population for these mutations, which will tell us whether someone has a predisposition to diabetes and what category they fall into 7 /UP$ -J2J+2),,13 0iller and 9olagiuri have pointed out that humans were primarily flesh-eating hunters consuming a low carbohydrate high protein diet until recently insulin resistance offered a survival and reproductive advantage during the $ce %ges which dominated the last two million years of human evolution 4he introduction of agriculture and subse>uent food processing have raised the >uantity and >uality of dietary carbohydrates, reversing the dietary evolution of the last two million years, causing the recent epidemic of :$DD0 4his is the only theory that e"plains why the prevalence of :$DD0 is lower in 8uropean and 0iddle 8astern populations, which developed agriculture thousands of years ahead of the rest of the world /Diabetologia /),,*3 16I)J+--F3 Research has been accumulating on the fattening effect of high levels of insulin during gestation and infancy High insulin levels are sometimes caused by e"cessive serum glucose in the mother;s blood and lea&age of a insulinantibody pairs across the placenta =bese individuals almost always e"hibit high insulin levels Hyperinsulinaemia itself could be one of the driving forces responsible for producing increased glucose utiliCation by white adipose tissue, increased total lipid synthesis with fat accumulation in adipose tissue and the liver, together with an insulin-resistant state in the muscles /@iochemical Journal ),,- JF6H,,-)-13 % decrease in glucose induced thermogenesis already e"ists at the onset of obesity /%m J 9lin :utr ),,1I#6H+#)-F3 =ne or two decades before type $$ diabetes is diagnosed, reduced glucose clearance /insulin resistance3 is already present 4his reduced clearance is accompanied by compensatory hyperinsulinemia, suggesting that the primary defect is in peripheral tissue response to insulin and glucose, not defective pancreatic beta cells /%nnals of $nternal 0edicine ),,- ))1H,-,-,)#3 5low glucose removal rate and hyperinsulinemia precede the development of 4ype $$ diabetes in the offspring of diabetic parents /%nnals of $nternal 0edicine ),,-H))1I,-,-)#3 insulin-mediated glucose disposal is reduced in otherwise healthy, lean normotensive sub(ects insulin resistance is present in these hypertension-prone individuals before the development of hypertension /Hypertension ),,1HJ)I J61-,3 7impairment of insulin sensitivity precedes both the development of overt hypertension and gain or redistribution of body fat 4herefore the concept that insulin sensitivity is low as a result of altered fat distribution has to be reconsidered7 /!ancet ),,1I 1*)H 1J6-1)3 7our data strongly support suggestion that hyperinsulinemia could be a common lin& between cardiological 5yndrome E and recently postulated metabolic 5yndrome E with the same characteristic finding - insulin resistance 7 /Nenderes&i et al, U of @eograd, @eograd, Bugoslavia, %bstracts, $J= ),,13 $ncreased lipid o"idation is one of the earlier dysfunctions observed in recent-onset obesityI lipid o"idation may induce a decrease of glucose o"idation, insulin resistance, and increased fasting insulin secretion /D$%@8485 ),,1H*J )-)--)F3 4his increased lipid o"idation may e"plain the higher percentage of energy from dietary fat sometimes reported in fatter children 0uscle fiber composition changed with hyperinsulinemia, with more fast-twitch fibers and fewer slow-twitch fibers /D$%@8485 ),,1H*J )-61-+)3 Hyperinsulinemia imposed on normal rats increased in vivo glucose utiliCation, lipogenesis and the fat accumulation in white adipose tissue, while producing an insulin resistant glucose transport im muscles /8ndocrinology ),,-H)J6IF 1J*F-+3 % large portion of middle aged and elderly people in .estern countries suffer from a combination of metabolic disorders and cardiovascular ris& factors 4his combination includes hyperinsulinemia /elevated insulin levels3,

insulin resistance /reduced sensitivity to insulin3, hyperlipidemia /elevated lipid levels3, obesity, and hypertension 4his combination is sometimes termed 75yndrome E7 or 7insulin resistance syndrome 7 %mlyin Pharmaceuticals scientists and others have observed that most sub(ects with hyperinsulinemia also have elevated amylin levels, or hyperamylinemia 4he finding that amylin can stimulate renin KenCyme associated with hypertensionL secretion is consistent with the idea that amylin may be a missing lin& between hypertension and the other metabolic disorders /%mlyin Pharmaceuticals press release3 insulin resistance and :$DD0 are accompanied by a progressive deterioration of the microcirculation in many tissues, including the s&eletal muscles that provide most of the body;s insulin mediated glucose disposal Aascular and circulatory changes causing a decline in muscle blood flow may be the cause of the metabolic disorder /Diabetologia ),,1I1FH+6F-,3

"aternal En'ironment
.hat one;s mother does or eats during or immediately before pregnancy affects one;s @0$ 4oo much carbohydrate during gestation is :ot Good Gestating infants whose blood was highest in insulin /0easured indirectly by sampling the amniotic fluid 3 /caused by elevated glucose in the mother;s blood3 were mar&edly obese by F years of age, independent of the mother;s weight 4his syndrome is thought to be a cause of Pima $ndians; high incidence of obesity /%rchives of Disease in 9hildhood ),,-I F#I )-#--J3 =ffspring of Diabetic 0others e"hibited an unusual pattern of fat growthI the baby is unusually fat at birth /macrosoma3, but assumes normal weight at ) year 'at growth creeps in over the ne"t several years, and accelerates at year # /girls3 or F /boys3 @y age + both male and female offspring of diabetic mothers are mar&edly obese and getting fatter, correlating with insulin levels during gestation /Diabetes, Aol *-, 5upplJ, Dec ),,), )J)-#3 0other;s insulin is not thought to cross the placenta However insulin in(ected into $DD0 mothers raises antibodies, and these insulin-antibody pairs do cross the placenta =nce in the fetus, the insulin increases fat deposition, resulting in macrosoma /:8J0 %ug J ),,- 1J1H# 1-,-)#3 4he 0ay ),,- 084%@=!$50 reported that changes in the rat sow;s diet during early pregnancy had a permanent effect on pups; lipid metabolism 74hus we propose that poor nutrition of the fetus and infant leads to permanent changes of the structure and function of certain organs and tissues 4he timing and precise nature of the deficiencies determine the pattern of metabolic and functional abnormalities seen in later life, including diabetes and hypertension and possibly including some hyperlipidaemias and even insulin resistance .e suggest that poor early development of islets of !angerhans and @eta cells is a ma(or factor in the aetiology of 4ype J diabetes 7 /Diabetologia ),,J 1#I #,#-F-)3 $n some diabetic sub(ects defective insulin-li&e molecules constitute up to two thirds of the total concentration of insulin-li&e molecules in plasma that are measured as 7insulin7 by normal tests 0easuring the defective molecules as 7insulin7 can lead to misdiagnosis that a patient is insulin resistant when in fact he is insulin deficient Pigs undernourished from )- days to ) year eventually became e"tremely fat 4hey had plenty of fat cells at )- days of age, but these cells were completely empty and did not register by conventional cell counting at ) year However, as soon as plentiful food was supplied, the pigs became e"tremely fatI the longer the period of deprivation the fatter they tended to become 4his finding refutes the commonly held belief view that an e"cessive number of adipocytes are formed only when overfeeding ta&es place in infancy /Proceedings of the :utrition 5ociety ),,JH #), 1#1-F#3 0others who e"perienced caloric deprivation in a critical portion of pregnancy during the ),** :etherlands Hungriwinter bore sons J-1 per cent of which were obese at age ),, more than twice the normal incidence of obesity $nfant undernutrition caused by smo&ing may produce similar results

:recocious :uberty
4he average age of puberty in women has dropped in the past )-- years from )6 to )1 4his has caused an increase in teen se"uality and pregnancy, but our interest here lies in its relationship to adiposity Douglas ! 'oster reported in the ),,# 8"perimental @iology meeting that blood glucose triggers the onset of puberty He was able to delay puberty in sheep by reducing blood glucose, and induce puberty by increasing it 5ince blood glucose is boosted by dietary carbohydrate, this reduction in the age of puberty indicates a ma(or increase in bioavailable dietary carbohydrate in the last century

@aby5s 8iet
% 9ase .estern Reserve University study /*P-)63 compared rat pups fed a mil&-substitute formula /#F? of calories from carbohydrates3 with mother-fed controls /only +? of calories from carbohydrates3 4he formula fed rats became fat 74he results show that alterations in the source of calories rather than the total caloric inta&e during the suc&ling period can have specific long-lasting effects on lipid metabolism in adulthood, leading to the development of obesity 7 8iet Change $esult in adult Prematurely weaned to High 9arbohydrate 0ore prone to hypercholesterolemia Prematurely weaned to High 'at Prevents hypercholesterolemia =vernutritionQ 8levated plasma cholesterol and insulin UndernutritionQ =besity KPrematurely weaned Q1-)- days after birthL /'%58@ Journal, June ),,-, p JF-F3 4he fattening effect of a high carbohydrate diet at weaning is e"plained in a review of the influence of diet on the development of adiposity appearing in the ),,J Proceedings of the :utrition 5ociety !aboratory reared rat pups fed a high carbohydrate formula have higher serum insulin and increased liver fat synthesis capacity compared with pups fed a high fat formula or reared naturally 8arly e"posure to a high carbohydrate diet predisposes an increased fat creation capacity in liver and adipose tissues and to the development of obesity later in life /J :utr )J1H 161-6, ),,13 7an increase in carbohydrate-derived energy during the immediate post-natal period in the rat leads to the onset of obesity later in life 9hronic hyperinsulinemia and accumulation of fat is adipose tissues, resulting from increased lipogenic capacity in these rats, ma&e this rat model uni>ue in enabling study of the role of neonatal nutritional e"perience on the development of obesity in adult life 7 /$nt J of =besity ),,1I)6,*,#-#-J3 Nramer found that breast feeding and delayed introduction of solid food protected against subse>uent obesity ,#? of the obese had not been breast fed /J Pediatr ),+) ,+H ++1-63 $n human, breast-fed infants are leaner than formula-fed infants at ) year 4he formula-fed infants were fatter because energy inta&e on high carbohydrate formula is higher /%m J of 9lin :utr ),,1I#6H)*--#3 David Pettit of the :ational $nstitute of Diabetes and Digestive and Nidney Disease in Phoeni" and colleagues studied 6J- Pima $ndians 4he 1J# who had been e"clusively bottle-fed weighed 7significantly7 more than those who had been breastfed 4hese results support the assertion of a Reader;s Digest article that breast feeding can 7'at Proof7 one;s baby /compared to formula feeding3 !eft unanswered is the >uestionH at what age should the suc&ling;s low carbohydrate diet evolve to the high carbohydrate diet currently favored by vegetarians and other low-fat diet evangelistsD $nsulin is the primary drive for the ma(or increase in hepatic and adipose tissue lipogenesis that occurs during the early dynamic phase of obesityI dietary carbohydrates increase insulin levels /Please refer to the discussions of adipose cell differentiation, reversion, and replication elsewhere in this document 3 @reast mil& contains human 8pidermal Growth 'actor /8G'3 /discussed above3, a potent inhibitor of obesity not present in infant formula and cow;s mil& 9hildren need dietary fat to insulate their nerve cells, prevent nerve crosstal& and brain damage 4here is concern that infant formula does not provide certain long-chain lipids necessary for good cerebral and retinal development /%cta Paediatr 5cand 5uppl 1F#H #+-F6, ),,-3 79hildren need fat and cholesterol for proper growth and brain development 9hildren under age two need fat and cholesterol every day - even if they loo& chubby @reast-fed babies get what they need from breast mil&, which draws #-? of its calories from fat 7 /@ottom !ine Personal 0arch )# ),,#3 8arly e"posure to cow;s mil& and solid foods in infancy increases the ris& of diabetes in genetically predisposed babies /D$%@8485 'eb ),,1H *JH J++-,#3

E11ECTS <1 <@ES T%

:ersonality :roblems
%s the causes of obesity become &nown, obesity is increasingly recogniCed as a cause of mental health problems rather than the result of mental problems =besity has been historically lin&ed to emotional factors by clinicians and the lay public ali&e 8arly psychiatric studies reinforced the popular perception that psychopathology is common among the overweight and plays an important role in the development of obesity 4his notion has been challenged by recent investigations which suggest that psychological disturbances are more li&ely to be the conse>uences than the causes of obesity 8motional difficulties faced by the obese may be largely attributable to an entrenched cultural contempt for the obese and a pervasive preoccupation with thinness /%nnals, :ew Bor& %cademy of 5ciences, ),+63 74here appear to be no global personality traits or profiles that are associated with obesity 7 /%m J of 9linical :utrition July ),,J3

2ealth :roblems
9orrelations between obesity and certain health problems have been widely reported in the media Joint problems and sleep apnea are generally recogniCed direct effects of obesity =besity causes problems in pregnancy =bese women have more cesarean deliveries, gestational diabetes, high blood pressure, and cesarean wound infections 4wice as many obese women;s babies re>uired convalescent or intensive care, compared to the newborns of lower-weight mothers =ver the centuries, these effects have selectively bred for thinness before today;s medical technology was available 4he effect of obesity on cardiovascular disease and diabetes is not well understoodI both may be mar&ers of basic underlying metabolic derangements 9ontroversy remains about the true cause and effect 4here is no agreement in the scientific community that dieting provides a long term health improvement 7 even though we li&e to believe that weight loss in the obese is accompanied by a reduction in the mortality rate, it is important to &eep in mind that no intervention study has yet dealt with this issue 7 /!etter to J%0% from @ouchard, Despres, and 4remblay3 0etformin, a drug that improves insulin sensitivity, improves glucose, lipid metabolism, and reduces blood pressure, left ventricular mass, cholesterol, triglycerides, and fibrinogen in hypertensive, obese women !evels of insulin, &nown to promote cardiovascular disease, dropped .eight was not affected, and sub(ects did not e"perience the usual diet side effects /D$%@8485 9%R8 ),,1H)FH)- )1+6-,-3 %n %ug # ),,- @@9 broadcast reported that the siCe of a baby relative to the siCe of the placenta had a greater correlation on adult blood pressure than the combined effects of weight or alcohol consumption % :orwegian study indicates moderate obesity /@0$ R 1#3 does not greatly increase mortality e"cept for diabetes /%cta 0ed 5cand, 5uppl 6J1I )6-J)3 5ome of the correlation between obesity and health problems may be caused by common factors 'or instance, DH8% and HGH help the healing process, help the immune system, bloc& autoimmune disease, hyperglycemia, and neoplasia, promote muscle buildup and fat loss 4he obese have much lower levels /order of magnitude3 of Human Growth Hormone /HGH3 and DH8% than normal sub(ects 0en with abdominal obesity have low testosterone values 0ice obesity genotypes are thought to promote various diseases $f both the obesity and poorer health result from common factors, only correction of the common factors will improve the patient;s health outloo& 8ven is there is no great health ris& from moderate corpulence, endomorphs would still wish for normal body composition simply because being fat in this society is an unmitigated bitch 5ome of the health problems associated with obesity result not from the obesity itself but from the effects of dieting %s reported in the ),,- House hearings on the diet industry, studies consistently show an increase in mortality with dietary weight cycling :one have shown an improvement in long term health outcomes from dieting 5ome obesity related health problems are the result of discrimination against obese patients by the medical establishment $nsurance companies discriminate against obese individuals, even those with no history of health problems $nsurance companies are forbidden to test applicants for H$A, a right of privacy not afforded to overweight applicants who are compelled to test and report their weight 4he obese often get substandard medical treatment $n one case, symptoms of allergy induced asthma /post nasal drip3 were attributed to obesity for several years, denying the patient effective treatment 0arginally overweight women are humiliated by male doctors $n one case, a surgeon 7called the patient a fat bitch7 and said 7people li&e this do not deserve to live and that the only e"ercise she probably got was wal&ing from the &itchen table to the

refrigerator 7 5imilar abuse was reported in a ),+1 :ova program $t is incumbent of the %0% and regulatory bodies to monitor this abuse and institute corrective measures 75ome doctors can be as cruel as &ids in a playground when faced with a fat patient 7 /0edical .orld :ews, 0ay ),,J3 4he University of Nentuc&y have a developed a course designed to correct the attitudes of doctors towards fat people /$J= ),,J )F, +#,-+F+3 7:ow that pre(udice against most formerly stigmatiCed groups has become unfashionable, if not illegal, one of the last acceptable forms of pre(udice is that against obese persons .hat is to be be done about this problemD 4he authors suggest the e"tension of the %mericans with Disabilities %ct to include the overweight, which would certainly be a beginning =vert discrimination against overweight people is only part of the problem, however, and we in the medical profession are among the cheif offenders .ho among us has not heard the horror stories told by obese persons about their treatment at the hands of insensitive and pre(udiced doctorsD 5tudies documenting our role in the stigmatiCation of obesity have been available for years =ur education has done nothing ot relieve this problem :ot only house officers but also medical students are clearly pre(udiced against obese persons 7 /8D$4=R$%!5, :ew 8ngland Journal of 0edicine, ),,)I1J,H)*I)-163

T$#8 T <+#L T$E#T"E+T

=besity prevalence estimates are virtually unchanged from the early ),F-s, according to the 9enters for Disease 9ontrol %s reported in the ),,- House hearings, there is no effective long term treatment for obesity

EXE$C SE
4he correlation between e"ercise and thinness is well &nown and firmly established in cultural and media stereotypes Aictims of obesity are criticiCed for not engaging in physical activities en(oyed by thin people @efore prescribing an e"ercise regimen for weight loss, one must consider obesity;s effect on ability to e"ercise and obtain pleasure from such activities =verweight people, and the more overweight the more of a problem, are limited in the amount of e"ercise that they can endure 4he lower athletic potential of obese individuals generally denies them the satisfaction of athletic success even if they manage to lose weight =bese individuals may be unable to attain altered states such as 7runner;s high7 4hese factors pose an alternative e"planation for the reported correlations between e"ercise and thinness Aery few studies have attempted to identify the causality of this correlation :o relationship was found between baseline physical activity level and subse>uent weight gain among either men or women Recreational physical activity reported at the baseline interview had little relationship to later weight gain 4here was little or no association between baseline physical activity and the ris& of becoming obese, but a strong association with followup physical activity /$nternational Journal of =besity ),,1H )6I J6,- +F3 $ndividuals vary widely in their metabolic response to e"ercise Reduction in body fat percentage varied from *,? to )? for sub(ects placed on the same supervised e"ercise regime A=J-ma" /liters2minute, a measure of fitness3 change varied from -? to )*? 4he differences in these responses were mostly genetic /%rteriosclerosis Aol +, :o *3 0esomorphs; favorable responses to e"ercise programs tend not to accrue to endomorphs 8ven after prolonged training program /F mo3, no pronounced effect on body fat was seen, whereas nonobese controls reduced their adipose deposit /0etabolism JFH1),, ),663 =bese sub(ects with fewer fat cells decreased in weight whereas patients suffering from severe obesity and an elevated number of fat cells even gained weight /0etabolism J+HF#-, ),6,3 4he fattening effects of e"ercise in hyperphagic obese may be e"plained by a post e"ercise peripheral tissue insulin resistance /Journal of 9linical 8ndocrinology and 0etabolism ),+, F+HJ *1+-*#3 74he poste"ercise recovery phase may be an important period during which energy-saving may occur in chronically undernourished sub(ects 7 /0ay 084%@=!$50 ),,1 *JH# #**-63 74he current low physical activity is possibly a result rather than a cause of higher body weight in old age 7 /$nt J of =besity, ),,J, p ),,3 %n $talian study found correlations between the children;s @0$ and their fathers; @0$ % significant correlation between @0$ and e"ercise was documented only in the group of girls Heavier boys didn;t get that way from lac& of e"ercise

% study conducted by the Physical 8ducation %ssociation Research 9entre and 5chools of 8ducation and Postgraduate 0edicine, University of 8"eter published in the July J+ ),,- @ritish 0edical Journal found 7:o significant relation was detected between the level of habitual activity and s&infold thic&ness in either se" 5imilarly, the children classified as overweight were not significantly less active than children who were not overweight 7 % 9harlottsville A% study in the ),,) $nternational Journal of =besity reportedH 7=bese and nonobese children had similar levels of physical activity and attitudes toward activity7 7%lthough many researchers and the lay press have argued that physical inactivity in children is strongly related to obesity and weight gain, the research is contradictory =ne should have e"pected that, in the better done epidemiological studies such as in 4ecumseh or in 'inland, a strong consistent relationship should be found between activity and obesity 4his was not found to be the case 7 /p #F1, Progress in =besity Research ),,-3 % 0innesota Heart Health Program study noted a significant increase in obesity from ),+- to ),+6 4he data did not lin& changes in energy inta&e, fat inta&e, e"ercise, or cessation of smo&ing to this increase /$nt J of =besity ),,) )#,*,,-#-13 $n a U9 Davis study, a high level of e"ercise /marathon training3 caused a modest weight loss, averaging 6 pounds when a permanent plateau was reached at + wee&s $n a three month 5wedish study of F- minute e"ercise to +- per cent of ma"imum capacity, obese men lost J , &g of body fat, an amount of 7borderline significance7 =bese women did not lose fat e"cept for some of the most obese sub(ects /$nternational Journal of =besity ),,), )#, 6#-+)3 =ther studies did not show an increase in weight loss when aerobic and anerobic e"ercise was added to A!9D /Aery !ow 9alorie Diet3 and other diet programs /7!ean @ody 0ass, 8"ercise and A!9D7, $nternational Journal of =besity /),+,3, )1 /suppl J3, )6-J# 3 7However, the addition of e"ercise does not affect total body mass loss % net loss of ''0 was observed in all groups, regardless of e"ercise modality Kincluding resistance strength trainingL 7 /%merican Journal of 9linical :utrition ),,JH ))IJH)#J-+3 5everal years ago it was widely reported that wor&ing out left one with an 7e"ercise afterglow7 for up to )J hours, during which body metabolism remained at least slightly elevated 0ore recent studies have shown that this effect re>uires a level of e"ercise attainable only by highly trained athletes 0oderate e"ercise does not increase the metabolism /@0R3 of obese sub(ects 8"ercise induces increased growth hormone levels in lean sub(ects 4he obese do not release growth hormone in response to moderate e"ercise $n obese sub(ects, fenfluramine partially restores GH responsiveness to arginine but not growth hormone releasing hormoneI fenfluramne may or may not restore GH responsiveness to e"ercise 8"perimentation to determine the optimum timing between fenfluramine doses and e"ercise is needed 7.eight loss does not readily occur in women unless accompanied by caloric restriction 'urther, the role of e"ercise in maintaining resting metabolic rate while dieting has only marginal support 7 /Journal of the %merican 9ollege of :utrition ),,1I)JH* 1F1-63 Neithf !ynch<f+ n)1# C) fidonet org has reported reading that individuals over J-? overweight should not e"ceed a pulse rate of - F Q /JJ- minus age3 4his guideline precludes robust e"ercise for the obese 8"ercise is generally credited with reducing cholesterol and triglyceride levels However, as reported in the =ctober )- ),,- Journal of the %merican 0edical %ssociation, it may not wor& for the overweight % J+ year old mildly overweight man went to a fitness center to begin an e"ercise program with the goal of losing )- pounds 4his man had recently had a physical in which the 7usual values were normal7 His fitness counselor put him on a e"ercise bi&e, a rowing machine, and then fast wal&ing on treadmill for a total of thirty minutes of vigorous e"ercise 4he ne"t morning he couldn;t get out of bed without help =n his ne"t visit to the fitness center, the fitness counselor advised him to repeat the e"ercise program, which he did 4he following day he was admitted to hospital with &idney failure 8mergency procedures restored his &idney function after )) days % long time later his blood pressure remains elevated, and he complains of headache, edema, and sleep problems His triglyceride and cholesterol levels are also elevated % U9 Davis study reports that rats sub(ected to an e"ercise regime reach plasma triglyceride and adipose !P! levels greater than sedentary controls within +* hours of e"ercise termination 4he lean sub(ects had mar&ed changes in lactate, pyruvate, ''%, and catecholamines, consistent with the need for rapid mobiliCation, upta&e, and utiliCation of carbohydrate and fet-derived fuels 4he responses of the obese sub(ects differed in insulin, ''%, glycerol, and, surprisingly, epinephrine 4he poste"ercise hyperglycemic hyperinsulinemic state was more intense in the obese sub(ects and associated with higher plasma ''% and blood glycerol levels %fter e"ercise, as in many other situations, obese sub(ects have insulin resistance /J of 9lin 8ndocrinology and 0etabolism ),+, F+HJ *1+-*#3

%n alarming study published in the $nternational Journal of =besity /),,JI)FI#),-#J63 reported 5hort-term e"ercise can reduce weight and fat gain in obese humans and animals However, the beneficial effects are not long-lasting %fter cessation of e"ercise, there was no difference in body weight, fat mass, and percentage body fat between e"ercised and sedentary =@ rats Unfortunately, the e"ercised rats had a significantly higher amount of internal fat and internalHsubcutaneous fat ratio $ncreased insulin sensitivity produced by e"ercise training has been reported previously, and this may be the cause of rapid fat gainI the same effect has been documented after dieting 'at cell :U0@8R5 in some areas were actually increased compared to the sedentary rats 4his increase in adiposity may pose health ris&s 5everely overweight sub(ects showed a #- per cent impairment in ''% K'ree 'atty %cidL mobiliCation in response to prolonged moderate e"ercise /level wal&ing3 4his energy shortfall was made good at the e"pense of a drop in blood sugar /causing tiredness3 and increase in lactate plasma /aching muscles3 4his represents a metabolic limitation on e"ercise by the obese /5ee 7fast fibres7 above 3 /),+1 $nternational Journal of =besity pp JJ)-JJ, 3 7.e tend to be thinner when we are young not because we consume fewer calories, but because we metaboliCe glucose more efficiently 7 /Aaldimie %nisimov 0 D , p JF, =ctober ),,- =mni3 9ontrary to the claims of 9able 4A ads, there is no clinical evidence of spot reducing from any e"ercise :early +- percent of the e"ercise e>uipment sold in the U5 will be used seriously for si" wee&s or less /Public Health 5ervice2 Good House&eeping ,2,*3 Unli&e diets, e"ercise-only weight loss programs have not been reported to result in weight rebound 4he small amount of weight loss may account for this 8"ercise induced weight loss is temporary, but will be maintained as long as the intensity of e"ercise is maintained 4he fragile bones of an old woman may develop early in a female athlete who pushes too hard to stay s&inny and e"cel in her sport 4hese women have developed eating disorders, pushed their endurance wor&outs too hard, or both -- and have ceased to menstruate 78"ercise can produce a modest gain of !ean @ody 0ass /!@03 and loss of fat in weight-stable individuals, but it is important to realiCe that if much weight is lost during e"ercise there is a ris& of erosion of the !@0 Data from both human and animal e"periments show that e"ercise cannot conserve lean weight in the face of significant energy deficit7 /!ead Review %rticle, :utrition Reviews #-IF June ,J3 7in older obese men, hypocaloric dieting combined with aerobic e"ercise does not attenuate the loss in fat-free mass that occurs during weight by hypocaloric dieting alone 7 /084%@=!$50 Aol *1 :o 6 July ),,* +F6-6)3 High dropout rates and the low rates of weight loss /- )* &g2wee&3 in e"ercise studies by @rownell and 5tun&ard indicate the difficulties encountered in the use of e"ercise for weight control !ong-term data are not available about the value of e"ercise in obesity 7)3 energy cost of e"ercise is minimal, J3 effects on thermic of food are negligible e"ercise may not prevent, and may even increase the fall of metabolic rate7 /%m J of 9linical :ut, 'eb ),,J3 $t is hoped that eventual progress in the treatment and prevention of obesity will allow more people to en(oy the pursuit of more active pleasures

8 ETS
74he high prevalence of obesity in affluent societies, coupled with an increasingly lean aesthetic ideal, has resulted in unprecedented rates of dieting 7 /$nternational Journal of =besity ),,-, )*, 161-1+13 Dieting is a natural idea given the obvious, if temporary, effects of famines and religious fasts 8nergy deprivation as a method of obesity treatment had changed little since Gree& anti>uity % supposition behind reducing diets is the conventional wisdom that overeating by the obese upsets the natural weight regulation en(oyed by the ma(ority of humans $t is incorrect to assume that people eat more now than in historical times 4he average calorie inta&e in the )1th century was up to #--- calories a day /Reuter3 $n distinction to the commonly accepted stereotype, research shows that the obese do not eat more than their lean counterparts $n addition, research has failed to demonstrate significant defect in obese sub(ects; hunger2satiety response to eating compared to that of lean sub(ects /$nt J of =besity ),,-,)*H J),-113 4here was no significant difference in energy inta&e at three months of age between babies of fat and thin mothers 4he findings can be compared with those in the strains of genetically obese rodents used as models of human obesity, in which the development of fatness precedes any increase of energy inta&e 7=ur findings suggest that the

most appropriate approach to preventing obesity in susceptible infants may be to increase their energy e"penditure, rather than decrease their energy inta&e 7 /:8J0 'eb J# ),++3 70ost people believe that the obese eat much more than other people, that this is the cause of their obesity, and that they could become lean and remain slender by eating 7normal7 amounts of food 4his belief is particularly resistant to change since it was the accepted scientific position for many years and since there is little opportunity for spontaneous revision of generaliCations about behaviors that show such great variability 8ven if it were possible for the average person to ma&e accurate observations of the habitual inta&es of fat and lean ac>uaintances, and to recall them without distortion, it would be hard to perform the re>uired arithmetic averaging operation in one;s mind $nstead, it seems, people recall the behaviors that fit their preconceptions, remembering the large inta&es of some obese people, while forgetting the modest inta&es of others $n fact, the best data available suggest that the obese, as a group, eat no more than the lean 7 /%merican J of 9linical :utrition 11H 'eb ),+- p *F#3 % number of studies compare the ratio of energy inta&e to some arbitrary measure of body parameters :ot surprisingly, the choice of body parameter to use in this 7normaliCation7 controls the outcome of the 7study7 5ome studies use fat free mass /whose definition and measurement is itself controversial3 for this normaliCation, ignoring actual body weight 5uch an intellectual maneuver should be reassuring to fat people who have been warned that their fat strains their body 74here should be no doubt that simply wal&ing, climbing stairs, or pumping blood through all of the e"cess tissue is a form of e"ercise 7 /$J= ),+,I)1IsJ )63 % study of energy re>uirements of dieting men found that replacing lost body weight with e>uivalent lead weights reduced the fall in energy e"penditure by more than #-? %dipose tissue is more active than either lead weights or many components of ''0, so normaliCations based on other than total weight must be regarded with cynicism 79anadian researchers who studied the eating patterns of +- women between the ages of 1- and 1+ found that smaller eaters weighed an average of )- pounds more than their larger-eating counterparts 5mall eaters in the study had an average of JJ per cent more body fat than the large eaters 7 /'), 4he =regonian, J2)*2,)3 70ean energy inta&es were not significantly different between the lean and fat individuals $t does not appear that the obesity is caused by overeating 7 /Journal of the %merican Dietetic %ssociation, ))2+F3 7!ess e"pected was the raised 5D5 KobesityL among those consuming recommended caloric inta&es 4his indicates that obese children have a higher, probably genetically determined, weight level than the non-obese population 7 /4he !ancet, %ug JF ),+,3 7KProfessionlL 0embers of dietetic associations do not appear to differ from the general public with regard to weight control Nnowledge is obviously not enough for the health professional or their clientele 7 /%merican Journal of 9linical :utrition, F2,J3 7.e found no significant relationship between obesity and the items documenting food consumption7 /$nt J of =besity ),,J, )F, #F#-#6J3 74he modest caloric inta&e of these men and the lac& of correlation per cent body fat and total calories suggest that calorie differences are not the ma(or causes of obesity in these men 7 /%merican Journal of 9linical :utrition, F2+F3 74here was no relationship between energy inta&e and adiposity7 /%merican Journal of 9linical :utrition, ,2,-3 7caloric inta&e per unit of lean body mass was constant regardless of the degree of obesity7 /Journal of the %merican Dietetic %ssociation, J2,J3 79omparisons of obese adolescents to normal peers have demonstrated comparable energy inta&e and nutrient distribution 7 /Journal of 5chool Health J2,J3 7:o significant G effect was found for daily energy inta&e, daily inta&e per &g body weight, and for any of the nutrient inta&e /g2day3 7 /Recent %dvances in =besity ResearchH A )F-J#3 7Rural sub(ects were leaner, suffered less from diabetes and hypertension, and generally had higher cholesterol levels 7 /J of the %merican 9ollege of :utrition, ),,J, p J+1-3 75tudies on habitual food inta&e have failed to observe any consistent differences between obese and lean sub(ects 7 /p +-, =besity and !eanness - @asic %spects3 78nergy inta&e was inversely related to the )J-yr incidence of myocardial infarction 4he correlation was independent of age, obesity, smo&ing, serum cholesterol, triglycerides, diabetes, systolic blood pressure, and physical activity :o correlation was found between dietary inta&e and incidence of stro&e or overall mortality, nor was any correlation found between end-points and inta&e of fish, energy percentage from fat, protein, and carbohydrates 7 /%m J of 9linical :utrition, =ct ),+F3 7the mean inta&e by the overweight sub(ects was less than that of the controls 'ood inta&e has declined over the past decade when body weight and presumably fat stores have, on average, increased 'rom the epidemiologic data, it appears that increased caloric inta&e in the population can not e"plain the positive energy balance KobesityL observed in adult life in the United 5tates, the :etherlands, or 5weden /7Diet and HealthH $mplications for reducing

chronic disease ris&7I 9ommittee on Diet and Health 'ood and :utrition @oard 9ommission on !ife 5ciences, :ational Research 9ouncilI :ational %cademy 9ouncil, .ashington D 9 3 7the following aspects of weight are myths rather than realityH /a3 4here are ob(ective definitions of obesityI /b3 obesity is prevalent among womenI /c3 obese people ta&e in more calories than the nonobeseI /d3 dieting is an effective way to reduce weightI /e3 obesity is related to poor physical health 7 /J of Psychology, Jan ),,-3 7Discrepant findings in the literature concerning relationships between obesity and energy inta&e may be e"plained by reporting error and by the relative lean mass of obese vs nonobese women but not by systematic underreporting uni>ue to obese sub(ects 7 /%m J of 9linical :utrition 'eb ),+,3 7@ody mass inde" did not correlate with either current energy inta&e or energy e"penditure 5mo&ers and drin&ers had lower age-ad(usted levels than non-smo&ers and abstainers 5ince the e"cess body mass inde" levels associated with low socioeconomic status in women could not be e"plained after controlling for adverse health behaviors, further epidemiologic study of ris& factors for obesity in @lac& women is recommended 7 /%merican J of Public Health, Jun ),,J3 .e believe that eating behavior is more li&ely a secondary phenomenon, rather than a primary event in its etiology 4he growing understanding of cellular physiology and biochemical genetics coupled with the repeated failures of dietary and behavioral forms of treatment spea& for obesity being a disease of un&nown etiology in which food inta&e is but lin& in a comple", causal chain /.estern Journal of 0edicine =ct ),,-I )#1I*J)-*J+3 Aarious techni>ues have been used to enforce diets, including appetite reducing drugs and surgical modification of the digestive system /balloons, staples, bypass, etc 3 :one of these has proven to improve the basic dynamics of the diet 0any have serious side effects beyond that of the diet itself, including immune system problems caused by low cholesterol levels !ean and obese female Puc&er rats were intermittently semistarved during their first 1J wee&s of life, then fed ad libitum 7long-term caloric restriction during development appears to be effective in suppressing dietary obesity in animals that do not have a genetic predisposition to obesity, it appears not to be effective in animals that have a genetic predisposition to obesity 7

SL<W 's $#: 8 Weight Loss

5ince the body adapts to low calorie diets /!9D3 by minimiCing weight loss, very low calorie diets /A!9D3 were developed @ut even with the most advanced versions of these diets, proteins are not totally spared, particularly during the early wee&s of dieting $t appears that a factor enables ground s>uirrels to lost large amounts of fat without losing lean tissue /$JP ),,* )+, 1#)-13 9ontroversy abounds about the efficacy of rapid vs slow weight loss 0any studies addressing this issue are flawed by sample selection problems 5lightly overweight sub(ects on mild diets do not reagain as much weight as massively overweight sub(ects placed on more stringent diets Results are different when sub(ect selection is randomiCed 5ub(ects on )J-- calorie and +-- calorie A!9D type diets had the same ratio of fat loss to lean tissue loss 4he ma(or effect of slowing the rate of weight loss was prolongation of the need to diet Diet induced metabolic slowdown was a direct function of the amount of weight lost and nothing else /$nternational Journal of =besity ),+,, pp )6,-)+)3 Prolonged energy restriction reduces metabolism both by reducing lean tissue and by a reduction in o"ygen consumption of the residual active tissue mass /0ay 084%@=!$50 ),,1 *JH# #**-63 5mall doses of 41 /thyroid3 during weight reduction prevented R0R reduction in obese women /#th 8uropean 9ongress on =besity )--)J June ),,J3 $t does not appear that fasts are more difficult than moderate diets for many patientsI indeed, many report considerably less hunger and a sense of well being /%merican J of 9linical :utrition 11H 'eb ),+- p *F+3

@E2#! <$ "<8 1 C#T <+

74he third aspect of treatment is maintenance of a stable caloric inta&e $t would seem that if anything has been clearly established in the research on behavioral treatment of obesity, it is that weight maintenance can be achieved with this therapy 4he shortcoming of behavioral programs has been the small losses achievedI the record of maintenance is, by contrast, impressive $t should be noted that behavioral programs do not really have to contend with the problem of refeeding since the losses are usually >uite small and achieved with minimal restriction 7 /%merican J of 9linical :utrition 11H 'eb ),+- p *F,3

8iet Side Effects

$f you;re genetically lean and otherwise healthy and active, there;s nothing wrong Kwith being leanL $f you;re lean because you;re smo&ing, drin&ing or seriously dieting, there are some ma(or problems /Dr 9alloway, .5J )-2J)2,#3 % common result of reducing diets is weight regain ,# per cent regain all the lost weight within # years 4homas .adden Ph D , paid =ptifast researcher and Director of the .eight and 8ating Disorders Program at the University of Pennsylvania in Philadelphia estimates the long-term success rate for dieters not involved in clinical weight loss programs may be as high as F- per cent /'amily 9ircle F2*2,F, *+3 Robert Jeffrey and colleagues recently tried to study women who had maintained long term weight loss 4hey studied women from the general population, not limiting their study to participants in weight loss programs =ut of 1---- women studied, only )-- had lost significant weight and &ept the weight off ,, 6 per cent did not %t least a third of women have tried to lose weight, so it is appropriate to ad(ust this - 1 per cent figure to reflect only those who have tried to lose weight Unfortunately, ad(usting this - 1 per cent figure still yields a success rate of one per cent /)?3 or less /U 5 :ews S .orld Report, )2+2,F3 4o see what dieters must do to &eep weight off, Dr 0ary Nlem of the University of Pittsburgh and researchers from the University of 9olorado started the :ational .eight 9ontrol Registry of long-term weight losers 5he reported the results in =ctober ),,F at a meeting of the :orth %merican %ssociation for the 5tudy of =besity %mong this small group of long term dieters, weight loss was maintained only by continued semistarvation %verage daily calories were ),J,6 for women and ),6J# for men 4his is hardly a normal lifeI many weight loss diets allow more food % 5wiss study compared various diets; effects on weight regain !ow caloric inta&e induces an adaptive increase in metabolic efficiency $ts persistence after slimming is an important factor in the ease with which the obese condition is regained %fter body fat is reduced by feeding a low calorie diet, refeeding a similar caloric inta&e as weightmatched controls over a J wee& period results in a )#-J-? lower energy e"penditure, 1-fold increase in the rate of fat deposition, and a doubling of energetic efficiency $socaloric diets varying in protein content /+-*-?3, fat content /#-##?3, differing fat types, and carbohydrate types were tested in search of an effective weight maintenance regimen 4he elevated energetic efficiency during refeeding was partially reduced by low protein diets .eight rebound was unaffected by the type of fat or the type of carbohydrate Provided the diet provided ade>uate protein and did not e"ceed 1# per cent fat, no diet, including low fat, had an impact on the post weight loss reduction in energy e"penditure that facilitates weight rebound Refeeding was associated with a metabolic adaptation during which all of the fat lost during restricted feeding was subse>uently deposited as body fat 5tudies in both obese rats and obese humans show that fat superaccumulation with refeeding after energy restriction is a ma(or factor contributing to relapsing obesity so often observed in humans 4he liver seems to be particularly prone to reaccumulate fat stores after refeeding Gualitative indication of super lipid accumulation in the liver after refeeding may be important in rebound obesity in humans after weight loss on A!8Ds /%m J 9lin :utr ),,1I#6H+#6-FJ3 %n $talian study /)P-))#3 indicates obese sub(ects with high insulin and triglyceride levels are more resistant to diets Dieting does not reduce the number of fat cells, even in sub(ects carrying ten times the normal number $n fact dieting can increase the number of fat cells $n a 5wiss study of lean and obese rats, reduced energy e"penditure /883 of obese rats with limited caloric inta&e resulted mostly from metabolic slowdown not related to reduction in lean body mass or activity levels 4his metabolic slowdown continued after the obese rats returned to normal caloric inta&e /eating the same as lean rats3 and regained the weight they had lost /$nternational Journal of =besity ),,), )#, 6-)F3 9orticosterone induced inhibition of thermogenesis is suspected Diet induced metabolic slowdown has two aspectsH Resting 0etabolism Rate /R0R3 and Diet $nduced 4hermogenesis /D$4324hermic 8ffect of 'ood /48'3 4he definitions and methodology for measuring and interpreting data on metabolism rates are not standardiCed, and it is no surprise that studies on diet induced decline in R0R are highly controversial 'urthermore, R0R studies may not distinguish between sub(ects in the depressed energy balance of weight suppression maintenance and sub(ects regaining lost weight Until this these flaws are satisfactorily resolved, studies of R0R must be approached with the greatest of caution % recent paper in the %merican Journal of 9linical :utrition concluded that conflicting results that did not detect diet induced drop in R0R might be due to defects in their body composition assessment methods 5ome studies that did not report diet induced metabolic slowdown were made on sub(ects who had already started weight regain, and

were thus at a higher R0R than those losing or maintaining weight 7'urther studies are re>uired to investigate mechanisms of metabolic adaptation to hypocaloric diets because the phenomenon itself appears to be an established fact 7 5tudies of D$4248' consistently report a metabolic slowdown with dieting not accounted for by the loss of muscle tissue 5tudies that do not report diet induced metabolic slowdown may be measuring the post-diet metabolism while sub(ects are actively regaining weight =ne study that did not ma&e this mista&e recorded a J6 per cent drop in weight stable caloric inta&e from J+ , to J) # &cal2&g per day as the )6#-J6- pound sub(ects lost a modest Jpounds /Journal of 9linical 8ndocrinology S 0etabolism ),+63 Past studies that support or deny the e"istence of an adaptive metabolic component contributing to the low 88 /metabolic slowdown3 during chronic underfeeding have been inconclusive in e"perimental designs and data interpretations 4he magnitude of the fall in 88 during low calorie inta&e is similar to that recently shown to occur after slimming of grossly obese mice, as well as that reported in post-obese human sub(ects maintaining body weight on a restricted inta&e of food 4his increase in metabolic efficiency may be important in the rapid relapse of obesity after slimming /$J= ),,1 )6, ))#-J13 7!ow and very low calorie diets have a common aimH to provo&e a negative energy balance in order to diminish energy stored in adipose tissue 4he purpose of people using them is less esotericH to lose weight and to provo&e morphological changes with the hope that this in turn will improve their health, their loo&s, and their se"ual status %s a rule, the aim succeeds and the purpose fails %daptative changes in energy e"penditure are the most intriguing feature .hen the level of 41 is artificially maintained by an ade>uate addition of 41, the nitrogen balance is not modified and the @0R remains at its baseline level 7 /$J= ),,1 )6 /5uppl )3 5)1-F3 7%daptive changes in metabolic rate in response to low caloric inta&e relies on comple" and highly redundant read(ustments of the thermoregulatory system including both behavioral and physiological regulations, and acting on both heat loss and heat production $t contributes to the rapid replenishment of fat stores as soon as an ade>uate amount becomes available again $t thus has a survival value in subsistence societies societies $n affluent societies it is a source of despair for the obese and of fortune for the authors of slimming programs 7 /$J= ),,1 )6 /5uppl )3 51-5+3 Dieting enhances or creates a fattening effect of some drugs Propanolol reduced the metabolic energy e"penditure of reduced-obese women but not that of nonobese women /%m J clin :utr ),,JI#FIFFJ3 4he value of the postabsorptive RG /Respiratory Guotient3 may be a predictor of relapse of weight gain %fter discontinuation of the low energy diet, an elevated RG shows that the endogenous lipid o"idation is low, a condition favoring weight gain 4his study confirms the great variability in the amount of weight regained after the cessation of a low-energy diet /%m J 9lin :ute ),,1I#6H1#-*J3 0any dieters e"perience unpleasant side effects 4he severity of side effects tends to be less for younger sub(ects and those whose weight gain was caused by overeating Ris& of cancer from to"ic chemicals released from fat cells during weight loss /5cience :ews 0ar )# ),,63 /9ancer Reseatch 0ar ) ),,63 5ubstantial impairment of cognitive performance, 1- per cent and worse accuracy reduction on a standardiCed cognitive tas& 4he cognitive impairment was related to the degree of weight loss Heart rate immediately before and after testing was lowest in the current dieters with high weight loss !owered heart rate is typical of a chronic state of undernutrition /Proceedings of the :utrition 5ociety ),,JH #), 1*1-#)3 =ne would hope mental performance would recover after weight loss, but this is not guaranteed % study reported in the 0ay J* ),,6 5cience news found a worsening of reaction time by dieters that accelerated during weight maintenance 5ome have reported e"periencing various problems related to their nervous system that resolved with an increase in fat consumption %ggression and suicide !ipids account for about half the dry matter of the brain 0on&eys on a low fat diet were significantly more aggressive than were controls on a normal diet $n si" R%:D=0$58D, 9=:4R=!!8D primary prevention trials, there was a significant increase in mortality due to suicides or violence 9ompared with control groups, the treated groups had J+ fewer deaths from 9HD and J, more deaths from suicide, homicide, and accident %dolescents are thought to be more susceptible to these effects $nterventions to reduce cholesterol concentrations on a large scale could lead to a population shift to a more violent pattern of behaviour, which would result in more aggression, more abuse of children and partners, and generally more unhappiness /!ancet 11,H 0arch J) ),,J, p 6J63 % number of studies confirming the lin& between low choesterol and mood changes have been reported in 5cience :ews

/12))2,#Hp )#6, ,2J)2,FH)+*3 !ow levels of DH%, a long-chain omega-1 fat, may e"plain the depressing effects of low-fat diets /5cience :ews ,-J-),,#3 5chiCophrenia Depressed levels of certain fatty acids have been observed in patients with schiCophrenia 4he preliminary evidence for clinically effective dietary manipulation to correct such an abnormality opens up novel and e"citing therapeutic possibilities /!ipids, ),,F 0ar, 1) 5upplH, 5)F1-#3 Radical low fat diets deplete the body of essential fatty acids, and should not be used during pregnancy or lactation 4he same concerns apply to childhood 9old $ntolerance 79old intolerance is a significant problem aggravated by dieting in morbid obesity 7 5uccessive restriction and refeeding resulted in a defect in the utiliCation of energy inta&e, facilitating the development of obesity /%merican Journal of 9linical :utrition ),,*I#,I#---#3 !ac& of energy $t has been reported that in the case of low carbohydrate diets, this condition resolves in a few wee&s after the body ad(usts to the diet =thers report increased energy on low carbohydrate diets !ea&y Gut 5yndrome may be caused or aggravated by high carbohydrate diets !ow pulse rate and blood pressure =ne symptom of low blood pressure from metabolic slowdown is diCCiness when abruptly arising from a chair /postural hypotension3 :ormally, low resting pulse rate and blood pressure indicate a healthy body Dieters and their doctors re(oice when energy deprivation lowers their high blood pressure and heart rate readings Unfortunately, these lower numbers do not imply better health when lower pulse rate and blood pressure result from diet induced metabolic slowdown and not cardiovascular improvement !owered heart rate is typical of a chronic state of undernutrition /Neys et al, 4he @iology of Human 5tarvation3 0enstrual Difficulties @rusing is sometimes enhanced $t has been corrected with increased vitamin 9 and bioflavonoid supplements !eg cramps have been reported Using potassium salt instead of table salt helps 5o do potassium supplements Beast $nfections /%ssociated with high 9H= diets3 Dr %t&ins claims that high carbohydrate diets promote 9andida %lbicans overgrowth /7yeast infections73, which can interfere with weight management !ab tests identified this condition in a third of his patients % low carbohydrate diet often controls yeast infections 'luid Retention 9onstipation 9onstipation may be helped if you drin& a lot more water, ta&e more vitamin 9, and add psyllium, fla"seed, or other fiber supplement to your diet Dry mouth 5leep Disruptions /difficulty falling asleep, e"cessive sleepiness, disturbed sleep, vivid dreams3 Gout % few people report flareups of gout associated with &etosis =thers report alleviation of gout symptoms # mg per day of folic acid twice a day has been reported to control gout 5tomach Distress Hair loss /ironT@-vitamin supplements may help3 /4hyroid treatment may help3 =ne correspondent reported hair loss provo&ed by a fen2phen diet regime was corrected by switching to an %t&ins diet Ridged :ails /low fat diet vitamin or mineral deficiency3 %dding fats and oils to the diet has been reported to correct this DiCCy spells .ea&ness Headaches /mostly women3 Hot flashes 4he reduction in adipose tissue from dieting may accelerate the drop in estrogen levels =ne individual reports DH8% supplements greatly reduced her symptoms Depression /as measured in standardiCed tests3 9ollagen generation as low as #? of normal /9ollagen is the ma(or protein of all connective tissues, a shortage of which is believed to cause wrin&les, etc 9ollagen production is necessary for wound healing and normal growth 3 4his might e"plain the degraded appearance seen in some dieters 0emory problems % !ondon conference held by the @ritish Psychological 5ociety heard that people who fight the flab can become forgetful and have difficulty performing simple tas&s Until now scientists had thought only people with anore"ia nervosa, the slimmer;s disease, suffered mental impairment as a result of chronic undernourishment

Diet induced metabolic changes include an increase in lipoprotein lipase /!P!3, an enCyme that stores fat in fat cells by brea&ing down triglycerides in the blood /Defects in !P! cause a wasting of fat tissue and high triglycerides 3 !P! levels drop during the first few wee&s of dieting, a time when when blood lipids often increase Depending on the study, !P! levels remained normal or depressed for some time 5ub(ects with @0$ R 1# or who lost less than )J? of their initial body weight did not show mar&ed increases in !P! @ut in the more obese sub(ects, !P! rose to J# times normal, and remained elevated for at least F months 4he fatter the person was to begin with, the more of the fattening enCyme they produced after weight loss Nern;s paper sheds insight on many issues related to the varied outcomes different people have to dietary weight cycling /:ew 8ngland Journal of 0edicine, Aol 1JJ :o )#, %pr )J ),,-3 /5ee alsoH 0etabolismH 9linical and 8"perimental, Jul ),+63

%dipose cells have different receptors for storing and releasing fat .eight loss diets worsen the ratio of fat cell receptors, promoting weight gain %uthor;s weight history in @0$ showing massive weight rebound after a hospital resident doctor supervised weight loss program % common side effect of dieting is the loss of lean tissue 5ome lean tissue loss is considered acceptable because the lighter body;s muscle needs are less 4he low levels of growth hormone characteristic of obese persons impedes the body;s regeneration of lean tissue 4his may be a factor in the adverse health effects of repeated weight loss Human Growth Hormone in(ections increase fat loss and drastically reduce lean tissue loss during dietary restriction /J of 9linical 8ndocrinology and 0etabolism, ),+6, p +6+3 !ipoprotein lipase /!P!3, which increases dramatically during dieting, appears to increase the formation of low density lipoproteins in arterial walls /foam cell formation3 !P! may enhance the interaction of plasma low density lipoprotein with arterial chondrotin sulfate protoglycan and dermatan sulfate protoglycan and thus facilitate low density lipoprotein retention in the artery wall /J of !ipid Res ),,1I1*H))##-F13 Dieters need drugs to suppress the e"cessive amounts of !P!, glucocorticoids, and runaway fat cell proliferation triggered by energy deprivation and dietary weight cycling 4he e"perimental drug !B6,66) has reduced post diet weight rebound in rats by about J- per cent %nother side effect of dieting is bloating % dieter with stomach distress may thin& she is overeating when in fact she is nearly e"periencing slight symptoms of bloating caused by dieting @loating is rarely discussed in diet boo&s, but is familiar to doctors wor&ing with famine victims 8"treme cases of bloating with distended stomachs are sometimes seen in 4A documentaries of famine, the ultimate hypocaloric diet % good guide to diet side effects /with recommendations for some3 may be found in %ppendi" 9 of 74he new, revolutionary Underburner;s Diet, How to Rid Bour @ody of 8"cess 'at 'orever7 by @arbara 8delstein 0 D /c ),+63 % study in the :ovember ),,* issue of the Journal of %bnormal Psychology shows a direct lin& between media e"posure and eating disorders such as bulimia and anore"ia nervosa %n important side effect of caloric restriction is the binging rebound Diet evangelists tal& of food as a substitute for love and other putative psychological upsets being a cause of binging 0ore commonly binging is a natural biological response to starving $t rarely appears in non dieting individuals @inging is part of the body;s set point servo system response to energy shortfall %nimal and human deprivation studies consistently demonstrate a period of mar&edly increased caloric input that tapers off as the body recovers from starvation $n one study of binging, the fre>uency of binges and the number of calories eaten appro"imated the diet;s caloric deprivation, resulting in a near normal overall energy balance Diet induced binging may be important in the onset of adipocyte hyperplasia associated with dietary weight cycling 4raditional wisdom on weight regulation holds that overeating and binging lead to obesity $n fact the reverse relationship e"ists, with dieting causing eating disorders 7dieting, rather than binging, is the disorder professionals should be attempting to cure 7 /Journal of 5chool Health, %ug ),+,3 % definitive study on the sub(ect appeared in the $nternational Journal of =besity @inge eating almost disappeared after weight normaliCation by biliopancreatic diversion surgery $f binge eating were a mental problem, the

surgically induced weight loss would not effect the binge eating $n most cases binge eating is not related to to neurotic personality, psychological distress, low self esteem or emotional instability Rather, the dissatisfaction with one;s shape and the continuous attempts to lose weight by chronic and strict dieting are the main factors compelling patients to binge /$J= /),,F3 J-, 6,1-*3

Eat "ore to Lose 1at

$ndividuals unable to build muscle or lose fat on an aggressive diet2e"ercise regimen have reported success when they increase their energy inta&e 4he number of such anecdotal reports reports suggests that a metabolic starvation protection mechanism was interfering with the weight loss one would normally e"pect from energy restriction $t may be relevant that studies of pre-obese children indicate lo)er energy inta&e /they eat less3 than lean counterparts $t has also been reported that some women cannot reduce their 7love handles7 e"cept when lactating

Weight Cycling
'or almost all dieters, starvation is not a normal state, and, unfortunately, neither is the associated weight loss 0any repeatedly attempt to shed their unwanted poundage 0any overweight people complain that dieting cycles cause net weight gain 4hey report e"cessive but relatively stable weight, e"cept during dieting and subse>uent weight regain 7with interest7 =n the surface, animal studies of dietary weight cycling are contradictory, but there does seem to be a unifying conceptH dietary perturbations increase the body;s resistance to future perturbations in the same direction .hen obesity is forced by overeating, cycles of weight fluctuation do not increase fatness .hen rats are dieted below their set point, weight cycled rats regained weight more rapidly, regained more weight, but ate no more food than non cycled rats /$nt J of =besI A)JI :F3 $n humans, weight rebound induced by dietary weight cycling is clinically used to add fat to underweight patients who cannot to gain weight by overeating 5uccessive restriction and refeeding resulted in a defect in the utiliCation of energy inta&e, facilitating the development of obesity /%merican Journal of 9linical :utrition ),,*I#,I#---#3 $n 7Aariability of @ody .eight and Health =utcomes in the 'ramingham Population7, sub(ects with larger weight fluctuations had mar&edly higher @0$s and, what;s worse, a higher slope of @0$ increase over time /@0$2year3 /: 8ngl J 0ed ),,)I 1J*I )+1,-**3 % study of wor&ers at .estern 8lectric;s Hawthorne .or&s in 9hicago also reported higher @0$ in weight cycling men /Hamm et al !arge fluctuations in body weight during young adulthood and J#-yr ris& of coronary death in men %merican Journal of 8pidemiology ),+,, )J,H1)J-1)+3 $n a ),+F Dutch study, men who e"perienced many life events in a short period showed a gain in body mass % year later this weight gain had disappeared in almost all subgroups of these men 4he e"ception was the subgroup that tried to lose weight by dietingI those who dieted had gained more weight /$nternational Journal of =besity /),++3, )J, J,- 3 7.e have compared the body composition of obese women who only once lost no more than )- &g, with a similar group of women who have had two or more cycles of weight loss and regain of more than )-&g %ll weight losses were obtained on energy restriction by conventional diets 4his retrospective study clearly demonstrates that the Udieters; had significantly lower lean body mass and more fat per &g body weight than non-dieters 7 /$nternational Journal of =besity /),+,3 )1 /suppl J3, J6-1)3 $n a landmar& study of the dieting loss-regain cycle, Drenic& et al /),F*I J%0% )+6H)---)-#3 and Johnson and Drenic& /),66I %rch $ntern 0ed )16H)1+)-)1+J3 placed sub(ects on fasts %s with other types of diets, sub(ects with childhood onset obesity had the most trouble /poor weight loss, side effects3 with the fast %t the conclusion of the fast, most of these patients maintained their weight loss for about a year Half the sub(ects regained all their weight within two or three years, and almost all had regained their weight by , years Patients with adult-onset and childhood-onset obesity gained weight at the same rate Regain beyond original admission weight /weight rebound3 was more common among the childhood-onset obese /*J?3 than adult-onset obese /JF?3 8ighty per cent developed diabetesI half of these cases were severe Patients at a weight loss clinic lost J ) pounds a wee& on the second bout of dieting compared to 1 ) pounds per wee& the first time 4his pattern also held true for a group of hospital inpatients whose food inta&e was carefully controlled

=bese rats too& J) days to lose their e"cess weight during their first cycle of food restriction, but too& *F days on the second cycle 4he cycled animals showed significant increases in food efficiency /weight gain2calorie3 in the second cycle /Physiol @ehav ),+FI1+I*#,-F*3 @ulemic patients with an average weight cycling of )6 &g had significantly lower metabolism than age, height, and weight matched controls /%rch Gen Psychiatry ),,- *6H)**-+3 %n increase in the sensation of hunger and overeating after a period of chronic energy deprivation can be part of an autoregulatory phenomenon attempting to restore body weight 4o gain insights into the role of fat and lean tissue depletion as determinants of such a hyperphagic response in humans, we reanalyCed the individual data on food inta&e and body composition available for the )J starved and refed men in the classical 0innesota 8"periment after a shift from a )J-w& period of restricted refeeding to an ad libitum refeeding period of + w& 'or each individual, the following were determinedH 13 the total hyperphagic response during the ad libitum refeeding period, calculated as the energy inta&e in e"cess of that during the prestarvation /control3 periodI 23 the degree of fat recovery and that of fat-free-mass /''03 recovery before ad libitum refeeding, calculated as the deviation in fat and ''0 from their respective prestarvation values /ie, the amount of fat or ''0 before ad libitum refeeding as a percentage of fat or ''0 during the control period3I and 33 the deficit in energy inta&e before ad libitum refeeding, calculated as the difference between the energy inta&e during the period of restricted refeeding and that during the control period 4he results indicate that 13 the total hyperphagic response is inversely correlated with the degree of fat recovery /r V -- F3 as well as with that of ''0 recovery /r V -- #3, 23 the correlation between hyperphagia and ''0 recovery persists after ad(ustment for fat recovery, and 33 the correlations between hyperphagia and fat recovery or ''0 recovery persist after ad(ustment for the variance in the energy deficit during the preceding period of restricted refeeding 4a&en together, these results in humans suggest that poststarvation hyperphagia is determined to a large e"tent by autoregulatory feedbac& mechanisms from both fat and lean tissues 4hese findings, which have implications for both the treatment of obesity and for nutritional rehabilitation after malnutrition and cache"ia, have been integrated into a compartmental model of autoregulation of body composition, and can be used to e"plain the phenomenon of poststarvation overshoot in body fat Am J Clin Nutr ),,6IF#H6)6-J1 Abdul G Dulloo, Jean Jacquet, and Lucien Girardier Department of Ph siolo! and Computer "nit #acult of $edicine "ni%ersit of Gene%a, Gene%a, &'it(erland %ddress reprint re>uests and correspondence to abdul dulloo unige ch Diet evangelists cite a number of studies which found no serious bad effects from weight cycling $n one, a short term study of U 5 high school wrestlers who diet to 7ma&e weight7 for matches reported that weight and metabolism returned to normal after the wrestling season :o long term followup was performed on these athletic mesomorphs who only lost a small amount of weight for very short periods 4hese elite athletes never met several of the conditions that trigger lipoprotein lipase /!P!, the 7fattening hormone73 overproduction in real world dieters 5ubse>uent studies have not noted impaired metabolism in the wrestlers who 7dieted7 to ma&e weight %n incidental, but critical, finding of one investigation, was that in the minds of these athletes dehydration and dieting were synonymous 4heir use of the word 7diet7 is in association with weight loss, not food restriction 4heir 7diets7 lasted but two days, and only a few restricted food inta&e during this period /0edicine and 5cience in 5ports and 8"ercise, ),,JI )J6--#3 Diet evangelists are >uic& to assert that since the diets they recommend differ in one detail or another from the fasts used by Drenic& et al, their diets will not provo&e the same horrific long term results 4here are few controlled studies comparing the safety and effectiveness of different types of diets, but those that have been made found no advantage to slowing the rate of weight loss 8"periments show that fat cells ta&en from massively obese sub(ects have much greater mitogenic /spontaneous cell replication3 activity than cells ta&en from lean sub(ects 7.hen mature fat cells from massively obese persons give up their fat and revert in culture to forms similar to preadipocytes, they replicate significantly more rapidly than analogous cells from the lean 4he reverted cells, therefore, retain the ;memory of their roots;, indicating an inherent property of these cells 7 Prolonged nutrient energy restriction would lead to reversion of mature fat cells 4his process would be increased by regular e"ercise .hen the sub(ect stops starving, the inherited program for e"cessive replication and differentiation creates even more fat cells 4hus, each diet cycle would lead to an even greater number of mature /large3 fat cells, resulting in stepwise progression of massive obesity /$nternational Journal of =besity, ),,-, )*, )+6-),J3 0ature /full3 fat cells cannot replicate, but 5ugihara has suggested that mature fat cells that have released their triglycerol as a result of dieting regain cell division ability /Journal of !ipid Research J+, )-1+-)-*#3

4he data of @(orntorp and 5(ostrom /084%@=!$50 AJ-I6I6-13 show a greater than )- per cent increase in fat cell numbers from a single diet2partial regain cycle in some sub(ects with many fat cells 'at cell numbers increased both during dieting /#?3 and again during regain /#?3 5ub(ects with fewer fat cells /normal range3 did not e"perience this increase in fat cell numbers 4he normal range is mar&ed by the crosses at the lower left of the chart above % paper appearing in 4he %merican Journal of 9linical :utrition found 7all three measures Kof weight cyclingL were significantly related to @0$ /P R - -)3 7 /%m J 9lin :utr ),,JI##IF*)-*3 $n 7.eight cyclingH the e"perience of human dieters7, @lac&burn et al found a metabolic effect of dietary weight cycling, with slower rates of weight loss on a second diet 4he .adden2=ptifast study on dietary weight cycling found a statistically significant correlation between dieting history and weight, @0$, fat mass, waist siCe, and hip siCe 4he .adden2=ptifast study attempted to refute the @lac&burn study by reporting that high diet cyclers lost weight as rapidly as low cyclers Unfortunately, the high cyclers had three times the e"cess fat of low cyclers :ormally weight loss on a diet is strongly correlated with initial fatness, but .adden;s high cyclers, with three times the e"cess weight, only lost the same as the much thinner low cyclers .ith half of their e"cess fat still remaining, .adden;s high cyclers reached a plateau and stopped losing weight on a )--- calorie diet /%m J 9lin :utr ),,JI#FIJ-15-+53 4he 'ramingham study also found weight cyclers to be much fatter 4o add in(ury to insult, dietary weight cycling may be bad for one;s health .eight cycling by dietary means may have a role in the development of chronic disease % study by Jeffrey, .ing, and 'rench published in the %merican Journal of 9linical :utrition 7ad(usted7 /fudged3 the health ris& data to 7account7 for the increased fatness of the diet cyclers 4his inappropriate data ad(ustment /$D%3 is barely mentioned and never (ustified in the paper 4his ad(ustment is unwarranted in light of the observation that 7without effort to diet, weight changes tend to be small over long periods of time7 /.estern Journal of 0edicine =ct ),,-I )#1I*J)3 %d(usting for current weight begs the >uestion that dietary weight cycling increases obesity %pplicants e"periencing negative health outcomes associated with weight cycling were e"cluded from the study %s an alternative to such e"ercises in manipulation, ad(usting for weight history before the sub(ects; first diet would be credible 4his and other studies that 7ad(usted7 for weight gain did not report adverse results of weight cycling besides those commonly attributed to the e"cess weight from weight cycling 4hese negative studies are discussed in 7Aariability of @ody .eight and Health =utcomes in the 'ramingham Population7 by !issner et al .ith a cohort of #)J6 and more detailed medical records, the !issner study of the 'ramingham population supersedes the earlier, smaller, and more idiosyncratic studies % newer study reported weight loss in ),F1-),F+ coincided with an increased incidence of coronary heart disease and diabetes mellitus and a declining level of serum total cholesterol /%merican Journal of 8pidemiology )*+/F3H#*F-##, ),,+ 5ep )# 3 .ith billions of dollars in diet sales and product liability litigation at sta&e, diet evangelists have bitterly attac&ed these studies Diet evangelists insist that un&nown factors other than dieting may have been responsible for these weight fluctuations 4hey have yet to suggest any credible alternative e"planations for these weight cycles 5tudies have shown that spontaneous weight loss is rare, occurring mainly from gastrointestinal disease or from very advanced cancer /%nn $nt 0ed , ),+D3 % careful reading of these papers will, however, reveal that these concerns were carefully considered and resolved during the study 4his author raised this >uestion with one of the 'ramingham study investigators in July ),,J He was confident that any cause of weight cycling other than yo-yo dieting widespread enough to affect the 'ramingham data would have been common &nowledge to the doctors of 'ramingham, who would have diagnosed and treated any such conditions UU% big surprise at the :$H meeting was a collection of of epidemiologic studies contradicting the conventional wisdom that e"tra fat shortens lives David ' .illiamson, Ph D , an epidemiologist in the division of nutrition of the 9enters for Disease 9ontrol, %tlanta, said that what 7made people sit up and ta&e notice7 were )# studies observing trends among several hundreds of thousands of people, all pointing to the possibility that dieting -- not being fat -- may increase a person;s relative mortality ris& about ) # to J # times 7$ was surprised by the consistency

of the data,7 Dr .illiamson said %nother issue that 7struc& a number of us7 was the strong relationship between weight loss and cardiovascular mortality, he said ;; /0edical .orld :ews, 0ay ),,J3 Platelet volume is thought to be an independent ris& factor for cardiovascular disease Platelet volume significantly increased during an + wee& weight loss programme using nutrition protocols and wee&ly control visits /#th 8uropean 9ongress on =besity )--)J June ),,J3 74his might result in an increased ris& of thrombo-embolic ischaemic events in atherosclerotic patients /$J= /),,*3 )+, 1##-F3 4he heart is not spared from the catabolic effects of undernutrition, but is sub(ect to the same degree of weight loss as s&eletal muscle 9urrent data suggest the duration and level of caloric restriction are the main ris& factors for fatal arrhythmic events % very low calorie diet probably should not be combined with strenuous e"ercise, or other situations of high sympathetic drive /$nternation Journal of =besity /),,J3 )F, *+)3 =bese weight cycling women develop left ventricular hypertrophy /!AH3 more than obese non cyclers !AH is a ma(or predictor of cardiovascular morbidity /#th 8uropean 9ongress on =besity )--)J June ),,J3 4he same has been found in obese rats that weight cycled /Hypertension J*HF,,-6-#, ),,*3 4he mechanisms by which dietary weight cycling leads to negative health outcomes have not been intensively researched, but some have been implicatedH Diet induced hypercholesterolemia /%merican J 9lin :ut ),,)I#1I)*-*-)-3 Diet induced depletion of =mega-1 reserves, believed to protect against colon cancer, heart attac&, etc /Phinney, %m J 9lin :ut ),,JI#FI6+)-J3 Diet induced replacement of linoleic and alpha- linolenic acids with saturates and monounsaturates /Phenyu 9hen, 5tephen 9 9unnane, Dept of :ut 5ci, U of 4oronto3 Decrease in HD! /7good73 cholesterol !oss of heart tissue !oss of bone mass /U5D% Grand 'or&s Human :utrition Research 9enter3 $ncrease in fat cell numbers /@(orntorp and 5(ostrom 084%@=!$50 AJ-I6I6-13 9hanges in fat cell receptors %nother ominous outcome is that the weight that is regained is more li&ely to be in the upper body than the lower, and for men at least, that type of weight distribution has been lin&ed to an increased ris& of heart disease /University of 9alifornia @er&eley .ellness !etter, #I*3 5ome studies on human weight cycling are tabulated below

2uman Studies on Weight Cycling

Study Subjects Sample $esults WCB@" 2ealth <utcome

/Dale3 J- f 5N8.8D $D% matched /5hort term study3 =ptifast #- f selected $D% yes un&nown @lac&burn #6 cyclers true yes n2a 4R$0 ++ 5N8.8D $D% yes /5hort term study3 Je>uier f yes 5lowed 0etabolism @altimore +*F m volun $D% D Glucose $ntolerance .89= J)-6 m all true yesD 9HD Gothenburg J1)6 random true n2a 9HD, diabetes 'ramingham #)J6 random true yes 9HD !ee /Harvard3 ))6-1 m alumni true n2a 9HD, all @lair20R'$4 )J+FF m '8D8R%! n2a n2a 9HD Helsin&i )#+1'innish true n2a 9HD, all WCB@" H .eight 9ycling lin&ed to increased fatness /@0$3 8#H $nappropriate Data %d(ustment /see $mproper use of Ratios to %d(ust Data3 % sample was (udged S9EWE8 if sub(ects were selectively e"cluded from the cohort because they developed diabetes, 9HD, morbid @0$, or other negative health outcomes lin&ed to weight cycling after the commencement of weight cycling Results were (udged $D% if @0$ was factored out, begging the >uestion that dietary weight cycling may damage health because of the increase in obesity from weight cycling

% survey paper on weight cycling by the :ational 4as& 'orce on the Prevention and 4reatment of =besity has attracted considerable media attention /J%0% J6JH)# )),F-)J-J3 4his report cited a number of studies on various types of weight cycling, including wrestlers who 7ma&e weight7 by dehydrating without dieting 4his group of nutritionists revaluated published studies on human weight cycling according to their own beliefs and decided dietary weight cycling had no adverse effect on metabolism 9enteral to their analysis is their belief that weight cycling does not cause weight gain 5tatements such as 7@0$, which is &nown to to be correlated with waist-to-hip ratio, was not ade>uately controlled for7 /p )),,3 are based on the assumption diets never e"acerbate obesity, a claim that is controversial at best 5uch a belief is understandable in a group of nutritionists with long standing financial and professional commitments to energy restriction weight loss schemes .hen all you have is a hammer, every problem starts to loo& li&e a nailI if you are a sincere craftsman you will not appreciate criticism of your stoc& in trade =besity researchers who have published papers detailing negative effects of dieting or calling for alternative therapies were e"cluded from this group $n writing its paper, the tas& force ignored studies showing bad effects from weight cycling, even one they cited in their bibliography /!ee et al3 % study by Jeffrey, .ing /one of the tas& force members3, and 'rench reported all three weight-cycling measures were significantly related to @0$ /P R - -)3, but this finding was not listed in the 7$ncreased total body fat7 entry in the 4as& 'orce report 4he nutritionists; >uasi-religious belief that dieting does not e"acerbate obesity affected the writing of this paper % paper by Rebuffe-5crive et al /$J= )--*H)+,F##3 was reported to have found no increased fasting plasma insulin, fasting glucose, or impaired glucose toleranceI in actuality, the paper showed mar&ed increases in plasma glucose and insulin levels in response to an oral glucose load, an ominous portent to the induced diabetes reported in other dieting followup studies Had the tas& force included other obesity researchers their conclusion might well have been different % recent survey of 8uropean obesity e"perts showed they consider repeated dieting a greater causative factor for obesity than lac& of will-power, physical inactivity, or depression leading to overeating .eight cycling enhances weight gain in later life 4he effects of repeated cycles of weight loss and regain on longterm weight development were studied in a national cohort of )6JJ former elite male athletes, including J61 men engaged in power sports /weight cyclers3 and F#) control men 4he controls were age-matched fit conscripts from the time period of the athletes; active sporting carrers 4he mean @0$ at age J- was identical for both groups of athletes and the control men @y ),+#, the mean weight gain of the weight cyclers e"ceeded that of of the other athletes and that of controls 4he prevalence of obesity /@0$ M 1-3 among the weight cyclers was three times that among the other athletes and twice that among controls 4he enhanced weight gain of the weight cyclers could not be e"plained by present habits 4he results indicate weight loss and regain predispose to subse>uent weight gain and obesity /Rissanan, Naprio, 5arna, Noshenvuo, Dept of Public Health, Univ of Helsin&i, #th 8uropean 9ongress on =besity )--)J June ),,J3 Dieting in childhood may not be any safer 4he often reported impressive gains in body fat during recovery from malnutrition may result from enhancement in the efficiency of food utiliCation and a shift in energy partitioning in favor of fat storage 9hildren recovering from protein- energy malnutrition were fatter than well nourished children of the same age /%merican Journal of 9linical :utrition ),,1H#+HF)*-J)3 @y considering the studies by Drenic& et al, !issner et al, and @(orntorp and 5(ostrom, it appears that obese /@0$ M 1#3 individuals with childhood onset obesity /@0$ M J- at age #3 who lose )J? or more of their weight are at the greatest ris& of gaining bac& more than they lose, with the attendant bad health effects 4he ris& is a serious one, a slope of # to , @0$2year weight gain /higher in some3 compared to - J# for normal adults % recent survey of 8uropean obesity e"perts showed they consider repeated dieting a greater causative factor for obesity than lac& of will-power, physical inactivity, or depression leading to overeating 0ost studies that did not report adverse effects from weight cycling have been flawed because they removed the effect of weight gain caused by weight cycling 4o correct this flaw, studies must match dieters and non dieters according to their physical characteristics and history Q@8'=R8Q their first diet .eight loss studies should report the number and siCe of adipose cells before slimming, after slimming, and after weight regain stabiliCes

#rtificial S)eeteners
4here has been considerable media coverage of claims that artificial sweeteners hamper weight loss efforts 4hese appear to result from an %merican 9ancer 5ociety study that found a correlation between overweight and the use of artificial sweeteners 4his correlation might better be e"plained by noting that people without weight problems generally avoid artificially sweetened products on account of cancer concerns, and unfamiliar taste 5ome complain that artificially sweetened beverages don;t give them their 7sugar high7 4here is no 7Diet Jolt 9ola7 $t is li&ely that thin people read labels on artificially sweetened products warning that such products be used only by those desiring to reduce their caloric inta&e % University of 4oronto study on the effects of %spartame sweetened diet soda on randomly assigned sub(ects found no effect on food selection at a meal F- minutes afterwards 5ub(ects who consumed a half liter of a diet drin& e"perienced reduced hunger for about *# minutes % :ew 8ngland Deaconess Hospital /)'-)F3 study found that aspartame facilitated greater weight loss among obese women on a multidisciplinary balanced deficit diet % Harvard 0edical 5chool study indicated %spartame facilitated long term weight maintenance in a multidisciplinary weight loss program %mong individuals consuming aspartame during a ),-wee& weight loss program, consuming more aspartame was associated with a greater weight loss %t wee&s 6) and )#F of follow-up, aspartame was associated with better long term weight control 9oncerns have been raised that ingestion of non-caloric beverages might trigger a hormonal response driven by a Pavlov response to the sweet taste However, )J sub(ects drin&ing 1-- ml of diet Nool-%id e"hibited only a very small insulin response consistent with the residual carbohydrate content of the drin& /%n J of 9lin :utr ),,-I#JH11#-*)3 4here was no evidence that aspartame promotes hunger or results in increased energy inta&es in obese or in lean women /$J= ),,* )+, #6--#6+3 % number of anecdotal reports have appeared claiming that :utrasweet consumption interferes with weight loss Diet beverages are a ma(or vehicle for :utrasweet consumption %lmost all diet sodas contain citric acid which has been shown to interfere with &etosis 4he sweet taste of nonnutritive sweeteners has been reported to increase hunger and food inta&e through the mechanism of cephalic-phase insulin release /9P$R3 .e investigated the effect of oral sensation of sweetness on 9P$R and other inde"es associated with glucose metabolism using nutritive and nonnutritive sweetened tablets as stimuli 5pontaneous oscillations in glucose, insulin, and glucagon concentrations were assessed as were increments /slopes3 of fatty acid concentrations during the baseline period 4he nature of the baseline /oscillationsH glucose, insulin, and glucagonI and slopesH fatty acids3 was ta&en into account in the analyses of poste"posure events :o 9P$R and no significant effect on plasma glucagon or fatty acid concentrations were observed after the three stimuli However, there was a significant decrease in plasma glucose and insulin after all three stimuli =nly the consumption of the sucrose tablet was followed by a postabsorptive increase in plasma glucose and insulin concentrations starting )6 and ), min, respectively, after the beginning of suc&ing 4his study suggested that oral stimulation provided by sweet nonflavored tablets is not sufficient for inducing 9P$R Am J Clin Nutr ),,6IF#H616*1 4he spontaneous oscillations noted above may e"plain the positive results reported by certain previous studies % recent double-blind crossover study has suggested a portion of the population are slightly more li&ely to get headaches if consuming aspartame, but one subgroup of the e"perimental cohort reported fewer headaches when consuming aspartame %nother study raises the possibility that sub(ects with a history of clinical depression may react negatively to aspartame 5ome assert that a litany of symptoms are associated with aspartame use 5ince most of these symptoms have been associated with dieting, it is difficult to assign causality 9oncerns have been raised about possible carcinogenic effects of %spartame =ne study reported a rise of *+ to #1 malignant brain tumors per million from ),+* to ),,J 4he 0ayo 9linic notes that the incidence of brain tumors has been rising since the ),6-;s, long before aspartame was approved % causal relationship has not been established /0ayo 9linic Health !etter 12,63 .hile this author is not convinced that aspartame poses a ris& to many, he does thin& the 'D% should, with due diligence, approve alternatives to aspartame, performing any necessary research itself in the case of commodity materials for which a corporate sponsor is unavailable !arge numbers of dieters have reported difficulties in sustaining urinary &etones after consumption of dietetic beverages, such as diet cola, or slices of lemon in water 4hese difficulties disappear when when beverage inta&e becomes restricted to blac& coffee, blac& tea, or water %lthough present only in small amounts, citric acid might be the offending substance because of the &nown ability of citrate to control carbohydrate metabolism at the subcellular

level 5ingle-blind trials of citric acid added to drin&ing water indicated many were particularly sensitive to the citrate /%m J of 9lin :utr ),,JI#FHJ)65-J153 *--#-? of people on &etogenic diets are sensitive to citric acidI they cannot tolerate the diet under these conditions $f difficulties arise, the only solution is to avoid fruits and beverages which contain citric acid, including most popular diet beverages :o test e"ists for this sensitivity /Private conversation, ),,J3

2igh 1iber 8iet

High fiber diets have been proposed for weight loss from time to time %ccording to 9onsumers Reports, increasing fiber in one;s diet does not induce long term weight loss $n ),,- the 'D% proposed to ban guar gum in nonprescription diet drug products, citing safety problems :ot all fibers are e>ual 0ost fiber types, including the fiber in oatmeal, do not have the metabolic effects of guar gum fiber %n increase in dietary fiber has been widely recommended for improving glucose homeostatsis, yet the amount of fiber is usually so high as to preclude the incorporation of such amounts into a palatable and acceptable diet 0any studies of dietary fiber are not well controlledI weight loss results from the gastric distress many people e"perience when switching to high fiber diets =ne well controlled study assessed changes in dietary fiber while controlling for the inta&e of other macronutrients, and found no effect on plasma glucose or insulin /%m J 9lin :utr ),,#IFJH*JF113

Lo) 1at 8iets

High carbohydrate low fat diets have been recommended since )##- @ 9 /@efore 9hristO3 !ow fat diets have been e"tensively studied for the last # decades 9oncerns about cholesterol levels have prompted nutritional authorities to favor high carbohydrate low fat diets 4he e"periments that prompted these recommendations were often unrepresentative of normal human conditionsI this fear of dietary fat may be oversimplistic 7studies suggest that it is the nature of the fatty acids rather than the amount of fat in the diet which is important7 /Proceedings of the :utrition 5ociety ),,JH #), 1,6-*-+3 @eef fat, not beef itself, is associated with elevations in cholesterol concentrations !ean beef can be included in cholesterol-lowering diets provided it is free of all visible fat /Journal of the %merican 9ollege of :utrition ),,1 )JH )H +F-,3 5tearic /beef3 acid and saturated fats with fewer than )J carbon atoms did not raise cholesterol /084%@=!$50 ),F#I)*I66F-+F3 % reduction in saturated fat, not total fat, is re>uired to reduce serum total cholesterol and !D!-9 levels Provided that the total diet is low in saturated fat, these serum lipid responses can be achieved even when the diet is rich in fat-trimmed lean beef /Journal of the %merican Dietetic %ssn ),,1I,1HF F**-+3 4he negligible long term success rate of semistarvation diets has spar&ed interest in the weight loss possibilities of low fat diets 4his interest springs from a number of observations 5ome ultra high fat /MM*-? fat3 diets cause weight gain in research rats !ow fat evangelists fail to note that high carbohydrate diets have proven even more fattening to these research rats $n addition, not all rats gain weight on the high fat diet, and most rats revert to normal weight when their diet is normaliCed %ll of the high fat rat diets seen in the literature involve a profound increase in total energy inta&e, contrary to most obese humans who have normal or depressed energy inta&e Replacing mother;s mil& /+? of calories from carbohydrates3 with a mil&-substitute formula /#F? of calories from carbohydrates3 grew fatter rats /5ee 74he Role of @aby;s Diet7, below 3 Decreased carbohydrate o"idation and increased lipid o"idation appears to have a primary role among the metabolic changes associated with the onset of obesity /D$%@8485, Aol *J, Jul ),,1, )-)--F3 =bese sub(ects often e"hibit a greater carving for fat than lean individuals 'at craving is a common after effect of energy deprivation 'ollowing food restriction, corpulent female rats had galanin /a substance that increases fat appetite3 levels *--#-? higher than lean females or freely-fed corpulent females 5ince most fat people have been on numerous diets, fat craving may be the result of the dietary restriction, not the initial fat inducing condition /Diabetes Research ),,- )#,)-63

$ncreased lipid o"idation is one of the earlier dysfunctions in recent onset obesity !ipid o"idation may induce a progressive decrease of glucose o"idation, insulin resistance, and increased fasting insulin secretion /D$%@8485 *JH)-)--)F, ),,13 5tudies show fat children obtain a slightly greater proportion of their energy input from fat than thin children do 4his slight increase is overshadowed by their lower total energy inta&e Pre-obese children consume less energy /#- calories2day average3 than their lean counterparts 5ome studies suggest energy from fat additions to an otherwise neutral energy balance cause a weight increase short term, which may be more pronounced in the obese 4his effect has not been demonstrated outside the conte"t of induced overfeeding $n 7="idative and nono"idative macronutrient disposal in lean and obese men after mi"ed meals7 /%m J of 9lin :ut, ),,JI##IF1--F3, =wen et al report 75ignificantly, there was no tendency for the obese men to have the defect in suppression of fat o"idation after mi"ed meals that had been reported by others7 Use of a fat substitute at )-? of energy from dietary fat did not significantly reduce J*-h energy inta&e /%m J or 9lin :utr ),,1I#+H1JF-13 !ow fat diets come in two types, semistarvation and ad libitum !i>uid Protein and A!9D diets are low fatI the 9ambridge 'ood 'or !ife Ultimate .eight !oss 'ormula provides F? energy from fat /1? by weight3 $t has been argued that the infamous Dr %t&ins Diet is sometimes a low fat diet because some people do not li&e fatty foods that are not also high in carbohydrates $n fact, Dr %t&ins; ),,J boo& includes a low fat version of his low carbohydrate diet for those patients whose blood lipids do not respond favorably to his standard low carbohydrate diet 4here is no epidemologic evidence indicating that total fat inta&e per se, independent of total caloric inta&e, is associated with increased adiposity in the population =besity itself has not been found to be associated with dietary fat in either inter- or intra- population studies /7Diet and HealthH $mplications for reducing chronic disease ris&7I 9ommittee on Diet and Health 'ood and :utrition @oard 9ommission on !ife 5ciences, :ational Research 9ouncilI :ational %cademy 9ouncil, .ashington D 9 3 7using a whole body calorimiter, we found no evidence of a decrease in J*-h energy e"penditure on a high-fat diet compared with a high-carbohydrate diet 7 /%merican J of Physiology 'eb ),,-3 % Roc&efeller University study found no significant variation in energy need as a function of percentage of fat inta&e /- to 6-?3, 9onfirming the results of a landmar& ),1- study, a Roc&efeller University study found no significant variation in energy need as a function of percentage of fat inta&e /- to 6-?3 /%merican Journal of 9linical :utrition ),,JI##I1#--#3 4he ),1- study found that the long-term effect on body weight of any diet is related only to the total energy content of the diet =ther features of the diet such as carbohydrate or fat content did not, in the long run, have conse>uential effects on body weight 74here is some problem in reconciling the short-term studies showing an association between high-fat diets and obesity with longer-term trials where there is no really strong evidence that high-fat diets do cause massive weight gain 4here is the :ational Diet Heart 5tudy in the United 5tates, which lasted one year, and had men on diets varying in fat content from *-? to J-? of energy 4he differences in body weight gain between these men were really very small7 7.hatever happens to fat in terms of its being deposited preferentially on short-term overfeeding, there seems to be no difference between carbohydrate and fat supplements in terms of energy balance when you loo& over a period of #- to +- days 7 7$f KdietaryL fat is a promoter of weight gain and obesity, it is more li&ely to be through its effects on the hedonic characteristics of the food source Kwhich would raise total caloric inputL than because of any mysterious effect on intermediary metabolism7 /Discussion, :utrition Reviews, Aol #-, :o *3 7.hether changing from a high-fat diet to an isoenergetic, low-fat, high-comple"-carbohydrate diet results in thermogenic benefits is controversial @rief dietary interventions and failure to account for the potential influence of body-fat distribution on energy metabolism could have confounded the interpretation of previous studies :o change in body composition, resting energy e"penditure, overnight energy e"penditure, or meal fat o"idation occurred .e conclude that isoenergetic shifts from dietary fat to dietary carbohydrate within the generally recommended range have little effect on energy metabolism7 /%merical Journal of 9linical :utrition ),,*IF-H*6-#3 7% diet of J- to J# per cent calories from fat has little effect on weight 4he body has an amaCing capacity to pic& up carbohydrate calories if fat calories are lost 7 /.alter .illett, 9hairman, Harvard University :utrition Dept , Health, #2,*3 79omparisons of obese adolescents to normal peers have demonstrated comparable energy inta&e and nutrient distribution 7 /Journal of 5chool Health J2,J3 4he anorectic effects of serotonin reupta&e inhibitors and #-hydro"trytophan, potent weight control drugs, are evidenced by decreased carbohydrate inta&e, not decreased fat or protein inta&e

The Cornell Lo) 1at Study

% 9ornell University study 7.eight loss on a low fat diet7 has been widely >uoted by low fat diet evangelists 4his study is interesting primarily for what the mass media never reported about its methods and results 4he 9ornell study located J# non-smo&ing women of greater than ideal weight who were not cognitively restricting their food inta&e to achieve weight control 7Unrestrained eaters were desired as sub(ects 7 5ince virtually all overweight women desperately try to reduce their weight, this study;s sample is hardly representative of real world overweight women =f the J# sub(ects that passed the initial screening, , were e"cluded from the study for unstated reasons, and another 1 dropped out during the low fat phase of the study, leaving only )1 sub(ects .hy all the fuss about sample selectionD 4he researchers undoubtedly wanted to use sub(ects who were not truly obese /they don;t respond to food the same as normalweights do3 :either did the researches wish to ris& using women whose metabolisms had been depressed by previous diets 5ub(ects were randomly assigned to ad libitum diets with low fat /J-? calories from fat3 or high fat /*-? calories from fat3 foods 5ub(ects were placed on one diet or the other for )) wee&s %fter an 6 wee& 7washout period7 the sub(ects switched diets 5ub(ects who first lost weight on the ad libitum 1#-*-? fat control diet subse>uently failed to lose weight on the low fat diet 9aloric inta&e on the low fat diet was mar&edly depressed at the beginning, with an initial weight loss of almost a pound a wee& .ithin )) wee&s, caloric inta&e on the low fat diet was increasing 4he difference in calorie inta&e was cut in half, and weight loss nearly halted 7.e are unable to e"plain the minimal effect that the low fat diet had in the second half of the study7 4he study paper also indicated that weight loss on the low fat diet was much less than e"pected from the caloric difference between the two diets, indicating a 7metabolic disadvantage7 compared to other diets $n addition, the media failed to report that the sub(ects regained twice as much weight in the 6 wee& period after the low fat diet as did the sub(ects on the control diet 4he 9ornell researchers have not seen fit to report any followups

<ther Lo) 1at 8iet Studies

$n a study of )6) women on a two year low fat diet, ma"imum weight loss of 1 J &g was reported at F months @y year J some of the weight was regained 4he standard deviation was more than twice the average weight loss 4his shows that >uite a few actually gained weight on the low fat diet, not counting the )1 that dropped out of the program /%m J 9lin :utr ),,)I#*H+J)-+ 3 4he Priti&in $nstitute promotes an ultra low fat diet to improve cardiovascular health $n a ),,) radio interview, a Priti&in $nstitute official characteriCed the weight loss effects of the Priti&in ultra low fat diet as 7slight7 %nn !ouise Gittleman, Priti&in !ongevity 9enter nutrition director, reported in ),,J that weight loss on the Priti&in diet was temporary for most ),,1 saw 9overt @ailey, inventor of the P@5 infomercial, proclaim 7diets don;t wor&7 as he shifted his endorsement to a line of e"ercise machines @ailey;s newer advertisments stress the fattening effects of diets 9areful observers of @ailey;s recent infomercials have noted @ailey now uses baggy pants and wide ties to disguise his substantial paunch %bsent @ailey, the low fat weight loss mantra appears to have passed to Dr Dean =rnish Dr =rnish is an ethical vegetarian and paid consultant to low fat meal producer 9on%gra and author of the best seller 78at 0ore .eigh !ess7 $n his paper /4he !ancet July J) ),,-3 =rnish describes a mid-term resident program with a low-fat vegetarian diet and supervised e"ercise up to +-? of ma"imum =rnish;s data, while incomplete, suggest that changes in caloric inta&e and energy e"penditure completely account for the reported weight loss %pparently =rnish;s 7eat more, weight less7 promise applies to roughage =rnish claims to have partitioned the e"perimental cohort into two groups randomly, yet the initial weight difference between the two groups was comparable to the e"perimental group;s weight loss 4hese results indicate the uncertainties caused by the small sample siCe %fter )J months of the ultra low fat vegetarian diet and rigorous supervised e"ercise, the the active group finished at about the same weight as the control group, but their triglycerides increased and their blood pressure reduction was less Dr =rnish has not responded to repeated re>uests for clarifying information % Roc&efeller University study reported energy inta&e re>uired to maintain body weight is not affected by wide variation in diet composition 8ven with e"treme changes in the percentage of energy from fat /-? - 6-?3 there was no detectable evidence of significant variation in energy need as a function of percentage fat inta&e /%merican Journal of 9linical :utrition ),,JI##I1#--#3 75i"ty years ago, !H :ewburgh and his colleagues e"amined the

possibility that so-called endogenous obesity might be the result of special metabolic factors unrelated to energy inta&e or physical activity 4hey found no evidence for such purely endogenous obesity and also demonstrated that the long-term effect of any diet on body weight is related only to the total energy content of the diet =ther features of the diet such as carbohydrate or fat content did not, in the long run, have conse>uential effects on body weight 7 4he incidence of obesity does not necessarily follow the amount of dietary fat 4he average U 5 daily fat consumption is J #J ounces, with )-? of males obeseI the average %ustralian daily fat consumption is much less at , but )*? are obese /!=:G8A$4B, 0ay ),,J3 74here is evidence that altering the proportion of the calories in the diet from fat, carbohydrate, and protein can have a limited effect on weight lossI however the effects appear to be >uite small7 /0ethods for Aoluntary .eight loss and 9ontrol, :$H 4echnology %ssessment 9onference Panel, %nnals of $nternal 0edicine June ),,J, ))FI))3 $n the presence of dietary carbohydrate, the preferred fuel is glucose and the capacity to mobiliCe fat is limited 'actors that increase blood glucose during dieting may stimulate insulin release and all the metabolic se>uelae of circulating insulin 'atty acid synthesis is activated and lipolysis is profoundly inhibited by insulin even at very low concentrations of the hormone /%m J of 9lin :utr ),,JI#FHJ)65-J153 9onventional wisdom holds that low fat diets improve insulin sensitivity Unfortunately, this is true only after an ultra-low carbohydrate diet :o changes in glucose tolerance and substrate o"idation were measured after a highcarbohydrate low fat diet $n addition, these studies confirm a growing body of evidence that increasing dietary carbohydrate increases plasma triglycerides and decreases plasma high-density-lipoprotein /HD!3, increasing the ris& of cardiovascular disease /084%@=!$50 ),,1H*JH1F#-6-3 7diets that are relatively low in fat and high in carbohydrate accenuate the abmormalities in glucose, insulin, A!D!, and HD! metabolism that are present in :$DD0 @ecause these results were observed in a population typical of those with :$DD0 seen in most clinics, it seems reasonable to suggest that it is time to reappraise the clinical benefit of low-fat high-carbohydrate diets in these patients 4his is not meant to >uestion the aim of reducing saturated fat and cholesterol inta&e in patients with :$DD0 but rather to indicate that this goal can be achieved without drastic reductions in total fat inta&e and reciprocal increases in carbohydrate consumption by simply substituting polyunsaturated and monounsaturated fat for saturated fat .e believe that the results no longer permit us to dismiss the deleterious metabolic effects of low-fat high-carbohydrate diets as purely transitory events in patients with :$DD0 and K4he resultsL re>uire that dietary regimens that address the defects in carbohydrate and lipid metabolism that e"ist in these patients be evaluated 7 /D$%@8485 9%R8 ),+,I)JHJ ,*-)-)3 7=ur results do not support the recommendation of an isoenergetic high carbohydrate, low fat diet for improving peripheral insulin action in adults with glucose intolerance the increase in insulin action that we observed previously with vigorous e"ercise training was negated when combined with a diet high in carbohydrates and fiber 4he sub(ects in this study are at increased ris& for developing :$DD07 /%m J 9lin :ute ),,#IFJH*JF-113 7the higher the fasting plasma insulin levels, the higher the mean annual 9HD mortality rate7 /Diabetes and 0etabolism /Paris3 ),+6, )1H 1#--1#13 4he increased consumption of fructose in the .estern diet has been lin&ed to rising incidences of hypertriglycemia and hyperinsulinamia /J @iol 9hem ),,JIJF6H)*#J1-F3 /%m J of 9lin :ut ),,1 ))F-))63 .e compared a cholesterol-free tofu- based froCen dessert containing high-fructose corn syrups with ice cream 4he tofu dessert elicited a higher glycemic response, related to the substantial amount of total glucose in this 7fructose7 dessert 4his highlights the error of using individual components of a commercially prepared food to recommend a product /D$%@8485 9%R8 )1H1+J-+#, ),,-3 7$f ever proof were needed that the proposition that there is a cause-and-effect relationship between diet and breast cancer far e"ceeds scientific data, the U5 :ational $nstitutes of Health;s plan to conduct a W)- million clinical trial is proof indeed Despite abundant evidence that dietary fat bears no relation to development of cancer of the breast, the :$H intends /under the fashionable umbrella of 7women;s health73 to initiate a study of *-,--- women /half of whom will be randomly assigned to consume no more than J- per cent of their calories in fat3 to try once again to prove a lin& that is probably not there .hy then does :$H insist on spending W)- million on a study whose hypothesis seems to be little more than wishful thin&ingD $s it only because of the faddish infatuation with fat as the root of all dietary evilD $n the United 5tates, as elsewhere, money for scientific research is in short supply 4here are many ways the :$H could better spend its W)- million 7 /8ditorial in :%4UR8 - A=! 1#, - J, =94=@8R ),,J3 4wo large studies published in the %pril J--- :ew 8ngland Journal of 0edicine failed to find any evidence that eating low-fat high fiber food lowered the ric& of colon cancer 4here is some concern that low-fat diets induce depletion of the body;s =mega-1 reserves, believed to protect against colon cancer, heart attac&, etc , and to promote lipolysis /7fat burning73 :-1 fatty acids /'%s3 are essential in early human development 'ish and shellfish are the main food sources of HD% .omen who consume fish have more DH% in their breast mil& than do those who do not eat seafood $nfant

formulas contain only !:%, which may not be suitable 7Pregnant and nursing women should be encouraged to consume seafood on a regular basis during pregnancy and lactation to furnish DH% for their infants 7 /Journal of the %merican Dietetic %ssoc ),,1I,1H#+-F*3 % number of fatty acids appear to lower blood lipids /J %m 9ol :ut ),,)H)-/F3I#,1-F-)3 4he loss of these nutrients on a low fat diet may e"plain the increase in triglycerides seen on high carbohydrate low fat diets

8ieting ?ourmets
% diet designed by 0ichel 0ontignac restricts the eating of certain &inds of foods together 'at and proteins marry well, but not with carbohydrates 8ven a single 'rench fry is forbidden, as is sugar 0ontignac satisfies his sweet tooth with artificially sweetened desserts or low-sugar chocolate mousse 4he diet;s basis is the relationship between insulin and the creation of stored fat 'or e"ample, the carbohydrate in several slices of whole-wheat bread at brea&fast will not cause weight gain, but adding butter will 4he method recommends plenty of fresh and coo&ed vegetables, meat, poultry and fish, and up to three glasses of red wine per meal 0ontignac encourages dieters to eat carbohydrates as main courses 'ruit, which must be delayed until three hours after a meal, becomes a morning or midnight snac&, not a dessert 74he man who put 'rance on a diet7 has drawn fire from the nutrition establishment Gerard Pascal, head of nutrition and food hygiene at the :ational $nstitute of 'ood Research, says 0ontignac;s method is dangerous and scientifically unfounded Pascal urged the overweight to eat a bit of everything 74hat;s difficult and unspectacular, but in the long run, it;s the only valid rule to follow 7 0ontignac is not sure his method will thrive in the United 5tates, where fast food and sugar-laced pac&aged foods are dietary staples /%Pn -)2J12),,13 5cientific papers on this diet techni>ue, is any, have yet to come into prominence

The Lope( 8iet C Eat li0e a Warrior

J $gnacio !opeC de %rriortua;s pamphlet on 7'eeding the .arrior 5pirit7 achieved must-read status at General 0otors before he left for A. How to 8at !i&e % .arrior T :o sugar, potatoes, or white flour T 'ruit must be eaten alone, not with other foods T $n the morning, eat only fruit, but as much as you li&e T Don;t mi" carbohydrates and protein at the same meal T Drin& only good wine

Lo) Carbohydrate 8iets

!ow carbohydrate weight loss diets have been used for centuries 5ugar consumption is lower, low carbohydrate diets are more popular, and the incidence of hyperobese individuals is lower in 8urope than in the U 5 /$nternational Journal of =besity ),,J, )F,#F#-#6J3 % number of short term studies, mostly in the #-;s and F-;s, showed a mar&ed advantage in weight loss from high protein, low carbohydrate diets compared to diets higher in carbohydrate .eight !oss on )+-- &cal Diets varying in 9arbohydrate 9ontent 9arbohydrate /g2day3 'at !oss /&g3 !ean @ody 0ass !oss 4iredness )-* + 1+ J* 6 ? ) F)- J)# , ? J 1)* +# *,? 1 8ach group had 1 sub(ects %ll three diets had ))# grams of protein per day 4iredness indicates the number of sub(ects reporting this symptom /%m J of 9lin :ut ),6) J,--F3 %nother study compared two #,- &cal diets 4he 7&etogenic7 diet had #Jg protein, )-g 9H=, and 1+g fat 4he other diet had #-g protein, )-g fat, and 6Fg 9H= 4he &etogenic diet did not e"hibit any advantages %t #,- &cal2day

neither of these diets was representative of popular 7low carbohydrate7 regimens /084%@=!$50, ),,J *)H*H *-F)*3 9ompared to high carbohydrate diets, a high protein low carbohydrate diet preserved lean body mass and improved glucose o"idation /084%@=!$50 Dec ),,* *1H)J )*+)-63 $n the presence of carbohydrate, the preferred fuel is glucose and the capacity to mobiliCe fat is limited 'actors that increase blood glucose during dieting may stimulate insulin release and all the metabolic se>uelae of circulating insulin 'atty acid synthesis is activated and lipolysis is profoundly inhibited by insulin even at very low concentrations of the hormone /%m J or 9lin :ut ),,JI#FIJ)65-J153 4hese studies indicate a low carbohydrate diet with generous protein allowance provides superior fat loss, reduced lean tissue loss compared to other types of weight loss diets 4he main disadvantage is a greater incidence of tiredness, not une"pected considering the dramatically greater fat loss =f particular interest is the famous 7%t&ins Diet Revolution7 developed by Dr Robert %t&ins, a :ew Bor& cardiologist Dr %t&ins claims that ,#? of e"cess adiposity is metabolic and not an eating disorder His solution is to limit sugar and other carbohydrates to the dietary levels man e"perienced before the agricultural revolution Dr %t&ins claims that high carbohydrate diets promote 9andida %lbicans overgrowth /7yeast infections73, which can interfere with weight management His lab tests confirmed this condition in a third of his patients !ow carbohydrate dieters sometimes report remission of allergies and hearburn %t the start, the %t&ins diet severely restricts carbohydrates %s weight loss proceeds, carbohydrates are increased to modulate the rate of weight loss 8"cept for carbohydrates, %t&ins dieters eat ad libitum 4he media attention afforded Dr %t&ins; Diet Revolution and Dr %t&ins; claim that high carbohydrate consumption promoted obesity and insulin resistance triggered a heated response from the %merican 0edical %ssociation 9ouncil on 'oods and :utrition 4he 9ouncil, whose members and their lin&s to high carbohydrate food producers were not disclosed, blasted the Dr %t&ins diet in the June * ),61 Journal of the %merican 0edical %ssociation .hile Dr %t&ins rebuts many of the 9ouncil;s points in his ),,J se>uel 7Dr %t&ins; :8. Diet Revolution,7 /$5@: --+6)1)F6,-E3 the 9ouncil;s observation that 7$t is unfortunate that no reliable mechanism e"ists to help the public evaluate and put into proper perspective the great volume of nutritional information and misinformation7 is, sadly, as true in ),,1 as it was in ),61 5ince the %0% 9ouncil on 'oods and :utrition put the %t&ins diet off limits, few if any investigations of the %t&ins diet have appeared in the literature 9onsumer Reports; Rating the Diets has rated %t&ins as 7absolutely not recommended7I ironically their top rated diet /:utri25ystems3 was the first to ma&e payments on product liability lawsuits, and has made hundreds of settlements 9ritics blast the %t&ins diet as a high-fat regimen that increases serum lipids Dr %t&ins, a cardiologist, respondsH UU%m $ advocating a high-fat dietD :ot in the long run %s my critics twenty years ago were forced to ac&nowledge when they loo&ed into the matter, and as Professor John Bud&in proved, this isn;t a high-fat diet 4he average person on a low-carbohydrate diet eats less fat than he was eating on his previous 7balanced7 diet - the average diet in %merica today ;; UUthe %0% K9ouncil on 'oods and :utritionL said they were 7deeply concerned about any diet that advocates the unlimited inta&e of saturated fats and cholesterol-rich foods 7 4hen they scrutiniCed all the medical literature they could bring to bear and came up with a single case described in ),J, 74his was the study of the %rctic e"plorer, Ailh(almur 5tefansson, who, impressed with the health of the native 8s&imos he observed, volunteered with an associate to be observed for a year on an all animal food diet $n this study, one of the two sub(ects cholesterol levels did go up but the other;s dropped 4he %0% inaccurately reported that both men had cholesterol increases 7 !et;s loo& at their languageH 7$ndividuals responding to such a diet with a rise in blood fat will have an increased ris& of coronary heart disease 7 %bsolutely, %ll $ can say isH 7$ agree, and individuals who (ump off a curb with a parachute and are thereupon attac&ed by an enraged bull will have an increased ris& of torn garments 7 4he %0%;s ad hoc nutrition panel had to phrase it that way, because they &new, of course, that they could not find any evidence that would have allowed him to ma&e a stronger statement $ thin& it is clear from their circumspect language that the %0% was aware of the difference between the results when fat and cholesterol are added to a high-carbohydrate diet and the results that occur when they are added to a low-carbohydrate lipolytic diet $n the usual scenario, when carbohydrates are a large part of the diet, the undesirable lipid reading may get worse if there is an increased inta&e of fat as wellI on the %t&ins diet, such a result is rare indeed ;; /9hapter )#, Dr %t&ins :8. D$84 R8A=!U4$=:, ),,J3 $t should be noted that serum cholesterol increases are encountered with other types of diet /%merican Journal of 9linical :utrition ),,)I#1I)*-*-)-3

!ow-fat high carbohydrate diets similar to those recommended by the %merican Dietetic %ssociation, have serious metabolic effects when consumed by patients with :$DD0 for )# days 4he dietary recommendations of the %D% may actually increase the ris& of coronary artery disease in patients with :$DD0 Hyperglycemia, hyperinsulinemia, hypertriglycemia, and reduced plasma HD! have been identified as factors predisposing to the ris& of coronary heart disease 'urthermore, these same four metabolic abnormalities have been shown to be e"aggerated following ingestion of a high- carbohydrate, low-fat diet /%merican Journal of 0edicine ),+6H+J J)1-JJ-3 High-carbohydrate diets lead to several changes in carbohydrate and lipid metabolism in patients with :$DD0 that could lead to an increased ris& of coronary artery disease 4hese effects persist for more than si" wee&s $t seems reasonable that the routine recommendation of low-fat high carbohydrate diets be reconsidered /Diabetes 9are )JH,*-)-), ),+,3 $n the obese :$DD0, &etones generated by A!9D or low carbohydrate diets suppress hepatic glucose output and fasting blood sugar /=F),, $J= ),,* )F#3 4iredness is a common, but hardly universal, complaint on low carbohydrate diets 5ome of these problems may be related to citric acid interacting with the %t&ins diet /see 7%rtificial 5weeteners7, above3 5everal Usenet readers have reported abandoning the %t&ins diet as a result of side effects and bad publicity in the press =ther problems include palatability, inconvenience and e"pense of obtaining low-carbohydrate foods Dr %t&ins; ),,J boo& claims 7the )-,--- active patients at the %t&ins 9enter for 9omplimentary 0edicine in :ew Bor& are living testimonials to the ma(or health improvements derived from a low-carbohydrate diet 7 Dr %t&ins advertises boo&s and vitamins on a syndicated radio tal& show /.=R radio, www audionet com3 /)-+---J%4N$:5, )-+---F-%4N$:53 4his author has not been able to find a single study of the %t&ins multistage ad libitum low carbohydrate type of diet in the scientific literature 4he available low carbohydrate studies have used energy restricted diets profoundly different from %t&ins; regime % nearly definitive study by Ne&wic& and Pawan appeared in 084%@=!$50 vol F, pp **6-F- 4his study carefully chec&ed for the weight loss that almost always occurs upon hospital admission as well as the possible effect of fluid loss or retention on weight figures Ne&wic& and Pawan found that a low carbohydrate diet was much more effective for fat loss in the obese than a low fat high carbohydrate diet with the same energy %t&ins; diet differs from that used by Ne&wic& and Pawan in that %t&ins limits carbohydrates, not total calories % relatively recent paper appeared in the 'eb ),61 %merican Journal of 9linical :utrition, 7Response of body weight to a low carbohydrate, high fat diet in normal and obese sub(ects7 4his paper is unusual for diet studies in that it discloses the individual results of each of its obese sub(ects instead of hiding them in the arithmetic mean 7we treated obese sub(ects with high fat, low carbohydrate diets $f the carbohydrate content of the diet was not more than #- to F- g2day and the fat content appro"imately )#- g2day, an average daily weight reduction of - 1 &g was achieved 4he cholesterol and triglyceride concentrations in the serum, which had been raised at the beginning of the e"periment, invariably showed a tendency towards normaliCation under this dietary program 7 % 5cottish study found lowering carbohydrate inta&e doubled weight loss, increased fat o"idation, and reduced metabolic slowdown compared to lowering fat inta&e 5ome studies did not find any advantages to low carbohydrate diets 0any of the regimens failed to follow the recommendation of a ),+* study that indicated increased protein re>uirements during dieting /Journal of 9linical $nvestigations ),+*I61H 6#--+3 4hese papers appear to confirm %t&ins; claim that his diet has a 7metabolic advantage7 over other types of diets 4he idea behind 7metabolic advantage7 is that a suitable low carbohydrate diet provides weight loss at a much higher caloric inta&e than other types of diets, with much less lean tissue loss @y comparison, the 9ornell low fat diet study discussed above found weight loss was much less than e"pected from the measured reduction in caloric inta&e $n the presence of dietary carbohydrate, the preferred fuel is glucose and the capacity to mobiliCe fat is limited 'actors that increase blood glucose during dieting may stimulate insulin release and all the metabolic se>uelae of circulating insulin 'atty acid synthesis is activated and lipolysis is profoundly inhibited by insulin even at very low concentrations of the hormone /%m J of 9lin :utr ),,JI#FHJ)65-J153 5everal recent papers have reported low carbohydrate diets to be better than the generally accepted low fat diet for control of type $$ diabetes /insulin resistance3 9lic& here to visit the !ow 9arbohydrate - Diabetes page at 5t John;s University =ne of the 9ouncil;s criticisms of the %t&ins diet was loss of appetite 5uch a criticism calls into >uestion the (udgement, if not the honesty, of the 9ouncil;s members %t&ins considers appetite reduction a virtue of his diet, as would most dieters However, if this loss of appetite is sufficient to decrease energy input below maintenance levels, then studies of energy restricted low carbohydrate diets may be relevant 4hese studies did not find a long term

7metabolic advantage7 to carbohydrate restriction $t remains to be seen if the anorectic effect of the %t&ins diet is powerful enough to reduce energy input to the low levels used in these studies %nother criticism is the diet;s &etogenic tendency, which %t&ins calls 7@enign Dietary Netosis7 to distinguish the mild &etosis caused by his diet with the dangerous form associated with diabetes emergencies People on very-lowcalorie diets go into &etosis without carbohydrate restriction Pregnant women are in &etosis most of the time 8ndurance athletes who;ve been running for an hour or more go into &etosis % &etogenic diet has been successful in controlling childhood seiCure disorders /8P$!8P5B D$84 4R8%408:4, John Hop&ins University Press3 %t&ins estimates that less than a third of individuals in his diet are 7fat-sensitive7 and will develop a less favorable cholesterol level on a high-fat Klow-carbohydrateL diet than on a low-fat diet His ),,J boo& includes procedures for testing for sensitivity to various types of fat and appropriate diet modifications Dr %t&ins reports long term results that are much better than those obtained with other diets He has offered to ma&e his patient records available to researchers, something .eight .atchers, :utri25ystems, et al refuse to do His favorable results, however, may be the result the same selective dropout mechanisms that generate spurious positive results in other diet studies $n early %ugust ),,1, % complaint was filed by Dr Paul Gennis, who treated an %t&ins patient in Jacobi Hospital;s emergency room for an embolism that he said had formed in her brain 4his led to a suspension of %t&ins; license, an event that was reported with obvious glee by some of %t&ins; detractors 4hese people apparently do not thin& the reversal of this diagnosis and suspension nearly so newsworthy

<rnish and #t0ins Compared

.e need large scale randomiCed studies comparing low fat and low carbohydrate diets Until such studies is published, we must compare results reported by =rnish and %t&ins themselves 4he =rnish figures are the average of the =rnish 8"perimental group /nVJJ3 carefully selected from hundreds of applicants 4he %t&ins data /nV)3 is from page )#- of his ),,J boo& :either of these samples is necessarily representative of the overweight population However, the starting age, weight, and body mass inde" of %t&ins; sample resembles those of =rnish;s e"perimental group much more closely than =rnish;s own control group, lending credence to the comparison 4he changes in metabolic ris& factors agree with those reported in the 084%@=!$50 and D$%@8485 9%R8 studies discussed above, suggesting the differences between low-fat and low-carbohydrate diets reported in those papers are applicable to a wider population =rnish and %t&ins Diets 9ompared =R:$5H %4N$:5 $:$4$%! 9=:D$4$=:5 /low fat3 /low carbohydrate3 %ge #F ## 5tarting weight J-) ),# @ody 0ass $nde" J+ * J+ ) =R:$5H %4N$:5 D$84 R85U!45 /low fat3 /low carbohydrate3 9holesterol change -J*? -)1? HD! /G==D3 9holesterol - 1? TF-? 4riglycerides /@%D3 T6#? -+J? .eight -)J? -),? 'urther confirmation of %t&ins; data comes from Dr Ronald Nrauss, chairman of the %merican Heart %ssociation;s :utrition 9ommittee $n some men with normal-siCed !D! cholesterol particles, a very low-fat diet can cause changes in the cholesterol profile that indicate an increased heart disease ris& $n one study, 1F out of +6 men with normal-siCed !D! particles switched to the small-particle abnormalities when their dietary fat was lowered from *F percent of calories from fat to J* percent =ne sign of the switch was a rise in their ratio of total cholesterol to 7good7 HD! cholesterol, which implies a higher heart disease ris& /%P$ 62)F2,F3

8iets 7 the @<TT<" L +E

7weight will return toward its baseline level whenever a previously instituted perturbation /such as diet, e"ercise, modified protein fast, behavior modification, or (aw wiring3 has been completed $n this case, continued diet, e"ercise, and behavior modification also did not help the sub(ects to avoid regaining lost weight 7 7@oth the medical profession and society loo& with disfavor on obese people and obesity in general 'or e"ample, students at a well-&nown university preferred a number of less savory people to obese individuals as potential marriage partners =bese people are treated negatively in cartoons and in literature 0any believe that obese people need only to 7close their mouths7 and to be more motivated to lose weight 4hus use of medications to correct a the public, deemed inappropriate 7 7Unfortunately, a lac& of understanding of both the natural history of obesity and its diversity adds to the pe(orative view of obese people and of anore"iants 5ome health professionals are not aware of data concerning mechanisms present in the human organism that act to countervene perturbations in body weight and that may account for the apparent failure of interventions, including medications 7 /9lin Pharmacol 4her, 0ay ),,J3 % paper by .illiam @ennett in the %nnals, :ew Bor& %cademy of 5ciences, /boo& length issue on Human =besity3 gives the bottom line on diets 7Data on the dietary treatment of obesity have been accumulating since ),1) :othing in the chronicle suggests that worthwhile progress has been made by pursuing efforts to teach people more effective ways to restrict their food inta&e 4here now is enough information to permit the prediction that results will be mediocre in the short run and after several years the results will be less than acceptable 4he burden should now be on the investigator to establish a strong reason for underta&ing yet another study of inta&e restriction, including studies employing behavior modification aimed primarily at altering eating behaviors 9ommittees reviewing the use of human sub(ects in these e"periments should not assume that they are ethically uncomplicated 4he low probability that information of therapeutic value will result from such a study should weigh heavily in any deliberation on whether to authoriCe it 7 7$ can see little reason for inta&e restriction to receive continued support, either as a sub(ect of research or as an accepted therapy for obesity @loodletting as a therapy for pneumonia was abandoned about a century before penicillin was discovered $t re>uired a modicum of courage and good sense on the part of practitioners who turned away from the practice, but there is no reason to believe their patients suffered from this lac& of therapy 7 7% survey of studies published ),66-),+F and reporting on dietary or behavioral treatment of obesity reveals that the ma"imum percentage of body weight lost is, on average, + # percent - no different from the value, + ,? in similar studies from ),FF-),6F, as reviewed by .ing and Jeffery 7 74he goals and research methods of studies on dietary treatments for obesity are overdue for ethical as well as scientific reevaluation 4he same may be said for the numerous programs providing such treatment outside the conte"t of research 7 % final footnote on combining diets and e"ercise % Harvard Health letter compared results of ),+J and ),,) surveys of doctors; lifestyles 5ince ),+J the doctors reduced their consumption of red meat, fat, and cholesterol 4hey increased their dietary fiber and e"ercised more Unfortunately, the increased attention to diet and e"ercise did not produce leaner bodiesI the proportion reporting weight problems increased from J, to 1, per cent .hile diet evangelists continually assert that new wrin&les in F-T year old treatments are improving weight loss outcomes, the long term success rate of even the best available weight loss programs using diet, e"ercise, and behavior modification remains less than five per cent /:$H conference on voluntary weight loss, 0ar 1--%pr ) ),,J3

1L#WE8 $ESE#$C2
4he >uality of diet research and media coverage of adiposity leaves much to be desired 4he vast ma(ority of this research is so poor it would never be accepted by the 'D% as proof of an ethical drug;s efficacy and safety % pervasive problem in published research is the refusal of authors to disclose financial and other conflicts of interest %n article in the 'eb J ),,, .all 5treet Journal reported that almost every researcher publicly supporting a new drug had financial ties to the drug manufacturers 0ost troubling, none of these conflicts of interest were disclosed 4he reader should beware of three common flaws in popular obesity studiesH

Correlation *'s* Cause and Effect

% typical correlation study might show that (oggers are thinner than couch potatoes 4his is a QcorrelationQ 5uch data are generally cited as proof that obesity is caused by lac& of e"ercise, with the implication that fat couch potatoes will become thin if only they get off their laCy butts and e"ercise .hat is the error in drawing such a conclusionD 4he error is the unstated assumption that the correlation proves a particular cause and effect $n fact, other cause and effect relationships may be involved 9onventional wisdom concludesH !ac& of e"ercise causes obesity %nother e"planation for the observed correlation isH =besity and associated impaired athletic performance ma&es sports activities unpleasant and frustrating, forcing a more sedentary lifestyle 7.hile the lin& between e"ercise and health in some large epidemologic studies seems powerful, intervention and outcome studies suggest a more >ualified correlation Bet we still have no clinical trial to demonstrate that increasing activity in a group of sedentary people reduces the rate of disease vs sedentary controls,7 says .illiam Has&ell, PhD, also a member of the 5tanford faculty /J%0% June )J, ),,)3 9orrelation studies that draw conclusions or ma&e recommendations without properly evaluating alternative models of causality are fundamentally flawed and must be treated with suspicion

1la)ed Sample SelectionC8istribution

:on-random selection or partitioning of the sample population flaws many studies that otherwise appear to be well designed =ne cannot allow sub(ects to select which e"perimental group they will (oin because the selection process may be stronger than the e"perimental intervention :ews media might not understand the implications, but the study will be flawed 'or e"ample, a study on the mortality effects of obesity was based on patients who had repeatedly lost and regained weight, compared to lean individuals .as the higher mortality caused by obesity, by the dieting, did weight cycling cause both, or did genetic factors cause all threeD 5tudies comparing the relative success of alternative treatments rarely assign sub(ects to the alternatives at random 4he factors that determined sample selection and partitioning may be more important than the alleged independent variable Diet studies typically e"clude dropouts from their data 4his is not acceptable in weight loss research because dropouts have lower weight loss and greater weight regain 8"cluding even a few such data points distorts the e"periment because the variability between sub(ects is much greater than the average weight loss 8E%0P!8H !et us put )# sub(ects through a thought e"periment # lose J- pounds on the :ew 'at or 'it program, # gain J-, and # end up the same 4he average weight loss is /#"J--#"J- T- V -3 -, about as well as real diet programs @ut before the #-year weigh-in, two of the sub(ects who regained their weight and three of the unfortunates that gained twenty gave up on 'at or 'it and went on an %t&ins; diet 4he five that dropped J- are of course eager to report the success of their superior will power to the researchers 5o now we have /#"J- -J"J- T1"V F-2)- sub(ects V F3 F pounds average loss 4hat F pound loss is completely bogus, but that;s how diet papers are put together Diet studies sometimes mista&e genetic differences for dietary intervention 9ompared with women in .estern cultures, traditional %sian women start menstruating later, give birth at a younger age and gain far less weight in adulthood - all factors that decrease breast-cancer ris& /Dr 0ichelle D Holmes, an instructor of medicine at Harvard 0edical 5chool and @righam and .omen;s Hospital in @oston 3

mproper use of $atios to #djust 8ata

4he use of ratios of variables /fre>uently called 7inde"7 variables3 is common in obesity and related research 4he use of such 7ad(ustments7 is invalid if the intercept is nonCero or if the relationship is nonlinear 4he article e"plains a number of other factors which can cause the use of ratios to cause interpreti'e difficulties /$nternational Journal of =besity ),,# ),,F**-#J3 $n common language, such ad(ustments may constitute serious 'UDG$:G of the data

T$UT2 + $ESE#$C2 :#:E$S

4he honesty and integrity in life sciences research has increasingly come under >uestion .e understand the pressure on a corporation or trade institute to manage information about the safety and efficacy of its products and services 5uch pressures are not limited to the corporate sector .eight loss researchers live by the 7publish or perish7 syndrome 8"aggeration of wea& results is sometimes a necessary e"pedient to secure continuing research funding 7.hen all you have is a hammer, everything starts to loo& li&e a nail7 applies to research pro(ects 7$t is seldom necessary to list individual results in a paper Data can usually be summariCed by a measure of location and a measure of dispersion % common practice is to list the arithmetic mean, standard deviation /5 D 3 and the number of observations /n3 used to estimate these statistics $f only a few observations are available the dispersion is better indicated by the range $f the distribution is significantly s&ewed Knot a 7normal distribution7L both the median K#-th percentileL and range Kminimum and ma"imumL should be cited 7 /Journal of 8ndocrinology, ),,J3 How can one spot 7fudged7 researchD =ne way is to loo& at the way data is presented $f mean /average3 values for the e"perimental groups are presented, chec& the standard deviation values 4he standard deviation must be small compared to the reported differences between groups $f the standard deviation is comparable to the differences between groups, the data can not be used to analyiCe individuals Diet evangelists dismiss or downplay the importance of genetics and other inborn differences affecting the development of obesity !arge standard deviations highlight the biological differences between fat and thin people $f the standard deviation is not disclosed, the researcher is hiding something from the reader 7the mean net weight gain in )*J1 women as a conse>uence of pregnancy was found to be small /- # &g3 :evertheless, this seemingly modest increase concealed the fact that )#? of these women had actually gained more than # &g7 /$J= )F, ,1#3 Diet studies typically e"clude dropouts from their data 4his is not valid in weight loss research because sub(ects tend to drop out after frustration with poor weight loss Dropouts have lower weight loss and greater weight regain 8"cluding even a few such data points generates a false positive finding because the variability between sub(ects is much greater than the average weight loss /5D MM 03 Goal directed programs and programs that dogmatically insist sub(ects will succeed if only they follow the regimen provo&e highly s&ewed dropouts .eight loss studies often present the average weight loss of a subset of the e"perimental cohort 0ost such samples are not representative of the overweight population, yet vital >uestions of relevance to the overweight population are rarely addressed .hat portion of the overweight population was not eligible for or e"cluded from the program, thus introducing selection biasD /.illiamson S !evy, $nt J of =besity, ),++, )J, #6,-+13 !ong term studies pose further problems for studies without a non-dieting control group .illiamson and !evy analyCed weights recorded for medical purposes at two clinic visits separated by intervals of ) to # years 4hese were 11J adult patients who were initially at least J- per cent overweight 4he #, patients measured over a # year interval showed an 7apparent weight loss7 for 1) per cent of this group with a mean decrease of 6 1 &g 4his long term random weight loss is comparable to the positive results reported by some diet and behavior programs 75ome variation in an individual;s body weight is e"pected to occur over time for a variety of reasons including mood swings, health status, seasonal variations in food inta&e, amount of e"ercise, tobacco smo&ing, pregnancy, and dieting attempts 4hese intervening variables have not been well controlled in long-term weight loss follow-up studies 4he sub-group of sub(ects who maintain a weight loss is usually reported in isolation without comparison to the ma(ority of overweight sub(ects who originally entered the survey or program 4hese results suggest the degree of variation that a Knon-dietingL control group would contribute both to the proportion of overweight sub(ects who would have naturally decreased in weight at a specific re- measurement interval and the mean amount of weight by which they would have decreased 4he sample siCe in this study e"ceeds that of most long-term follow-up studies reported in the literature 7 'ew studies are available of body composition changes after weight losses from standard dieting programs .eight losses beyond the initial glycogen and water shifts have proven difficult to achieve /.eight loss of #&g /)) pounds3 or less may not involve any loss of fatO3 .hen they do occur it is difficult to verify the actual protocol the sub(ects followed 5ub(ects often report they often became Ustuc&; on traditional protocols and resorted to some more drastic form of food restriction to achieve weight loss 4hey are often reluctant to report such behavior at the time of the actual diet /%m J of 9lin :utr ),,JI#FHJ)65-J153 Unless a significant loss beyond baseline is demonstrated by weight loss studies and programs, no effect should be attributed to the program 9ontrol groups that account for random weight changes /mostly from unsupervised dieting3 are essential in studying the long-term maintenance of weight loss

%ny study that ta&es weight loss as a goal should include the following informationH .eight, height, and @ody 0ass $nde" /@0$3 for sub(ects at entry, then weight and @0$ at each follow-up time :umber and siCe of fat cells before slimming, after slimming, and after weight regain .hen e"pressed as means, these values should be accompanied by the standard deviation, not the standard error Data for males and females should always be separated $f the study contains more than one e"perimental group and2or a control group, sub(ects must be randomly assigned to each group $f the study contains more than one e"perimental group and2or a control group, the data should be presented for each group 5tudies with #- or fewer sub(ects should present individual data Data should include followup for a minimum of three years after treatment ends $f there are drop-outs, the remaining number of sub(ects should be recalculated and reported along with the mean weight at follow-up %lmost all drop-outs regain their weight loss or more, and must be calculated this way .eight loss studies should report the number and siCe of adipose cells before slimming, after slimming, and after weight regain /@ased on recommendations by by .illiam @ennett, Harvard 0edical 5chool Health !etter3

"E8 # 8 ST<$T <+

Heavy advertising, a 7thin is in7 ethic, media preoccupation with unusually obese individuals, and built-in repeat business have bloated the diet industry into a 11 billion dollar a year enterprise 4he media often sensationaliCe studies confirming public stereotypes while ignoring research that disproves those stereotypes 4he following news release is typicalH 7.hy Johnnie gets fat 9H$9%G=, Reuter - 4elevision may be contributing to a near epidemic of obesity among %merican children because it drives metabolism dramatically lower, even below levels found in youngsters who are simply resting, researchers said on 0onday 4he metabolic lowering -- caused by a still un&nown mechanism -- may combine with the high-fat snac&s that often accompany the hours so-called couch potatoes spend in front of the tube, according to a study published in the 'ebruary issue of the medical (ournal Pediatrics $t said obesity affects as many as one out of every four U 5 youngsters, as well as about 1- per cent of adults 7 .hile entranced by the sedating effect of a 74he .onder Bears7 episode on 1) children measured for a 0aster;s thesis, the media completely ignored the lead article in the same issue % )J#- child study by 5tanford and :$9H that concluded that 7television viewing time appears to have only wea&, if any, meaningful associations with adiposity7 /Pediatrics ),,1I ,)HJ61-+-3 %s Professor Garner;s ),,- testimony before the House of Representatives indicated, deceptive advertising is standard operating procedure in the weight loss industry .hile an isolated deceptive diet2e"ercise ad may not be too misleading to the public at large, the collective effect of such deception /:aCi @ig !ie effect3 creates great damage .eight .atchers, :utri25ystems and other diet promoters refuse to divulge their long term weight loss data 0isleading advertising is, unfortunately, normal for the diet industry 4he ma(ority of diet food products tested for the :ew Bor& state 9onsumer Protection @oard contained more calories than listed on their pac&age labels +percent of the diet food products tested e"ceeded claimed calories, some by as much as 61 calories per serving %dded sugar has been found in J#? of orange (uice brands described as pure and unsweetened %dvertising ethics are no better in the related e"ercise industry % :ordic4rac& ad claimed a fat person could lose up to ))-- calories per hour, several times what an endomorph with middle age spread could reasonably e"pect

+EW TEC2+<L<?%

1ood #llergy #'oidance

'ood allergies may be responsible for some adiposity according to an article in the %merican Journal of @ariatric 0edicine /),,F2D3 5ub(ects with weight problems lost fat and gained muscle after eliminating foods to which they are allergic as identified by tests $nformation on food intolerance testing using 4he %!9%4 4est is available from %04! 9orp at )-+---++)-JF+# =ther articles and boo&s on food allergies have appeared over the years

ST "UL#T <+ <1 T2E$"<?E+ES S

4hermogenesis refers to the generation of body heat in muscle and brown adipose tissue /@%43 # !ean sub(ects increase thermogenesis in response to meals, e"ercise, and cold weather =bese sub(ects show less of each of these responses than lean sub(ects =bese sub(ects are less tolerant to long term cold e"posure because of their inferior thermogenesis capability 4hese facts have prompted many investigations into the possibility of reducing obesity by increasing thermogenesis in the obese $n their boo& 7!ife 8"tension .eight !oss7, Pearson and 5haw suggest thermogenesis enhancing drugs and cold e"posure as ways to burn up fat 9affeine, ephedrine, nicotine and other materials have been shown to increase metabolism in humans %spirin increases the thermogenic effectiveness of ephedrine in obese but not lean women 5ome are associated with weight loss during the treatment period 9ommon side effects of such treatment include high blood pressure and heart palpitations 8phedrine >uadrupled the weight loss of obese women whose metabolisms had been depressed by previous dieting /$nternational Journal of =besity, ),+6H )F1-+3 % double-blind Danish study reported that ephedrine J-mg T caffeine J--mg administered three times daily dramatically increased fat loss and fat o"idation /see 7fast fibres73 and reduced loss of fat-free mass 4hree of the + patients on 8T9 complained of insomnia, palpitations, and tremor, respectively /0etabolism, *)I6 July ),,J3 % combination of ephedrine/6#-)#-mg3, caffeine/)#-mg3, and asprin/11-mg3, in divided premeal doses, supports modest, sustained weight loss even without prescribed caloric restriction, and may be more effective combined with diet /$J= ),,1 )6 /5uppl )3 561-+3 9affeine consumption is controversial 5ome diet boo&s recommend it, some forbid it 8arly %t&ins boo&s allowed it, the ),,J se>uel does not 9affeine and ephedrine are &nown to increase blood pressure, so caution is advised 4he 'D% has warned against dietary supplements containing ephedrine /.all 5treet Journal, @#, *2))2,F3 4he 'D% is considering regulating ephedrine /),,63 5mo&ers gain weight when they >uit smo&ing, up to F- pounds %verage is )F 6 pounds for men, ), J for women after # years /%m (r of 8pidiemology :ov ),,+3 4heir final weight averages the same as that of non smo&ers 4his suggests nicotine reversibly depresses weight, F to 6 per cent according to University of .isconsin researcher Richard Neesey :icotine reduces weight by increasing metabolism, not by reducing appetite or food inta&e % growing number of young women have discovered this, and cigarette smo&ing is gaining popularity as a weight control measure 7!ove ma&eth lean the fatte mens tumor, so doth 4obacco7 /4obias Hume, 4he 'irst Part of %yres, !ondon, )F-#3 Pearson and 5haw recommend nicotinic acid to increase thermogenesis and as a recreational drug % study of obese women on a swimming program suggests their heat loss to water had the opposite effect, increasing their fat stores $t;s been reported that women gain )- pounds in less than a wee&;s time when they move to %las&aI they lose this weight when they move bac& to a warmer climate 4his weight gain may be the result of @%4 lipogenesis $t has been suggested that early e"posure to cold might promote adult leaness /p 6#, =besity and !eanness - @asic %spects3 $mprovements in household heating in this century may contribute to an increase in obesity

?$<WT2 2<$"<+E T$E#T"E+T

/%lso called somatropin, or 54 3 0a"imally effective doses of 54 can reduce lipid accretion rates and adipose tissue mass by as much as +-?, and increase protein /lean tissue3 deposition by #-? 54 affects numerous target tissues to effect mar&ed changes in

nutrient partitioning 0any of the metabolic effects are a direct action of 54, involving a variety of tissues and the metabolism of all nutrient classes, i e , 9H=, lipid, protein and minerals 4hese metabolic changes are important because theyH /)3 establish the rate of lipid accretion and, therefore, the e"tent to which 54 affects body composition in a growing animal, /J3 play a &ey role in redirecting nutrients /e g , glucose3, normally destined to be deposited as lipid, to other tissues thereby supporting the nutrient needs for lean tissue accretion during growth .hen animals are in positive energy balance, 54 causes a reduction in lipogenic rate 4he ability of 54 to reduce lipid accretion in growing pigs is the result of a decrease in insulin sensitivity of fat cells, which reduces lipid synthesis 4he effects of 54 are chronic rather than acute /Proceedings of the :utrition 5ociety /),,J3 #), *),-1)3 Human Growth Hormone promotes muscle growth and fat loss Growth Hormone restricts glucose incorporation into fat cells 4he pituitary gland releases Human Growth Hormone /HGH3 in bursts, mostly during the early hours of sleep 4he obese produce fewer HGH bursts, and each burst is much smaller than normal Reduction of plasm insulin levels does not restore GH to normal in obese children =besity is associated with reduced J* hour integrated concentrations of growth hormone /$9-GH3 and elevated concentrations of insulin /$9-$3 compared to lean individuals 4he difference in growth hormone levels is greatest in childhood 4he difference in growth hormone between lean and obese children are typical of poorly growing children with classical growth hormone /GH3 deficiency $n contrast to children with classical GH deficiency, obese children are generally normal or above average for height, growth rate, osseous maturation and $G'-) levels % study reported in the Dec 1 ),,- .all 5treet Journal reported that short children treated with growth hormone lost a 7drastic 6F per cent of body fat7 while gaining as much as J#? lean body mass /compared to untreated controls3 =bese individuals normally release very little or no detectable HGH bursts 8ven under the most strenuous e"ercise, obese individuals release only a small fraction of the HGH lean sedentary individuals release in normal sleep % study of lipid metabolism in lean and pre-obese swine /pigs of normal weight which will become fat3 indicated low levels of growth hormone at least until se"ual maturity, and an enhanced deposition of blood lipids as fat compared to lean sub(ects /$nternational Journal of =besity ),,-, )*, J)-J,3 4his enhanced deposition is significant in two ways 'irst there is the direct accumulation of fat 5econdly this deposition of fat 7short circuits7 metabolism of blood lipids into cholesterol and steroid hormones 4his theory helps e"plain why destruction of fat tissue allows animals to grow up with more muscle mass than identical but untreated controls Growth Hormone deficiency in adults is associated with psychosocial malad(ustment, reduced muscle strength and reduced e"ercise capacity @ody composition is significantly altered with increased fat and decreased muscle volume as compared to healthy sub(ects 8pidemiological data suggest premature mortality from cardiovascular disease 5hort-term GH treatment trials have shown improved psychosocial performance, normaliCation of body composition, increased muscle strength, improved e"ercise capacity, and increased cardiac performance /9hristiansen S Jorgensen, Univ Dept of 8ndocrinology and $nt 0ed, %arhus Nommunehospital, Denmar&3 $n a recent study, administration of synthetic growth hormone to elderly male patients with low HGH levels to normaliCe their HGH levels resulted in significant muscle gain and fat loss % Dutch study + GH deficient patients reported that F months GH therapy increased lean body mass and decreased fat mass 4he sense of well-being improved in most patients 9holesterol levels decreased /9linical 8ndocrinology ),,J 16, 6,-+63 % study at 5t 4homas; Hospital in !ondon found that patients with hypopituitarism have altered body composition and >uality of life $n comparison with a matched control group such patients had considerably reduced lean body mass and increased fat mass and waist to hip ratio % number were significantly depressed, sufficient to (ustify therapy 7.e conclude that there is a morbid syndrome associated with growth hormone deficiency in adult life which responds dramatically to hormone replacement 4o be effective this therapy has to be continued indefinitely 7 8"ogenous GH increases lean tissue and reduces body fat in obese women in the absence of significant energy restriction /Hormone Research ),,), ),-J*3 =bese men manifest fewer GH secretory bursts per J* h and accelerated HGH disposal rates /Journal of 9linical 8ndocrinology and 0etabolism 6JH) p #)3 # wee&s HGH treatment reduced the fat mass of obese women J &g as it increased lean body mass 1 &g !P! activity was reduced #- per cent /#th 8uropean 9ongress on =besity )-- )J June ),,J3 $n the future, pre-obese individuals might be treated with HGH and DH8% to &eep them from becoming fat

?ro)th 2ormone Stimulation

Human growth hormone is e"pensive, and side effects are an issue %n alternative to HGH in(ection is to stimulate the body to e"crete HGH

Pearson and 5haw recommend stimulation of human growth hormone /HGH3 e"cretion with arginine amino acid supplements as a weight loss method !ong term propranolol therapy increases body weight in heart attac& patients /JP-)*3I this may modify some of Pearson and 5haw;s recommendations :ormal people re>uire as much as )+ grams of arginine to increase HGH secretion Unfortunately, the references given in their boo& indicate their recommended amino acid megadosage is still orders of magnitude too small to cause the obese to release detectable amounts of HGH 4he obese have a high threshold which must be surpassed by strenuous e"ercise /to the point of e"haustion3 or 7incredible7 doses of amino acids /orders of magnitude more than even PearsonS5haw recommend3 before any stimulation of HGH release is noted HGH levels achieved under these e"ceptional conditions are still only a fraction of what lean sub(ects spontaneously produce in their sleep Dbla&e<bme (hu edu reports that double-blind studies with weight lifters have shown := benefit 4he antiobesity drug fenfluramine normaliCes obese sub(ects; human growth hormone /HGH3 response to arginine /Hormone Research ),+6H J6I ),--),*3 79hronic ingestion of !-dopa /an HGH releaser3 leads to sustained but reversible weight loss in both lean and obese Puc&er rats 7 GH 5ecretion in response to all provocative stimuli is decreased in the obeseI the precise mechanism of this impairment in un&nown %dministration of GHRH /Growth Hormone Releasing Hormone3 and the synthetic compound GHRP-F causes a massive GH release, indicating that impaired GH secretion in the obese is a functional state that might be corrected by suitable medication /J of 9lin 8ndo S 0etab ),,1H%pr +),-J13 7.e conclude that obese patients are highly sensitive to the lipolytic and calorigenic actions of e"ogenous GHI however, administration of e"ogenous GH is associated with a distinct resistance to the actions of insulin on glucose matabolism 7 /084%@=!$50 Aol *1 :o 6 July ),,* +6J-63 :etnews postings report that oral arginine is mostly destroyed in the stomach $nstances of acromegaly associated with arginine use have been reported

82E# T$E#T"E+T
Dehydroepiandrostone /DH8%3 reduces weight gain in the hypercorticosteronemic Puc&er fatty rat, an animal of genetic obesity $ts chronic anti-obesity effect is thought to reflect a chronic antiglucocorticoid activity /$nt J of =besity, ),,J, #6,-3 University of .isconsin researchers treated normal and ), spontaneously obese dogs with DH8% 4he normal weight dogs did not reduce weight or energy inta&e 4wo-thirds of the obese dogs lost J- percent of their e"cess body weight and dropped cholesterol levels by nearly J# percent without reduction in food inta&e /$nt J of =besity ),,-, )*,,#- )-*3 4he ),,- Journal of :utrition reported that DH8% treatment reversed dietary induced obesity /from a mi"ture of corn oil and condensed mil&3 as well as genetically induced obesity /fa2fa rat3 $n premenopausal obese women, DH8% levels are inversely proportional to @0$ %dipose cells remove DH8% from the bloodstreamI enhanced removal of DH8% in severely obese may account for their impaired sensitivity to caloric restriction Kinability to lose weight as e"pectedL /0etabolism, 'eb ,), p )+63 4he author of 74he Aitamin @ible7 reports successful personal weight loss with DH8% but gives no sources or details Pearson S 5haw claim the 7DH8%7 sold by health food stores is bogus $t has been noted on the net that pharmacologically-inert plant sterols found in 0e"ican yam can be used by pharmaceutical manufacturers as raw material to synthesiCe a wide variety of medicinally-useful steroids, but the human body can;t do the same feat Aendors of such 7yam precursors7 are either very confused or they;re being duplicitous DH8% administration may have adverse effects in some women /!ancet, 1*1/+,))3I)*6,-+), ),,* Jun )) 3 %n article in the Jan J- ),,6 .all 5treet Journal was >uite pessimistic about DH8%;s prospects, and reported that DH8% accelerated prostate cancer Until more is &nown about the benefits and dangers of DH8% one should not use this steroid without competent medical supervision 9hec& www ceri com2dhea htm 9hec& DH8% and 0elatonin .eb Page

$U76=D T$E#T"E+T
RU-*+F completely reversed the obesity of genetically obese /fa2fa3 rats by bloc&ing the effects of glucocorticoids and insulin causing e"cessive fat cell proliferation RU-*+F reduced fat storage from ),-6 &( to )-J &(, while increasing protein /lean tissue3 storage from ** &( to J)6 &( /%merican Journal of Physiology ),,-, R#1,-*13 RU-*+F /mifepristone3 reduces the deposition of fat tissue and increases the deposition of lean tissue, but only in obese sub(ects RU-*+F also causes obese mice to lose weight by increasing @%4 thermogenesis Reportedly RU*+F can help cure 9ushing;s syndrome, a gland disorder characteriCed by obesity and hypertension 7Potentially the most potent anti-aging drug available 7 /!ongevity, Jan ),,)3 % paper in the ),,J $nternational Journal of =besity reports that :orepinephrine /the neural transmitter, not the asthma drug3 inhibits rat pre-adipocyte proliferation

Co:: T$E#T"E+T
4he ),,- Pharmacology reported that in(ections of cobalt- protoporphyrin completely reversed the obesity of Puc&er fa2fa fatty rats Unli&e diets, lean tissue is not affected Untreated rats that were fed the same amount of food as the 9oPP treated rats for the first *J days reverted to the same weight as untreated fatty rats by day F- 4his indicates 9oPP caused a long term reduction in the rats; set point 4ypical 9oPP treated /left3 and untreated /right3 Puc&er fatty rats are shown

@$<"<C$ :T +E T$E#T"E+T
J6 hyperprolactinaemic obese women /@0$ 1+ 63 lost ) J-) # &g per wee& when treated with bromocriptine /#th 8uropean 9ongress on =besity )--)J June ),,J3

C $C#8 #+ L :<ST#T "#+ :UL#T <+

5ome obesity and type $$ diabetes may be caused by defective circadian Kdaily cycleL neuroendocrine rhythms %lbert 0eier, professor of Coology at !ouisiana 5tate University, initiated a study of bromocriptine after J# years of research on animals; body rhythm biology during migration and hibernation .hat he attempted to translate to humans was the finding that many animals reduce or increase their body fat without altering food inta&e or activity levels /$nsight, 0ar JF ),,-3 0eier, 9incotta and !ovell have dramatically reduced body fat with oral bromocriptine ta&en orally at times calculated to reset circadian hormone rhythms to phase relationships that cause loss of body fat @romocriptine is a dopamine agonist used to suppress lactation and in treatment of Par&inson;s disease 74he phase of the prolactin rhythm differs in lean and fat sparrows, fish, rats, and humans Daily in(ections of prolactin in animals at times when the daily pea&s occur in the plasma of lean and fat animals produce the appropriate decrease or increase in fat stores within two wee&s 7 $n early clinical trials, without food restriction, body fat was reduced e>uivalent to a *J- calorie A!9D, but without the loss of lean body mass caused by weight loss diets 5tudies with 5yrian hamsters investigating whole body protein turnover indicate this treatment enhances protein synthesis, redirecting anabolic activities from lipid to protein %pparently the timed bromocriptine treatment alters the genetically controlled partitioning of nutrients described in 74he response to long-term overfeeding in identical twins7 discussed above $n the second study reported in 8"perientia *+ /0arch ),,J p J*+-3, )# diabetic sub(ects were given timed bromocriptine treatment %s with the non-diabetic sub(ects, all )# diabetic sub(ects lost fat -That EallE subjects lost fat is significant* n energy depri'ation diet studies, some subjects in'ariably fail to lose )eight* n long term diet follo)up, the standard de'iation is t)o or three times as great as the a'erage )eight loss because a large minority gain )eight, sometimes a great amount* Without indi'idual data or the standard de'iation, one simply cannot judge the true effecti'eness of the e&perimental inter'ention* "any diet studies suppress this information as it )ould cause the reader to discount the 'alidity of the claimed results*/ @lood glucose dropped significantly =ral hypoglycemic medication was was discontinued in 1 participants, and glucose levels remained

near normal for at least two months after treatment Doses of hypoglycemic drugs and insulin were reduced in three other sub(ects during treatment @lood pressure was also reduced, allowing blood pressure medication to be discontinued in several $n a telephone conversation /June ),,J3 Dr 0eier reported that a third series of clinical trials was underway as part of the 'D% process to approve the treatment as safe and effective He strongly emphasiCed how critical 4$0$:G is to fat lossI correct dosage given in the wrong rhythm actually increases body fat 4he timing calculation is a process patented by !ouisiana 5tate University and licensed to 8rgo $:9, :ewport R$ Drs 0eier and 9incotta have financial interest in the process 7=ur studies also indicate that a cause-effect relationship between overfeeding and obesity is oversimplistic and that food inta&e and lipid synthesis may be regulated in a concerted fashion by circadian neuroendocrine activities 7

8<:#" +E #?<+ STS

@esides bromocriptine, other dopamine agonists may be useful in the fight against 5yndrome E 8rgo researchers found that a combination of dopamine Dl2DJ agonists improved blood levels of insulin, glucose, lipids and free fatty acids 4hey also had positive effects on proteins, enCymes and other measures related to diabetes, obesity and cardiovascular health 4he findings are to be presented to the %merican Diabetes %ssociation June J)-J* ),,6

TEST<STE$<+E T$E#T"E+T
4estosterone has been shown to decrease adipose tissue mass by several mechanisms Boung men with high testosterone secretion have low visceral fat mass 4estosterone and HGH synergistically promote beta-adrenergic receptor mediated lipolysis of fat cells 0en with abdominal obesity have low testosterone values and insulin resistance %n + month study at the 5ahigren;s Hospital in Goteborg, 5weden tested J1 men aged *--F# years in a fully controlled, double blind e"periment in restoring testosterone levels to normal 4he testosterone treated group improved in waist siCe, blood pressure, plasma lipids, fasting glucose, and insulin sensitivity 4he treated group reported improvements of well-being and energy :ormaliCation of testosterone levels reduced many of the health warning signs associated with obesity :o adverse functional side-effects were found /$nternational Journal of =besity ),,J )FH,,)- 63 5ome reports of negative side effects from oral testosterone have been reportedI it is thought that the liver is the cause of these problems, and that application by s&in patch to the scrotum avoids this problem

@ET#F7#8$E+<CE:T<$ #?<+ STS

%nimal studies on several @eta1-agonists show they fulfill many of the properties of the ideal anti-obesity drug 4hese compounds produce selective loss of body fat mass with a preservation of lean tissue $n addition, the changes in body composition are accompanied by favourable metabolic changes including improvement in glucose tolerance, reduction of hyperinsulinemia and hyperlipidaemia /5)+-13

SE$<T<+ + $EU:T#9E +2 @ T<$S

74he genesis of this pro(ect was an invitation to discuss anore"iant medications with the house officers in the 0edical 9linic as 5trong 0emorial Hospital 4he colleague who invited me was dismayed that the treatment options used in the medical clinic were not helping people lose weight 7 0ichael .eintraub, 0D 7both the medical profession and society loo& with disfavor on obese people and obesity in general =bese people are treated negatively in cartoons and in literature 0any believe that obese people need only to 7close their mouths7 and be more motivated to lose weight 4he use of medications to correct a characterologic defect is, in the opinion of physicians and the public, deemed inappropriate Unfortunately, a lac& of understanding of both the natural history of obesity and its diversity adds to the per(orative view of obese people and of anore"iants 5ome health professionals are not aware of data concerning mechanisms present in the human organism that act to contravene perturbations in body weight and that may account for the apparent failure of interventions, including medications 7

4o provide longer-term data, .eintraub et al developed a * year multimodal program using state-of-the-art behavior modification, caloric restriction, and e"ercise as the 7placebo7 for the entire duration of the four year study 5ub(ects attended nearly )-- visitations with health professionals during the study .hen reading reports on 4he :ational Heart, !ung, and @lood $nstitute funded 0ultimodal $ntervention 5tudy, please &eep in mind that this 7state- of-theart7 treatment was the 7placebo7 /5tate of the diet2e"ercise2shrin& art, that isO3 7'rom the end of the second doubleblind phase at wee& ),- through wee& J)-, we monitored study participants to see what happened without medication but with continuing behavior modification, caloric restriction, and e"ercise therapy =ne measure of the e"cellence of the ancillary KplaceboL therapy in this study was that it enabled participants treated with placebo to lose (ust - -) &g2wee& less than participants receiving active therapy in the )+ studies that lasted at least + wee&s reviewed by 5coville for the 'D% 7 )J) sub(ects, )+ to F- years old, mean @0$ of 11 * T- J J, three fourths female, entered the medication phase of the study after F wee&s of behavior mod, diet and e"ercise F, per cent had been on si" or more diets previously 5ub(ects on medication lost about three times the weight as those only receiving behavior modification, diet and e"ercise 4here was no indication of tolerance or abuse potential of the medication 4here was no indication that use of anore"iant inhibits the learning of behavior modification %s reported by the :ew Bor& 4imes :ew 5ervice, Dr %lbert 5tun&ard, an obesity researcher at the University of Pennsylvania, said he &new of no other study that had elicited such a dramatic and sustained weight loss $t UUpoints to the way things are going to go,;; he said 4he investigators found their patients could not maintain their weight loss without the drugs 4he final 1- wee&s of the program assessed what happened when all the patients were weaned from the drugs, relying on continued diet, e"ercise and behavior control 4hey gradually regained almost all the weight they had lost, despite the continuing program of diet, e"ercise and behavior modification 5ome who believe that the essential defect in obesity is will power have asserted that the weight regain was from sub(ects; going 7off the diet7 when medication was withdrawn, instead of the diets; poor long term performance % number of facts argue against this assertionH M08:UM 'enfluramine;s appetite reducing effect wears off within a wee& %ny increased eating from cessation of the anroectic effect would have occurred much earlier Patients were on moderate diets, up to )+-- calories2day for men, )J-- for women 0ost of the patients were veterans of a half doCen or more diet attempts .ith this amount of metabolic slowdown, the traditional /diet2e"ercise2behavior mod3 part of the program may not have been able to induce much long-term weight loss without benefit of the drugs; lowering of set point !ipid profiles, primarily affected by the diet and e"ercise, confirmed the weight regain was not caused by cheating on the diet .hen the study was over, and sub(ects ta&en off the drugs were nearly as fat as they were initially, many tried to get the drug combination from their private doctors and ran into s&epticism over the treatment 5ome e"perts on weight loss hailed the studies, saying they could mar& a pronounced shift in the way obesity is studied and treated 4hese e"perts said the results showed obesity could be treated the way chronic diseases li&e high blood pressure or arthritis are $n those diseases, drugs must be ta&en indefinitely to &eep symptoms in chec& UU4his is a landmar& study,;; said Dr George @lac&burn, an obesity researcher at :ew 8ngland Deaconess Hospital in @oston, author of the ),+, paper 7.eight cyclingH the e"perience of human dieters7 5tudy A$ of the report discusses individual outcomes =ne sub(ect did not reach goal weight /)J-? of ideal3 but he was able to maintain his weight loss even after medication ceased 5ome others did reach goal weight but gained it all bac&, or more 0ost lost at least some weight but regained after medication ceased, despite continuing behavior modification, diet and e"ercise 5ome lost little or no weight, or gained weight 0any of the failures were due to the e"perimental protocol which did not allow for individual ad(ustments that would have been made in a health care setting Diet evangelists who do not appreciate the deep biological diversity of fat people should study this paper /and the papers on identical twins3 carefully 5erotonin-reupta&e inhibiting agents include flou"etine /ProCac3, fenfluramine, and d-fenfluramine /de"fenfluramine, d'3 $n 'rance and 8ngland, fenfluramine has been used in the treatment of human obesity for J# years :o une>uivocal report of ma(or health haCards has appeared with fenfluramine in spite of e"tensive worldwide prescription for decades De"fenfluramine is the de"tro stereoisomer of fenfluramine, and is a more potent antiobesity agent with fewer side effects 4iredness and drowsiness were the most commonly reported unwanted side effects of treatment, but occurred as fre>uently with placebo treatment as with de"fenfluramine 7 /9linical :europharmacology Aol )) 5uppl ) 5)6,3

=ver five million people have benefited from de"fenfluramine over the past seven years 7$t;s proven itself over and over again 7 /Dr Rudolf :oble, Dir 9athedral Hill =besity 9linic, 5an 'rancisco3 4he conventional characteriCation of d-fenfluramine as an appetite suppressant is hopelessly oversimplified at best, if not downright inaccurate 7=ur calorimeteric data indicate that de"fenfluramine induced anore"ia and body weight reduction is a conse>uence of activated lipid o"idation7 /@oschmann, 'renC, :oac&, German $nst of Human :utrition, #th 8uropean 9ongress on =besity )--)J June ),,J33 7%ccording to most authors, tolerance to the anorectic effects of d-fenfluramine in rats rapidly sets inI food inta&e is depressed or only J to F days However, as long as the drug is administrated, the weight deficit persists 7 /9linical :europharmacology Aol )) 5uppl ) 5)-#3 7'ollowing appro"imately a wee& of daily ingestion of fenfluramine, the body weight of female rats is reduced and remains chronically suppressed for as long as treatment is continued 4his chronic suppression of body weight by fenfluramine cannot be e"plained by the anorectic effects of fenfluramine, since food inta&e returns to normal after about a wee& Part of this chronic suppression of body weight lies in the ability of fenfluramine to enhance the thermic effect of food 'enfluramine ingested by a fasted rat causes no change in metabolic rate However, following the ingestion of the meal consisting of mi"ed nutrients or only carbohydrates, the thermic effect of the food is significantly greater than that of the meal without fenfluramine % similar observation was observed in humans 4hese observations when combined with the negligible effects of dieting as a means of controlling body weight, argue for the chronic use of fenfluramine as a therapeutic techni>ue to produce sustained weight loss in humans 7 /9linical :europharmacology Aol )) 5uppl ) 5,--J3 $s fenfluramine;s anorectic effect essential to its antiobesity propertiesD .hen body weight was reduced in rats prior to treatment with fenfluramine, administration of the drug was followed by a rapid increase in food inta&e with maintenance of the reduced weight 4he reduced body weight in fenfluramine-treated rats is defendedI when animals are force fed to a higher weight and then allowed to eat ad libitum their food inta&e drops and body weight drops /Recent %dvances in =besity ResearchH A J,-3 'enfluramine normaliCes obese sub(ects; human growth hormone /HGH3 response to arginine :ormally obese sub(ects generate negligible amounts of HGH in response to arginine stimulation /Hormone Research ),+6H J6I ),--),*3 'luo"etine, another serotonin-reupta&e inhibiting agent, has been shown to improve insulin sensitivity and other metabolic actions De"fenfluramine is a related drug that increases metabolic rate /0R3, diet induced thermogenesis /D$43, decreases blood pressure, and enhances glucose clearance De"fenfluramine reduces or prevents weight regain after slimming 4he drug appears well suited for use in hypertensive or diabetic obese patients /9linical :europharmacology Aol )) 5uppl )3 /Progress in =besity Research ),,-3 $n rat, d-fenfluramine improves the insulin action of reducing the liver;s glucose output /D$%@8485 %pr ),+,3 4he .eintraub study maintains a level of e"perimental design, reportage, disclosure and honesty that distinguishes it from most studies of traditional weight loss techni>ues $t is the longest weight control study of any type $t underscores the ab(ect failure of traditional weight loss technology to improve the >uality of life for most fat people 'ree reprints of this F# page supplement are available 9onsumers Reports discounted the significance of the .eintraub study in their June ),,1 issue on diets 9R would have served its overweight readers better if they had applied the same criteria to the marginal nostrums they recommended %nother study is underway at the Aeterans %dministration 0edical 9enter in Hampton, Aa 74his is comparable or superior to any medical treatment of obesity,7 said the study;s author, Dr Richard ! %t&inson %t&inson and his colleagues gave the two drugs to #-F women and #6 men, most of whom have been followed for at least si" months, and some for more than a year @lood pressure in *, sub(ects with high blood pressure dropped to normal 4wentyfour patients with high cholesterol saw those levels fall to normal, %t&inson said %nd blood sugar -- an indication of diabetes -- also dropped to normal 74hat;s dramatic stuff 7 7.e;re fi"ing high blood pressure, high sugar and high fats by treating the underlying disease -- obesity,7 %t&inson said 4he study underscores the growing belief among obesity researchers that diet, e"ercise and behavior change are not enough in most cases to produce long-term weight loss in overweight people 7.e need to loo& for additional treatments,7 %t&inson said :umerous papers on the antiobesity properties of serotonin- reupta&e inhibiting agents appeared in Aol )) 5upplement ) of 9linical :europharmacology /),++3 % three year German study reported on a four year group therapy weight loss study During the first year de"fenfluramine was administered to half of the group double-blind 4hree years after cessation of drug treatment, the cholesterol, triglycerides, blood glucose and systolic blood pressure of both groups were above baseline values

4he fenfluramine group lost more weight than the placebo group on group therapy, but suffered weight rebound after the drug was withdrawn /$J= ),,* )+, 1,)-#3 4he ultimate application of serotonin-reupta&e inhibiting agents may be to prevent or minimiCe weight regain that usually follows dieting /%m J 9lin :utr ),,JH#FH ),#5-+53 %nimal e"periments have raised concerns about potential brain damage from some of these drugs 4hese e"periments may not be relevant to human usage for weight loss 5tudy results presented Dec )-, ),,+ at the annual 8UR=89H= meeting showed no statistically significant increase in heart valve regurgitation or cardiovascular physical findings and outcomes when patients previously treated with fenfluramine or placebo for appro"imately three months were compared Dr Ravin Davidoff of @oston University 0edical 9enter presented echocardiographic data and cardiovascular evaluations of women who had previously ta&en fenfluramine or placebo as part of a smo&ing cessation trial Patients too& the drug as part of that study appro"imately four years ago at 4he 'red Hutchinson 9ancer Research 9enter in 5eattle 'enfluramine was fre>uently prescribed as part of the diet drug combination &nown as phen-fen 'enfluramine, which was sold in the United 5tates as Pondimin/R3, was voluntarily withdrawn from the mar&etplace by .yeth%yerst !aboratories on 5ept )#, ),,6 74he study represented a uni>ue opportunity to evaluate patients years after their participation in a placebocontrolled study with fenfluramine,7 Dr Davidoff said 7%fter an average of * * years following cessation of drug, there were no statistically significant increases in the prevalence of echocardiographic valvular abnormalities, cardiovascular physical findings and outcomes between fenfluramine-treated patients and placebo 7 Data were presented on #1- female patients /J6F fenfluramine, J#* placebo3 who participated in the smo&ing cessation trial 4he echocardiographic portion of the study focused primarily on the 'D%-defined criteria of mild or greater aortic regurgitation and moderate or greater mitral regurgitation 74hese results are consistent with other data from controlled studies involving use of anore"igens for less than three months,7 Dr Davidoff said 4he withdrawl of these drugs and the massive lawsuit that resulted may be another result of today;s widespread use of (un& science and general abandoning of critical thin&ing in legal actions

1#T CELL $E"<!#L 1at Cell $emo'al by Surgery

5urgery is the only currently available fat reduction treatment that has demonstrated long term success in a ma(ority of patients Unfortunately, the amount of fat removed by currently accepted surgical procedures is too small to be useful for mainstream weight reduction purposes % newspaper recently reported an increase in breast siCe for women who had 7love handles7 removed $t is possible the breast siCe was recovering from the effects of stringent dieting underta&en in unsuccessful attempts to spot reduce the 7love handles7 % 5outh %frican study of freely-eating, non-obese liposuction patients showed no increase in fat cell siCe, metabolic efficiency, or regional adipose distribution ) to J months after surgery 5urgical removal of fat in 9ushing;s 5yndrome patients /*'- J)3 resulted in an increase in lean tissue mass, and no fat regain $n adult male rats, having combined subcutaneous and epididymal lipectomy /7adipectomy73 removing J*? of all fat, there was no difference in cell siCe between any fat depots compared to sham-operated animals at sacrifice after )J wee&s 4here was no evidence of redistribution or compensatory growth of adipose tissues after lipectomy /%cta 0ed 5cand, 5uppl 6J1H JJ#-1)3 Diabetic patients receiving abdominal liposuction have reduced insulin re>uirements /dose reduced from J- to )units3 /Unpublished data3 )) obese patients with truncal obesity treated with abdominal lipectomy which removes subcutaneous fat * # month later, triglycerides, !D!, plasma insulin, and 9 Peptides were lowered /9aCes et al, U of 4oronto, $J= ),,* =F)63 @y ),,# obese 4ype $$ diabetics will be treated with liposuction 4his procedure is intended to lower the need for insulin by reducing the total number of fat cells in the diabetic;s body /!ongevity Jan ),,1I 'red GlaCer 0 D 3

Ultrasonic suction lipectomy was applied to J-# patients with varying degrees of obesity 4riglyceride and blood glucose were improved 1- days after surgery !ate postoperative improvement in the blood glucose tolerance test was seen in 1 of the cases 5ome efforts are underway to develop surgical procedures to significantly normaliCe fat cell numbers

1at Cell $emo'al by mmunological "anipulation

4he Hannah Research $nstitute in 5cotland have developed a treatment to reduce adiposity by targeting cytoto"ic antibodies to fat cells $n early e"periments, rat fat cell plasma was in(ected into sheep 4he resultant antibodies were filtered and introduced into the rats 4he treated rats lost fat 4he treated rats also had more lean tissue than untreated controls 4his suggests fat cells deprive lean tissue of nutrients necessary for growth %fter treatment ended, the rats gained fat in other areas, restoring a normal amount of fat 4his suggests some higher level mechanism prevents adipose mass from falling below norms :ormal weight rats were used in these e"perimentsI results may be better for obese humans with diet induced adipocyte hyperplasia $n a ),,) telephone conversation this author was told Hannah;s research is proceeding very well toward its goal of producing leaner animal meat Human application in the near future was thought unli&ely due to ris& of malpractice lawsuits % followup conversation in December ),,F found the previous pissimism regarding human application replaced by optimism coupled with an understandable reticence to disclose proprietary information 4he specificity of antigens no longer appears to be an insurmountable problem 9ambridge %ntibody 4echnology are cooperating with =besus, and some of the large pharmaceuticals are interested in human applications of this technology =ther researchers, using monoclonal antibodies, report success in longer term suppression of fat cell numbers /Private conversation, ),,J3

:$E8 CT <+S
5ome of the current obesity epidemic will be traced to nutritional and hormonal problems during pregnancy and2or infancy Pregnancies with gestational diabetes and other problems that previously failed now produce preobese children 4he introduction of high carbohydrate baby formula and sugary baby foods in this century will also be a factor !ow 8nergy weight loss diets applied early in life will also be implicated .ithin the decade, prescription of energy restriction weight loss diets for patients with childhood onset obesity will be recogniCed as a violation of the Hippocratic =ath

$EC<""E+8#T <+S 1<$ #CT <+

Popular attitudes on obesity are based on the notion that obesity is caused by sloth and gluttony Recent research has discredited this stereotype and suggested possibilities for effective prevention or treatment in the future %dd a W# chec&off to income ta" forms allowing ta"payers to earmar& money for the research and deployment of new weight control technology 4ruth in %dvertising must be enforced on all weight loss claims %dvertising must accurately and graphically depict the long term results obtained by typical users, accurately reporting the prevalence of long term weight regain and rebound $n the meantime, the protections of the %mericans with Disabilities %ct should be e"tended to fat %mericans whose diligence in dieting has made them so heavy Diagnostic procedures are needed to identify the ) per cent of overweight sub(ects for whom weight loss diets provide long term benefits Policies and public education are urgently needed to reduce diet induced adipocyte hyperplasia 4his is an area where malpractice and product liability lawyers can do some good 4he recent lawsuit settlements by :utri-5ystem .eight !oss $nc are a promising start % meeting on the sub(ect at a recent 4rial !awyers; convention bodes well for the future President 9linton;s lin&s to trial lawyers and his refusal to criticiCe malpractice suits may encourage this development

8ffective interventions to correct human obesity must be developed and deployed =ne hundred million %merican endomoprphs deserve more than a few dimes; worth of legitimate obesity research %ccurate information on medications; weight gain side effects must be provided :on fattening alternatives should be developed 0edical interventions must be developed to replace the natural selection against obese2diabetic offspring that has been short circuited by modern medicine :either eugenics nor today;s discrimination are acceptable 5ince impaired insulin sensitivity often precedes obesity and other complications of 5yndrome E, infants and children should be routinely screened for insulin sensitivity or high insulin levels Prompt corrective action to normaliCe insulin sensitivity is needed to ward off obesity, :$DD0, and other complications of 5yndrome E %t ris& children should also be screened for testosterone, thyroid, growth hormone, cortisol, and fat cell numbers Doctors should properly diagnose and properly treat the medical conditions of their obese patients instead of insisting on unrealistic weight loss as an alternative or precondition to treatment Doctors should ascertain patients; fat cell numbers and siCes before prescribing weight loss regimens 4hey should disclose the long term effects of their proposed regimens on fat cell number 4hey should disclose the long term reduction /if any3 of patients; fat cell siCes Doctors must monitor collagen, essential fatty acid, and serotonin levels during dietary restriction and correct as necessary to avoid the unhealthy dieting conse>uences documented in the medical literature Regulatory interference in the development and deployment of effective new treatments must abate Public health would be better served if regulators shifted their attention to the abuses of the traditional weight loss industry 0others should limit carbohydrate and sugar consumption during pregnancy and lactation to prevent e"cessive insulin levels .hen possible, mothers should e"clusively breast feed F to )J months or longer 8"clusive breast feeding decreases the development of eventual obesity $n cases where breast mil& is unavailable, the infant;s diet should have the same macronutrient composition as human breast mil& $nfants should not be fed a high carbohydrate diet unless repeated measurements of their insulin levels demonstrate they can tolerate high levels of carbohydrate consumption "We recogni(e that the message )e ha'e for endocrinologists and metabolic specialists is a somber one, difficult to the sufferer from obesity* <n the other hand, it seems to us most consonant )ith the true state of affairs* <ur understanding of genetic mechanisms is progressing rapidly and the interaction bet)een genetic endo)ment and early en'ironment )ill be under intensi'e study in the ne&t decade* This is the hopeful side of the problem*" /9!$:$9%! R8A$8. J+H % @iological @asis for Human =besity, Journal of 9linical 8ndocrinology and 0etabolism, ),,) 3

$EGU $E8 $E#8 +?

Dr @ernstein;s Diabetes 5olution /:ot only for diabetics3 Human =besityH 8"ploding the 0yths 4he .estern Journal of 0edicine =ct ),,-I )#1I*J)-*J+ 4he carnivore connectionH dietary carbohydrate in the evolution of :$DD0 /Diabetologia /),,*3 16I)J+--F3 %nnals, :ew Bor& %cademy of 5ciences, boo& length issue on Human =besity !=:G 48R0 .8$GH4 9=:4R=!H 4he :ational Heart, !ung, and @lood $nstitute funded multimodal intervention study, 9lin Pharmacol 4her, 0ay ),,J Reprints of the entire supplement are available at no charge Direct re>uests toH 0ichael .eintraub 0D Department of 9ommunity and Preventive 0edicine University of Rochester 5chool of 0edicine P= @o" F** Rochester :B )*F*J $nformation on the medications used may be obtained with a self addressed stamped envelope mailed toH D$84 54UDB University of Rochester 0edical 9enter P=@ F*1 Rochester :B )*F*J =@85$4B %:D !8%::855, @asic %spects, $5@: - +F),F -)61 :ever 5ay DietD article by Ruth PapaCian, 'D% 9=:5U08R, article downloaded from the 'ood and Drug %dministration @ulletin @oard 'or copies contact the 'D% Publications 5taff at 1-)-**1-1JJ-

70a&ing Peace with 'ood7, 5usan Nano, ),+,, Harper S Row, $5@: ---F--,F1J+-E Proceedings of the :utrition 5ociety /),,J3 Aol #), pp *-- ff /special issue on the 0anipulation of %diposity3 5B0P=5$U0 =: =@85$4BH 0etabolic 5tudy in Human =besity with $socaloric Diets High in 'at, Protein, or 9arbohydrate 084%@=!$50 F /),#63 **6-F-

$EC<""E+8E8 $E#8 +?
References such as /*'-J)3 refer to paper designations in the 4o&yo $nternational 9ongress on =besity abstracted in the $nternational Journal of =besity 5ome of these papers appear in Progress in =besity Research ),,/Proceedings of the Fth $nternational 9ongress on =besity3, John !ibbey S 5ons $5@: - +F),F J6* # References to the #th 8uropean 9ongress on =besity are abstracted in the $nternational Journal of =besity v )6 5upplement J 7Recent %dvances in =besity ResearchH A7 $5@: --+F),F--6J-F 79!$:$9%! R8A$8. J+H % @iological @asis for Human =besity7, Journal of 9linical 8ndocrinology and 0etabolism, ),,) 7Progress in =besity Research ),,-7 $5@: - +F),F J6* # 7=besity in 8urope ++7 $5@: --+F),F-)F6-F $nternational Journal of =besity /Periodical3 7'at 9hance7 :ova episode broadcast on P@5 /),+13 %nnals, :ew Bor& %cademy of 5ciences, boo& length issue on Human =besity 4he 9allaway Diet, @antam non fiction paperbac&, $5@:--- ##1-J+6-+-6 7Diet and HealthH $mplications for reducing chronic disease ris&7I 9ommittee on Diet and Health 'ood and :utrition @oard 9ommission on !ife 5ciences, :ational Research 9ouncilI :ational %cademy 9ouncil, .ashington D 9 ),+, Progress in =besity Research ),,- /Proceedings of the Fth $nternational 9ongress on =besity3, John !ibbey S 5ons $5@: - +F),F J6* # 7:umber and 5iCe of %dipose 4issue 'at 9ells in Relation to 0etabolism in Human =besity7 Page 6-1, 0etabolism, Aol J- :o 6 July ),6) 7!ean @ody 0ass, 8"ercise and A!9D7, $nternational Journal of =besity /),+,3, )1 /suppl J3, )6-J# 75uper :utrition for .omen7, %nn !ouise Gittleman, 5anta 0onica Priti&in !ongevity 9enter nutrition director, @antam @oo&s, ),,)

+TE$EST +? WE@ :#?ES

4he !ow 9arb Retreat 9anadian !ow 9arb 5ite 4he .orld;s @iggest 'ad Diet 4he latest %diposity )-) is available at )))*omen*com !ow 9arbohydrate S Netogenic Diet Resources $nsulin Resistance /5yndrome E3 $nformation !ow 9arbohydrate - Diabetes page at 5t John;s University !ow 9arbohydrate Diets .eb Page Paul on 'at /!ow 9arb %dvice3 Hypoglycemics; Diet Dr @arry 5ears; The Hone .eb Page Diabetic :europathy - % :ew %pproach Glycemic $nde" .eb Page !ipid 0etabolism %ltered $mmunity and the !ea&y Gut 5yndrome ... .eight com DH8% .eb Page DH8% and 0elatonin .eb Page %merican Journal of 9linical :utrition Paul 0c%leer;s 'at %cceptance Page

=ther resources =ther resources =ther resources =ther resources =ther resources =ther resources =ther resources Dangers of 4rans-'atty %cids Diet and Human 8volution X),,6 9huc& 'orsberg 4his page may be freely lin&ed to, mirrored, or redistributed provided it is not modified

End of #diposity 1>1

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Rece+,e-# .rom mael/(rom./(0o*n/.e-u 1mael/(rom./(0o*n/.e-u 213&."4.1. 356 b7 omen.com 14.4.%8S9O%6 w+(* ESMT) +- JAA14'!" .or ; Ce-< 4 Oc( 1&&' !&# #% -!'!! 1)DT6 Me//age-=-# >1&&'1!!41" .JAA14'!"@omen.com? Rece+,e-# .rom mael/(rom./(0o*n/.e-u b7 mael/(rom./(0o*n/.e-u 1LSMT) .or O@enAMS ,1.1a6 w+(* SMT) +- >1 .3&F&$AE3@mael/(rom./(0o*n/.e-u?; Ce-< 4 Oc( 1&&' 1 # # 1 -1$!! Da(e# Ce-< 4 Oc( 1&&' 1 #1"#$" -!3!! Re@l7-To# Low9arb Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on Sen-er# Low9arb Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on From# Dean E/ma7 Sub0ec(# Re# Some Low 9arb concern/8Lue/(+on/ To# LOC9ARD@MAELSTROM.STJOHNS.EDU =n-Re@l7-To# >1&&'1!!' !! .)AA! 4""@/era@*.w/@ou(.com? S(a(u/# RO 9o,er( Da+le7 /@rea-/ a w*ole lo( o. m+/+n.orma(+on. H+/ o,err+-+ng @*+lo/o@*7 (*a( eGerc+/e +/ (*e onl7 /ure wa7 (o lo/e .a( +gnore/ one +m@or(an( .ac(# e,er7 /+ngle /(u-7 on eGerc+/e (o -a(e< regar-le// o. (*e (7@e o. eGerc+/e< 1aerob+c< anaerob+c< re/+/(ance (ra+n+ng< /@l+( rou(+ne/ M combo a@@roac*e/< e(c.6 *a/ /*own (*a( eGerc+/e almo/( alwa7/ .a+l/ (o alle,+a(e obe/+(7--w*e(*er comb+ne- w+(* *7@ocalor+c an-8or low .a( -+e( or no(. )eo@le *a,e go((en angr7 w+(* me man7 (+me/ .or /a7+ng (*+/. Du( none o. (*em e,er @o+n( (o an7 re/earc* re.u(+ng (*+/ @o+n(--becau/e (*ere +/nE( an7. Or +. +(E/ (*ere< = *a,e 7e( (o .+n- +(< an- no one w*o argue/ w+(* me *a/ .oun- +( e+(*er. So .ar an7wa7. T*ere are< o. cour/e< numerou/ bene.+(/ (o *eal(* an- well-be+ng .or eGerc+/e< +nclu-+ng mo-era(e .a( lo// an- lean (+//ue ga+n/. )eo@le w+(* onl7 1! @oun-/ or /o (o lo/e ma7 ge( all (*e we+g*( lo// bene.+(/ (*e7 nee.rom eGerc+/e. Du( an7one w*o cla+m/ (*a( eGerc+/e +/ (*e Fe7 (o /ol,+ng we+g*( @roblem/ +n (*e c*ron+call7 obe/e +/ /+m@l7 no( (ell+ng (*e com@le(e (ru(* abou( w*a( (*e ac(ual re/earc* on (*e /ub0ec( *a/ /*own. Swe-en-Obe/+(7 9o@7r+g*(< 1&&'. T*e A//oc+a(e- )re//. All r+g*(/ re/er,e-. T*e +n.orma(+on con(a+ne- +n (*+/ new/ re@or( ma7 no( be @ubl+/*e-< broa-ca/( or o(*erw+/e -+/(r+bu(e- w+(*ou( (*e @r+or wr+((en au(*or+(7 o. T*e A//oc+a(e)re//. STO9NHOLM< Swe-en 1A)6 -- A new /(u-7 @ro,+-e/ more e,+-ence (*a( obe/+(7 +/ an +n*er+(e- con-+(+on .or man7< re/earc*er/ a( (*e Narol+n/Fa =n/(+(u(e /a+Tue/-a7. T*e re/ul(/ ma7 no( *el@ o,erwe+g*( @eo@le /l+m -own< bu( coul- com.or( (*em b7 /*ow+ng (*e7 are no( (o blame .or (*e+r we+g*( @roblem.

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)ar( o. (*e @roblem w+(* +n/ul+n re/+/(ance8me(abol+c /7n-rome +/ (*e -+,er/+(7 o. cl+n+cal .ea(ure/ w*+c* are a//oc+a(e-. A/ Rea,en .+r/( /(a(e- +n *+/ benc*marF lec(ure bacF +n 1&4" 1J4'6 - +( wa/ (*e HDan(+ng Memor+al Lec(ureH. He /a+-< or wor-/ (o (*e e..ec( - Ha( .+r/( blu/* +( a@@ear/ ou(lan-+/* (o /ugge/( an a//oc+a(+on be(ween *7@er+n/ul+naem+a< *7@er(en/+on an- *7@er(r+gl7cer+-em+aH. H7@er+n/ul+naem+a *a/ now o. cour/e been clearl7 a//oc+a(e- w+(* +n.er(+l+(7 ano,ar+an -7/.unc(+on an- = enclo/eSS a @*o(o/(a( o. an ar(+cle .rom (*e A-,er(+/er +n w*+c* )ro.e//or Norman @ubl+cl7 acFnowle-ge/ (*+/ @*enomenon; +( +/ now recogn+/e- b7 (*e Hear( Foun-a(+on 1enclo/e-SS6 a/ be+ng an +m@or(an( @+ece +n (*e 0+g/aw @uBBle o. coronar7 ,a/cular -+/ea/e an- +( +/ now Lu+(e clearl7 acce@(e- b7 (*e AMA +n (wo recen( ar(+cle/ w*+c* a@@eare- +n (*e Me//enger )re//1enclo/e-SS6 - bo(* o. w*+c* re.er clearl7 (o +n/ul+n re/+/(ance. Un.or(una(el7 un-er/(an-+ng o. +n/ul+n re/+/(ance +/ be-e,+lle- b7 (*e eG(reme com@leG+(7 o. (*e en-ocr+ne orc*e/(ra. = (*oug*( +( woul- be *el@.ul (o /e( (*e .ollow+ng @o+n(/ -own. =n m7 rea-+ng< (*e 1g7necolog+cal6 cl+n+cal .ea(ure/ a//oc+a(ew+(* +n/ul+n re/+/(ance +nclu-e eclam@/+a< +m@a+re- +n(rau(er+ne grow(* an- +n(ra,a/cular abnormal+(+e/ o. (*e clo((+ng mec*an+/m a/ well a/ ge/(a(+onal -+abe(e/< general+/e- @rur+(u/< ,ag+n+(+/< men/(rual +rregular+(+e/< c*ron+c can-+-al ,ul,o,ag+n+(+/< large bab+e/ 1?& lb or 3.1Fg6< @ol7*7-ramn+o/< @reeclam@/+a< or uneG@la+ne- .oe(al lo//e/. Ano(*er angle +n (*e 0+g/aw @uBBle o. =R +n women +/ +llu/(ra(eb7 a ca/e (*a( recen(l7 *a/ come un-er m7 care. A woman w*o *a/ *a- re@ea(e- .oe(al lo//e/ w*ere = wa/ unable (o -+/@la7 con,+nc+ng e,+-ence o. +n/ul+n re/+/(ance +n (*e mo(*er bu( (*e .a(*er *a/ clearcu( +n/ul+n re/+/(ance on gluco/e8+n/ul+n (olerance (e/(+ng. T*+/ +mme-+a(el7 ra+/e- (*e Lue/(+on o. (*e +m@ac( o. a .oe(u/ bear+ng (*e (*r+.(7 gene +nu(ero o. a woman w*o un-er (*e @*7/+olog+cal re/@on/e/ o. @regnanc7 become/ normall7 +n/ul+n re/+/(an( - +n/ul+n re/+/(ance be+ng @ar( o. (*e normal @*7/+olog+cal re/@on/e (o @regnanc7. Suc* a mo(*er< +n (*e ab/ence o. (*e (*r+.(7 gene ma7 well ge( (*roug* (*e @regnanc7 w+(*ou( @rogre//+ng (o ge/(a(+onal -+abe(e/ e,en (*oug* *er -+e( con(a+n/ a *+g* +n(aFe o. re.+necarbo*7-ra(e. Howe,er w*a( +/ (*e +m@ac( o. (*a( on (*e .oe(u/J =n/ul+n *a/ been a@(l7 -e/cr+be- a/ a H-angerou/ @e@(+-eH anaga+n w*a( woul- be (*e +m@ac( on (*e mo(*er o. r+/+ng +n/ul+n le,el/ +n (*e .oe(u/. Oou ma7 Fnow o. (*e worF o. (*e Au/(r+an @*7/+c+an +n rela(+on (o mea/uremen( o. amn+o(+c +n/ul+n le,el/. = *a,e no( *a- a c*ance (o .ollow u@ (*+/ lea- bu( = coul- /en.ur(*er -e(a+l/ la(er.SS Du( = -+gre//I M7 @ur@o/e +n wr+(+ng wa/ (o /ugge/( (*a( w*+l/( we nee- (o mea/ure bo(* gluco/e an- +n/ul+n le,el/< (*e -+agno/+/ o. +n/ul+n re/+/(ance8me(abol+c /7n-rome ma7 o.(en re/( en(+rel7 on cl+n+cal groun-/. T*e .a+lure (o ge( con/+/(en( re/ul(/ -oe/ no( mean (*a( we /*oul- no( -o (*e (e/( bu( ra(*er /ugge/(/ (*a( (*ere are /e,eral w+l--car-/ w*+c* *a,e

no( 7e( -eclare- (*e+r @re/ence. To reca@+(ula(e m7 un-er/(an-+ng o. +n/ul+n re/+/(ance< +( run/ (*+/ wa7#- an- = welcome 7our commen(/8cr+(+c+/m/ an- /ugge/(+on/ an- commen(/ an- cr+(+c+/m/ .rom (*e o(*er/ w*o rece+,e an- ma7 /(+ll be rea-+ng (*+/ le((erI#=n/ul+n re/+/(ance 1=R6 ma7 be @re-rece@(or< rece@(or or @o/(-rece@(or; @re-rece@(or =R ma7 be -ue (o +n/ul+n an(+bo-+e/ - (*+/ a@@ear/ (o be rare an- +/ re@or(e- (o be a//oc+a(e- w+(* acan(*o/+/ n+gr+can/ an- (*e HA=R-AN S7n-rome. = *a,e .oun- a number o. @a(+en(/ w+(* (*e @+gmen(a(+on w*+c* +/ /u@@o/e- (o be cla//+cal o. acan(*o/+/ n+gr+can/ bu( *a,e no( .oun- one @a(+en( w+(* +n/ul+n an(+bo-+e/ 1(*e Lue/(+on +/#- are we m+//+ng (*e an(+bo-+e/ becau/e o. .aul(7 labora(or7 (ec*n+Lue or +/ (*+/ con-+(+on rareJ6. Rece@(or =R ma7 be an7 one o. o,er 3! -+..eren( mu(a(+on/ o. (*e +n/ul+n rece@(or. =( woul- a@@ear @urel7 on cl+n+cal groun-/ (*a( (*e bo-7 u/e/ =R a/ a @*7/+olog+cal re/@on/e (o (*e nee-/ .or a *+g* bloo- /ugar le,el - +n (*e (eenage 7ear/< +n @regnanc7< -ur+ng acu(e an- c*ron+c /(re// a//oc+a(e- w+(* +n.ec(+on< (rauma< /urger7 an- o. cour/e emo(+onal /(re//. Al/o on @urel7 cl+n+cal groun-/ +( woul- a@@ear (*a( (*e/e mec*an+/m/ o. =R -ue (o mu(a(+on/ o. (*e rece@(or are /w+(c*e- on an- o.. (o ac*+e,e cer(a+n @*7/+olog+cal @roce//e/ - @re/umabl7 muc* a/ ele,a(+on o. (*e bo-7 (em@era(ure +/ @ar( o. (*e bo-7E/ -e.ence aga+n/( +n.ec(+on. Doe/ (*e -+,er/+(7 o. -+..eren( mu(a(+on/ o. (*e +n/ul+n rece@(or re.lec( (*e -+,er/+(7 o. cl+n+cal .ea(ure/ a//oc+a(e- w+(* +n/ul+n re/+/(ance - (*e l+/( grow+ng almo/( -a+l7 an- rang+ng .rom (*e or+g+nal -ea-l7 (r+a- o. Rea,en (o -+abe(e/ an- @ol7c7/(+c o,ar7 -+/ea/e< (o name (*e commone/(. T*en (*ere +/ (*e @o/(-rece@(or =R. A( m7 la/( ra+n-c*ecF (*ere were o,er ' -+..eren( gluco/e (ran/@or(er @ro(e+n/ - glu( 3 be+ng (*e ac(+,e (ran/@or(er +n all cell/ eGce@( (*e gu(< recell/ an- bra+n; glu( 3 @ro-uc(+on be+ng /(+mula(e- (o be @ro-uce- b7 (*e m+(oc*on-r+a o. (*e cell b7 (*e eGc+(a(+on o. (*e +n/ul+n rece@(or b7 a((ac*men( o. (*e +n/ul+n molecule. Du( (*e /cenar+o onl7 0u/( beg+n/ w+(* (*e abo,e< +n/ul+n +(/el. +/ o@@o/e- b7 glucagon /ecre(e- .rom (*e al@*a cell/ o. (*e @ancrea/; Soma(o/(a(+n al/o /ecre(e- b7 (*e @ancrea/ o@@o/e/ bo(* +n/ul+n an- glucagon an- ano(*er w+l--car- +/ @ancrea(+c @e@(+-e w*o/e .unc(+on elu-e/ me; (*en Soma(a/(o(+n +/ al/o /ecre(e- b7 (*e gu(. T*en o. cour/e (*ere +/ (*e w*ole l+/( o. +n/ul+n-l+Fe grow(* .ac(or/ w*+c* @re/umabl7 become .+Ge- +n (+//ue/ an- *a,e +n/ul+n-l+Fe ac(+,+(7 an- ca@able o. @ull+ng -own gluco/e. F+nall7 (*ere +/ (*+/ @ro(e+n re.erre- (o a/ H)9-1HSS @ro-uce- b7 (*e obe/e cell/. T*+/ a@@aren(l7 +/ ca@able o. +n-uc+ng a @o/(-rece@(or -e.ec( +n blocF+ng (*e ac(+on o. gluco/e (ran/@or(er @ro(e+n. = am /ure (*ere are o(*er @o/(-rece@(or mec*an+/m/ o. =R w*+c* = *a,e no( -+/co,ere- a/ 7e( +n (*e l+(era(ure. M7 br+e. a((em@( (o (+e (*e .ea(ure/ (oge(*er *a/ no( a((em@(e(o l+nF +n le@(+n an- (*e o(*er me-+a(or/.

9er(a+nl7 a cla+m coul- be ma-e .or (*e recogn+(+on o. +n/ul+n a//a7/ a/ a u/e.ul a-0unc( +n (*e e,alua(+on o. +n/ul+n re/+/(ance. A/ 7ou ma7 Fnow< = *a,e been .orce- (o con/+-er mea/uremen( o. +n/ul+n a//a7/ a/ a re/earc* (ool +n ,+ew o. (*e o@@o/+(+on = *a,e encoun(ere- .rom m7 en-ocr+ne colleague/ an(*e Lue/(+on/ = *a,e been a/Fe- b7 (*e Heal(* =n/urance 9omm+//+on (o ,al+-a(e m7 u/e o. (*+/ (e/(. 1=nc+-en(all7 = am ou( o. (rouble w+(* (*e Heal(* 9omm+//+on /+nce all o. m7 @a(+en(/ now @a7 .or (*e +n/ul+n a//a7/6. An +n(ere/(+ng commen( came (o me .rom one @a(*olog+/(. He /(a(e- (*a( (*ere are /o man7 un-+agno/e- +n-+,+-ual/ +n (*e commun+(7 w+(* +n/ul+n re/+/(ance (*a( +. (*e7 were all -+agno/e- accura(el7 +( woul- banFru@( (*e *eal(* care /7/(emI T*e bo((om l+ne o. cour/e rema+n/ *ow -o we (rea( (*e/e +n-+,+-ual/. T*+/ woul- a@@ear (o be (*roug* -+e(< eGerc+/e anwe+g*( con(rol< (*e la((er onl7 com+ng w*en (*ere +/ correc( -+e( an- eGerc+/e. 9orrec( -+e( rema+n/ a con(ro,er/7 an- +( +/ +n(ere/(+ng (*a( our Amer+can .r+en-/ are (alF+ng abou( a cla// ac(+on aga+n/( -+e(+(+an/ an- nu(r+(+on+/(/ .or m+/-+n.orma(+on +n rela(+on (o (*e *+g* carbo*7-ra(e low-.a( -+e(I Hea,en /@are u/ .rom /uc* l+(+g+ou/ (*+nF+ng bu( (*e me//age +/ (*ere; (*e me-+cal @ro.e//+on /*oul- a-o@( an o@en an- +nLu+r+ng m+n- an- w*+l/( (*e/e newer (o@+c/ mu/( be regar-e- a/ re/earc*< +( +/ (*o/e w*o r+-+cule /uc* (*+nF+ng (*a( /*oul- be (*e one/ (o @u( (*em/el,e/ a( r+/F o. l+(+ga(+onI = woul- -raw 7our a((en(+on (o an ar(+cle .rom (*e low carb l+/( g+,+ng Luo(e/ .rom a re,+ew o. -+e(/ +n @re,en(+on o. *ear( -+/ea/e; = w+ll /en- +( la(er.SS SS (*e abo,e re.erence/ are curren(l7 onl7 +n *ar- co@7< bu( = w+ll ge( (*em (7@e- u@ an- /en( (o (*e l+/(I --------------------------------Now (o (*row +n a w*ole new conce@(< *a,e alooF a( (*e .ollow+ng ab/(rac(; (*+/ come/ +n(o l+ne w+(* (*e abo,e conce@(/ +. :o-.re7E/ /ub0ec(/ are mo(*er/ w+(* normal ge/(a(+onal =R bu( (*e .oe(u/ carr+e/ (*e (*r+.(7 gene .rom (*e .a(*er. Fa/c+na(+ngI --------------------------------------Ab/(rac(-------------------------FETAL )RO:RAMM=N: AND ADULT D=SEASE Ne+(* :o-.re7 MR9 En,+ronmen(al E@+-em+olog7 Un+(< Un+,er/+(7 o. Sou(*am@(on UN T*e H.a(al or+g+n/H *7@o(*e/+/ /(a(e/ (*a( a-ul( coronar7 *ear( -+/ea/e< an- (*e a//oc+a(e- -+/or-er/ /(roFe< non-+n/ul+n -e@en-en( -+abe(e/ an*7@er(en/+on are @rogramme- b7 un-ernu(r+(+on +n u(ero. An+mal S(u-+e/# EG@er+men(al /(u-+e/ *a,e long /+nce e/(abl+/*e- (*e @r+nc+@le (*a( /(+mul+ a@@l+e- a( cr+(+cal< /en/+(+,e @er+o-/ o. earl7 l+.e can *a,e @ermanen( e..ec(/ on a range o. @*7/+olog+cal @roce//e/<1 a @*enomenon (erme- H@rogramm+ngH. Numerou/ eG@er+men(/ +n an+mal/ *a,e

/*own (*a( un-ernu(r+(+on +n u(ero lea-/ (o @er/+/(+ng c*ange/ +n bloo@re//ure< c*ole/(erol me(abol+/m< +n/ul+n re/@on/e/ (o gluco/e< an- +n a range o. me(abol+c< en-ocr+ne an- +mmune @arame(er/. E@+-em+olog+cal /(u-+e/# E,+-ence (*a( coronar7 *ear( -+/ea/e< *7@er(en/+on an- -+abe(e/ are @rogramme- +n+(+all7 came .rom long+(u-+nal /(u-+e/ o. %<!!! UN men an- women +n w*+c* /+Be a( b+r(* wa/ rela(e- (o (*e occurrence o. -+/ea/e +n m+--le age. )eo@le w*o were /mall or -+/@ro@or(+ona(e 1(*+n or /*or(6 a( b+r(* *a- *+g* ra(e/ o. coronar7 *ear( -+/ea/e< ra+/e- bloo- @re//ure an- c*ole/(erol le,el/< an- abnormal +n/ul+n me(abol+/m. T*e/e rela(+on/ *a,e been /*own (o re.lec( .e(al grow(* re(ar-a(+on ra(*er (*an @rema(ure b+r(*. Re@ea(ere@l+ca(+on o. (*e UN .+n-+ng/ *a/ le- (o w+-e acce@(ance (*a( low ra(e/ o. .e(al grow(* are a//oc+a(e- w+(* car-+o,a/cular -+/ea/e +n la(er l+.e. A//oc+a(+on/ w+(* coronar7 *ear( -+/ea/e *a,e< .or eGam@le< been /*own +n /(u-+e/ .rom (*e USA< =n-+a an- F+nlan-;$ +n -+..eren( @o@ula(+on/< a//oc+a(+on/ w+(* ra+/e- bloo- @re//ure an- w+(* non-+n/ul+n -e@en-en( -+abe(e/ *a,e been re@l+ca(e- +n $ /(u-+e/3 an+n 4 /(u-+e/ re/@ec(+,el7.%." 9l+n+cal /(u-+e/# De(a+le- cl+n+cal /(u-+e/ o. a-ul(/ w+(* Fnown bo-7 @ro@or(+on/ a( b+r(* are beg+nn+ng (o unra,el (*e mec*an+/m/ (*a( m+g*( l+nF .e(al eG@o/ure/ w+(* la(er -+/ea/e. T*+nne// a( b+r(*< .or eGam@le< +/ (*oug*( (o re.lec( .e(al un-ernu(r+(+on +n m+--la(e ge/(a(+on;' +( +/ a//oc+a(e- w+(* +n/ul+n re/+/(ance an- coronar7 *ear( -+/ea/e +n a-ul( l+.e. Magne(+c re/onance /@ec(ro/co@7 *a/ /*own (*a( (*e a-ul(/ w*o were (*+n a( b+r(* *a,e re-uce- ra(e/ o. gl7col7/+/ +n (*e+r mu/cle/. T*+/ coul- +n-+ca(e @er/+/(ence o. a .e(al gluco/e /@ar+ng a-a@(a(+on. )er/+/(+ng al(era(+on/ +n me(abol+/m ma7 be @ar(l7 me-+a(e- b7 @rogramme- c*ange/ +n (*e @ro-uc(+on o. *ormone/ or +n (+//ue /en/+(+,+(7 (o (*em# @rogramm+ng o. (*e *7@o(*alam+c-@+(u+(ar7-a-renal aG+/ +/ one curren( .ocu/ o. re/earc*.4 Fe(al un-ernu(r+(+on# Small /+Be a( b+r(* an- -+/@ro@or(+on +n *ea/+Be< leng(* an- we+g*( are (*oug*( (o be /urroga(e marFer/ .or (*e +n.luence/ (*a( @rogramme (*e *uman .e(u/. Se,eral l+ne/ o. e,+-ence /ugge/( (*a( nu(r+(+onal +n.luence/ ma7 un-erl+e car-+o,a/cular @rogramm+ng#$.'.&.1! 116 .e(al un-ernu(r+(+on @rogramme/ @*7/+olog7 anme(abol+/m +n an+mal/; 1 6 .e(al grow(* +/ e//en(+all7 regula(e- b7 nu(r+en( /u@@l7; 1$6 al(era(+on/ +n .e(al an- @lacen(al grow(* (*a( @re-+c( car-+o,a/cular -+/ea/e +n *uman/ are rela(e- (o nu(r+(+on +n @regnanc7 an- can be eG@er+men(all7 +n-uce- +n an+mal/; 136 -+e( +n @regnanc7 +/ a//oc+a(e- w+(* al(ere- bloo- @re//ure le,el/ +n (*e o../@r+ng; an- 1%6 ma(ernal bo-7 com@o/+(+on +n @regnanc7 *a/ been l+nFe- w+(* coronar7 *ear( -+/ea/e +n (*e o../@r+ng. T*e .u(ure# Ce nee- (o @rogre// be7on- e@+-em+olog+cal a//oc+a(+on/ (o -e.+ne (*e un-erl7+ng cellular an- molecular @roce//e/< an- (o -e(erm+ne *ow (*e/e @rogramme- c*ange/ become (ran/la(e- +n(o @a(*olog7. Ce nee(o +-en(+.7 (*e /@ec+.+c a/@ec(/ o. ma(ernal bo-7 com@o/+(+on< me(abol+/m an- nu(r+en( +n(aFe (*a( lea- (o .e(al un-ernu(r+(+on< an- (o un-er/(an- (*e con/eLuen( .e(al a-a@(a(+on/. Fur(*er re/earc* reLu+re/ a /(ra(eg7 o. +n(er-e@en-en( cl+n+cal< an+mal an- e@+-em+olog+cal /(u-+e/. 1. Mc9ance RA< C+--ow/on EM 11&'36 T*e -e(erm+nan(/ o. grow(* an.orm. )roc R Soc Lon-on 14%#1-1'. . O/mon- 9< DarFer DJ)< C+n(er )D< Fall 9HD< S+mmon-/ SJ 11&&$6 Earl7 grow(* an- -ea(* .rom car-+o,a/cular -+/ea/e +n women. DMJ $!'#1%1&- 3. $. For/en T< Er+F//on J:< Tuom+le*(o J< Teramo N< O/mon- 9< DarFer DJ) 11&&'6 Mo(*erE/ we+g*( +n @regnanc7 an- coronar7 *ear( -+/ea/e +n a

co*or( o. F+nn+/* men# .ollow u@ /(u-7. DMJ $1%#4$'-43!. 3. Law 9M< S*+ell AC 11&&"6 =/ bloo- @re//ure +n,er/el7 rela(e- (o b+r(* we+g*(J T*e /(reng(* o. e,+-ence .rom a /7/(ema(+c re,+ew o. (*e l+(era(ure. J H7@er(en 13#&$%-&31. %. Hale/ 9N< DarFer DJ)< 9larF )MS< 9oG LJ< Fall 9HD< O/mon- 9< C+n(er )D 11&&16 Fe(al an- +n.an( grow(* an- +m@a+re- gluco/e (olerance a( age "3. DMJ $!$#1!1&- . ". L+(*ell HO< McNe+gue )M< Derglun- L< Mo*/en R< L+(*ell UD< Leon DA 11&&"6 Rela(+on o. /+Be a( b+r(* (o non-+n/ul+n -e@en-en( -+abe(e/ an+n/ul+n concen(ra(+on/ +n men age- %!-"! 7ear/. DMJ $1 #3!"-1!. '. DarFer DJ)< :lucFman )D< :o-.re7 NM< Har-+ng JE< Owen/ JA< Rob+n/on JS 11&&$6 Fe(al nu(r+(+on an- car-+o,a/cular -+/ea/e +n a-ul( l+.e. Lance( $31#&$4-31. 4. E-war-/ 9RC< Dene-+F(//on R< L+n-/a7 RS< SecFl JR 11&&$6 D7/.unc(+on o. @lacen(al glucocor(+co+- barr+er# l+nF be(ween .e(al en,+ronmen( an- a-ul( *7@er(en/+onJ Lance( $31#$%%-'. &. 9am@bell DM< Hall MH< DarFer DJ)< 9ro// J< S*+ell AC< :o-.re7 NM. 11&&"6 D+e( +n @regnanc7 an- (*e o../@r+ngE/ bloo- @re//ure 3! 7ear/ la(er. Dr J Ob/(e( :7naecol 1!$# '$- 4!. :o-.re7 N< Rob+n/on S< DarFer D< O/mon- 9< 9oG A. 11&&"6 Ma(ernal nu(r+(+on +n earl7 an- la(e @regnanc7 +n rela(+on (o @lacen(al an- .e(al grow(*. DMJ $1 #31!-313. T*e Au/(ral+an Soc+e(7 .or Me-+cal Re/earc* $"(* Na(+onal Sc+en(+.+c 9on.erence A-ela+-e 9on,en(+on 9en(re< A-ela+-e< SA. $- " No,ember< 1&&'. ----------------------------------------------------------------------------------------=nc+-en(all7< +n ,+ew o. m7 +n(ere/( +n grow+ng S*+raB +n (*e Fl+n-er/ Range/< = won-er w*ere (*e bene.+(/ o. re- w+ne +n rela(+on (o coronar7 ,a/cular -+/ea/e .+(/ +nJ A@@aren(l7 /(u-+e/ *a,e al/o /ugge/(e- re-uce- mor(al+(7 +n (*o/e w*o -r+nF w*+(e bu( (*e ma0or bene.+( a@@ear/ (o come .rom (*e re- w+ne. =/ +( 0u/( (*e an(+-oG+-an(/ or +/ +( /ome more /ub(le e..ec(/ on (*e me(abol+c @a(*wa7/. O. /ome anec-o(al +n(ere/( +/ one @a(+en( = *a- w*o *a/e,ere *7@er+n/ul+naem+a an- *e wa/ concerne- w*e(*er *e /*oul- cea/e *+/ en0o7men( o. w+ne. = /en( *+m (o (*e labora(or7 (o con/ume a *al. bo((le o. w*+(e w+ne on an em@(7 /(omac*I Ne+(*er *+/ bloo- gluco/e or +n/ul+n le,el/ ma-e an7 grea( c*ange/ bu( *e cer(a+nl7 wa/ no( .+( (o -r+,e a( (*e en- o. *our/I Du( (*en /omeone (*e o(*er -a7 wa/ /a7+ng (*a( alco*ol ele,a(e/ bloo- (r+gl7cer+-e/J Some *a,e /ugge/(e- (*a( alco*ol ele,a(e/ bloo- (r+gl7cer+-e/. Du( +/ (*+/ w+ne or beer; (*+/ +/ w*7 HLongbrewH beer *a/ en(ere- (*e marFe(; (*e carb/ *a,e been .ermen(e- (o a low le,el< an- (*+/ re-uce/ (*e (en-enc7 .or beer (o +ncrea/e +n(ra-ab-om+nal .a(. = /u/@ec(< .rom m7 un-er/(an-+ng o. =R< (*a( (*e real -anger o. alco*ol onl7 /(ar(/ w*en (*e -r+nFer +/ on a *+g* carbo*7-ra(e -+e(. Ce nee- more -a(a. 9*eer/ From#-

Allen agale@me-e/er,.com.au Dec'E&' Da(e# Fr+< $ Jan 1&&4 1"#$&#33 -!%!! From# Dana 9ar@en-er To# LOC9ARD@MAELSTROM.STJOHNS.EDU ? . All are men eGce@( m7 -aug*(er. ? 1Oou(*J6 )robabl7. Doe/nE( +( maFe 7ou craB7J #-6 bo(* lo/e more ea/+l7 (*an ma(ure women. ? ? ? ? Oe/< men an- (*e 7oung -o

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Are 7ou (aF+ng (*e @+llJ Or< +. 7ouEre ol-er (*an (*a(< are 7ou on ERTJ Do(* can *a,e a b+g e..ec( on +n/ul+n< an- ren-er (*e -+e( +ne..ec(+,e. = Fnow more (*an one woman w*o *a/ ga+ne- (wen(7 @oun-/ or more .rom go+ng on (*e @+ll. =. 7ouEre (aF+ng +(< =E- /w+(c* o,er (o barr+er me(*o-/ or (*e =UD. 1Nor@lan( an- De@o@ro,era wonE( *el@.6 =. 7ouEre on ERT< (alF (o a -oc(or abou( (r7+ng DHEA +n/(ea-. 1=. 7ouEre o,er $% or /o< 7ou m+g*( looF a( (aF+ng DHEA an7wa7. = wen( on +( (wo 7ear/ ago< a( $'< an- .el( -rama(+call7 be((er -- more energe(+c anbe((er moo-/ -- w+(*+n a .ew -a7/. M7 mu/cle (one +m@ro,e-< m7 a(*le(+c /(am+na +ncrea/e-< an- = -ro@@e- ' lb/ +n 1! -a7/. OouE- nee- a gun (o ge( (*e /(u.. awa7 .rom meII6 S(ero+- me-+ca(+on/< l+Fe @re-n+/one< can be a @roblem. T*e7 m+m+c (*e ac(+on o. /ome o. (*e a-renocor(+cal *ormone/ (*a( encourage wa(er re(en(+on an- .a( -e@o/+(+on. 1T*e we+g*( cree@ = com@la+ne- abou( /e,eral weeF/ bacF (urne- ou( (o be -ue (o an a-renal-/(+mula(+ng *erbal (on+c = *a- /(ar(e- (aF+ng .or allerg+e/. Hel@e- (*e allerg+e/< bu( ma-e me grow l+Fe a Dall@arF FranF (*a( @lum@/ w*en 7ou cooF +(I =Era(*er *a,e allerg+e/.6 Foo- /en/+(+,+(+e/ can be a real @roblem< (oo. =Em *a,+ng a muc* ea/+er (+me Fee@+ng m7 we+g*( -own now (*a( =E,e .+gure- ou( (*a( @eanu(/ maFe me bl+m@ u@. Doe/nE( /eem (o be (*e carb/< = wa/nE( ea(+ng enoug* .or (*a( (o be (*e @roblem. = 0u/( /eem (o *a,e an +-+o/7ncra(+c reac(+on -- ea( @eanu(/< ge( a -ouble c*+n +n .+.(een m+nu(e/. 1DUMMERII6 Ano(*er /@o+ler +/ can-+-a. =. 7ouE,e *a- a lo( o. an(+b+o(+c/ +n 7our l+.e< an- *a,e a lo( o. ga/ an- bloa(+ng< .a(+gue< bra+n .og< ancon/(+@a(+on an-8or -+arr*ea< 7ou m+g*( looF a( (*+/. Un.or(una(el7< +. (*+/ +/ (*e @roblem< 7ouEll *a,e (o re/(r+c( (*e -+e( e,en .ur(*er -- no c*ee/e< ,+negar or o(*er .ermen(e- .oo-/< mu/*room/< e(c. )robabl7 *a,e (o (aFe n7/(a(+n or ca@r7l+c ac+-< (oo. T*e Sla/(S (*+ng =E- looF a( +/ @or(+on con(rol. T*ere are a .ew @eo@le w*o *a,e (o con(rol Sbo(*S carb/ an- @or(+on/< al(*oug* (*e7 can ea( more calor+e/ on a lowcarb -+e( (*an (*e7 coul- on low.a(8*+g* carb. Du( +. an7 o. (*+/ o(*er /(u.. *a/ rung a bell< =E- /(ar( (*ere .+r/(.

Dana 1w*o *a(e/ (*e ,er7 S(*oug*(S o. @or(+on con(rolI6 A( 1!# ! AM 38"8&4< De,erl7 Me7er wro(e# ?= *a,e rea- man7 (+me/ (*a( @ro(e+n u/e/ more energ7 1calor+e/J6 +n ?-+ge/(+on (*an +( ac(uall7 @ro-uce/. =. (rue< can an7one eG@la+n (*+/J No( (*ermo-7nam+call7 @o//+ble. )ro(+en -oe/ *a,e a *+g*er S@ec+.+c D7nam+c Ac(+on 1SDA6 (*an carb/ or .a(. =nge/(+on o. @ro(e+n w+ll cau/e an eG@en-+(ure o. %R a/ man7 calore+/ a/ are con/ume-. So +. 7ou ea( 1!! calore+/ o. @ro(e+n< 7ou w+ll burn % calor+e/ -+ge(+on (*em. 9arb/ *a,e a SDA T1%- !R< .a( abou( $R. L7le McDonal-< 9S9S HT*e Fe(ogen+c -+e( /+mula(e/ .a/(+ng bo-7 burn/ +( own .a( -er+,e/ energ7 @r+nc+@all7 b7 energ7 /ource< carbo*7-ra(e.H Trea(men(- An =n(ro-uc(+on (o (*e me(abol+/m o. a .a/(+ng bo-7....A/ a .or energ7< /o a @er/on on a Fe(ogen+c -+e( burn+ng .a( ra(*er (*an .rom (*e more common Jo*n Freeman M.D. +n HT*e E@+le@/7 D+e( (*e Ne(ogen+c D+e(H

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Rece+,e-# .rom mael/(rom./(0o*n/.e-u 1mael/(rom./(0o*n/.e-u 213&."4.1. 356 b7 omen.com 14.4.%8S9O%6 w+(* ESMT) +- OAA!$1%1 .or ; Sa(< 14 A@r 1&&4 13#!4#%1 -!'!! 1)DT6 Me//age-=-# >1&&4!314 1!4.OAA!$1%1@omen.com? Rece+,e-# .rom mael/(rom./(0o*n/.e-u b7 mael/(rom./(0o*n/.e-u 1LSMT) .or O@enAMS ,1.1a6 w+(* SMT) +- >3." DF&&D!@mael/(rom./(0o*n/.e-u?; Sa(< 14 A@r 1&&4 1'#!$#$3 -1$!! Da(e# Sa(< 14 A@r 1&&4 1'#!$#!% -!3!! Re@l7-To# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on Sen-er# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on From# Don C+// Sub0ec(# Re# @o+n(er (o ar(+cle on c*ole/(erol ,er/u/ -+e( To# LOC9ARD@MAELSTROM.STJOHNS.EDU S(a(u/# R To-- Moo-7 wro(e# ?Cell< = lo/( 3! @oun-/ .a+rl7 Lu+cFl7 on a lowcarb -+e(< an- m7 ?c*ole/(erol wen( .rom " (o $! < almo/( all o. (*e +ncrea/e a/ ?LDL. S+nce (*en< = *a,e c*ecFe- +( a .ew (+me/ an- +( a@@eare?(o be /lowl7 -ro@@+ng. To-- 7ou *a,e o.(en @o/(e- 7our (o(al c*ole/(erol. La/( Fall E-war9am@bell @o/(e- (*e .ollow+ng (o (*+/ l+/(# T*e 1!8 18&' +//ue o. 9+rcula(+on con(a+ne- an ar(+cle calle-# HFa/(+ng Tr+gl7cer+-e/ 1T:6 an- HDL an- R+/F .or M7ocar-+al =n.arc(+onH. T*+/ Har,ar- /(u-7 conclu-e- (*a( (*e ra(+o o. T:#HDL wa/ (*e mo/( /+gn+.+can( r+/F .ac(or +n -e,elo@+ng 9HD. T*e T:#HDL ra(+o wa/ a be((er @re-+c(or (*an (o(al c*ole/(erol 1T96< be((er (*an T9#HDL ra(+o< an- be((er (*an LDL#HDL ra(+o. No(e (*a( (*e T:#HDL ra(+o (*e7 cla+m +/ mo/( @re-+c(+,e +gnore/ LDL. =( +/ ,er7 @o//+ble (*a( on 7our lowcarb -+e( 7ou *a,e a .+ne T:#HDL ra(+o. =( maFe/ /en/e a/ a *+g* carb -+e( +ncrea/e/ T:< an- a low .a( -+e( -ecrea/e/ HDL. A.(er go+ng on (*e )aleol+(*+c -+e( m7 (o(al al/o wen( u@ /ome< bu( w+(* a T: o. '4 an- HDL o. '" =Em no( concerne-. Don.

From owner-lowcarb@MAELSTROM.STJOHNS.EDU Sun A@r 1& 11#3&#1' 1&&4 Re(urn-)a(*# owner-lowcarb@MAELSTROM.STJOHNS.EDU Rece+,e-# .rom mael/(rom./(0o*n/.e-u 1mael/(rom./(0o*n/.e-u 213&."4.1. 356 b7 omen.com 14.4.%8S9O%6 w+(* ESMT) +- LAA11"14 .or ; Sun< 1& A@r 1&&4 11#3&#13 -!'!! 1)DT6 Me//age-=-# >1&&4!31&143&.LAA11"14@omen.com? Rece+,e-# .rom mael/(rom./(0o*n/.e-u b7 mael/(rom./(0o*n/.e-u 1LSMT) .or O@enAMS ,1.1a6 w+(* SMT) +- >1$.!4 A' !E@mael/(rom./(0o*n/.e-u?; Sun< 1& A@r 1&&4 13#3$#%1 -1$!! Da(e# Sun< 1& A@r 1&&4 1$#3$#$4 -!%!! Re@l7-To# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on

Sen-er# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on From# L7le McDonalSub0ec(# Re# :lucagon an- =n/ul+n To# LOC9ARD@MAELSTROM.STJOHNS.EDU S(a(u/# R A( #31 AM 381&8&4< RST 9A wro(e# ?A/ = recall .rom (*e booF< :lucagon 1(*e .a(-remo,+ng *ormone6 +/ @ro-uce?mo/( +n (wo /cenar+o/# w*en 7ou ea( @ro(e+n< an- w*en 7ou ea( a comb+na(+on o. ?.a( an- @ro(e+n. =. = recall correc(l7< (*e H)ro(e+n onl7H +nge/(+on ?@ro-uce- (*e *+g*e/( amoun( o. glucagon. =. = am wrong< (*+/ w*ole @o/(+ng ?maFe/ no /en/e< /o @lea/e correc( meI )ro(e+n +/ o-- +n (*a( +( cau/e/ bo(* an +n/ul+n AND glucagon +ncrea/e. = woul- eG@ec( @ro(e+n an- .a( (o +nrea/e glucagon more bu( onl7 becau/e (*e .a( /*oul- -ecrea/e (*e +n/ul+n re/@on/e (o @ro(e+n. ?Du( *ereE/ w*a( = am (*+nF+ng-- (*e AERO low.a(< AND ,er7 low carb -+e(/ are ?.abulou/l7 e..ec(+,e. T*+/ ma7 be no( .rom (*e calor+e -e.+c+( a/ +/ u/uall7 ?(*oug*(< bu( .rom (*e +ncrea/e- ou(@u( o. :lucogan. T*e .a( lo// +/ ul(+ma(e+l7 rela(e- (o bo(* *ormonal an- calor+c e..ec(/. An7 -+e( (*a( +/ low +n calor+e/ w+ll cau/e we+g*( lo//. T*e @r+mar7 -+..erence w+ll be +n (*e Lual+(7 o. we+g*( lo//. Delow a cer(a+n calor+e (*re/*ol-< a lower carb -+e( w+ll cau/e grea(er .a( lo// an- le// mu/cle lo// (*an a *+g*er carb -+e(. T*+/ +/ becau/e (*e re-uc(+on +n +n/ul+n allow/ Fe(o/+/ (o -e,elo@ w*+c* /er,e/ (o /@are gluco/e 1an- @ro(e+n6 w*+le maG+m+B+ng .a( u(+l+Ba(+on 1/+nce +n/ul+n +/ Fe@( low allow+ng maG+mal ra(e/ o. l+@ol7/+/6. a//um+ng a-eLua(e @ro(e+n +n(aFe 1w*+c* +/ 1.% g @ro(e+n8Fg bo-7 we+g*( OR 1%! gram/ w*+c*e,er +/ grea(er6< a Fe(ogen+c ,er7 low calor+e -+e( w+ll /*ow le/ @ro(e+n lo//e/ (*an a non-Fe(ogen+c -+e( a( (*a( /ame calor+e le,el. (*e @roblem +/ (*e +ne,+(able -ro@ +n me(abol+ ra(e -ue (o low calor+e/. ?=. a large @ar( o. low-carb low-.a( /ucce// +/ .rom (*e +ncrea/e- glucagon ?@ro-uc(+on .rom ea(+ng /(ra+g*( @ro(e+n< @er*a@/ (*a( coul- be +ncor@ora(e?+n(o a low-carb rou(+ne< bu( +n /uc* a/ wa7 a/ NOT (o crea(e an ab7/mall7 low ?calor+e le,el (*a( woul- e,en(uall7 lower me(abol+/m le,el/. To(al /(ar,a(+on w+ll ra+/e glucagon (*e mo/( 1/+nce +n/ul+n w+ll be (*e lowe/(6 bu( 7ouEll lo/e bo-7 @ro(e+n. C*en 7ou a-- @ro(e+n 1w*+c* /(+mula(e/ bo(* +n/ul+n AND glucagon relea/e6< 7ou -e,elo@ a/ -ee@ o. Fe(o/+/ an- 7ou *a,e a )SMF. Du( 7ou *a,e @roblem/ w+(* me(abol+c /low-own. So 7ou a-- -+e(ar7 .a( a/ a 1.a+rl76 *ormonall7 neu(ral nu(r+en( (o ge( calor+e/ u@. Hence (*e Fe(ogen+c -+e(. L7le McDonal-< 9S9S H9ome ge( /omeIH DuFe NuFem

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Ce- Ma7 1$ !'#!$#$" 1&&4

Re(urn-)a(*# owner-lowcarb@MAELSTROM.STJOHNS.EDU Rece+,e-# .rom mael/(rom./(0o*n/.e-u 1mael/(rom./(0o*n/.e-u 213&."4.1. 356 b7 omen.com 14.4.%8S9O%6 w+(* ESMT) +- HAA!$% 3 .or ; Ce-< 1$ Ma7 1&&4 !'#!$# " -!'!! 1)DT6 Me//age-=-# >1&&4!%1$13!$.HAA!$% 3@omen.com? Rece+,e-# .rom mael/(rom./(0o*n/.e-u b7 mael/(rom./(0o*n/.e-u 1LSMT) .or O@enAMS ,1.1a6 w+(* SMT) +- >13. 4D'$D'9@mael/(rom./(0o*n/.e-u?; Ce-< 1$ Ma7 1&&4 &#%4#$" -1$!! Da(e# Mon< 11 Ma7 1&&4 #13#! -!3!! Re@l7-To# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on Sen-er# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on From# To-- Moo-7 Sub0ec(# E..ec(/ o. lowcarb To# LOC9ARD@MAELSTROM.STJOHNS.EDU S(a(u/# R M7 /+/(er 0u/( /en( me (*e H:oo- 9alor+e D+e(H< b7 )*+l+@ L+@e(B. S*e wan(e- m7 commen(/ on +(< /+nce /*e Fnow/ (*a( = am caug*( u@ +n (*+/ nu(r+(+on /(u... For (*o/e w*o -onE( Fnow o. L+@e(B or (*+/ -+e(< +( +/ ba/+call7 a -+e( (*a( em@*a/+Be/ low gl7cem+c +n-eG .oo-/< .or rea/on/ .am+l+ar (o mo/( low-carb @eo@le# con(rol o. bloo- /ugar ancon/eLuen( con(rol o. +n/ul+n. T*e -+..erence +/ (*a( (*+/ -+e( em@*a/+Be/ low-:= Scarbo*7-ra(e/S< /uc* a/ cer(a+n legume/. No /ur@r+/e (*ere e+(*er. He -oe/< *owe,er< maFe a cla+m (*a( = .+n- +n(ere/(+ng< namel7 (*a( /a(ura(e- .a(/ no( onl7 +ncrea/e +n/ul+n re/+/(ance bu( (*a( +n/ul+n re/+/(ance +(/el. +n*+b+(/ (*e relea/e o. glucagon. =. (*+/ +/ (rue< +( woul- (en- (o un-erm+ne (*e e..ec(+,ene// o. lowcarb -+e(/ *+g* +n /a(ura(e- .a(/< /+nce (*e/e +ncrea/e +n/ul+n re/+/(ance. He al/o /(a(e/ (*a( *+g* @ro(e+n an- *+g* .a( meal/ -rama(+call7 +ncrea/e oneE/ bloo- /ugar re/@on/e (o .u(ure carb-con(a+n+ng meal/< c+(+ng re/earc* .rom 1& ' 1J.S. Sweene7< Arc*. =n(. Me-. 3!#414-$!6 an- 1&$% 1H.). H+m/wor(*< 9l+n. Sc+. #"'-&36. T*e/e are ol- /(u-+e/< bu( (*e7 /eem (o .+( (*e eG@er+ence o. man7 @eo@le on low-carb -+e(/< namel7 (*a( (*e7 become e,en more Hcarbo*7-ra(e +n(oleran(.H T*e .ollow+ng /(u-7< c+(e- b7 L+@e(B< ma7 al/o be o. +n(ere/(< @ar(+cularl7 w+(* re/@ec( (o (*e e..ec( o. -+e(ar7 @ro(e+n on glucagon. To-- Moo-7 (moo-7@/0u.e-u ----------------------------------------------------------T+(le 9+rcula(+ng am+no ac+-/ an- @ancrea(+c en-ocr+ne .unc(+on a.(er +nge/(+on o. a @ro(e+n-r+c* meal +n obe/e /ub0ec(/.

Au(*or Sc*m+- R; Sc*u/-B+arra A; Sc*ul(e-Fro*l+n-e E; Ma+er A; 9la//en M A--re// De@ar(men( o. =n(ernal Me-+c+ne ==< Tec*n+cal Un+,er/+(7 o. Mun+c*< Ce/( :erman7. Source J 9l+n En-ocr+nol Me(ab< "41"6#11!"-1! Ab/(rac( Ce mea/ure- @la/ma am+no ac+- (oge(*er w+(* +n/ul+n< glucagon< @ancrea(+c @ol7@e@(+-e 1))6< an- gluco/e concen(ra(+on/ a.(er (*e +nge/(+on o. a @ro(e+n meal +n lean an- obe/e /ub0ec(/. T*e ba/al @la/ma am+no ac+- le,el/ were /+m+lar +n bo(* grou@/. T*e @o/(@ran-+al +ncrea/e +n (*e @la/ma am+no ac+- le,el/ +n (*e obe/e /ub0ec(/ wa/ onl7 1%-%!R o. (*a( +n (*e lean /ub0ec(/. T*e mean ba/al an- @eaF @o/(@ran-+al @la/ma +n/ul+n le,el/ were /+gn+.+can(l7 *+g*er 1' an- 1"% @mol8L6 +n (*e obe/e grou@ (*an +n (*e lean grou@ 1$" an- 11% @mol8L; ) le// (*an !.!%-!.!16. T*e @o/(@ran-+al r+/e +n @la/ma glucagon wa/ largel7 a((enua(e- +n (*e obe/e /ub0ec(/< an- (*ere wa/ no -+..erence +n @la/ma )) angluco/e le,el/ +n (*e grou@/. To .ur(*er e,alua(e (*e role o. c+rcula(+ng am+no ac+-/ on @ancrea(+c en-ocr+ne .unc(+on +n obe/e an- lean /ub0ec(/< an am+no ac+- m+G(ure con/+/(+ng o. 1% am+no ac+-/ wa/ +n.u/e- +,. Dur+ng (*e +n.u/+on (*e @la/ma am+no ac+le,el/ were com@arable +n bo(* grou@/. )la/ma +n/ul+n ro/e b7 $" P8- ' 1P8- SE6 @mol8L 1% P8- 1 m+croU8mL6 +n (*e lean an- 1 & P8@mol8L 114 P8- $ m+croU8mL6 +n (*e obe/e /ub0ec(/< w*erea/ @la/ma glucagon< ))< an- gluco/e le,el/ were /+m+lar +n bo(* grou@/. =n ,+ew o. (*e $."-.ol- grea(er +n/ul+n re/@on/e/ +n (*e obe/e /ub0ec(/< +( +/ l+Fel7 (*a( c+rcula(+ng am+no ac+-/ con(r+bu(e (o (*e+r *7@er+n/ul+nem+a +n /@+(e o. (*e re-uce@o/(@ran-+al r+/e o. am+no ac+-/ +n (*+/ grou@ 1%!-4%R6. T*u/< un-er @*7/+olog+cal con-+(+on/ am+no ac+-/ *a,e (o be con/+-erea/ an +m@or(an( regula(or7 com@onen( o. @o/(@ran-+al +n/ul+n relea/e +n obe/e /ub0ec(/. 1&4& Jun

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From# L7le McDonalSub0ec(# Re# Ne(one/< +n/ul+ an- glucagon To# LOC9ARD@MAELSTROM.STJOHNS.EDU S(a(u/# R A( #%& )M %8 18&4< To-- Moo-7 wro(e# ?= un-er/(an-< al(*oug* = al/o /ee (*+/ a/ rea/on no( (o /(r+,e ?.or H-ee@ Fe(o/+/H< a/ +( +/ /ome(+me/ calle-. = (*eor+Be- man7 mon(*/ ago 1an- eG@er+ence worF+ng w+(* +n-+,+-ual/ bear/ (*+/ ou(6 (*a( -ee@er Fe(o/+/ w+ll ac(uall7 be CORSE .or .a( lo//. (*e rea/on be+ng (*a( *+g* le,el o. Fe(one/ +n (*e bloo- no( onl7 /(+mula(e +n/ul+n bu( al/o -+recl(7 +n*+b+( .ur(*er .a( breaF-own 1(*e/e are (*e (wo .ee-bacF loo@/ (*a( @re,en( runawa7 Fe(oac+-o/+/ +n non--+abe(+c/6. Mo/( /eem (o lo/e .a( MU9H more e..ec(+,el7 +. (*e7 ma+n(a+n r+g*( a( (race Fe(o/+/ 1= u/e (*+/ /+nce +(E/ (*e lowe/( Fe(one concen(ra(+on (*a( we can mea/ure b7 Ne(o/(+G an- /(+ll be /ure (*a( we are ge((+ng (*e a-a@(a(+on/ .rom Fe(o/+/6. ?A/ = /ee +(< (*e ma+n a-,an(age o. a Fe(ogen+c -+e( .or we+g*( ?lo// +/ (*a( +( a@@aren(l7 allow/ .or (*e maG+mum re(en(+on o. ?mu/cle -ur+ng (*e we+g*(-lo// @er+o-. = (*+nF (*e ma+n ?-+/a-,an(age +/ (*a( Fe(ogen+c -+e(/ +n,ol,e con/um@(+on o. a lo( ?o. calor+call7 -en/e .oo-/< maF+ng +( .a+rl7 ea/7 (o @la(eau a( a ?calor+c breaF-e,en @o+n( (*a( +/ /(+ll /ub/(an(+all7 abo,e +-eal ?we+g*(. Du( numerou/ /(u-+e/ /*ow (*a( @eo@le w*o are +n/(ruc(e- (o re-uce carb/ (o below %! gram/ @er -a7< bu( ea( Eall (*e7 wan( o. @ro(e+n an- .a(E w+ll au(oma(+call7 re-uce calor+c +n(aFe< (*u/ crea(+ng a calor+c -e.+c+( anlo/e we+g*(. = .+n- (*a( man7 +n-+,+-ual/ re-uce calor+e/ TOO muc*< /low+ng me(abol+/m an- .a( lo//. ?O. cour/e< all we+g*(-lo// -+e(/ .ace (*e /ame @roblem. A/ one ?lo/e/ we+g*( one u/e/ .ewer calor+e/ 0u/( (o ge( aroun-< an- /o ?(*e breaF-e,en @o+n( /lowl7 .all/< unle// one +ncrea/e/ ac(+,+(7 ?le,el/ an- mu/cle ma// (o com@en/a(e. =ncrea/+ng ac(+,+(7 le,el/ ?+(/el. (en-/ (o /(+mula(e a@@e(+(e. T*e -a(a on (*+/ +/ .ar .rom conclu/+,e. M7 eG@er+ence 1worF+ng w+(* a lo( o. @eo@le a/ a (ra+ner6 +/ (*+/# w*en @eo@le /(ar( eGerc+/e @rogram/< (*e7 (en- (o ge( *ungr+er. T*e rea/on +/ (*a( (*e+r bo-+e/ are ,er7 goo- a( u/+ng gluco/e .or .uel< an- ,er7 ba- a( u/+ng .a(. Lower+ng bloo- gluco/e (en-/ (o /en- a *unger /+gnal (o (*e bra+n (o ea( more. A.(er /e,eral weeF/ o. (ra+n+ng< a/ (*e bo-7E/ ab+l+(7 (o u/e .a( +ncrea/e/< *unger +/ (7@+call7 blun(e- b7 eGerc+/e. AS well< /ome /(u-+e/ 1no( all6 /*ow (*a( (*e +ncrea/e +n ea(+ng -oe/ no( com@en/a(e .or (*e calor+e/ burne- b7 eGerc+/e. T*a( +/< +n-+,+-ual/ w*o +ncrea/e eGerc+/e (o burn an a--+(+onal %!! cal8-a7 1or w*a(e,er6 ma7 onl7 ea( $!! cal8-a7 more. ?= -onE( (*+nF (*e/e @roblem/ are +n/urmoun(able< bu( (*e7 can ?maFe .a( lo// more -+..+cul( (*an one woul- eG@ec( .rom rea-+ng ?e,en low-carb -+e( booF/. =E,e rea- (*e ma0or lowcarb -+e( booF/ an- mo/( are (rul7 @+// @oor. (*e

onl7 one = e,en *a- marg+nal re/@ec( .or 1+n (erm/ o. ac(uall7 @re/en(+ng *uman @*7/+olog7 a/ +( reall7 +/< ra(*er (*an maF+ng cra@ u@ (o /ell more booF/6 +/ H)ro(e+n )owerH b7 (*e Ea-e/. = *a- /ome m+nor Lu+bble/ abou( /ome o. (*e+r -e(a+l/ 1(*oE = un-er/(oo- w*7 (*e7 *a- (o /+m@l+.7 /ome conce@(/ (o maFe +( more rea-able6 bu( muc* le// (*an (*e o(*er lowcarb booF/ 1wonE( name name/6. D+e( booF au(*or/ /eem (o .eel (*a( (*e7 can maFe u@ *uman @*7/+olog7 a/ (*e7 go along< maF+ng /uc* ba/+c m+/(aFe/ (*a( +( /+cFen/ me 1a/ = wro(e be.ore< a ba/+c b+oc*em+/(r78@*7/+olog7 booF woul- be a goo- +n,e/(men( .or woul- be -+e( booF au(*or/6. = can onl7 a//ume (*a( mo/( .+gure (*e a,erage rea-er wonE( care (o eGam+ne (*e -e(a+l/ .or cla+m/ be+ng ma-e. Le(E/ .ace +(< (*e /(u@+-e/( -+e( booF can /ell a m+ll+on co@+e/ +. (*e7 *a,e a goomarFe(+ng @lan. Tell @eo@le w*a( (*e7 wan( o( *ear< wra@ +( +n /ome log+cal /oun-+ng 1bu( no( nece//ar+l7 correc(6 argumen(/< an- 7ouE,e go( a be/(/eller. =nc+-en(ell7 (*+/ +/ al/o w*7 = (*+nF (*e ma+n/(ream *a/ come -own /o *aron @ur,e7or/ o. lowcarb -+e( booF/. T*e cla+m/ be+ng ma-e< an- (*e ra(+onale be+ng g+,en .or (*o/e cla+m/< are /o ou( o. 0+be w+(* *uman @*7/+olog7 (*a( mo/( -+e( booF/ are a 0oFe. = S*o@eS (o c*ange (*a( w+(* m7 booF (*oug* = Fnow (*a( lowcarb -+e(/ w+ll ne,er be acce@(e- (o(all7. = can -e.en-< w+(* *uman re/earc* a,a+lable (o an7one w*o wan(/ (o looF .or +(< an7 cla+m = maFe abou( Fe(ogen+c -+e(/. C*en = canE( -e.en- /ome(*+ng w+(* /c+ence< or (*ere 0u/( +/nE( enoug* -a(a (o /u@@or( /ome(*+ng< =Em go+ng (o @o+n( +( ou(. An- unl+Fe mo/( -+e( booF/< =Em no( go+ng (o @a+n( lowcarb -+e(/ +n an7 l+g*( o(*er (*an a @urel7 ob0ec(+,e one. =Em @re/en(+ng (*e @*7/+olog+cal .ac(/ abou( w*a( *a@@en/ +n Fe(o/+/< bo(* gooan- ba-. = wonE( /ell a/ man7 co@+e/ +. = wro(e a @+ece o. -ung -+e( booF @rom+/+ng ea/7 we+g*( lo// w+(*ou( eGerc+/e bu( = *o@e (*a( a( lea/( /ome RDE/ an- MDE/ w+ll ge( /ome o. (*e+r -amn .ac(/ /(ra+g*( abou( Fe(o/+/ anFe(ogen+c -+e(/. = wan( @eo@le (o be able (o (aFe (*+/ booF (o (*e+r MD or RD 1w*o o. cour/e w+ll be (ell+ng (*em *ow aw.ul Fe(o/+/ +/6 an- /a7 HRea(*+/< +(E/ (*e .ac(/H. T*a(E/ w*7 =Em onl7 u/+ng re/earc* 1*a,e aroun- "%! /(u-+e/ r+g*( now< go( a .ew more (o ge(6< no( (e/(+mon+al/ or an7 o(*er cra@ l+Fe (*a(. O. cour/e all o. (*+/ +/ @re-+ca(e- on me ac(uall7 .+n+/*+ng (*e -amn (*+ng. L7le McDonal- wro(e# ? ? ?C*a( are Hor(*o/(a(+c /7m@(om/HJ ? ? Or(*o/(a(+c *7@o(en/+on re.er/ (o a Lu+cF -ro@ +n bloo- @re//ure w*en ? +n,+-+ual/ go .rom /+((+ng (o /(an-+ng 1or o(*erw+/e c*ange @o/(ure6. T*e/e /7m@(om/ w+ll al/o *a@@en +. /(an-+ng u@ .or a @rolonge- @er+o- o. (+me 1(*oug* go+ng .rom /+((+ng (o /(an-+ng +/ u/uall7 ea/+er (o no(+ce6. ? C*a( = .+n- F+n- o. +n(ere/(+ng abou( Fe(ogen+c -+e(/ +/ (*a( +n-+,+-ual/ ? w+(* *7@er(en/+on 1*+g* bloo- @re//ure6 (en- (o normal+Be (*e+r D) on a ? Fe(ogen+c -+e(< @re/umabl7 .rom (*e /ame e..ec(/. Doub( +(. Or(*o/(a(+c *7@o(en/+on occur/ becau/e o. (*e low le,el/ o. al-o/(erone 1an- (o /ome -egree cor(+/ol6. :o+ng low carb allow/ a-renal/ (o reco,er. Mo/( (e/(/ w+ll no( /*ow eG*au/(e- a-renal/. T*a(E/ becau/e (*e7 looF a( curren( le,el/ o. cor(+/ol an- /uc*. C*a( one nee-/ (o looF a( +/ (*e le,el -ur+ng a @er+o- o. +ncrea/e- -eman-. )a(+en(/ w+(* c*ron+c .a(+gue

< .or eGam@le< re/@on- ,er7 -+..eren(l7 (o eGerc+/e (*an normal @eo@le - (*e+r cor(+/ol -ro@/ a.(er a /(a(+onar7 b+Fe r+-e. A/ an a/+-e< +( +/ Lu+(e @o//+ble (o *a,e bo(* or(*o/(a(+c *7@o(en/+on an- *7@er(en/+on a( (*e /ame (+me. For (*o/e +n(ere/(e- +n looF+ng +n(o or(*o/(a(+c *7@o(en/+on 7ou m+g*( wan( (o looF u@ neurall7 me-+a(e*7@o(en/+on 1ba/+call7 (*e /ame (*+ng< -+agno/e- on (*e (+l( (able +n/(ea-6. =l7a From owner-lowcarb@MAELSTROM.STJOHNS.EDU Fr+ Jul 3 1'#!"#!4 1&&4 Re(urn-)a(*# owner-lowcarb@MAELSTROM.STJOHNS.EDU Rece+,e-# .rom mael/(rom./(0o*n/.e-u 1mael/(rom./(0o*n/.e-u 213&."4.1. 356 b7 omen.com 14.4.%8S9O%6 w+(* ESMT) +- RAA " 4' .or ; Fr+< 3 Jul 1&&4 1'#!"#!3 -!'!! 1)DT6 Me//age-=-# >1&&4!' %!!!".RAA " 4'@omen.com? Rece+,e-# .rom mael/(rom./(0o*n/.e-u b7 mael/(rom./(0o*n/.e-u 1LSMT) .or O@enAMS ,1.1a6 w+(* SMT) +- >1.EFE&$4&A@mael/(rom./(0o*n/.e-u?; Fr+< 3 Jul 1&&4 !#!%#%4 -1$!! Da(e# Fr+< 3 Jul 1&&4 1&#34#$% EDT Re@l7-To# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on Sen-er# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on From# Su/+e McDonalSub0ec(# Re# low carb an- @/7c*+a(r+c @a(+en(/ To# LOC9ARD@MAELSTROM.STJOHNS.EDU S(a(u/# R re/earc*@S)EEDNET.9OM.AU 1Du.. Ca(F+n/6 wr+(e/# >> =/ an7one aware o. an7 re/earc* -one regar-+ng (*e e..ec(/ o. a low carb -+e( u@on @/7c*+a(r+c +n-@a(+en(/J M7 ob/er,a(+on +/ (*a( +n@a(+en(/ @robabl7 *a,e (*e wor/( -+e( +n (*e worl-< com@oun-eb7 *ea,7 -u(7 @/7c*o(ro@+c me-+ca(+on. So =Em cur+ou/ abou( w*a( a low carb -+e( woul- -o .or (*+/ @o@ula(+on. ?? = -onE( Fnow +. (*+/ w+ll be *el@.ul (o 7ou< bu( = .oun- (*+/# A /(rong correla(+on eG+/(/ be(ween /c*+Bo@*ren+a an- -e.+c+enc+e/ +n .a(/< e/@ec+all7 +n (*e n-$ /er+e/. Sc*+Bo@*ren+c/ w*o na(urall7 ea( lo(/ o. Omega-$ .a(/ (en- (o *a,e le// /e,ere /7m@(om/ (*an (*o/e w*o -onE(. Su@@lemen(a(+on w+(* eG(ra .a(/ +n (*e Omega-$ grou@ /+gn+.+can(l7 +m@ro,e/ /7m@(om/ o. /c*+Bo@*ren+a +n mo/( @a(+en(/. 9lo/e rela(+,e/ o. /c*+Bo@*ren+c/ /*ow /+m+lar -e.+c+enc+e/ +n Omega-$ .a(/. T*e @o//+b+l+(7 (*a( -+e(/ generall7 low +n .a( m+g*( wor/en /c*+Bo@*ren+a or e,en br+ng on (*e con-+(+on among (*o/e alrea-7 @re-+/@o/e- (o +( +/ *ar- (o +gnore. 1Laug*arne JD; Mellor JE; )ee( M. Fa((7 ac+-/ an- /c*+Bo@*ren+a. L+@+-/< 1&&" Mar< $1 Su@@l#< S1"$-%. See al/o )ee( M e(. al. E//en(+al .a((7 ac+-e.+c+enc7 +n er7(*roc7(e membrane/ .rom c*ron+c /c*+Bo@*ren+c @a(+en(/< an(*e cl+n+cal e..ec(/ o. -+e(ar7 /u@@lemen(a(+on. )ro/(aglan-+n/ LeuFo( E//en( Fa((7 Ac+-/< 1&&" Aug< %%#1- < '1-%6

From owner-lowcarb@MAELSTROM.STJOHNS.EDU Sa( Jul % 1'#$$#1" 1&&4 Re(urn-)a(*# owner-lowcarb@MAELSTROM.STJOHNS.EDU Rece+,e-# .rom mael/(rom./(0o*n/.e-u 1mael/(rom./(0o*n/.e-u 213&."4.1. 356 b7 omen.com 14.4.%8S9O%6 w+(* ESMT) +- RAA!3$&' .or ; Sa(< % Jul 1&&4 1'#$$#1$ -!'!! 1)DT6 Me//age-=-# >1&&4!' "!!$$.RAA!3$&'@omen.com? Rece+,e-# .rom mael/(rom./(0o*n/.e-u b7 mael/(rom./(0o*n/.e-u 1LSMT) .or O@enAMS ,1.1a6 w+(* SMT) +- >&.E$!3"A 4@mael/(rom./(0o*n/.e-u?; Sa(< % Jul 1&&4 !#$$#!$ -1$!! Da(e# Sa(< % Jul 1&&4 1&#$3#$% -!3!! Re@l7-To# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on Sen-er# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on From# Dana 9ar@en-er Sub0ec(# Re# low carb an- @/7c* To# LOC9ARD@MAELSTROM.STJOHNS.EDU S(a(u/# R Au(oma(+c -+ge/( @roce//or wro(e# =/ an7one aware o. an7 re/earc* -one regar-+ng (*e e..ec(/ o. a low carb ? ? ? ? ? -+e( u@on @/7c*+a(r+c +n-@a(+en(/J M7 ob/er,a(+on +/ (*a( +n@a(+en(/ @robabl7 *a,e (*e wor/( -+e( +n (*e worl-< com@oun-e- b7 *ea,7 -u(7 @/7c*o(ro@+c me-+ca(+on. So =Em cur+ou/ abou( w*a( a low carb -+e( woul- -o .or (*+/ @o@ula(+on.

C*en = wa/ on (*e lowcarb -+e( /u@@or( l+/( a cou@le o. 7ear/ bacF< (*ere wa/ one l+/(er w*o/e @/7c*+a(r+/( *a- @re/cr+be- a Fe(ogen+c -+e( /@ec+.+call7 .or (rea(men( o. c*ron+c -e@re//+on. Un.or(una(el7< /ome .olF/ @la7e- ama(eur /*r+nF< ma-e *+m8*er angr7< an- (*e7 -+-nE( /(a7 on (*e l+/(< /o = -+-nE( *ear *ow +( (urne- ou(. ? = am Feenl7 +n(ere/(e- +n (*+/ /ame Lue/(+on.....@ar(+cularl7 a/ +( ? a@@l+e/ (o ? alco*ol+/m......well all o. (*e @/7c*+a(r+c DK. T*ere wa/ an ar(+cle +n (*e local @a@er a .ew mon(*/ bacF -- = now rue (*a( = -+-nE( cl+@ +( -- /a7+ng (*a( a /(u-7 *a- /(rongl7 correla(e- a H/wee( (oo(*H w+(* alco*ol+/m; /a+- +( wa/ (*e /(ronge/( @re-+c(or. T*+/ 0+be/ w+(* m7 @er/onal eG@er+ence. Al/o remember rea-+ng 7ear/ ago o. ra( /(u-+e/< w*ere ra(/ .e- /ugar an- o(*er re.+ne- carb/ c*o/e< w*en g+,en a c*o+ce< (o -r+nF alco*ol< w*+le ra(/ on a w*ole .oo-/ -+e( c*o/e wa(er. =n (*e booF Mega,+(am+n T*era@7< a Dr. FranF Du(ler +/ c+(e- a/ *a,+ng /ucce//.ull7 (rea(e- alco*ol+/m b7 (ube-.ee-+ng a *+g* @ro(e+n -+e( w+(* /ub/(an(+al ,+(am+n/ an- m+neral/. Sa7/ (*e /(u-7 wa/ @ubl+/*e- +n T*e Journal o. T*e Amer+can :er+a(r+c/ Soc+e(7 +n Se@(. E"'. T*+/ booF c+(e/ a number o. /(u-+e/ o. (*+/ /or(. ? A /(rong correla(+on eG+/(/ be(ween /c*+Bo@*ren+a an- -e.+c+enc+e/ +n ? .a(/< ? e/@ec+all7 +n (*e n-$ /er+e/. An- (*ere +/ a@@aren(l7 a c*ole/(erol8/ero(on+n connec(+on a/ well<

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.a((7 ac+-/< w*+c* occur/ un-er (*e ac(+on o. /ome(*+ng calle- Hormone Sen/+(+,e L+@a/e 1HSL6. HSL +/ ac(+,a(e- @r+mar+l7 b7 (*e ca(ec*olam+ne/ 1a-renal+ne8nora-renal+ne or e@+ne@*r+ne8nore@+ne@*r+ne -e@en-+ng on w*a( /+-e o. (*e @on- 7ou l+,e on6 al(*oug* grow(* *ormone< cor(+/ol an- glucagon @la7 /mall role/. HSL +/ almo/( (o(all7 +nac(+,a(e- b7 +n/ul+n 1w*+c* al/o /(+mula(e/ /ome(*+ng calle- l+@o@ro(e+n l+@a/e or L)L w*+c* (ell/ (*e .a( cell (o /7n(*e/+Be (r+gl7cer+-e/6. C*en HSL +/ ac(+,a(e- 1b7 low +n/ul+n an- *+g* ca(ec*olam+ne le,el/6 +( /+gnal/ (*e .a( cell (o breaF -own (r+gl7cer+-e/ (o gl7cerol an- FFA. T*e gl7cerol +/ relea/e- +n(o (*e bloo-/(ream an- can be (urne- +n(o gluco/e +n (*e l+,er. FFA en(er/ (*e bloo-/(ream< @robabl7 bou-n (o album+n< w*ere +( (ra,el/ (o ,ar+ou/ (+//ue/ (o be burne- 1+.e. (*e l+,er< mu/cle (+//ue6. So 7ouEre go+n (o ge( maG+mal bloo- FFA le,el/ un-er con-+(+on/ o. low +n/ul+n an- *+g* ca(ec*olam+ne/ w*+* +/ -ur+ng .a/(+ng. T*e neG( *+g*e/( woul- be a Fe(ogen+c -+e(. A/ 7ou a-- carb/< +n/ul+n goe/ u@ an- (*e ca(ec*olam+ne/ go -own< an- 7ou ge( @rogre//+,el7 le// bloo- borne FFA< an *ence le// .a( burn+ng. L7le McDonal-< 9S9S T*+/ /@ace .or lea/e A( &#34 AM &848&4< 9*ucF For/berg CA'N:K wro(e# ?Oour commen( (*a( aerob+c eGerc+/e +/ +ne..ec(+,e .or we+g*( lo// ?+/ +n(ere/(+ng. =( woul- be more accura(e (o /a7 (*a( (*e amoun( o. eGerc+/e w*+c* w+ll8can be real+/(+call7 -one b7 (*e a,erage @er/on +/ +ne..ec(+,e .or /+gn+.+can( we+g*( lo//. Sure< runner/ are ,er7 (*+n bu( 7ouEre looF+ng a( runn+ng ,olume/ o. 1- *our/8-a7. T*e curren( recommen-a(+on/ .or $!E o. aerob+c eGerc+/e a .ew (+me/ a weeF a/ an e..ec(+,e mo-al+(7 .or we+g*( lo// are a 0oFe. =( ma7 maFe 7ou *eal*+er 1aga+n< /ee )a..enberg6 bu( +( wonE( cau/e an7 bo-7 com@o/+(+on c*ange/. (*e +m@ac( calor+call7 o. aerob+c eGerc+/e on ,ar+ou/ @arame(er/ o. we+g*( lo// +/ /e,erel7 o,er/(a(e- 1/ee 9. Vela/Fo HEGerc+/e .or we+g*( lo//# C*a( are (*e .ac(/JH J Am D+e( A//oc 11&&%6 &%# 1313-131'. .or a br+e. re,+ew6. T*e calor+c burn o. aerob+c eGerc+/e< e/@ec+all7 a( (*e +n(en/+(+e/ (*a( mo/( can /u/(a+n< +/ low< @er*a@/ % cal8m+nu(e. So 7ouEre looF+ng a( $!! cal8*our< .a+rl7 +n/+gn+.+can(. 9on(rar7 (o @o@ular bel+e.< aerob+c eGerc+/e -oe/ NOT ra+/e me(abol+c ra(e a.(er (ra+n+ng. An- a.(er an a,erage (ra+n+ng bou(< (*e number o. calor+/ burne- a.(er eGerc+/e ma7 be %-1! calor+e/ a( mo/(. E,en a.(er eG*au/(+ng eGerc+/e< +(E/ onl7 1%! calor+e/. De7on- (*a(< aerob+c eGerc+/e -oe/nE( -o a lo( (o /@are @ro(e+n lo//e/ or @re,en( (*e -ro@ +n me(abol+ ra(e -ur+ng -+e(+ng 1/ome /(u-+e/ /a7 7e/< /ome /(u-+e/ /a7 no6. )robabl7 (*e b+gge/( bene.+( o. aerob+c/ +/ (*a( +( +m@ro,e/ (*e mu/cle/ ab+l+(7 (o u/e .a( .or .uel< b7 +nrea/+ng m+(oc*on-r+al -en/+(7 an- (*e ac(+,+(78number o. aerob+c enB7me/. To (*e con(rar7< w*+le (*e calor+c burn o. we+g*( (ra+n+ng +/nE( ,er7 *+g* e+(*er 1@er*a@/ & cal8m+nu(e6< (*ere are long (erm +ncrea/e/ +n me(abol+c ra(e 1a@@roG+ma(+ng $%-3! cal8lb o. m/ucle ga+ne- al(*oug* /(ar,a(+on -+e( ma7 @re,en( (*+/< b7 -ecrea/+ng calor+e/ burne-8Fg ac(+,e (+//ue6< an(*ere +/ a mo-era(el7 /+gn+.+can( +ncrea/e +n me(abol+c ra(e a.(er we+g*(

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bo(* o. w*+c* .oun- (*a( -e@le(+ng mu/cle gl7cogen 1w+(* eG*au/(+,e c7cl+ng< al(*oug* we+g*( (ra+n+ng woul- a*,e been mor e..+c+en(6 ma-e +( ea/+er .or (*e bo-7 (o a-a@( (o a E*+g* .a(E -+e( 1w*+c* wa/ almo/( Fe(ogen+c +n (*+/ /(u-76. Decau/e -e@le(+on o. gl7cogen +ncrea/e- .a( oG+-a(+on. An- (*e7 ma-e /ure (o /(u-7 bo(* lean an- obe/e /ub0ec(/ (o /ee +. (*ere wa/ an7 +n*eren( -e.ec( +n obe/e +n-+,+-ual/ (*a( @re,en(e- (*e ob/er,a(+on (*a( *a- been ma-e +n lean +n-+,+-ual/. T*ere wa/nE(. L7le McDonal-< 9S9S T*+/ /@ace .or lea/e = onl7 Fnow .rom @er/onal eG@erence. C*en = .eel an energ7 -ra+n< = ea( a *+g* .a( .oo- an- .eel more energ7 w+(*+n a .ew m+nu(e/. S(e.an//on con-uc(e- /(u-+e/ .or (*e U.S. m+l+(ar7 on @emm+can con/um@(+on an- +(/ e..ec(/ on @*7/+cal en-urance. A.(er a a-a@(a(+on @er+o-< /(am+na +m@ro,e- a/ +( -+- +n a recen( /(u-7 o. .a( con/um@(+on an- a(*le(+c @er.ormance w*+c* = w+ll en-e,or (o .+n- .or 7ou. Man7 @eo@le (r7 (o l+m+( .a( becau/e o. concern/ abou( car-+o,a/cular *eal(*. T*e/e concern/ *a,e been el+m+na(e- la(el7 b7 man7 /(u-+e/. T*+/ ar(+cle on /(roFe @re,en(+on /*ow/ w*a( =Em (alF+ng abou(. 1 8 38&'<Reu(er/- HH+g*er Fa( D+e( Re-uce/ S(roFe R+/FJH =n a /ur@r+/+ng new /(u-7< (*e e-+(or+alE/ au(*or/< Dr/. Roger S*erw+n an- T*oma/ )r+ce o. (*e Un+,er/+(7 o. Mar7lan- Sc*ool o. Me-+c+ne +n-+ca(e (*a( -+e(ar7 .a( -oe/ no( +ncrea/e (*e r+/F o. (*e mo/( common (7@e o. /(roFe. Al/o< cer(a+n (7@e/ o. .a( - +nclu-+ng /a(ura(e- .a( anmonoun/a(ura(e- .a( - ma7 e,en -ecrea/e (*e r+/F o. /(roFe +n m+--le-agemen. Fur(*er /(u-+e/ are nece//ar7 (o con.+rm (*+/. T*+/ .+n-+ng +/ +n con.l+c( w+(* o(*er /(u-+e/ l+nF+ng *ear( -+/ea/e w+(* a *+g* .a( -+e(. H=n (*e new /(u-7< (*e r+/F o. *a,+ng a /(roFe -ro@@e- 1%R .or e,er7 $R +ncrea/e +n energ7 ga+ne- .rom (o(al .a( an- -ro@@e- &R .or e,er7 1R +ncrea/e +n /a(ura(e- .a(< (*e (7@e .oun- +n mea( an- -a+r7 @ro-uc(/. T*e /(roFe r+/F -ecl+ne- 11R .or e,er7 1R +ncrea/e +n monoun/a(ura(e- .a( +n(aFe< (*e (7@e o. .a( .oun- +n canola< nu( an- ol+,e o+l< accor-+ng (o a re@or( +n (*e curren( +//ue o. T*e New Englan- Journal o. Me-+c+ne. T*ere wa/ no @ro(ec(+,e e..ec( o. @ol7un/a(ura(e- .a(< w*+c* +/ .oun- +n .+/* an- ,ege(able o+l/.H Ra7 Au-e((e Au(*or HNean-erT*+n#A 9a,emanE/ :u+-e (o Nu(r+(+onH *((@#88www./o.-e/+gn.com8nean-er From owner-lowcarb@MAELSTROM.STJOHNS.EDU Tue Se@ 1!# '#1& 1&&4 Re(urn-)a(*# owner-lowcarb@MAELSTROM.STJOHNS.EDU Rece+,e-# .rom mael/(rom./(0o*n/.e-u 1mael/(rom./(0o*n/.e-u 213&."4.1. 356 b7 omen.com 14.4.%8S9O%6 w+(* ESMT) +- NAA1'%'! .or ; Tue< Se@ 1&&4 1!# '#1% -!'!! 1)DT6 Me//age-=-# >1&&4!& 1' '.NAA1'%'!@omen.com? Rece+,e-# .rom mael/(rom./(0o*n/.e-u b7 mael/(rom./(0o*n/.e-u 1LSMT) .or O@enAMS ,1.1a6 w+(* SMT) +- >$.!3 9!%&!@mael/(rom./(0o*n/.e-u?; Tue< Se@ 1&&4 1$# "#!" -!%!! Da(e# Tue< Se@ 1&&4 1&#!$#34 -!'!! Re@l7-To# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on Sen-er# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on

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S(e+n an- Le,an(*al .+r/( -e/cr+be- )9O +/ 1&$% -- +( +/ a con-+(+on w*+c* ba/+call7 +/ c*arac(er+Be- b7 @er/+/(en( anno,ula(+on 1lacF o. o,ula(+ng6. T*ere are a ,ar+e(7 o. c*arac(er+/(+c/ women w+(* )9OS /*are. Comen w+(* )9OS @ro-uce an o,er@ro-uc(+on male *ormone/ -- (e/(o/(erone an- an-ro/(ene-+one. T*e (7@+cal /enar+o +/ +rregular men/(rual c7cle/< on/e( o. *+r/u(+/m +n (*e (een/ or earl7 !/< an- gra-uall7 wor/en+ng eGce// *a+r grow(*. Al/o< women w+(* )9OS -e,elo@ a Luan(+(7 o. /mall c7/(/ on (*e o,ar+e/. T*e o,ar+e/ w+ll *a,e a @ar(+cular HlooFH on ul(ra/oun- eGam+na(+on. T*e c*arac(er+/(+c )S o,ar7 ar+/e/ w*en anno,ula(+on occur/ o,er an- o,er .or a leng(* o. (+me. T*e ba/+c @roblem +/ (*a( al(*oug* (*e/e o,ar+e/ con(a+n man7 .oll+cle/ w+(* egg/< - (*e egg/ are +mma(ure unl+Fe (*e HnormalH o,ar7 (*a( -e,elo@/ one egg eac* mon(* (*a( relea/e/ m+- c7cle. 1*((@#88www.+nc++-.org8+mage/8.g+.6 One o. (*e ma0or b+oc*em+cal .ea(ure/ o. @ol7c7/(+c o,ar7 /7n-rome +/ +n/ul+n re/+/(ance accom@an+e- b7 com@en/a(or7 *7@er+n/ul+nem+a 1ele,a(e.a/(+ng bloo- +n/ul+n le,el/6. T*ere +/ +ncrea/+ng -a(a (*a( *7@er+n/ul+nem+a @ro-uce/ (*e *7@eran-rogen+/m o. @ol7c7/(+c o,ar7 /7n-rome b7 +ncrea/+ng o,ar+an an-rogen @ro-uc(+on< @ar(+cularl7 (e/(o/(erone an- an-ro/(ene-+one an- b7 -ecrea/+ng (*e /erum /eG *ormone b+n-+ng globul+n concen(ra(+on. T*e *+g* le,el/ o. an-rogen+c *ormone/ +n(er.ere w+(* (*e @+(u+(ar7 o,ar+an aG+/< lea-+ng (o +ncrea/e- LH le,el/< ano,ula(+on< amenorr*ea< an- +n.er(+l+(7. Accor-+ng (o MarF )erloe< MD 1a re@ro-uc(+,e en-ocr+nolog+/( +n A(lan(a6 Dr/. AelaBLueB< Ne/(ler an- Duna+. *a,e /*own (*a( lower+ng /erum +n/ul+n concen(ra(+on/ w+(* METFORM=N 1:luco@*age 1%!! mg a -a76 or (rogl+(aBone 1ReBul+n 3!! mg a -a76 amel+ora(e/ *7@eran-rogen+/m< b7 re-uc(+on o. o,ar+an enB7me ac(+,+(7 (*a( re/ul(/ +n male *ormone @ro-uc(+on. T*e/e me-+ca(+on/ *a,e been /*own (o re,er/e (*e en-ocr+ne abnormal+(+e/ /een w+(* @ol7c7/(+c o,ar7 /7n-rome w+(*+n (wo or (*ree mon(*/. T*e7 can re/ul( +n -ecrea/e- *a+r lo//< -+m+n+/*e- .ac+al an- bo-7 *a+r grow(*< normal+Ba(+on o. ele,a(e- bloo- @re//ure< regula(+on or men/e/< we+g*( lo// an- normal .er(+l+(7. Ce *a,e /een @regnanc+e/ re/ul( +n le// (*an (wo mon(*/ +n woman w*o conce+,e- +n (*e+r ,er7 .+r/( o,ula(or7 men/(rual c7cle. Ra7 Au-e((e Au(*or HNean-erT*+n#A 9a,emanE/ :u+-e (o Nu(r+(+onH *((@#88www./o.-e/+gn.com8nean-er

From owner-lowcarb@MAELSTROM.STJOHNS.EDU T*u Se@ 3 !#$!#3! 1&&4 Re(urn-)a(*# owner-lowcarb@MAELSTROM.STJOHNS.EDU Rece+,e-# .rom mael/(rom./(0o*n/.e-u 1mael/(rom./(0o*n/.e-u 213&."4.1. 356 b7 omen.com 14.4.%8S9O%6 w+(* ESMT) +- UAA!'44! .or ; T*u< 3 Se@ 1&&4 !#$!#$4 -!'!! 1)DT6 Me//age-=-# >1&&4!& %!$$!.UAA!'44!@omen.com? Rece+,e-# .rom mael/(rom./(0o*n/.e-u b7 mael/(rom./(0o*n/.e-u 1LSMT) .or O@enAMS ,1.1a6 w+(* SMT) +- >11.D3$1%"1%@mael/(rom./(0o*n/.e-u?; T*u< 3 Se@ 1&&4 $# &#%' -!%!! Da(e# T*u< 3 Se@ 1&&4 1&#31# ' -!'!! Re@l7-To# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on Sen-er# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on From# Donna H Sub0ec(# Re# LacF o. o,ula(+on /ol,e- on Fe(ogen+c -+e(J K-To# clecFler@M9= !!!.9OM To# LOC9ARD@MAELSTROM.STJOHNS.EDU S(a(u/# R T*+/ wa/ a reall7 +n(ere/(+ng @o/(. Oou ma7 -o well (o rea- u@ on )9O 1al/o calle- )9OS6 on (*e web-- @ol7c7/(+c o,ar+an /7n-rome. T*+/ +/ w*ere a woman -oe/ no( o,ula(e-- an- *+g* +n/ul+n le,el/ are .oun,er7 o.(en< al/o mo/( or man7 )9OS @a(+en(/ are obe/e. From w*a( = un-er/(an-< re/earc*er/ arenE( /ure +. *+g* +n/ul+n +/ (*e car( or (*e *or/e +n (*+/ -+/or-er. Du( @er*a@/ 7our /+(ua(+on +/ rela(e- (o (*+/< /+nce b7 low-carb+ng 7ouEre mo/( cer(a+nl7 lower+ng +n/ul+n @ro-uc(+on. Ano(*er (*oug*(< 0u/( @o//+bl7< +/ (*a( +. 7ou were ,er7 low-.a( +n (erm/ o. -+e( be.ore< (*e *+g*er .a( con(en( o. a (7@+cal low-carb -+e( ma7 be g+,+ng 7ou more ba/+c c*ole/(erol .or 7our bo-7 (o maFe /eG *ormone/ ou( o.. No( (o men(+on (*e @ro(e+n an- +ron (*a( are +m@or(an( +n regular c7cle/. = -onE( recall +. +( wa/ men(+one- on (*+/ l+/( or el/ew*ere< bu( one /(u-7 /omeone c+(e- no(e- (*a( women (en- (o E-o be((erE /ome*ow on larger amoun(/ o. -+e(ar7 .a( (*an men. :+,en our +n(r+ca(e /eG *ormone @ro-uc(+on /+(ua(+on< (*a( maFe/ /en/e (o me. )er*a@/ /omeone can @o+n( (o (*e /(u-7< w*o remember/ +(J 9ongra(/ on (*e normal+Ba(+on. Donna

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From owner-lowcarb@MAELSTROM.STJOHNS.EDU T*u Oc( 1 1'# %#1 1&&4 Re(urn-)a(*# owner-lowcarb@MAELSTROM.STJOHNS.EDU Rece+,e-# .rom mael/(rom./(0o*n/.e-u 1mael/(rom./(0o*n/.e-u 213&."4.1. 356 b7 omen.com 14.4.%8S9O%6 w+(* ESMT) +- RAA!$'%1 .or ; T*u< 1 Oc( 1&&4 1'# %#!& -!'!! 1)DT6 Me//age-=-# >1&&41!! !! %.RAA!$'%1@omen.com? Rece+,e-# .rom mael/(rom./(0o*n/.e-u b7 mael/(rom./(0o*n/.e-u 1LSMT) .or O@enAMS ,1.1a6 w+(* SMT) +- >1!.99F9&39D@mael/(rom./(0o*n/.e-u?; T*u< 1 Oc( 1&&4 !# $# $ -!%!! Da(e# T*u< 1 Oc( 1&&4 11#$1#13 -!'!! Re@l7-To# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on Sen-er# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on From# Doug SFrecF7 Sub0ec(# *+g* @ro(e+n -+e( /@are/ mu/cle ma// To# LOC9ARD@MAELSTROM.STJOHNS.EDU S(a(u/# R Au(*or/ )+a((+ )M. Mon(+ F. Fermo =. Daru..al-+ L. Na//er R. San(ambrog+o :. L+bren(+ M9. :all+-N+enle M. )on(+rol+ AE. )oBBa :. =n/(+(u(+on =/(+(u(o Sc+en(+.+co San Ra..aele< D+@ar(+men(o -+ 9*+m+ca e D+oc*+m+ca Me-+ca< M+lano< =(al7. T+(le H7@ocalor+c *+g*-@ro(e+n -+e( +m@ro,e/ gluco/e oG+-a(+on an- /@are/ lean bo-7 ma//# com@ar+/on (o *7@ocalor+c *+g*-carbo*7-ra(e -+e(. Source Me(abol+/m# 9l+n+cal M EG@er+men(al. 3$11 6#1341-'< 1&&3 Dec. Ab/(rac( T*e a+m o. (*e /(u-7 wa/ (o +n,e/(+ga(e (*e e..ec(/ o. (wo *7@ocalor+c 14!!-Fcal6 -+e(/ on bo-7 we+g*( re-uc(+on an- com@o/+(+on< +n/ul+n /en/+(+,+(7< an- @ro(eol7/+/ +n % normal gluco/e-(oleran( obe/e women. T*e (wo -+e(/ *a- (*e .ollow+ng com@o/+(+on# 3%R @ro(e+n< $%R carbo*7-ra(e 19HO6< an- !R .a( 1H) -+e(< 1! /ub0ec(/6< an- "!R 9HO< !R @ro(e+n< an- !R .a( 1H9 -+e(< 1% /ub0ec(/6; bo(* la/(e- 1 -a7/. A eugl7cem+c *7@er+n/ul+nem+c 1 % mU8Fg8*6 clam@ la/(+ng 1%! m+nu(e/ comb+ne- w+(* +n-+rec( calor+me(r7 wa/ @er.orme- be.ore an- a.(er (*e -+e(. Do(* -+e(/ +n-uce- a /+m+lar -ecrea/e +n bo-7 we+g*( an- .a( ma// 1FM6< w*erea/ .a(-.ree ma// 1FFM6 -ecrea/e- onl7 a.(er (*e H9 -+e(. $-Me(*7l*+/(+-+ne 1$-9H$-H=S6 eGcre(+on wa/ re-uce- b7 34R a.(er (*e H) -+e( an- rema+ne- unc*ange- a.(er (*e H9 -+e( 1) > .!%6. A /+gn+.+can( correla(+on wa/ .oun- be(ween (*e c*ange/ +n FFM an- +n $-9H$H=S eGcre(+on a.(er (*e -+e( 1r/ Q .%!< ) > .! 6. Dloo- gluco/e rema+neunc*ange-< w*+le +n/ul+n -ecrea/e- +n bo(* -+e(/. Free .a((7 ac+-/ 1FFA6 /+gn+.+can(l7 +ncrea/e- onl7 a.(er (*e H9 -+e( 1) > .!%6. Dur+ng (*e clam@ @er+o-< gluco/e -+/@o/al an- gluco/e oG+-a(+on /+gn+.+can(l7 +ncrea/e- a.(er (*e H) -+e( an- /+gn+.+can(l7 -ecrea/e- a.(er (*e H9 -+e(. O@@o/+(e re/ul(/ were .oun- w*en mea/ur+ng l+@+- oG+-a(+on. =n conclu/+on< our eG@er+ence /ugge/(/ (*a( 116 a *7@ocalor+c -+e( @ro,+-+ng a *+g* @ercen(age o. na(ural @ro(e+n can +m@ro,e +n/ul+n /en/+(+,+(7; an- 1 6 con,er/el7< a *7@ocalor+c

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From owner-lowcarb@MAELSTROM.STJOHNS.EDU Ce- Dec !"#3 #$4 1&&4 Re(urn-)a(*# owner-lowcarb@MAELSTROM.STJOHNS.EDU Rece+,e-# .rom mael/(rom./(0o*n/.e-u 1mael/(rom./(0o*n/.e-u 213&."4.1. 356 b7 omen.com 14.4.%8S9O%6 w+(* ESMT) +- :AA1$&33 .or ; Ce-< Dec 1&&4 !"#3 #$% -!4!! 1)ST6 Me//age-=-# >1&&41 ! 133 .:AA1$&33@omen.com? Rece+,e-# .rom mael/(rom./(0o*n/.e-u b7 mael/(rom./(0o*n/.e-u 1LSMT) .or O@enAMS ,1.1a6 w+(* SMT) +- >'.A%$DD!E1@mael/(rom./(0o*n/.e-u?; Ce-< Dec 1&&4 &#$"#!3 -!%!! Da(e# Ce-< Dec 1&&4 !'# &#!1 -!%!! Re@l7-To# eFoc*@bulloc*.com Sen-er# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on From# HEl+Babe(* A. Noc*H Sub0ec(# Re# C*7 Low 9arb Ea(+ng CorF/ To# LOC9ARD@MAELSTROM.STJOHNS.EDU S(a(u/# RO = -onE( ,er7 o.(en a-- m7 o@+n+on< bu( *ere goe/. = *a,e been on low carb ea(+ng .or .our mon(*/ now< an- *a,e ne,er< e,er *a- a more @lea/an( -+e(+ng or ea(+ng eG@er+ence. = wa/ on low< low .a( .or o,er /+G 7ear/ an- coul- no( con,+nce m7 M.D. (*a( = wa/ /(+cF+ng (o low .a(. M7 c*ole/(erol wa/ +n (*e 3!! range< m7 (r+gl7cer+-e/ were *+g*< an- all +n all< = wa/ a me//. A.(er onl7 one mon(* on low carb/< m7 c*ole/(erol -ro@@e- 1!! @o+n(/< = lo/( ! @lu/ @oun-/< am *ar-l7 e,er *ungre7. = u/e- (o be H/(ar,e-H all o. (*e (+me. = (*+nF +( -e.+n+(el7 *a/ (o -o w+(* m7 +n/ul+n le,el an- bloo- gluco/e. Du( +n (*e long run< = -onE( care w*7 +( worF/< = 0u/( Fnow (*a( +( -oe/. El+Babe(*

From owner-lowcarb@MAELSTROM.STJOHNS.EDU Fr+ Dec 14 !%#%3#3& 1&&4 Re(urn-)a(*# owner-lowcarb@MAELSTROM.STJOHNS.EDU Rece+,e-# .rom mael/(rom./(0o*n/.e-u 1mael/(rom./(0o*n/.e-u 213&."4.1. 356 b7 omen.com 14.4.%8S9O%6 w+(* ESMT) +- FAA $1' .or ; Fr+< 14 Dec 1&&4 !%#%3#3" -!4!! 1)ST6 Me//age-=-# >1&&41 141$%3.FAA $1' @omen.com? Rece+,e-# .rom mael/(rom./(0o*n/.e-u b7 mael/(rom./(0o*n/.e-u 1LSMT) .or O@enAMS ,1.1a6 w+(* SMT) +- >1!. %41D"E@mael/(rom./(0o*n/.e-u?; Fr+< 14 Dec 1&&4 4#%1#%4 -!%!! Da(e# T*u< 1' Dec 1&&4 $#% #$" -!4!! Re@l7-To# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on Sen-er# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on From# S(e. Maruc* Sub0ec(# Re# Volo.( To# LOC9ARD@MAELSTROM.STJOHNS.EDU

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From owner-lowcarb@MAELSTROM.STJOHNS.EDU Fr+ Dec 14 13#!"#3& 1&&4 Re(urn-)a(*# owner-lowcarb@MAELSTROM.STJOHNS.EDU Rece+,e-# .rom mael/(rom./(0o*n/.e-u 1mael/(rom./(0o*n/.e-u 213&."4.1. 356 b7 omen.com 14.4.%8S9O%6 w+(* ESMT) +- OAA "!"3 .or ; Fr+< 14 Dec 1&&4 13#!"#3% -!4!! 1)ST6 Me//age-=-# >1&&41 14 !".OAA "!"3@omen.com? Rece+,e-# .rom mael/(rom./(0o*n/.e-u b7 mael/(rom./(0o*n/.e-u 1LSMT) .or O@enAMS ,1.1a6 w+(* SMT) +- >".9!&4&94D@mael/(rom./(0o*n/.e-u?; Fr+< 14 Dec 1&&4 1'#!$#!& -!%!! Da(e# Fr+< 14 Dec 1&&4 1"#!1#1 -!"!! Re@l7-To# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on Sen-er# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on From# L7le McDonalSub0ec(# Re# )ro(e+n con,er/+on To# LOC9ARD@MAELSTROM.STJOHNS.EDU S(a(u/# R A( 11#3' AM 1 81"8&4< Ma(( N+rFwoo- wro(e# ?T*+/ ma7 be (*e /ource o. m7 m+/un-er/(an-+ng. = (*+nF = rea- 1@robabl7 +n ?A(F+n/6 (*a( .a( *a/ an e,en lower gluco/e con,er/+on ra(e (*an @ro(e+n< ?/o a ,er7 /mall @or(+on o. (*e .a( we ea( can be con,er(e- b7 (*e l+,er ?+n(o gluco/e 1or gl7cogen< or w*a(e,er6.

Oe/< gl7cerol 1w*+c* +/ (*e bacFbone o. (r+gl7cer+-e/< aFa .a(6 can be con,er(e- (o gluco/e. ON a,erage< 1!R o. (*e (o(al .a( broFen -own w+ll rea@@er +n (*e bloo-/(ream a/ gluco/e 1+.e. 14! gram/ o. .a( Q 14 gram/ o. gluco/e6. ?S+nce gluco/e +/ (*e bo-7E/ ?energ7 /ource< +. 7ou canE( ge( muc* gluco/e ou( o. (*e .a(< 7ou canE( ge( ?muc* energ7. 1J6 =Em @robabl7 (o(all7 lo/(. #-6 T*e bo-7 can maFe gluco/e +n (*e l+er .rom# 1. cer(a+n am+no ac+-/ . gl7cerol $. lac(a(e8@7ru,a(e 1breaF-own @ro-uc(/ o. gl7cogen +n (*e mu/cle an- l+,er6 gl7cerol con(r+bu(e/ m+n+mall7 1T14- ! gram/8-a76< an- lac(a(e an- @7ru,a(e con(r+bu(e abou( 3! g8-a7. T*e re/( o. (*e bo-7E/ gluco/e reLu+remen(/ 1w*+c* are abou( 13! gram/8-a7 a( (*e beg+nn+ng o. a Fe(ogen+c -+e( an-ro@ (o abou( 4! gram/8-a7 a.(er $ weeF/6 come .rom (*e con,er/+on o. @ro(e+n. So 7ouEre looF+ng a( abou( '! gram/ o. gluco/e (o be ma-e .rom @ro(e+n. Now< 7ou can e+(*er le( 7our bo-7 breaF -own /(ore- bo-7 @ro(e+n 1mu/cle< e(c6 or 7ou can g+,e +( /u..+c+en( -+e(ar7 @ro(e+n (o /@are bo-7 @ro(e+n lo//e/. A( a %4R con,er/+on ra(e o. @ro(e+n (o gluco/e< +( (aFe/ abou( 1%! gram/ @ro(e+n8-a7 (o el+m+na(e bo-7 @ro(e+n lo//e/ -ur+ng (*e .+r/( .ew -a7/ o. Fe(o/+/ 11%! S !.%4 Q 4'6. A.(er a .ew weeF/ +n Fe(o/+/< +( /*oulonl7 (aFe abou( %! gram/ o. @ro(e+n (o el+m+na(e @ro(e+n lo//e/. T*+/ a//ume/ (*a( /omeone +/ no( eGerc+/+ng< w*+c* +ncrea/e/ @ro(+en reLu+remen(/. ?= (*+nF = rea- +n a 9o,er( Da+l7 booF (*a( bo-7 .a( +/ l+bera(e- (o re.+ll ?gl7cogen /(ore/ a.(er eGcerc+/e. =Ell looF .or +( aga+n (on+g*(. = /ure *o@e Da+le7 -+-nE( /a7 (*a(< becau/e *eE/ -ea- wrong. ?A(F+n/ argue/ (*a( (*+/ +/nE( (rue. He /a7/ (*e calor+e balance ma(* ?-oe/nE( worF unle// 7ou @a7 a((en(+on (o (*e -+e( maFeu@. T*+/ m+g*( no( ?be (rue< bu( +( woul- .+( w+(* m7 rea/on+ng (*a( +. 7ou canE( ge( gluco/e ?ou( o. +(< 7ou canE( ge( energ7 ou( o. +(. =Em no( /ure = agree w+(* m7 ?own rea/on+ng< *owe,er. A(F+n/ maFe/ no -+/(+nc(+on be(ween we+g*( lo// an- .a( lo//. He +/ ba/+ng *+/ commen(/ on earl7 /(u-+e/ /*ow+ng muc* grea(er we+g*( lo// .or low carb -+e(/< bu( +(E/ all wa(er. L7le McDonal-< 9S9S No ./+g nee-e-

From owner-lowcarb@MAELSTROM.STJOHNS.EDU Sa( Dec 1& 1'# !# $ 1&&4 Re(urn-)a(*# owner-lowcarb@MAELSTROM.STJOHNS.EDU Rece+,e-# .rom mael/(rom./(0o*n/.e-u 1mael/(rom./(0o*n/.e-u 213&."4.1. 356 b7 omen.com 14.4.%8S9O%6 w+(* ESMT) +- RAA!%!$' .or ; Sa(< 1& Dec 1&&4 1'# !#14 -!4!! 1)ST6 Me//age-=-# >1&&41 !!1 !.RAA!%!$'@omen.com?

Rece+,e-# .rom mael/(rom./(0o*n/.e-u b7 mael/(rom./(0o*n/.e-u 1LSMT) .or O@enAMS ,1.1a6 w+(* SMT) +- >4.F%D'9$1'@mael/(rom./(0o*n/.e-u?; Sa(< 1& Dec 1&&4 !#1"#33 -!%!! Da(e# Sa(< 1& Dec 1&&4 1%#%'# ' -!%!! Re@l7-To# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on Sen-er# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on From# =l7a Sub0ec(# Re# )ro(e+n con,er/+on To# LOC9ARD@MAELSTROM.STJOHNS.EDU S(a(u/# R To-- Moo-7 wro(e# ? F+r/(< +( +/ m7 un-er/(an-+ng (*a( an ? all-@ro(e+n -+e( w+ll @robabl7 maFe 7ou /+cF. = bel+e,e (*+/ +/ (rue< bu( no( becau/e o.... ? T*ere mu/( be an ? u@@er l+m+( (o *ow muc* @ro(e+n (*e bo-7 can @roce// +n a -a7. Do-7bu+l-er/ *a,e been ea(+ng *uge amoun(/ o. @ro(e+n w+(* no a@@aren( -amage (o (*e bo-7. = *a,e rea- abou( u@war-/ o. %!!gm @er -a7 1no +-ea *ow anec-o(al (*+/ +/ an- +. +( +/ an eGagera(+on6 w*+c* woul- g+,e !!! calor+e/ or /o. ? Secon-< e,en +. (*ere +/ a gluco/e -e.+c+(< +( -oe/nE( .ollow ? (*a( (*ere +/ an energ7 -e.+c+(. Fa( can be burne-< an- +( ? -oe/nE( *a,e (o be Sbo-7S .a(. = (*+nF +( m+g*( be *el@.ul (o -+..eren(+a(e .a( lo// .rom .a( ga+n. 1No E-u*E 0oFe/ @lea/e #6 C+(*ou( +n/ul+n .a( w+ll no( be /(ore- +n an7 a@@rec+able amoun(/. T*+/ +/ con.+rme- b7 m7 own 1an- a .ew o(*er/6 eG@er+ence w*ere = woul- ea( %!!! calor+e/ @er -a7 an- no( ga+n we+g*(< a/ long a/ = -+-nE( *a,e an7 carb/ an- -+-nE( allow m7/el. (o /l+@ +n(o -ee@ Fe(o/+/. 1= am r+g*( now @robabl7 aroun1'%lb/< /o %!!! calor+e/ @er -a7 .or me on a con(+nou/ ba/+/ +/ a lo(6. S+nce .a( LOSS +/ -e(erm+ne- more b7 o(*er *ormone/< e.g. ,ar+ou/ a-renal *ormone/< /uc* a/ glucagon< +n/ul+n woul- nee- (o be lowere1/+nce +( /u@@re//e/ glucagon6. Du( (*a( +/ onl7 a nece//ar7< no( a /u..+c+en( con-+(+on .or .a( lo//. So< be+ng +n Fe(o/+/ +/ l+Fel7 (o re/ul( +n .a( lo// +. 7ou *a,e a lo( (o lo/e< bu( +. 7ou are alrea-7 .a+rl7 lean< (*en (*a( ma7 no( be enoug* (o lo/e (*e la/( b+(/ o. .a(. ? T*+r-< = -onE( (*+nF .a( can *el@ (o re.+ll gl7cogen /(ore/. Abou( %R or /o o. .a( 1b7 calor+e/6 on a,erage can be (urne- +n(o gluco/e 1(*e gl7cerol molecule can be con,er(e-6. T*+/ -e@en-/ on (*e (7@e o. .a(. =n ,er7 /*or( c*a+n .a(/ (*+/ +/ *+g*er. = bel+e,e +( -oe/nE( go abo,e 1!R .or .a(/ encoun(ere- +n .oo-/ 1(*e mo/( common .oocon(a+n+ng -ecen( amoun(/ o. /*or( c*a+n .a(/ +/ bu((er6. 1Sorr7< = -onE( remember w*ere = *a,e rea- (*e @ercen(age ,alue/< (*e7 m+g*( be a l+((le o..6. ? ? So w*+le a low carb -+e( ma7 con(a+n lo(/ o. calor+e/ an- ,olume o. .oo-< ? ? (*e Hb+oa,a+lableH energ7 +n (*e -+e( +/ muc* lower (*an +n a *+g* carb ? ? -+e( w+(* (*e /ame amoun( o. calor+e/. ?

? Cell< .a( +/ 0u/( a/ b+oa,a+lable a/ gluco/e. Su@@o/e 7ou ea( ? 0u/( .a( .or a w*+le< bu( +n calor+call7 ma//+,e amoun(/. =. ? (*ere +/ no calor+c -e.+c+(< w*7 /*oul- 7our bo-7 (a@ +(/ /(ore? .a( w*en (*ere +/ an abun-ance o. -+e(ar7 .a( (o u/e .or .uelJ So 7ou @robabl7 woul-nE( lo/e an7 we+g*(< bu( l+Fel7 no( ga+n muc* e+(*er. OMMA o. cour/e. =l7a Me//age $# From owner-lowcarb@MAELSTROM.STJOHNS.EDU T*u Dec Re(urn-)a(*# owner-lowcarb@MAELSTROM.STJOHNS.EDU Da(e# Ce-< $ Dec 1&&4 !"#1&#$% -!%!! Re@l7-To# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on Sen-er# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on From# elo+/e cam@bell Sub0ec(# Re# 7our *+ (o (*e low carb l+/( To# LOC9ARD@MAELSTROM.STJOHNS.EDU H+< a.(er a 7ear o. low-carb+ng an- lurF+ng on (*+/ l+/(< = *a,e .+nall7 -ec+-e- (o con(r+bu(eI T*e @o/(/ on 9u/*+no+- (en-anc+e/< )9OS an+n.er(+l+(7 reall7 +n(ere/( me. A.(er m7 +n+(+al we+g*( lo// o. %! lb/ +n abou( 3 mon(*/ 1=Em 3 6 = no(+ce- .ur(*er c*ange/ o,er (*e en/u+ng mon(*/. All m7 l+.e< @*7/+c+an/ *a,e remarFe- on m7 @oor mu/cle (one< *+r/u(+/m an- 9u/*+ngo+- .ea(ure/. An7wa7< looF+ng o,er @*o(o/ o,er (*e la/( 7ear< +( +/ reall7 -rama(+c (o /ee *ow m7 .ace *a/ c*ange-...= *a,e c*eeFbone/ an- 7ou can ac(uall7 /ee a 0aw l+ne. T*e/e c*ange/ @rogre//e- AFTER m7 we+g*( lo//I Al/o (*e m+l- acne on m7 c*eeF/ com@le(el7 cleare- anab/olu(el7 no more )MS. FreLuen( *ea-ac*e/ an- ar(*r+(+c /7m@(om/ are com@le(el7 gone. EGce// *a+r +/ /(ar(+ng (o le//en a/ well. Moo- /w+ng/ an- m+l- -e@re//+on are a (*+ng o. (*e @a/(. Mu/cle (one +/ al/o be((er< an- m7 -en(+/( *a/ commen(e- on (*e *eal(* o. m7 gum/. So< = canE( /a7 enoug* goo- (*+ng/ abou( (*e low-carb reg+men an-< w*en = ge( (*e u/ual lec(ure/ abou( w*a( =Em -o+ng (o m7 *eal(*< = 0u/( *a,e (o SM=LEI =E,e ne,er been *eal(*+er or .el( be((er. Helen -----Or+g+nal Me//age----From# Donna H 2SMT)#-*-onna@OAHOO.9OM5 Sen(# Sa(ur-a7< December 1&< 1&&4 1 #3 AM To# LOC9ARD@MAELSTROM.STJOHNS.EDU Sub0ec(# Re# 7our *+ (o (*e low carb l+/( N+cole< Celcome (o (*e l+/(-- +(E/ a grea( l+/(. C*a( 7ou men(+one- abou( )9OS wa/ o. grea( +n(ere/( (o me. = wa/ rea-+ng u@ on -+..eren( (*+ng/ 1be/+-e/ no( ea(+ng @ro@erl76 (*a( can cau/e obe/+(7< rea- abou( )9OS an- go( ,er7 cur+ou/. = *a,e /o man7 o. (*e /7m@(om/ eGce@( (*a( m7 @er+o-/ are ,er7 normal an- m7 o,ar+e/ a@@ear /o (oo. Du( = /(+ll (*+nF (*ereE/ /ome l+nF /omew*ere. C*en = wen( .rom low-calor+e (o low-carb< = no(+ce- m7 /F+n go( be((er an- a (+n7 b+( o. -arF *a+r = *a- abo,e m7 l+@ (*+nne- ou( a LOT. C+(*

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(*a( +n m+n-< = wa/ reall7 rea-7 (o /u/@ec( *7@er+n/ul+n+/m< w*+c* a/ +( /oun-/ l+Fe 7ou Fnow< +/ rou(+nel7 @ar( o. )9OS. Da/e- on (*a( = @er/ua-e- m7 goo- -oc (o le( me -o a (r+al run o. a -+abe(e/ me- calle- Me(.orm+n... +(E/ /u@@o/e- (o /en/+(+Be 7our bo-7 (o +(/ own +n/ul+n an- man7 -+abe(+c/ lo/e we+g*( on +(. Al/o among (*e )9OS @o@ula(+on< man7 women =E,e rea- @o/(/ o. are be+ng @re/cr+be- +( (o re/(ore (*e+r .er(+l+(7 17ou coul- *+( (*e +n.er(+l+(7 new/grou@ an- .+n- ou( abou( (*a( (*ere6. An7*ow... *a,enE( lo/( we+g*( on Me(.orm+n a.(er abou( a mon(* 1-arnII6< bu( *o@+ng o,er a .ew mon(*/ +( w+ll /(ab+l+Be ou( m7 *ormone/ an- @er*a@/ THEN. C*a( = -+- no(+ce wa/ a Lu+cF e..ec( .or /o.(er /F+n< m7 nearl7 l+.elong bo-7 acne *a/ -rama(+call7 cleare-< an- (*a( l+((le -arF *a+r *a/ (oo. >? =n(ere/(+ng. Onl7 a.(er a LOT o. rea-+ng -+- = run acro// -+/cu//+on o. 9u/*+ngo+- (en-enc+e/ +n SOME )9OS @a(+en(/ 1/ome *a,e *+g* @rolac(+n le,el/ (oo6. An7*ow< =Em no( /ure +. 7ou mean( (*e u@@ermo/( @ar( o. 7our bacF< +n (*e Luo(e abo,e< or /ome o(*er area< bu( = *aalwa7/ (*oug*( = *a- a m+l-l7 anno7+ngl7 /*a@e- u@@er bacF 1(oo /lo@e7 an- (oo muc*6< an- a.(er /a7 a weeF or (wo on Me(.orm+n w*a( can = /a7< (*e /*a@e o. m7 necF an- /*oul-er/ 0u/( looF/ a LOT more l+Fe o(*er @eo@leE/. =(E/ we+r- (*a( +( coul- *a@@en< bu( an7wa7< (*e Me(.orm+n /eem/ (o *a,e a--re//e- /ome(*+ng nee-e- +n m7 bo-7< an- +( =S u/e- +n )9OS< +. 7ouEre cur+ou/. Ma7be (*e lowcarb+ng w+ll -o (*e (r+cF .or 7ou< (*oug*. =. 7ou wan( (o rea- u@ on )9OS< (*ere are a .ew grea( /+(e/ ea/+l7 .oun- w+(* 7our .a,e /earc* eng+ne. De/( w+/*e/< Donna

WWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWW DO OOU OAHOOIJ :e( 7our .ree @7a*oo.com a--re// a( *((@#88ma+l.7a*oo.com From owner-lowcarb@MAELSTROM.STJOHNS.EDU T*u Dec 3 #!&#% 1&&4 Re(urn-)a(*# owner-lowcarb@MAELSTROM.STJOHNS.EDU Rece+,e-# .rom mael/(rom./(0o*n/.e-u 1mael/(rom./(0o*n/.e-u 213&."4.1. 356 b7 omen.com 14.4.%8S9O%6 w+(* ESMT) +- CAA % 31 .or ; T*u< 3 Dec 1&&4 #!&#3& -!4!! 1)ST6 Me//age-=-# >1&&41 %!"!&.CAA % 31@omen.com? Rece+,e-# .rom mael/(rom./(0o*n/.e-u b7 mael/(rom./(0o*n/.e-u 1LSMT) .or O@enAMS ,1.1a6 w+(* SMT) +- >4.31&3E'1"@mael/(rom./(0o*n/.e-u?; Fr+< % Dec 1&&4 1#!"# 3 -!%!! Da(e# Ce-< $ Dec 1&&4 !"#1&#$% -!%!! Re@l7-To# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on

Sen-er# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on From# elo+/e cam@bell Sub0ec(# Re# 7our *+ (o (*e low carb l+/( To# LOC9ARD@MAELSTROM.STJOHNS.EDU S(a(u/# R H+< a.(er a 7ear o. low-carb+ng an- lurF+ng on (*+/ l+/(< = *a,e .+nall7 -ec+-e- (o con(r+bu(eI T*e @o/(/ on 9u/*+no+- (en-anc+e/< )9OS an+n.er(+l+(7 reall7 +n(ere/( me. A.(er m7 +n+(+al we+g*( lo// o. %! lb/ +n abou( 3 mon(*/ 1=Em 3 6 = no(+ce- .ur(*er c*ange/ o,er (*e en/u+ng mon(*/. All m7 l+.e< @*7/+c+an/ *a,e remarFe- on m7 @oor mu/cle (one< *+r/u(+/m an- 9u/*+ngo+- .ea(ure/. An7wa7< looF+ng o,er @*o(o/ o,er (*e la/( 7ear< +( +/ reall7 -rama(+c (o /ee *ow m7 .ace *a/ c*ange-...= *a,e c*eeFbone/ an- 7ou can ac(uall7 /ee a 0aw l+ne. T*e/e c*ange/ @rogre//e- AFTER m7 we+g*( lo//I Al/o (*e m+l- acne on m7 c*eeF/ com@le(el7 cleare- anab/olu(el7 no more )MS. FreLuen( *ea-ac*e/ an- ar(*r+(+c /7m@(om/ are com@le(el7 gone. EGce// *a+r +/ /(ar(+ng (o le//en a/ well. Moo- /w+ng/ an- m+l- -e@re//+on are a (*+ng o. (*e @a/(. Mu/cle (one +/ al/o be((er< an- m7 -en(+/( *a/ commen(e- on (*e *eal(* o. m7 gum/. So< = canE( /a7 enoug* goo- (*+ng/ abou( (*e low-carb reg+men an-< w*en = ge( (*e u/ual lec(ure/ abou( w*a( =Em -o+ng (o m7 *eal(*< = 0u/( *a,e (o SM=LEI =E,e ne,er been *eal(*+er or .el( be((er. Helen -----Or+g+nal Me//age----From# Donna H 2SMT)#-*-onna@OAHOO.9OM5 Sen(# Sa(ur-a7< December 1&< 1&&4 1 #3 AM To# LOC9ARD@MAELSTROM.STJOHNS.EDU Sub0ec(# Re# 7our *+ (o (*e low carb l+/( N+cole< Celcome (o (*e l+/(-- +(E/ a grea( l+/(. C*a( 7ou men(+one- abou( )9OS wa/ o. grea( +n(ere/( (o me. = wa/ rea-+ng u@ on -+..eren( (*+ng/ 1be/+-e/ no( ea(+ng @ro@erl76 (*a( can cau/e obe/+(7< rea- abou( )9OS an- go( ,er7 cur+ou/. = *a,e /o man7 o. (*e /7m@(om/ eGce@( (*a( m7 @er+o-/ are ,er7 normal an- m7 o,ar+e/ a@@ear /o (oo. Du( = /(+ll (*+nF (*ereE/ /ome l+nF /omew*ere. C*en = wen( .rom low-calor+e (o low-carb< = no(+ce- m7 /F+n go( be((er an- a (+n7 b+( o. -arF *a+r = *a- abo,e m7 l+@ (*+nne- ou( a LOT. C+(* (*a( +n m+n-< = wa/ reall7 rea-7 (o /u/@ec( *7@er+n/ul+n+/m< w*+c* a/ +( /oun-/ l+Fe 7ou Fnow< +/ rou(+nel7 @ar( o. )9OS. Da/e- on (*a( = @er/ua-e- m7 goo- -oc (o le( me -o a (r+al run o. a -+abe(e/ me- calle- Me(.orm+n... +(E/ /u@@o/e- (o /en/+(+Be 7our bo-7 (o +(/ own +n/ul+n an- man7 -+abe(+c/ lo/e we+g*( on +(. Al/o among (*e )9OS @o@ula(+on< man7 women =E,e rea- @o/(/ o. are be+ng @re/cr+be- +( (o re/(ore (*e+r .er(+l+(7 17ou coul- *+( (*e +n.er(+l+(7 new/grou@ an- .+n- ou( abou( (*a( (*ere6. An7*ow... *a,enE( lo/( we+g*( on Me(.orm+n a.(er abou( a mon(* 1-arnII6< bu( *o@+ng o,er a .ew mon(*/ +( w+ll /(ab+l+Be ou( m7 *ormone/ an- @er*a@/ THEN. C*a( = -+- no(+ce wa/ a Lu+cF e..ec( .or /o.(er /F+n< m7 nearl7 l+.elong bo-7 acne *a/

-rama(+call7 cleare-< an- (*a( l+((le -arF *a+r *a/ (oo. >? =n(ere/(+ng. Onl7 a.(er a LOT o. rea-+ng -+- = run acro// -+/cu//+on o. 9u/*+ngo+- (en-enc+e/ +n SOME )9OS @a(+en(/ 1/ome *a,e *+g* @rolac(+n le,el/ (oo6. An7*ow< =Em no( /ure +. 7ou mean( (*e u@@ermo/( @ar( o. 7our bacF< +n (*e Luo(e abo,e< or /ome o(*er area< bu( = *aalwa7/ (*oug*( = *a- a m+l-l7 anno7+ngl7 /*a@e- u@@er bacF 1(oo /lo@e7 an- (oo muc*6< an- a.(er /a7 a weeF or (wo on Me(.orm+n w*a( can = /a7< (*e /*a@e o. m7 necF an- /*oul-er/ 0u/( looF/ a LOT more l+Fe o(*er @eo@leE/. =(E/ we+r- (*a( +( coul- *a@@en< bu( an7wa7< (*e Me(.orm+n /eem/ (o *a,e a--re//e- /ome(*+ng nee-e- +n m7 bo-7< an- +( =S u/e- +n )9OS< +. 7ouEre cur+ou/. Ma7be (*e lowcarb+ng w+ll -o (*e (r+cF .or 7ou< (*oug*. =. 7ou wan( (o rea- u@ on )9OS< (*ere are a .ew grea( /+(e/ ea/+l7 .oun- w+(* 7our .a,e /earc* eng+ne. De/( w+/*e/< Donna

WWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWW DO OOU OAHOOIJ :e( 7our .ree @7a*oo.com a--re// a( *((@#88ma+l.7a*oo.com Au(*or/ Oaar+ S. :ol-bour( U. =n/(+(u(+on 9om@u(+ng 9en(er< Dar-=lan Un+,er/+(7< Rama(-:an< =/rael. T+(le Aolun(ar7 an- +n,olun(ar7 we+g*( lo//# a//oc+a(+on/ w+(* long (erm mor(al+(7 +n &< 4 m+--le-age- an- el-erl7 men. Source Amer+can Journal o. E@+-em+olog7. 1341"6#%3"-%%< 1&&4 Se@ 1%. Ab/(rac( Recen( /(u-+e/ *a,e /ugge/(e- (*a( we+g*( lo// +n m+--le-age- @er/on/ an(ece-e/ +ncrea/e- mor(al+(7. T*ere.ore< (*e au(*or/ /oug*( (o eGam+ne (*e a//oc+a(+on be(ween c*ange/ +n bo-7 we+g*( an- /ub/eLuen( mor(al+(7< accor-+ng (o /el.-re@or(e- -+e(+ng /(a(u/. T*e au(*or/ .ollowe- &< 4 men age- 3!-"% 7ear/ +n 1&"$< .or w*om we+g*( c*ange/ be(ween 1&"$ an- 1&"4 were recor-e- an- eG(en/+,e cl+n+cal< an(*ro@ome(r+c< b+oc*em+cal< an- -+e(ar7 a//e//men(/ were ma-e. O. (*e/e men< <3'1 re@or(e- be+ng on a -+e( w*en .+r/( eGam+ne- +n 1&"$< an- "$" were -+e(+ng @r+mar+l7 (o lo/e we+g*(. Mor(al+(7 .ollow-u@ co,ere- an 14-7ear @er+o11&"4-1&4"6. Men w*o lo/( % Fg or more be(ween 1&"$ an- 1&"4 1HeG(reme we+g*( lo/er/H6 eG*+b+(e- (*e .ollow+ng age-@oole- r+/F/ o. mor(al+(7 rela(+,e (o (*e /(able we+g*( grou@# .or (o(al

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From owner-lowcarb@MAELSTROM.STJOHNS.EDU T*u Mar 11 1%#!"# 1&&& Re(urn-)a(*# owner-lowcarb@MAELSTROM.STJOHNS.EDU Rece+,e-# .rom mael/(rom./(0o*n/.e-u 1mael/(rom./(0o*n/.e-u 213&."4.1. 356 b7 omen.com 14.4.%8S9O%6 w+(* ESMT) +- )AA &%3$ .or ; T*u< 11 Mar 1&&& 1%#!"# ! -!4!! 1)ST6 Me//age-=-# >1&&&!$11 $!".)AA &%3$@omen.com? Rece+,e-# .rom mael/(rom./(0o*n/.e-u 113&."4.1. 36 b7 mael/(rom./(0o*n/.e-u 1LSMT) .or O@enAMS ,1.1a6 w+(* SMT) +- >'.1 F493&&@mael/(rom./(0o*n/.e-u?; T*u< 11 Mar 1&&& 14#!3#$! -!%!! Da(e# T*u< 11 Mar 1&&& 1$#!$#1! -!"!! Re@l7-To# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on Sen-er# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on From# E+leen Sub0ec(# =n/ul+n Rece@(or/ To# LOC9ARD@MAELSTROM.STJOHNS.EDU S(a(u/# R H+ all- = 0u/( rea- a ,er7 +n(ere/(+ng ar(+cle +n (*e +//ue o. Sc+ence w*+c* 0u/( came acro// m7 -e/F 1Sc+ence< ,ol. 4$< @@. 1%33-4< 1&&&6. 1New/ an- A+ew/< @. 13 $6. Re/earc*er/ +n 9ana-a .oun- (*a( b7 +nac(+,a(+ng (*e enB7me w*+c* -e@*o/@*or7la(e/ (*e +n/ul+n rece@(or 1)T)-1D6 +n a (ran/gen+c mou/e mo-el< (*a( (*e m+ce were able (o ma+n(a+n normal bloo- gluco/e le,el/ .ollow+ng a meal< e,en (*oug* (*e7 *a- *al. a/ muc* +n/ul+n +n (*e+r bloo-. C*en .e- a -+e( 1!K *+g*er +n .a( 1an- al/o calor+e/6 (*an con(rol m+ce< (*e7 were re/+/(an( (o we+g*( ga+n an- (*e -e,elo@men( o. -+abe(e/ rela(+,e (o (*e con(rol m+ce. C*+le (*e neG( /(e@ w+ll be (o /ee w*a( +nac(+,a(+ng (*+/ enB7me -oe/ +n a -+abe(+c an+mal mo-el1an- @er/on<e(c.6< +( +/ a ,er7 encourag+ng re/ul( (*a( *a/ +-en(+.+ea new (arge( .or -rug (*era@7. Ma7be one -a7 we w+ll all be able (o ea( carb/ aga+n +. we can (aFe a -rug (*a( w+ll re/(ore +n/ul+n /en/+(+,+(7 (o our +n/ul+n rece@(or/ 1+-ea +/ (*a( @*o/@*or7la(e- .orm o. (*e +n/ul+n rece@(or w+ll ac(+,el7 (aFe u@ gluco/e< w*+le (*e -e@*o/@*or7la(e- .orm +/ +nac(+,e< +.e. E+n/ul+n re/+/(an(E< /o +. we coul- -e/+gn a -rug (o Fee@

(*e =R @*o/@*or7la(e-< we coul- +m@ro,e +n/ul+n /en/+(+,+(76. O(*er goonew/ +/ (*e an+mal/ *a,e been *eal(*7 .or 7ear/< no /+gn/ o. cancer or o(*er abnormal+(+e/ .rom -+/ru@(+ng (*+/ molecule (*a( coul- .unc(+on +n mul(+@le /+gnal (ran/-uc(+on @a(*wa7/. SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS E+leen# $".3R bo-7 .a(11"%U68 4.$R bo-7 .a(11%%U61%E%H /+Be 1!68 R bo-7 .a(; 31 7.o< ))

From owner-lowcarb@MAELSTROM.STJOHNS.EDU Fr+ Mar 1 !'#$&#3$ 1&&& Re(urn-)a(*# owner-lowcarb@MAELSTROM.STJOHNS.EDU Rece+,e-# .rom mael/(rom./(0o*n/.e-u 1mael/(rom./(0o*n/.e-u 213&."4.1. 356 b7 omen.com 14.4.%8S9O%6 w+(* ESMT) +- HAA!% 4' .or ; Fr+< 1 Mar 1&&& !'#$&#31 -!4!! 1)ST6 Me//age-=-# >1&&&!$1 1%$&.HAA!% 4'@omen.com? Rece+,e-# .rom mael/(rom./(0o*n/.e-u 113&."4.1. 36 b7 mael/(rom./(0o*n/.e-u 1LSMT) .or O@enAMS ,1.1a6 w+(* SMT) +- >1$.ED1"%%DD@mael/(rom./(0o*n/.e-u?; Fr+< 1 Mar 1&&& 1!#$1#1' -!%!! Da(e# Fr+< 1 Mar 1&&& !&#$!#!& EST Re@l7-To# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on Sen-er# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on From# Jerr7 S(egenga Sub0ec(# Re# D+e(ar7 .a( an- brea/( cancer To# LOC9ARD@MAELSTROM.STJOHNS.EDU S(a(u/# RO =n a me//age -a(e- $81 81&&& 1 #11#$" AM Ea/(ern S(an-ar- T+me< bl@a(ca+@EROLS.9OM wr+(e/# >> A-- (o (*a( a -+..eren( race w*+c* @re/umabl7 +n-+ca(e/ more gene(+c -+..erence/ (*an 0u/( a@@earance< -+..eren( l+.e/(7le/--eGerc+/e @a((ern/< .or eGam@le--an- man7 man7 -+e(ar7 -+..erence/ +nclu-+ng -+..eren( .oo-/< -+..eren( cooF+ng me(*o-/< an- -+..eren( ea(+ng @a((ern/. T*e /(u-+e/ = .+n- mo/( con,+nc+ng arenE( (*e ma//+,e one/ com@ar+ng one coun(r7 (o ano(*er 1/*oul-nE( we all ea( l+Fe (*e Frenc*J --grea( .or (*e (a/(ebu-/ an- (*e *ear( bu( no( /o goo- .or (*e l+,er--(alF abou( a (ra-eo..I6 bu( (*o/e com@ar+ng -e/cen-an(/ w*o *a,e a-a@(e- (o a -+..eren( l+.e/(7le--a/ +n A/+an/ ,er/u/ Amer+can/ o. A/+an eG(rac(+on. OTOH< a/ a (*+r--genera(+on @re/umabl7-a//+m+la(e- Amer+can< = Fee@ man7 a/@ec(/ o. m7 ance/(ral cul(ure +nclu-+ng -+e(< a/ -o m7 .r+en-/ .rom o(*er cul(ural bacFgroun-/< /o = Fnow .rom @er/onal ob/er,a(+on (*a( (*ere ma7 /(+ll be /+gn+.+can( -+..erence/--+. we coul- .+gure ou( 0u/( w*a( +/ /+gn+.+can(. Darbara ?? Man7 booF/ an- @a@er/ *a,e been wr+((en on w*a( *a@@en/ (o ,ar+ou/ HNa(+,eH @o@ula(+on/ w*en (*e7 become Hc+,+l+Be-H an- @roce//e- .oo-/ are +n(ro-uce+n(o (*e+r -+e(/. T*e mo/( remarFable +/ a booF wr+((en b7 Ce/(on A. )r+ce< D.D.S. en(+(le- HNu(r+(+on an- )*7/+cal Degenera(+onH w*+c* recor-/ (*e general *eal(* an- -en(al con-+(+on/ o. @eo@le/ all o,er (*e worl- w*o a-o@(e(*e H9+,+l+Be- H -+e(. =( +/ well wor(* rea-+ng. Mo/( o. (*e o(*er

@ubl+ca(+on/ *a,e a@@eare- +n (*e Lance(. T*e conclu/+on o. (*e/e .+n-+ng/ wa/ (*a( 1! (o ! 7ear/ a.(er a-o@(+ng (*e Hc+,+l+Be-1we/(ern6H -+e( c*ron+c +llne//e/ began (o a@@ear (*a( were unFnown be.ore. Ce/(on A. )r+ceH/ booF +/ a,a+lable .rom AmaBon. Jerr7 TARFN

From owner-lowcarb@MAELSTROM.STJOHNS.EDU T*u A@r 4 !%#%4#%% 1&&& Re(urn-)a(*# owner-lowcarb@MAELSTROM.STJOHNS.EDU Rece+,e-# .rom mael/(rom./(0o*n/.e-u 1mael/(rom./(0o*n/.e-u 213&."4.1. 356 b7 omen.com 14.4.%8S9O%6 w+(* ESMT) +- FAA 3%&3 .or ; T*u< 4 A@r 1&&& !%#%4#3& -!'!! 1)DT6 Me//age-=-# >1&&&!3!41 %4.FAA 3%&3@omen.com? Rece+,e-# .rom mael/(rom./(0o*n/.e-u 113&."4.1. 36 b7 mael/(rom./(0o*n/.e-u 1LSMT) .or O@enAMS ,1.1a6 w+(* SMT) +- >1!.1EEFD3!A@mael/(rom./(0o*n/.e-u?; T*u< 4 A@r 1&&& 4#%"#13 -!%!! Da(e# T*u< 4 A@r 1&&& #1!#34 P1!!! Re@l7-To# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on Sen-er# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on From# Dr Ne+(* H 9*arl(on Sub0ec(# Re# LOC9ARD D+ge/( - " A@r 1&&& (o ' A@r 1&&& - S@ec+al +//ue1U1&&&-416 To# LOC9ARD@MAELSTROM.STJOHNS.EDU S(a(u/# RO Sorr7 =E,e (r+e- (o -ele(e (*e bulF o. (*e @rom@(+ng (eG( an- canE(. =Em a Dr+/bane c*+ro@rac(or w+(* an +n(ere/( 1Lual+.+ca(+on< e,en6< +n cl+n+cal e@+-em+olog78e,+-ence-ba/e- me-+c+ne. =E,e al/o been .a( /+nce 4 7ear/ o. age< an- am now 3&. = recen(l7 lo/( $!Ng on A(F+n/< an- m7 T7@e == -+abe(e/. E..or(le//l7. Oe/(er-a7 = rece+,e- Dr Dern/(e+nE/ booF on -+abe(e/ 1(*anF :o- .or AmaBon.com6. An- rea- +(. To-a7 = calle- an- (alFe- (o *+m. He *a/ been an MD /+nce abou( 1&4! 1ma(ure /(u-en(6. HeE/ been -+abe(+c .or o,er %! 7ear/. H+/ a@@roac* +/ a re.+ne- ,er/+on o. A(F+n/. = care .or @eo@le w+(* mo/(l7 MS -+/or-er/< bu( = *a,e a goo-l7 number o. @a(+en(/ w*om = am @r+,+lege(o /er,e w*o /(ruggle -a+l7 w+(* (*e low .a( @ara-+gm. S+nce =E,e 0u/( /@en( (*e la/( .+,e 7ear/ +n OG.or- an- /@en( (+me w+(* (*e go-.a(*er o. e,+-ence-ba/e- me-+c+ne 1Da,+- SacFe((6< = wa/ -+/ma7e- (o re(urn (o Dr+/ an- .+n- (*e OB go- o. low .a( +/ al+,e an- well 1a/ +n (*e UN an- (*e US< w*ere =E,e recen(l7 /@en( (+me6. Some o. 7ou ma7 Fnow o. (*e 9oc*rane 9ollabora(+on< w*+c* @ro,+-e/< Luar(erl7< a -a(aba/e o. /7/(ema(+c re,+ew/ o. (rea(men( e..ec(+,ene//. U/+ng (*+/< a/F+ng a )ro.e//or o. 9ar-+olog7 *ere< a cl+n+cal me(*o-/ re,+ewer .or (*e 99 1)aul :la/B+ou< w+(* w*om = w+ll /oon be (eac*+ng me-+cal /(u-en(/ e,+-ence ba/e- me-+c+ne6< a re/earc* ba/e- en-ocr+nolog+/( w*o worFe- recen(l7 .or (*e :ar,an =n/(+(u(e +n S7-ne7< ALL a-m+( (*a( (*ere +/ no cl+n+cal e,+-ence /u@@or(+ng low .a( -+e(/. =n .ac(< +. an7 o. 7ou /earc* )ubMe- a( N=H< 7ou w+ll .+n- a long l+/( o. @a@er/ /*ow+ng *arm .rom low .a( -+e(/ 1ele,a(e- (r+gl7cer+-e/< +ncrea/e- +n/ul+n re/+/(ance<

e(c6. M7 cl+n+cal c*em+/(r7 +/ a Luar(er cen(ur7 ol-< an- =Em no( an aca-em+c. T*ere +/ no e,+-ence /u@@or(+ng e+(*er low .a( or low carb 1o(*er (*an (*e +n.amou/ Orn/(e+n (r+al 1= can (alF (o 7ou -+rec(l7 +. 7ou wan( a cr+(+cal a@@ra+/al o. (r+al -e/+gn an- eG(ernal ,al+-+(7 +//ue/6. T*e b+olog+call7 @lau/+ble wa7 (o @rocee- w+(* obe/e< or (7@e == -+abe(+c @er/on/< clearl7 /eem/ (o be low carb< un(+l /omeone -oe/ /u+(abl7 -e/+gne(r+al/ /ugge/(+ng o(*erw+/e. T*e non-(r+al e,+-ence aga+n/( low .a( /eem/ com@ell+ng a( (*+/ /(age 1@er,er/el7 enoug*< = Fnew Na(*an )r+(+F+n @er/onall7 an- *o/(- *+m (o -+nner +n Dr+/bane 1%P 7ear/ ago6. Surel7 +(E/ (+me .or (*o/e o. 7ou be((er Lual+.+e- (*an me (o moun( a( lea/( a /emblance o. cr+(+c+/m a( (*+/ @arlou/ /(a(e o. a..a+r/ /u@@or(+ng low .a( -+e(/. = en0o7 (*e L9 -+/cu//+on/ *ere 1=Em a lurFer6< bu( +/ (*ere an en-ocr+nolog+/( or -+abe(olog+/( w*o +/ w+ll+ng (o /@eaF u@J T*o/e o. u/ @r+,+lege- (o care .or @a(+en(/ -+rec(l7 /*oul- calcula(e (*e @lau/+b+l+(7 ga@ 1we /*oul- be e,+-ence-ba/e-< /urel76 an- come clean. Nobo-7 = Fnow +n OB +/ @re@are- (o -o /o. MD/ *ere w+(* w*om = /*are (*e (ec*n+Lue/ .or acce//+ng )ubMe- an- 9oc*rane are rou(+nel7 /*ocFe- a( (*e @auc+(7 o. (*e e,+-ence ba/e .or low .a(. Are (*ere an7 more o. 7ou ou( (*ereJ Ne+(* 9*arl(on D9 M)*+l ---------? From# Dean E/ma7 ? To# LOC9ARD@MAELSTROM.STJOHNS.EDU ? Sub0ec(# Re# LOC9ARD D+ge/( - " A@r 1&&& (o ' A@r 1&&& - S@ec+al +//ue1U1&&&-416 ? Da(e# T*ur/-a7< 4 A@r+l 1&&& 1$#$3 ? ? Mo/( o. (*e/e +//ue/ *a,e been a--re//e---w+(* eG(en/+,e re.erence/ an? re.erral/ (o cl+n+cal eG@er+ence o. /ea/one- @*7/+c+an/--on (*+/ l+/( o,er ? (*e la/( (wo 7ear/. Howe,er# ? ? ?T*ere are no mag+c -+e(/< /+m@l7 (*ermo-7nam+c/ ? ?ea( le// (*an 7ou burn an- 7ou w+ll lo/e we+g*(. ? ? T*ere +/ no( one @eer-re,+ewe- /(u-7 (o /u@@or( an7 cla+m (*a( a ? low-calor+e -+e(< w*e(*er comb+ne- w+(* eGerc+/e or no(< +/ an e..ec(+,e ? long-(erm (rea(men( .or a..ec(+ng more (*an ,er7 mo-era(e we+g*( lo// +n a ? ma0or+(7 o. /ub0ec(/. ? ? T*+/ +/ no( an o@+n+on. =( +/ a .ac(. =. 7ou -oub( +(< = +n,+(e 7ou (o ? -+/cu// (*e ma((er w+(* an7 @ro.e//+onal obe/+(7 re/earc*er. Or (o /+m@l7 ? (r7 (o .+n- an7 /(u-7 w*+c* re.u(e/ w*a( = /a7. =E- be ,er7 /ur@r+/e- +. ? 7ou coul- .+n- one. -Se,eral- /(u-+e/ *a,e looFe- a( calor+e-re/(r+c(e? -+e(/ comb+ne- w+(* eGerc+/e an- Hl+.e/(7le mo-+.+ca(+onH o,er a @er+oo. ? 1 7ear< (wo 7ear/< an- e,en .+,e 7ear/< an- -all- *a,e /*own ab7/mal ? .a+lure +n (*e ,a/( ma0or+(7 o. /ub0ec(/. ? ? ?= al/o agree (*a( (*ere ? ?are man7 unan/were- Lue/(+on/ abou( Fe(o/+/ an- a *+g* @ro(e+n -+e(. C*a( ? ?are (*e e..ec(/ on bone -en/+(7 .or .emale/J ?

? T*e long-(erm an/wer (o (*+/ +/ unFnown. T*+/ +/ al/o (rue o. almo/( all ? -+e(ar7 a@@roac*e/. ? ? T*ere are< *owe,er< a number o. /(u-+e/ on @eo@le w*o l+,e (*e+r en(+re ? l+,e/ ea(+ng -+e(/ o. u@ (o an- e,en be7on- %!R @ro(e+n on a -a+l7 ba/+/< ? w+(* almo/( no e,+-ence o. o/(eo@oro/+/ among e+(*er male or .emale ? @o@ula(+on/< nor +n-ee- an7 e,+-ence o. an7 /ub/(an(+al *eal(* @roblem/ or ? -ecrea/e- longe,+(7. ? ? T*ere are /(u-+e/ w*+c* +n-+ca(e no /ub/(an(+al calc+um lo// .rom na(ural ? an+mal @ro(e+n/. T*ere are< on (*e o(*er *an-< /*or(-(erm lab /(u-+e/ ? w*+c* +n-+ca(e *+g* calc+um lo// w*en +nge/(+ng large Luan(+(+e/ o. /o7 ? @ro(e+n +/ola(e/. ? ? =n general (*e e,+-ence (*a( (*ere +/ a mean+ng.ul -anger (o bone -en/+(7 ? rom a *+g* @ro(e+n -+e( +/ Lu+(e l+m+(e-< w+(* muc* con(rar7 -a(a. Aga+n ? man7 o. (*e/e /(u-+e/ *a,e been -+/cu//e- a( grea( leng(* *ere o,er (*e ? la/( (wo 7ear/. ? ? ?C*a( are (*e long-(erm e..ec(/ o. Fe(o/+/J ? ? De.+ne Hlong (erm.H Se,eral /(u-+e/ *a,e looFe- a( @eo@le +n Fe(o(+c ? /(a(e/ o,er @er+o-/ o. weeF/< mon(*/< an- +n a .ew ca/e/ 1mo/(l7 ? e@+le@(+c/6 7ear/. To -a(e (*ere +/ no /ub/(an(+al e,+-ence o. long-(erm ? *eal(* -amage. ? ? Dr. R+c*ar- Dern/(e+n< a re/@ec(e- -+abe(+c re/earc*er 1an- a man w*oE/ ? l+,e- w+(* =DDM .or abou( $! 7ear/6 +/ a goo- cl+n+cal eGam@le. No( onl7 ? *a/ *e been on a Fe(ogen+c -+e( .or -eca-e/< bu( *eE/ been +n me-+cal ? @rac(+ce almo/( a/ long< (rea(+ng *+/ -+abe(+c @a(+en(/ w+(* (*+/ /ame ? -+e(. So .ar *eE/ manage- (o a,o+- lo/+ng *+/ l+cen/e< go+ng (o 0a+l< or ? ge((+ng /ue- .or F+ll+ng *+/ @a(+en(/--w*o +n general /eem (o -o ? eG(raor-+nar+l7 well on *+/ @rogram. ? ? A/ mo/( @eo@le 1a/+-e .rom /e,ere -+abe(+c/6 w+ll no( rema+n +n a Fe(o(+c ? /(a(e .or more (*an a .ew mon(*/< +( (*ere.ore /eem/ /+ll7 (o +n/+/( (*a( ? (*ere +/ a gra,e -anger (o (*e+r *eal(*. ? ? =. 7ou /@en- an7 (+me on (*e /u@@or( l+/(/ .or Fe(ogen+c -+e(/< w*ere ? l+(erall7 *un-re-/ o. -+e(er/ *el@ eac* o(*er on /uc* -+e(/< 7ou w+ll .+n? no recor-e- ca/e/ o. *o/@+(al+Ba(+on -ue (o ac+-o/+/--(*+/ +n /u@@or( ? grou@/ (*a( *a,e been aroun- o,er .our 7ear/< w+(* l+(erall7 (*ou/an-/ o. ? member/. =n-ee-< w*+le Fe(ogen+c -+e(/ *a,e been u/e- .or a/ muc* a/ ! ? 7ear/ b7 /ome -+abe(+c/< (*ere +/ /(+ll (o -a(e no recor-e- e,+-ence o. ? long-(erm -amage. ? ? De/@+(e w+-e/@rea- cla+m/ (*a( (*e mo-era(e -+e(ar+l7-+n-uce- Fe(o/+/ ? +n-uce- b7 carbo*7-ra(e /(ar,a(+on +/ -angerou/< (*e eG@lo/+on +n ? @o@ular+(7 o. Fe(o(+c -+e(/ o,er (*e la/( .+,e 7ear/ *a/ 7e( (o @ro-uce ANO ? /+gn+.+can( +ncrea/e +n re@or(/ o. @a(+en(/ be+ng *o/@+(al+Be- or -7+ng -ue ? (o Fe(oac+-o/+/. ? ? T*o/e w*o con(+nue (o /ugge/( (*a( mo-era(e -+e(ar+l7-+n-uce- Fe(o/+/ +/

? -angerou/ looF more an- more .ool+/* e,er7 7ear. Aer7 muc* l+Fe @*7/+c+an/ ? w*o were cla+m+ng all (*roug*ou( (*e 1&'!/ (*a( anabol+c /(ero+-/ canno( ? @o//+bl7 +ncrea/e mu/cle ma//. C*+c* wa/ (*e con/en/u/ o@+n+on o. (*e AMA< ? me-+cal (eG(booF au(*or/< an- mo/( @*7/+c+an/. ? ? ?How abou( Fe(o/+/ an- @regnanc7J ? ? S@eaF (o an ob/(e(r+c+an abou( (*+/< or (o a -+abe(olog+/(. Man7 +. no( ? mo/( @regnan( women are na(urall7 +n a /(a(e o. mo-era(e Fe(o/+/ (*roug*ou( ? (*e+r @regnanc+e/. Mo/( ob/(e(r+c+an/ con/+-er an7(*+ng le// (*an *ea,7 ? Fe(o/+/ (o be .a+rl7 normal an- /+m@l7 +gnore +(< or maFe a no(e (o -o ? no(*+ng more (*an mon+(or +( a( eac* c*ecFu@. ? ? =n @o@ula(+on/ w*ere carbo*7-ra(e +n(aFe +/ Bero (o none 1/uc* a/ +n (*e ? =nu+(6 (*ere +/ no e,+-ence o. an7 nega(+,e .e(al e..ec(/. ? ? C*a(< b7 (*e wa7< are (*e long-(erm e..ec(/ o. low-.a(< low-@ro(e+n< ? *+g*-carbo*7-ra(e -+e(/J 9an 7ou -ocumen( (*em w+(* e,+-enceJ ? ? ?1(*e /(an-ar- an/wer (o (*+/ ? ?+/ no-one /*oul- -+e( w*+le @regnan(< *owe,er = *a,e *ear- o. @regnan( ? ?women on Fe(ogen+c -+e(/ - no( .or we+g*( lo//< bu( cau/e (*e7 (*+nF +( +/ ? ?*eal(*76 ? ? =n-ee-< = Fnow one @*7/+c+an w*o /@ec+al+Be/ +n -+abe(+c/ w*o rou(+nel7 ? Fee@/ all *+/ @regnan( -+abe(+c @a(+en(/ +n on a Fe(ogen+c -+e(< be+ng /ure ? merel7 (o Fee@ (*em +n no -ee@er (*an (*e mo-era(e-(o-l+g*( Fe(o/+/ (*a( +/ ? normal .or @regnanc7 an7wa7. Dern/(e+n -oe/ (*+/. T*ere rema+n/ (o -a(e ? ,er7 l+((le e,+-ence (*a( /uc* a /(a(e +/ -angerou/; w*a( *7@o(*e(+cal ? -anger (*ere +/ ma7 well be o../e( b7 (*e coun(er--anger (*a( *+g* +n/ul+n ? an- bloo- /ugar le,el/ ma7 o..er (o bo(* c*+l- an- mo(*er. ? ? M7 own w+.e wa/ +n mo-era(e Fe(o/+/ (*roug*ou( mo/( o. *er @regnanc7. Our ? 14 mon(* ol- /on *a/ been +n eGcellen( *eal(* an- been a*ea- o. (*e grow(* ? an- -e,elo@men( cur,e /+nce *+/ b+r(*. ? ? T*e =nu+( *a,e (ra-+(+onall7 ea(en -+e(/ o. un-er 'R carbo*7-ra(e--w+(* ? mo/( o. (*e 7ear /@en( ea(+ng @rac(+call7 no carbo*7-ra(e a( all--an- 7e( ? (*ere *a/ ne,er been an7 e,+-ence (*a( (*e7 /u..er an7 /ub/(an(+all7 ? +ncrea/e- le,el o. /(+llb+r(*< m+/carr+age< .e(al -e.orm+(7< or ? c*+l-b+r(*-rela(e- -ea(*. ? ? Doe/ (*+/ mean Fe(o/+/ +/ ab/olu(el7 /a.eJ No. Du( +( -oe/ +n-+ca(e (*a( ? eG(reme .ear +/ un0u/(+.+e-. Du( +( woul- be unw+/e (o a-,+/e a @regnan( ? woman (o +n(en(+onall7 /eeF (o @u( *er/el. +n(o Fe(o/+/ .or no @ar(+cular ? rea/on--0u/( a/ muc* a/ +( woul- be unw+/e (o a-,+/e a @regnan( woman (o ? (aFe almo/( an7 me-+ca(+on unnece//ar+l7.

? ? ?= *ear- an MD /(a(e (*a( /ome .e(al -ea(*/ *a- been a((r+bu(e- (o ? ?Fe(o/+/< bu( *a,e no( .oun- an7 re.erence/ (o -a(e. ? ? = *a,e been /earc*+ng .or o,er (wo 7ear/ .or (*e e,+-ence (*a( (*ere +/ an ? a//oc+a(+on be(ween .e(al -ea(*/ an- Fe(o/+/. U@ (o an- +nclu-+ng -+rec(l7 ? Lue/(+on+ng @ro.e//+onal re/earc*er/ on (*e /ub0ec(. T*e en(+re(7 o. (*e ? e,+-ence +n (*+/ regar- a@@ear/ (o be ba/e- on (wo (*+ng/# ? ? 16 T*ere +/ e,+-ence o. eG(reme ma(ernal an- .e(al -anger .rom ? NETOA9=DOS=S< a /(a(e o. eG(remel7 *ea,7 Fe(o/+/ accom@an+e- b7 eG(remel7 ? *+g* gluco/e le,el/ /een +n T7@e = -+abe(+c/. =n (*+/ /(a(e< bo(* Fe(one ? le,el/ an- bloo- /ugar le,el/ are man7 (+me/ *+g*er (*an an7(*+ng (*a( ? coul- be ac*+e,e- -ue (o /+m@le carbo*7-ra(e /(ar,a(+on. ? ? 6 T*ere are a cou@le o. /(u-+e/ w*+c* +n-+ca(e (*a( abnormall7 *+g* Fe(one ? le,e/ *a,e a (era(ogen+c e..ec( on lab ra(/. ? ? T*ere rema+n/ no e,+-ence (*a( (*e l+g*( (o mo-era(e Fe(o/+/ (*a( +/ cau/e? b7 Fe(ogen+c -+e(/ +/ an7 /+gn+.+can( -anger (o *eal(*7 a-ul(/. ? ? ? ?= /ub/cr+be (o (*+/ ? ?l+/( becau/e = am +n(ere/(e-. = Fnow m7 o@+n+on/ are -+..eren( .rom (*e ? ?ma0or+(7 w*o /ub/cr+be< bu( = am (r7+ng (o log+call7 looF a( w*a( m7 ? ?@a(+en(/ are /ub0ec( (o. ? ? T*+/ l+/( eG+/(/ (o g+,e @*7/+ca+n/< -+e(+c+an/< @ro.e//+onal (ra+ner/< ? me-+cal re/earc*er/< an- o(*er/ a @lace (o -+/cu// (*e/e +//ue/. T*ereE/ ? no(*+ng wrong w+(* ra+/+ng (*e/e Lue/(+on/< al(*oug* (*ere +/ /ome ? .ru/(ra(+on a( *a,+ng (o re@ea( -+/cu//+on/ weE,e alrea-7 *a-. On (*e ? o(*er *an-< @er*a@/ +(E/ w+/e (o @er+o-+call7 re,+ew (*e/e ma((er/. Or @u( ? (oge(*er ano(*er FAX l+Fe (*e one a( *((@#88www./7n-+comm.com8low.a(.*(ml ? -- Ala/ = *a,e no (+me. ? -Q? ? H=( +/ +m@o//+ble .or a man (o learn w*a( *e (*+nF/ *e alrea-7 Fnow/.H ? E@+c(e(u/ 1%!-1$4 A.D.6

From owner-lowcarbSca.SSOMENS-9OM@MAELSTROM.STJOHNS.EDU Mon A@r " !&#3%#$$ 1&&& Re(urn-)a(*# owner-lowcarbSca.SSOMENS-9OM@MAELSTROM.STJOHNS.EDU Rece+,e-# .rom mael/(rom./(0o*n/.e-u 1mael/(rom./(0o*n/.e-u 213&."4.1. 356 b7 omen.com 14.4.%8S9O%6 w+(* ESMT) +- JAA!&&%" .or ; Mon< " A@r 1&&& !&#3%# 4 -!'!! 1)DT6 Me//age-=-# >1&&&!3 "1"3%.JAA!&&%"@omen.com? Rece+,e-# .rom mael/(rom./(0o*n/.e-u 113&."4.1. 36 b7 mael/(rom./(0o*n/.e-u 1LSMT) .or O@enAMS ,1.1a6 w+(* SMT) +- >13.DAD !4D&@mael/(rom./(0o*n/.e-u?; Mon< " A@r 1&&& 1 #3 #$4 -!%!!

Da(e# Mon< " A@r 1&&& 11#3 # 4 -!3!! Re@l7-To# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on Sen-er# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on From# Dana 9ar@en-er Sub0ec(# Re# Earl7 Low 9arb To# LOC9ARD@MAELSTROM.STJOHNS.EDU S(a(u/# R ? ? ? ? ? ? ? ? ? ? ? Man7 7ear/ ago< = rea- a booF wr+((en +n e+(*er (*e %!E/ or "!E/ b7 a gen(leman w*o /u@@or(e- general L9 (*eor7 an- +nclu-e- (*e -r+nF+ng o. @ol7un/a(ura(e- o+l/ on a -a+l7 ba/+/. La(er< w*en = rea- Dr. A(F+nE/ .+r/( booF< = no(e- (*a( muc* o. *+/ (*eor7 /eeme- (o be -er+,e- .rom (*e booF = *a- rea- earl+er. 9an an7one (ell me (*e gen(lemanE/ name w*o wro(e (*a( earl7 booFJ Some +n.o on la(er /(u-+e/ (*a( e+(*er bacF u@ or (ear -own *+/ (*eor+e/ woulal/o be a@@rec+a(e-.

Dr. Herman Taller< W9alor+e/ DonE( 9oun(W< E" < +. = remember correc(l7. Long ou( o. @r+n(< bu( wor(* rea-+ng +. 7ou can .+n- +(. Earl+er (*an (*a( wa/ Dr. R+c*arMcNarne//< WEa( Fa( An- :row Sl+mW< w*+c* came ou( +n (*e E%!/< an- aga+n wa/ ,er7 /+m+lar (o A(F+n/ or )). Ha/ a .orwar- b7 (*e w+.e o. @olar eG@lorer an- low carb .an A+*l0amer S(e..an/on. 1For (*a( ma((er< = *a,e a co@7 o. a booF .rom 1&13 calle- WEa( an- :row T*+nW< al/o a low carb booF. Recommen-/ (*e mo/( SamaB+ngS -+nner/ -- (*ree cour/e/ m+n+mum< all @ro(e+n o. /ome /or(.6 Dana

From owner-lowcarb@MAELSTROM.STJOHNS.EDU Sa( Ma7 1 !"#1'#1" 1&&& Re(urn-)a(*# owner-lowcarb@MAELSTROM.STJOHNS.EDU Rece+,e-# .rom mael/(rom./(0o*n/.e-u 1mael/(rom./(0o*n/.e-u 213&."4.1. 356 b7 omen.com 14.4.%8S9O%6 w+(* ESMT) +- :AA14&$" .or ; Sa(< 1 Ma7 1&&& !"#1'#1! -!'!! 1)DT6 Me//age-=-# >1&&&!%!11$1'.:AA14&$"@omen.com? Rece+,e-# .rom mael/(rom./(0o*n/.e-u 113&."4.1. 36 b7 mael/(rom./(0o*n/.e-u 1LSMT) .or O@enAMS ,1.1a6 w+(* SMT) +- >1 ."E$D$%F"@mael/(rom./(0o*n/.e-u?; Sa(< 1 Ma7 1&&& &#13#!4 -!%!! Da(e# Sa(< 1 Ma7 1&&& !4#% #%% -!3!! Re@l7-To# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on Sen-er# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on From# A@r+l C+llmore Sub0ec(# Re# 9an-+-a# -+e(ar7 an- nu(r+(+onal /u@@lemen( @ro(ocol/ To# LOC9ARD@MAELSTROM.STJOHNS.EDU

S(a(u/# R EGcer@(e- .rom an ar(+cle a( (*e web/+(e o. Jo*n AloF DOMm+//e< MD< FR9)196< a nu(r+(+onal M me(abol+c me-+cal @rac(+(+oner< l+nF cour(e/7 o. Am7< L9-D+abe(e/ l+/(# *((@#88www.galaG7mall.com8*eal(*8Nu(rnlWM(blc8re@or( .*(ml D+e(# C+(*ou( /(r+c( a-*erence (o (*e .ollow+ng -+e(< no an(+-can-+-a -rug or (rea(men( w+ll /uccee-# 116 A,o+- a--e- /ugar/.... 1 6 A,o+- w*+(e-/(arc* .oo-/< l+Fe w*+(e brea-< caFe/< cooF+e/< w*+(e @a/(a< w*+(e r+ce< @o(a(oe/ w8o (*e+r /F+n/< an- all re.+ne- .lour/< e(c.... 1$6 =ncrea/e 7our +n(aFe o. e//en(+al o+l/< e/@. omega-$ o+l/< w*+c* are ,er7 lacF+ng +n (*e Ce/(ern Corl-E/ -+e(. T*e/e +nclu-e# F+/* o+l/< ano+l7 .+/*< l+Fe /almon< macFerel< (una-+n-o+l< /ar-+ne/-+n-o+l< e(c.; FlaG-/ee-< borage an- e,en+ng @r+mro/e o+l/.....A,oca-oe/< nu(/< ol+,e/ an- ol+,e-o+l< canola an- o(*er ,ege(able o+l/ are mo/(l7 omega-"< w*+c* are al/o goo- bu( no( a/ lacF+ng +n our -+e(/. 136 A,o+- an(+b+o(+c/ an- cor(+/one-(7@e @re/cr+@(+on/ +. a( all @o//+ble.

From owner-lowcarb@MAELSTROM.STJOHNS.EDU Ce- Ma7 " 14#%!# ' 1&&& Re(urn-)a(*# owner-lowcarb@MAELSTROM.STJOHNS.EDU Rece+,e-# .rom mael/(rom./(0o*n/.e-u 1mael/(rom./(0o*n/.e-u 213&."4.1. 356 b7 omen.com 14.4.%8S9O%6 w+(* ESMT) +- SAA!&"3! .or ; Ce-< " Ma7 1&&& 14#%!# % -!'!! 1)DT6 Me//age-=-# >1&&&!% '!1%!.SAA!&"3!@omen.com? Rece+,e-# .rom mael/(rom./(0o*n/.e-u 113&."4.1. 36 b7 mael/(rom./(0o*n/.e-u 1LSMT) .or O@enAMS ,1.1a6 w+(* SMT) +- >4.D3ED4%D$@mael/(rom./(0o*n/.e-u?; Ce-< " Ma7 1&&& 1#3"#3 -!%!! Da(e# Ce-< " Ma7 1&&& 1%#34#1" EDT Re@l7-To# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on Sen-er# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on From# De(/7 Cal+(/ Sub0ec(# Re# Heal(*7 go,ernmen( -+e( @rogram/ To# LOC9ARD@MAELSTROM.STJOHNS.EDU S(a(u/# R =n a me//age -a(e- %8 "8&& wr+(e/# # 1#$ AM IIIF+r/( Doo(III< e/ma7@SOND=9OMM.9OM

>> A/+-e .rom (*e +ron7 o. (*e @+ece< =Em @robabl7 no( (*e onl7 one *ere w*o no(e/ *ow un*eal(*7 (*a( .oo- reg+men +/. A @acFe( o. 0u+ce an- cereal/ anl7< e*J No( eGac(l7 /e((+ng (*e F+-/ u@ .or a l+.e(+me o. *eal(*7

ea(+ng. No won-er -+abe(e/ +/ a( /uc* e@+-em+c le,el/ +n (*e +nner c+(+e/. ?? :oo- @o+n(... = wa/ one o. (*o/e mo(*er/ w*o -+-nE( @ro-uce enoug* m+lF< /o = /u@@lemen(e- w+(* .ormula. A.(er real+B+ng (*e bene.+(/ o. re-uce- carb 1an*a,+ng m7 .+r/( c*+l- be c*unF7 l+Fe me6< = /u@@lemen(e- m7 /econ- c*+l- w+(* @ro(e+n enr+c*e- .ormula. D7 a--+ng @ro(e+n @ow-er (o *+/ .ormula< = bel+e,e (*a( = @ro-uce- m7 .+r/( (*+n F+-. An- *eE/ /(+ll (*+n an- now *eE/ (*ree. Accor-+ngl7< .or (*o/e w*o mu/( u/e .ormula< = alwa7/ recommen- (*a( @ro(e+n @ow-er be a--e-. For me< = a--e- enoug* @ro(e+n (o maFe +( $!R o. calor+e/. DTC< = al/o regularl7 a--e- .a(< u/uall7 ol+,e o+l. None o. (*a( goo- /(u.. +/ +n (*e go,ernmen( C+c .orumla/. DTC< regar-+ng cereal/< = al/o u/e@ro(e+n enr+c*e- oa(meal w*+le m7 bab7 wa/ l+((le. De(/7

From owner-lowcarb@MAELSTROM.STJOHNS.EDU Fr+ Ma7 4 !3#1 #3& 1&&& Re(urn-)a(*# owner-lowcarb@MAELSTROM.STJOHNS.EDU Rece+,e-# .rom mael/(rom./(0o*n/.e-u 1mael/(rom./(0o*n/.e-u 213&."4.1. 356 b7 omen.com 14.4.%8S9O%6 w+(* ESMT) +- EAA !33% .or ; Fr+< 4 Ma7 1&&& !3#1 #3' -!'!! 1)DT6 Me//age-=-# >1&&&!% 4111 .EAA !33%@omen.com? Rece+,e-# .rom mael/(rom./(0o*n/.e-u 113&."4.1. 36 b7 mael/(rom./(0o*n/.e-u 1LSMT) .or O@enAMS ,1.1a6 w+(* SMT) +- >'."F9A&A!&@mael/(rom./(0o*n/.e-u?; Fr+< 4 Ma7 1&&& '#!&#!% -!%!! Da(e# Ce-< " Ma7 1&&& #1!#%& -!3!! Re@l7-To# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on Sen-er# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on From# A@r+l C+llmore Sub0ec(# Re# HHeal(*7H go,ernmen( -+e( @rogram/< F+-/< an- /en+or/ To# LOC9ARD@MAELSTROM.STJOHNS.EDU S(a(u/# RO ? ? ? ? Dean wr+(e/# A/+-e .rom (*e +ron7 o. (*e @+ece< =Em @robabl7 no( (*e onl7 one *ere w*o no(e/ *ow un*eal(*7 ..A @acFe( o. 0u+ce an- cereal/ ..+/. ... No won-er -+abe(e/ +/ a( /uc* e@+-em+c le,el/ +n (*e +nner c+(+e/.

? De(/7 wr+(e/# ? :oo- @o+n(... = .. /u@@lemen(e- w+(* .ormula. A.(er real+B+ng (*e bene.+(/ o. ? re-uce- carb 1an- *a,+ng m7 .+r/( c*+l- be c*unF7 l+Fe me6< = /u@@lemen(em7 ? /econ- c*+l- w+(* @ro(e+n enr+c*e- .ormula. D7 a--+ng @ro(e+n @ow-er (o *+/ ? .ormula< = bel+e,e (*a( = @ro-uce- m7 .+r/( (*+n F+-. An- *eE/ /(+ll (*+n an? now *eE/ (*ree. = /u@@lemen(e- bo(* m7 bo7/ w+(* Hw*ole m+lF no a--e- carb/ 7ogur(H .rom an +n.a-.ee-er. T*e .+r/( *a/ alwa7/ *a- a we+g*( @roblem< bu( *a/ been be((er /+nce our/ became a lowcarb *ou/e*ol-. T*e /econ- *a/ alwa7/ been /len-er< an(*e7 are now gra-ua(+ng .rom *+g* /c*ool +n (wo weeF/< an- /(ar(+ng *+g* /c*ool

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From owner-lowcarb@MAELSTROM.STJOHNS.EDU Ce- Jun #$1# 4 1&&& Re(urn-)a(*# owner-lowcarb@MAELSTROM.STJOHNS.EDU Rece+,e-# .rom mael/(rom./(0o*n/.e-u 1mael/(rom./(0o*n/.e-u 213&."4.1. 356 b7 omen.com 14.4.%8S9O%6 w+(* ESMT) +- CAA!%4%1 .or ; Ce-< Jun 1&&& #$1#13 -!'!! 1)DT6 Me//age-=-# >1&&&!"!$!%$1.CAA!%4%1@omen.com? Rece+,e-# .rom mael/(rom./(0o*n/.e-u 113&."4.1. 36 b7 mael/(rom./(0o*n/.e-u 1LSMT) .or O@enAMS ,1.1a6 w+(* SMT) +- >1 .&1E"'4&$@mael/(rom./(0o*n/.e-u?; T*u< $ Jun 1&&& 1# "# & -!%!! Da(e# T*u< $ Jun 1&&& 1"#!&#$3 -!'!! Re@l7-To# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on Sen-er# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on From# Ra7 Au-e((e Organ+Ba(+on# )aleol+(*+c )re// Sub0ec(# Re# -+abe(e/ (7@e ,er/u/ lowcarb To# LOC9ARD@MAELSTROM.STJOHNS.EDU S(a(u/# R Alan S+l,er/(e+n wro(e# ? ? T*e7 0u/( -onE( ge( +(... ? =( /a7/ +n @ar(# HA.(er (*ree mon(*/ on a low-.a(< *+g*-carbo*7-ra(e< ? *+g*-.+bre -+e(< HE..ec(/ o. Aar7+ng 9arbo*7-ra(e 9on(en( +n )a(+en(/ w+(* Non-=n/ul+n-De@en-en( D+abe(e/ Mell+(u/H JAMA< ,ol. '1<U141Ma7 11 1&&36@g/.13 1-13 4 A.(er le// (*an " weeF/ on a low-.a(< *+g* carbo*7-ra(e -+e(< -+abe(+c /ub0ec(/ a,erage- a 3 @ercen( +ncrea/e +n LDL c*ole/(erol an- a $ @ercen( +ncrea/e +n (r7gl7cer+-e/. T*e /(u-7 wa/ -+/con(+nue- +n .ear o. /ub0ec(/ /a.e(7. Ra7 Au-e((e Au(*or HNean-erT*+nH S(. Mar(+nE/ )re// No,.E&&

From owner-lowcarb@MAELSTROM.STJOHNS.EDU T*u Jun 1' !3#%4#13 1&&& Re(urn-)a(*# owner-lowcarb@MAELSTROM.STJOHNS.EDU Rece+,e-# .rom mael/(rom./(0o*n/.e-u 1mael/(rom./(0o*n/.e-u 213&."4.1. 356 b7 omen.com 14.4.%8S9O%6 w+(* ESMT) +- EAA1 4' .or ; T*u< 1' Jun 1&&& !3#%4#1 -!'!! 1)DT6 Me//age-=-# >1&&&!"1'11%4.EAA1 4' @omen.com? Rece+,e-# .rom mael/(rom./(0o*n/.e-u 113&."4.1. 36 b7 mael/(rom./(0o*n/.e-u 1LSMT) .or O@enAMS ,1.1a6 w+(* SMT) +- >". A E%3&!@mael/(rom./(0o*n/.e-u?; T*u< 1' Jun 1&&& '#%%#!! -!%!! Da(e# T*u< 1' Jun 1&&& !"#$!#$$ -!3!! Re@l7-To# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on Sen-er# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on From# HAnn D. Mull+F+nH Sub0ec(# H+-.a(8Lowcarb .or D+abe(e/ To# LOC9ARD@MAELSTROM.STJOHNS.EDU S(a(u/# R H+ L+/(; T*e En-ocr+nolog+/(/ *a,e been *ol-+ng a mee(+ng recen(l7 an- /ome o. (*e /(u.. (*a( came ou( o. +( +/ Lu+(e +n(ere/(+ng. +e< HD+abe(+c/ =m@ro,e Heal(* C+(* Aer7 H+g*-Fa(< Low 9arb D+e(H No( new (o u/< bu( remarFable (o be com+ng .rom /uc* a ma+n/(ream grou@. T*e -awn +/ breaF+ngJ -------------------------------------------------------------------------------------------------D:-D=S)AT9H - ENDO &&# D+abe(+c/ =m@ro,e Heal(* C+(* Aer7 H+g*-Fa(< Low 9arb D+e( ------------------------------------------------------------------------------------------------------------------------------------------------------------D7 9ameron Jo*n/(on S@ec+al (o D: New/ SAN D=E:O< 9A -- June 1%< 1&&& -- A ,er7 *+g*-.a(< low-carbo*7-ra(e -+e( *a/ been /*own (o *a,e a/(oun-+ng e..ec(/ +n *el@+ng (7@e -+abe(+c/ lo/e we+g*( an- +m@ro,e (*e+r bloo- l+@+- @ro.+le/. T*e re/ul(/ o. (*ree /(u-+e/ +n,ol,+ng /uc* a -+e(< w*+c* +/ /+m+lar (o< bu( *a/ a .ew Fe7 -+..erence/ .rom (*e .amou/ HDr. A(F+n/ D+e(H< were @re/en(e(o-a7 a( (*e annual mee(+ng o. (*e En-ocr+ne Soc+e(7. Dr. Jame/ Ha7/< an en-ocr+nolog+/( an- -+rec(or o. (*e L+me/(one Me-+cal 9en(er +n C+lm+ng(on< DE< a-m+((e- (*a( (*e conce@( o. a *+g*-.a( -+e( +n @eo@le w*o are alrea-7 a( *+g*er r+/F o. car-+o,a/cular -+/ea/e m+g*( /eem +ncongruou/. None(*ele//< (*+/ /(u-7 o. 1%' men an- women w+(* (7@e -+abe(e/ /*owe- an +m@re//+,e bene.+( +n bo-7 ma// +n-eG 1DM=6 (r+gl7cer+-e/< HDL< LDL an- HbA1c. ----------------------------------------------------------------------------

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From owner-lowcarb@MAELSTROM.STJOHNS.EDU Fr+ Oc( 4 !$#13#13 1&&& Re(urn-)a(*# owner-lowcarb@MAELSTROM.STJOHNS.EDU Rece+,e-# .rom mael/(rom./(0o*n/.e-u 1mael/(rom./(0o*n/.e-u 213&."4.1. 356 b7 omen.omen.com 14.4.%8S9O%6 w+(* ESMT) +- DAA!1!%% .or ; Fr+< 4 Oc( 1&&& !$#1$#%& -!'!! 1)DT6 Me//age-=-# >1&&&1!!41!1$.DAA!1!%%@omen.omen.com? Rece+,e-# .rom mael/(rom./(0o*n/.e-u 113&."4.1. 36 b7 mael/(rom./(0o*n/.e-u 1LSMT) .or O@enAMS ,1.1a6 w+(* SMT) +- >3.D1A!ED13@mael/(rom./(0o*n/.e-u?; Fr+< 4 Oc( 1&&& "#13#1& -!%!! Da(e# T*u< ' Oc( 1&&& !#%'#!% -!'!! Re@l7-To# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on Sen-er# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on From# Doug SFrecF7 Sub0ec(# a *+g* @ro(e+n -+e( *el@/ -+e(er/ lo/e a .ew @oun-/ To# LOC9ARD@MAELSTROM.STJOHNS.EDU S(a(u/# R Au(*or/ SFo, AR. Toubro S. Ronn D. Holm L. A/(ru@ A. =n/(+(u(+on Re/earc* De@ar(men( o. Human Nu(r+(+on< T*e Ro7al Ae(er+nar7 anAgr+cul(ural Un+,er/+(7< 9o@en*agen< DenmarF. T+(le Ran-om+Be- (r+al on @ro(e+n ,/ carbo*7-ra(e +n a- l+b+(um .a( re-uce- -+e( .or (*e (rea(men( o. obe/+(7. Source =n(erna(+onal Journal o. Obe/+(7 M Rela(e- Me(abol+c D+/or-er/. $1%6#% 4-$"< 1&&& Ma7. Ab/(rac( ODJE9T=AE# To /(u-7 (*e e..ec( on we+g*( lo// +n obe/e /ub0ec(/ b7 re@lacemen( o. carbo*7-ra(e b7 @ro(e+n +n a- l+b+(um con/ume- .a(-re-uce- -+e(/. DES=:N# Ran-om+Be- -+e(ar7 +n(er,en(+on /(u-7 o,er /+G mon(*/ com@ar+ng (wo a- l+b+(um .a( re-uce-+e(/ 1$!R o. (o(al energ76 /(r+c(l7 con(rolle- +n com@o/+(+on# H+g*-carbo*7-ra(e

1H9< @ro(e+n 1 R o. (o(al energ76 or *+g*-@ro(e+n 1H)< @ro(e+n %R o. (o(al energ76. SETT=N: AND )ART=9=)ANTS# Sub0ec(/ were "% *eal(*7< o,erwe+g*( anobe/e /ub0ec(/ 1%! women< 1% men< age- 14-%% 76 ran-oml7 a//+gne- (o H9 1n Q %6< H) 1n Q %6 or a con(rol grou@ 19< n Q 1%6. All .oo- wa/ @ro,+-e- b7 /el.-/elec(+on +n a /*o@ a( (*e -e@ar(men(< an- com@l+ance (o (*e -+e( com@o/+(+on wa/ e,alua(e- b7 ur+nar7 n+(rogen eGcre(+on. MA=N OUT9OME MEASURE# 9*ange +n bo-7 we+g*(< bo-7 com@o/+(+on an- bloo- l+@+-/. RESULTS# More (*an &!R com@le(e- (*e (r+al. Ce+g*( lo// a.(er /+G mon(*/ wa/ %.1 Fg +n (*e H9 grou@ an- 4.& Fg +n (*e H) grou@ 1-+..erence $.' Fg< &%R con.+-ence +n(er,al 19=611.$-". Fg6 ) > !.!!16< an- .a( lo// wa/ 3.$ Fg an- '." Fg< re/@ec(+,el7 1-+..erence $.$ Fg 11.1-%.% Fg6 ) > !.!!!16< w*erea/ no c*ange/ occurre- +n (*e con(rol grou@. More /ub0ec(/ lo/( ? 1! Fg +n (*e H) grou@ 1$%R6 (*an +n (*e H9 grou@ 1&R6. T*e H) -+e( onl7 -ecrea/e.a/(+ng @la/ma (r+gl7cer+-e/ an- .ree .a((7 ac+-/ /+gn+.+can(l7. 9ON9LUS=ONS# Re@lacemen( o. /ome -+e(ar7 carbo*7-ra(e b7 @ro(e+n +n an al+b+(um .a(-re-uce- -+e(< +m@ro,e/ we+g*( lo// an- +ncrea/e/ (*e @ro@or(+on o. /ub0ec(/ ac*+e,+ng a cl+n+call7 rele,an( we+g*( lo//. More .ree-om (o c*oo/e be(ween @ro(e+n-r+c* an- com@leG carbo*7-ra(e-r+c* .oo-/ ma7 allow obe/e /ub0ec(/ (o c*oo/e more lean mea( an- -a+r7 @ro-uc(/< an- *ence +m@ro,e a-*erence (o low-.a( -+e(/ +n we+g*( re-uc(+on @rogram/.

From owner-lowcarb@MAELSTROM.STJOHNS.EDU Mon Oc( 14 !4#11#3! 1&&& Re(urn-)a(*# owner-lowcarb@MAELSTROM.STJOHNS.EDU Rece+,e-# .rom mael/(rom./(0o*n/.e-u 1mael/(rom./(0o*n/.e-u 213&."4.1. 356 b7 omen.omen.com 14.4.%8S9O%6 w+(* ESMT) +- =AA &$4! .or ; Mon< 14 Oc( 1&&& !4#11#$4 -!'!! 1)DT6 Me//age-=-# >1&&&1!141%11.=AA &$4!@omen.omen.com? Rece+,e-# .rom mael/(rom./(0o*n/.e-u 113&."4.1. 36 b7 mael/(rom./(0o*n/.e-u 1LSMT) .or O@enAMS ,1.1a6 w+(* SMT) +- >1$.FE3F3FFE@mael/(rom./(0o*n/.e-u?; Mon< 14 Oc( 1&&& 11#11#$! -!%!! Da(e# Fr+< 1% Oc( 1&&& 1"#31#11 EDT Re@l7-To# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on Sen-er# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on From# Ellen 9ar@en(er Sub0ec(# 9*ange/ +n DMR a.(er low carb To# LOC9ARD@MAELSTROM.STJOHNS.EDU S(a(u/# RO =/ (*ere an7 e,+-ence ou( (*ere (o -ocumen( a correla(+on be(ween (*e +ncrea/e +n DMR a/ a re/ul( o. low carb/ 1G 14 mon(*/6 an- an +ncrea/e +n core (em@era(ureJ C*a( u/e- (o be a /ub-normal ba/el+ne (em@ 1&'."6 *a/ become ele,a(e- 11!!.!6 con/+/(en(l7 .or /e,eral mon(*/ w+(*ou( an7 Fnown /ource. =n/ul+n le,el/ -ro@@e- .rom "% (o $!< comb+ne- w+(* 1!!P lb we+g*( lo//. An7 (*oug*(/JJ Ellen< RN

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From owner-lowcarb@MAELSTROM.STJOHNS.EDU Tue Oc( " 13# 4# 3 1&&& Re(urn-)a(*# owner-lowcarb@MAELSTROM.STJOHNS.EDU Rece+,e-# .rom mael/(rom./(0o*n/.e-u 1mael/(rom./(0o*n/.e-u 213&."4.1. 356 b7 omen.omen.com 14.4.%8S9O%6 w+(* ESMT) +- OAA11'%3 .or ; Tue< " Oc( 1&&& 13# 4# -!'!! 1)DT6 Me//age-=-# >1&&&1! " 1 4.OAA11'%3@omen.omen.com? Rece+,e-# .rom mael/(rom./(0o*n/.e-u 113&."4.1. 36 b7 mael/(rom./(0o*n/.e-u 1LSMT) .or O@enAMS ,1.1a6 w+(* SMT) +- >&.ED&E3A 4@mael/(rom./(0o*n/.e-u?; Tue< " Oc( 1&&& 1'# 4#!" -!%!! Da(e# Mon< % Oc( 1&&& 1$#3%#3% -!'!! Re@l7-To# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on Sen-er# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on From# )a( Sonnen/(u*l Sub0ec(# Re# Fa( /ource/ To# LOC9ARD@MAELSTROM.STJOHNS.EDU =n-Re@l7-To# >1&&&1!!'!$ 1.UAA1"$'"@mG$-w.ma+l.*ome.com? S(a(u/# R An n eGcellen( booF .or (*+/ +n.orma(+on +/ Ea( Fa(< Lo/e Ce+g*( b7 Ann Lou+/e :+((leman. Ea/7 (o rea- an- =E,e /een +( a( Targe(. *((@#88www.member/.*ome.ne(8cnm@a(8ea(.a(.*(m T*ere +/ -e.+n+(el7 a (r+cF (o ea(+ng (*e Er+g*( (7@eE o. .a(. )a( Sonnen/(u*l< ARN)< 9NM HLe( 7our *ear( +n/(ruc(+on 7ou. mar7 anne ra-mac*er-*er/*e7 L+/(en well# 7ou w+ll Fnow 7our wa7.H

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To# LOC9ARD@MAELSTROM.STJOHNS.EDU Sub0ec(# Fa( /ource/ Ha/ an7one collec(e- -a(a on (*e /ource/ or c*o+ce/ mo/( *a,e ma-e +n go+ng (o a *+g*er .a( -+e(J Ma7be (*e7 *a,enE( c*ange- (*e+r .a(/ bu( ea( more o. (*em. -/(+ll w*a( are (*o/e .oo-/. T*+/ ma7 be +m@or(an( +n looF+ng a( +m@ac(/ on bloo- l+@+- @ro.+le/. )o//+bl7 /(eer+ng (owar- *eal(*7 .a(/ ma7 maFe a more @o/+(+,e c*ange +n *eal(* .ac(or/. = ge( (*e .eel+ng (*a( man7 @eo@le are c*oo/+ng (o ea( wa7 (oo muc* /a(ura(e- an- al(ere- .a(/ +n (*e wa7 o. *7-rogena(e- o+l/< .r+e- .oo-< bacon< @orF r+n-/< *o(-og/ e(c. D. Du(ler =SSA 9FT

From owner-lowcarb@MAELSTROM.STJOHNS.EDU Tue No, $ !%# '#!& 1&&& Re(urn-)a(*# owner-lowcarb@MAELSTROM.STJOHNS.EDU Rece+,e-# .rom mael/(rom./(0o*n/.e-u 1mael/(rom./(0o*n/.e-u 213&."4.1. 356 b7 omen.omen.com 14.4.%8S9O%6 w+(* ESMT) +- FAA11$4% .or ; Tue< $ No, 1&&& !%# '#!$ -!4!! 1)ST6 Me//age-=-# >1&&&11 $1$ '.FAA11$4%@omen.omen.com? Rece+,e-# .rom mael/(rom./(0o*n/.e-u 113&."4.1. 36 b7 mael/(rom./(0o*n/.e-u 1LSMT) .or O@enAMS ,1.1a6 w+(* SMT) +- >".FA$&!$D&@mael/(rom./(0o*n/.e-u?; Tue< $ No, 1&&& 4# '#!! -!%!! Da(e# Mon< No, 1&&& $# #$' -!4!! Re@l7-To# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on Sen-er# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on From# Doug SFrecF7 Sub0ec(# mo-era(e eGerc+/e +ne..ec(+,e +n we+g*( lo// To# LOC9ARD@MAELSTROM.STJOHNS.EDU S(a(u/# R =n( J S@or( Nu(r 1&&4 Se@;41$6# 1$=n.luence o. -+e( an-8or eGerc+/e on bo-7 com@o/+(+on ancar-+ore/@+ra(or7 .+(ne// +n obe/e women. U((er A9< N+eman D9< S*annon*ou/e EM< Du((erwor(* DE< N+eman 9N De@ar(men( o. Heal(*< Le+/ure< an- EGerc+/e Sc+ence< A@@alac*+an S(a(e Un+,er/+(7< Doone< N9 4"!4< USA. T*e @ur@o/e o. (*+/ /(u-7 wa/ (o mea/ure (*e +n.luence o. -+e(< eGerc+/e< or bo(* on bo-7 com@o/+(+on ancar-+ore/@+ra(or7 .+(ne// +n obe/e women. N+ne(7-one obe/e /ub0ec(/ were ran-om+Be- +n(o one o. .our grou@/# -+e( 1D6 13.1&-%.33 MJ or 1< !!-1<$!! Fcal8-a76< eGerc+/e 1E6 1.+,e 3%-m+n /e//+on/ a( '4.%P8-!.%R maG+mum *ear( ra(e6< eGerc+/e an- -+e( 1ED6< an- con(rol/ 196. MaG+mal aerob+c @ower an- bo-7 com@o/+(+on were mea/ure- +n all /ub0ec(/ be.ore an- a.(er a 1 -weeF -+e( +n(er,en(+on @er+o-. Sub0ec(/ +n D an- ED lo/( '.4P8-!.' an- 4.1P8-!." Fg bo-7 ma//< w+(* no /+gn+.+can( c*ange .or E rela(+,e (o 9. Lo//e/ o. @ercen( bo-7 .a( an- .a( ma// were /+gn+.+can(l7 grea(er +n D an- ED bu( no( +n E rela(+,e (o 9. T*e c*ange +n AO maG wa/

grea(er +n ED an- E bu( no( D w*en com@are- (o 9. Re/ul(/ +n-+ca(e (*a( mo-era(e aerob+c eGerc+/e (ra+n+ng -ur+ng a 1 -weeF @er+o- *a/ no -+/cern+ble e..ec(/ on bo-7 com@o/+(+on bu( -oe/ +m@ro,e car-+ore/@+ra(or7 .+(ne// +n -+e(+ng obe/e women.

From owner-lowcarb@MAELSTROM.STJOHNS.EDU Sa( Dec 14 1 #$ #%$ 1&&& Re(urn-)a(*# owner-lowcarb@MAELSTROM.STJOHNS.EDU Rece+,e-# .rom mael/(rom./(0o*n/.e-u 1mael/(rom./(0o*n/.e-u 213&."4.1. 356 b7 omen.omen.com 14.4.%8S9O%6 w+(* ESMT) +- MAA!434 .or ; Sa(< 14 Dec 1&&& 1 #$ #%1 -!4!! 1)ST6 Me//age-=-# >1&&&1 14 !$ .MAA!434 @omen.omen.com? Rece+,e-# .rom mael/(rom./(0o*n/.e-u 113&."4.1. 36 b7 mael/(rom./(0o*n/.e-u 1LSMT) .or O@enAMS ,1.1a6 w+(* SMT) +- >&.&91D3"%D@mael/(rom./(0o*n/.e-u?; Sa(< 14 Dec 1&&& 1%#$ #%1 -!%!! Da(e# Sa(< 14 Dec 1&&& 1%#! #1& -!%!! Re@l7-To# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on Sen-er# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on From# T*oma/ =ncle-on Sub0ec(# Omn+,orou/ be((er (*an lac(oo,o,ege(ar+an -+e(J To# LOC9ARD@MAELSTROM.STJOHNS.EDU S(a(u/# R T*+/ 0u/( came ou(. Tom =ncle-on T=TLE# E..ec(/ o. an omn+,orou/ -+e( com@are- w+(* a lac(oo,o,ege(ar+an -+e( on re/+/(ance-(ra+n+ng-+n-uce- c*ange/ +n bo-7 com@o/+(+on an- /Fele(al mu/cle +n ol-er men 2=n )roce// 9+(a(+on5 AUTHORS# 9am@bell CC; Dar(on ML Jr; 97r-9am@bell D; Da,e7 SL; Dear- JL; )ar+/e :; E,an/ CJ AUTHOR AFF=L=AT=ON# Nu(r+(+on< Me(abol+/m< an- EGerc+/e Labora(or7< DonalC Re7nol-/ De@ar(men( o. :er+a(r+c/< Un+,er/+(7 o. ArFan/a/ .or Me-+cal Sc+ence/< L+((le RocF. SOUR9E# Am J 9l+n Nu(r 1&&& Dec;'!1"6#1!$ -& 2MEDL=NE recor- +n @roce//5 9=TAT=ON =DS# )M=D# 1!%43!34 U=# !!%1!&' ADSTRA9T# DA9N:ROUND# Aer7 l+m+(e- -a(a /ugge/( (*a( mea( con/um@(+on b7 ol-er @eo@le ma7 @romo(e /Fele(al mu/cle *7@er(ro@*7 +n re/@on/e (o re/+/(ance (ra+n+ng 1RT6. ODJE9T=AE# T*e ob0ec(+,e o. (*+/ /(u-7 wa/ (o a//e// w*e(*er (*e con/um@(+on o. an omn+,orou/ 1mea(-con(a+n+ng6 -+e( woul+n.luence RT-+n-uce- c*ange/ +n w*ole-bo-7 com@o/+(+on an- /Fele(al mu/cle /+Be +n ol-er men com@are- w+(* a lac(oo,o,ege(ar+an 1LOA6 1mea(-.ree6 -+e(. DES=:N# N+ne(een men age- %1-"& 7 @ar(+c+@a(e- +n (*e /(u-7. Dur+ng a 1 -wF @er+o- o. RT< & men con/ume- (*e+r *ab+(ual omn+,orou/ -+e(/< w*+c* @ro,+-ea@@roG+ma(el7 %!R o. (o(al -+e(ar7 @ro(e+n .rom mea( /ource/ 1bee.< @oul(r7< @orF< an- .+/*6 1m+Ge---+e( grou@6. Ano(*er 1! men were coun/ele- (o /el.-/elec( an LOA -+e( 1LOA--+e( grou@6. RESULTS# MaG+mal /(reng(* o. (*e u@@er- an- lower-bo-7 mu/cle grou@/ (*a( were eGerc+/e- -ur+ng RT +ncrea/eb7 1!- $4R 1) > !.!!16< +n-e@en-en( o. -+e(. T*e RT-+n-uce- c*ange/ +n T*oug*( /ome ma7 en0o7 rea-+ng +(.

w*ole- bo-7 com@o/+(+on an- /Fele(al mu/cle /+Be -+..ere- /+gn+.+can(l7 be(ween (*e m+Ge-- an- LOA--+e( grou@/ 1(+me-b7-grou@ +n(erac(+on/< ) > !. !%6. C+(* RT< w*ole-bo-7 -en/+(7< .a(-.ree ma//< an- w*ole-bo-7 mu/cle ma// +ncrea/e- +n (*e m+Ge- -+e( grou@ bu( -ecrea/e- +n (*e LOA- -+e( grou@. T7@e == mu/cle .+ber area o. (*e ,a/(u/ la(eral+/ mu/cle +ncrea/e- w+(* RT .or all men comb+ne- 1) > !.!16< an- (*e +ncrea/e (en-e- (o be grea(er +n (*e m+Ge---+e( grou@ 11". P8- 3.3 R6 (*an +n (*e LOA -+e( grou@ 1'.$ P8- %.1R6. T7@e = .+ber area wa/ unc*ange- w+(* RT +n bo(* -+e( grou@/. 9ON9LUS=ON# 9on/um@(+on o. a mea(-con(a+n+ng -+e( con(r+bu(e- (o grea(er ga+n/ +n .a(-.ree ma// an- /Fele(al mu/cle ma// w+(* RT +n ol-er men (*an -+- an LOA -+e(.

From owner-lowcarb@MAELSTROM.STJOHNS.EDU Sun Jan & ! #$%#%& !!! Re(urn-)a(*# owner-lowcarb@MAELSTROM.STJOHNS.EDU Rece+,e-# .rom mael/(rom./(0o*n/.e-u 1mael/(rom./(0o*n/.e-u 213&."4.1. 356 b7 omen.omen.com 14.4.%8S9O%6 w+(* ESMT) +- 9AA 4&" .or ; Sun< & Jan !!! ! #$%#%4 -!4!! 1)ST6 Me//age-=-# > !!!!1!&1!$%.9AA 4&"@omen.omen.com? Rece+,e-# .rom mael/(rom./(0o*n/.e-u 113&."4.1. 36 b7 mael/(rom./(0o*n/.e-u 1LSMT) .or O@enAMS ,1.1a6 w+(* SMT) +- >".E 3'49EF@mael/(rom./(0o*n/.e-u?; Sun< & Jan !!! %#$"#!3 -!%!! Da(e# Sa(< 4 Jan !!! 1"#!1# & )ST Re@l7-To# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on Sen-er# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on From# JacF :ol-berg Sub0ec(# Re# LOC9ARD D+ge/( - " Jan To# LOC9ARD@MAELSTROM.STJOHNS.EDU S(a(u/# R . To /u@@or( (*+/< (*ere +/ muc* anec-o(al ?e,+-ence ..... M7 /u/@+c+on +/ (*a( +( +/ cell-me-+a(e-< T*e e,+-ence +/ +n (*e .ermen(e- m+lF @ro-uc( me-+cal l+(era(ure. Do a /earc* on Me-l+ne. Lac(obac+llu/ +/ Fnown (o boo/( +mmun+(7 (*roug* c7(oF+ne mec*an+/m/. M7 re.erence/ are +n (*e booF. Anec-o(all7< an- .rom 0u/( m7 own @er/onal eG@er+ence (*e .ollow+ng *a,e occurre- +n (*e almo/( 3 7ear/ =E,e been on (*e :O-D+e(. 1. = *a,e no( *a- one col- +n (*a( (+me.1 = u/e- (o /u..er .rom 3 (o % col-/ e,er7 7ear.6 . No /+cF -a7/ eGce@( .or one broFen leg w*+c* co/( me (*ree *our/ +n (*e ER. $. No more a(*le(e/ .oo(. A c*ron+c @roblem o. @eo@le w*o u/e (*e locFer room/ a( *eal(* club/. 3. All 7ellow+ng na+lbe-/ *a,e w*+(ene-. 17ellow+ng o. (*e na+lbe-/ +/ a common @*enomenon cau/e- b7 .ungal +n.ec(+on o. (*e na+l6. To me (*+/ a--/ u@ (o an +mmune boo/(. JacF :ol-berg< )*.D. 9o-au(*or T*e :O-D+e(. !!! (o ' Jan !!! 1U !!!-36

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From owner-lowcarb@MAELSTROM.STJOHNS.EDU Sun Jan & 1!#$ #3' !!! Re(urn-)a(*# owner-lowcarb@MAELSTROM.STJOHNS.EDU Rece+,e-# .rom mael/(rom./(0o*n/.e-u 1mael/(rom./(0o*n/.e-u 213&."4.1. 356 b7 omen.omen.com 14.4.%8S9O%6 w+(* ESMT) +- NAA %4!3 .or ; Sun< & Jan !!! 1!#$ #3$ -!4!! 1)ST6 Me//age-=-# > !!!!1!&14$ .NAA %4!3@omen.omen.com? Rece+,e-# .rom mael/(rom./(0o*n/.e-u 113&."4.1. 36 b7 mael/(rom./(0o*n/.e-u 1LSMT) .or O@enAMS ,1.1a6 w+(* SMT) +- >$.'!A4D&E%@mael/(rom./(0o*n/.e-u?; Sun< & Jan !!! 1$#$ # & -!%!! Da(e# Sun< & Jan !!! 1!#$"#%& -!'!! Re@l7-To# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on Sen-er# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on From# ElB+ AolF Sub0ec(# Re# LOC9ARD Ne(o-+e(/ an- +mmune /7/(em con(+nueTo# LOC9ARD@MAELSTROM.STJOHNS.EDU =n-Re@l7-To# > !!!!1!&1!$%%%.DD"E4%A%1@/+erra.onr.com? S(a(u/# R A( !3#!1 )M 1848!! )ST< 7ou wro(e# ?Anec-o(all7< an- .rom 0u/( m7 own @er/onal eG@er+ence (*e .ollow+ng *a,e ?occurre- +n (*e almo/( 3 7ear/ =E,e been on (*e :O-D+e(. ?1. = *a,e no( *a- one col- +n (*a( (+me.1 = u/e- (o /u..er .rom 3 (o % col-/ ?e,er7 7ear.6 ? . No /+cF -a7/ eGce@( .or one broFen leg w*+c* co/( me (*ree *our/ +n (*e ?ER. ?$. No more a(*le(e/ .oo(. A c*ron+c @roblem o. @eo@le w*o u/e (*e locFer ?room/ a( *eal(* club/. ?3. All 7ellow+ng na+lbe-/ *a,e w*+(ene-. 17ellow+ng o. (*e na+lbe-/ +/ a ?common @*enomenon cau/e- b7 .ungal +n.ec(+on o. (*e na+l6. T*+/ +/ w*a( @uBBle/ me. Man7 on (*e lowcarb-l l+/( re@or( (*e7 *a,e .ewer col-/< e(c w*+le on a Fe(o -+e(. Al(*oug* no( all re@or( 1!!R re/+/(ance 1= *a,e one now6< (*e rela(+,e +nc+-ence +/ le//. 9on,er/el7< (*o/e w*o -o become /+cF w+(* a .lu or col- w*+le on a Fe(o -+e( re@or( +ncrea/e- (+me .or reco,er7. So w*+le /ome o. (*e anec-o(al e,+-ence 1lacF o. allerg7 /7m@(om/< ar(+cle/< e(c6 +m@l7 /u@@re//+on o. +mmune /7/(em< /ome o. (*e re@or(/ 1lacF o. col-/< e(c6 al/o +m@l7 +ncrea/e- +mmune /7/(em. T*+/ +/ w*a( *a/ be /(um@e-. T*ere are al/o /ome /(u-+e/ (*a( *a,e men(+one- re-uc+ng gluco/e8+n/ul+n le,el/ +ncrea/e/ au(o- an- Genogra.( /ur,+,al +n @a(+en(/. A/ well a/ -ecrea/e c*ron+c +n.lamma(+on /uc* a/ +n r*euma(o+- ar(*r+(+/. =( *a/ been @o/(ula(e- (*a( +( ma7 -ecrea/e /7m@(om/ o. lu@u/ a/ well. T*+/ @o+n(/ (o an au(o-+mmune /@ec+.+c mec*an+/m< a/ /omeone men(+one- @r+,a(el7. An- (*+/ ma7 be< bu( (*+/ /(+ll -oe/ no( .ull7 eG@la+n reac(+on/ (o allerg+e/< w*+c* +/ no( com@le(el7 an au(o-+mmune reac(+on. ?To me (*+/ a--/ u@ (o an +mmune boo/(.

Man7 o(*er/ al/o re@or( con(rol o. /7/(em+c bac(er+al an- .ungal +n.ec(+on/< /uc* a/ can-+-a e(c. T*+/ ma7 al/o be more /@ec+.+c (o a reLu+remen( o. gluco/e b7 .ungal an- bac(er+al organ+/m/ ra(*er (*an /@ec+.+call7 an +mmune boo/(. =( +/ re@or(e- (*a( lacF o. gluco/e re-uce/ (umor grow(*< an- +/ no( /olel7 a .unc(+on o. (*e +mmune /7/(em. :luco/e an- +n/ul+n are +n-+rec(l7 an-+rec(l7 reLu+re- .or eG@re//+on o. man7 gene/. LacF o. one or (*e o(*er /er,e/ (o regula(e gene eG@re//+on o. cer(a+n @ro(e+n/ (*a( con/eLuen(l7 regula(e (*e grow(* o. (umor/. A/ well a/ +n(r+n/+c< (*ere +/ a *umoral e..ec(. Low @la/ma gluco/e an- +n/ul+n /*+.( man7 en-ocr+ne8@aracr+ne8au(ocr+ne .ac(or/ (*a( con(r+bu(e (o -ecrea/e- (umor grow(*. = canno( len- an7 re@u(able cre-ence (o m7 *7@o(*e/e/ a/ 7ou canno( (o 7our/ unle// /omeone ac(uall7 +n,e/(+ga(e/ +mmune marFer/ +n (*e bo-7 w*+le on a Fe(o-+e(. Ce can maFe a//um@(+on/ .rom (*e anec-o(al ob/er,a(+on/ we all *a,e< bu( +mmunolog7 +/ Lu+(e com@leG an- mul(+.ac(oral. Ce mu/( a@@roac* re-uc(+,e conclu/+on/ w+(* care. = *a,e been mean+ng (o con(ac( a re/earc*er +n -+e(ar7 nu(r+en(/ an- +mmunolog7 1/*eE/ +n (*e UN6 on (*+/ /ub0ec(< bu( +( *a/ been near (*e bo((om o. m7 @r+or+(7 l+/( 1worF an- gra/c*ool are on (o@6. ElB+ AolF< SSSR HTo be +n (*e /(a(e o. E*ambre -el almaE< a /(ar,e- /oul< +/ (o be ma-e relen(le//l7 *ungr7.H

From owner-lowcarb@MAELSTROM.STJOHNS.EDU Mon Jan 1! 1%#%'#31 !!! Re(urn-)a(*# owner-lowcarb@MAELSTROM.STJOHNS.EDU Rece+,e-# .rom mael/(rom./(0o*n/.e-u 1mael/(rom./(0o*n/.e-u 213&."4.1. 356 b7 omen.omen.com 14.4.%8S9O%6 w+(* ESMT) +- )AA!'&!1 .or ; Mon< 1! Jan !!! 1%#%'#$& -!4!! 1)ST6 Me//age-=-# > !!!!11! $%'.)AA!'&!1@omen.omen.com? Rece+,e-# .rom mael/(rom./(0o*n/.e-u 113&."4.1. 36 b7 mael/(rom./(0o*n/.e-u 1LSMT) .or O@enAMS ,1.1a6 w+(* SMT) +- >!.!1A9D D!@mael/(rom./(0o*n/.e-u?; Mon< 1! Jan !!! 14#%'# & -!%!! Da(e# Mon< 1! Jan !!! 14#%1#$1 -!%!! Re@l7-To# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on Sen-er# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on From# Dana 9ar@en-er Sub0ec(# Re# +mmune /7/(em To# LOC9ARD@MAELSTROM.STJOHNS.EDU S(a(u/# RO Au(oma(+c -+ge/( @roce//or wro(e# =/ (*ere an7 non-anec-o(al -a(a on (*+/J H9ol-/H are ,ague (*+ng/< an-

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? c*+-ren6. An- al/o *a,e -e,elo@e- +mmun+(+e/ (o man7 o. (*e common /(ra+n/ o. col-. S(+ll< m7 /ub0ec(+,e eG@er+ence +/ (*a( = ca(c* le// /(u.. /+nce =E,e gone low carb. )o//+bl7 u/e.ul -a(a @o+n(/< .rom W:e( (*e Sugar Ou(W b7 Ann Lou+/e :+((leman< M.S.< 9.N.S.# HSugar +/ a Fnown +mmuno/u@@re//an(. T*+/ +/ .r+g*(en+ng con/+-er+ng (*a( our ab+l+(7 (o w+(*/(an- all -+/ea/e/ 1.rom (*e common col- (o A=DS6 -e@en-/ on *a,+ng an ac(+,e< *eal(*7 +mmune /7/(em. No ma((er w*a( .orm +( (aFe/< /ugar @aral7Be/ (*e +mmune /7/(em +n a ,ar+e(7 o. wa7/# 1. =( *a/ been @ro,en (o -e/(ro7 (*e germ-F+ll+ng ab+l+(7 o. w*+(e bloocell/ .or u@ (o .+,e *our/ a.(er +nge/(+on. . =( re-uce/ (*e @ro-uc(+on o. an(+bo-+e/< @ro(e+n/ (*a( comb+ne w+(* an+nac(+,a(e .ore+gn +n,a-er/ +n (*e bo-7. $. =( +n(er.ere/ w+(* (*e (ran/@or( o. ,+(am+n 9< one o. (*e mo/( +m@or(an( nu(r+en(/ .or all .ace(/ o. +mmune .unc(+on. 3. =( cau/e/ m+neral +mbalance/ an- /ome(+me/ allerg+c reac(+on/< bo(* o. w*+c* weaFen (*e +mmune /7/(em. %. =( neu(ral+Be/ (*e ac(+on o. e//en(+al .a((7 ac+-/< (*u/ maF+ng cell/ more @ermeable (o +n,a/+on b7 allergen/ an- m+croorgan+/m/. -Dana C. 9ar@en-er

From owner-lowcarb@MAELSTROM.STJOHNS.EDU Mon Jan $1 14#34#3$ !!! Re(urn-)a(*# owner-lowcarb@MAELSTROM.STJOHNS.EDU Rece+,e-# .rom mael/(rom./(0o*n/.e-u 1mael/(rom./(0o*n/.e-u 213&."4.1. 356 b7 omen.omen.com 14.4.%8S9O%6 w+(* ESMT) +- SAA11%'3 .or ; Mon< $1 Jan !!! 14#34#31 -!4!! 1)ST6 Me//age-=-# > !!!! !1! 34.SAA11%'3@omen.omen.com? Rece+,e-# .rom mael/(rom./(0o*n/.e-u 113&."4.1. 36 b7 mael/(rom./(0o*n/.e-u 1LSMT) .or O@enAMS ,1.1a6 w+(* SMT) +- >13."3F1E$&'@mael/(rom./(0o*n/.e-u?; Mon< $1 Jan !!! 1#34#$4 -!%!! Da(e# Mon< $1 Jan !!! !#!'#1% -!%!! Re@l7-To# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on Sen-er# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on From# Leanne R+-le7 Sub0ec(# S(u-7 re# +n/ul+n an- :H re/@on/e To# LOC9ARD@MAELSTROM.STJOHNS.EDU S(a(u/# RO = .+gure- (*a(< w+(* (*e recen( -+/cu//+on/ concern+ng grow(* *ormone< (*+/ recen( /(u-7 woul- be o. +n(ere/(# Leanne R+-le7 SSSSSSSSSSSSSSSSSSSSSSSSSSSSSS T+(le

Ele,a(e- +n/ul+n le,el/ con(r+bu(e (o (*e re-uce- grow(* *ormone 1:H6 re/@on/e (o :H-relea/+ng *ormone +n obe/e /ub0ec(/. Au(*or LanB+ R ; LuB+ L ; 9aumo A ; An-reo((+ A9 ; ManBon+ MF ; Mal+g*e((+ ME ; Seren+ L) ; )on(+rol+ AE A--re// =/(+(u(o Sc+en(+.+co San Ra..aele< D+,+/+one -+ Me-+c+na =n(erna< Un+(Ya -+ D+o+ngegner+a< Un+,er/+(Ya -egl+ /(u-+ -+ M+lano< M+lan< =(al7. Source Me(abol+/m< 341&6#11% -" 1&&& Se@ Ab/(rac( Ce *a,e recen(l7 @re/en(e- eG@er+men(al e,+-ence +n-+ca(+ng (*a( +n/ul+n *a/ a @*7/+olog+c +n*+b+(or7 e..ec( on grow(* *ormone 1:H6 relea/e +n *eal(*7 *uman/. T*e a+m o. (*e @re/en( /(u-7 wa/ (o -e(erm+ne w*e(*er +n obe/+(7< w*+c* +/ c*arac(er+Be- b7 *7@er+n/ul+nem+a an- blun(e- :H relea/e< +n/ul+n con(r+bu(e/ (o (*e :H -e.ec(. To (*+/ a+m< we u/e- a /+m@l+.+e- eG@er+men(al @ro(ocol @re,+ou/l7 u/e- +n *eal(*7 *uman/ (o +/ola(e (*e e..ec( o. +n/ul+n b7 remo,+ng (*e +n(er.erence o. .ree .a((7 ac+-/ 1FFA/6< w*+c* are Fnown (o blocF :H relea/e. S+G obe/e /ub0ec(/ 1.our men an- (wo women; age< $!.4 P8%. 7ear/; bo-7 ma// +n-eG< $".4 P8- .4 Fg8m 2mean P8- SE56 an- /+G normal /ub0ec(/ 1.our men an- (wo women; age< %.4 P8- 1.& 7ear/; bo-7 ma// +n-eG< .' P8- 1.1 Fg8m 6 rece+,e- +n(ra,enou/ 1+.,.6 :H-relea/+ng *ormone 1:HRH6 !." m+crog8Fg un-er (*ree eG@er+men(al con-+(+on/# 116 +.,. !.&R Na9l +n.u/+on an- oral @lacebo< 1 6 +.,. !.&R Na9l +n.u/+on an- oral ac+@+moG< an an(+l+@ol7(+c agen( able (o re-uce FFA le,el/ 1 %! mg a( " an*our/ be.ore :HRH6< an- 1$6 eugl7cem+c-*7@er+n/ul+nem+c clam@ 1+n/ul+n +n.u/+on ra(e< !.3 mU G Fg1-16 G m+n1-166. A/ eG@ec(e-< a.(er @lacebo< (*e :H re/@on/e (o :HRH wa/ lower .or obe/e /ub0ec(/ ,er/u/ normal/ 1344 P8- 1$& , 1<'%% P8- 31 m+crog8L G 1 ! m+n< ) > .!%6. Ac+@+moG marFe-l7 re-uce- FFA le,el/ an- @ro-uce- a m+l- re-uc(+on o. +n/ul+n le,el/; un-er (*e/e con-+(+on/< (*e :H re/@on/e (o :HRH wa/ +ncrea/e- +n bo(* grou@/< rema+n+ng lower +n obe/e ,er/u/ normal /ub0ec(/ 11<43 P8- $"! , 3<4'1 P8- 1< 4" m+crog8L G 1 ! m+n< ) > .!%6. =n bo(* grou@/< +n/ul+n +n.u/+on 7+el-e+n/ul+n le,el/ u/uall7 ob/er,e- un-er @o/(@ran-+al con-+(+on/ an- re-ucec+rcula(+ng FFA (o (*e le,el/ ob/er,e- a.(er ac+@+moG a-m+n+/(ra(+on. Aga+n< (*e :H re/@on/e (o :HRH wa/ lower .or obe/e /ub0ec(/ ,er/u/ normal/ 1$4! P83! , 1<!'% P8- !" m+crog8L G 1 ! m+n< ) > .!%6< an- +n bo(* grou@/< +( wa/ /+gn+.+can(l7 lower (*an (*e corre/@on-+ng re/@on/e a.(er ac+@+moG. =n obe/e /ub0ec(/< a/ @re,+ou/l7 re@or(e- +n normal/< (*e :H re/@on/e (o :HRH wa/ +n,er/el7 correla(e- w+(* (*e mean /erum +n/ul+n 1r Q -.'!< ) > .!16. =n conclu/+on< our -a(a +n-+ca(e (*a( +n (*e obe/e< a/ +n normal /ub0ec(/< (*e :H re/@on/e (o :HRH +/ a .unc(+on o. +n/ul+n le,el/. T*e .+n-+ng (*a( a.(er bo(* (*e ac+@+moG (rea(men( an- (*e +n/ul+n clam@ (*e obe/e /(+ll /*ow *+g*er +n/ul+n le,el/ an- a lower :H re/@on/e (o :HRH (*an normal /ub0ec(/ /ugge/(/ (*a( *7@er+n/ul+nem+a +/ a ma0or -e(erm+nan( o. (*e re-uce- :H relea/e a//oc+a(e- w+(* obe/+(7. Language Eng Un+Lue =-en(+.+er &&3114%'

From owner-lowcarb@MAELSTROM.STJOHNS.EDU T*u Feb 1' 14#$4#%4 !!! Re(urn-)a(*# owner-lowcarb@MAELSTROM.STJOHNS.EDU Rece+,e-# .rom mael/(rom./(0o*n/.e-u 1mael/(rom./(0o*n/.e-u 213&."4.1. 356 b7 omen.com 14.4.%8S9O%6 w+(* ESMT) +- SAA!''33 .or ; T*u< 1' Feb !!! 14#$4#%" -!4!! 1)ST6 Me//age-=-# > !!!! 14! $4.SAA!''33@omen.com? Rece+,e-# .rom mael/(rom./(0o*n/.e-u 113&."4.1. 36 b7 mael/(rom./(0o*n/.e-u 1LSMT) .or O@enAMS ,1.1a6 w+(* SMT) +- >!.DF' '&4A@mael/(rom./(0o*n/.e-u?; T*u< 1' Feb !!! 1#$&#!$ -!%!! Da(e# T*u< 1' Feb !!! 13# 1#1" P!1!! Re@l7-To# we+g*(lo//.gu+-e@abou(.com Sen-er# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on From# Tan7a V+lber(er Organ+Ba(+on# Abou(.com Sub0ec(# Re# H+g* LDL Xue/(+on To# LOC9ARD@MAELSTROM.STJOHNS.EDU S(a(u/# R -----Or+g+nal Me//age----?a/ T:L goe/ -own< /o -oe/ (*e amoun( o. /mall< -en/e LDL +n (*e ?o,erall LDL .rac(+on. =( +/ /(+ll -+/@u(e-< *owe,er< w*e(*er (*e ?/mall< -en/e LDL +/ an +n-e@en-en( r+/F .ac(or .or *ear( -+/ea/e. ?To-- Moo-7 HA ,er7 low-.a( -+e( +/ no( a//oc+a(e- w+(* +m@ro,e- l+@o@ro(e+n @ro.+le/ +n men w+(* a @re-om+nance o. large< low--en/+(7 l+@o@ro(e+n/.H 1A J 9l+n Nu(r. "&1$6#311-4< 1&&&6 --

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/u@@lemen(/< .+/* o+l /u@@lemen(/ an- ! m+nu(e/ o. eGerc+/e a( lea/( (*ree (+me/ @er weeF. O,er .our mon(*/ on (*e -+e(< (*e @ar(+c+@an(/ lo/( an a,erage o. 1.$ @oun-/< an- /*owe- a ".1R -ro@ +n c*ole/(erol< an- almo/( a 3!R -ro@ +n (*e le,el o. (r+gl7cer+-e/ +n (*e+r bloo-. =n a--+(+on< (*e+r HDL le,el/ +ncrea/e- b7 abou( 'R. =n a @re// relea/e< (*e re/earc*er/ al/o /a7 (*a( (*e+r /(u-7 -+- no( .+n- an7 o. (*e /a.e(7 concern/ ,o+ce- b7 (*e Amer+can D+e(e(+c A//oc+a(+on< /uc* a/ @o(en(+all7 -angerou/ e..ec(/ on l+,er an- F+-ne7 .unc(+on. H=n .our /*or( mon(*/ on (*e A(F+n/ D+e(< we were able (o con.+rm /c+en(+.+call7 w*a( Dr. A(F+n/ /(a(e/ *e *a/ /een +n *+/ @rac(+ce o,er (*e @a/( -eca-e/. T*e -+e( lower/ c*ole/(erol an- (r+gl7cer+-e/ an- ra+/e/ HDL... w*+c* ma7 re@re/en( an en(+rel7 new a@@roac* (o (*e con(rol an- @re,en(+on o. *ear( -+/ea/e<H /a+lea- re/earc*er Dr. Er+c 9. Ce/(man< a//+/(an( @ro.e//or o. me-+c+ne a( Nor(* 9arol+naE/ DuFe Un+,er/+(7. T*e /(u-7 +/ con(+nu+ng +n or-er (o a//e// (*e long-(erm e..ec(/ o. (*e -+e(. Re@or(+ng (*e re/ul(/ o. (*e /econ- /(u-7< 9ole((e He+mow+(B< -+rec(or o. nu(r+(+on a( (*e A(F+n/ 9en(er +n New OorF< /a+- (*a( +( wa/ ba/e- on $1& o,erwe+g*( or obe/e @a(+en(/ (rea(e- a( (*e 9en(er .or a( lea/( a 7ear. =n,e/(+ga(or/ collec(e- +n.orma(+on on we+g*(< bloo- @re//ure< c*ole/(erol< F+-ne7 an- l+,er .unc(+on an- o(*er @arame(er/ -ur+ng (*e /(u-7. HC*a( we .oun+/ w*a( we alrea-7 Fnew .rom anec-o(al -a(a<H He+mow+(B (ol- Reu(er/ Heal(* +n an +n(er,+ew a.(er (*e mee(+ng on Fr+-a7. H T*ere were /ome @re((7 +m@re//+,e bene.+(/ +n bo-7 com@o/+(+on< HDL le,el/ wen( u@< LDL le,el/ wen( -own an- bloo- @re//ure -ecrea/e-<H /*e re@or(e-. C*ere HDL +/ (*e goo- c*ole/(erol .or +(/ a//oc+a(+on w+(* re-uce- *ear( r+/F< LDL *a/ earne- (*e name o. be+ng (*e Hba-H c*ole/(erol becau/e *+g* le,el/ are a//oc+a(e- w+(* *ear( -+/ea/e. HCe now *a,e -a(a .or (*e /c+en(+.+c commun+(7H on (*e *eal(*.ul bene.+(/ o. (*e A(F+n/ -+e(< He+mow+(B a//er(e-. T*e A(F+n/ -+e( /e,erel7 re/(r+c(/ carbo*7-ra(e +n(aFe (o +n-uce a /(a(e o. Fe(o/+/< or me(abol+c /(ar,a(+on. D+e(er/ are encourage- (o mea/ure ur+nar7 Fe(one eGcre(+on a/ an +n-+ca(+on o. *ow e..ec(+,e (*e -+e( +/ +n +n-uc+ng .a( breaF-own. HNe(o/+/ +/ a ben+gn b7@ro-uc( o. .a( burn+ng<H He+mow+(B a//er(e-. HC+(* an a-eLua(e @ro(e+n an- .a( +n(aFe< (*ere +/ no lo// o. mu/cle ma//...T*ere +/ no c*ange +n 1bloo-6 @H +. (*e -+e( +/ @ro@erl7 -one<H /*e /a+-. Howe,er (*e -+e( +/ no( .or e,er7one< He+mow+(B warne-. H=(E/ .or (*o/e w*o nee- a correc(+on +n (*e+r /ugar an- carbo*7-ra(e me(abol+/m...Ce encourage 1,+(am+n6 /u@@lemen(a(+on an- an +n(aFe o. Egoo-E .a(/< /uc* a/ .+/* o+l<H He+mow+(B commen(e-. L+B H. TTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTT Ma+l(o#lolla@/F./7m@a(+co.ca

From owner-lowcarb@MAELSTROM.STJOHNS.EDU Mon Feb 4 1'#$$#$$ !!! Re(urn-)a(*# owner-lowcarb@MAELSTROM.STJOHNS.EDU Rece+,e-# .rom mael/(rom./(0o*n/.e-u 1mael/(rom./(0o*n/.e-u 213&."4.1. 356 b7 omen.com 14.4.%8S9O%6 w+(* ESMT) +- RAA!11'4 .or ; Mon< 4 Feb !!! 1'#$$#$1 -!4!! 1)ST6 Me//age-=-# > !!!! &!1$$.RAA!11'4@omen.com? Rece+,e-# .rom mael/(rom./(0o*n/.e-u 113&."4.1. 36 b7 mael/(rom./(0o*n/.e-u 1LSMT) .or O@enAMS ,1.1a6 w+(* SMT) +- >$.&1D!$1E4@mael/(rom./(0o*n/.e-u?; Mon< 4 Feb !!! !#$$#3$ -!%!! Da(e# Mon< 4 Feb !!! !# 4#$1 -!%!! Re@l7-To# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on Sen-er# Low-9arbo*7-ra(e Tec*n+cal D+/cu//+on From# A@r+l C+llmore Sub0ec(# Re# ca(/ an- gra+n -+e(/ wa/ AnG+e(7 an- De@re//+on To# LOC9ARD@MAELSTROM.STJOHNS.EDU S(a(u/# RO l+/(member wro(e# ? 1:ro,er6 wa/ ? *7@er(*7ro+-< an- (*e ,e( (ol- me (*a( w*en /o7 @ro-uc(/ are @r+mar7 +n ca( ? .oo-< /ome ca(/ w+ll -e,elo@ *7@er(*7ro+-+/m. An- w*en ca(/ are .e- a commerc+al .oo- *+g* +n r+ce8o(*er gra+n/< (*e7 ge( -+abe(e/. :o .+gureI 19a(/ are< a.(er all< carn+,ore/.6 = -onE( un-er/(an*ow e-uca(e- +n-+,+-ual/ l+Fe ,e(/ are /o bra+nwa/*e- +n(o recommen-+ng (*e ma0or commerc+al @ro-uc(/< all o. w*+c* are @r+mar+l7 carb/. E,en (*e one/ (*a( /a7< Hour U1 +ngre-+en( +/ mea( 1or @ro(e+n6H *a,e (*ree F+n-/ o. corn .ollow+ng (*e U1 +ngre-+en(< mea(< /o (*a( w*en 7ou looF a( (*e o,erall maFe-u@ o. (*e .oo-< +( +/ a *+g* @ercen(age o. carbo*7-ra(e. 1=. +( /eem/ = am @o/(+ng a -+/@ro@or(+ona(el7 *+g* number o. e-ma+l/< = 0u/( came o.. a "-weeF a//+gnmen(< /o *a,e a l+((le (+me (o wr+(e. T*+/ commerc+al -og an- ca( .oo- +//ue +/ a @e( @ee,e o. m+ne.6 A@r+l

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