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LIQUID DIETS AND FASTS -Are liquid diets a good way to lose weight?- They're probably not the best answer for most people, since slurping down a high-protein, low-fat, minimal calorie, blenderized concoction doesn't do much to teach you the new, healthier eating habits that you'll need to maintain your weight loss. These diets can also be expensive--an average of US$2,000-3,000 for a medically-supervised six month plan--especially in light of the fact that the "food" you're paying for isn't much more than dried egg whites (an excellent source of protein) and flavoring. Although nearly all liquid diet programs include classes to help participants ease back into eating regular food and to maintain their weight loss, the ratio of clients who actually maintain their new weight for long periods is low. On the other hand, some obese people have found that the fast, steady weight loss and ease of such diets (there's no need to plan menus) can help them lose significant amounts of weight for the first time in their lives. Liquid diets can succeed, but only if those who use them are dtermined to adopt healthy eating habits once the diet is over. -Is fasting a good way to lose weight?- No. Prolonged fasts can cause serious harm by depleting the levels of protein, calcium, phosphorus, sodium, and potassium in your body. Fasting can also cause toxic levels of ketone bodies (compounds produced when body fats are broken down) to accumulate in the bloodstream, despite the popular belief that fasting is a good way to "cleanse the system." On the other hand, short (1-2 day), occasional (no more than once every few weeks) fasts do not appear to be harmful to most healthy people. [The previous sentence is intended as recognition of the fact that many people fast for religious or spiritual reasons; it is not intended to encourage fasting, however briefly, or weight loss purposes.--kbc] WEIGHT LOSS ORGANIZATIONS, PLANS, AND DIET BOOKS NOTE: Mention of an organization, weight loss plan, or diet does not imply an endorsement of that organization, plan, or diet. -How does Weight Watchers work?- Weight Watchers is a commercial diet organization that offers a variety of eating plans and aids for weight loss. Members who follow the selection plan (an exchange-type plan) are allowed to consume a certain number of servings from each selection group (breads, fruits/vegetables, proteins/dairy, and fats) each day. For example, if you've chosen to eat five bread selections per day, you can choose five servings of any item categorized as a "bread," be it whole wheat bread, rice, a corn tortilla, or any of the other foods that fall into the bread group. The number of selections you consume per group per day depends on how fast you wish to lose weight; the program recommends a maximum loss of 2 pounds per week. The selection plan allows members to stray from the plan occasionally to accommodate special foods or events, and a "Weekends Off" option permits less regulated eating on weekends in exchange for smaller portions through the rest of the week. The Weight Watchers 123 Success Plan was started in the US on August 24th, 1997. It gives all of the foods you eat a certain amount of points. You eat the foods, add up the points and you are done for the day. Everybody is given a different point range depending on their starting weight. They do give you some nutritional guidelines, such as drinking 6, 8-oz glasses of water a day, eating 5 fruits and vegtables, and having 2 milk products a day. You are encouraged to do at least 20 minutes of exercise a day, and for every 20 minutes after that, you can "earn" another point for your daily total. You can carry unused points, (also known as "Banking your points") from one day to the next.. But only after-you have consumed your minimum points allocated for the day, in your point range are you allowed to bank these unused points. If you don't use them by the end of the week, you lose them. You are given a "sliding scale" that helps determine point values for all foods with a nutritional label depending on fat grams, fiber and calories. They have new cookbooks, a "points manager" calculator to help figure out points, and other products to help make the plan even easier. There has been a really positvie response to this plan because of the flexibility. Members are happy because they can eat what they want, within reason, and not worry as much about getting all of their fat, protein, and bread selections each day. They just need to make sure they don't go above their point allotment for the day. The old plan "Fat and Fiber" was added in December 1994. Under this plan, members are instructed to limit fat intake to between 15 and 35 grams daily (men and youths can go up to 45 g/day), eat between 20-60 grams of fiber daily, consume a minimum of 2 servings of dairy foods daily (3 servings for youths), eat at least 5 servings of fruits and vegetables daily, and limit intake of refined sugars and alcoholic beverages. WW markets several types of processed foods, which are not necessarily lower in calories than "regular" or other diet plan products, but are designed to fit easily into the WW program; use of the WW brand foods is completely optional. WW encourages moderate exercise in combination with the diet plan. Each member sets his or her own goal weight based on a height/weight chart compiled by WW from several sources. A big part of the WW plan is weekly meetings, which feature a "weigh in" for each member (your weight is revealed only to you and the person doing the weighing, not to the rest of the group) and various activities such as motivational videos, discussions, distribution of program materials and recipes, etc. Members who attain their goal weights become "lifetime members," and can attend meetings for free so long as they maintain their new weights. There is an initial membership fee (~US$15-20, but low-cost or free specials are frequent), plus a fee for each meeting attended (~US$9-12). The June 1993 isse of "Consumer Reports" reported that the average cost for several months' participation in WW is approximately US$110. Weight Watchers has a Web site at http://www.weight-watchers.com/. There is also a Weight Watchers mailing list, run by Michele Coleman (firstname.lastname@example.org or email@example.com), which is intended as a friendly place for people following the Weight Watchers plan to exchange support and suggestions. To subscribe to the list, send an e-mail message to firstname.lastname@example.org, and put the command "subscribe ww-support email@example.com" (without the quotes) on a line by itself in the body of the message. -How does Jenny Craig work?- The JC program combines a diet of frozen and shelf-stable pre-packaged foods with one-on-one counseling, independent homework (which includes instructional workbooks and video tapes, and motivational audio tapes) and group classes on behavior modification. Participants initially purchase most of their food, particularly entrees, from JC; these foods are supplemented with regular (grocery store) foods such as dairy products and fresh vegetables. As the diet progresses, the ratio of JC foods to regular foods is gradually lowered. There are different menu plans (regular, no red meat, vegetarian) available. The prepackaged foods are intended to teach participants about portion control while freeing them from the necessity of weighing, measuring, and preparing food. The behavior modification classes are supposed to teach participants how to make healthy food choices once they've been weaned off the JC foods. (A maintenance program is available for those who've reached the goal weights that they've chosen for themselves; goal weights should not fall below those on a standard height/weight chart.) Exercise is encouraged. There is an initial registration fee (one a.s.d member reported a US$19 sign-up fee); the cost of the JC food averages US$60-70 per week. -How does Nutri/System work?- N/S is very similar to the Jenny Craig plan in format and price--it provides prepackaged foods (shelf-stable only, no frozen foods), individual counseling sessions, and group classes. Nutri/System has a Web site at http://www.nutrisystem.com/. -How does Overeaters Anonymous work?- OA is a 12-step program, very similar to Alcoholics Anonymous, designed for people who consider themselves compulsive overeaters, who believe that they are powerless over food and that their lives are unmanageable. (Not all members are overweight; some suffer from other eating disorders such as bulimia.) Members are encouraged to turn their lives over to a "higher power" (be it a personal deity or the strength of the group), to form a relationship with a "sponsor" (another OA member who provides one-on-one support), to give up "problem foods" permanently (as an alcoholic gives up alcohol), and to attend OA meetings regularly (daily, weekly or monthly) for the rest of their lives. OA does not advocate any specific diet plan; members who are interested in better nutrition are urged to seek qualified professional advice. (Note: One a.s.d reader reports that some OA groups are offshoots of various eating disorder clinics, and that some such groups do advocate specific diets which may not conform with current standards of effectiveness and safety.) There are no dues or fees, although donations are welcome. As with AA, members' anonymity is preserved; first names only are used during meetings. -How does TOPS work?- TOPS ("Take Off Pounds Sensibly") is an international, non-profit weight loss support group. TOPS does not advocate any particular food plan, but rather encourages members to consult their physicians for individually tailored diets. The TOPS philosophy includes weekly meetings at which members are weighed in (amounts lost or gained are publicly announced, although members' actual weights are not announced), using food diaries to track your daily intake, awards of non-fattening gifts from other group members for the person who loses the most each week, small monetary penalties (e.g., US$0.05-0.50) for those who gain weight, etc. TOPS encourages lifetime membership to keep the pounds from creeping back on; their maintenance program is known as KOPS ("Keep Off Pounds Sensibly"). One a.s.d reader reports that TOPS membership fees are US$16/year for the first two years, US$14/year thereafter; there are also weekly fees (usually a few dollars, but this varies from chapter to chapter). TOPS' official Web site is at http://www.tops.org/. Rick Stonehouse, a TOPS member, also maintains an unofficial TOPS Web site at http://www3.ns.sympatico.ca/stoner/tops.html. -How does "Stop the Insanity" work?- "Stop the Insanity" is a program promoted by Susan Powter, a trim, assertive, crewcut blond who formerly weighed 260 pounds. According to her 30-minute infomercial, the program is based on the principles that: a) diets don't work, b) you can lose weight by eating high volumes of low-fat foods, and c) you must exercise to burn fat and adequately oxygenate all parts of your body. Ms. Powter shuns the concept of weighing, advocating instead measuring your body fat percentage (using calipers provided with the program materials) and tracking weight loss progress in terms of how many clothing sizes you lose. The program materials consist of audio tapes, booklets, and videotapes that discuss deciphering food labels, exercise techniques, and motivational tips. The current cost of the program is about US$80. -What is the Carbohydrates Addict's diet?- The premise of this diet is that there are people who, for biological reasons, develop unmanageable cravings for carbohydrates which can lead to weight gain. The authors believe that this results from an overproduction of insulin, impairing glucose metabolism, and an insufficient rise of brain serotonin, responsible for the feeling of satiety. The objective of the diet is to control insulin release by minimizing the carbohydrate consumption which triggers it. The basic daily diet consists of two carbohydrate-restricted meals, and one "reward" meal which must be consumed within 60 minutes, but at which you may eat absolutely anything. At the restricted meals, you eat standard portions of such foods as eggs, fish, meat, cheese, salads and most non-starchy vegetables. The general rule of thumb for restricted meals is that an allowable food contains no more than 4 grams of carbohydrate per standard serving. Some surprises among the foods not allowed at these meals include fruits, broccoli, milk and yogurt. No snacks are permitted. Depending on the foods you select, the diet can be compatible with the standard recommendations for healthy eating (low-fat, high-fiber, etc.). The authors recommend a weight loss of no more than two pounds per week. Guidelines suggest variants on the diet based on how much weight you have lost in the past week, and what your goals are for the following week. A short paper and pencil test helps you determine if you are a carbohydrate addict. There are currently three books in the Carbohydrate Addict series, all by Rachael and Richard Heller: The Carbohydrate Addict's Diet, The Carbohydrate Addict's Gram Counter, and The Carbohydrate Addict's Program for Success. The first (and most useful) contains the theory, the diet, lists of foods permitted and not permitted for the restricted meals, recipes, and a host of success stories. The second is a small handbook with an itemized list of foods, identifying those believed to trigger addictive behaviors in carbohydrate addicts, which expands somewhat on the original material. The third book is a workbook with more success stories and general dieting tips, but no obvious new news. -What is Dr. Atkins' diet?- The Atkins diet is something of a precursor to the Carbohydrate Addict's Diet in that it advocates unrestricted amounts of protein and fat, but restricted carbohydrate intake. The diet was developed by Robert C. Atkins, M.D.; he published a book about the diet in the 1970's, and has recently released a new book titled The New Diet Revolution. According to Dr. Atkins, many people react unfavorably to carbohydrates by overproducing insulin, which causes the body to retain excess fat. Therefore, carbohydrates are held to an absolute minimum (in contrast to CAD, which allows the consumption of reasonable amounts of carbohydrates, but only during one meal per day). The goal on the Atkins' diet is to get your body into a state of ketosis, a condition in which the body burns stored fat, rather than carbohydrates, for fuel. The presence or absence of ketosis can be determined by testing your urine with Ketostix, which are readily available at drugstores. Dr. Atkins has a Web site at http://www.atkinscenter.com/. There are multiple mailing lists and Web sites devoted to the discussion of CAD, Atkins, and other restricted carbohydrate diets; please see the Mailing Lists and World Wide Web sites sections. -What is the Zone diet?- The Zone diet is described by Barry Sears, Ph.D., in his book The Zone: A Dietary Road Map. It recommends balancing one's intake of protein, carbohydrates, and fat so that, along with every 7 grams of protein, 9 grams of carbohydrates and 3 grams of fat are eaten. Carbs contribute about 40% of total calories on the diet, while fats and proteins each contribute about 30% of the calories. (This varies from current dietary recommendations from the American Heart Association and similar groups, which recommend 30% of calories from fat, 55-65% calories from carbohydrates, and 10-15% of calories from protein.) Serious athletes are advised to ingest 4.5 grams of fat for each 7 grams of protein, resulting in a diet in which approximately 40% of calories are supplied by fat. Sears believes that the diet, which restricts calories, carbohydrates, and saturated fats, and limits protein to the amount required for the individual (which depends on the individual's lean body mass and activity level) prevents excess formation of insulin and leads to optimum mental and physical performance (i.e., "being in the Zone"). The goal of the diet is to switch the body's metabolism from a carbohydrate-burning mode to a fat-burning mode. There are a number of Internet-based resources on the Zone diet, including a variety of Web pages and a mailing list. Russell Swan's Zone page (http://www.cs.umass.edu/~swan/zone.html) provides a list of pointers to other pages. To subscribe the Zone diet mailing list, send an e-mail message to firstname.lastname@example.org, and put the command "subscribe zone" (without the quotes) on a line by itself in the body of the message. -What is the "TJ Soup diet" (a.k.a. "The Sacred Heart Hospital Diet" or "Cabbage Soup Diet")?- The "TJ Soup" diet (also known as the "Sacred Heart Hospital Diet" or "Cabbage Soup Diet") purports to take off 10-17 pounds within one week through the use of a "miracle" vegetable soup, along with a strict rotating diet of fruits and vegetables, meat, and brown rice. The soup may be eaten as often as desired. Alcohol, carbonated drinks (including those made with artificial sweeteners), and fried foods are not allowed. Although the diet is adequate in vegetables (from the soup) and features fruit on several days, it is not well balanced. Day 5, for example, calls for 10-20 ounces of beef or skinless chicken, 6 tomatoes, and the soup. Aside from brown rice on the 7th day, no grains are permitted. Dairy products, which many women use to increase their calcium intake, are not allowed except on day 4, when you're supposed to consume 8 glasses of skim milk (along with 6 bananas and the soup). While you probably can lose weight on this diet, you should keep in mind that: 1) the first several pounds lost on any dit are usually water weight, not fat, and 2) almost any diet which forbids you to eat your usual foods will cause at least temporary weight loss. Although this diet has been repeatedly linked with one hospital or another (allegedly recommended for heart patients awaiting surgery), it is highly unlikely that any reputable medical practitioner or organization would recommend such a diet. (Check out the American Heart Association's position on this and other fad diets at http://www.amhrt.org/pubs/phoney.html.) The full text of the diet is available via WWW at http://kxan.com/special.html for the insatiably curious. DIET AIDS (PILLS, ETC.) -I've heard about several weight loss aids like herbal teas, "fat-burning" pills, etc. Do any of these work?- Some of the non-prescription drugs can temporarily cause your weight to drop, but not because they're eliminating excess fat from your body. Most over-the-counter "diet aids" contain stimulants, which hike up your central nervous system and decrease your appetite, and/or mild diuretics which cause you to eliminate fluids (by urination) more quickly than normal. The stimulants can cause unpleasant side effects such as dizziness and nausea, and the diuretics can make it difficult for you to get too far away from a bathroom. And as soon as you go off the pills, your weight bounces right back up to its previous level, making such nostrums useless for long-term weight loss. -What about prescription drugs (phentermine, fenfluramine)?- On September 15, 1997 the perscription weight loss aids redux and fenfluramine were recalled by their manufactureers afte the FDA reccomendeed a that anyone who is taking them stop and consult with their doctors. Phentermine, is not affected by the withdrawal, but patients could no longer use the combination. The FDA asked manufacturers to withdraw the drugs after reviewing the records of 291 patients and found 30 percent had abnormal echocardiograms -- a test that shows doctors how the heart is functioning -- even though they had no symptoms yet. Some 92 patients had problems with their aortic or mitral heartvalves, the data showed. The FDA said the numbers were much higher than it had expected, prompting the agency to recommend stopping salesof the drugs. The withdrawal comes after doctors at the Mayo Clinic announced inJuly they had discovered 24 cases of a rare heart valve defect inwomen who took fen-phen. The FDA later announced that it had received 66 additional reports ofthis dangerous valve disorder, including some that were also seen inpatients taking Redux. These prescription weight loss aids had show somewhat more promise than the non-prescription nostrums. Fenfluramine (marketed as "Pondimin") suppresses appetite by acting on the brain chemical serotonin. Phentermine (marketed as "Ionamin") is an amphetamine-type stimulant and appetite depressant. The two drugs are often used in combination with each other in order to provide more effective weight control while minimizing side effects; a study on the combined effects of the drugs is available at http://www.weight.com/nongifphenfen.html. The newest addition to the pharmacological weight-loss arsenal is Redux (dexfenfluramine), which is essentially the active portion of fenfluramine and is used in smaller doses than fenfluramine. Studies indicate that these drugs do cause weight loss in many people, but they can also cause side effects: nervousness, dry mouth, rapid or irregular heartbeat, etc., in the case of phentermine, while fenfluramine and dexfenfluramine can cause dry mouth, sleep disturbances, diarrhea, depression, etc., and have been associated with a few cases of a serious condition known as pulmonary hypertension. Participants in studies of these drugs gradually regained the weight they'd lost when they stopped taking the medication. Additional information on prescription drugs used in weight control and the recall of redux and phenfluramine can be found at http://pharminfo.com/pubs/msb/obesity.html and http://pharminfo.com/pubs/msb/seroton.html. Barbara Hirsch (email@example.com) maintains a very comprehensive list of medication-related links on her Phen/Fen Web site at http://www.vais.net/~bhirsch/phenfen.htm. There is also a newsgroup, alt.support.diet.rx, which is devoted to the discussion of medications used in weight control. -Do I need to take a supplement (vitamin/mineral pill) while dieting?- A balanced diet (see "Food Pyramid") which is low in fats, sugars, and alcohol and is adequate in calories (no fewer than 1,200 cal/day for women, 1,400 cal/day for adolescent girls, 1,600 cal/day for men) may contain sufficient vitamins and minerals to meet the FDA's recommended Daily Value. However, not many of us meet those requirements every day, and some physicians and researchers feel that the FDA's recommendations regarding many vitamins and minerals are too low to promote optimal health. (The recommended Daily Values are intended to prevent deficiency-related diseases such as scurvy and pellagra; they do not necessarily reflect the amount of a vitamin or mineral needed to sustain an adequate reserve against illness or injury.) If you do decide to take a vitamin/mineral supplement as insurance against an inadequate diet, you should look for a brand which contains a variety of vitamins and minerals, and keep in mind that excesses (amounts greater than 100% of the FDA's recommended Daily Value) of certain vitamins and minerals, in particular Vitamin A and iron, can be toxic. - -What is chromium? Can taking a chromium supplement help me lose or maintain weight?- Chromium is a nutrient which plays a factor in maintaining blood glucose (sugar) levels. Chromium occurs naturally in the diet, and is found in foods such as brewer's yeast, whole grains, liver, and shellfish. Individuals whose diets consist mainly of processed foods may not have an adequate intake of chromium; symptoms of chromium deficiency include weight loss and impairment in the body's ability to maintain blood sugar levels. Although there is no recommended daily allowance for chromium, a daily intake of between 50 and 200 micrograms (µg) is recommended by many physicians and nutrition experts. Chromium is available in several forms, including inorganic chromium, high-chromium yeast, chromium picolinate, and chromium polynicotinate. Of these, chromium polynicotinate seems to be the best absorbed. While chromium does seem to be of benefit in regulating blood sugar in diabetics, its role in weight loss or maintenance for non-diabetics is not yet clear. Some individuals who have made a conscious effort to raise their chromium levels through diet changes or dietary supplements have reported that chromium does seem to lessen their cravings for sweets, but I am unaware of any formal studies that support this. Additional information on chromium picolinate is available via WWW at http://www.lifelines.com/libry1a.html.