New Science What Works What Doesn't

ASPARTAME ALERT
Harv Haakonson M.D.

We have just received some information that aspartame may be a more serious health risk for some than previously known. We are attempting to track down any solid evidence to this effect and will advise you as soon as we are able to confirm the indications. If you have any reaction at all to aspartame, we suggest even more strongly that you eliminate it from your diet. The biggest culprit may well be diet drinks. The reports that we have seen indicate that a sensitivity to aspartame may actually cause symptoms similar to those found in patients with Multiple Sclerosis. These symptoms might include muscle pain or spasms, numbness in your legs, cramps, headaches, tinnitus and joint pain. Do not panic. Even if you experience some of these symptoms due to aspartame, they are completely reversible by eliminating aspartame from your diet.

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CONSUMPTION OF HIGH-FRUCTOSE
CORN SYRUP IN BEVERAGES
MAY PLAY A ROLE IN
THE EDPIDEMIC OF OBESITY
American Journal of Clinical Nutrition, 2004;79:537-43
George A. Bray, Samara Joy Nielson, & Barry M. Popkin

High Fructose Corn Syrup (HFCS) is a very sweet, corn based syrup that is inexpensive to produce and thus is a profitable replacement for sucrose (sugar). This article draws attention to the fact that in 1970 HFCS represented less than 1% of the caloric sweeteners consumed in the USA. By the year 2000 HFCS consumption was 42% of caloric sweeteners, more than a 1000% increase. It is the authors' opinion that this huge increase has contributed to the epidemic of obesity. They have some good scientific reasons to support their opinion.

Those of us who live in the low carb world know all about blood sugar stimulating the release of insulin, and we know the negative consequences. These authors discuss the different effect on insulin release when the blood sugar results from ingesting sucrose (or glucose) as compared to fructose. They believe the fructose does not stimulate insulin release nearly as much as glucose. At first this seems like a good thing but there is down side that is more important. One of insulin's jobs is to release a substance called leptin so when the insulin is released in quantities that are too low, there isn't enough leptin released. Low concentrations of leptin are associated with increased hunger, lower levels of energy expenditure, and gains in body fat. The authors say: "To the extent that fructose increases in the diet, one might expect less insulin secretion and thus less leptin release and a reduction in the inhibitory effect of leptin on food intake, ie, an increase in food intake." The connection from increased HFCS to increased obesity is obvious.

Where do we find HFCS? By far the greatest source (2/3 of all fructose consumed) is in carbonated beverages and fruits juices, but it is also the favorite sweetener in many baked goods, cereals, canned fruits, jams, jellies, flavored yogurt, and dairy products. Fortunately, if you are following a low carb lifestyle you won't be drinking or eating many of those products.

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DIETARY SUGAR, GLYCEMIC LOAD,
AND PANCREATIC CANCER RISK
Journal of the National Cancer Institute
94(17), 2002; pages 1293 - 1300

BACKGROUND: Evidence from both animal and human studies suggests that abnormal glucose metabolism plays an important role in pancreatic carcinogenesis. The authors investigated whether diets high in foods that increase postprandial (after eating) glucose levels are associated with an increase of pancreatic cancer.

METHODS: In cohort (group) of 88,802 U.S. women participating in the Nurses' Health Study, 180 case subjects with pancreatic cancer were diagnosed during the 18 year follow-up. The frequency of intake of individual foods as reported on a food-frequency questionnaire in 1980 was used to calculate sucrose, fructose, and carbohydrate intakes; glycemic index (postprandial blood glucose response as compared with a reference food); and glycemic load (glycemic index multiplied by carbohydrate content).

CONCLUSION: These data support other findings that impaired glucose metabolism may play a role in pancreatic cancer etiology. A diet high in glycemic load may increase the risk of pancreatic cancer in women who already have an underlying degree of insulin resistance.

Note: The foregoing report is an abridged version of a summary report at Pub Med.

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DUKE UNIVERSITY
LOW CARB DIET RESEARCH
American Journal of Medicine 2002 Jul; 113(1):30-6

This is the first published scientific study of the popular low-carbohydrate Atkins diet in two decades.

"Study participants were put on a very low carbohydrate diet of 25 grams per day for six months," said Eric Westman, M.D., associate professor of medicine at Duke and principal investigator of the study. "They could eat an unlimited amount of meat and eggs, as well as two cups of salad and one cup of low-carbohydrate vegetables such as broccoli and cauliflower a day."

Researchers found that 80 percent of the 50 enrolled patients adhered to the diet program for the duration of the study and lost an average of 10 percent of their body weight. The average amount of weight lost per person was approximately 20 pounds. The study further showed that patients' cholesterol levels improved by the end of six months - a finding that was unexpected, according to Westman.

"We were somewhat surprised to find that the patients' blood lipid profiles improved, even though there was much more fat in the diet," he said. "We had thought the fat in the diet would increase the cholesterol."

Although exercise was recommended, it was not a requirement for the study. Half of the subjects didn't exercise at all and still lost weight, according to researchers.

Because of the intensity of this type of diet program, Westman cautions that "If someone has a medical problem or is taking medications, they should only do this diet under the supervision of a health care provider."

Note: The foregoing report was extracted from the website www.lowcarb.ca

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EFFECTIVE CAROHYDRATE COUNT
ON LOW CARB BARS
Harv Haakonson M.D.

We frequently get asked how to interpret the statement "Effective Carb Count" that is present on most low carb bars. Most of these bars are produced in the USA and within the last couple of years there has been a change in the packaging information that must be included. Previously the nutrition information would simply say "Carbohydrates 3gm" or whatever the amount. The change requires that manufactures now list all the carbs, including glycerin and maltitol (or other sugar alcohol) which were previously not listed as part of the carb count. The result is that most bars will now list the total carb count as about 21gm with the glycerin and maltitol making up about 18gm of the total.

The rationale for not counting glycerin and maltitol is that in theory these substances, though carbohydrates, convert so slowly to blood sugar that they move through the bowel before getting absorbed thus "effectively" don't contribute to the total carb intake. That is probably true for most people since most of us can eat the low carb bars without any apparent affect on our weight. Nonetheless, there are some people who do absorb the carbs and for them, they need to count all the carbs in those bars. In fact, one of the first questions we ask when someone is either not losing weight, or has stalled, is whether they eat low carb bars, and if so, how many. If you are one of those people it may be that commercial low carb bars are not for you.

Even if you seem to be able to tolerate the low carb bars, we believe you should limit your consumption to one per day or less. Consuming more than that means you are short changing other more healthy foods.

By the way, Atkins is now producing most of their low carb bars with sucralose (Splenda) instead of sugar alcohols like Maltitol. That is a great improvement since there are no health risks to sucralose and few carbs to count.

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EFFICACY AND SAFETY OF
LOW-CARBOHYDRATE DIETS:
A Systematic Review
Journal of the American Medical Association, April 9, 2003
Vol 2 No.14, 1837-1850 Dena M. Bravata, MD, MS et al

This group of scientists reviewed 107 articles on low carb diets. There were a total of 3268 participants involved in the 94 studies reported. They concluded that "there is insufficient evidence to make recommendations for or against the use of low-carbohydrate diets …" That is not surprising given that only recently are studies being done which will provide a scientific basis for such recommendations to be made.

Perhaps the most interesting statement made in the review paper is the following: "Among the published studies, participant weight loss while using low-carbohydrate diets was principally associated with decreased caloric intake and increased diet duration but not with reduced carbohydrate content." This finding sticks close to the traditional medical and nutritional wisdom that weight management is a matter of calorie control. We will talk a little more about that in a section on "What About Calories?" later in the Newsletter.

The report did identify 5 significant gaps in the published literature of low-carbohydrate diets:

1. There has not been enough long-term follow up to allow assessment of efficacy or safety.

2. It is not possible to evaluate the effects on different racial or ethnic groups.

3. Although exercise is included in most studies, they do not report what kind of exercise or how much thus preventing an evaluation of the role exercise plays in weight control.

4. Some diets use counseling or other supportive measures but they do not report how well participants adhere to these measures.

5. Many studies included only the participants who finished the dietary intervention and did not report on what happened to those who started but did not complete.

All in all this extensive review tells us pretty much what we already know. Further studies with better control are going to be necessary to provide the solid scientific information that will settle once and for all the longstanding debate in the scientific community over low carb diets. In the meantime those of us whose practical experience tells us it works, and that it is healthy, will continue to follow our path.

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EGGS HAVE BEEN GETTING A BUM RAP
Harv Haakonson M.D.

Dr. Michael Mogadam, who is an assistant professor of medicine at Georgetown University in Washington, DC, is a cholesterol-disorders specialist. He is quoted responding to a question in Shape magazine (June 2002 issue) about whether the reader should only eat egg-whites to cut down on cholesterol, as she eats eggs 2 or 3 mornings a week for protein.

Mogadam says: "The beauty of the egg is in the yolk. The white has nothing but protein. The yolk has the nutrients, including vitamins, minerals and antioxidants." Shape magazine goes on to say:

"Sure, the yolk also contains the fat and cholesterol. However, of the 6 grams of fat in a large egg, only 2 grams are saturated (bad fat). The other 4 are unsaturated and actually coronary friendly," says Mogadam. "What's more", he says, "1 gram of the saturated fat is stearic acid, which behaves like monounsaturated fat (good fat). The bottom line: Only 1 gram of the 6 is the unhealthy kind. The other 5 grams of healthy fat more than offset this 1 gram," Mogadam says.

The cholesterol - about 213 milligrams per egg - is nothing to worry about either, Mogadam says. "The human body only absorbs 10-30 percent of that." Also, in most people, dietary cholesterol intake has a negligible effect on blood cholesterol levels. Research suggests that eating two eggs a day for 12 weeks raises LDL cholesterol by only 4 points, and the numbers level off soon thereafter.

"Over the years, it becomes a non-issue," Mogadam says. "The body adjusts." What does elevate blood cholesterol significantly is high intake of saturated fat (found in whole milk, cheese and fatty red meat) and trans fat (found in cakes, cookies and other commercial baked goods). We would add that another major contributor to high cholesterol is a high carbohydrate diet.

"One egg contains about 75 calories and 6 grams of protein. If you toss out the yolk, you lose 4.5 grams of protein and 59 calories, along with the vitamins A and D and folic acid."

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EXERCISE IN LONG TERM
WEIGHT MANAGEMENT
Harv Haakonson M.D.

Results from clinical trials continue to show that exercise is associated with improved success in managing weight for both initial loss and long term maintenance. Exercise has also been demonstrated to have an independent beneficial effect on high blood pressure, blood cholesterol levels, blood insulin and low fitness levels. We frequently get questions as to how much and what kind of exercise is required to get the benefits.

The first thing we can say is that any amount of exercise is better than none at all. If you aren't accustomed to regular exercise it is important to start slow. It is also important to consult with your doctor before you start if you are significantly overweight, or if you have any condition that might require medical care. Now you need to know how much and what kind of exercise.

The answer will vary depending on who you ask, and your objectives. Do you want to exercise just to be healthy? Do have your mind set on participating in the next 10K Terry Fox run? Or do you want to train to run a marathon? The advice will vary so to keep it simple, let's assume you just want to get into an exercise program that will improve your health and help you achieve and maintain your weight.

The US Centers for Disease Control and Prevention, the American College of Sports Medicine and the US Surgeon General all recommend 30 minutes of exercise of moderate intensity on most days of the week. That is generally interpreted to mean 150 minutes of moderate exercise per week.

The Institute of Medicine and the International Association for the Study of Obesity rely on a growing body of literature to base their recommendations for more than 30 minutes on most days. They recommend 45 to 60 minutes per day (300 minutes per week) to successfully control body weight in the long term.

For anyone who is starting out from a point of no exercise this might seem overwhelming. But don't be intimidated. There are many positive aspects to hang onto.

1. Research shows that there does not appear to be any additional weight control benefit to doing intense exercise rather than moderate. An easy way to identify 'moderate' is that when you are walking (the exercise we recommend to most overweight individuals) you should be putting in enough effort that it makes it difficult - but not impossible - to talk while you are walking.

2. Be happy starting where you are and advancing from there. If you can only manage a quarter of a block on the first day, do a quarter of a block. Increase it slightly (not more than 10 percent) each day. If necessary spend a few days at one level until you are ready to go to the next.

3. If finding the time is an issue, do your exercise in intermittent installments. If you are trying to do 30 minutes per day for example, you can do it all at once, or in three 10 minutes installments, or one 10 minute and one twenty minute. It will require at least 10 minutes for an installment to give you reasonable benefit.

4. Some people are counters. If that describes you, it may help to know that about 10,000 steps per day are required to achieve health benefits. Most sedentary people accumulate 6000 to 7000 steps per day so the additional required from your exercise program is 3000 to 4000 steps, the equivalent of 3 to 4 miles. Why not make it interesting and invest in a pedometer ($20 to $30) so you can count your steps every day? This is also a useful way of monitoring your daily increases as you gradually move from being a couch potato to walking your 10,000 steps per day.

5. Find a partner, or several, make it a social event.

6. Have fun. Enjoy the journey. And reap the benefits.

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FRUIT AND VEGETABLE CONSUMPTION
AND LDL CHOLESTEROL:
the National Heart, Lung, and Blood Institute Family Heart Study
American Journal of Nutrition 2004;79:213-7
Luc Djoussé, Donna K. Arnett, Hilary Coon, Michael A. Province,
Lynn L. Moore, and R Curtis Ellison
 

This study evaluated 1245 participants from the National Heart, Lung and Blood Institute Family Heart Study to determine whether a high intake of fruit and vegetables had any impact on the level of LDL bad cholesterol. Their conclusion was that "the consumption of fruit and vegetables is associated with lower concentrations of LDL cholesterol in a dose response manner." This means that the more fruits and vegetables the participants ate, the more their LDL cholesterol decreased.

"Subjects in the highest fruit and vegetable intake groups had LDL concentrations that were ˜ 6 - 7% lower than those in the lowest fruit and vegetable intake groups." These findings are consistent with several other studies that have looked at this relationship. The authors suggest that a likely explanation is the fact that fruits and vegetables are good sources of dietary fiber. Other studies have shown that dietary fiber can reduce cholesterol by as much as 8%.

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HAIR LOSS
Harv Haakonson M.D.

Occasionally we get an email message from someone experiencing hair loss and they wonder if it is related to their low carb diet. Our reply can never be simple. Causes of hair loss are many and anyone who thinks they may be having greater than normal hair loss should consult their family doctor. For example, lower than normal thyroid function can cause hair loss and this is clearly a problem that should be treated with the help of your family doctor.

Hair loss can also result from major stress in your life, or a major stressful event. The stress of rapid weight loss, no matter how you achieve it, can cause hair loss. This is but one of the reasons why it is recommended that weight loss should be gradual, not more than 2½ pounds per week. It is thought by many that hair loss related to rapid weight loss is due to the changed metabolic rate.

Hormonal changes, such as going on (or off) the pill can cause hair loss. Some of you may have experienced hair loss during pregnancy, usually starting about the third month and ending after the sixth month. After the hormonal changes have stabilized the hair grows back.

Can hair loss be a side effect of a low carb diet? The answer is probably yes. After all, with your low carb diet you are triggering significant hormonal changes, your body is being stressed by the weight loss and your metabolic rate is going through an adjustment. Many people believe that if hair loss is experienced it is likely due to the radical changes, not the low carb diet itself. That point of view is consistent with the fact that after a few months of "adjusting" the hair loss stops for most people.

The most common experience seems to be that if hair loss is going to occur, it starts at around the three month point and stops at about six months. The good news is that many people experience regrowth that is thick and shiny. The real question for most people is "What can I do to prevent or minimize hair loss?" Here some actions you might want to consider.

1. If you are already experiencing hair loss, see your family doctor.

2. Keep your weight loss slow, 1 to 1½ pounds per week.

3. Be conscientious about taking your daily multivitamin.

4. Eat salmon and tuna frequently to get the benefit of their Omega 3 & 6 oils.

5. Consider taking Omega 3 & 6 oil supplements.

6. Consider adding a biotin vitamin supplement.

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HIGH-GRAIN DIET MAY INCREASE RISK
OF CARDIOVASCULAR DISEASE
American Journal of Clinical Nutrition January 2003 77: 43-50
Schwarz JM, Linfoot P, Dare D, Aghajanian K.

This is a scientifically written study out of the University of California, Berkley and San Francisco, that is a little difficult to struggle through but it is so important to have these conclusions reported in the American Journal of Clinical Nutrition that we wanted to share them here.

Researchers concluded that the low-fat, high-carbohydrate diet might not be ideal, as it can induce liver fat production (triglycerides) and insulin resistance. This is especially true when most of the carbohydrate is in the form of simple sugar. This explains why so many of us have put on weight while trying to follow a low-fat approach to foods!

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 HOW TO BECOME A 21st CENTURY
HUNTER-GATHERER
Cardiovascular Disease Resulting From a Diet and Lifestyle
At Odds With Our Paleolithic Genome
Mayo Clin Proc. 2004;79:101-108
by James H. O'Keefe, Jr, MD and Loren Cordain, PhD.

This is an excellent article from the Mayo Clinic Foundation for Medical Education and Research. It uses the findings from recent scientific papers to illustrate how our "current maladaptive diet and lifestyle" leads to degenerative cardiovascular diseases. The wonderful aspect of this article is that it also provides guidance as to how we can reduce our risk by improving our diet and lifestyle. We provide quotes of a few key passages.

"In a recently published large review of approximately 150 studies on the link between diet and cardiovascular health, the authors concluded that 3 major dietary approaches have emerged as the most effective in preventing cardiovascular events:

1. replacing saturated and trans-fats with monounsaturated and polyunsaturated fats;

2. increasing consumption of omega-3 fats from fish or plant sources such as nuts; and

3. eating a diet high in various fruits, vegetables, nuts, and whole grains and avoiding foods with a high glycemic load (a large amount of quickly digestible carbohydrates).

Despite common misperceptions, this report found no strong evidence for a link between risk of cardiovascular disease and intake of meat, cholesterol, or total fat."

The authors compare how our current diet varies from that of our Paleolithic (primitive) ancestors to illustrate that our bodies have not evolved to be able to consume much of what we eat today and remain healthy.

"The typical Paleolithic diet compared with the average North American diet contained 2 to 3 times more fiber, 1.5 to 2 times more polyunsaturated and monounsaturated fats, 4 times more omega-3 fats, but 60% to 70% less saturated fat. Protein intake was 2 to 3 times higher, and potassium intake was 3 to 4 times higher, however, sodium intake was 4 to 5 times lower.

Finally, the Paleolithic diet contained no refined grains and sugars (except for seasonally available honey). Clearly, the ongoing epidemic of cardiovascular diseases is at least in part due to these striking discrepancies between the diet we are designed to eat and what we eat today."

Many of us who have followed a low fat diet for years have found it difficult to adjust to the fact that there are fats that are good for you, and should be increased in our diets. The authors in this paper report:

"Replacing saturated fat with monounsaturated fat would result in a 30% reduction in risk, or 3 times the risk reduction achieved by replacing saturated fat with carbohydrates."

The paper reports that sugar consumption per person per year has doubled in the last 100 years with more than half of that increase occurring in the last 30 years. The paper goes on to say:

"A recent study showed that a high-glycemic-load diet is the most important dietary predictor of HDL level (as an inverse relationship)."

This means that the higher the glycemic (sugar) load, the lower the HDL level. Since HDL is the good cholesterol, this is bad news, and good reason to avoid the high glycemic foods.

We provided advice elsewhere on this website about the dangers of trans fatty acids. We have stated for example that these 'bad' fats cause a decrease in the 'good' cholesterol (HDL) and an in crease in the 'bad' cholesterol (LDL). The authors of this paper give it some perspective.

"Studies indicate that replacing trans-fatty acids (typically 2% of total daily calories in the American diet) with the same amount of natural unsaturated fatty acids would result in a large (50%) decrease in coronary heart disease."

What should we do to decrease our risk of cardiovascular disease, maintain our weight and improve our health?

1. Eat eight or more daily servings of fresh fruit and vegetables (avoiding potatoes and bananas because of their high glycemic loads).

2. Consume moderate amounts of beneficial fat and protein.

3. If you find it difficult to eat foods rich in omega-3 fatty acids, take a supplement. This can reduce cardiovascular risk by 32% to 50%.

4. Frequently (5 or more time per week) consume nuts. Associated with up to a 50% reduction in myocardial infarction (heart attack).

5. Choose carbohydrates consisting exclusively of low-glycemic foods (non-starchy vegetables and fruits).

6. Avoid foods that contain trans-fatty acid.

7. Have a daily exercise program.

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INFLAMMATORY BOWEL DISEASES
Harv Haakonson M.D.

There are many possible causes of inflammatory bowel diseases and their symptoms and proper medical management can be complicated. It is important therefore that if you are a under doctor's care for one of these conditions you consult with your doctor before you embark on anything different from what you have been advised.

So many readers tell us they have had wonderful relief of symptoms of bowel disorders like Irritable Bowel Syndrome (IBS), colitis or diverticulitis after switching to a low carb lifestyle that we are convinced it is worthwhile for anyone with those symptoms to give low carb a good try. In fact, Patricia is one whose lifelong symptoms of colitis disappeared within ten days of switching to low carb and she has not had any recurrence. Clearly that is what anyone with one of these diseases wants, to keep the condition from becoming symptomatic so whatever action you take should aim for prevention.

From the medical reading I have done, and the feedback from readers, I suspect that for many people the problem with IBS and other conditions like colitis is a sensitivity to wheat. So long as your low carb diet avoids (or minimizes as much as possible) wheat products you should have a good chance of keeping those symptoms under control.

There may be a component of the wheat sensitivity in diverticulitis as well but probably the more important preventive action in this case is to keep a high volume of stool movement. That requires generous portions of high fiber food which is right in keeping with a low carb diet. Eat lots of the green vegetables like lettuce, broccoli, zucchini, cucumber, celery, spinach, Swiss chard, bok choy and so on. Brussel sprouts and cauliflower are also good. I would suggest you try using All Bran with Extra Fiber. A half cup will be enough for most people to have a modest sized daily stool. The Extra Fiber variety (you may have to search in more than one store to find it) is important because that product has 20g of carbs per serving but 13 of those grams are fiber thus they don't count in your daily carb total. You might like to sweeten the All Bran with Splenda.

Many doctors recommend that you eat more frequent smaller meals. I think that is very good advice. We recommend, and follow, the practice of three fairly normal meals and three snacks every day. We never eat large meals anymore, there is no desire to do so when you have the snacks between meals. If you do not wish to lose weight, I suggest that you go directly to the maintenance guidelines in our book SLOW CARB FOR LIFE to figure out your daily carb intake

Please be aware that diet drinks (and many other products with artificial sweetening) may pose a problem if you happen to be sensitive to aspartame. Aspartame has been reported to cause symptoms similar to IBS. Many low carb products also use sugar alcohols like maltitol for sweetening and add glycerin to the mixture. This is especially true with the low carb protein bars. Both sugar alcohols and glycerin cause bowel symptoms for some people. I suggest that you be cautious in your use of these products until you can determine if you are one of those people who can not tolerate their action.

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INTAKES OF WHOLE GRAINS, BRAN,
AND GERM AND THE RISK OF
CORONARY HEART DISEASE IN MEN
Majken K Jensen et al, American Journal
of Clinical Nutrition, 2004;80:1492-9

This important paper reports on a prospective study of 42,850 male health professionals. The principle finding was that the higher the intake of whole grains, the lower the incidence of coronary heart disease (CHD). Not surprisingly, those who had a high intake of whole grains had an overall healthier diet and lifestyle. This isn’t entirely new knowledge but it is an important affirmation of the health benefits of whole grains, bran and germ. Previous studies have also shown fiber rich diets to be associated with a lower risk of obesity and diabetes, increased insulin sensitivity, and reduced cholesterol.

The researchers found that the risk of CHD was reduced by approximately 15% when the intake of whole grains was greater than 25 grams per day. It was also interesting that they found the beneficial effects of a high intake of whole grain could be achieved regardless of the food source. This is reassuring to those who wish to have a variety in the source of their daily fiber intake.

The authors suggest that one of the main explanations for the beneficial effects of bran intake is that it has a high concentration of dietary fiber. They point out that oat bran in particular is linked with reduced blood cholesterol.

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LOW-CARB, MORE CALORIES,
LOSE WEIGHT?
LOW-CARB DIETERS
LOST MORE POUNDS & INCHES
WebMD Medical News, October 14, 2003
by Jeanie Lerche Davis, reviewed by Dr. Michael Smith

Could it be true? Can you actually cut back on carbs, eat more calories, and still lose weight? It may be so, say researchers. Reported success behind low-carb diets is thought to be because you eat fewer calories. But this new study suggests that something more may be happening.

"It was a very happy study because everyone lost weight," reports Penelope Greene, PhD, a researcher with the Harvard School of Public Health. She presented her findings at the conference for the American Association for the Study of Obesity in Fort Lauderdale, Fla. this week.

In fact, her volunteers liked the food so much, they voted to continue the study, she tells WebMD. Who wouldn't? The small group was catered to, literally, by an upscale Italian restaurant in Cambridge. "The food had to be good, or people wouldn't eat it," Greene says. "Some salad ingredients were organic, chickens were free-range. That was the quality of restaurant we used."

As for the 21 volunteers: "All were over 50, overweight, and overly concerned about their future health problems if they didn't lose the weight," says Greene. "They were very motivated."

From the Kitchen ...

The chefs, she says, were fastidious in their preparation of these weight-loss diets. Under her tutelage, they got special training, special recipes, even specific, brand names to follow in preparing 12 weeks' worth of either low-fat or low-carb meals, she reports.

From the kitchens emerged quiches, puddings, halibut with Dijon sauce, poached salmon, chicken teriyaki, beef stroganoff, lots of vegetables, lovely salads, and foods made with only unsaturated oils -- all carefully prepared, all weighed to the gram and ready for pick up, every single day. "There was very little red meat," Greene explains. In addition to teasing out the perfect weight-loss diet, "we wanted to show an effect on cholesterol, too."

Researchers randomly assigned two groups of volunteers to eat either low-fat or low-carb meals -- with women consuming up to 1500 calories a day and men maxing out at 1800 calories a day. The low-fat weight-loss diet was outlined as 55% carbs, 15% protein, and 30% fat. The low-carb diet was 5% carbs, 30% protein, and 65% fat. A third group also ate low-carb -- but this group got to eat an extra 300 calories, boosting their daily intake to 1800 calories per day.

"The extra-calorie group got the exact same recipes as the low-carb group," Greene explains. "But in the extra-calorie group, every item was increased by a few grams. The quiche, the crackers -- everything weighed a few grams more."

As for the low-fat changes: "If one group had chocolate pudding, so did the other. But one may have been made with skim milk whereas the other had cream. One quiche had cheddar cheese and bacon bits, whereas another had low-fat cheese and broccoli."

And 12 weeks later ... participants lost beaucoup weight:

• The low-carb, low-cal group lost 23 pounds.

• The low-fat group lost 17 pounds.

• The group getting 300 extra calories of low-carb food lost 20 pounds.

In fact, both low-carb groups lost more inches from their weight-loss diet -- four inches at the waist, and three at the hips, compared with the low-fat group, which lost three waist and two hip inches.

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The INTERHEART STUDY
Effect of potentially modifiable risk factors
associated with myocardial infarction in 52 countries:
case-control study, Salim Yusuf, Steven Hawken, et al
Lancet September 3, 2004; 364: 937-52h

This well designed study included 15,152 cases of individuals from 52 countries who had suffered their first myocardial infarction (heart attack) compared with 14,820 controls. The study looked at nine easily measured and potentially modifiable risk factors: 1) smoking, 2) history of high blood pressure, 3) history of diabetes, 4) waist/hip ratio, 5) dietary patterns, 6) physical activity, 7) consumption of alcohol, 8) blood lipids, and 9) psychosocial factors.

The study found that the effect of these risks is consistent in men and women, across different geographic regions, and by ethnic group, making the results applicable world wide. The two most important risk factors are smoking and abnormal lipids. Together they account for approximately two-thirds of the risk of having a heart attack. The next most important risk factors were psychosocial factors, abdominal obesity as measured by waist/hip ratio, diabetes, and high blood pressure. It is important to note that the risk associated with obesity was more effectively measured using waist/hip ratio than the more commonly used method of Body Mass Index (BMI).

One of the most important findings was that smoking alone accounts for about 36% of the risk overall, and about 44% of the risk in men. By contrast, regular consumption of fruits and vegetables was associated with a 30% relative risk reduction. The implication of these findings is that by regularly eating fruits and vegetables, exercising actively, and avoiding smoking it is possible to reduce the risk of heart attack by about 80%. The study recommends that these actions, combined with a lowering of blood lipids (cholesterol and triglycerides), should be the cornerstone of prevention of heart attacks worldwide.

There were two other conclusions that are important in order to maintain an accurate perspective of relative risk. The nine potentially modifiable risk factors used accounted for 90% of the risk of having a heart attack. The overall risk when alcohol consumption was excluded was 89.7% thus the inclusion of alcohol increases the risk by less than 1%.

Perhaps the most important finding for those with a family history of heart attack was the risk attributable to family history. It is known that when family history is looked at independently, the risk is about 1 in 5 that an individual will have a heart attack if they have a family history of heart attack. However, when this study added family history to the nine potentially modifiable risk factors, the risk of heart attack rose only 1%, to 91%. The good news for individuals with a family history is that if you actively reduce the modifiable risks, you can very significantly decrease your overall risk in spite of the family history.

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LOW-CARBOHYDRATE DIETS
AND REALITIES OF WEIGHT LOSS
Journal of the American Medical Association, April 9, 2003
Vol 2 No.14, 1853-1855 George A. Bray, MD

This is an editorial written in the same issue of the Journal of the American Medical Association as the review article discussed in the section above. Dr. Bray says three things that we want to highlight.

First, "the study findings illustrate that calories do count and that low-carbohydrate diets produce weight loss by reducing caloric intake …" We'll talk more about this in the next section of the Newsletter.

Second, "… low-carbohydrate diets do not have deleterious effects on either serum lipid or fasting glucose levels." It is important for us to know that eating low carb does not do harm so whenever the science identifies that we can be further reassured.

Third, he says that the authors of the review "… are concerned about the role of low-carbohydrate diets in the maintenance of weight loss, although this concern may be somewhat misguided. Diets do not cure obesity." It is the last sentence that is the key statement. Those of you who have read "Easy Low Carb Living" will know that we make a strong point of the fact that what we are advocating is not a diet, it is lifestyle change. To treat low carb eating as a diet simply to lose weight is doomed to the same long-term failure as any other diet. Sustained success will result when we have made the commitment to choose to eat differently.

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MANAGING HYPERTRIGLYCERIDEMIA
Canadian Medical Association Journal, April 1, 2003
168(7), 831 - 832 Joseph Mercola, MD

This is a letter to the editor to address an article entitled "Common Problems in the Management of Hypertriglyceridemia" published in an earlier edition of the Canadian Medical Association Journal. Dr. Mercola cites previous research that showed a low-fat diet actually increased the levels of triglycerides (blood fats that are associated with an increased risk of heart disease). He proposes this strategy.

"An alternative approach is to radically reduce consumption of all grains and simple sugars. In contrast to the pharmacological options that are traditionally applied, it is simple and inexpensive to substitute green leafy vegetables, which have a low glycemic index, for grains and sugars, and there are no toxic effects."

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MEDITERRANEAN DIET
Adherence to a Mediterranean Diet and Survival in a Greek Population,
The New England Journal of Medicine, June 26, 2003, 348:26, 2599-2608,
Antonia Trichopoulou et al

Much has been written in medical and nutritional journals about the health benefits of the traditional diet followed by much of the population that lives around the Mediterranean. This study of 22,043 adults scientifically tested whether this conventional wisdom is fact. Here is how they describe the diet:

The traditional Mediterranean diet is characterized by a high intake of vegetables, legumes, fruits and nuts, and cereals (that in the past were largely unrefined), and a high intake of olive oil but a low intake of saturated lipids, a moderately high intake of fish (depending on the proximity of the sea), a low-to-moderate intake of dairy products (and then mostly in the form of cheese or yogurt), a low intake of meat and poultry, and a regular but moderate intake of ethanol, primarily in the form of wine and generally during meals.

The scoring in the study measured how closely the individual adhered to the Mediterranean diet using a range of scores from 0 to 9. The outcome of the study that ran for a little less than four years showed that the more closely people followed the Mediterranean diet, the lower the mortality. A two point difference in score corresponded to a 25% difference in mortality. The authors conclude that a healthy diet is associated with a significant and substantial reduction in overall mortality.

The Mediterranean Diet and Mortality Olive Oil and Beyond,
The New England Journal of Medicine 6/26/03 348:26 2595-6
Frank B. Hu, MD, PhD

Dr. Hu, writing in the same issue of the New England Medical Journal, offered further perspective on the topic to which the previous study was devoted. Here are some of the comments by Dr. Hu:

Although the Mediterranean-diet score predicted the risk of death, dietary components that were not considered by Trichopoulou et al. May also be important in determining the health effects of a diet. For example, trans fatty acids are an important determinant of the risk of coronary heart disease, although the intake of trans fatty acids may have been low in this cohort. Also, recent evidence suggests that higher dietary glycemic load has adverse effects on blood lipids and is associated with an increased risk of coronary heart disease but that whole grains are beneficial; thus, the effects of "cereal" intake may depend on the degree of processing.

Higher level of olive oil are considered the hallmark of the traditional Mediterranean diet. For centuries, olive oil has been treasured in Greece and other Mediterranean countries for its healing and nutritional properties. The use of olive oil now extends beyond the Mediterranean region. Cumulative evidence suggests that olive oil may have a role in prevention of coronary disease and several types of cancer because of its high levels of monounsaturated fatty acids and polyphenolic compounds.

It is worth noting that traditional diets from the Mediterranean and Asian countries share most dietary characteristics, such as a relatively high intake of fruits, vegetables, nuts, legumes, and minimally processed grains, despite use of different sources of plant oils.

The encouraging aspect of these findings and comments for us is that all of the healthy practices that are identified are encompassed in a low carb lifestyle.

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OBESITY IN CHILDREN - HEALTH CONSEQUENCES
Harv Haakonson M.D.

We see a huge amount of media attention about obesity in children so it seemed like a good idea to look briefly at what is being written in some of the recent medical literature.

We start with a review article in the Archives of the Diseases of Children, 2003, Volume 88. These authors concluded that obese children are more likely to experience psychological problems than non-obese children, girls are at greater risk than boys, and the risk increases with age. Low self esteem and behavioural problems are particularly common.

The review also reported that it is now well established that childhood obesity has adverse effects on the cardiovascular system similar to those known in adults. Pediatric obesity is reported to be associated with more than a twofold increase in risk of developing type 1 diabetes. For parents of obese children it is significant that the likelihood of an obese child continuing to be obese in adulthood is substantially more likely if the child has at least one obese parent.

This review shows that childhood obesity is likely to be a major cause of ill health in adulthood. In fact, one study reviewed showed that an individual who is obese at age 18 has a significantly increased risk of death over the next 20 years. All of this sobering news lead us to look at what can be done to deal with the problem.

The medical journal PEDIATRICS, Vol. 112 No.2, August 2003 offered a Policy Statement by the Committee on Nutrition of the American Academy of Pediatrics. Most of the statement makes common sense but it always help to have our ideas reinforced with some authority. This article points out that less active children are more likely to be overweight.

The authors suggest several causes for the decreased activity. First is the increase in sedentary activities such as television, videos and computer games. Second is the decrease in physical activity, such as walking to school and doing household chores, which were much more common when our society was more rural. Third is the decrease in physical activity programs for many students in school.

This policy statement advises that controlled studies have demonstrated that obese children respond with substantially more weight loss when they are reinforced for decreasing sedentary activity (such as watching television) rather than being reinforced for increasing physical activity.

All levels of society with some role in feeding children are encouraged to make available foods that are nutrient rich and tasty but low in excess energy from added sugars and fat. One notorious source of excess energy from added sugar is the sweetened drink, whether soda pop, fruit juice or fruit flavored drink mix.

The Journal of Pediatrics, June 2003 reported a study of the consequences when children consumed sweetened drinks. They found that children showed little evidence of regulating their energy intake. The increase in energy consumed through sweetened drinks was not offset by a decrease in energy consumed from solid foods.

The excess energy resulted in greater weight gain. It was interesting that the study found the increase in sweetened drinks was associated with a decrease in milk consumption. This caused a lowering in the intake of protein, calcium, phosphorous, magnesium, zinc and vitamin A. In the same issue of the Journal of Pediatrics Dr. Robert Schwartz provided suggestions for how to reduce soft drink consumption in children. Click here to see his suggestions.

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RANDOMIZED CLINICAL TRIALS
ON THE EFFECTS OF DIETARY FAT
AND CARBOHYDRATES ON
PLASMA LIPOPROTEINS AND CARDIOVASCULAR DISEASE
American Journal of Medicine, Volume 113, Number Suppl B
December 30, 2002 Frank M. Sacks, MD and Matijn Katan, PhD

This report provides a great deal of information that helps understand how diet impacts risk of heart disease. One of the reported findings is that when carbohydrates are used to replace saturated fats in a low fat diet both the LDL and HDL components of cholesterol are reduced in similar amounts thus the ratio between the two is not improved, as is necessary to reduce risk. The other consequence of higher carbohydrate intake is an increase in triglycerides, the other blood fat that is associated with risk of heart disease.

This paper has an excellent explanation of why trans unsaturated fatty acids are so unhealthy. You may remember from Easy Low Carb Living that these "bad" fats are found in any product, such as margarine, that has the term "partially hydrogenated" on the label. These trans fatty acids are present in large amounts in the frying fats used in restaurants and in baked goods such as cookies and pastry. Among all the dietary fats, these trans fatty acids have the unique action of increasing LDL cholesterol and decreasing HDL.

Trans fatty acids have the worst effect on blood fats of all dietary fats, including the saturated ones. This effect is so harmful that a large part of the fats and oils industry in Europe has gotten rid of them. In North America McDonald's and Frito-Lay are gradually reducing the trans fatty acid content of their food.

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REBUILDING THE FOOD PYRAMID
Scientific American, January, 2003, 64 - 71
Walter C. Willett and Meir J. Stampfer

In our book Easy Low Carb Living we reviewed a wonderful book called Eat, Drink and Be Healthy by Dr. Walter Willet from Harvard Medical School. In fact, the recommendations for healthy eating in his book form the basis for our eating plan. We were delighted therefore to find the article written by Dr. Willett and his colleague Dr. Stampfer in the January 2003 edition of Scientific American. Most of what is in this article is the same information that is in the book but it is so important that we feel it warrants repeating here. We are choosing to quote directly from the article. It is important to point out that they are talking about the new Healthy Eating Pyramid discussed in Easy Low Carb Living on pages 23 and 24. Here is what they say.

"Our revised pyramid emphasizes weight control through exercising daily and avoiding excessive total intake of calories. This pyramid recommends that the bulk of one's diet should consist of healthy fats (liquid vegetable oils such as olive, canola, soy, corn, sunflower and peanut) and healthy carbohydrates (whole grain foods such as whole wheat bread, oatmeal and brown rice).

If both the fats and the carbohydrates in your diet are healthy, you probably do not have to worry too much about the percentages of total calories coming from each. Vegetables and fruits should also be eaten in abundance. Moderate amounts of healthy sources of protein (nuts, legumes, fish, poultry and eggs) are encouraged, but dairy consumption should be limited to one to two servings per day. The revised pyramid recommends minimizing the consumption of red meat, butter, refined grains (including white bread, white rice and white pasta), potatoes and sugar.

Trans fat does not appear at all in the pyramid, because it has no place in a healthy diet. A multiple vitamin is suggested for most people, and moderate alcohol consumption can be a worthwhile option (if not contraindicated by specific health conditions or medications). This last recommendation comes with a caveat: drinking no alcohol is clearly better than drinking too much. But more and more studies are showing the benefits of moderate alcohol consumption (in any form: wine, beer or spirits) to the cardiovascular system."

You will note that the recommendations don't specifically talk about eating low carb, apart from removing the refined grains, potatoes and sugar. In our opinion the low carb approach to eating, when combined with the overall principles recommended by Dr. Willett, is important for two reasons. First it makes it easy to eat a balanced and healthy diet. Second it is a very effective way to reduce or maintain weight. Once you are on a weight maintenance program there is sufficient flexibility in the daily carb intake to allow you to follow very closely the Healthy Eating Pyramid recommendations.

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RED MEAT AS A RISK FOR COLON CANCER
Harv Haakonson M.D.

A recent article published in the Journal of the American Medical Association reported on the largest study ever done on the relationship between the long term ingestion of red meat and the occurrence of colon cancer. The study included 148,000 men and women age 50 to 74. The results revealed that those who ate the highest amounts of red meat had a 50% greater chance of getting colon cancer than those who ate the least amount of red meat. Men who ate red meat 5 to 6 days a week, and women who ate 2 to 3 days per week, were at higher risk. Colon cancer is the third commonest kind of cancer in North American men and women.

Although these findings sound a little scary, the results from the study are not significantly different from what we already knew. As with most things related to health, moderation is the important message. Most experts, including Dr. Steven Zeisel of the American Institute of Cancer Research, emphasize that moderation is the key. Dr. Zeisel makes the point that we needn't all begin eating as vegans but we probably ought to modify our intake of red meat if it fills a major portion of our diet.

It is quite possible (and wise from a health perspective) to follow a slow carb eating plan by simply being aware of keeping our red meat intake limited. It is easy to get the necessary protein by eating poultry and fish instead. The advice provided in Slow Carb For Life gives you a good basis of understanding and guidance to do this sensibly.

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TIPS ON HOW TO KEEP "REGULAR"
Harv Haakonson M.D.

It can be a challenge for some people to maintain regularity when eating low carb. If you do your own cooking you can help considerably by including the right kinds of vegetables, fruits and cereal but as you know, you have to check the carb content of each choice you make in order to keep the daily carb count on target. If you follow these options you will get large quantities of fiber (roughage) and as a bonus you will also get plenty of vitamins and minerals.

The following are good choices of vegetables: red or green cabbage (raw or cooked), cauliflower, broccoli, spinach, celery, lettuce, cucumber, and green beans. Fruits are excellent to stimulate soft stools. Good low carb choices are fresh fruits such as: berries of any sort (raspberries, strawberries, blackberries, blueberries), kiwi, pineapple, grapefruit, and peaches.

You might also want to try sprinkling some flax seed meal on your breakfast food since the carb content is low and the laxative effect is good. The Lemon Carrot Muffins recipe in the SLOW CARB FOR LIFE book is good because it includes flax seed meal.

Most dry cereals are so high in carbohydrate that it is nearly impossible to include them in the eating plan, especially during weight loss. Kellogg All Bran Extra Fiber is an exception. This product works well to keep most people regular. Patricia's Food Tip Counting Fiber provides guidance for how to make choices that control the carb content.

We have a physician friend who uses a mixture of ¼ cup of oatmeal/sunflower/flaxseed cold cereal most mornings and 1 small teaspoon of Metamucil in the evenings as his way of keeping regular. If you aren't successful keeping regular with diet management it is important for you to seek advice from your doctor.

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TIPS TO HELP SUCCEED WITH YOUR
NEW YEAR'S RESOLUTION TO LOSE WEIGHT
Harv Haakonson M.D.

Resolutions for many people include a commitment to lose a few pounds. Print off a copy of these and put them on your fridge door.

1. Decide what your goal is and make sure it is achievable.

2. Write down your goal.

3. Post your goal on your fridge door and carry a written copy in your wallet or purse.

4. Find a picture of yourself that you don't like.

5. Post it beside your goal on the fridge door and carry a copy with you.

6. Remember that nothing tastes as good as thin feels.

7. Find a buddy or buddies who are also going to lose weight and support each other.

8. Meet with your buddies at least once a week (over the phone or via email if unable to meet face to face) to discuss your successes and your problem areas.

9. Get yourself a good low carb cookbook (we know a great one!).

10. Remember the old adage, all things in moderation.

11. If you do decide to eat or drink something high in carbs, keep your portions small.

12. Offer to bring a dish or dessert if you are invited out to dinner. That ensures that there will be some delicious low carb food that you can enjoy without worry.

13. Remember that nothing tastes as good as thin feels.

14. Eat three meals and three snacks each day.

15. Make sure there is some protein in every meal or snack.

16. Keep some celery with cream cheese or a few pieces of cheese or some nuts easily available for great snacks.

17. Avoid the dangerous situation of feeling starved when you sit down to eat a meal!

18. If you go to a restaurant for dinner, ask the waiter not to bring a bread basket to your table.

19. Remember that nothing tastes as good as thin feels.

20. If you sweeten your tea or coffee, use Splenda.

21. Limit your drinking to wine as the best low carb choice, and have only one glass.

22. Hard liquor contains few carbs, but you have to be careful of the mix you choose. Avoid the extra carbs by not mixing with regular soft drinks.

23. Light beer has less than half the carbs that there is in regular beer.

24. Liqueurs tend to be very high in carbohydrates, so use them very sparingly.

25. Remember that nothing tastes as good as thin feels.

26. Add a regular walking program to your daily activity.

27. Keep a food diary and weigh yourself once weekly.

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UNDERSTANDING
THE MEDITERRANEAN DIET
Postgraduate Medicine, August 2002, Vol 112, No 2, 35-45
Brian M. Curtis, MD and James H. O'Keefe, Jr, MD

This report also provides condemning information about trans fatty acids. The report states:
"Trans-fatty acids increase LDL-Cholesterol levels to the same extent as saturated fat; the difference is that trans-fatty acid intake also decreases HDL-Cholesterol levels, whereas saturated fat typically raises them. The overall result is that the adverse effect of trans-fatty acids on the ratio of LDL-C to HDL-C is double the effect of saturated fat. … It appears that long-term Coronary Artery Disease risk is more than doubled in persons who consume a diet high in trans-fatty acids."

This information is powerful motivation to avoid the partially hydrogenated products, all food commercially deep fried and those tempting commercial baked goods.

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WAS DR ATKINS RIGHT?
Journal of the AMERICAN DIETETIC ASSOCIATION,
April 2004 Volume 104 Number 4; 537-542
Dean Ornish, MD

For many years the controversy has raged between Dr. Atkins, the staunchest proponent of a low carb diet, and Dr. Ornish, an equally staunch advocate of a low fat diet. This paper is a commentary by Dr. Ornish "…to find a common ground among the seemingly contradictory information about different diets, present an evidence-based rationale for optimal nutrition, and describe many of the half-truths and distortions of the Atkins diet and other similar diets."

I have to give Dr. Ornish credit for doing a decent job of achieving his objective though he clearly hasn't lost any of his passion for his point of view. I do suspect that this paper was written before Dr. Ornish read the most recent book authored in Dr. Atkins name, Atkins for Life, published in 2003. This most recent book by Atkins presents a much more moderate perspective on low carb living, resulting in more agreement with Dr. Ornish than this paper would suggest.

It was of considerable interest to us that the science Dr. Ornish quotes, and the conclusions he draws, follow closely the lifestyle choices that form the basis of our current book Easy Low Carb Living and even moreso our forthcoming book Slow Carb For Life. It always encouraging to find another source that supports the growing evidence that this is the way to healthy weight control and better heart health.

Dr. Ornish sticks to his mantra that weight loss is only going to happen when the intake of calories is reduced below the calories expended, and that this happens when fat intake is reduced. He does make the point that the one place where he and Atkins could agree was that Americans eat excessive amounts of processed foods high in simple carbohydrates. He almost gets to the point of describing the Easy Low Carb Living approach when he says:

"Even better would be to reduce the intake of simple carbohydrates and most fats, which results in losing even more weight while enhancing health rather than potentially harming it."

We believe his advice would be even better if he had recommended an intake of carbs that convert slowly to blood sugar, a reduction in saturated fats, elimination of trans fats and an increase in unsaturated fats. He does comes closer to this perspective when he recommends replacement of simple carbohydrates with complex (unrefined) carbohydrates such as fruits, vegetables, legumes and whole grains.

There is an important distinction in Dr. Ornish's comments about the difference between reducing risk factors and actually decreasing disease. He makes his point by contrasting the increase in HDL, the good cholesterol, that may occur on a high fat diet with the lowering of HDL that often accompanies a low fat diet. The heart health is actually greater in the case of the lowered HDL because the LDL, the bad cholesterol, has reduced even more. This effect has actually been proven by measurement of the amount of hardening in the heart blood vessels and how well the heart muscle is supplied with blood. The message to those of us trying to make healthy eating decisions is that our choices must produce both an increase in the HDL and a decrease in the LDL, as happens when we choose slow carbs and 'good' fats.

We like the perspective Dr. Ornish presents in his concluding comments.

"The concept of a dietary spectrum empowers people with information and freedom of choice rather than the feeling of constraint or restriction. This becomes a way of eating rather than a diet with rigid "eat this" and "don't eat that" guidelines. For example, someone may indulge himself or herself one day and eat more healthfully the next. To the degree that people reduce their overall intake of simple carbohydrates and excessive fat and increase their intake of whole foods such as complex carbohydrates, they are likely to lose weight and gain health."

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WHAT ABOUT CALORIES?
DO THEY MATTER?
Harv Haakonson M.D.

How often have you heard the statement "calories in = calories out" to describe what is required to manage weight control? This is the traditional medical and nutritional wisdom, a dictum that is hard for those professionals to move beyond. In fact, the science has not yet proved that this dictum is incorrect.

By contrast, both Dr. Atkins and Dr. Barry Sears (The Zone) are convinced that there is another metabolic process in play when we choose to eat low carb. Their contention is that the reduction in carbs results in a shift in the body's efficiency to metabolize fat thus if we eat low carb we can actually lose weight while consuming a higher number of calories than we did while eating high carb. Our question is: "Why would we want to do that?" It seems to us that the more healthy approach is to choose our food intake on the basis of what we know to be most healthy.

We are guided to a significant extent by the advice of Dr. Walter Willett in his book "Eat, Drink and Be Healthy." His Healthy Eating Pyramid was developed based on the results of scientific research over the past two or three decades so it has a sound basis. We like that. We also like the fact that it allows us to eat a balanced intake of proteins, fats and carbohydrates. In other words, it provides a balanced diet. By making better choices for our carbohydrates we are able to eat a low carb diet while still maintaining the balance.

Many people ask if they have to count calories. Our consistent answer is that: "It is not necessary to count calories. If you follow a low carb eating program the calories will look after themselves." Do the calories matter? Probably. Do you reduce the number of calories you take in when you eat low carb? Almost certainly if you follow our lifestyle plan. Do you need to count your calories? Absolutely not. Remember, this is supposed to be Easy and it can be. Don't complicate it when that isn't necessary.

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WHAT CAN WE DO TO REDUCE SOFT DRINK CONSUMPTION IN CHILDREN
AND ADOLESCENTS?
Editorial, The Journal of Pediatrics, June 2003, 599-600
Robert P. Schwartz, MD

• Reduce the availability and limit portion sizes of sugar-sweetened drinks sold at school and provided at home.

• Teach children that water is the best thirst quencher.

• Advocate for healthier choices in beverage vending machines in schools and communities (bottled water, low-fat milk, and 100% fruit and vegetable juice products).

• Prohibit advertising of sugar-sweetened beverages at school and daycare centers.

• Parents should model healthy behavior by limiting their own soft drink consumption.

• Provide schools with adequate funding for educational and extra-curricular programs.

• Advocate for small taxes on soft drinks and snack foods with the revenues applied to school programs, or subsidization of healthful foods such as fruits and vegetables.

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WHAT WE KNOW ABOUT SPLENDA
By Dr. Harv Haakonson

Splenda (sucralose) is made from sugar (sucrose) through a process that selectively substitutes three atoms of chlorine for three hydrogen-oxygen groups on the sucrose molecule. Corporate researchers claim that the chlorine atoms in Splenda have been altered to be so tightly bound, they create a molecular structure that is exceptionally stable under extreme pH and temperature conditions. Splenda's corporate marketers state that:

"...more than 100 studies on the safety of sucralose designed to meet the highest scientific standards have been conducted and evaluated over the course of 20 years."

Sucralose (trichlorogalactosucrose) was approved by the US Food and Drug Administration (FDA) in 1988 as a tabletop sweetener and for use in a number of desserts, confections, and nonalcoholic beverages. Today it is the most popular sugar substitute on the market.

Those who use the Splenda regularly, and recommend it to others must answer the question as to why we would recommend the use of sucralose when there are no long term studies to substantiate the safety of it. One of the realities of life is that we aren't always able to wait for "definitive proof" before we make decisions. It is correct that there aren't yet any long term studies to tell us that sucralose is a safe product. Of course there also are no long term studies to tell us that it is unsafe. I am reassured by the fact that it is a modified sugar molecule, not an artificial chemical. Can I be positive that there will never be evidence of long term concerns? No I cannot. Do I see any evidence to suggest that there may be a long term finding of concern? I do not.

In the face of the alternative sweeteners like refined sugar, aspartame or saccharin, I believe sucralose is by far the best choice. Some would argue that stevia is a better choice. I don't think it is a better choice though it may be close to being as good a choice. The problem with stevia is that most people won't use it because of the licorice after taste and because it is so powerfully sweet, even in small quantities.

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