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5 Easy Weeknight Dinner Recipes for Weight Loss Eat This Not That – Eat This, Not That

Posted: June 8, 2022 at 1:46 am

Half the battle of weight loss is trying to incorporate a healthy diet into your everyday routine. The busier you are throughout the week, the less time you have to make substantial dinners, and then the harder it gets to eat healthy meals. After a busy day, who wants to come home and prep something that could take hours to cook, just so you can be on the path to weight loss?

What if we told you that there were easy meals you could make that wouldn't interfere with your relaxation time? We spoke with The Nutrition Twins, Lyssie Lakatos, RDN, CDN, CFT, and Tammy Lakatos Shames, RDN, CDN, CFT, authors of The Nutrition Twins' Veggie Cure and members of our Medical Expert Board, to help give you ideas on easy dinner recipes for weight loss to make during your busy week.

There's one for each night weeknight, so you can plan! For your morning pick-me-up, take a look at 5 Easy Coffee Recipes for Weight Loss.

"While most burgers aren't great choices when you want to lose body fat, these sweet and savory juicy burgers can be whipped up quickly and are the perfect delicious ending to a stressful day," says The Nutrition Twins.

Each burger is loaded with 27 grams of satisfying protein to help keep you full for hours. Including the balsamic glaze and lettuce wrap, the meal only contains 150 calories.

As for the wild blueberries, The Nutrition Twins call them weight-loss superstars.

"They have the phytonutrient C3G which increases adiponectin to enhance fat burning, while also increasing leptin, to suppress appetite," they say.

If you need more to the meal, go ahead and add a whole wheat bun to replace the lettuce wrap and a heaping side of steamed vegetables to amp up the fiber, antioxidants, and satisfaction even more. This meal will not only be satisfying, but it will still encourage weight loss.

Get the recipe from The Nutrition Twins.

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"When you're craving Mexican food, you can whip up this meal in less time than it takes to drive to a Mexican restaurant, and you'll get only a fraction of the calories that you'd get from the restaurant meal," says The Nutrition Twins.

According to The Nutrition Twins, these tacos are low-fat and vegan. Research from the Journal of the American Nutrition Associationshows that eating a low-fat, vegan diet increases weight loss and improves body composition, even more so than a Mediterranean diet. The lentils, avocado, and corn tortillas in this meal all play a part in fighting cravings thanks to their combination of blood-sugar stabilizing protein and fiber.

"Additionally, lentils are an amazing source of slow-digesting carbohydrates that keep you feeling full and satisfied longer than other foods, even reducing calorie intake at your next meal," says The Nutrition Twins. "These tacos also have a whopping 14 grams of fiber, which is 2 grams more than the average American gets in their entire day! Fiber slows digestion and promotes fullness, which research shows may reduce the calories you eat throughout the day."6254a4d1642c605c54bf1cab17d50f1e

Get the recipe from The Nutrition Twins.

Pasta AND a creamy sauce? That sounds too good to be true for a meal to help with weight loss. However, there's a way around it.

"While most people think both pasta and Alfredo are taboo when they're trying to shed pounds, this tasty waistline-friendly version swaps out the cream, packs in blood-sugar stabilizing whole wheat pasta, low-calorie, fiber-loaded veggies, and satisfying protein," say The Nutrition Twins.

According to the Nutrition Twins, the antioxidant-packed cremini mushrooms provide anti-inflammatory benefits that help to protect against obesity. The fiber-rich broccoli fills you up with minimal calories.

"Most importantly, this meal satisfies pasta cravings that can come from feelings of deprivation after avoiding it, and that typically result in giving in to the cravings whole-heartedly and throwing in the towel on healthy eating completely," says The Nutrition Twins.

Get our recipe for Loaded Alfredo Pasta here.

One-pan meals are a great go-to during busy weeks, and this recipe happens to be both easy and healthy.

"Simply toss everything on a sheet pan, roast it, and a low-calorie, satisfying ideal weight loss dinner is served," says The Nutrition Twins.

In just 300 calories, this recipe offers nearly 30 grams of satisfying protein and 8 grams of filling fiber. Adding the slow-digesting brown rice helps satisfies your carb cravings, so you won't be needing an energy "pick-me-up" and sugar an hour later.

The Nutrition Twins suggest that increasing veggie consumption means greater weight loss and greater hunger prevention, and this meal happens to be both veggie and fiber-packed.

They further suggest using the lemon liberally since lemon's polyphenols may help to suppress body fat accumulation and prevent obesity.

Get the recipe from The Nutrition Twins.

Not only can you cook up this Chinese stir-fry recipe faster than you can get your Chinese take-out delivery, but this lightened-up version has less than half the calories of traditional Chinese take-out.

"Packed with the winning combination of 18 grams of protein and 6 grams of fiber for ultimate satisfaction, this meal won't leave you hungry and raiding the pantry for a snack an hour later," says The Nutrition Twins.

In addition, the soy isoflavones found in tofu may help to reduce body fat. Research from NAD shows that broccoli's sulforaphane may help you to lose weight.

Get the recipe from The Nutrition Twins.

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5 Easy Weeknight Dinner Recipes for Weight Loss Eat This Not That - Eat This, Not That

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25 Weight Loss Smoothies to Help You Lose Fat – Eat This Not That

Posted: May 20, 2022 at 1:49 am

If you had the power to make your life better in just 30 seconds, would you use it? Well, that power is yours. With the simple push of a button, you can blend up weight loss smoothies that turn your body into a hyper-efficient fat-burning machine. Weight loss smoothies rev up your metabolism, tone and define your muscles, and turn off the genes that contribute to fat storage and a myriad chronic health issues.

All you need is a blender and the perfect weight loss smoothie.

Healthy smoothies for weight loss are made with the right blend of weight loss foods that are scientifically proven to decrease body fat. Some of the common ingredients we include in these smoothies for weight loss are:

When you replace your standard breakfast with a weight loss smoothie, you can lose weight.

On the Zero Belly Smoothies diet, a 39-year-old emergency-response adviser from Katy, Texas, Fred drank Zero Belly Smoothies as part of his weight-loss program. "I noticed results in the first week," he says. "It really was amazing." Fred lost 21 pounds and 5 inches off his waist over the next six weeks.

Ohio's Martha Chesler, 52, who lost 21 pounds and 7 inches off her waist in less than 40 days, had the same experience. "I saw results immediately," she says.

In fact, in our original Zero Belly Test Panel of more than 500 men and women, many lost up to 16 pounds in the first 14 days. Now you can achieve results like these even more quickly with this carefully created, highly effective collection of Zero Belly Smoothies.

Here's just a selection of the amazing weight-loss smoothies you'll find in the book Zero Belly Smoothies!

For this selection, I asked the country's top nutritionists to share with me their favorite weight loss smoothies, keeping the best weight loss foods in mind, and the results are all delicious and nutritious. Pay attention to the protein countsif it's under 25 grams, you don't want them as a meal replacement, but rather paired with a meal.

All recipes serve one unless otherwise indicated.

by Isabel Smith, MS, RD, CDN

"I really love this weight loss smoothie because it tastes super-decadent, but in reality is just loaded with a ton of natural, unprocessed, and healthful ingredients. The cocoa powder is a good source of flavonoids that are both brain and heart-healthy, and also makes the smoothie taste like I've added a ton of chocolate. In addition to the healthy cocoa, this smoothie also has other healthy ingredients like raspberries that are a source of immune-boosting vitamin C, and the spinach that's a source of energizing B vitamins. If I have this smoothie post-workout, I'll also add a plant-based protein like sprouted rice or pea protein to help my muscles recover more quickly."

NUTRITION: (With scoop of protein) 391 calories / 15 g fat / 38 g carbs / 12 g fiber / 12 g sugar / 34 g proteinNUTRITION: (Without scoop of protein) 257 calories / 15 g fat / 32 g carbs / 11 g fiber / 10 g sugar / 8.6 g protein

by Kristin Reisinger, MS, RD, CSSD,founder and owner of IronPlate Studios

"Combining a non-dairy, low-calorie smoothie first thing in the morning with a roughly even portion of high-quality protein and good carbs is a great start to anyone looking to lose weight and be healthy. Starting the day off with a smoothie such as this will pull your body out of it's overnight fasting state, and the carbohydrates from healthy, mixed berries combined with high-quality protein will give you the quick energy and protein uptake your body needs first thing in the morning without being 'too much."

NUTRITION: 230 calories / 2.5 g fat / 20 g carbs / 5 g fiber / 7 g sugar / 26 g protein

by Cassie Bjork, RD, LD of Redefined Weight Loss

"This is my go-to smoothie recipe for weight loss because it contains a balance of protein, fat, and carbs which promote stable blood sugar levels, and in turn, your pancreas can secrete your fat-burning hormone, glucagon! And it's so good, you can drink one every morning and not get sick of it."

NUTRITION: 315 calories / 21 g fat / 26 g carbs / 4 g fiber / 9 g sugar / 14 g protein

by Lyssie Lakatos, RDN, CDN, CFT and Tammy Lakatos Shames, RD, CDN, CFT, The Nutrition Twins

With such a low protein count, this smoothie wouldn't qualify as a meal replacement, but it does pair well with an omelet, as the nutritionists suggest. Serves 3.

NUTRITION: 58 calories / 0 g fat / 14 g carbs / 3 g fiber / 5 g sugar / 2 g protein

by Jennifer Cassetta, MS, CN, clinical nutritionist, personal trainer

"Pumpkin pie without the pie, all year round? Yes, please! Pumpkin is a good clean burning carbohydrate and when you add the protein powder you'll balance your blood sugar as well as add the perfect components for a post-workout recovery meal."

NUTRITION: 331 calories / 10 g fat / 42 g carbs / 11 g fiber / 17 g sugar / 24 g protein

Fruits are like people: They come in all sorts of shapes, sizes, colors, and styles, and each has its own temperament. Some are so sweet you can barely stand it, others so bitter you avoid them at all costs. But regardless of their individual qualities, all fruits have something to offer and deserve our utmost respect.

That said, my favorites are red fruits. While there are studies linking nearly every kind of fruit to some sort of health benefit, the most evidence tends to pile up around fruits that are red or reddish, like purple or orange fruits. For example, a study in the journal Nutrition & Metabolism found that eating half a red grapefruit before a meal may help reduce visceral fat and lower cholesterol levels. Another study found that tart cherries reduce belly fat; blueberries, strawberries, and raspberries have also been linked to lower abdominal fat accumulation.

So while a number of different fruits will show up in Zero Belly Smoothies, expect many of your smoothies from this chapter to have a cool red or purple hue. That's a sign that you're getting a massive hit of antioxidants and fat-fighting fiber.

All recipes make one serving.

Pink Lady apples are among the most nutrient-rich varieties, according to a study at the University of Western Australia. This smoothie combines the apple with vanilla and cinnamon flavors to give you a uniquely autumnal fruit drink.

NUTRITION: 273 calories / 7.4 g fat / 27 g carbs / 5.5 g fiber / 15 g sugar / 26 g protein

Like a light, summery bowl of oatsthis is comfort food in a glass. Unless it's August and the peaches in your neck of the woods are perfect, opt for frozen peaches instead. The vanilla in the protein powder will combine with the peaches for a bright, warm, and hearty drink.

NUTRITION: 277 calories / 4 g fat / 33 g carbs / 6 g fiber / 14 g sugar / 28 g protein

Ginger packs high levels of health-boosting phytonutrients. But use fresh ginger: Chances are you bought that powdered ginger in your cabinet three years ago when you made a pumpkin pie, and it's been losing potency ever since. To keep fresh ginger on hand, break it into small chunks and freeze it, then allow to defrost before grating.

NUTRITION: 264 calories / 5 g fat / 26 g carbs / 6 g fiber / 11 g sugar / 29 g protein

Those Hulk-colored nuts have their own special fat-burning powers. In a recent Nutrition study, two groups followed nearly identical diet and exercise regimens; however, one of the groups was fed unsalted pistachios, while the other group was not. Surprisingly enough, the pistachio group members lost more belly chub and showed better improvements in their blood glucose and cholesterol levels than the control group participants.

NUTRITION: 266 calories / 9 g fat / 18 g carbs / 5 g fiber / 8 g sugar / 30 g protein

Valentine's Day in a glass. Don't underestimate the healing powers of dark chocolateit's not there as a gimmick. When you combine fruit and dark chocolate (at least 70 percent cacao), you accelerate the release of butyrate, a compound made in your large intestine that tells your fat-storage genes to chill out.

NUTRITION: 280 calories / 3 g fat / 35 g carbs / 6 g fiber / 17 g sugar / 28 g protein

As fruits go, bananas and peaches are polar opposites: bananas provide fiber and a rich consistency, while peaches add antioxidants for very few calories.

NUTRITION: 287 calories / 3 g fat / 36 g carbs / 5 g fiber / 22 g sugar / 29 g protein

Popping into a juice bar for a cold cup of extruded kale juice may be all the rage, but when it comes to both nutritional impact and weight-loss power, juices can't hold a candle to smoothies.

Next time you want to drink your veggies, blend up one of these seriously nutritious recipes from the book Zero Belly Smoothies.

All recipes make one serving.

Putting lemon in your blender is like taking out a nutrition insurance policy for your smoothie. That's because a significant percentage of the antioxidant polyphenols in any food or drink break down before they reach your bloodstream. But researchers at Purdue University discovered that adding lemon juice to the equation helped preserve the polyphenols.

NUTRITION: 254 calories / 7 g fat / 20 g carbs / 5 g fiber / 10 g sugar / 30 g protein

This is the world's most overlooked superfood: Studies show that parsley is actually denser with nutrients than kale, dandelion greens, or romaine lettuce. Combine it with superheroes like watercress and chia and you've got a mighty fat-fighting drink.

NUTRITION: 214 calories / 2 g fat / 22 g carbs / 4 g fiber / 10 g sugar / 28.5 g protein

We think of romaine lettuce as the crispy stuff at the bottom of a Caesar salad, but it's one of the 10 most nutritious vegetables around, and higher in fiber than almost any other form of lettuce. And because it's mostly water, it makes this smoothie a real thirst-quencher.

NUTRITION: 280 calories / 5.8 g fat / 27 g carbs / 10 g fiber / 12 g sugar / 201 g protein

Combining hemp and chia seeds gives you a superdose of omega-3 fatty acids. And hemp seeds, by weight, provide more protein than even beef or fish.

NUTRITION: 270 calories / 6 g fat / 26 g carbs / 6 g fiber / 10 g sugar / 29 g protein

I can't recommend green tea enough as a smoothie enhancer. In fact, people who drink green tea regularly have nearly 20 percent less body fat than those who don't, according to one 10-year Taiwanese study. And EGCG, the unique ingredient in green tea, can deactivate the genetic triggers for diabetes and obesity.

NUTRITION: 245 calories / 6 g fat / 23 g carbs / 5 g fiber / 11 g sugar / 26 g protein

Have you ever heard of the "health halo"? It's a term nutrition experts use to describe foods that use a healthy-sounding word like natural on their labels, or add ingredients that people think of as good for you ("Now with chia!"), but which are really junk at heart.

These smoothies are the reverse of that theory. These drinks are tremendously nutritiouspacked with as much, or more, fiber, protein, and healthy fats as any other drinks in the whole book. But they seem like they're bad for you. How can drinks that seem like they came right from the ice cream shop flatten your belly so effectively?

These are the drinks you'll whip up on a night when you want something to satisfy your ice cream jones. They're the recipes you'll lean on when your kids are complaining that they want something sweet for dessert. And they're the drinks you'll use to reward yourself after a hard day at work or in the gym. Deep, comforting, and delicious, these filling smoothies taste more like dessert than what they really arepowerful weight-loss weapons, compliments of the new book, Zero Belly Smoothies.

All recipes make one serving.

If you want your weight loss smoothies to taste like dessert, this recipe should be your go-to. Four words that combine to sound like a jam session at Ben & Jerry's house. The density of the banana will have you convinced you're drinking a milkshake, while the omega-3s in the walnuts will keep your mind sharp and your belly lean.

NUTRITION: 229 calories / 11 g fat / 26 g carbs / 7 g fiber / 10 g sugar / 28 g protein"

Confession: This recipe is adapted from one of our favorites from Zero Belly Cookbook. We loved it so much we had to include it here as well. For 150-plus recipes that melt belly fat firstfeaturing foods you lovecheck out the cookbook today.

NUTRITION: 300 calories / 9 g fat / 34 g carb / 11 g fiber / 9 g sugar / 25 g protein

Beans? In a smoothie? Use canned or pre-cooked beans for a thick, earthy protein and fiber punch. One study found that people who ate cup of beans daily weighed 6.6 pounds less, on average, than those who didn't, even though the bean eaters took in more calories.

NUTRITION: 280 calories / 3 g fat / 31 g carbs / 7 g fiber / 9 g sugar / 31 g protein"

One of my favorite almond butters is Justin's. It's made with dry-roasted almonds and a bit of sustainably-sourced palm fruit oil, which lends the spread its creamy texture. (They also make all-natural peanut butter cups that will make you question everything you thought you knew about the PB-chocolate combo.)

NUTRITION: 340 calorie/ 15 g fat / 36 g carbs / 10 g fiber / 13 g sugar / 20 g protein

A smoothie can be a lot of things: a pre- or post-workout boost, a cold and refreshing thirst quencher, a thick and creamy dessert, a perfectly balanced breakfast. But one thing most of us never think of when we think of smoothies: comfort food.

These recipes, from the book Zero Belly Smoothies, stake out a new territory in the smoothie landscape, a culinary point of departure into a taste realm you might not have considered. While these smoothies are still cold and refreshing, they're going to taste more like a savory soup than a bright pick-me-up.

This one has a kick to it, softened by the cherry aftertaste.

NUTRITION: 232 calories / 2 g fat / 28 g carbs / 3.5 g fiber / 10 g sugar / 26 g protein

Bananas and sweet potatoes both add starch, but that's why the cinnamon is in there. Adding cinnamon to a starchy meal helps stabilize blood sugar and ward off insulin spikes, according to a series of studies printed in The American Journal of Clinical Nutrition.6254a4d1642c605c54bf1cab17d50f1e

NUTRITION: 280 calories / 5 g fat / 34 g carbs / 6 g fiber / 14 g sugar / 28 g protein

You won't even taste the secret ingredient here.

NUTRITION: 340 calories / 4.5 g fat / 53 g carbs / 11 g fiber / 14 g sugar / 24 g protein

The nutty, roasted flavor of nutmeg steps in brilliantly here as a base for a delicious smoothie that will have you reminiscing about the Thanksgivings of your childhood.

NUTRITION: 283 calories / 5 g fat / 35 g carbs / 7 g fiber / 14 g sugar / 28 g protein

Unlike the pumpkin spice lattes you love, this drink has actual pumpkin in it. One-third cup of pumpkin provides protein, fiber, omega-3 fatty acids, and 16% of your recommended daily intake of vitamin C a nutrient researchers say is directly related to the body's ability to burn through fat. In fact, one study by researchers from Arizona State University showed deficiencies of vitamin C were strongly correlated with increased body fat and waist measurements.

NUTRITION: 292 calories / 5 g fat / 33 g carbs / 7 g fiber / 14 g sugar / 29 g protein

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25 Weight Loss Smoothies to Help You Lose Fat - Eat This Not That

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Nutritionists Say Eat These Winter Superfoods to Lose Weight – The Beet

Posted: January 22, 2021 at 2:48 pm

New year, new goals. And if youre all aboard the Lets Shed the Pounds This Year Train, then its hard to do better than the vegan diet for healthy, sustainable weight loss. But if youre anything like us, sometimes you simply arent sure where to start. So many recipes, so many cookbooks...what should I add tomy grocery cart? Well, thats exactly why we reached out to the nutrition pros to cut through the noise and share the best foods in season during the winter to load up on if youre looking to lose weight. Read on, and please pass the pomegranate seeds.

Broccoli is a superhero when it comes to fighting inflammation and helping to prevent disease. It helps to fight against heart disease and cancer, lower cholesterol, decrease the risk of age-related eye disease, aid in healthy digestion, and it helps to keep the brain healthy, remark Lyssie Lakatos, RDN, CDN, CFT & Tammy Lakatos Shames, RDN, CDN, CFT, aka The Nutrition Twins, authors of The Nutrition Twins Veggie Cure and co-founders of NutritionTwins.com and the 21-Day Body Reboot.

In terms of crushing your weight loss goals, its also quite low in caloriesclocking in at only 31 calories a cup, and its 89% water say The Nutrition Twins. You could eat it and fill up on cups of it and still not gain weight.

Another cool thing worth noting? Recent researchfound that the phytochemical, sulforaphane found in broccoli (and especially broccoli sprouts) gives metabolism a boost by activating brown fat cells and also undoes the damage of high-fat food on your gut microbiome to help reduce inflammation and stop weight gain, say The Nutrition Twins.

Amy Gorin, MS, RDN, a plant-based registered dietitianand owner of Plant-Based Eatsin Stamford, CT, loves using ginger in warming winter recipes, and were totally with her. I find that by flavoring recipes with it, I can often reduce or even eliminate added sugar in a recipe because it has such a strong flavor, she says.

Personally, were big fans of drinking hot water with ginger to promote weight loss and boost immunity. And its amazing how a fast weeknight dinner like a quick tempeh and veggie bowl over brown rice gets a gourmet boost by the addition of fresh sauted ginger.

Trista K. Best, MPH, RD, at Balance One Supplementsattributes two main characteristics that make sweet potatoes an ideal weight-loss food: First, sweet potatoes are high in fiber. Fiber works towards weight loss efforts in two ways. One, fiber leaves the consumer feeling fuller which makes them less likely to overeat at mealtimes and eat less between meals. Two, fiber removes toxins from the body and keeps the bowels regular, both of which reduce inflammation and weight, she explains.

Need more convincing? Second, the low-calorie content of sweet potatoes makes them a great addition to just about any meal when trying to lose weight. They are extremely versatile and add robust flavor to many recipes, she continues.

Try one of our tuber go-to's: Sweet Potato Mexican Fry Up.

These fruits are a winter nutrient powerhouse, according to The Nutrition Twins, who also note that they contain potent antioxidants and anti-inflammatory compounds that have been shown to do everything from reducing inflammatory activity in breast cancer cells, colon cancer cells, and the digestive tract; reduce the risk of heart disease, diabetes, and obesity; fight against bacteria and fungus; improve memory, and possibly even protect against Alzheimers disease.

Pomegranate arils are a deliciously sweet-tart burst of flavor that explodes in your mouth as you bite into them, they comment, noting that theyre an ideal no-sugar-added treat to indulge in when you have a craving for sweets. We love that our clients happily choose them over typical sugary, calorie-dense snacks like candy bars and cookies, which helps them to achieve their weight loss goals. One cup of pomegranate arils contains seven grams of fiber, which helps you stay fuller for longer, making them an ideal add-on to oatmeal, salads, or your favorite plant-based yogurt.

The Nutrition Twins have eaten one of these winter superfoods nearly every day since high school, and were betting adding apples to our daily routine would do a whole lot of good for us, too. Researchshows that their flavonoids are great for your heart since they lower blood pressure and the risk of stroke while their soluble fiber helps to lower blood cholesterol, all important factors when it comes to heart health. They also protect against cancer, promote the good bacteria in the gut, and protect against mental decline. Several studies show apples can benefit weight loss, The Nutrition Twins say of the 80-calorie fruit (thats assuming your serving size is one medium-sized apple)

Bonus: One study showed that people who started their meal with apple slices ate 200 calories fewer than people who didnt! they add.

Gorin often incorporates these wholesome nuts when cooking in the winter, and based on the nutrition profile she shared with us, were pretty impressed: Pistachios are a good source of plant protein and fiber and about 90% of the fats found in pistachios are unsaturated, for a trio of nutrients that may help keep you fuller longer, she says.

If youre snacking on pistachios, you get even more weight-management benefits. A preliminary studyin Appetite found that people eating in-shell pistachios consumed 41 percent fewer calories than people snacking on the shelled version.

Best praises butternut squash for both supplying 40% of the daily vitamin C recommendation and 100% of the daily requirement for vitamin A in one serving. These two nutrients are just the tip of all that butternut squash provides, but are possibly the most important for its ability to boost the immune system, says Best. Additionally, with nearly three grams of fiber per cup, butternut squash is a good source of fiber, and with fiber intake linked to dropping weight, its a solid choice for a side dish or snack (try it roasted with cinnamon!) if youre hoping to slim down.

Butternut squash is versatile and can be used to enhance a wide variety of dishes and boost their nutrient content, she adds. Well, were sensing this creamy vegan butternut squash soupin our near future, dear readers.

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Nutritionists Say Eat These Winter Superfoods to Lose Weight - The Beet

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The 15 inspiring Devon people who have achieved phenomenal weight loss – Devon Live

Posted: January 2, 2020 at 4:43 am

We all know what should be doing to be fit and healthy, but the thought of having to lose weight or start exercising is often so daunting that it's easier to put it off.

Millions of people in 2020 will be making new year's resolutions to lose weight and get healthy and to give you the motivation you need, Devon Live has chosen 15 inspiring people from across the county who have achieved incredible goals.

They range from a family who have lost 15st between them to a woman who not only battled cancer but conquered her weight demons and got married.

Chris, Gareth and Aimee Pridham

Struggling to get in an airplane seat four years ago was the turning point for Chris Pridham.

His experience at the airport "set the tone" for the whole holiday and due to his 24 stone weight, he could not partake in all of the activities with his partner and old friends.

After two weeks back at home he ended up in hospital with an infected mosquito bite and got sepsis and cellulitis.

He then joined his nearest WW workshop in Saltash and lost more than six stone.

Chris said: "Basically, I was given a daily budget of smart points and every food had a value. It was up to me to balance my budget which I did and in a short space of time, I lost two stone and went to New York with my partner to visit my daughter.

"I could walk around and thought, this is brilliant.

I love bread and before joining WW would have three or four slices of thick white bread with lashings of butter and marmalade for breakfast, a big sandwich for lunch and a huge dinner. I now start the day with fruit and yoghurt; at lunchtime I have two slices of granary bread with a boiled egg and salad; dinner is stir fry veg with left over roast meat.

"I eat a lot of salad and am never hungry! I dont deny myself anything and have realised you have to have a bit of what you fancy otherwise you dont stick to it."

Research carried out by WW has identified what is known as the ripple effect.

This shows that when somebody joins a weight loss programme, the other members of the family can lose weight too without even trying as they are influenced by the new healthy habits they see.

Chris's nephew Gareth and his wife Aimee watched his transformation and were so impressed they joined the same WW workshop. Between the three of them they lost 15st.

Bonnie Stainer

Had someone told Devon DJ Bonnie Stainer four years ago she would be crowned UK Glamour Awards Model of the Year she would never have believed it because back then she weighed more than 16.5st.

Despite being a single mum of two girls, aged five and four, the 35-year-old, of Saunton, North Devon, has found the time to exercise six days a week and eat healthily to lose an amazing 8.5st.

Bonnie, who is 5ft 7, has seen her waist shrink by an incredible 30 inches from 56 to 26 inches, and now weighs 9st.

She had been considering quitting her DJ career because she had lost her confidence to get up on stage when she was overweight, but is now getting more work than ever and is also working as a model.

Bonnie recalled: I hadnt been overweight until I fell pregnant with my first child. I just ate literally whatever I was not meant to, which I enjoyed at the time, but I pilled on the pounds. The last time I weighed myself I was 16.5st.

After I gave birth I tried to lose the weight and feel like me again, but within six months I was pregnant with my second daughter and it happened all over again.

I need an incentive to get myself into the right state of mind so I decided to raise money for Cancer Research by signing up for the London Marathon in 2017.

I was down to about 12st when I did it and just kept going with exercising and eating healthy.

Bonnie added: The key is being in the right frame of mind, along with routine, exercise, eating well and drinking water.

I workout six days a week and try to rest one day a week, but Im still active running around after the kids. Sometimes I get up at 6am and do 30 minutes on the cross trainer wearing 27 kilos of weights. People think that sounds a lot but I was carrying a lot more than that when I was overweight.

I also go to the gym, run and I have two horses so I enjoy horse riding. Sometimes I do look at my cross trainer and think I cant be bothered, then all I do is just think about what Im trying to achieve and after Ive done it I feel so much better."

Tracey May

An inspirational slimmer who has lost nearly 5st in less than six months has told how she has gone from barely ever leaving her home to finding a new zest for life at the age of 53 years old.

Tracey May, of Exeter, saw the pounds pile on after undergoing spinal surgery three years ago to remove a tumour.

Her recovery took many months and it began a pattern of living an inactive lifestyle which she struggled to break the heavier she got.

However, since completely changing her lifestyle in March she has lost almost a third of a body weight. She has gone from 15st 10lbs to 11st, and dropped from a size 20 to almost a size 12.

The mum-of-three joined Wonford Sports Centre in March, and has gone from struggling to do two minutes on the cross trainer on the lowest setting, to doing an hour easily.

She goes a couple of times a week, has joined a Back to Netball team and a running club, and also goes swimming if she finds the time during the week.

Traceys initial goal was to lose 3st in a year, but she has done so well that she has doubled her target.

She said: I want to be 9st 10 and that will be exactly 6st I have lost. I havent been on a diet as such but what I have done is switch everything from full fat to low fat and sugar free, and have swapped coke for water.

Ive always now got fruit and vegetables in the house, and I cook everything from scratch. I also dont eat fast food, but I do have the odd treats.

She said: I only went out if I had to which was maybe twice a week, if that, because it was just so painful. Everything hurt because of how heavy I was.

I got depressed and thought this is it. My confidence was so low. I now feel 100 per cent better. I used to take a lot of painkillers but dont take any now, and Ive also come off anti-depressants. It really has changed my life."

Mandy Coles

A Tavistock mum who lost more than 12 stone believes there's a simple solution to weight loss - taking time out - and now she is urging parents to take time for themselves to change their lives too.

Mandy Coles reached 24 stone at her heaviest weight but astonishingly she managed to shed the pounds and drop to an impressive 11.5st in just 14 months, after joining Slimming World.

Since losing the weight, Mandy' slife has changed dramatically and she is now helping others as a Slimming World consultant and whilst working with other slimmers.

She says she often meets parents who would just love to lose weight and lead a healthier lifestyle, but they feel that their life as a busy parent is preventing them from making those changes.

Mandy explained that one of the greatest gifts she has gained as a result of her weight loss is the drive and physical ability to play with her six-year-old son.

She said: "Actually having the energy to be the mum I have always wanted to be is priceless and taking that time for me to go to group each week was worth every moment".

She added: "Taking that one hour a week to attend a group is an investment in your and your familys future happiness.

"It is also an hour of you time which you do deserve. Sometimes I hear parents say they cant get that time for themselves, so I want to urge them to find that time.

"It is something you never regret as you and your family will benefit from a much healthier and happier you and that is priceless.

Dr Katie Giddy-Pannell

A Plymouth GP lost a whopping 5st 2lbs and is now able to motivate patients with her lose weight.

Due to her profession, she said she "should know better" but with a vegan diet, a supportive exercise class, and Slimming World online, she has managed to shed some weight and control her lupus, a chronic health conditon.

The 41-year-old underwent the dramatic transformation in just over a year and has seen drastic improvements to her health.

She said: "I was getting terrible debilitating back pain, out of breath, swollen legs. Just generally felt unhealthy, especially in the heat.I had no energy, no get up and go.

"Now, my health is better, less back pain and other joint pain, I have a chronic health condition called lupus, which is better controlled with my diet now, and the exercise."

Katie advises anyone who wishes to lose weight to find an eating plan that suits them and to ensure that they do not make something up, as planning is key.

She said: "I would advise others to find an eating plan that suits them and stick to it, don't try to make it up, a small under-calculation in calories could mess up a lot of hard work. Eat loads of veg and group exercise is also important."

Katie credits her weight loss to RockFit, which has kept her "motivated" and has meant that she has formed life-long friendships, some of which encourage her to attend classes on days where she feels "exhausted" after work.

She added: "I've lost five stone by doing Slimming World online, RockFit and a bit of running, but it is RockFit that's kept me motivated and help change my body shape."

couple fromBrixhamlost a staggering nine stone between them after realising they were both unhappy with their weight.

Joanne and Scott Mason

After a combined weight loss of 13.5lbs with the help of their local Slimming World group inBrixham, Joanne and Scott Mason reached the semi-finals of the organisations Couple of the Year 2019 competition along with only 17 other couples from across the UK and Ireland.

JoanneandScottbelieve the secret of their success was getting support from one another at home, as well as each week at their Slimming World group.

Joanne,48, who slimmed from15st5lbs to9st, said: I knew that my weight was an issue and I was becoming more and more uncomfortable in my own skin, but I didnt really know where to start when it came to losing weight.

"The lightbulb moment came whenScotttold mehewas unhappy withhisweight too. Wed heard great things about Slimming World, and it seemed to be the perfect fit for us.

"We knew that we needed the encouragement of a group each week and that wed support each other along the way too."

Scott,45, who downsized from16st3.5lb to12st9lbs, added: It came as a huge relief once I realised thatJoannewanted to lose weight too, because I knew that by supporting each other to make healthier choices it would give us both a brighter future and it absolutely has we have a whole new lease of life.

"Losing weight also made us think about how active we were. Weve started walking regularly now and we love it!

"Joining Slimming World is one of the best decisions weve ever made. We feel great and we know that we have a long, healthy, happy life to look forward to together.

Elly Dickinson

No one was more surprised by Elly Dickinson's amazing weight loss, and she says she doesn't even recognise the person in old photographs now.

As she is only 5ft 2in tall, Elly says her 31lbs weight loss shows more on her than it would on a taller person.

And she admits that she found if difficult to track down old 'before' pictures to demonstrate her weight loss because she would never stand in front of a camera and always deleted 'horrible' pictures of herself because she didn't like how she looked.

Now 31-year-old Elly, who works as a relationship executive for Newcross Healthcare in Torquay, says her confidence has soared and she's happy in her own skin - eating and exercising healthily.

She said: "With Weight Watchers - or WW as it's now called - you don't ever feel like you are losing out. I have managed to keep it on track without much effort. You always know where you are without getting obsessed about food because it's so maintainable.

"It's been great for my confidence - amazing!"

Laura Gilpin

An overweight grandma, who temporarily lost the site in one eye at a celebratory barbecue, has gone on a mammoth diet after being told her weight contributed to her having a mini stroke.

Laura Gilpin, of Newton Abbot, had her out of the blue health scare while celebrating her grandchilds football team in 2015, but still continued to pile on the weight.

It wasnt until last year that she finally decided to get fit and healthy and set herself a target of losing a stone a month.

The 62 year old joined LighterLife last July, and succeeded by losing an incredible 5st 2lbs in just five months. Her weight dropped from 17st 6lb to 12st 4lb.

She said: Losing 5st has been life changing in so many ways. Im no longer on blood pressure medication, I have the energy to keep up with my grandchildren and Im now enjoying cooking for the first time. It feels amazing to have my zest for life back."

Fern Parkin and Jacqui Blackman

A mother and daughter from Barnstaple who both beat cancer have also had their lives transformed by an incredible weight loss.

Fern Parkin, 32 and mother Jacqui Blackman, 68, lost 5st 5lbs between them. Fern was diagnosed with liver cancer at the age of six months, while her mother beat ovarian cancer in 2004 aged 54.

Fern thanked the team at WW (formerly Weight Watchers) for her newfound self-confidence. She added that she is no longer afraid to show her scars from surgery when she was a baby.

She said: I love the fact that I can roll over my points and add them to my weekly points. I have lost all my weight through WW, and I love that I can eat what I like as long as it's within my points. My mindset has changed completely, and I've never lasted this long on a diet. This is me for life now, being careful what I eat.

Jacqui added: After starting the program in January 2018 when a group opened up near me, I have never looked back, only forward to losing the next pound. I have found the plan so easy to follow, and there was no need to change my shopping habits greatly.

The app is an invaluable tool which keeps you on track, and weekly meetings are an inspiration. Even my health has improved as I no longer require tablets for high blood pressure which is huge.

My husband has also benefited just by eating smaller portions which the plan helps you to do. I have dropped two dress sizes and now able to wear more fashionable clothes.

I have been able to enjoy holidays and not gain more than 1lb which has always come off the following week."

Sharon Foxhall

A woman who lost weight in honour of her mother has been able to once again wear the wedding dress she made for her.

Sharon Foxhall, 47, from Hawkchurch, married in September 1993 after a five year courtship. At the time it was the lowest weight she had ever been.

She said: My mum made my wedding dress along with the bridesmaids. We decided to have a party for our 25th as its such a big milestone but then I lost both my parents within months of each other four years ago.

Sharon vowed to get to her target weight after her mother died in 2015 as she had always struggled with her weight. After 18 months she had lost three stone after joining WW (Weight Watchers).

She said: I joined WW as I had issues with my knees and I though losing weight would help them. As I lost weight my knees started to improve along with my self-esteem and confidence. It totally changed my life and wanted to give that feeling to others, so I became a coach to help others achieve what I had. It has been the most remarkable work I have ever done, seeing lives unfold and change over the weeks and months.

We booked our party in January 2018 for that September and decided I wanted to wear my dress again. I lost a further stone and got into my dress as if Id only just stepped out of it, it was amazing.

"I hadnt seen the dress since the day we got married and so was a very emotional moment opening the case and seeing it for the first time in 25 years, the dress my mum made.

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Rim width explained for road bikes, mountain bikes and gravel bikes – BikeRadar

Posted: October 4, 2022 at 2:11 am

One of the most significant trends in road bike, mountain bike and gravel bike design has been the move to ever-wider tyres. Thats resulted in an increase in wheel rim widths too, because theres a need to support the wider tyres properly to ensure they perform optimally and safely.

The improved accessibility of carbon rims, in place of alloy, has helped enable the increase in rim widths by reducing the weight and increasing the strength of the material required to make a rim wider.

Heres everything you need to know about rim width.

Key measures are the rims outer width, its inner width and its depth. Enve

The width of a bicycle wheel rim is the distance across the rim from edge to edge. Thats as opposed to the depth, which is the distance measured from the outer circumference to the inner circumference of the rim.

Rim width is usually quoted as two figures:

Its worth noting that some aero rims (mainly seen in road bike wheels) bulge out further lower down the rim profile. In these wheels, the overall external rim width will be greater than the external rim width at the tyre bead.

The internal rim width (in the position where the tyre beads sit) is where official measurements for tyre compatibility and safety are taken, and are the vital measurements to pay attention to.

Rim and tyre width both have a significant effect on tyre profile. Katherine Moore / Immediate Media

There are a number of reasons why rim width is important.

Firstly, it determines which tyre sizes will fit safely.

As a general rule, a very wide tyre on a narrow rim will be unstable thanks to inadequate support for the sidewalls and large air volume.

Similarly, mounting a tyre that is too narrow for a wide rim risks insecure fitting and damage to the rim if you strike an object as you ride.

Rim and tyre widths are determined by the ETRTO (European Tyre and Rim Technical Organisation), with a range of sizes that are deemed safely compatible. You should never ride a wheel and tyre combination outside of the safe range.

Although most wheel makers publish both internal and external rim width measurements, its the internal width that is most important when it comes to safe compatibility with tyres.

In general, a tyre will be wider than the visible external rim, but there are limits to how much wider it can be before it falls outside the safe range.

That said, there are examples of external rim widths that measure wider than the widths of the tyre, while remaining safe. This is usually in pursuit of maximising aerodynamic efficiency.

Wider rims are a trend in both road and mountain bikes, assisted by the use of carbon fibre. Alex Evans / Our Media

Rims have become a lot wider in recent years, with some road bike rims having an internal width of around 25mm or more, whereas 17mm or even narrower was a more usual width a few years ago.

External rim widths have also grown in tandem. External widths of 28mm or more are now common, and aero rims designed for maximum efficiency may be significantly wider still.

Hunts 60 Limitless Aero Disc wheelset has rims with an external width of 34mm, for example.

Theres been a similar expansion in the width of mountain bike wheel rims, with some as wide as 40mm across the rim bed.

Wide internal rim width can plump 28mm tyres up to over 30mm. Simon von Bromley / Our Media

As rim widths grow, the real width of a mounted tyre may increase too.

Most road bike tyres and gravel tyres are now designed around an ETRTO standard rim with a 19mm internal width, meaning they should measure true to their stated size on such rims.

Using rims with an internal width greater than 19mm will therefore see the inflated width of those tyres increase in tandem.

A nominally 700 x 28c road bike tyre may actually measure around 30mm wide on rims with a 21mm internal width, for example.

This results in the volume of air contained in the tyre being significantly larger. For example, a 700 x 28c tyre will contain around 15 per cent more air when stretched to a 30mm width than at 28mm on a narrower rim.

Actual tyre width varies significantly with rim width. Enve

You can also get the extra volume without the additional weight a nominally wider tyre would bring.

In turn, that means that tyre pressure can be lowered because the weight of the bike and rider is supported over a larger surface area.

Road riders in particular typically run much lower tyre pressures than they did a few years ago, because doing so can bring benefits in comfort and rolling resistance.

The effect is less pronounced with mountain bike tyres, which have much larger air volumes already. Incremental increases in rim and tyre width lead to proportionately less increase in the air volume in the tyre, although there are other effects of increased rim width, as described below.

Vernier calipers enable you to measure the internal and external width of your rims accurately. Russell Eich / Immediate Media

There are two widths to measure: the internal width and the external width. The internal width is more important for the safety of the wheel-tyre interface, while the external width is significant for frame clearance, aerodynamics and brake compatibility (if youre running rim brakes).

Typically, wheel makers will quote rim width on spec sheets for their wheels.

If not, to get an accurate measurement of rim width, you need a set of Vernier calipers. These can measure the width of your rim precisely, either digitally or with a scale embossed on the caliper.

There are two sets of jaws to Vernier callipers and you use the main outside-facing ones to measure the rims outer width and the smaller inward-facing ones to measure the internal width.

You can also get a rough estimate, down to around a millimetre, using a ruler to eyeball the rim width.

Many brands have guides to help you match rims and tyes. Continental

There are various online resources you can refer to, including Schwalbes guide to recommended tyre widths for different rim widths. Other tyre makers, including WTB, have similar charts and most wheel makers will also provide a recommended tyre width range for their wheels.

Mountain bike tyres can usually be a little wider relative to the rim width than road bike tyres, because they have more inherent structural rigidity.

These recommendations will be based on the ETRTOs recommendations, and should always be adhered to.

There are no hard and fast rules when it comes to the ideal rim width. Matthew Loveridge / Immediate Media

Theres no one answer to this question, but it will depend largely on the kind of riding you want to do, and the experience you want to have from your wheel and tyre combination.

As weve mentioned above, rims have become progressively wider over the last few years.

In general, modern road bike rims are between 19mm and 25mm wide, whereas mountain bike rims are between 25mm and 35mm wide. Gravel bike wheel rims are towards the top end of the range for road bikes.

Wider rims can lead to better aerodynamics for road bike wheels. Hunt

Wider rims can offer a more rounded, less light-bulb-esque tyre shape that can improve handling. They can also offer aerodynamic advantages, because a wider rim is typically better able to recapture the airflow from the tyre and help reduce turbulence.

The main drawback of wider rims is that, all else being equal, they tend to be heavier than narrower ones. Though the performance benefits generally outweigh the negatives created by that increased weight, it may be something to consider.

If your tyres are towards the upper end of the spectrum 28mm or above for road tyres, 42mm and above for gravel tyres and 2.6in and above for mountain bike tyres your rim width should be wider for optimum tyre support.

You also need to consider your frames clearance. A wide tyre on a wide rim may push how much space there is between the frame and the perimeter of the tyre.

HED was an early advocate of wider rims for road bike wheels. Steve Sayers / Our Media

Opinions on rim width have changed significantly over the last few years. So whereas 17mm or narrower was a typical internal rim width eight or 10 years ago, 19mm is now a more usual starting point, and many road bike wheels now have much larger internal widths.

HED was the first brand to promote the benefits of wider rims and we remarked on the 23mm external width of its HED Ardennes wheels and the ancillary benefit of better aerodynamics and lower tyre pressures as long ago as 2008.

It took more than 10 years for the mainstream to catch on, but wide rims are now a feature of wheels from almost every wheel maker. For example Zipps wheels typically have 23mm internal width rims and ENVEs go as wide as 25mm internal.

A wide rim may mean the side knobs are not positioned to provide optimal cornering grip. Jack Tennyson / Our Media

As with road bikes, theres been a trend towards wider rims on mountain bike wheels.

With hard turns under compression a feature of mountain biking, the ability of wider rims to provide a less light-bulb-shaped tyre profile and reduce the tendency of the tyre to deform when turning is the key reason, just as with road bikes.

Older mountain bike wheelsets tended to come with 25mm internal width rims, but this has increased to 30 or 35mm internal in many modern mountain bike wheelsets.

Note that whereas mountain bike tyre widths are usually expressed in inches, rim widths are given in millimetres.

There are a couple of issues with going ever-wider though.

First, wider rims may lose rigidity over narrower ones because theres more material between the point of attachment of the spokes and the rims edge. That potentially makes the rim more prone to damage.

Weight also increases. Thats less of an issue with carbon rims, which can be built stronger for a given width, while still being lighter than alloy, which is a driver of the trend for carbon wheels in mountain biking in particular.

A tyre will deform less under cornering load if its supported by a wider rim. Elite Wheels

Secondly, as rim width increases, the tyre profile becomes more flat, so theres more of the tyres tread in contact with the ground. Thats great for straight-line grip, but means the knobs on the edge of the tyre designed to give you cornering grip arent there when you do make a turn, so your ability to turn at may speed actually decrease.

The Zipp 3Zero Moto wheels rim is designed to flex under asymmetric load. Zipp

Zipp makes a benefit of the decreased rigidity of wider rims with its 30mm internal-width 3Zero Moto wheelsets rims. These have a single-wall carbon rim (meaning it doesnt have a hollow mid-section, as many other rims do) and are designed to flex under cornering load. This results, Zipp says, in less chance of rim and tyre damage, greater traction and a smoother ride, among other benefits.

The wider tyres typically fitted to 650b wheels mean rims are usually wider than 700c gravel wheels. Katherine Moore

As with mountain bikes, gravel bike wheels have to cope with high loads on uneven surfaces. Gravel bike tyres are wider than road bike tyres, so considerations of tyre-wall support lead to wider rims than on road-going wheelsets.

Although many gravel bikes come fitted with road-going wheelsets, its increasingly likely they will have gravel-specific wheels with wider rims.

Mavics Allroad gravel wheels, for example, have rim widths between 22mm and 25mm depending on the model, with many of the latest gravel wheels from most brands sitting around the 25mm mark.

650b gravel bike wheel rims tend to go even wider, to better support the wider tyres typical with this wheel size. For example, ENVEs G-series wheels are 23mm internal width in 700c, but 27mm internally in 650b size.

Hookless rims can be lighter and cheaper, but they require precise tolerances. Warren Rossiter / Our Media

Carbon bicycle rims are increasingly going hookless, with a straight profile to the edges of the rim rather than having a rounded hooked section at the top edge to help retain the tyre.

In a hookless rim, a close fit between the rim and the tyre holds the two together and prevents the tyre from popping off the rim.

This relies on precise tolerances in making the rim and the tyre, which havent always been the case in the past.

Although hookless rims are only compatible with tubeless tyres, some wheel brands are known to specify which tyres will work with their hookless rims and dont recommend using tyres other than these. Some tyre makers will also stipulate that their tyres should only be used on hooked rims.

A hookless rim has a straight-edged profile to the rim. Hunt Bike Wheels

The main advantages of hookless rims are that they can be made lighter, and theres less manufacturing complexity, which can make them cheaper.

The tyre-to-rim interface may also be smoother, which some manufacturers cite as an aerodynamic advantage to hookless rims.

Hookless rims are easier to use in mountain bike wheels, where tyre pressure is a lot lower than with road wheels. At higher road wheel pressures, there is a greater risk of the tyre separating from the rim, particularly if hitting an object at speed, which could result in explosive loss of pressure, damage to the rim and a crash.

ENVE is one of many brands that now use hookless rims for their road bike wheels. Warren Rossiter / Our Media

Brands such as Zipp and ENVE, who have introduced hookless beads on many of their road bike wheelsets, recommend a maximum tyre pressure (typically 72.5psi / 5 BAR or less), which is much lower than has been typically used by road cyclists in the past.

This gives headroom for sudden increases in tyre pressure seen when the tyre is compressed by hitting objects, as described above, and helps prevent blow-offs.

The trend to wider rims for road bike wheels helps here, because you dont need to run such high pressures for the same support.

For optimum performance and safety, then, its important to pay close attention to wheel manufacturers recommendations for compatible tyre sizes and pressures.

For more information and advice, on topics such as silencing noisy disc brakes and repairing punctured tubeless tyres, check out our workshop hub page.

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5 Surprising Effects of Eating Soy, Say Dietitians Eat This Not That – Eat This, Not That

Posted: September 2, 2022 at 2:05 am

When you hear the word "soybeans," the first things that may come to mind are all the health claims you remember from years ago. Wasn't there talk about soy causing "man-boobs?" And what about those possible links to breast cancer, thyroid disease, and dementia? But those claims have not been clinically substantiated, according to experts at Harvard T.H. Chan School of Public Health.

"Soy is probably the most controversial nutrition topic out there," says Kathryn Piper, RD, LD, a registered dietitian and founder of The Age-Defying Dietitian. "The different outcomes in the research are most likely related to the variations in how soy is studied."

Soy can be safely consumed several times a week especially when eaten as an alternative to red and processed meats, say dietitians we spoke with.

"Numerous studies support the safety of 25 grams of soy protein per day," says Piper. "Soy is nutrient-dense, providing protein, fiber, calcium, and B vitamins and it appears to have a positive impact on those with heart disease and diabetes and women in menopause."

Let's consider the potential benefits of eating more soy. Read on, and for more, don't miss4 Surprising Effects of Cottage Cheese.

Soy is a rich source of protein, which is critical for repairing and building muscle. And as we've reported many times, muscle is metabolically active. The more muscle you have, the more calories you burn and the less fat you're likely to carry on your frame.

Protein is also satiating, keeping you feeling full longer and fighting cravings for sugary carbohydrates. "Soy may play a positive role on insulin resistance, fatty acid metabolism, and other hormonal, cellular, or molecular changes associated with weight gain," says medical review board member Lauren Manaker, MS, RDN, a registered dietitian nutritionist and founder of Nutrition Now Counseling.

A study in the International Journal of Medical Sciences that looked at soy's impact on obese people found that consuming dietary soy protein regularly reduced body weight, fat mass, and cholesterol levels.

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While a diet rich in soy protein may help you lose weight and take some strain off your heart, there are other circulatory perks to gain from eating soy and soy products. "Soy can help lower cholesterol and reduce your risk of cardiovascular disease," says Eatthis.com medical review board member Toby Amidor, MS, RD, author of Diabetes Create Your Plate Meal Prep Cookbook. She cites a 2019 meta-analysis published in the Journal of Nutrition, which found that soy protein reduced low-density lipoprotein, the so-called "bad" cholesterol, by 3 to 4% in adults.6254a4d1642c605c54bf1cab17d50f1e

RELATED:The Best Proteins for Lowering Cholesterol, Says Dietitian

Two other conditions play a key role in heart disease, heart attacks, and strokes that eating more soy may alleviatehigh blood pressure and inflammation, says Amidor.

Chronic low-grade inflammation is a condition where the immune system cells consistently flood the body due to poor diet, smoking, alcohol abuse, and other lifestyle factors. This covert assault may damage tissues, such as the linings of arteries, which can trigger another silent killerhigh blood pressure.

Both inflammation and high blood pressure may cause plaques to develop in arteries that can break off and trigger blood clots that initiate heart attacks and strokes. Two recent studies suggest supplementing the diet with soy protein may reduce blood pressure and chronic inflammation.

As you get older, your risk of osteoporosis increases. Half of all adults over 50, some 54 million Americans (including men), are at risk of breaking a bone due to low bone density, according to the National Osteoporosis Foundation. Eating more soy may help protect you from fractures.

"The isoflavones in soy foods are linked to improved bone mineral density and preventing osteoporosis-related bone loss, regardless of your weight," says Manaker. Isoflavones are a type of phytoestrogen, a plant-derived compound that's found in more abundance in soybeans and soy products than in any other food.

RELATED:#1 Best Supplement for Strong Bones After 50, Says Dietitian

High levels of estrogen have been associated with breast cancer. For that reason, women with breast cancer on hormone therapy were once told to avoid eating soy products. However, moderate soy consumptionup to two servings of tofu, soy milk, or edamame dailydoes not increase the risk of breast cancer, according to the Mayo Clinic. And eating soy products may actually have a protective effect, according to a large study in the journal Cancer, which found that isoflavone, the major phytoestrogen in soy, was associated with reduced mortality from not just breast cancer but all causes.

Other research published in 2022 by the American Association for Cancer Research found that soy might protect young girls from developing breast cancer later in life, says Amidor. The study looked at the diets of 329 girls from puberty until 2 years after first menstruation and found an inverse association between soy consumption and absolute fibroglandular volume, which is indicative of a lower risk of breast cancer.

Jeff Csatari

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Diagnosis and Management of Growth Hormone Deficiency in Adults – Consultant360

Posted: July 16, 2022 at 2:00 am

AUTHORS:Alexandra Martirossian, MD1 Julie Silverstein, MD2

AFFILIATIONS:1Fellow, Division of Endocrinology, Metabolism, & Lipid Research, Washington University School of Medicine in St. Louis, St. Louis, Missouri

2Associate Professor of Medicine and Neurological Surgery, Division of Endocrinology, Metabolism, & Lipid Research, Washington University School of Medicine in St. Louis, St. Louis, Missouri

CITATION:Martirossian A, Silverstein J. Diagnosis and management of growth hormone deficiency in adults. Consultant.2022;62(6);e20-e27.doi:10.25270/con.2021.10.00004

Received July 25, 2021. Accepted August 27, 2021.Published online October 14, 2021.

DISCLOSURES:The authors report no relevant financial relationships.

CORRESPONDENCE:Julie Silverstein, MD, Washington University School of Medicine in St. Louis, 660 South Euclid Avenue, St. Louis, MO 63110 (jsilverstein@wustl.edu)

Growth hormone deficiency (GHD) is a clinical syndrome caused by decreased production of or decreased tissue responsiveness to growth hormone. The most common cause of GHD in adults is pituitary tumors and their associated treatments of surgery or radiotherapy. Clinical manifestations of adult-onset GHD are nonspecific and include central obesity, loss of lean muscle mass, decreased bone density, insulin resistance, cardiovascular disease, hyperlipidemia, decreased exercise tolerance, and decreased quality of life. Diagnosis of GHD is confirmed by stimulatory testing or a low insulin-like growth factor 1 (IGF-1) level in the setting of multiple pituitary hormone deficiencies and organic pituitary disease. Treatment involves replacement with recombinant human growth hormone, and goals of therapy include clinical improvement, avoidance of adverse effects, and normalization of IGF-1 levels. Recombinant human growth hormone should only be prescribed for its approved clinical uses by an endocrinologist, and the risks and benefits of therapy should be weighed on a case-by-case basis.1,2

Physiology

Growth hormone (GH) is a polypeptide hormone secreted by somatotroph cells in the anterior pituitary that exerts several anabolic effects throughout the body. The GH receptor is expressed in multiple tissues including the liver, cartilage, muscle, fat, and kidneys.1 Activation of the GH receptor in the liver leads to hepatic production of insulin-like growth factor 1 (IGF-1), a peptide important for mediating many of GHs effects. In children, GH and IGF-1 are required for chondrocyte proliferation and linear growth. In adults, GH promotes several primarily anabolic effects including breakdown of fat, muscle growth, hepatic glucose production, and bone formation.1,3 Growth hormone secretion is regulated by a complex mixture of signals from the hypothalamus, gut, liver, and gonads, with production stimulated by growth hormone-releasing hormone (GHRH) from the hypothalamus and inhibited by somatostatin, which is primarily secreted in the brain and gastrointestinal tract. Factors that stimulate GH secretion include deep sleep, fasting, hypoglycemia, -adrenergic pathways, ghrelin, sex steroids, stress, and amino acids (eg, arginine, leucine).3 Factors that suppress GH secretion include obesity, glucocorticoids, glucose, hypothyroidism, IGF-1 (negative feedback), -adrenergic pathways, and free fatty acids. GH secretion is episodic and exhibits a diurnal rhythm with approximately two-thirds of the total daily GH secretion produced at night triggered by the onset of slow-wave sleep.3 GH levels reach a nadir during the day and may be undetectable, especially in obese or elderly persons. Over the course of a lifetime, GH secretion gradually rises during childhood, peaks during puberty, then gradually declines through adulthood. The phenomenon of age-related decline in GH levels is sometimes referred to as somatopause.4

Causes of Growth Hormone Deficiency

GHD can occur at any age and results from both congenital and acquired disorders (Table 1). Congenital causes include gene mutations and structural defects. Mutations in the genes encoding GH, GH receptor, GHRH receptor, and various transcription factors can cause GHD. Structural defects include empty sella syndrome, septo optic dysplasia, hydrocele, and pituitary hypoplasia.2 Acquired causes include intracranial tumors (eg, pituitary adenoma, craniopharyngioma, Rathke cleft cyst, glioma/astrocytoma, metastasis), head trauma, central nervous system infection, infarction (Sheehan syndrome), and infiltrative/granulomatous disease (eg, sarcoidosis, Langerhans cell histiocytosis, tuberculosis). GHD can also result from treatments for some of the aforementioned conditions, particularly cranial surgery or irradiation. In adults, the most common cause of GHD is a pituitary adenoma or treatment of the adenoma with pituitary surgery and/or radiotherapy, with the risk of deficiency proportional to the size of the tumor and extent of treatment.2

Manifestations of GHD in adults may include central obesity, loss of lean muscle mass, decreased bone mass, insulin resistance, cardiovascular disease, hyperlipidemia, and decreased quality of life.1 Data supporting the benefits of GH replacement are mixed, with much of the data showing benefit coming from retrospective and open-label observational studies. Some, but not all, studies show that GH replacement is associated with an increase in strength and exercise capacity2 and is associated with an increase in bone mineral density5,6 and decreased fracture risk.7 In terms of cardiovascular disease, a metanalysis of randomized, blinded, placebo-controlled trials suggests that GH replacement increases lean body mass and decreases fat mass, has a beneficial effect on low-density lipoprotein cholesterol, and lowers diastolic blood pressure8, but there is no evidence that these changes are associated with measurable changes in cardiovascular function.9

Benefits of Growth Hormone Deficiency

The effect of GH replacement on glucose metabolism is complex. GH antagonizes the action of insulin, and evidence suggests that GH replacement may lead to a transient increase in fasting glucose10 but not necessarily an increased incidence of diabetes.11 Long-term observational studies of patients with adult GHD also suggest that GH replacement is associated with an improvement in quality of life when assessing parameters such as memory and concentration, fatigue, tenseness, socializing, and self-confidence.12,13

Diagnosing Growth Hormone Deficiency

Making the diagnosis of GHD is generally easier in children because the outcome of short stature is readily apparent. The task is more difficult in those with adult-onset deficiency because the symptoms are generally nonspecific, so a higher index of suspicion is required.

Because of the high financial cost of recombinant human growth hormone (rhGH) and possibility of adverse effects, it is crucial that the correct diagnosis is made and that treatment is only pursued in those adults who are truly GH deficient. This shrewdness is important for prevention of inappropriate treatment that is sometimes seen in nonmedical conditions such as aging and sports. In deciding who to screen, a clinical history guides the extent of required testing (Figure).

In adults with a history of organic hypothalamic-pituitary disease (eg, pituitary mass with previous surgery and cranial irradiation) with at least 3 hormone deficiencies (eg, hypothyroidism, adrenal insufficiency, and hypogonadism) and a low serum IGF-1 level (< 2.0 standard deviation score, also reported as a Z-score), no further testing is required, and treatment can be initiated.14 This also applies to adults who have congenital structural defects or genetic mutations affecting the hypothalamic-pituitary axes who have at least 3 other hormone deficiencies and low serum IGF-1 level. In adults who have a history of organic hypothalamic-pituitary disease with 2 or fewer hormone deficiencies, high clinical suspicion, and a low IGF-1 level (< 0 standard deviation score), provocative testing for GHD is indicated.14

In the absence of any of these risk factors, testing is not advised. It should be noted that 30% to 40% of patients with adult-onset GHD may have normal IGF-1 levels, so if clinical suspicion remains high, diagnostic testing should be pursued.15 In adults with idiopathic GHD in childhood, retesting should be performed because a significant proportion of this population may have normal GH secretion as adults.16-19

Figure. Algorithm for Stimulation Testing and Treatment in Adults With Suspected Growth Hormone Deficiency14

Measurement of random GH levels for the purpose of diagnosing GHD is not reliable for multiple reasons. First, GH has a short circulating half-life of only 10 to 20 minutes, and the pulsatility of GH secretion makes interpretation of single measurements difficult.20 Second, GH secretion is suppressed in the postprandial state, so timing of food consumption is important to know. Other factors associated with decreased IGF-1 levels that should be taken into consideration when interpreting laboratory test results include advanced age, obesity, poorly controlled diabetes, liver disease, renal failure, oral estrogen use, hypothyroidism, and critical illness.21 Additionally, assays for GH and IGF-1 have not been rigorously standardized, and normal baseline values for adults are often inadequate. To circumvent these diagnostic issues, GH stimulation tests are used. There are several GH provocative tests available in clinical practice (Table 2), each with its own advantages and disadvantages.

The insulin tolerance test (ITT), although not commonly used in the United States, is considered the gold standard for diagnosis of GHD.4,14,22 Insulin-induced hypoglycemia stimulates the release of GH. The ITT is performed by having the patient fast for at least 8 hours and then intravenous insulin is administered at a dose of 0.05 to 0.15 U/kg. Blood is drawn fasting and then 20, 30, 40, and 60 minutes after adequate hypoglycemia is achieved (blood glucose, < 40 mg/dL).22,23 The diagnostic cutoff for GHD is a GH level 5 g/L or lower after hypoglycemia is achieved. The positive predictive value is 93%, sensitivity is 96%, and specificity is 92%.22 Several drawbacks of the ITTincluding the requirement for close medical supervision by a physician throughout the test, the possibility of inducing severe life-threatening hypoglycemia, and the risk of causing seizures and altered consciousness in certain susceptible populationslimit its use. The ITT is contraindicated in individuals aged older than 65 years, those who are pregnant, and those who have a history of or are at risk for seizures and cardiovascular disease. Moreover, normoglycemic or hyperglycemic patients with obesity and insulin resistance may require higher doses of insulin (0.15-0.2 U/kg) to achieve target hypoglycemia, thus increasing their risk for delayed hypoglycemia.

Finding an alternative to the ITT for the diagnosis of GHD has been challenging. The GHRH-arginine stimulation test showed favor for some time because of its convenience, reproducibility, and discriminatory power. However, in 2008, the recombinant GHRH (ie, injectable sermorelin) was removed from the market, so the test could no longer be performed in the United States.14,22 Since then, the glucagon stimulation test (GST) has become a preferred alternative diagnostic test for GHD in the United States. The exact mechanism for how glucagon stimulates GH secretion is poorly understood, but it has been shown to be a more-potent stimulator of GH secretion than other agents, including arginine and clonidine.24,25 Glucagon is more effective at stimulating GH secretion when administered intramuscularly compared with intravenously.26 The GST is performed by first having the patient fast for 8 to 10 hours, and then intramuscular glucagon is administered (1 mg if weight is 90 kg, 1.5 mg if weight is > 90 kg). Serum GH and blood glucose levels are measured at 0, 30, 60, 90, 120, 150, 180, 210, and 240 minutes after glucagon is administered. A GH cutoff of 3 g/L has been shown to have sensitivity and specificity of up to 100% in lean subjects (body mass index, 25 kg/m2).22 However, because obesity blunts the GH secretion response to glucagon, a lower cutoff of 1 g/L is recommended in individuals who are overweight or obese (body mass index, > 25 kg/m2).22 Advantages of the GST include its availability, reproducibility, safety, lack of influence by gender and hypothalamic cause of GHD, and relatively few contraindications. Disadvantages include its long duration, the need for intramuscular administration and multiple blood draws, and gastrointestinal adverse effects. The test is contraindicated in malnourished individuals or individuals who have not eaten for more than 48 hours, as well as those with severe fasting hyperglycemia (> 180 mg/dL).22,23 Because late hypoglycemia may occur, individuals should be advised to eat small and frequent meals after completion of the test.

In 2017, the US Food and Drug Administration (FDA) granted approval for the use of macimorelin for diagnosing adult GHD.27 Macimorelin acetate is an oral ghrelin receptor agonist with GH secretagogue activity that is readily absorbed and effectively stimulates endogenous GH secretion in healthy volunteers with good tolerability.28 To validate the efficacy and safety of macimorelin in the diagnosis of adult GHD, Garcia and colleagues performed an open-label, randomized, multicenter, 2-way crossover study of the macimorelin test vs the ITT.29 Participants with high (n = 38), intermediate (n = 37), and low (n = 39) likelihood for adult GHD and healthy, matched controls (n = 25) were included in the efficacy analysis. The macimorelin oral solution was prepared at a dose of 0.5 mg/kg of body weight. Blood samples for GH serum levels were collected before and at 30, 45, 60, and 90 minutes after administration of macimorelin. Using a GH cutoff of 2.8 ng/mL for the macimorelin test and 5.1 ng/mL for the ITT, the sensitivity was 87% and specificity was 96%. In post-hoc analyses, increasing the GH cutoff for the macimorelin test to 5.1 ng/mL while maintaining the GH cutoff of 5.1 ng/mL for the ITT resulted in a sensitivity of 92% and specificity of 96%. A greater peak GH level was seen in all groups with the macimorelin test compared with the ITT. Reproducibility for macimorelin was high at 97%. The macimorelin test was well tolerated with no serious or frequent adverse effects reported. The most common adverse effect was mild and transient dysgeusia. Garcia and colleagues later performed post-hoc analyses to determine whether macimorelin performance was affected by age, body mass index, or sex and evaluated its performance vs ITT over a range of GH cutoffs.30 They found that macimorelin performance was not meaningfully affected by age, body mass index, or sex. Caution should be used in generalizing these results in pediatric, elderly, and severely obese patients, since the study population age range was 18 to 66, and the highest recorded baseline body mass index was 36.6 kg/m2, with most participants having a body mass index of less than 30 kg/m2. Of the 4 GH cutoffs evaluated (2.8 ng/mL, 4.0 ng/mL, 5.1 ng/mL, and 6.5 ng/mL), the cutoff of 5.1 ng/mL provided maximal specificity (96%) and high sensitivity (92%) and was in good overall agreement with the ITT at the same cutoff (87%). At present, the approved FDA cutoff is the lower value of 2.8 ng/mL.29 Compared with the ITT and GST, the macimorelin stimulation test has the advantages of being safer, well tolerated, easier to perform, and is less influenced by body weight, so its use in clinical practice may increase in coming years. A major factor currently limiting its widespread use is high financial cost.14

Treatment of Growth Hormone Deficiency

Once the diagnosis of GHD has been made, treatment is initiated with rhGH, which contains the identical sequence of amino acids found in HGH. For many years, the only rhGH product on the US market was somatropin, a once-daily injection. In September 2020, the FDA approved once-weekly somapacitan for the treatment of adult GHD, but it is not yet available on the market.31,32 It is hoped that the decreased frequency of injections should lower the burden of treatment and improve treatment adherence. Multiple brands of somatropin are available, and there is no evidence that one commercial product is different or more advantageous than another, apart from differences in pen devices, electronic autoinjector devices that are user-friendly, dose per milligram adjustments, and whether the product requires refrigeration.14

In adults, the typical dose of somatropin ranges from 0.1 to 0.4 mg/d and is influenced by age, sex, comorbidities, and concomitant medications. Per the 2019 guidelines published by the American Association of Clinical Endocrinologists (AACE), the recommended starting dose for patients aged younger than 30 years is 0.4 to 0.5 mg/d, aged between 30 to 60 years is 0.2 to 0.3 mg/d, and aged older than 60 years is 0.1 to 0.2 mg/d. In patients transitioning from pediatric to adult care, rhGH should be continued at 50% of the dose used in childhood and then gradually adjusted. In patients with concurrent type 2 diabetes, previous gestational diabetes, and obesity, lower doses of 0.1 to 0.2 mg/d are recommended. Women tend to require higher doses than men to achieve the same IGF-1 level, especially if they are taking oral estrogen.33,34 Approximately 85% of circulating IGF-I is liver derived, and oral estrogen, which undergoes first pass metabolism, suppresses hepatic production of IGF-1. rhGH dose reduction is often necessary when oral estrogen is stopped or switched to transdermal. Most adverse effects of treatment are dose related. The most common adverse effects are related to insulin resistance and fluid retention and include hyperglycemia, paresthesias, joint stiffness, peripheral edema, arthralgias, myalgias, and carpal tunnel syndrome.2 Contraindications to treatment include active malignancy and active proliferative or severe nonproliferative diabetic retinopathy.

After GH replacement therapy is initiated, it is recommended that patients follow-up in 1- or 2-month intervals at first, which can later be spaced out to 6- or 12-month intervals once a stable dose has been reached.14 Determination of the appropriate dose is influenced by multiple factors, including clinical improvement in symptoms, avoidance of adverse effects, and IGF-1 level. Assessment of fasting glucose, hemoglobin A1c, fasting lipids, body mass index, waist circumference, waist-to-hip ratio, and quality of life should be performed at least once per year. Assessment of other pituitary hormone deficiencies and structural pituitary lesions with laboratory and imaging studies, respectively, should be performed as clinically indicated. If the initial bone density scan is abnormal, repeat evaluations at 2- to 3-year intervals are recommended. IGF-1 levels are commonly used to guide the adequacy of rhGH dosing, and the general recommendation is to target a level within age-adjusted reference ranges (standard deviation score, 2 and +2). However, studies have shown varying benefits and drawbacks to targeting IGF-1 levels in the upper or lower half of this range. Targeting IGF-1 levels in the upper range of normal (standard deviation score, 1-2) has shown benefits in body fat composition, waist circumference, and microcirculatory function but at the expense of increased insulin resistance and myalgias.35,36 Targeting IGF-1 levels in the lower range of normal (standard deviation score, 2 to 1) is more often associated with fatigue. Women may have a narrower therapeutic dose window than men. In a study by van Bunderen and colleagues, a high-normal IGF-1 target level in female study participants was associated with impaired prefrontal cognitive functioning, whereas a low-normal target IGF-1 level was associated with decreased vigor.37

The question of how long to continue GH replacement therapy is frequently debated. If clinical benefits have resulted from treatment (eg, improved quality of life, body composition, cardiovascular health, bone density), rhGH can be continued indefinitely presuming there are no contraindications. If there are neither subjective nor objective benefits after at least 12 to 18 months of treatment, the option of discontinuing GH replacement should be discussed with the patient.2,14 Since GH promotes cellular proliferation and tissue growth, there has been a longstanding theoretical concern that rhGH leads to increased risk of malignancy. Although studies show no increased risk of malignancy in hypopituitary patients on long-term growth hormone treatment, an abundance of caution should be exercised when deciding whether to start rhGH in patients with GHD and a history of or genetic predisposition to malignancy.38 It has been suggested that in adult patients with a history of cancer, low-dose rhGH should only be initiated 5 years after cancer remission is achieved.14,39 The patients oncologist should be in agreement and closely involved in follow-up care while the patient is taking therapy. In all patients, regardless of cancer risk, cancer screening guidelines should be followed.

A topic that has gained much attention in our culture is the use of GH for antiaging, with some citing it as a fountain of youth.40 Despite the popularity of this idea, no studies have assessed long-term (> 6 months) efficacy or safety of rhGH administration for this purpose in humans.14 Paradoxically, studies performed in mice have shown that mice with isolated GHD caused by GHRH or GHRH receptor mutations, combined deficiency of GH, prolactin, and thyroid-stimulating hormone, or global deletion of GH receptors live longer than their normal siblings and exhibit multiple features of delayed and/or slower aging.41-43 Liu and colleagues performed a meta-analysis of 31 studies describing the use of GH in healthy elderly adults and found that GH use was associated with small changes in body composition but increased rates of adverse events.44 In the United States, off-label distribution or marketing of rhGH to treat aging or aging-related conditions and for the enhancement of athletic performance is illegal. Given the clinical concerns and legal issues involved, it is strongly recommended that rhGH only be prescribed for the well-defined approved uses of the medication, which are GHD and HIV-associated lipodystrophy.14,45,46

Conclusions

Growth hormone replacement therapy in adults with confirmed GHD has been shown to be associated with improvement in multiple aspects of health, including body composition, muscle mass, cardiovascular health, bone density, and quality of life. The clinical manifestations of GHD in adults are often nonspecific, so diligence to confirm an accurate diagnosis is essential for avoiding the costs and ethical dilemmas of inappropriate treatment. There are multiple GH stimulatory tests available, each with its own benefits and caveats. Once the diagnosis of adult GHD is established, rhGH should be initiated at low doses and uptitrated based on IGF-1 levels and symptoms, while avoiding adverse effects. Research into longer-acting rhGH formulations and enhanced diagnostic testing is ongoing and will be essential for guiding the management of adult GHD.

References

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2. Molitch ME, Clemmons DR, Malozowski S, et al. Evaluation and treatment of adult growth hormone deficiency: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2006;91(5):1621-1634. https://doi.org/10.1210/jc.2005-2227

3. Kaiser U, Ho K. Pituitary physiology and diagnostic evaluation. In: Melmed S, Koenig R, Rosen C, Auchus R, Goldfine A, eds. Williams Textbook of Endocrinology. 14th ed. Elsevier; 2020:184-235.e14.

4. Van Den Beld AW, Lamberts SWJ. Endocrinology and aging. In: Melmed S, Koenig R, Rosen C, Auchus R, Goldfine A, eds. Williams Textbook of Endocrinology. 14th ed. Elsevier; 2020:1179-1194.

5. Barake M, Klibanski A, Tritos NA. Effects of recombinant human growth hormone therapy on bone mineral density in adults with growth hormone deficiency: a meta-analysis. J Clin Endocrinol Metab. 2014;99(3):852-860. https://doi.org/10.1210/jc.2013-3921

6. Elbornsson M, Gtherstrm G, Bosus I, Bengtsson B, Johannsson G, Svensson J. Fifteen years of GH replacement increases bone mineral density in hypopituitary patients with adult-onset GH deficiency. Eur J Endocrinol. 2012;166(5):787-795. https://doi.org/10.1530/eje-11-1072

7. Mazziotti G, Bianchi A, Bonadonna S, et al. Increased prevalence of radiological spinal deformities in adult patients with GH deficiency: influence of GH replacement therapy. J Bone Miner Res. 2006;21(4):520-528. https://doi.org/10.1359/jbmr.060112

8. Maison P, Griffin S, Nicoue-Beglah M, et al. Impact of growth hormone (GH) treatment on cardiovascular risk factors in GH-deficient adults: a metaanalysis of blinded, randomized, placebo-controlled trials. J Clin Endocrinol Metab. 2004;89(5):2192-2199. https://doi.org/10.1210/jc.2003-030840

9. He X, Barkan AL. Growth hormone therapy in adults with growth hormone deficiency: a critical assessment of the literature. Pituitary. 2020;23(3):294-306. https://doi.org/10.1007/s11102-020-01031-5

10. Woodmansee WW, Hartman ML, Lamberts SW, Zagar AJ, Clemmons DR; International HypoCCS Advisory Board. Occurrence of impaired fasting glucose in GH-deficient adults receiving GH replacement compared with untreated subjects. Clin Endocrinol (Oxf). 2010;72(1):59-69. https://doi.org/10.1111/j.1365-2265.2009.03612.x

11. Attanasio AF, Jung H, Mo D, et al. Prevalence and incidence of diabetes mellitus in adult patients on growth hormone replacement for growth hormone deficiency: a surveillance database analysis. J Clin Endocrinol Metab. 2011;96(7):2255-2261. https://doi.org/10.1210/jc.2011-0448

12. Mo D, Blum WF, Rosilio M, Webb SM, Qi R, Strasburger CJ. Ten-year change in quality of life in adults on growth hormone replacement for growth hormone deficiency: an analysis of the hypopituitary control and complications study. J Clin Endocrinol Metab. 2014;99(12):4581-4588. https://doi.org/10.1210/jc.2014-2892

13. Koltowska-Hggstrm M, Mattsson AF, Shalet SM. Assessment of quality of life in adult patients with GH deficiency: KIMS contribution to clinical practice and pharmacoeconomic evaluations. Eur J Endocrinol. 2009;161 Suppl 1:S51-S64. https://doi.org/10.1530/eje-09-0266

14. Yuen KCJ, Biller BMK, Radovick S, et al. American Association of Clinical Endocrinologists and American College of Endocrinology guidelines for management of growth hormone deficiency in adults and patients transitioning from pediatric to adult care. Endocr Pract. 2019;25(11):1191-1232. https://doi.org/10.4158/gl-2019-0405

15. Hilding A, Hall K, Wivall-Helleryd IL, Sf M, Melin AL, Thorn M. Serum levels of insulin-like growth factor I in 152 patients with growth hormone deficiency, aged 19-82 years, in relation to those in healthy subjects. J Clin Endocrinol Metab. 1999;84(6):2013-2019. https://doi.org/10.1210/jcem.84.6.5793

16. Maghnie M, Strigazzi C, Tinelli C, et al. Growth hormone (GH) deficiency (GHD) of childhood onset: reassessment of GH status and evaluation of the predictive criteria for permanent GHD in young adults. J Clin Endocrinol Metab. 1999;84(4):1324-1328. https://doi.org/10.1210/jcem.84.4.5614

17. Wacharasindhu S, Cotterill AM, Camacho-Hbner C, Besser GM, Savage MO. Normal growth hormone secretion in growth hormone insufficient children retested after completion of linear growth. Clin Endocrinol (Oxf). 1996;45(5):553-556. https://doi.org/10.1046/j.1365-2265.1996.00850.x

18. Longobardi S, Merola B, Pivonello R, et al. Reevaluation of growth hormone (GH) secretion in 69 adults diagnosed as GH-deficient patients during childhood. J Clin Endocrinol Metab. 1996;81(3):1244-1247. https://doi.org/10.1210/jcem.81.3.8772606

19. Nicolson A, Toogood AA, Rahim A, Shalet SM. The prevalence of severe growth hormone deficiency in adults who received growth hormone replacement in childhood. Clin Endocrinol (Oxf). 1996;44(3):311-316. https://doi.org/10.1046/j.1365-2265.1996.671492.x

20. Iranmanesh A, Lizarralde G, Veldhuis JD. Age and relative adiposity are specific negative determinants of the frequency and amplitude of growth hormone (GH) secretory bursts and the half-life of endogenous GH in healthy men. J Clin Endocrinol Metab. 1991;73(5):1081-1088. https://doi.org/10.1210/jcem-73-5-1081

21. Kwan AY, Hartman ML. IGF-I measurements in the diagnosis of adult growth hormone deficiency. Pituitary. 2007;10(2):151-157. https://doi.org/10.1007/s11102-007-0028-8

22. Yuen KC, Tritos NA, Samson SL, Hoffman AR, Katznelson L. American Association of Clinical Endocrinologists and American College of Endocrinology disease state clinical review: update on growth hormone stimulation testing and proposed revised cut-point for the glucagon stimulation test in the diagnosis of adult growth hormone deficiency. Endocr Pract. 2016;22(10):1235-1244. https://doi.org/10.4158/ep161407.dscr

23. Yuen KCJ. Growth hormone stimulation tests in assessing adult growth hormone deficiency. In: Feingold KR, Anawalt B, Boyce A, et al., eds. Endotext. MDText.com, Inc.; November 1, 2019. http://www.ncbi.nlm.nih.gov/books/nbk395585/

24. Rahim A, Toogood AA, Shalet SM. The assessment of growth hormone status in normal young adult males using a variety of provocative agents. Clin Endocrinol (Oxf). 1996;45(5):557-562. https://doi.org/10.1046/j.1365-2265.1996.00855.x

25. Aimaretti G, Baffoni C, DiVito L, et al. Comparisons among old and new provocative tests of GH secretion in 178 normal adults. Eur J Endocrinol. 2000;142(4):347-352. https://doi.org/10.1530/eje.0.1420347

26. Ghigo E, Bartolotta E, Imperiale E, et al. Glucagon stimulates GH secretion after intramuscular but not intravenous administration. Evidence against the assumption that glucagon per se has a GH-releasing activity. J Endocrinol Invest. 1994;17(11):849-854. https://doi.org/10.1007/bf03347790

27. Macrilen (macimorelin) for Oral Solution. US Food & Drug Administration. Published January 31, 2018. Accessed March 14, 2021. https://www.accessdata.fda.gov/drugsatfda_docs/nda/2017/205598Orig1s000TOC.cfm

28. Piccoli F, Degen L, MacLean C, et al. Pharmacokinetics and pharmacodynamic effects of an oral ghrelin agonist in healthy subjects. J Clin Endocrinol Metab. 2007;92(5):1814-1820. https://doi.org/10.1210/jc.2006-2160

29. Garcia JM, Biller BMK, Korbonits M, et al. Macimorelin as a diagnostic test for adult GH deficiency. J Clin Endocrinol Metab. 2018;103(8):3083-3093. https://doi.org/10.1210/jc.2018-00665

30. Garcia JM, Biller BMK, Korbonits M, et al. Sensitivity and specificity of the macimorelin test for diagnosis of AGHD. Endocr Connect. 2021;10(1):76-83. https://doi.org/10.1530/ec-20-0491

31. FDA approves weekly therapy for adult growth hormone deficiency. News Release. US Food & Drug Administration. Published September 1, 2020. Accessed March 27, 2021. https://www.fda.gov/drugs/drug-safety-and-availability/fda-approves-weekly-therapy-adult-growth-hormone-deficiency

32. Johannsson G, Gordon MB, Hjby Rasmussen M, et al. Once-weekly somapacitan is effective and well tolerated in adults with GH deficiency: a randomized phase 3 trial. J Clin Endocrinol Metab. 2020;105(4):e1358-e1376. https://doi.org/10.1210/clinem/dgaa049

33. Burman P, Johansson AG, Siegbahn A, Vessby B, Karlsson FA. Growth hormone (GH)-deficient men are more responsive to GH replacement therapy than women. J Clin Endocrinol Metab. 1997;82(2):550-555. https://doi.org/10.1210/jcem.82.2.3776

34. Cook DM, Ludlam WH, Cook MB. Route of estrogen administration helps to determine growth hormone (GH) replacement dose in GH-deficient adults. J Clin Endocrinol Metab. 1999;84(11):3956-3960. https://doi.org/10.1210/jcem.84.11.6113

35. van Bunderen CC, Lips P, Kramer MH, Drent ML. Comparison of low-normal and high-normal IGF-1 target levels during growth hormone replacement therapy: a randomized clinical trial in adult growth hormone deficiency. Eur J Intern Med. 2016;31:88-93. https://doi.org/10.1016/j.ejim.2016.03.026

36. van Bunderen CC, Meijer RI, Lips P, Kramer MH, Sern EH, Drent ML. Titrating growth hormone dose to high-normal IGF-1 levels has beneficial effects on body fat distribution and microcirculatory function despite causing insulin resistance. Front Endocrinol (Lausanne). 2021;11:619173. https://doi.org/10.3389/fendo.2020.619173

37. van Bunderen CC, Deijen JB, Drent ML. Effect of low-normal and high-normal IGF-1 levels on memory and wellbeing during growth hormone replacement therapy: a randomized clinical trial in adult growth hormone deficiency. Health Qual Life Outcomes. 2018;16(1):135. https://doi.org/10.1186/s12955-018-0963-2

38. Child CJ, Conroy D, Zimmermann AG, Woodmansee WW, Erfurth EM, Robison LL. Incidence of primary cancers and intracranial tumour recurrences in GH-treated and untreated adult hypopituitary patients: analyses from the Hypopituitary Control and Complications Study. Eur J Endocrinol. 2015;172(6):779-790. https://doi.org/10.1530/eje-14-1123

39. Yuen KC, Heaney AP, Popovic V. Considering GH replacement for GH-deficient adults with a previous history of cancer: a conundrum for the clinician. Endocrine. 2016;52(2):194-205. https://doi.org/10.1007/s12020-015-0840-2

40. DiGiorgio L, Sadeghi-Nejad H. Growth hormone and the fountain of youth. J Sex Med. 2018;15(9):1208-1211. https://doi.org/10.1016/j.jsxm.2018.04.647

41. Bartke A, Darcy J. GH and ageing: pitfalls and new insights. Best Pract Res Clin Endocrinol Metab. 2017;31(1):113-125. https://doi.org/10.1016/j.beem.2017.02.005

42. Aguiar-Oliveira MH, Bartke A. Growth hormone deficiency: health and longevity. Endocr Rev. 2019;40(2):575-601. https://doi.org/10.1210/er.2018-00216

43. Flurkey K, Papaconstantinou J, Miller RA, Harrison DE. Lifespan extension and delayed immune and collagen aging in mutant mice with defects in growth hormone production. Proc Natl Acad Sci U S A. 2001;98(12):6736-6741. https://doi.org/10.1073/pnas.111158898

44. Liu H, Bravata DM, Olkin I, et al. Systematic review: the safety and efficacy of growth hormone in the healthy elderly. Ann Intern Med. 2007;146(2):104-115. https://doi.org/10.7326/0003-4819-146-2-200701160-00005

45. Clemmons DR, Molitch M, Hoffman AR, et al. Growth hormone should be used only for approved indications. J Clin Endocrinol Metab. 2014;99(2):409-411. https://doi.org/10.1210/jc.2013-4187

46. Burgess E, Wanke C. Use of recombinant human growth hormone in HIV-associated lipodystrophy. Curr Opin Infect Dis. 2005;18(1):17-24. https://doi.org/10.1097/00001432-200502000-00004

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Pippa Middleton’s New Wedding-Day Diet – The Daily Meal

Posted: May 2, 2017 at 7:41 pm

Pippa Middleton is an English socialite and the sister of Kate Middleton, the Duchess of Cambridge. Her good looks, chic style, and frequent appearances at Londons hottest clubs thrust her into the public spotlight and earned her many admirers, as well as critics. In May, Pippa will be marrying her financier fianc, Jordan Matthews, and to really wow on her wedding day, she is turning to a questionable weight-loss routine the Sirtfood Diet, based on a book of the same name published in January by British nutritionists Aidan Goggins and Glen Matten.

Click here for The Sorta Weird Diet Habits of Your Favorite Celebrities Slideshow

So where does the Sirtfood Diet rank in terms of fad diets adopted by wealthy social elites? Researchers believe that a special group of polyphenol-rich foods help activate sirtuins a class of proteins that have been implicated in a range of cellular processes such as aging, inflammation, and stress resistance. Sirtuins are also believed to affect the bodys ability to burn fat, which is why theyve suddenly received more attention from the diet/weight-loss community. In an ideal scenario, the Sirtfood Diet leads to a seven-pound-per-week weight loss while preserving muscle mass.

If youre wondering which foods you can eat on this diet, the answer is not many. The ten most common sirtfoods are green tea, dark chocolate, apples, citrus fruits, parsley, turmeric, kale, blueberries, capers, and red wine. These foods are undoubtedly healthy and contain a number of beneficial antioxidants, flavonoids, and other nutrients, but nutritionists are skeptical that they provide enough protein and carbohydrates to make up a healthy eating regimen. The Sirtfood Diet is one part calorie restriction and one part juice cleanse.

The diet involves two distinct phases. The initial phase lasts one week, requires that participants eat no more than 1,000 calories for three consecutive days, and usually involves three sirtfood juices (celery, kale, and lemon are common juice components) and one low-calorie meal per day. For the next four days, calorie restrictions are increased to 1,500 kilocalories, with an extra solid meal added in place of a juice. The second phase is where consistent weight loss takes place. For the next two weeks, dieters eat three meals per day of only sirtfoods and one sirtfood juice.

If this diet stinks of starvation, then your nose is spot on. Registered dietitian Brigitte Zeitlin explained to The Cut that although its true that a person can initially lose weight on this diet due to its overly restrictive nature, theyd be starving themselves in the process. Zeitlin argues that eating fewer than 1,200 calories per day is potentially dangerous, and youll lack the necessary energy to get through the day. Rapid weight loss is usually just water weight, not fat, meaning that after you get off the diet the pounds come right back.

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Pippa Middleton's New Wedding-Day Diet - The Daily Meal

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Low-carbohydrate diet – Wikipedia

Posted: December 7, 2016 at 11:43 am

Low-carbohydrate diets or low-carb diets are dietary programs that restrict carbohydrate consumption, often for the treatment of obesity or diabetes. Foods high in easily digestible carbohydrates (e.g., sugar, bread, pasta) are limited or replaced with foods containing a higher percentage of fats and moderate protein (e.g., meat, poultry, fish, shellfish, eggs, cheese, nuts, and seeds) and other foods low in carbohydrates (e.g., most salad vegetables such as spinach, kale, chard and collards), although other vegetables and fruits (especially berries) are often allowed. The amount of carbohydrate allowed varies with different low-carbohydrate diets.

Such diets are sometimes 'ketogenic' (i.e., they restrict carbohydrate intake sufficiently to cause ketosis). The induction phase of the Atkins diet[1][2][3] is ketogenic.

The term "low-carbohydrate diet" is generally applied to diets that restrict carbohydrates to less than 20% of caloric intake, but can also refer to diets that simply restrict or limit carbohydrates to less than recommended proportions (generally less than 45% of total energy coming from carbohydrates).[4][5]

Low-carbohydrate diets are used to treat or prevent some chronic diseases and conditions, including cardiovascular disease, metabolic syndrome, auto-brewery syndrome, high blood pressure, and diabetes.[6][7]

Gary Taubes has argued that low-carbohydrate diets are closer to the ancestral diet of humans before the origin of agriculture, and humans are genetically adapted to diets low in carbohydrate.[8] Direct archaeological or fossil evidence on nutrition during the Paleolithic, when all humans subsisted by hunting and gathering, is limited, but suggests humans evolved from the vegetarian diets common to other great apes to one with a greater level of meat-eating.[9] Some close relatives of modern Homo sapiens, such as the Neanderthals, appear to have been almost exclusively carnivorous.[10]

A more detailed picture of early human diets before the origin of agriculture may be obtained by analogy to contemporary hunter-gatherers. According to one survey of these societies, a relatively low carbohydrate (2240% of total energy), animal food-centered diet is preferred "whenever and wherever it [is] ecologically possible", and where plant foods do predominate, carbohydrate consumption remains low because wild plants are much lower in carbohydrate and higher in fiber than modern domesticated crops.[11] Primatologist Katherine Milton, however, has argued that the survey data on which this conclusion is based inflate the animal content of typical hunter-gatherer diets; much of it was based on early ethnography, which may have overlooked the role of women in gathering plant foods.[12] She has also highlighted the diversity of both ancestral and contemporary foraging diets, arguing no evidence indicates humans are especially adapted to a single paleolithic diet over and above the vegetarian diets characteristic of the last 30 million years of primate evolution.[13]

The origin of agriculture brought about a rise in carbohydrate levels in human diets.[14] The industrial age has seen a particularly steep rise in refined carbohydrate levels in Western societies, as well as urban societies in Asian countries, such as India, China, and Japan.

In 1797, John Rollo reported on the results of treating two diabetic Army officers with a low-carbohydrate diet and medications. A very low-carbohydrate, ketogenic diet was the standard treatment for diabetes throughout the 19th century.[15][16]

In 1863, William Banting, a formerly obese English undertaker and coffin maker, published "Letter on Corpulence Addressed to the Public", in which he described a diet for weight control giving up bread, butter, milk, sugar, beer, and potatoes.[17] His booklet was widely read, so much so that some people used the term "Banting" for the activity usually called "dieting".[18]

In 1888, James Salisbury introduced the Salisbury steak as part of his high-meat diet, which limited vegetables, fruit, starches, and fats to one-third of the diet.[original research?]

In the early 1900s Frederick Madison Allen developed a highly restrictive short term regime which was described by Walter R. Steiner at the 1916 annual convention of the Connecticut State Medical Society as The Starvation Treatment of Diabetes Mellitus.[19]:176177[20][21][22] People showing very high urine glucose levels were confined to bed and restricted to an unlimited supply of water, coffee, tea, and clear meat broth until their urine was "sugar free"; this took two to four days but sometimes up to eight.[19]:177 After the person's urine was sugar-free food was re-introduced; first only vegetables with less than 5g of carbohydate per day, eventually adding fruits and grains to build up to 3g of carbohydrate per kilogram of body weight. Then eggs and meat were added, building up to 1g of protein/kg of body weight per day, then fat was added to the point where the person stopped losing weight or a maximum of 40 calories of fat per kilogram per day was reached. The process was halted if sugar appeared in the person's urine.[19]:177178 This diet was often administered in a hospital in order to better ensure compliance and safety.[19]:179

In 1958, Richard Mackarness M.D. published Eat Fat and Grow Slim, a low-carbohydrate diet with much of the same advice and based on the same theories as those promulgated by Robert Atkins more than a decade later. Mackarness also challenged the "calorie theory" and referenced primitive diets such as the Inuit as examples of healthy diets with a low-carbohydrate and high-fat composition.

In 1967, Irwin Stillman published The Doctor's Quick Weight Loss Diet. The "Stillman diet" is a high-protein, low-carbohydrate, and low-fat diet. It is regarded as one of the first low-carbohydrate diets to become popular in the United States.[23] Other low-carbohydrate diets in the 1960s included the Air Force diet[24] and the drinking man's diet.[25]Austrian physician Wolfgang Lutz published his book Leben Ohne Brot (Life Without Bread) in 1967.[26] However, it was not well known in the English-speaking world.

In 1972, Robert Atkins published Dr. Atkins Diet Revolution, which advocated the low-carbohydrate diet he had successfully used in treating patients in the 1960s (having developed the diet from a 1963 article published in JAMA).[27] The book met with some success, but, because of research at that time suggesting risk factors associated with excess fat and protein, it was widely criticized by the mainstream medical community as being dangerous and misleading, thereby limiting its appeal at the time.[28] Among other things, critics pointed out that Atkins had done little real research into his theories and based them mostly on his clinical work. Later that decade, Walter Voegtlin and Herman Tarnower published books advocating the Paleolithic diet and Scarsdale diet, respectively, each meeting with moderate success.[29][not in citation given]

The concept of the glycemic index was developed in 1981 by David Jenkins to account for variances in speed of digestion of different types of carbohydrates. This concept classifies foods according to the rapidity of their effect on blood sugar levels with fast-digesting simple carbohydrates causing a sharper increase and slower-digesting complex carbohydrates, such as whole grains, a slower one.[30] The concept has been extended to include the amount of carbohydrate actually absorbed, as well, as a tablespoonful of cooked carrots is less significant overall than a large baked potato (effectively pure starch, which is efficiently absorbed as glucose), despite differences in glycemic indices.

In the 1990s, Atkins published an update from his 1972 book, Dr. Atkins New Diet Revolution, and other doctors began to publish books based on the same principles. This has been said to be the beginning of what the mass media call the "low carb craze" in the United States.[31] During the late 1990s and early 2000s, low-carbohydrate diets became some of the most popular diets in the US. By some accounts, up to 18% of the population was using one type of low-carbohydrate diet or another at the peak of their popularity,[32] and this use spread to many countries.[citation needed]Food manufacturers and restaurant chains like Krispy Kreme noted the trend, as it affected their businesses.[33] Parts of the mainstream medical community has denounced low-carbohydrate diets as being dangerous to health, such as the AHA in 2001,[34] the American Kidney Fund in 2002,[35] Low-carbohydrate advocates did some adjustments of their own, increasingly advocating controlling fat and eliminating trans fat.[36][37]

Proponents who appeared with new diet guides at that time like the Zone diet intentionally distanced themselves from Atkins and the term 'low carb' because of the controversies, though their recommendations were based on largely the same principles .[38][39] It can be controversial which diets are low-carbohydrate and which are not.[citation needed] The 1990s and 2000s saw the publication of an increased number of clinical studies regarding the effectiveness and safety (pro and con) of low-carbohydrate diets (see low-carbohydrate diet medical research).

In the United States, the diet has continued to garner attention in the medical and nutritional science communities, and also inspired a number of hybrid diets that include traditional calorie-counting and exercise regimens.[7][40][41][42] Other low-carb diets, such as the Paleo Diet, focus on the removal of certain foods from the diet, such as sugar and grain.[43] On September 2, 2014 a small randomized trial by the NIH of 148 men and women comparing a low-carbohydrate diet with a low fat diet without calorie restrictions over one year showed that participants in the low-carbohydrate diet had greater weight loss than those on the low-fat diet.[44] The low-fat group lost weight, but appeared to lose more muscle than fat.[45]

No consensus definition exists of what precisely constitutes a low-carbohydrate diet.[46] Medical researchers and diet advocates may define different levels of carbohydrate intake when specifying low-carbohydrate diets.[46][not in citation given]

The American Academy of Family Physicians defines low-carbohydrate diets as diets that restrict carbohydrate intake to 20 to 60 grams per day, typically less than 20% of caloric intake.[47]

The body of research underpinning low-carbohydrate diets has grown significantly in the decades of the 1990s and 2000s.[48][49] Most research centers on the relationship between carbohydrate intake and blood sugar levels (i.e., blood glucose), as well as the two primary hormones produced in the pancreas, that regulate the blood sugar level, insulin, which lowers it, and glucagon, which raises it.[50]

Low-carbohydrate diets in general recommend reducing nutritive carbohydrates, commonly referred to as "net carbs", i.e., grams of total carbohydrates reduced by the non-nutritive carbohydrates[51][52] to very low levels. This means sharply reducing consumption of desserts, breads, pastas, potatoes, rice, and other sweet or starchy foods. Some recommend levels less than 20g of "net carbs" per day, at least in the early stages of dieting[53] (for comparison, a single slice of white bread typically contains 15g of carbohydrate, almost entirely starch). By contrast, the U.S. Institute of Medicine recommends a minimum intake of 130g of carbohydrate per day.[54] The FAO and WHO similarly recommend that the majority of dietary energy come from carbohydrates.[55][56]

Although low-carbohydrate diets are most commonly discussed as a weight-loss approach, some experts have proposed using low-carbohydrate diets to mitigate or prevent diseases, including diabetes, metabolic disease, and epilepsy.[57][58] Some low-carbohydrate proponents and others argue that the rise in carbohydrate consumption, especially refined carbohydrates, caused the epidemic levels of many diseases in modern society, including metabolic disease and type 2 diabetes.[59][60][61][62]

A category of diets is known as low-glycemic-index diets (low-GI diets) or low-glycemic-load diets (low-GL diets), in particular the Low GI Diet.[63] In reality, low-carbohydrate diets can also be low-GL diets (and vice versa) depending on the carbohydrates in a particular diet. In practice, though, "low-GI"/"low-GL" diets differ from "low-carb" diets in the following ways: First, low-carbohydrate diets treat all nutritive carbohydrates as having the same effect on metabolism, and generally assume their effect is predictable. Low-GI/low-GL diets are based on the measured change in blood glucose levels in various carbohydrates these vary markedly in laboratory studies. The differences are due to poorly understood digestive differences between foods. However, as foods influence digestion in complex ways (e.g., both protein and fat delay absorption of glucose from carbohydrates eaten at the same time) it is difficult to even approximate the glycemic effect (e.g., over time or even in total in some cases) of a particular meal.[64]

The low-insulin-index diet, is similar, except it is based on measurements of direct insulemic responses i.e., the amount of insulin in the bloodstream to food rather than glycemic response the amount of glucose in the bloodstream. Although such diet recommendations mostly involve lowering nutritive carbohydrates, some low-carbohydrate foods are discouraged, as well (e.g., beef).[65] Insulin secretion is stimulated (though less strongly) by other dietary intake. Like glycemic-index diets, predicting the insulin secretion from any particular meal is difficult, due to assorted digestive interactions and so differing effects on insulin release.[citation needed]

At the heart of the debate about most low-carbohydrate diets are fundamental questions about what is a 'normal' diet and how the human body is supposed to operate. These questions can be outlined as follows.

The diets of most people in modern Western nations, especially the United States, contain large amounts of starches, including refined flours, and substantial amounts of sugars, including fructose. Most Westerners seldom exhaust stored glycogen supplies and rarely go into ketosis. This has been regarded by the majority of the medical community in the last century as normal for humans.[citation needed] Ketosis should not be confused with ketoacidosis, a dangerous and extreme ketotic condition associated with type I diabetes. Some in the medical community have regarded ketosis as harmful and potentially life-threatening, believing it unnecessarily stresses the liver and causes destruction of muscle tissues.[citation needed] A perception developed that getting energy chiefly from dietary protein rather than carbohydrates causes liver damage and that getting energy chiefly from dietary fats rather than carbohydrates causes heart disease and other health problems. This view is still held by the majority of those in the medical and nutritional science communities.[66][67][68] However, it is now widely recognized that periodic ketosis is normal, and that ketosis provides a number of benefits, including neuroprotection against diverse types of cellular injury.[69]

People critical of low-carbohydrate diets cite hypoglycemia and ketoacidosis as risk factors. While mild acidosis may be a side effect when beginning a ketogenic diet,[70][71] no known health emergencies have been recorded. It should not be conflated with diabetic ketoacidosis, which can be life-threatening.

A diet very low in starches and sugars induces several adaptive responses. Low blood glucose causes the pancreas to produce glucagon,[72] which stimulates the liver to convert stored glycogen into glucose and release it into the blood. When liver glycogen stores are exhausted, the body starts using fatty acids instead of glucose. The brain cannot use fatty acids for energy, and instead uses ketones produced from fatty acids by the liver. By using fatty acids and ketones as energy sources, supplemented by conversion of proteins to glucose (gluconeogenesis), the body can maintain normal levels of blood glucose without dietary carbohydrates.

Most advocates of low-carbohydrate diets, such as the Atkins diet, argue that the human body is adapted to function primarily in ketosis.[73][74] They argue that high insulin levels can cause many health problems, most significantly fat storage and weight gain. They argue that the purported dangers of ketosis are unsubstantiated (some of the arguments against ketosis result from confusion between ketosis and ketoacidosis, which is a mostly diabetic condition unrelated to dieting or low-carbohydrate intake).[75] They also argue that fat in the diet only contributes to heart disease in the presence of high insulin levels and that if the diet is instead adjusted to induce ketosis, fat and cholesterol in the diet are beneficial. Most low-carb diet plans discourage consumption of trans fat.

On a high-carbohydrate diet, glucose is used by cells in the body for the energy needed for their basic functions, and about two-thirds of body cells require insulin to use glucose. Excessive amounts of blood glucose are thought to be a primary cause of the complications of diabetes, when glucose reacts with body proteins (resulting in glycosolated proteins) and change their behavior. Perhaps for this reason, the amount of glucose tightly maintained in the blood is quite low. Unless a meal is very low in starches and sugars, blood glucose will rise for a period of an hour or two after a meal. When this occurs, beta cells in the pancreas release insulin to cause uptake of glucose into cells. In liver and muscle cells, more glucose is taken in than is needed and stored as glycogen (once called 'animal starch').[76] Diets with a high starch/sugar content, therefore, cause release of more insulin, and so more cell absorption. In diabetics, glucose levels vary in time with meals and vary a little more as a result of high-carbohydrate meals. In nondiabetics, blood-sugar levels are restored to normal levels within an hour or two, regardless of the content of a meal.

However, the ability of the body to store glycogen is finite. Once liver and muscular stores are full to the maximum, adipose tissue (subcutaneous and visceral fat stores) becomes the site of sugar storage in the form of fat.[citation needed] The body's ability to store fat is almost limitless, hence the modern dilemma of morbid obesity.

While any diet devoid of essential fatty acids (EFAs) and essential amino acids (EAAs) will result in eventual death, a diet completely without carbohydrates can be maintained indefinitely because triglycerides (which make up fat stored in the body and dietary fat) include a (glycerol) molecule which the body can easily convert to glucose.[77] It should be noted that the EFAs and all amino acids are structural building blocks, not inherent fuel for energy. However, a very-low-carbohydrate diet (less than 20 g per day) may negatively affect certain biomarkers[78] and produce detrimental effects in certain types of individuals (for instance, those with kidney problems). The opposite is also true; for instance, clinical experience suggests very-low-carbohydrate diets for patients with metabolic syndrome.[79]

Because of the substantial controversy regarding low-carbohydrate diets and even disagreements in interpreting the results of specific studies, it is difficult to objectively summarize the research in a way that reflects scientific consensus.[80] Although some research has been done throughout the 20th century,[81] most directly relevant scientific studies have occurred in the 1990s and early 2000s. Researchers and other experts have published articles and studies that run the gamut from promoting the safety and efficacy of these diets[82][83] to questioning their long-term validity[84][85] to outright condemning them as dangerous.[86][87] A significant criticism of the diet trend was that no studies evaluated the effects of the diets beyond a few months. However, studies emerged which evaluate these diets over much longer periods, controlled studies as long as two years and survey studies as long as two decades.[82][88][89][90][91]

A systematic review published in 2014 included 19 trials with a total of 3,209 overweight and obese participants, some with diabetes. The review included both extreme low carbohydrate diets high in both protein and fat, as well as less extreme low carbohydrate diets that are high in protein but with recommended intakes of fat. The authors found that when the amount of energy (kilojoules/calories) consumed by people following the low carbohydrate and balanced diets (45 to 65% of total energy from carbohydrates, 25 to 35% from fat, and 10 to 20% from protein) was similar, there was no difference in weight loss after 3 to 6 months and after 1 to 2 years in those with and without diabetes. For blood pressure, cholesterol levels and diabetes markers there was also no difference detected between the low carbohydrate and the balanced diets. The follow-up of these trials was no longer than two years, which is too short to provide an adequate picture of the long term risk of following a low carbohydrate diet.[5]

A 2003 meta-analysis that included randomized controlled trials found that "low-carbohydrate, non-energy-restricted diets appear to be at least as effective as low-fat, energy-restricted diets in inducing weight loss for up to one year."[92][93][94] A 2007 JAMA study comparing the effectiveness of the Atkins low-carb diet to several other popular diets concluded, "In this study, premenopausal overweight and obese women assigned to follow the Atkins diet, which had the lowest carbohydrate intake, lost more weight and experienced more favorable overall metabolic effects at 12 months than women assigned to follow the Zone, Ornish, or LEARN diets."[89] A July 2009 study of existing dietary habits associated a low-carbohydrate diet with obesity, although the study drew no explicit conclusion regarding the cause: whether the diet resulted in the obesity or the obesity motivated people to adopt the diet.[95] A 2013 meta-analysis that included only randomized controlled trials with one year or more of follow-up found, "Individuals assigned to a very low carbohydrate ketogenic diet achieve a greater weight loss than those assigned to a low fat diet in the long term."[96] In 2013, after reviewing 16,000 studies, Sweden's Council on Health Technology Assessment concluded low-carbohydrate diets are more effective as a means to reduce weight than low-fat diets, over a short period of time (six months or less). However, the agency also concluded, over a longer span (1224 months), no differences occur in effects on weight between strict or moderate low-carb diets, low-fat diets, diets high in protein, Mediterranean diet, or diets aiming at low glycemic indices.[97]

In one theory, one of the reasons people lose weight on low-carbohydrate diets is related to the phenomenon of spontaneous reduction in food intake.[98]

Carbohydrate restriction may help prevent obesity and type 2 diabetes,[99][100] as well as atherosclerosis.[101]

Potential favorable changes in triglyceride and high-density lipoprotein cholesterol values should be weighed against potential unfavorable changes in low-density lipoprotein cholesterol and total cholesterol values when low-carbohydrate diets to induce weight loss are considered.[102] However, the type of LDL cholesterol should also be taken into account here, as it could be that small, dense LDL is decreased and larger LDL molecules are increased with low-carb diets.[citation needed] The health effects of the different molecules are still being elucidated, and many cholesterol tests do not account for such details, but small, dense LDL is thought to be problematic and large LDL is not. A 2008 systematic review of randomized controlled studies that compared low-carbohydrate diets to low-fat/low-calorie diets found the measurements of weight, HDL cholesterol, triglyceride levels, and systolic blood pressure were significantly better in groups that followed low-carbohydrate diets. The authors of this review also found a higher rate of attrition in groups with low-fat diets, and concluded, "evidence from this systematic review demonstrates that low-carbohydrate/high-protein diets are more effective at six months and are as effective, if not more, as low-fat diets in reducing weight and cardiovascular disease risk up to one year", but they also called for more long-term studies.[103]

A study of more than 100,000 people over more than 20 years within the Nurses' Health Study observationally concluded a low-carbohydrate diet high in vegetables, with a large proportion of proteins and oils coming from plant sources, decreases mortality with a hazard ratio of 0.8.[104] In contrast, a low-carbohydrate diet with largely animal sources of protein and fat increases mortality, with a hazard ratio of 1.1.[104] This study, however, has been met with criticism, due to the unreliability of the self-administered food frequency questionnaire, as compared to food journaling,[105] as well as classifying "low-carbohydrate" diets based on comparisons to the group as a whole (decile method) rather than surveying dieters following established low-carb dietary guidelines like the Atkins or Paleo diets.[106]

Opinions regarding low-carbohydrate diets vary throughout the medical and nutritional science communities, yet government bodies, and medical and nutritional associations, have generally opposed this nutritional regimen.[citation needed] Since 2003, some organizations have gradually begun to relax their opposition to the point of cautious support for low-carbohydrate diets. Some of these organizations receive funding from the food industry.[citation needed] Official statements from some organizations:

The AAFP released a 'discussion paper' on the Atkins diet in 2006. The paper expresses reservations about the Atkins plan, but acknowledges it as a legitimate weight-loss approach.[107]

The ADA revised its Nutrition Recommendations and Interventions for Diabetes in 2008 to acknowledge low-carbohydrate diets as a legitimate weight-loss plan.[108][109] The recommendations fall short of endorsing low-carbohydrate diets as a long-term health plan, and do not give any preference to these diets. Nevertheless, this is perhaps the first statement of support, albeit for the short term, by a medical organization.[110][111] In its 2009 publication of Clinical Practice Recommendations, the ADA again reaffirmed its acceptance of carbohydrate-controlled diets as an effective treatment for short-term (up to one year) weight loss among obese people suffering from type two diabetes.[112]

As of 2003 in commenting on a study in the Journal of the American Medical Association, a spokesperson for the American Dietetic Association reiterated the association's belief that "there is no magic bullet to safe and healthful weight loss."[113] The Association specifically endorses the high-carbohydrate diet recommended by the National Academy of Sciences. They have stated "Calories cause weight gain. Excess calories from carbohydrates are not any more fattening than calories from other sources. Despite the claims of low-carb diets, a high-carbohydrate diet does not promote fat storage by enhancing insulin resistance."[114][bettersourceneeded]

As of 2008[update] the AHA states categorically that it "doesn't recommend high-protein diets."[115] A science advisory from the association further states the association's belief that these diets "may be associated with increased risk for coronary heart disease."[34] The AHA has been one of the most adamant opponents of low-carbohydrate diets.[citation needed] Dr. Robert Eckel, past president, noted that a low-carbohydrate diet could potentially meet AHA guidelines if it conformed to the AHA guidelines for low fat content.[116]

The position statement by the Heart Foundation regarding low-carbohydrate diets states, "the Heart Foundation does not support the adoption of VLCARB diets for weight loss."[46] Although the statement recommends against use of low-carbohydrate diets, it explains their major concern is saturated fats as opposed to carbohydrate restriction and protein. Moreover, other statements suggest their position might be re-evaluated in the event of more evidence from longer-term studies.

The consumer advice statements of the NHS regarding low-carbohydrate diets state that "eating a high-fat diet could increase your risk of heart disease" and "try to ensure starchy foods make up about a third of your diet"[117]

In 2008, the Socialstyrelsen in Sweden altered its standing regarding low-carbohydrate diets.[118] Although formal endorsement of this regimen has not yet appeared, the government has given its formal approval for using carbohydrate-controlled diets for medically supervised weight loss.

In a recommendation for diets suitable for diabetes patients published in 2011 a moderate low-carb option (3040%) is suggested.[119]

The HHS issues consumer guidelines for maintaining heart health which state regarding low-carbohydrate diets that "they're not the route to healthy, long-term weight management."[120]

Low-carbohydrate diets became a major weight loss and health maintenance trend during the late 1990s and early 2000s.[121][122][123] While their popularity has waned recently from its peak, they remain popular.[124][125] This diet trend has stirred major controversies in the medical and nutritional sciences communities and, as yet, there is not a general consensus on their efficacy or safety.[126][127] Many in the medical community remain generally opposed to these diets for long term health[128] although there has been a recent softening of this opposition by some organizations.[129][130]

Because of the substantial controversy regarding low-carbohydrate diets, and even disagreements in interpreting the results of specific studies, it is difficult to objectively summarize the research in a way that reflects scientific consensus.[131][132][133]

Although there has been some research done throughout the twentieth century, most directly relevant scientific studies have occurred in the 1990s and early 2000s and, as such, are relatively new and the results are still debated in the medical community.[132] Supporters and opponents of low-carbohydrate diets frequently cite many articles (sometimes the same articles) as supporting their positions.[134][135][136] One of the fundamental criticisms of those who advocate the low-carbohydrate diets has been the lack of long-term studies evaluating their health risks.[137][138] This has begun to change as longer term studies are emerging.[82]

A 2012 systematic review studying the effects of low-carbohydrate diet on weight loss and cardiovascular risk factors showed the LCD to be associated with significant decreases in body weight, body mass index, abdominal circumference, blood pressure, triglycerides, fasting blood sugar, blood insulin and plasma C-reactive protein, as well as an increase in high-density lipoprotein cholesterol (HDL). Low-density lipoprotein cholesterol (LDL) and creatinine did not change significantly. The study found the LCD was shown to have favorable effects on body weight and major cardiovascular risk factors (but concluded the effects on long-term health are unknown). The study did not compare health benefits of LCD to low-fat diets.[139]

A meta-analysis published in the American Journal of Clinical Nutrition in 2013 compared low-carbohydrate, Mediterranean, vegan, vegetarian, low-glycemic index, high-fiber, and high-protein diets with control diets. The researchers concluded that low-carbohydrate, Mediterranean, low-glycemic index, and high-protein diets are effective in improving markers of risk for cardiovascular disease and diabetes.[140]

In the first week or two of a low-carbohydrate diet, much of the weight loss comes from eliminating water retained in the body.[141] The presence of insulin in the blood fosters the formation of glycogen stores in the body, and glycogen is bound with water, which is released when insulin and blood sugar drop.[citation needed][142] A ketogenic diet is known to cause dehydration as an early, temporary side-effect.[143]

Advocates of low-carbohydrate diets generally dispute any suggestion that such diets cause weakness or exhaustion (except in the first few weeks as the body adjusts), and indeed most highly recommend exercise as part of a healthy lifestyle.[142][144] A large body of evidence stretching back to the 1880s shows that physical performance is not negatively affected by ketogenic diets once a person has been accustomed to such a diet.[145]

Arctic cultures, such as the Inuit, were found to lead physically demanding lives consuming a diet of about 1520% of their calories from carbohydrates, largely in the form of glycogen from the raw meat they consumed.[145][146][147][148] However, studies also indicate that while low-carb diets will not reduce endurance performance after adapting, they will probably deteriorate anaerobic performance such as strength-training or sprint-running because these processes rely on glycogen for fuel.[144]

Many critics argue that low-carbohydrate diets inherently require minimizing vegetable and fruit consumption, which in turn robs the body of important nutrients.[149] Some critics imply or explicitly argue that vegetables and fruits are inherently all heavily concentrated sources of carbohydrates (so much so that some sources treat the words 'vegetable' and 'carbohydrate' as synonymous).[150] While some fruits may contain relatively high concentrations of sugar, most are largely water and not particularly calorie-dense. Thus, in absolute terms, even sweet fruits and berries do not represent a significant source of carbohydrates in their natural form, and also typically contain a good deal of fiber which attenuates the absorption of sugar in the gut.[151] Lastly, most of the sugar in fruit is fructose, which has a reported negligible effect on insulin levels in obese subjects.[152]

Most vegetables are low- or moderate-carbohydrate foods (in the context of these diets, fiber is excluded because it is not a nutritive carbohydrate). Some vegetables, such as potatoes and carrots, have high concentrations of starch, as do corn and rice. Most low-carbohydrate diet plans accommodate vegetables such as broccoli, spinach, cauliflower, and peppers.[153] The Atkins diet recommends that most dietary carbs come from vegetables. Nevertheless, debate remains as to whether restricting even just high-carbohydrate fruits, vegetables, and grains is truly healthy.[154]

Contrary to the recommendations of most low-carbohydrate diet guides, some individuals may choose to avoid vegetables altogether to minimize carbohydrate intake. Low-carbohydrate vegetarianism is also practiced.

Raw fruits and vegetables are packed with an array of other protective chemicals, such as vitamins, flavonoids, and sugar alcohols. Some of those molecules help safeguard against the over-absorption of sugars in the human digestive system.[155][156] Industrial food raffination depletes some of those beneficial molecules to various degrees, including almost total removal in many cases.[157]

The major low-carbohydrate diet guides generally recommend multivitamin and mineral supplements as part of the diet regimen, which may lead some to believe these diets are nutritionally deficient. The primary reason for this recommendation is that if the switch from a high-carbohydrate to a low-carbohydrate, ketogenic diet is rapid, the body can temporarily go through a period of adjustment during which it may require extra vitamins and minerals. This is because the body releases excess fluids stored during high-carbohydrate eating. In other words, the body goes through a temporary "shock" if the diet is changed to low-carbohydrate quickly, just as it would changing to a high-carbohydrate diet quickly. This does not, in and of itself, indicate that either type of diet is nutritionally deficient. While many foods rich in carbohydrates are also rich in vitamins and minerals, many low-carbohydrate foods are similarly rich in vitamins and minerals.[158]

A common argument in favor of high-carbohydrate diets is that most carbohydrates break down readily into glucose in the bloodstream, and therefore the body does not have to work as hard to get its energy in a high-carbohydrate diet as a low-carbohydrate diet. This argument, by itself, is incomplete. Although many dietary carbohydrates do break down into glucose, most of that glucose does not remain in the bloodstream for long. Its presence stimulates the beta cells in the pancreas to release insulin, which has the effect of causing about two-thirds of body cells to take in glucose, and causing fat cells to take in fatty acids and store them. As the blood-glucose level falls, the amount of insulin released is reduced; the entire process is completed in non-diabetics in an hour or two after eating.[citation needed] High-carbohydrate diets require more insulin production and release than low-carbohydrate diets,[citation needed] and some evidence indicates the increasingly large percentage of calories consumed as refined carbohydrates is positively correlated with the increased incidence of metabolic disorders such as type 2 diabetes.[159]

In addition, this claim neglects the nature of the carbohydrates ingested. Some are indigestible in humans (e.g., cellulose), some are poorly digested in humans (e.g., the amylose starch variant), and some require considerable processing to be converted to absorbable forms. In general, uncooked or unprocessed (e.g., milling, crushing, etc.) foods are harder (typically much harder) to absorb, so do not raise glucose levels as much as might be expected from the proportion of carbohydrate present. Cooking (especially moist cooking above the temperature necessary to expand starch granules) and mechanical processing both considerably raise the amount of absorbable carbohydrate and reduce the digestive effort required.

Analyses which neglect these factors are misleading and will not result in a working diet, or at least one which works as intended. In fact, some evidence indicates the human brain the largest consumer of glucose in the body can operate more efficiently on ketones (as efficiency of source of energy per unit oxygen).[160]

The restriction of starchy plants, by definition, severely limits the dietary intake of microbiota accessible carbohydrates (MACs) and may negatively affect the microbiome in ways that contribute to disease.[161] Starchy plants, in particular, are a main source of resistant starch an important dietary fiber with strong prebiotic properties.[162][163][164] Resistant starches are not digestible by mammals and are fermented and metabolized by gut flora into short chain fatty acids, which are well known to offer a wide range of health benefits.[163][165][166][167][168][169] Resistant starch consumption has been shown to improve intestinal/colonic health, blood sugar, glucose tolerance, insulin-sensitivity and satiety.[170][171][172] Public health authorities and food organizations such as the Food and Agricultural Organization, the World Health Organization,[173] the British Nutrition Foundation[174] and the U.S. National Academy of Sciences[175] recognize resistant starch as a beneficial carbohydrate. The Joint Food and Agricultural Organization of the United Nations/World Health Organization Expert Consultation on Human Nutrition stated, "One of the major developments in our understanding of the importance of carbohydrates for health in the past twenty years has been the discovery of resistant starch."[173]

In 2004, the Canadian government ruled that foods sold in Canada could not be marketed with reduced or eliminated carbohydrate content as a selling point, because reduced carbohydrate content was not determined to be a health benefit. The government ruled that existing "low carb" and "no carb" packaging would have to be phased out by 2006.[176]

Some variants of low-carbohydrate diets involve substantially lowered intake of dietary fiber, which can result in constipation if not supplemented.[citation needed] For example, this has been a criticism of the induction phase of the Atkins diet (the Atkins diet is now clearer about recommending a fiber supplement during induction). Most advocates[who?][dubious discuss] today argue that fiber is a "good" carbohydrate and encourage a high-fiber diet.[citation needed]

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