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FEATURE STORY
Spring into Weight Loss

IN THE NEWS
Lose Weight—and Keep It Off—on a High-Protein Diet

CHECKLIST
Useful Herbs & Supplements

COOKING CORNER
Arugula and White Bean Salad

VITAMINS & MINERALS
Add Fiber to Lose Weight

HERBAL REMEDIES
Hoodia: A Natural Appetite Suppressant

EVERYDAY ANSWERS
How Do I Pick a Diet That Fits My Lifestyle?

Diet, exercise, and supplements help battle the bulge 
Spring into Weight Loss

april picGet the skinny on weight loss.  Discover what works for you to improve your chances of losing weight and keeping it off.  According to research or other evidence, the following self-care steps may be helpful:

  • Aim for total nutrition with a multivitamin. Extra vitamins and minerals will help ensure your body gets the nutrition it needs, especially if you are avoiding certain foods.
  • Find a diet that fits. For long-term success, choose a healthy diet that you can stay with.
  • Create a custom exercise plan. Exercise you truly enjoy is much easier to stick to, so find activities that fit your personal style, fitness level, and workout opportunities.
  • Find support. Improve your chances for long-term weight loss by joining a group while you adjust to new diet and exercise habits.
  • Get a boost from pyruvate. Combining exercise with 6 to 10 grams a day of this supplement may help speed up your metabolism.

About weight loss and obesity
About two-thirds of the adult U.S. population is overweight. Almost one-third not only exceeds ideal weight, but also meets the clinical criteria for obesity. Excess body weight is implicated as a risk factor for many different disorders, including heart disease, diabetes, several cancers (such as breast cancer in postmenopausal women, and cancers of the uterus, colon, and kidney), prostate enlargement (BPH), female infertility, uterine fibroids, and gallstones, as well as several disorders of pregnancy, including gestational diabetes, preeclampsia, and gestational hypertension. The location of excess body fat may affect the amount of health risk associated with overweight. Increased abdominal fat, which can be estimated by waist size, may be especially hazardous to long-term health.

For overweight women, weight loss can significantly improve physical health. A four-year study of over 40,000 women found that weight loss in overweight women was associated with improved physical function and vitality as well as decreased bodily pain. The risk of death from all causes, cardiovascular disease, cancer, or other diseases increases in overweight men and women in all age groups. Losing weight and keeping it off is, unfortunately, very difficult for most people. However, repeated weight loss followed by weight regain may be unhealthy, as it has been associated with increased heart disease risk factors and bone loss in some studies. Rather than focusing on weight loss as the most important health outcome of a change in diet or lifestyle, some doctors advocate paying more attention to overall fitness and reduction in known risk factors for heart disease and other health hazards.

Dietary changes that may be helpful
Calorie restriction
Calories in the diet come from fat, carbohydrate, protein, or alcohol. Weight-loss diets are typically designed to limit calories either by restricting certain foods that are thought to result in increased calorie intake, and/or by emphasizing foods that are believed to result in reduced calorie intake. Some popular diets restrict fat while emphasizing fiber and a balanced intake of healthful foods. Others restrict carbohydrates, either to extremely low amounts as in the Atkins diet, or to a lesser degree, emphasizing foods low in the glycemic index or high in protein. Discussions of the research on these diets follow; however, it should be remembered that no diet has been proven effective for long-term weight loss, and many people find it difficult to stay on most diets.

Low-fat, low-calorie, high-fiber, balanced diets are recommended by many doctors for weight loss. According to controlled studies, when people are allowed to eat as much food as they desire on a low-fat diet, they tend to lose more weight than people eating a regular diet. However, low-fat diets have not been shown to be more effective than other weight-loss diets that restrict calories. Nonetheless, a low-fat, high-fiber, balanced diet has additional potential benefits, such as reducing the risk of chronic diseases including heart disease and cancer.

Preliminary research indicates that people who successfully lost weight got less of their total calories from fat and more of them from protein foods. They also ate fewer snacks of low nutritional quality and got more of their calories from “hot meals of good quality.” Other preliminary studies find that dieters who maintain long-term weight loss report using fat restriction and eating a regular breakfast as key strategies in their success.

Low-carbohydrate, high-protein diets
Low-carbohydrate, high-fat diets such as the Atkins diet are very popular among people trying to lose weight. In a preliminary study, overweight individuals who adhered to a very-low-carbohydrate diet (25 grams per day initially, increased to 50 grams per day after a certain weight loss target was achieved), with no limit on total calorie intake, lost on average more than 10% of their body weight over a six-month period. The participants also engaged in aerobic exercise at least three times a week, so it is not clear how much of the weight loss was due to the diet. An analysis of other preliminary studies of this type of diet concluded that its effectiveness is primarily due to reduced calorie intake. Recently, three controlled trials found people using low-carbohydrate, high-fat diets lost more weight in six months than those using diets low in fat and calories. However, 20 to 40% of these dieters did not stay on their diets, and were not counted in the results. In addition, one of these trials continued for an additional six months, at the end of which there was no longer a significant difference in weight loss between the two diet groups. A recent 12-week controlled trial found that overweight adolescents also lost more weight with a low-carbohydrate diet than with a low-fat diet, even though they consumed 50% more calories than did the children on the low-fat diet. That study suggests that the weight loss occurring on the Atkins diet is not due entirely to calorie restriction. Blood tests suggest that low-carbohydrate diets induce a condition called mild metabolic acidosis, which might increase the risk of osteoporosis and kidney stones.

The effect of low-carbohydrate diets on cardiovascular risk is also an unresolved issue. The short-term studies discussed above found that blood cholesterol levels did not worsen with these diets. Other heart-disease risk factors (triglyceride levels and insulin sensitivity) actually improved with a low-carbohydrate diet. Some studies, however, have shown a worsening of certain cardiovascular risk factors in people using a low-carbohydrate, high-fat diet for up to one year. Adverse changes included increases in blood levels of homocysteine, lipoprotein(a), and fibrinogen, and a decrease in blood flow to the heart. Individuals wishing to consume a very-low-carbohydrate diet for weight loss or for other reasons should be monitored by a doctor.

Some research has investigated weight-loss diets that are high in protein, but moderate in fat and not as low in carbohydrate content as the diets discussed above. While this type of diet does not usually lead to greater weight loss than other diets when calorie intakes are kept equal, one controlled trial found greater body fat loss in women eating a diet almost equal in calories and fat but approximately twice as high in protein and lower in carbohydrate compared with a control group’s diet. Another controlled trial compared two diets similar in fat content but different in protein and carbohydrate content. People allowed to eat freely from the higher protein diet (25% of calories from protein, 45% calories from carbohydrate) consumed fewer calories and lost more weight compared with people eating the lower protein diet (12% of calories from protein, 59% calories from carbohydrate).

Low-glycemic-index foods
Diets that emphasize choosing foods with a low glycemic index have been shown to help control appetite in some, though not all, controlled studies. A controlled study in two phases found no difference in weight loss between a low- and a high-glycemic-index diet in the first 12-week phase, but when the diets were switched for a second 12-week phase, the low-glycemic-index diet was significantly more effective for weight loss. A preliminary study reported that obese children using a low-glycemic-index diet lost more weight compared with a similar group using a low-fat diet.

Lifestyle changes that may be helpful
Group sessions where participants are given information and help on how to make lifestyle changes appear to improve the chances of losing weight and keeping it off. Such changes may include shopping from a list, storing foods out of sight, keeping portion sizes under control, and avoiding fast-food restaurants.

Exercise appears to help people maintain weight loss. People who have successfully maintained weight loss for over two years report continuing high levels of physical activity. Combining exercise with healthier eating habits results in the best short- and long-term effects on weight loss, and should reduce the risk of many serious diseases.

Vitamins that may be helpful
Diets that are low in total calories may not contain adequate amounts of various vitamins and minerals. For that reason, taking a multiple vitamin-mineral supplement is advocated by proponents of many types of weight-loss programs, and is essential when calorie intake will be less than 1,100 calories per day.

Pyruvate, a compound that occurs naturally in the body, might aid weight-loss efforts. A controlled trial found that pyruvate supplements (22 to 44 grams per day) enhanced weight loss and resulted in a greater reduction of body fat in overweight adults consuming a low-fat diet. Three controlled trials combining 6 to 10 grams per day of pyruvate with an exercise program reported greater effects on weight loss and body fat than that seen with a placebo plus the exercise program.

5-HTP (5-hydroxytryptophan), the precursor to the chemical messenger (neurotransmitter) serotonin, has been shown in three short-term controlled trials to reduce appetite and to promote weight loss. In one of these trials (a 12-week double-blind trial), overweight women who took 600 to 900 mg of 5-HTP per day lost significantly more weight than did women who received a placebo. In a double-blind trial with no dietary restrictions, obese people with type 2 (non-insulin-dependent) diabetes who took 750 mg per day of 5-HTP for two weeks significantly reduced their carbohydrate and fat intake. Average weight loss in two weeks was 4.6 pounds, compared with 0.2 pounds in the placebo group.

The ability of 7-KETO (3-acetyl-7-oxo-dehydroepiandrosterone), a substance related to DHEA, to promote weight loss in overweight people has been investigated in one double-blind trial. Participants were advised to exercise three times per week for 45 minutes and to eat an 1,800-calorie-per-day diet. Each person was given either a placebo or 100 mg of 7-KETO twice daily. After eight weeks, those receiving 7-KETO had lost more weight and lowered their percentage of body fat further compared to those taking a placebo. These results may have been due to increases in levels of a thyroid hormone (T3) that plays a major role in determining a person’s metabolic rate, although the levels of T3 did not exceed the normal range.

In a study of obese people consuming a low-calorie diet for 24 weeks, those receiving a calcium supplement (800 mg per day) lost significantly more weight than those given a placebo. Calcium was effective when provided either as a supplement, or in the form of dairy products. In a second study, however, the amount of weight loss resulting from calcium supplementation (1,000 mg per day) was small and not statistically significant. In that study, participants' typical diet contained more calcium than in the study in which calcium supplementation was more effective. Thus, it is possible that calcium supplementation enhances weight loss only when the diet is low in calcium.

A double-blind trial found that exercising individuals taking 1,800 mg per day of conjugated linoleic acid (CLA) lost more body fat after 12 weeks than did a similar group taking a placebo. However, two other studies found that amounts of CLA from 0.7 to 3.0 grams per day did not affect body composition. Most double-blind trials have found that larger amounts of CLA, 3.2 to 4.2 grams per day, do reduce body fat; however, one double-blind study of experienced strength-training athletes reported no effect of 6 grams per day of CLA on body fat, muscle mass, or strength improvement.

Fiber supplements are one way to add fiber to a weight-loss diet. Several trials have shown that supplementation with fiber from a variety of sources accelerated weight loss in people who were following a low-calorie diet. Other researchers found, however, that fiber supplements had no effect on body weight, even though it resulted in a reduction in food intake.

Supplementation with 3 to 4 grams per day of a bulking agent called glucomannan, with or without a low-calorie diet, has promoted weight loss in overweight adults, while 2 to 3 grams per day was effective in a group of obese adolescents in another controlled trial.

Herbs that may be helpful
Research has suggested that incorporating cayenne pepper into the diet may help people lose weight. Controlled studies report that adding 6 to 10 grams of cayenne to a meal or 28 grams to an entire day’s diet reduces hunger after meals and reduces calories consumed during subsequent meals. Other controlled studies have reported that calorie burning by the body increases slightly when 10 grams of cayenne is added to a meal or 28 grams is added to an entire day’s diet. However, no studies have been done to see if regularly adding cayenne to the diet has any effect on weight loss.

Green tea extract rich in polyphenols (epigallocatechin gallate, or EGCG) may support a weight-loss program by increasing energy expenditure or by inhibiting the digestion of fat in the intestine. Healthy young men who took two green tea capsules (containing a total of 50 mg of caffeine and 90 mg of EGCG) three times a day had a significantly greater energy expenditure and fat oxidation than those who took caffeine alone or placebo. In a preliminary study of moderately obese individuals, administration of a specific green tea extract (AR25) resulted in a 4.6% reduction in average body weight after 12 weeks. The amount of green tea extract used in this study supplied daily 270 mg of EGCG and 150 mg of caffeine. While caffeine is known to stimulate metabolism, it appears that other substances besides caffeine were responsible for at least part of the weight loss. Although the extract produced few side effects, one individual developed abnormal liver function tests during the study. Additional studies are needed to confirm the safety and effectiveness of green tea extracts for promoting weight loss.

One small, double-blind clinical study in humans found that hoodia latex and inner plant can significantly reduce food intake. Available products are of unknown quality and much more work remains to be done to determine if hoodia will be a sustainable, safe way to reduce appetite.

 


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