Responsible and irresponsible use of very-low-calorie diets in the treatment of obesity

Article Abstract:

Oprah Winfrey's experience of losing 67 lbs in only four months by the use of a medically supervised very-low-calorie diet has focused the country's attention on this diet strategy. Older very-low-calorie diets used in the 1970s and were associated with a large number of deaths. In general these diets were used by individuals who were not under the care of a physician, and were deficient in protein and other essential vitamins and minerals. Although the present version of very-low-calorie diets contains essential nutrients with high-quality protein, and are much safer than their predecessors, they should only be used by individuals who are severely obese and only when under strict medical supervision. These diets provide between 400 to 800 calories/day and are designed to cause the greatest weight loss possible without a significant effect on the lean (muscle) mass of the body. These diets provide between 45 to 100 grams per day of protein (30 grams equal one ounce) which is contained in a powder derived from egg or milk products. The diet powder is stirred into water and consumed three to five times per day. In some forms of this diet portions of lean meat, fish or fowl are also included in the daily food intake. Dieters also take supplements of vitamins, minerals and drink at least 2 liters of water or non-caloric fluid per day. An average woman will lose approximately 1.5 kg/week and a man 2.0 kg/week (1 kilogram is equal 2.2 lbs). Patients in controlled experimental conditions have been kept on this type of diet for 12 to 16 weeks; this period of dieting is usually sufficient to produce satisfactory results. Following this phase of the diet the patient enters a refeeding period in which conventional foods are gradually introduced into the patient's diet. This is followed by a weight-maintenance period. Medical supervision is required for all three periods: weight loss, refeeding, and maintenance. Patients require weekly physician examinations and should have their electrolyte levels (level of ions such as sodium and potassium) checked at least every other week. The authors strongly advise that no modification from the above guidelines be taken as there are risks associated with irresponsible use of this method of dieting, particularly by individuals who are not grossly obese. Physicians wishing to use very-low-calorie diets within their practice are similarly warned that they must possess adequate knowledge and training concerning these diets.

Usage, Complications and side effects, Risk factors, Reducing diets, Obesity, Low-calorie diet, Low calorie diet, Liquid protein diet, Liquid diet

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Enteral nutrition with structured lipid: effect on protein metabolism in thermal injury

Article Abstract:

Burn injuries cause increased metabolic rate and substantial losses of body weight and protein. As a result, burn patients require intensive nutritional therapy to support healing. Both parenteral (intravenous) feeding and enteral nutrition (tube-feeding into the digestive tract) have been effective in reducing protein loss, preventing severe malnutrition, and protecting immune function in burn patients. The standard formulas used for nutrition support include balanced amounts of protein, carbohydrate, and lipid (fat). It is not clear which of several sources of lipid is most beneficial in these circumstances. A study compared lipids from different sources which were fed enterally to burned rats. The four lipid sources were long-chain triglycerides (LCTs), medium-chain triglycerides (MCTs), structured lipid (SL), and a physical mix (PM) of the oils utilized in the structured lipid. Structured lipid is manufactured using a combination of LCTs and MCTs and thus, possesses certain characteristics of both. SL can be altered to meet specific medical and nutritional needs. The burned rats fed with SL or PM retained more protein which was measured by nitrogen balance, muscle protein, and serum albumin, when compare with rats fed MCTs or LCTs. It is concluded that enterally administered SL and PM lipids support healing better than standard lipid solutions in animals with burn injuries. Structured lipid and its physical mix should be investigated for use with burn patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Models, Burns, Parenteral feeding, Parenteral nutrition, Burns and scalds, Burn therapy, Enteral feeding, Enteral nutrition, Tube feeding

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Determinants of the pressor effect of phenylpropanolamine in healthy subjects

Article Abstract:

Phenylpropanolamine (PPA) hydrochloride is a synthetic drug that is included in many over-the-counter diet aids and in some cold medicines. The federal Food and Drug Administration (FDA) has issued three reports that have concluded that PPA is both safe and effective. However, there has been some concern about possible adverse reactions, particularly the elevation of blood pressure (the pressor effect) from the use of these medications. This possibility is particular distressing in that hypertension is a common problem in the obese, which is the intended population for much of the use of PPA. The current study examines the effect of PPA on 881 healthy individuals of various body weight. Immediate and sustained release capsules in varying dosages were compared against placebos ("sugar pills"). Although a significant short-term increase in blood pressure was detected in the first 6 hours after its administration, the effect was not considered clinically relevant. The pressor effect was more marked in the first six hours after administration and was more pronounced in those individuals receiving the sustained-released capsules. Baseline measures of blood pressure, body weight and treatment were also independently related to changes in blood pressure within the test group.

Research, Phenylpropanolamine, Adrenergic alpha-agonists

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