Bodybuilding supplements are dietary supplements commonly used by those involved in bodybuilding and athletics. Bodybuilding supplements may be used to replace meals, enhance weight gain, promote weight loss or improve athletic performance. Among the most widely used are vitamin supplements, protein, branched-chain amino acids (BCAA), glutamine, essential fatty acids, meal replacement products, creatine, weight loss products and testosterone boosters. Supplements are sold either as single ingredient preparations or in the form of "stacks" - proprietary blends of various supplements marketed as offering synergistic advantages. While many bodybuilding supplements are also consumed by the general public, their salience and frequency of use may differ when used specifically by bodybuilders.

Annual sales of sport nutrition products in the US is over $2.7 billion (US) according to Consumer Reports.

History

Athletes in ancient Greece were advised to consume large quantities of meat and wine. A number of herbal concoctions and tonics have been used by strongmen and athletes since ancient times across cultures for the enhancement of strength, vigour, prowess and stamina. In the 1910s, Eugen Sandow, widely considered to be the first modern bodybuilder in the West, advocated the use of dietary control to enhance muscle growth. Later, bodybuilder Earle Liederman advocated the use of "beef juice" or "beef extract" (basically, consomme) as a way to enhance muscle recovery. In 1950s with recreational and competitive bodybuilding becoming increasingly popular Irvin P. Johnson began to popularize and market egg-based protein powders marketed specifically at bodybuilders and physical athletes. The 1970s and 1980s marked an explosion in the growth of the bodybuilding supplement industry fueled by an unprecedented increase in mainstream recreational bodybuilding and the widespread use of modern marketing techniques.

In the USA, in October 1994, the Dietary Supplement Health and Education Act (DSHEA) was signed into law. Under DSHEA, a supplement manufacturer alone is responsible for determining that the dietary supplements it manufactures or distributes are safe. Dietary supplements did not henceforth need approval from the U.S. Food and Drug Administration (FDA) before they were marketed. Except in the case of a new dietary ingredient, a firm did not have to provide FDA with the evidence to substantiate safety or effectiveness. It is widely believed that the 1994 DSHEA further consolidated the position of the supplement industry and lead to unprecedented growth and sales figures.

Health problems

The US FDA reports 50,000 health problems a year due to dietary supplements. These often involve bodybuilding supplements.

For example, the "natural" best-seller Craze, 2012's "New Supplement of the Year" by bodybuilding.com, sold in Walmart, Amazon etc., was found to contain undisclosed amphetamine-like compounds. Also other products by Matt Cahill have contained dangerous substances causing blindness or liver damages, and experts say that Cahill is emblematic for the whole industry.

Liver damage

The incidence of liver damage from dietary supplements has tripled in a decade. Most of the supplements involved were bodybuilding supplements. Some of the patients require liver transplants and some die. One third of the supplements involved contained unlisted steroids. Dr. Victor Navarro, the chairman of the hepatology division at Einstein Healthcare Network in Philadelphia, said that "while liver injuries linked to supplements were alarming, he believed that a majority of supplements were generally safe. Most of the liver injuries tracked by a network of medical officials are caused by prescription drugs used to treat things like cancer, diabetes and heart disease"

Supplement categories

Modern bodybuilding supplements are often marketed as promoting various desirable processes related to improving nutrition, enhancing body composition or improving lifting performance. Supplements are often categorized accordingly. While many of these categories are based on scientifically based physiological or biochemical processes, their use in bodybuilding parlance is often heavily colored by bodybuilding lore and industry marketing and as such may deviate considerably from traditional scientific usages of these terms.

Protein shake

Bodybuilders often supplement their diets with a powdered form of protein. The powder is mixed with water, milk or juice. Protein powder is generally consumed immediately before and after exercising, or in place of a meal. Some types of protein are to be taken directly before and after a workout (whey protein), while others are to be taken before going to bed (casein protein). The theory behind this supplementation is that bodybuilders, by virtue of their unique training methods and end-goals, require higher-than-average quantities of protein to support maximal muscle growth.

"The Recommended Dietary Allowance (RDA) for both men and women is 0.80 g of good quality protein/kg body weight/d and is based on careful analyses of available nitrogen balance studies.". "In view of the lack of compelling evidence to the contrary, no additional dietary protein is suggested for healthy adults undertaking resistance or endurance exercise."

No consensus has been reached in determining whether or not an individual in exercise training can benefit from protein and amino acid supplements. Protein supplements come in various forms: ready to drink shakes, bars, bites, oats, gels and powders. Protein powders are available in a variety of flavors.

• Whey protein contains high levels of all the essential amino acids and branched-chain amino acids. It also has the highest content of the amino acid cysteine, which aids in the biosynthesis of glutathione. For bodybuilders whey protein provides amino acids used to aid in muscle recovery. Whey protein is derived from the process of making cheese from milk. There are three types of whey protein: whey concentrate, whey isolate, and whey hydrolysate. Whey concentrate is 29-89% protein by weight whereas whey isolate is 90%+ protein by weight. Whey hydrolysate is enzymatically predigested and therefore has the highest rate of digestion of all protein types.
• Casein protein (or milk protein) has glutamine, and casomorphin.
• Soy protein from soybeans contain isoflavones, a type of phytoestrogen.
• Egg-white protein is a lactose- and dairy-free protein.
• Hemp seed contains complete and highly-digestible protein and hemp oil is high in essential fatty acids.
• Rice protein, when made from the whole grain, is a complete protein source that is highly digestible and allergen free. Since rice protein is low in the amino acid lysine, it is often combined with pea protein powder to achieve a superior amino acid profile.
• Pea protein is a hypoallergenic protein with a lighter texture than most other protein powders. Pea protein has an amino acid profile similar to that of soy, but pea protein does not elicit concerns about unknown effects of phytoestrogens. Pea protein is also less allergenic than soy.

Although it is generally believed that athletes and bodybuilders need an increased intake of protein, the exact amount is highly individualized and dependent on the type and duration of the exercise as well as the physiological make up of the individual. Age, gender, and body size may vary this protein intake. Some health experts have criticized protein shakes as being unnecessary for most people that consume them, since most users already get enough protein in the normal varied diet with enough calories. However, there is some evidence to support the idea that protein shakes are superior to whole foods with regards to enhancing muscle hypertrophy in the one hour window following intensive exercise. Moreover, for athletes who do not have the time to prepare whole food meals on the run or immediately after exercise, a protein shake may be preferred for practical as well as performance reasons.

A dietitian has suggested that low-calorie dieters, vegetarians, haphazard eaters and those who train very heavily may benefit from protein supplements. However, at least in the case of people following vegetarian diets, the Institute of Medicine of the National Academies states: "Available evidence does not support recommending a separate protein requirement for vegetarians who consume complementary mixtures of plant proteins.".

Taking an overdose of protein can lead to a loss of appetite, which may be useful for some dieters. Nutritionists claim that osteoporosis occurs from excessive protein intake because protein can put pressure on the kidneys and lead to bone loss due to calcium leaching. However, recent research has cast doubts on these claims, and suggests that higher calcium excretion may be due to increased calcium absorption in the intestines due to protein intake. Indeed, it is well known that dietary protein is itself important for bone growth, and some studies have found increased bone formation in response to exchanging dietary carbohydrates for protein. Nutritionists also argue against increased protein consumption because weight gain may occur because, as the body cannot store protein, excess protein will either be burned as energy or stored as fat (if you are already getting the calories you need). However, dietary protein is converted to fat far less efficiently than either carbohydrates or lipids, so consuming a calorie excess in protein will result in far less fat gain than would a calorie excess of other macronutrients.

Research by Tarnopolsky et al. (1988) showed that for bodybuilding individuals, 0.96g of protein per kg of body weight per day is recommended, whereas endurance athletes require 1.34g per kg per day. Their findings indicated that protein requirements are actually much lower than might be expected and that protein supplements therefore may not be as effective as is popularly believed. It should be noted that both of these levels are significantly higher than the levels recommended for the general population (0.8 g protein / kg body weight). The study concluded that "Bodybuilders during habitual training require a daily protein intake only slightly greater than that for sedentary individuals in the maintenance of lean body mass and that endurance athletes require daily protein intakes greater than either bodybuilders or sedentary individuals to meet the needs of protein catabolism during exercise.".

Another study suggest that the protein requirements for anaerobic and aerobic exercise are opposite those presented by Tarnopolsky. Endurance athletes in aerobic activity may have increased daily protein intake at 1.2-1.4 g per kg body weight per day--the same as the aforementioned study--where strength training athletes performing anaerobic activity may have increased daily protein intake needs at 1.4-1.8 g per kg body weight so as to enhance muscle protein synthesis or to make up for the loss of amino acid oxidation during exercise.

Branched-chain amino acids

Amino acids are the building blocks of protein; the body breaks consumed protein into amino acids in the stomach and intestines. Amino Acids are classified as essential, conditionally essential and non-essential. There are three branched-chain amino acids (BCAAs): leucine, isoleucine, and valine. All three branched-chain amino acids are essential amino acids. Each has numerous benefits on various biological processes in the body. Unlike other amino acids, BCAAs are metabolised in the muscle and have an anabolic/anti-catabolic effect on it. BCAAs account for 33% of muscle protein.

Glutamine

Glutamine is the most abundant amino acid found in human muscle and is commonly found in supplements or as a micronized, instantly soluble powder because supplement manufacturers claim the body's natural glutamine stores are depleted during anaerobic exercise. Some studies have shown there to be no significant effect of glutamine on bench press strength, knee-extension torque or lean muscle mass when compared to controls taking a placebo, though another study found that glutamine is beneficial in raising T-helper/suppressor cell ratio in long-distance runners.

Essential fatty acids

The essential fatty acids (alpha-linolenic acid and linoleic acid) may be especially important to supplement while bodybuilding; these cannot readily be made in the body, but are required for various functions within the body to take place.

Fatty fish, such as fresh salmon and trout are rich in essential fatty acids and fish oils can also be taken in supplement form.

Flaxseed oil, often sold as a supplement on its own, is an ideal source of alpha-Linolenic acid, which can also be found in walnuts and pumpkin seeds.

Meal replacement products

Meal replacement products (MRPs) are either pre-packaged powdered drink mixes or edible bars designed to replace prepared meals. MRPs are generally high in protein, low in fat, have a low to moderate amount of carbohydrates, and contain a wide array of vitamins and minerals.

The majority of MRPs use whey protein, casein (often listed as calcium caseinate or micellar casein), soy protein, and/or egg albumin as protein sources. Carbohydrates are typically derived from maltodextrin, oat fiber, brown rice, and/or wheat flour. Some MRPs also contain flax oil powder as a source of essential fatty acids.

MRPs can also contain other ingredients, such as creatine monohydrate, glutamine peptides, L-glutamine, calcium alpha-ketoglutarate, additional amino acids, lactoferrin, conjugated linoleic acid, and medium-chain triglycerides.

A sub-class of MRPs are called 'weight gainers' and have a high ratio of carbohydrates:protein. Where a MRP would have a 0.25-2:1 ratio of Carbohydrates:Protein a weight gainer would have in the order of between 3-5:1 ratios.

Prohormones

Prohormones are precursors to hormones and were most typically sold to bodybuilders as a precursor to the natural hormone testosterone. This conversion requires naturally occurring enzymes in the body. Side effects are not uncommon, as prohormones can also convert further into DHT and estrogen. To deal with this, many supplements also have aromatase inhibitors and DHT blockers such as chrysin and 4-androstene-3,6,17-trione. To date most prohormone products have not been thoroughly studied, and the health effects of prolonged use are unknown. Although initially available over the counter, their purchase was made illegal without a prescription in the US in 2004, and they hold similar status in many other countries. Additionally, their use is proscribed by most sporting bodies.

Creatine

Creatine is an organic acid naturally occurring in the body that supplies energy to muscle cells for short bursts of energy (as required in lifting weights) via creatine phosphate replenishment of ATP. A number of scientific studies have shown that creatine can improve strength, energy, muscle mass, and recovery times. In addition, recent studies have also shown that creatine improves brain function. and reduces mental fatigue. Unlike steroids or other performance-enhancing drugs, creatine can be found naturally in many common foods such as herring, tuna, salmon, and beef.

Creatine increases what is known as cell volumization by drawing water into muscle cells, making them larger. This intracellular retention should not be confused with the common myth that creatine causes bloating (or intercellular water retention).

Creatine is sold in a variety of forms, including creatine monohydrate and creatine ethyl ester, amongst others. Though all types of creatine are sold for the same purposes, there are subtle differences between them, such as price and necessary dosage.

In The New Encyclopedia of Modern Bodybuilding, 2nd ed., author Arnold Schwarzenegger states:

Creatine monohydrate is regarded as a necessity by most bodybuilders. Creatine monohydrate is the most cost-effective dietary supplement in terms of muscle size and strength gains. ... There is no preferred creatine supplement, but it is believed that creatine works best when it is consumed with simple carbohydrates. This can be accomplished by mixing powdered creatine with grape juice, lemonade, or many high glycemic index drinks.

Some studies have suggested that consumption of creatine with protein and carbohydrates can have a greater effect than creatine combined with either protein or carbohydrates alone.

Thermogenic products

A thermogenic is a broad term for any supplement that the manufacturer claims will cause thermogenesis, resulting in increased body temperature, increased metabolic rate, and consequently an increased rate in the burning of body fat and weight loss. Until 2004 almost every product found in this supplement category comprised the "ECA stack": ephedrine, caffeine and aspirin. However, on February 6, 2004 the Food and Drug Administration (FDA) banned the sale of ephedra and its alkaloid, ephedrine, for use in weight loss formulas. Several manufacturers replaced the ephedra component of the "ECA" stack with bitter orange or citrus aurantium (containing synephrine) instead of the ephedrine.

See also

• Fish oil
• Glycocarn
• Instant breakfast
• Protein
• Protein bar

References

External links

• Dietary Supplement Health and Education Act of 1994

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In nutrition, diet is the sum of food consumed by a person or other organism.

Dietary habits are the habitual decisions an individual or culture makes when choosing what foods to eat. The word diet often implies the use of specific intake of nutrition for health or weight-management reasons (with the two often being related). Although humans are omnivores, each culture and each person holds some food preferences or some food taboos. This may be due to personal tastes or ethical reasons. Individual dietary choices may be more or less healthy.

Proper nutrition requires ingestion and absorption of vitamins, minerals, and food energy in the form of carbohydrates, proteins, and fats. Dietary habits and choices play a significant role in the quality of life, health and longevity. It can define cultures and play a role in religion.

Religious and cultural dietary choices

Some cultures and religions have restrictions concerning what foods are acceptable in their diet. For example, only Kosher foods are permitted by Judaism, and Halal foods by Islam. Although Buddhists are generally vegetarians, the practice varies and meat-eating may be permitted depending on the sects. In Hinduism, vegetarianism is the ideal, Jain are strictly vegetarian and consumption of roots is not permitted.

Dietary choices

Many people choose to forgo food from animal sources to varying degrees (e.g. flexitarianism, vegetarianism, veganism, fruitarianism) for health reasons, issues surrounding morality, or to reduce their personal impact on the environment, although some of the public assumptions about which diets have lower impacts are known to be incorrect. Raw foodism is another contemporary trend. These diets may require tuning or supplementation such as vitamins to meet ordinary nutritional needs.

Weight management

A particular diet may be chosen to seek weight loss or weight gain. Changing a subject's dietary intake, or "going on a diet", can change the energy balance and increase or decrease the amount of fat stored by the body. Some foods are specifically recommended, or even altered, for conformity to the requirements of a particular diet. These diets are often recommended in conjunction with exercise. Specific weight loss programs can be harmful to health, while others may be beneficial (and can thus be coined as healthy diets). The terms "healthy diet" and "diet for weight management" are often related, as the two promote healthy weight management. Having a healthy diet is a way to prevent health problems, and will provide your body with the right balance of vitamins, minerals, and other nutrients.

Eating disorders

An eating disorder is a mental disorder that interferes with normal food consumption. It is defined by abnormal eating habits that may involve either insufficient or excessive diet.

Health

A healthy diet may improve or maintain optimal health. In developed countries, affluence enables unconstrained caloric intake and possibly inappropriate food choices.

It is recommended by many authorities that people maintain a normal weight by (limiting consumption of energy-dense foods and sugary drinks), eat plant-based food, limit red and processed meat, and limit alcohol. However, there is no total consensus on what constitutes a healthy diet.

Diet classification table

Notes

External links

• The dictionary definition of diet at Wiktionary

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The Judds were an American country music duo composed of Naomi Judd and her daughter, Wynonna Judd (born in 1964). Signed to RCA Records in 1983, the duo released six studio albums between then and 1991. One of the most successful acts in country music history, The Judds won five Grammy Awards for Best Country Performance by a Duo or Group with Vocal, and eight Country Music Association awards. The duo also charted twenty-five singles on the country music charts between 1983 and 2000, fourteen of which went to Number One and six more of which made Top Ten on the same chart.

The Judds ended their performance association in 1991 after Naomi was diagnosed with Hepatitis C. Shortly after, Wynonna began her solo career. The two have occasionally reunited for special tours, the most recent of which began in late 2010.

In 2011, the duo starred in the reality television series The Judds during their Last Encore Tour.

History

Naomi Judd was born Diana Ellen Judd on January 11, 1946, in Ashland, Kentucky. She played piano at her local church. At age seventeen, she married Michael Ciminella, with whom she had Christina Ciminella, who would later be renamed Wynonna Judd. After Diana's parents divorced, she and her daughter moved to Los Angeles, California, in 1968, and lived on welfare after she and Michael divorced in 1972. By 1979, Diana and her daughter moved back to Tennessee. Diana renamed herself Naomi and began playing music with her daughter, who sang lead and played guitar. At the same time, Naomi began studying to be a nurse.

Reunion shows

Wynonna and Naomi briefly reunited for a performance at the Super Bowl XXVIII halftime show. The reunited again in a commercial for the retail chain Kmart, performing the song "Changing for the Better". The duo also performed several shows in 1998. During this time, the duo also charted one more single credited to the Judds, as well as receiving an Academy of Country Music nomination for Duo of the Year in 2001. In addition, Naomi sang harmony on Wynonna's 2004 single "Flies on the Butter (You Can't Go Home Again)", although this song was credited as "Wynonna with Naomi Judd".

In 2008, the Judds once again reunited for a concert at the 2008 Stagecoach Festival in Indio, California, as well as two shows in Canada, including one at the world famous Calgary Stampede and another at the Merritt Mountain Music Festival in Merritt, British Columbia. In 2009, the Judds performed at the CMA Music Festival in Nashville.

In February 2010, Wynonna Judd appeared on CBS's The Early Show and announced that she would reunite with Naomi, to tour and record a studio album for the final time as the Judds by the end of 2010. The tour, known as the Last Encore Tour, became an 18-city tour of the US that was expanded to 29 dates in 2011.

On September 14, 2010, the Judds appeared on The Oprah Winfrey Show where Wynonna discussed "her recent weight loss, her year of living dangerously and what it's like going back on stage as part of the iconic duo, the Judds." The Judds also performed their new single "I Will Stand By You," which was released on iTunes that same day. In March 2011, Curb Records announced the release of the Judds' new album, I Will Stand by You: The Essential Collection, which features two new songs and twelve of the duo's hits. The album was released on April 5, 2011.

In April 2011, the Judds began starring in their first reality series, The Judds, on OWN: Oprah Winfrey Network. The new series, which premiered April 10, follows the duo on their final concert tour and explores their mother-daughter relationship.

Discography

Awards

Academy of Country Music

• 1984 Top Vocal Duo
• 1985 Top Vocal Duo
• 1986 Top Vocal Duo
• 1987 Top Vocal Duo
• 1988 Top Vocal Duo
• 1989 Top Vocal Duo
• 1990 Top Vocal Duo
• 2013 Cliffie Stone Pioneer Award

Country Music Association

• 1984 Horizon Award
• 1985 Single of the Year - "Why Not Me"
• 1985 Vocal Group of the Year
• 1986 Vocal Group of the Year
• 1987 Vocal Group of the Year
• 1988 Vocal Duo of the Year
• 1989 Vocal Duo of the Year
• 1990 Vocal Duo of the Year
• 1991 Vocal Duo of the Year

Grammy Awards

• 1985 Best Country Performance by a Duo or Group with Vocal - "Mama He's Crazy"
• 1986 Best Country Performance by a Duo or Group with Vocal - "Why Not Me"
• 1987 Best Country Performance by a Duo or Group with Vocal - "Grandpa (Tell Me 'Bout the Good Old Days)"
• 1989 Best Country Performance by a Duo or Group with Vocal - "Give A Little Love"
• 1992 Best Country Performance by a Duo or Group with Vocal - "Love Can Build A Bridge"

References

Array

External links

• Official website

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Weight loss, in the context of medicine, health, or physical fitness refers to a reduction of the total body mass, due to a mean loss of fluid, body fat or adipose tissue and/or lean mass, namely bone mineral deposits, muscle, tendon, and other connective tissue. Weight loss can either occur unintentionally due to an underlying disease or arise from a conscious effort to improve an actual or perceived overweight or obese state. "Unexplained" weight loss that is not caused by reduction in calorific intake or exercise is called cachexia and may be a symptom of a serious medical condition. Intentional weight loss is commonly referred to as slimming.

Unintentional

Characteristics

Unintentional weight loss may result from loss of body fats, loss of body fluids, muscle atrophy, or even a combination of these. It is generally regarded as a medical problem when at least 10% of a person's body weight has been lost in six months or 5% in the last month. Another criterion used for assessing weight that is too low is the body mass index (BMI). However, even lesser amounts of weight loss can be a cause for serious concern in a frail elderly person.

Unintentional weight loss can occur because of an inadequately nutritious diet relative to a person's energy needs (generally called malnutrition). Disease processes, changes in metabolism, hormonal changes, medications or other treatments, disease- or treatment-related dietary changes, or reduced appetite associated with a disease or treatment can also cause unintentional weight loss. Poor nutrient utilization can lead to weight loss, and can be caused by fistulae in the gastrointestinal tract, diarrhea, drug-nutrient interaction, enzyme depletion and muscle atrophy.

Continuing weight loss may deteriorate into wasting, a vaguely defined condition called cachexia. Cachexia differs from starvation in part because it involves a systemic inflammatory response. It is associated with poorer outcomes. In the advanced stages of progressive disease, metabolism can change so that they lose weight even when they are getting what is normally regarded as adequate nutrition and the body cannot compensate. This leads to a condition called anorexia cachexia syndrome (ACS) and additional nutrition or supplementation is unlikely to help. Symptoms of weight loss from ACS include severe weight loss from muscle rather than body fat, loss of appetite and feeling full after eating small amounts, nausea, anemia, weakness and fatigue.

Serious weight loss may reduce quality of life, impair treatment effectiveness or recovery, worsen disease processes and be a risk factor for high mortality rates. Malnutrition can affect every function of the human body, from the cells to the most complex body functions, including:

• immune response;
• wound healing;
• muscle strength (including respiratory muscles);
• renal capacity and depletion leading to water and electrolyte disturbances;
• thermoregulation; and
• menstruation.

In addition, malnutrition can lead to vitamin and other deficiencies and to inactivity, which in turn may pre-dispose to other problems, such as pressure sores.

Unintentional weight loss can be the characteristic leading to diagnosis of diseases such as cancer and type 1 diabetes.

In the UK, up to 5% of the general population is underweight, but more than 10% of those with lung or gastrointestinal diseases and who have recently had surgery. According to data in the UK using the Malnutrition Universal Screening Tool ('MUST'), which incorporates unintentional weight loss, more than 10% of the population over the age of 65 is at risk of malnutrition. A high proportion (10-60%) of hospital patients are also at risk, along with a similar proportion in care homes.

Causes

Disease-related

Disease-related malnutrition can be considered in four categories:

Weight loss issues related to specific diseases include:

• As chronic obstructive pulmonary disease (COPD) advances, about 35% of patients experience severe weight loss called pulmonary cachexia, including diminished muscle mass. Around 25% experience moderate to severe weight loss, and most others have some weight loss. Greater weight loss is associated with poorer prognosis. Theories about contributing factors include appetite loss related to reduced activity, additional energy required for breathing, and the difficulty of eating with dyspnea (labored breathing).
• Cancer, a very common and sometimes fatal cause of unexplained (idiopathic) weight loss. About one-third of unintentional weight loss cases are secondary to malignancy. Cancers to suspect in patients with unexplained weight loss include gastrointestinal, prostate, hepatobilary (hepatocellular carcinoma, pancreatic cancer), ovarian, hematologic or lung malignancies.
• People with HIV often experience weight loss, and it is associated with poorer outcomes. Wasting syndrome is an AIDS-defining condition.
• Gastrointestinal disorders are another common cause of unexplained weight loss - in fact they are the most common non-cancerous cause of idiopathic weight loss. Possible gastrointestinal etiologies of unexplained weight loss include: celiac disease, peptic ulcer disease, inflammatory bowel disease (crohn's disease and ulcerative colitis), pancreatitis, gastritis, diarrhea and many other GI conditions.
• Infection. Some infectious diseases can cause weight loss. Fungal illnesses, endocarditis, many parasitic diseases, AIDS, and some other subacute or occult infections may cause weight loss.
• Renal disease. Patients who have uremia often have poor or absent appetite, vomiting and nausea. This can cause weight loss.
• Cardiac disease. Cardiovascular disease, especially congestive heart failure, may cause unexplained weight loss.
• Connective tissue disease
• Neurologic disease, including dementia
• Oral, taste or dental problems (including infections) can reduce nutrient intake leading to weight loss.

Therapy-related

Medical treatment can directly or indirectly cause weight loss, impairing treatment effectiveness and recovery that can lead to further weight loss in a vicious cycle.

Many patients will be in pain and have a loss of appetite after surgery. Part of the body's response to surgery is to direct energy to wound healing, which increases the body's overall energy requirements. Surgery affects nutritional status indirectly, particularly during the recovery period, as it can interfere with wound healing and other aspects of recovery. Surgery directly affects nutritional status if a procedure permanently alters the digestive system. Enteral nutrition (tube feeding) is often needed. However a policy of 'nil by mouth' for all gastrointestinal surgery has not been shown to benefit, with some suggestion it might hinder recovery.

Early post-operative nutrition is a part of Enhanced Recovery After Surgery protocols. These protocols also include carbohydrate loading in the 24 hours before surgery, but earlier nutritional interventions have not been shown to have a significant impact.

Some medications can cause weight loss, while others can cause weight gain.

Social conditions

Social conditions such as poverty, social isolation and inability to get or prepare preferred foods can cause unintentional weight loss, and this may be particularly common in older people. Nutrient intake can also be affected by culture, family and belief systems. Ill-fitting dentures and other dental or oral health problems can also affect adequacy of nutrition.

Loss of hope, status or social contact and spiritual distress can cause depression, which may be associated with reduced nutrition, as can fatigue.

Intentional

Intentional weight loss is the loss of total body mass as a result of efforts to improve fitness and health, or to change appearance through slimming.

Weight loss in individuals who are overweight or obese can reduce health risks, increase fitness, and may delay the onset of diabetes. It could reduce pain and increase movement in people with osteoarthritis of the knee. Weight loss can lead to a reduction in hypertension (high blood pressure), however whether this reduces hypertension-related harm is unclear.

Weight loss occurs when the body is expending more energy in work and metabolism than it is absorbing from food or other nutrients. It will then use stored reserves from fat or muscle, gradually leading to weight loss.

It is not uncommon for some people who are at their ideal body weight to seek additional weight loss in order to improve athletic performance or meet required weight classification for participation in a sport. Others may be driven to lose weight to achieve an appearance they consider more attractive. Being underweight is associated with health risks such as difficulty fighting off infection, osteoporosis, decreased muscle strength, trouble regulating body temperature and even increased risk of death.

According to the U.S. Food and Drug Administration (FDA), healthy individuals seeking to maintain their weight should consume 2,000 calories (8.4 MJ) per day.

According to the Dietary Guidelines for Americans those who achieve and manage a healthy weight do so most successfully by being careful to consume just enough calories to meet their needs, and being physically active.

Low-calorie regimen diets are also referred to as balanced percentage diets. Due to their minimal detrimental effects, these types of diets are most commonly recommended by nutritionists. In addition to restricting calorie intake, a balanced diet also regulates macronutrient consumption. From the total number of allotted daily calories, it is recommended that 55% should come from carbohydrates, 15% from protein, and 30% from fats with no more than 10% of total fat coming from saturated forms. For instance, a recommended 1,200 calorie diet would supply about 660 calories from carbohydrates, 180 from protein, and 360 from fat. Some studies suggest that increased consumption of protein can help ease hunger pangs associated with reduced caloric intake by increasing the feeling of satiety. Calorie restriction in this way has many long-term benefits. After reaching the desired body weight, the calories consumed per day may be increased gradually, without exceeding 2,000 net (i.e. derived by subtracting calories burned by physical activity from calories consumed). Combined with increased physical activity, low-calorie diets are thought to be most effective long-term, unlike crash diets, which can achieve short-term results, at best. Physical activity could greatly enhance the efficiency of a diet. The healthiest weight loss regimen, therefore, is one that consists of a balanced diet and moderate physical activity.

Weight gain has been associated with excessive consumption of fats, sugars, carbohydrates in general, and alcohol consumption. Depression, stress or boredom may also contribute to weight increase, and in these cases, individuals are advised to seek medical help. A 2010 study found that dieters who got a full night's sleep lost more than twice as much fat as sleep-deprived dieters.

The majority of dieters regain weight over the long term.

Therapeutic techniques

The least intrusive weight loss methods, and those most often recommended, are adjustments to eating patterns and increased physical activity, generally in the form of exercise. The World Health Organization recommended that people combine a reduction of processed foods high in saturated fats, sugar and salt and caloric content of the diet with an increase in physical activity.

An increase in fiber intake is also recommended for regulating bowel movements.

Other methods of weight loss include use of drugs and supplements that decrease appetite, block fat absorption, or reduce stomach volume.

Bariatric surgery may be indicated in cases of severe obesity. Two common bariatric surgical procedures are gastric bypass and gastric banding. Both can be effective at limiting the intake of food energy by reducing the size of the stomach, but as with any surgical procedure both come with their own risks that should be considered in consultation with a physician.

Dietary supplements, though widely used, are not considered a healthy option for weight loss. Many are available, but very few are effective in the long term.

Virtual gastric band uses hypnosis to make the brain think the stomach is smaller than it really is and hence lower the amount of food ingested. This brings as a consequence weight reduction. This method is complemented with psychological treatment for anxiety management and with hypnopedia. Research has been conducted into the use of hypnosis as a weight management alternative. In 1996 a study found that cognitive-behavioral therapy (CBT) was more effective for weight reduction if reinforced with hypnosis. Acceptance and Commitment Therapy ACT, a mindfulness approach to weight loss, has also in the last few years been demonstrating its usefulness.

Crash dieting

A crash diet is the willful restriction of nutritional intake (except water) for more than 12 waking hours. The desired result is for the body to burn fat for energy and thereby lose a significant amount of weight in a short time. Crash dieting can be dangerous to health and this method of weight loss is not recommended by physicians.

According to the Academy of Nutrition and Dietetics, "If the diet or product sounds too good to be true, it probably is. There are no foods or pills that magically burn fat. No super foods will alter your genetic code. No products will miraculously melt fat while you watch TV or sleep." Certain ingredients in supplements and herbal products can be dangerous and even deadly for some people.

Weight loss industry

There is a substantial market for products which promise to make weight loss easier, quicker, cheaper, more reliable, or less painful. These include books, DVDs, CDs, cremes, lotions, pills, rings and earrings, body wraps, body belts and other materials, fitness centers, personal coaches, weight loss groups, and food products and supplements.

In 2008 between US$33 billion and $55 billion was spent annually in the US on weight-loss products and services, including medical procedures and pharmaceuticals, with weight-loss centers taking between 6 and 12 percent of total annual expenditure. Over $1.6 billion a year was spent on weight-loss supplements. About 70 percent of Americans' dieting attempts are of a self-help nature.

In Western Europe, sales of weight-loss products, excluding prescription medications, topped £900 million ($1.4 billion) in 2009.

See also

References

External links

• Weight loss at DMOZ
• Health benefits of losing weight By IQWiG at PubMed Health
• Weight-control Information Network U.S. National Institutes of Health
• Nutrition in cancer care By NCI at PubMed Health
• Unintentional weight loss

Interesting Informations

Looking products related to this topic, find out at Amazon.com

Source of the article : here

Weight loss, in the context of medicine, health, or physical fitness refers to a reduction of the total body mass, due to a mean loss of fluid, body fat or adipose tissue and/or lean mass, namely bone mineral deposits, muscle, tendon, and other connective tissue. Weight loss can either occur unintentionally due to an underlying disease or arise from a conscious effort to improve an actual or perceived overweight or obese state. "Unexplained" weight loss that is not caused by reduction in calorific intake or exercise is called cachexia and may be a symptom of a serious medical condition. Intentional weight loss is commonly referred to as slimming.

Unintentional

Characteristics

Unintentional weight loss may result from loss of body fats, loss of body fluids, muscle atrophy, or even a combination of these. It is generally regarded as a medical problem when at least 10% of a person's body weight has been lost in six months or 5% in the last month. Another criterion used for assessing weight that is too low is the body mass index (BMI). However, even lesser amounts of weight loss can be a cause for serious concern in a frail elderly person.

Unintentional weight loss can occur because of an inadequately nutritious diet relative to a person's energy needs (generally called malnutrition). Disease processes, changes in metabolism, hormonal changes, medications or other treatments, disease- or treatment-related dietary changes, or reduced appetite associated with a disease or treatment can also cause unintentional weight loss. Poor nutrient utilization can lead to weight loss, and can be caused by fistulae in the gastrointestinal tract, diarrhea, drug-nutrient interaction, enzyme depletion and muscle atrophy.

Continuing weight loss may deteriorate into wasting, a vaguely defined condition called cachexia. Cachexia differs from starvation in part because it involves a systemic inflammatory response. It is associated with poorer outcomes. In the advanced stages of progressive disease, metabolism can change so that they lose weight even when they are getting what is normally regarded as adequate nutrition and the body cannot compensate. This leads to a condition called anorexia cachexia syndrome (ACS) and additional nutrition or supplementation is unlikely to help. Symptoms of weight loss from ACS include severe weight loss from muscle rather than body fat, loss of appetite and feeling full after eating small amounts, nausea, anemia, weakness and fatigue.

Serious weight loss may reduce quality of life, impair treatment effectiveness or recovery, worsen disease processes and be a risk factor for high mortality rates. Malnutrition can affect every function of the human body, from the cells to the most complex body functions, including:

• immune response;
• wound healing;
• muscle strength (including respiratory muscles);
• renal capacity and depletion leading to water and electrolyte disturbances;
• thermoregulation; and
• menstruation.

In addition, malnutrition can lead to vitamin and other deficiencies and to inactivity, which in turn may pre-dispose to other problems, such as pressure sores.

Unintentional weight loss can be the characteristic leading to diagnosis of diseases such as cancer and type 1 diabetes.

In the UK, up to 5% of the general population is underweight, but more than 10% of those with lung or gastrointestinal diseases and who have recently had surgery. According to data in the UK using the Malnutrition Universal Screening Tool ('MUST'), which incorporates unintentional weight loss, more than 10% of the population over the age of 65 is at risk of malnutrition. A high proportion (10-60%) of hospital patients are also at risk, along with a similar proportion in care homes.

Causes

Disease-related

Disease-related malnutrition can be considered in four categories:

Weight loss issues related to specific diseases include:

• As chronic obstructive pulmonary disease (COPD) advances, about 35% of patients experience severe weight loss called pulmonary cachexia, including diminished muscle mass. Around 25% experience moderate to severe weight loss, and most others have some weight loss. Greater weight loss is associated with poorer prognosis. Theories about contributing factors include appetite loss related to reduced activity, additional energy required for breathing, and the difficulty of eating with dyspnea (labored breathing).
• Cancer, a very common and sometimes fatal cause of unexplained (idiopathic) weight loss. About one-third of unintentional weight loss cases are secondary to malignancy. Cancers to suspect in patients with unexplained weight loss include gastrointestinal, prostate, hepatobilary (hepatocellular carcinoma, pancreatic cancer), ovarian, hematologic or lung malignancies.
• People with HIV often experience weight loss, and it is associated with poorer outcomes. Wasting syndrome is an AIDS-defining condition.
• Gastrointestinal disorders are another common cause of unexplained weight loss - in fact they are the most common non-cancerous cause of idiopathic weight loss. Possible gastrointestinal etiologies of unexplained weight loss include: celiac disease, peptic ulcer disease, inflammatory bowel disease (crohn's disease and ulcerative colitis), pancreatitis, gastritis, diarrhea and many other GI conditions.
• Infection. Some infectious diseases can cause weight loss. Fungal illnesses, endocarditis, many parasitic diseases, AIDS, and some other subacute or occult infections may cause weight loss.
• Renal disease. Patients who have uremia often have poor or absent appetite, vomiting and nausea. This can cause weight loss.
• Cardiac disease. Cardiovascular disease, especially congestive heart failure, may cause unexplained weight loss.
• Connective tissue disease
• Neurologic disease, including dementia
• Oral, taste or dental problems (including infections) can reduce nutrient intake leading to weight loss.

Therapy-related

Medical treatment can directly or indirectly cause weight loss, impairing treatment effectiveness and recovery that can lead to further weight loss in a vicious cycle.

Many patients will be in pain and have a loss of appetite after surgery. Part of the body's response to surgery is to direct energy to wound healing, which increases the body's overall energy requirements. Surgery affects nutritional status indirectly, particularly during the recovery period, as it can interfere with wound healing and other aspects of recovery. Surgery directly affects nutritional status if a procedure permanently alters the digestive system. Enteral nutrition (tube feeding) is often needed. However a policy of 'nil by mouth' for all gastrointestinal surgery has not been shown to benefit, with some suggestion it might hinder recovery.

Early post-operative nutrition is a part of Enhanced Recovery After Surgery protocols. These protocols also include carbohydrate loading in the 24 hours before surgery, but earlier nutritional interventions have not been shown to have a significant impact.

Some medications can cause weight loss, while others can cause weight gain.

Social conditions

Social conditions such as poverty, social isolation and inability to get or prepare preferred foods can cause unintentional weight loss, and this may be particularly common in older people. Nutrient intake can also be affected by culture, family and belief systems. Ill-fitting dentures and other dental or oral health problems can also affect adequacy of nutrition.

Loss of hope, status or social contact and spiritual distress can cause depression, which may be associated with reduced nutrition, as can fatigue.

Intentional

Intentional weight loss is the loss of total body mass as a result of efforts to improve fitness and health, or to change appearance through slimming.

Weight loss in individuals who are overweight or obese can reduce health risks, increase fitness, and may delay the onset of diabetes. It could reduce pain and increase movement in people with osteoarthritis of the knee. Weight loss can lead to a reduction in hypertension (high blood pressure), however whether this reduces hypertension-related harm is unclear.

Weight loss occurs when the body is expending more energy in work and metabolism than it is absorbing from food or other nutrients. It will then use stored reserves from fat or muscle, gradually leading to weight loss.

It is not uncommon for some people who are at their ideal body weight to seek additional weight loss in order to improve athletic performance or meet required weight classification for participation in a sport. Others may be driven to lose weight to achieve an appearance they consider more attractive. Being underweight is associated with health risks such as difficulty fighting off infection, osteoporosis, decreased muscle strength, trouble regulating body temperature and even increased risk of death.

According to the U.S. Food and Drug Administration (FDA), healthy individuals seeking to maintain their weight should consume 2,000 calories (8.4 MJ) per day.

According to the Dietary Guidelines for Americans those who achieve and manage a healthy weight do so most successfully by being careful to consume just enough calories to meet their needs, and being physically active.

Low-calorie regimen diets are also referred to as balanced percentage diets. Due to their minimal detrimental effects, these types of diets are most commonly recommended by nutritionists. In addition to restricting calorie intake, a balanced diet also regulates macronutrient consumption. From the total number of allotted daily calories, it is recommended that 55% should come from carbohydrates, 15% from protein, and 30% from fats with no more than 10% of total fat coming from saturated forms. For instance, a recommended 1,200 calorie diet would supply about 660 calories from carbohydrates, 180 from protein, and 360 from fat. Some studies suggest that increased consumption of protein can help ease hunger pangs associated with reduced caloric intake by increasing the feeling of satiety. Calorie restriction in this way has many long-term benefits. After reaching the desired body weight, the calories consumed per day may be increased gradually, without exceeding 2,000 net (i.e. derived by subtracting calories burned by physical activity from calories consumed). Combined with increased physical activity, low-calorie diets are thought to be most effective long-term, unlike crash diets, which can achieve short-term results, at best. Physical activity could greatly enhance the efficiency of a diet. The healthiest weight loss regimen, therefore, is one that consists of a balanced diet and moderate physical activity.

Weight gain has been associated with excessive consumption of fats, sugars, carbohydrates in general, and alcohol consumption. Depression, stress or boredom may also contribute to weight increase, and in these cases, individuals are advised to seek medical help. A 2010 study found that dieters who got a full night's sleep lost more than twice as much fat as sleep-deprived dieters.

The majority of dieters regain weight over the long term.

Therapeutic techniques

The least intrusive weight loss methods, and those most often recommended, are adjustments to eating patterns and increased physical activity, generally in the form of exercise. The World Health Organization recommended that people combine a reduction of processed foods high in saturated fats, sugar and salt and caloric content of the diet with an increase in physical activity.

An increase in fiber intake is also recommended for regulating bowel movements.

Other methods of weight loss include use of drugs and supplements that decrease appetite, block fat absorption, or reduce stomach volume.

Bariatric surgery may be indicated in cases of severe obesity. Two common bariatric surgical procedures are gastric bypass and gastric banding. Both can be effective at limiting the intake of food energy by reducing the size of the stomach, but as with any surgical procedure both come with their own risks that should be considered in consultation with a physician.

Dietary supplements, though widely used, are not considered a healthy option for weight loss. Many are available, but very few are effective in the long term.

Virtual gastric band uses hypnosis to make the brain think the stomach is smaller than it really is and hence lower the amount of food ingested. This brings as a consequence weight reduction. This method is complemented with psychological treatment for anxiety management and with hypnopedia. Research has been conducted into the use of hypnosis as a weight management alternative. In 1996 a study found that cognitive-behavioral therapy (CBT) was more effective for weight reduction if reinforced with hypnosis. Acceptance and Commitment Therapy ACT, a mindfulness approach to weight loss, has also in the last few years been demonstrating its usefulness.

Crash dieting

A crash diet is the willful restriction of nutritional intake (except water) for more than 12 waking hours. The desired result is for the body to burn fat for energy and thereby lose a significant amount of weight in a short time. Crash dieting can be dangerous to health and this method of weight loss is not recommended by physicians.

According to the Academy of Nutrition and Dietetics, "If the diet or product sounds too good to be true, it probably is. There are no foods or pills that magically burn fat. No super foods will alter your genetic code. No products will miraculously melt fat while you watch TV or sleep." Certain ingredients in supplements and herbal products can be dangerous and even deadly for some people.

Weight loss industry

There is a substantial market for products which promise to make weight loss easier, quicker, cheaper, more reliable, or less painful. These include books, DVDs, CDs, cremes, lotions, pills, rings and earrings, body wraps, body belts and other materials, fitness centers, personal coaches, weight loss groups, and food products and supplements.

In 2008 between US$33 billion and $55 billion was spent annually in the US on weight-loss products and services, including medical procedures and pharmaceuticals, with weight-loss centers taking between 6 and 12 percent of total annual expenditure. Over $1.6 billion a year was spent on weight-loss supplements. About 70 percent of Americans' dieting attempts are of a self-help nature.

In Western Europe, sales of weight-loss products, excluding prescription medications, topped £900 million ($1.4 billion) in 2009.

See also

References

External links

• Weight loss at DMOZ
• Health benefits of losing weight By IQWiG at PubMed Health
• Weight-control Information Network U.S. National Institutes of Health
• Nutrition in cancer care By NCI at PubMed Health
• Unintentional weight loss

Interesting Informations

Looking products related to this topic, find out at Amazon.com

Source of the article : here

The DASH diet (Dietary Approaches to Stop Hypertension) is a dietary pattern promoted by the U.S.-based National Heart, Lung, and Blood Institute (part of the National Institutes of Health, an agency of the United States Department of Health and Human Services) to prevent and control hypertension. The DASH diet is rich in fruits, vegetables, whole grains, and low-fat dairy foods; includes meat, fish, poultry, nuts, and beans; and is limited in sugar-sweetened foods and beverages, red meat, and added fats. In addition to its effect on blood pressure, it is designed to be a well-balanced approach to eating for the general public. DASH is recommended by the United States Department of Agriculture (USDA) as one of its ideal eating plans for all Americans.

The DASH diet is based on NIH studies that examined three dietary plans and their results. None of the plans were vegetarian, but the DASH plan incorporated more fruits and vegetables, low fat or nonfat dairy, beans, and nuts than the others studied. The diet reduced systolic blood pressure by 6 mm Hg and diastolic blood pressure by 3 mm Hg in patients with high normal blood pressure, now called "pre-hypertension." Those with hypertension dropped by 11 and 6, respectively. These changes in blood pressure occurred with no changes in body weight. The DASH dietary pattern is adjusted based on daily caloric intake ranging from 1600 to 3100 dietary calories.

History and design

Background

Currently, hypertension is thought to affect roughly 50 million people in the U.S. and approximately 1 billion worldwide. According to the National Heart, Lung and Blood Institute (NHLBI), citing data from 2002, "The relationship between BP and risk of cardiovascular disease (CVD) events is continuous, consistent, and independent of other risk factors. The higher the BP, the greater is the chance of heart attack, heart failure, stroke, and kidney disease. For individuals 40-70 years of age, each increment of 20 mm Hg in systolic BP (SBP) or 10 mm Hg in diastolic BP (DBP) doubles the risk of CVD across the entire BP range from 115/75 to 185/115 mm Hg.".

The prevalence of hypertension led the U.S. [National Institutes of Health] (NIH) to propose funding to further research the role of dietary patterns on blood pressure. In 1992 the NHLBI worked with five of the most well-respected medical research centers in different cities across the U.S. to conduct the largest and most detailed research study to date. The DASH study used a rigorous design called a randomized controlled trial (RCT), and it involved teams of physicians, nurses, nutritionists, statisticians and research coordinators working in a cooperative venture in which participants were selected and studied in each of these five research facilities. The chosen facilities and locales for this multi-center study were (1) Johns Hopkins University in Baltimore, Maryland, (2) Duke University Medical Center in Durham, North Carolina, (3) Kaiser Permanente Center for Health Research in Portland, Oregon, (4) Brigham and Women's Hospital in Boston, Massachusetts and (5) Pennington Biomedical Research Center in Baton Rouge, Louisiana.

Two DASH trials were designed and carried out as multi-center, randomized, outpatient feeding studies with the purpose of testing the effects of dietary patterns on blood pressure. The standardized multi-center protocol is an approach used in many large-scale multi-center studies funded by the NHLBI. A unique feature of the DASH diet was that the foods and menu were chosen based on conventionally consumed food items so it could be more easily adopted by the general public if results were positive. The initial DASH study was begun in August 1993 and ended in July 1997. Contemporary epidemiological research had concluded that dietary patterns with high intakes of certain minerals and fiber were associated with low blood pressures. The nutritional conceptualization of the DASH meal plans was based in part on this research.

Diet

Two experimental diets were selected for the DASH study and compared with each other, and with a third: the control diet. The control diet was low in potassium, calcium, magnesium and fiber and featured a fat and protein profile so that the pattern was consistent with a "typical American diet at the time". The first experimental diet was higher in fruits and vegetables but otherwise similar to the control diet (a "fruits and vegetables diet" ), with the exception of fewer snacks and sweets. Magnesium and Potassium levels were close to the 75th percentile of U.S. consumption in the fruits-and-vegetables diet, which also featured a high fiber profile. The second experimental diet was high in fruits-and-vegetables and in low-fat dairy products, as well as lower in overall fat and saturated fat, with higher fiber and higher protein compared with the control diet--this diet has been called "the DASH Diet". The DASH diet (or combination diet) was rich in potassium, magnesium and calcium--a nutrient profile roughly equivalent with the 75th percentile of U.S. consumption. The combination or "DASH" diet was also high in whole grains, poultry, fish, and nuts while being lower in red meat content, sweets, and sugar-containing beverages.

The DASH diet was designed to provide liberal amounts of key nutrients thought to play a part in lowering blood pressure, based on past epidemiologic studies. One of the unique features of the DASH study was that dietary patterns rather than single nutrients were being tested. The DASH diet also features a high quotient of anti-oxidant rich foods thought by some to retard or prevent chronic health problems including cancer, heart disease, and stroke.

Researchers have also found that the DASH diet is more effective than a low oxalate diet in the prevention and treatment of kidney stones, specifically calcium oxalate kidney stones (the most common type).

Study population

8,813 people were screened for the study, out of which were ultimately chosen 459 participants whose demographic characteristics most closely resembled the target population and study requirements. The sample population consisted of healthy men and women with an average age of 46, with systolic blood pressures of less than 160 mm Hg and diastolic blood pressures within 80 to 95 mm Hg. African-American and other minority groups were planned to comprise 67% of the study sample, with 49% of the sample being female. Indeed, due to the exceptional burden of high blood pressure in minority populations, especially among African-Americans, a major goal of the trial was to recruit enough ethnic minorities to constitute two thirds of the target sample.

Study design

Participants ate one of the three aforementioned dietary patterns in 3 separate phases of the trial, including (1) Screening, (2), Run-in and (3) Intervention. In the screening phase, participants were screened for eligibility based on the combined results of blood pressure readings. In the 3 week run-in phase, each subject was given the control diet for 3 weeks, had their blood pressure measurements taken on each of five separate days, gave one 24-hour urine sample and completed a questionnaire on symptoms. At this point, subjects who were compliant with the feeding program during the screening phase were each randomly assigned to one of the three diets outlined above, to begin at the start of the 4th week. The intervention phase followed next; this was an 8-week period in which the subjects were provided the diet to which they had been randomly assigned. Blood pressures and urine samples were collected again during this time together with symptom & physical activity recall questionnaires. The first group of study subjects began the run-in phase of the trial in September 1994 while the fifth and final group began in January 1996. Each of the three diets contained the same 3 grams (3,000 mg) of sodium, selected because that was the approximate average intake in the nation at the time. Participants were also given two packets of salt, each containing 200 mg of sodium, for discretionary use. Alcohol was limited to no more than two beverages per day, and caffeine intake was limited to no more than three caffeinated beverages.

Study results

The DASH trial showed that dietary patterns can and do affect blood pressure in the high normal BP to moderately hypertensive adult population (systolic < 180 mm Hg & diastolic of 80 to 95 mm Hg). Respectively, the DASH or "combination" diet lowered blood pressures by an average of 5.5 and 3.0 mm Hg for systolic and diastolic, compared with the control diet. The minority portion of the study sample and the hypertensive portion both showed the largest reductions in blood pressure from the combination diet against the control diet. The hypertensive subjects experienced a drop of 11.4 mm Hg in their systolic and 5.5 mm Hg in their diastolic phases. The fruits-and-vegetables diet was also successful, although it produced more modest reductions compared with the control diet (2.8 mm Hg systolic and 1.1 mm Hg diastolic). In the subjects with and without hypertension, the combination diet effectively reduced blood pressure more than the fruits-and-vegetables diet or the control diet did. The data indicated that reductions in blood pressure occurred within two weeks of subjects' starting their designated diets, and that the results were generalizable to the target sample of the U.S. population. Side effects were negligible, but the NEJM study reports that some subjects reported constipation as a problem. At the end of the intervention phase, 10.1, 5.4 & 4.0 percent of the subjects reported this problem for the control, fruits-and-vegetables and combination diets, respectively, showing that the fruits and vegetables and combination diets reduce constipation. Apart from only one subject (on the control diet) who was suffering from cholecystitis, other gastrointestinal symptoms had a low rate of incidence.

DASH-Sodium study

Design

The DASH-Sodium study was conducted following the end of the original DASH study to determine whether the DASH diet could produce even better results if it were low in salt and also to examine the effects of different levels of sodium in people eating the DASH diet. The researchers were interested in determining the effects of sodium reduction when combined with the DASH diet as well as the effects of the DASH diet when at three levels of sodium intake. The DASH-Sodium trial was conducted from September 1997 through November 1999. Like the previous study, it was based on a large sample (412 participants) and was a multi-center, randomized, outpatient feeding study where the subjects were given all their food. The participants were adults with prehypertension or stage 1 hypertension (average systolic of 120 to 159 mm Hg & average diastolic of 80 to 95 mm Hg) and were randomly assigned to one of two diet groups. The two randomized diet groups were the DASH diet and a control diet that mirrored a "typical American diet", and which was somewhat low in key nutrients such as potassium, magnesium and calcium. The DASH diet was the same as in the previous DASH study. After being assigned to one of these two diets, the participants were given diets that differed by 3 distinct levels of sodium content, corresponding to 3,000 mg, 2,400 mg or 1,500 mg/day (higher, intermediate or lower), in random order, for 30 consecutive days each. During the two week run-in phase, all participants ate the high sodium control diet. The 30 day intervention phase followed, in which subjects ate their assigned diets at each of the aforementioned sodium levels (high, intermediate and low) in random order, in a crossover design. During the 30 day dietary intervention phase, each participant therefore consumed his or her assigned diet (either DASH or control) at all three sodium levels.

Results and conclusions

The primary outcome of the DASH-Sodium study was systolic blood pressure at the end of the 30 day dietary intervention periods. The secondary outcome was diastolic blood pressure. The DASH-Sodium study found that reductions in sodium intake produced significantly lower systolic and diastolic blood pressures in both the control and DASH diets. Study results indicate that the quantity of dietary sodium in the control diet was twice as powerful in its effect on blood pressure as it was in the DASH diet. Importantly, the control diet sodium reductions from intermediate to low correlated with greater changes in systolic blood pressure than those same changes from high to intermediate (change equal to roughly 40 mmol per day, or 1 gram of sodium).

As stated by Sacks, F. et al., reductions in sodium intake by this amount per day correlated with greater decreases in blood pressure when the starting sodium intake level was already at the U.S. recommended dietary allowance, than when the starting level was higher (higher levels are the actual average in the U.S.). These results led researchers to postulate that the adoption of a national lower daily allowance for sodium than the currently held 2,400 mg could be based on the sound scientific results provided by this study. The U.S. Dietary Guidelines for Americans recommend eating a diet of 2300 mg of sodium a day or lower, with a recommendation of 1500 mg/day in adults who have elevated blood pressure; the 1500 mg/day is the low sodium level tested in the DASH-Sodium study.

The DASH diet and the control diet at the lower salt levels were both successful in lowering blood pressure, but the largest reductions in blood pressure were obtained by eating a combination of these two (i.e., a lower-salt version of the DASH diet). The effect of this combination at a sodium level of 1,500 mg/day was an average blood pressure reduction of 8.9/4.5 mm Hg (systolic/diastolic). The hypertensive subjects experienced an average reduction of 11.5/5.7 mm Hg. The DASH-sodium results indicate that low sodium levels correlated with the largest reductions in blood pressure for participants at both pre-hypertensive and hypertensive levels, with the hypertensive participants showing the greatest reductions in blood pressure overall.

References

Further reading

• Heller, Marla (2011). The DASH Diet Action Plan: Based on the National Institutes of Health Research, Dietary Approaches to Stop Hypertension. New York: Grand Central Life & Style. ISBN 978-1455512805. OCLC 162507208. 
• The DASH Diet Solution and 60 Day Weight Loss and Fitness Journal. Los Angeles, California: Learning Visions. 2013. ISBN 978-1-936583-29-4. 
• Nowlan, Sandra (2008). Delicious DASH Flavours: The proven, drug-free, doctor-recommended approach to reducing high blood pressure. Halifax N.S.: Formac. ISBN 978-0-88780-766-4. OCLC 185022611. 
• Sacks, Frank M; Svetkey, Laura; Vollmer, William; Appel, Lawrence; Bray, George; Harsha, David; Obarzanek, Eva; Conlin, Paul et al. (2001-01-04). "Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet". New England Journal of Medicine (Massachusetts Medical Society sunshinehs) 344 (1): 3-10. doi:10.1056/NEJM200101043440101. ISSN 0028-4793. PMID 11136953. 

External links

• What Is the DASH Eating Plan? at The National Heart, Lung, and Blood Institute (NHLBI)
• VIDEO - Which Diet Works: A Nutritional Review, Gail Underbakke, MS, RD, speaks at the University of Wisconsin School of Medicine and Public Health
• DASH A Diet for all diseases at cspinet.org
• DASH for Women at womensheartfoundation.org

Interesting Informations

Looking products related to this topic, find out at Amazon.com

Source of the article : here