This list contains (all of the) studies cited on this site, or which are relevant for supporting the theory presented. Except for the NHANES study, all are abstracts, which are publicly available on PubMed (www.pubmed.com) or other sources.

1) The case for low carbohydrate diets in diabetes management, Nutr Metab (Lond). 2005 Jul 14;2:16

Arora SK, McFarlane SI.

Division of Endocrinology, Diabetes and Hypertension, SUNY Downstate Medical Center, and Kings County Hospital Center, Brooklyn, NY 11203 NY 11203, USA. Samy.McFarlane@downstate.edu.

A low fat, high carbohydrate diet in combination with regular exercise is the traditional recommendation for treating diabetes. Compliance with these lifestyle modifications is less than satisfactory, however, and a high carbohydrate diet raises postprandial plasma glucose and insulin secretion, thereby increasing risk of CVD, hypertension, dyslipidemia, obesity and diabetes. Moreover, the current epidemic of diabetes and obesity has been, over the past three decades, accompanied by a significant decrease in fat consumption and an increase in carbohydrate consumption. This apparent failure of the traditional diet, from a public health point of view, indicates that alternative dietary approaches are needed. Because carbohydrate is the major secretagogue of insulin, some form of carbohydrate restriction is a prima facie candidate for dietary control of diabetes. Evidence from various randomized controlled trials in recent years has convinced us that such diets are safe and effective, at least in short-term. These data show low carbohydrate diets to be comparable or better than traditional low fat high carbohydrate diets for weight reduction, improvement in the dyslipidemia of diabetes and metabolic syndrome as well as control of blood pressure, postprandial glycemia and insulin secretion. Furthermore, the ability of low carbohydrate diets to reduce triglycerides and to increase HDL is of particular importance. Resistance to such strategies has been due, in part, to equating it with the popular Atkins diet. However, there are many variations and room for individual physician planning. Some form of low carbohydrate diet, in combination with exercise, is a viable option for patients with diabetes. However, the extreme reduction of carbohydrate of popular diets (<30 g/day) cannot be recommended for a diabetic population at this time without further study. On the other hand, the dire objections continually raised in the literature appear to have very little scientific basis. Whereas it is traditional to say that more work needs to be done, the same is true of the assumed standard low fat diets which have an ambiguous record at best. We see current trends in the national dietary recommendations as a positive sign and an appropriate move in the right direction.

Background: The metabolic syndrome is characterized by an atherogenic dyslipidemia identifiable using lipoprotein subclass analysis. This study assesses the effect of a carbohydrate-restricted diet on the dyslipidemia of the metabolic syndrome in a clinical setting.

Methods: This is a retrospective chart review of patients attending a preventive medicine clinic using lipoprotein subclass analysis (by NMR spectroscopy) to identify the atherogenic dyslipidemia. If present, patients were counseled to begin a carbohydrate-restricted diet (< 20 g/day). Patients already on statin therapy were included only if the medication dose was not changed. The outcomes were changes in body weight, fasting serum lipid profiles and serum lipoprotein subclasses.

Results: Of 122 patients identified, 80 patients had complete pre- and post-treatment data. The mean (±SD) age was 66 ± 9 years, baseline weight was 85 ± 12 kg, BMI was 28.1 ± 3.6, 73% were male, 99% were Caucasian. Sixty-five percent were taking statin medication. Carbohydrate-restriction led to a 13% reduction in total cholesterol, 16% reduction in LDL cholesterol, 38% reduction in triglycerides, and a 13% increase in HDL cholesterol (all p values < 0.001). Carbohydrate-restriction also led to a reduction in LDL particle concentration of 28%, a reduction in small LDL of 82%, a reduction of large VLDL of 62%, and an increase in large HDL of 30% (all p values < 0.001).

Conclusions: A carbohydrate-restricted diet recommendation led to improvements in lipid profiles and lipoprotein subclass traits of the metabolic syndrome in a clinical outpatient setting, and should be considered as a treatment for the metabolic syndrome.

CONCLUSIONS: There is no apparent lipoprotein benefit of reduction in dietary fat from 20-24% to 10% in men with large LDL particles: LDL-cholesterol concentration was not reduced, and in a subset of subjects there was a shift to small LDL along with increased triacylglycerol and reduced HDL-cholesterol concentrations.

4) Change in dietary saturated fat intake is correlated with change in mass of large low-density-lipoprotein particles in men, Am J Clin Nutr. 1998 May;67(5):828-36

Dreon DM, Fernstrom HA, Campos H, Blanche P, Williams PT, Krauss RM.

Children's Hospital Oakland Research Institute, CA, USA.

We tested whether nutrient intakes estimated from 4-d diet records were associated with plasma lipoprotein subclasses in 103 men who were randomly assigned to a low-fat (24% fat) and a high-fat (46% fat) diet for 6 wk each in a crossover design. Postheparin plasma lipoprotein lipase (LPL) and hepatic lipase (HL) activities were also determined in a subset of 43 men. Changes in intake (ie, high fat minus low fat) of total saturated fatty acids, as well as myristic (14:0) and palmitic (16:0) acids, were positively correlated (P < 0.01) with increases in mass of large LDL particles [measured by analytic ultra-centrifugation as mass of lipoproteins of flotation rate (Sf) 7-12] and with LDL peak particle diameter and flotation rate, but not with changes in LDL-cholesterol concentration. Changes in total saturated fatty acids as well as myristic and palmitic acids were also inversely associated with changes in HL activity (P < 0.05). With the high-fat diet only, variation in dietary total saturated fatty acid intake was inversely correlated (P < 0.01) with concentrations of small, dense LDL of Sf 0-5. This correlation was significant specifically for myristic acid (P < 0.001). Stearic acid (18:0), monounsaturates, and polyunsaturates showed no significant associations with lipoprotein concentrations. These data indicate that a high saturated fat intake (especially 14:0 and 16:0) is associated with increased concentrations of larger, cholesterol-enriched LDL and this occurs in association with decreased HL activity.

5) Low-density lipoprotein size and subclasses are markers of clinically apparent and non-apparent atherosclerosis in type 2 diabetes, Metabolism. 2005 Feb;54(2):227-34

Berneis K, Jeanneret C, Muser J, Felix B, Miserez AR.

Department of Internal Medicine and Central Laboratories, Basel University Hospital Bruderholz, Switzerland 4101. kaspar@berneis.ch

The atherogenic lipoprotein phenotype is characterized by an increase in plasma triglycerides, a decrease in high-density lipoprotein (HDL), and the prevalence of small, dense low-density lipoprotein (LDL) particles. The present study investigated the clinical significance of LDL size and subclasses as markers of atherosclerosis in diabetes type 2. Thirty-eight patients with type 2 diabetes, total cholesterol of less than 6.5 mmol/L, and hemoglobin A1c (HbA1c) of less than 9% were studied. Median age was 61 years, mean (+/-SD) body mass index 29 +/- 4.3 kg/m2 , and mean HbA1c 7.1 +/- 0.9 %. Laboratory parameters included plasma lipids and lipoproteins, lipoprotein (a), apolipoprotein (apo) A-I, apo B-100, apo C-III, and high-sensitivity C-reactive protein. Low-density lipoprotein size and subclasses were measured by gradient gel electrophoresis and carotideal intima media thickness (IMT) by duplex ultrasound. By factor analysis, 10 out of 21 risk parameters were selected: age, body mass index, systolic blood pressure, smoking (in pack-years), HbA1c, high-sensitivity C-reactive protein, lipoprotein (a), LDL cholesterol, HDL cholesterol, and LDL particle size. Multivariate analysis of variance of these 10 risk parameters identified LDL particle size as the best risk predictor for the presence of coronary heart disease (P = .002). Smaller LDL particle size was associated with an increase in IMT (P = .03; cut-off >1 mm). Within the different lipid parameters (total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, apo B, apo A-I, apo C-III, LDL particle size), LDL particle size was most strongly associated with the presence of coronary heart disease (P = .002) and IMT (P = .03). It is concluded that LDL size is the strongest marker for clinically apparent as well as non-apparent atherosclerosis in diabetes type 2.

6) Atherogenic lipoprotein phenotype and diet-gene interactions, J Nutr. 2001 Feb;131(2):340S-3S.(review)

Krauss RM.

Department of Molecular and Nuclear Medicine, Life Sciences Division, Ernest Orlando Lawrence Berkeley National Laboratory, University of California, Berkeley, CA 94720, USA.

Studies employing analysis of LDL subclasses have demonstrated heterogeneity of the LDL response to low fat, high carbohydrate diets in healthy nonobese subjects. In individuals with a genetically influenced atherogenic lipoprotein phenotype, characterized by a predominance of small dense LDL (LDL subclass pattern B), lowering of plasma LDL cholesterol levels by diets with < or =24% fat has been found to represent a reduction in numbers of circulating mid-sized and small LDL particles, and hence an expected lowering of cardiovascular disease risk. In contrast, in the majority of healthy individuals with larger LDL (pattern A, found in approximately 70% of men and a larger percentage of women), a significant proportion of the low fat diet-induced reduction in plasma LDL cholesterol is made by depletion of the cholesterol content of LDL particles. This change in LDL composition is accompanied by a shift from larger to smaller LDL particle diameters. Moreover, with progressive reduction of dietary fat and isocaloric substitution of carbohydrate, an increasing number of subjects with pattern A convert to the pattern B phenotype. Studies in families have indicated that susceptibility to induction of pattern B by low fat diets is under genetic influence. Thus, diet-gene interactions affecting LDL subclass patterns may contribute to substantial interindividual variability in the effects of low fat diets on coronary heart disease risk.

7) Triglyceride, small, dense low-density lipoprotein, and the atherogenic lipoprotein phenotype, Curr Atheroscler Rep. 2000 May;2(3):200-7 (review)

Austin MA.

Department of Epidemiology, Box 357236, School of Public Health and Community Medicine, University of Washington, Seattle, WA 98195-7236, USA. maustin@u.washington.edu

This review provides an overview of the recent data evaluating triglyceride and low-density lipoprotein (LDL) size, two highly interrelated, genetically influenced, risk factors for cardiovascular disease (CVD). An examination of new epidemiologic studies continues to demonstrate that plasma triglyceride levels predict CVD. The first prospective study of the familial forms of hypertriglyceridemia has shown that relatives in familial-combined hyperlipidemia families are at increased risk for CVD mortality and that triglyceride levels predicted 20-year, CVD mortality among relatives in familial hypertriglyceridemia families. A meta-analysis of three, large-scale, prospective studies in men, and the first study to examine the correlation of LDL particle size distribution and vascular changes measured by B-mode ultrasound, add to growing evidence that small, dense LDL is atherogenic. Quantitative genetic analysis has recently shown substantial pleiotropic (common) genetic effects on triglyceride and LDL size. At least part of this may be explained by variation at the cholesterol ester transfer protein locus on chromosome 16, possibly through its role in reverse cholesterol transport. Taken together, these data provide new insights into the importance of triglyceride and LDL particle size for understanding genetic susceptibility to cardiovascular disease and its prevention.

8) Measurement of small dense low-density lipoprotein particles, J Atheroscler Thromb. 2005;12(2):67-72 (review)

Hirano T, Ito Y, Yoshino G.

Division of Diabetes and Metabolism, First Department of Internal Medicine, Showa University School of Medicine, 1-5-8 Hattanodai, Shinagawa-ku, Tokyo 142-8666, Japan. hirano@med.showa-u.ac.jp

Low density lipoprotein (LDL) particles are heterogeneous with respect to their size, density and lipid composition. Among LDL particles, the smaller and denser LDL particles [small dense (sd) LDL] are more atherogenic and the sd LDL phenotype is strongly associated with development of coronary heart disease. Here we will review various methods for measurement of sd LDL. Although ultracentrifugation, nuclear magnetic resonance (NMR) spectroscopy and gradient-gel electrophoresis (GGE) are usually employed for the measurement of sd LDL, such methods are either too laborious or expensive for general clinical use. We recently established a simple precipitation method for the quantification of sd LDL. This method is applicable to routine clinical use and allows the rapid measurement of a large number of samples.

9) Low-glycemic-load diets: impact on obesity and chronic diseases, Crit Rev Food Sci Nutr. 2003;43(4):357-77

Bell SJ, Sears B.

Historically, carbohydrates have been thought to play only a minor role in promoting weight gain and in predicting the risk of development of chronic disease. Most of the focus had been on reducing total dietary fat. During the last 20 years, fat intake decreased, while the number of individuals who were overweight or developed a chronic conditions have dramatically increased. Simultaneously, the calories coming from carbohydrate have also increased. Carbohydrates can be classified by their post-prandial glycemic effect, called the glycemic index or glycemic load. Carbohydrates with high glycemic indexes and high glycemic loads produce substantial increases in blood glucose and insulin levels after ingestion. Within a few hours after their consumption, blood sugar levels begin to decline rapidly due to an exaggerated increase in insulin secretion. A profound state of hunger is created. The continued intake of high-glycemic load meals is associated with an increased risk of chronic diseases such as obesity, cardiovascular disease, and diabetes. In this review, the terms glycemic index and glycemic load are defined, coupled with an overview of short- and long-term changes that occur from eating diets of different glycemic indexes and glycemic loads. Finally, practical strategies for how to design low-glycemic-load diets consisting primarily of low-glycemic carbohydrates are provided.

10) Novel treatments for Obesity, Asia Pac J Clin Nutr. 2003;12 Suppl:S8

Ludwig DS.

Department of Medicine, Children's Hospital Boston, MA, USA.

Background - Excessive fat consumption is commonly believed to cause obesity and, for this reason, conventional approaches to weight loss have focused on decreasing dietary fat. However, the relationship between dietary fat and adiposity has been questioned for several reasons: 1) weight loss on low-fat diets is characteristically modest in nature; 2) prospective epidemiological studies have not consistently found that individuals eating the most fat are heavier than those eating the least fat; and 3) obesity prevalence has risen markedly since the 1970s in the US despite a significant decrease in fat consumption as a percent of total energy. As dietary fat has decreased, carbohydrate consumption has increased in a compensatory fashion, and most of this increase has been in the form of refined starchy food and concentrated sugar that are high in glycemic index (GI) and/or glycemic load (GL). Review - Physiological studies demonstrate that consumption of high GI/GL meals induce a sequence of hormonal changes that limit availability of metabolic fuels in the post-prandial period and cause overeating. Short-term feeding studies consistently show less satiety or greater voluntary energy intake after consumption of high compared to low GI meals. Several intermediate-term clinical trials found greater weight loss among overweight individuals on low compared to low GI diets. A recent study from our group found significantly greater weight and fat mass decrease among obese adolescents consuming a reduced GL compared to a reduced fat diet for 12 months. Animal studies support a role for GI in body weight regulation. Moreover, GI and GL appear to affect risk for diabetes and heart disease after controlling for body weight. Conclusions - Reduction in GI/GL comprises a novel and exciting approach to the prevention and treatment of obesity and related complications. A low GI/GL diet may be an ideal compromise between low fat diets at one end of the spectrum, and very low carbohydrate diets at the other. Long-term, large-scale studies of such diets should assume a high public health priority.

11) The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: one-year follow-up of a randomized trial.

Stern L, Iqbal N, Seshadri P, Chicano KL, Daily DA, McGrory J, Williams M, Gracely EJ, Samaha FF.

Philadelphia Veterans Affairs Medical Center, University of Pennsylvania Medical Center, and Drexel University College of Medicine, Philadelphia, Pennsylvania 19104, USA.

BACKGROUND: A previous paper reported the 6-month comparison of weight loss and metabolic changes in obese adults randomly assigned to either a low-carbohydrate diet or a conventional weight loss diet. OBJECTIVE: To review the 1-year outcomes between these diets. DESIGN: Randomized trial. SETTING: Philadelphia Veterans Affairs Medical Center. PARTICIPANTS: 132 obese adults with a body mass index of 35 kg/m2 or greater; 83% had diabetes or the metabolic syndrome. INTERVENTION: Participants received counseling to either restrict carbohydrate intake to <30 g per day (low-carbohydrate diet) or to restrict caloric intake by 500 calories per day with <30% of calories from fat (conventional diet). MEASUREMENTS: Changes in weight, lipid levels, glycemic control, and insulin sensitivity. RESULTS: By 1 year, mean (+/-SD) weight change for persons on the low-carbohydrate diet was -5.1 +/- 8.7 kg compared with -3.1 +/- 8.4 kg for persons on the conventional diet. Differences between groups were not significant (-1.9 kg [95% CI, -4.9 to 1.0 kg]; P = 0.20). For persons on the low-carbohydrate diet, triglyceride levels decreased more (P = 0.044) and high-density lipoprotein cholesterol levels decreased less (P = 0.025). As seen in the small group of persons with diabetes (n = 54) and after adjustment for covariates, hemoglobin A1c levels improved more for persons on the low-carbohydrate diet. These more favorable metabolic responses to a low-carbohydrate diet remained significant after adjustment for weight loss differences. Changes in other lipids or insulin sensitivity did not differ between groups. LIMITATIONS: These findings are limited by a high dropout rate (34%) and by suboptimal dietary adherence of the enrolled persons.

12) Pilot 12-Week Weight-Loss Comparison: Low-Fat vs Low-Carbohydrate (Ketogenic) Diets, Abstract Presented at The North American Association for the Study of Obesity Annual Meeting 2003, Obesity Research, 11S, 2003, page 95OR.

Greene P, Willett W, Devecis J, et al.,

Summary:

The following summarizes information presented at multiple conferences on a pilot study conducted by Greene et al. This information was written by Atkins professionals.

BACKGROUND: Some researchers claim that people only lose weight on very low carb diets due to a reduction in calorie intake. Others have argued that very low carb diets offer a “metabolic advantage” allowing people to lose weight without restricting calories. The objective of this study was to evaluate if people who follow very low carb diets lose weight only due to restricting calories.

METHOD: Twenty-one participants were recruited and were randomly assigned to three separate diets for 12 weeks: a low fat diet (55% carb, 15% protein, and 30% fat) and two different very low carb diets (both had 5% carb, 30% protein, and 65% fat). The low fat (LF) diet and one of the very low carb (LC1) diets provided a total of 1500 calories a day for women and 1800 calories a day for men. The second very low carb diet group was allowed 300 additional calories a day (1800 calories for women and 2100 calories for men). Meals were provided during the study.

RESULTS: After 12 weeks, all participants lost weight. Both the very low carb groups lost more weight than the low fat group (LC1: -23 lbs, LC2: -20 lbs, and LF: -17 lbs). The difference between the diets was not statistically significant. More body fat was lost than lean body mass (such as muscle) or water on all the diets. All participants lost inches from their waist and hips. LDL, triglycerides, and total cholesterol to HDL ratio improved on the diets. VLDL improved significantly more on the low carb diets. BUN increased on the low carb diets only. However, creatinine levels (a marker of kidney function) remained unchanged.

CONCLUSION: All three diets were effective in reducing weight in adults and the weight lost was primarily body fat. Even participants consuming higher calories on the very low carb diet were able to lose more weight compared to the lower calorie, low fat diet. The low carb diets improved several risk factors for heart disease. The authors concluded that very low carb diets do not reduce weight only by restricting calories.

13) Results of use of metformin and replacement of starch with saturated fat in diets of patients with type 2 diabetes, Endocr Pract. 2002 May-Jun;8(3):177-83

14) Dietary fat intake and risk of stroke in male US healthcare professionals: 14 year prospective cohort study, BMJ. 2003 Oct 4;327(7418):777-82

He K, Merchant A, Rimm EB, Rosner BA, Stampfer MJ, Willett WC, Ascherio A.

Department of Nutrition, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA. hpkhe@channing.harvard.edu

OBJECTIVE: To examine the association between intake of total fat, specific types of fat, and cholesterol and risk of stroke in men. Design and setting Health professional follow up study with 14 year follow up. PARTICIPANTS: 43 732 men aged 40-75 years who were free from cardiovascular diseases and diabetes in 1986. MAIN OUTCOME MEASURE: Relative risk of ischaemic and haemorrhagic stroke according to intake of total fat, cholesterol, and specific types of fat. RESULTS: During the 14 year follow up 725 cases of stroke occurred, including 455 ischaemic strokes, 125 haemorrhagic stokes, and 145 strokes of unknown type. After adjustment for age, smoking, and other potential confounders, no evidence was found that the amount or type of dietary fat affects the risk of developing ischaemic or haemorrhagic stroke. Comparing the highest fifth of intake with the lowest fifth, the multivariate relative risk of ischaemic stroke was 0.91 (95% confidence interval 0.65 to 1.28; P for trend = 0.77) for total fat, 1.20 (0.84 to 1.70; P = 0.47) for animal fat, 1.07 (0.77 to 1.47; P = 0.66) for vegetable fat, 1.16 (0.81 to 1.65; P = 0.59) for saturated fat, 0.91 (0.65 to 1.28; P = 0.83) for monounsaturated fat, 0.88 (0.64 to 1.21; P = 0.25) for polyunsaturated fat, 0.87 (0.62 to 1.22; P = 0.42) for trans unsaturated fat, and 1.02 (0.75 to 1.39; P = 0.99) for dietary cholesterol. Intakes of red meats, high fat dairy products, nuts, and eggs were also not appreciably related to risk of stroke.

CONCLUSIONS: These findings do not support associations between intake of total fat, cholesterol, or specific types of fat and risk of stroke in men.

15) Lasting improvement of hyperglycaemia and bodyweight: low-carbohydrate diet in type 2 diabetes--a brief report, Ups J Med Sci. 2005;110(1):69-73

Nielsen JV, Jonsson E, Nilsson AK.

In two groups of obese patients with type 2 diabetes the effects of 2 different diet compositions were tested with regard to glycaemic control and bodyweight. A group of 16 obese patients with type 2 diabetes was advised on a low-carbohydrate diet, 1800 kcal for men and 1600 kcal for women, distributed as 20 % carbohydrates, 30 % protein and 50 % fat. Fifteen obese diabetes patients on a high-carbohydrate diet were control group. Their diet, 1600-1800 kcal for men and 1400-1600 kcal for women, consisted of approximately 60 % carbohydrates, 15 % protein and 25 % fat. Positive effects on the glucose levels were seen very soon. After 6 months a marked reduction in bodyweight of patients in the low-carbohydrate diet group was observed, and this remained one year later. After 6 months the mean changes in the low-carbohydrate group and the control group respectively were (+/-SD): fasting blood glucose (f-BG): -3.4+/-2.9 and -0.6+/-2.9 mmol/l; HBA1c: -1.4+/-1.1 % and -0.6+/-1.4 %; Body Weight: -11.4+/-4 kg and -1.8+/-3.8 kg; BMI: -4.1+/-1.3 kg/m_ and -0.7+/-1.3 kg/m_. Large changes in blood glucose levels were seen immediately. CONCLUSION: A low-carbohydrate diet is an effective tool in the treatment of obese patients with type 2 diabetes.

16) Effects of a low-carbohydrate diet on weight loss and cardiovascular risk factor in overweight adolescents, J Pediatr. 2003 Mar;142(3):253-8.

Sondike SB, Copperman N, Jacobson MS.

Division of Adolescent Medicine, Schneider Children's Hospital, New Hyde Park, New York 10128, USA.

OBJECTIVES: To compare the effects of a low-carbohydrate (LC) diet with those of a low-fat (LF) diet on weight loss and serum lipids in overweight adolescents. DESIGN: A randomized, controlled 12-week trial. SETTING: Atherosclerosis prevention referral center. METHODS: Random, nonblinded assignment of participants referred for weight management. The study group (LC) (n = 16) was instructed to consume <20 g of carbohydrate per day for 2 weeks, then <40 g/day for 10 weeks, and to eat LC foods according to hunger. The control group (LF) (n = 14) was instructed to consume <30% of energy from fat. Diet composition and weight were monitored and recorded every 2 weeks. Serum lipid profiles were obtained at the start of the study and after 12 weeks. RESULTS: The LC group lost more weight (mean, 9.9 +/- 9.3 kg vs 4.1 +/- 4.9 kg, P <.05) and had improvement in non-HDL cholesterol levels (P <.05). There was improvement in LDL cholesterol levels (P <.05) in the LF group but not in the LC group. There were no adverse effects on the lipid profiles of participants in either group. CONCLUSIONS: The LC diet appears to be an effective method for short-term weight loss in overweight adolescents and does not harm the lipid profile.

17) A randomized study comparing the effects of a low-carbohydrate diet and a conventional diet on lipoprotein subfractions and C-reactive protein levels in patients with severe obesity, Am J Med. 2004 Sep 15;117(6):398-405

Seshadri P, Iqbal N, Stern L, Williams M, Chicano KL, Daily DA, McGrory J, Gracely EJ, Rader DJ, Samaha FF.

Department of Internal Medicine, Division of Endocrinology, University of Pennsylvania Health System, Philadelphia 19104, USA.

PURPOSE: To compare the effects of a low-carbohydrate diet and a conventional (fat- and calorie-restricted) diet on lipoprotein subfractions and inflammation in severely obese subjects. METHODS: We compared changes in lipoprotein subfractions and C-reactive protein levels in 78 severely obese subjects, including 86% with either diabetes or metabolic syndrome, who were randomly assigned to either a low-carbohydrate or conventional diet for 6 months. RESULTS: Subjects on a low-carbohydrate diet experienced a greater decrease in large very low-density lipoprotein (VLDL) levels (difference = -0.26 mg/dL, P = 0.03) but more frequently developed detectable chylomicrons (44% vs. 22%, P = 0.04). Both diet groups experienced similar decreases in the number of low-density lipoprotein (LDL) particles (difference = -30 nmol/L, P = 0.74) and increases in large high-density lipoprotein (HDL) concentrations (difference = 0.70 mg/dL, P = 0.63). Overall, C-reactive protein levels decreased modestly in both diet groups. However, patients with a high-risk baseline level (>3 mg/dL, n = 48) experienced a greater decrease in C-reactive protein levels on a low-carbohydrate diet (adjusted difference = -2.0 mg/dL, P = 0.005), independent of weight loss. CONCLUSION: In this 6-month study involving severely obese subjects, we found an overall favorable effect of a low-carbohydrate diet on lipoprotein subfractions, and on inflammation in high-risk subjects. Both diets had similar effects on LDL and HDL subfractions. (Copyright 2004 Elsevier Inc.)

18) Dietary cholesterol and atherosclerosis, Biochim Biophys Acta. 2000 Dec 15;1529(1-3):310-20. Review

McNamara DJ.

Egg Nutrition Center, 1050 17th St. NW, Suite 560, Washington, DC 20036, USA. enc@enc-online.org

The perceived relationship between dietary cholesterol, plasma cholesterol and atherosclerosis is based on three lines of evidence: animal feeding studies, epidemiological surveys, and clinical trials. Over the past quarter century studies investigating the relationship between dietary cholesterol and atherosclerosis have raised questions regarding the contribution of dietary cholesterol to heart disease risk and the validity of dietary cholesterol restrictions based on these lines of evidence. Animal feeding studies have shown that for most species large doses of cholesterol are necessary to induce hypercholesterolemia and atherosclerosis, while for other species even small cholesterol intakes induce hypercholesterolemia. The species-to-species variability in the plasma cholesterol response to dietary cholesterol, and the distinctly different plasma lipoprotein profiles of most animal models make extrapolation of the data from animal feeding studies to human health extremely complicated and difficult to interpret. Epidemiological surveys often report positive relationships between cholesterol intakes and cardiovascular disease based on simple regression analyses; however, when multiple regression analyses account for the colinearity of dietary cholesterol and saturated fat calories, there is a null relationship between dietary cholesterol and coronary heart disease morbidity and mortality. An additional complication of epidemiological survey data is that dietary patterns high in animal products are often low in grains, fruits and vegetables which can contribute to increased risk of atherosclerosis. Clinical feeding studies show that a 100 mg/day change in dietary cholesterol will on average change the plasma total cholesterol level by 2.2-2.5 mg/dl, with a 1.9 mg/dl change in low density lipoprotein (LDL) cholesterol and a 0.4 mg/dl change in high density lipoprotein (HDL) cholesterol. Data indicate that dietary cholesterol has little effect on the plasma LDL:HDL ratio. Analysis of the available epidemiological and clinical data indicates that for the general population, dietary cholesterol makes no significant contribution to atherosclerosis and risk of cardiovascular disease.

Trends in Intake of Energy and Macronutrients --- United States, 1971--2000

During 1971--2000, the prevalence of obesity in the United States increased from 14.5% to 30.9% (1). Unhealthy diets and sedentary behaviors have been identified as the primary causes of deaths attributable to obesity (2). Evaluating trends in dietary intake is an important step in understanding the factors that contribute to the increase in obesity. To assess trends in intake of energy (i.e., kilocalories [kcals]), protein, carbohydrate, total fat, and saturated fat during 1971--2000, CDC analyzed data from four National Health and Nutrition Examination Surveys (NHANES): NHANES I (conducted during 1971--1974), NHANES II (1976--1980), NHANES III (1988--1994), and NHANES 1999--2000. This report summarizes the results of that analysis, which indicate that, during 1971--2000, mean energy intake in kcals increased, mean percentage of kcals from carbohydrate increased, and mean percentage of kcals from total fat and saturated fat decreased (Figures 1 and 2). An expert advisory committee appointed by the U.S. Department of Health and Human Services and the U.S. Department of Agriculture (USDA) is conducting a review of the Dietary Guidelines for Americans (3). Revised guidelines will be published in 2005.

NHANES provides information on the health and nutritional status of the U.S. civilian, noninstitutionalized population by using a complex, multistage probability sample design. NHANES I sampled persons residing in the contiguous 48 states; subsequent surveys sampled all 50 states. Surveys consisted of a household interview followed by an examination at a mobile examination center (MEC). All of the surveys included a dietary recall interview that was conducted at the MEC to obtain information on foods and beverages consumed during the preceding 24 hours. In this report, estimates of energy intake include kcals from alcoholic beverages; however, the percentage of kcals from alcohol is not presented separately. Age was recorded at the time of the household interview. The upper age limit was 74 years for NHANES I and NHANES II. No upper age limit was established for NHANES III and NHANES 1999--2000. To compare estimates across surveys, the analysis included only adults aged 20--74 years. Sample sizes ranged from 1,730 men and 2,003 women in NHANES 1999--2000 to 6,630 men and 7,537 women in NHANES III (Table).

Statistical analyses were conducted by using SAS version 8.2 and SUDAAN version 8.0.0, which used sample weights and design variables to produce national estimates. The recommended age categories used are based on the survey sample domains (4). Because of differences in the relative age distribution, estimates for persons aged 20--74 years were adjusted by direct standardization to the 2000 U.S. Census population by using the age groups 20--39, 40--59, and 60--74 years. Six persons who reported fasting (i.e., consuming 0 kcals) during the preceding 24 hours were excluded from these analyses.

During 1971--2000, a statistically significant increase in average energy intake occurred (Table). For men, average energy intake increased from 2,450 kcals to 2,618 kcals (p<0.01), and for women, from 1,542 kcals to 1,877 kcals (p<0.01). For men, the percentage of kcals from carbohydrate increased between 1971--1974 and 1999--2000, from 42.4% to 49.0% (p<0.01), and for women, from 45.4% to 51.6% (p<0.01) (Table). The percentage of kcals from total fat decreased from 36.9% to 32.8% (p<0.01) for men and from 36.1% to 32.8% (p<0.01) for women. In addition, the percentage of kcals from saturated fat decreased from 13.5% to 10.9% (p<0.01) for men and from 13.0% to 11.0% (p<0.01) for women. A slight decrease was observed in the percentage of kcals from protein, from 16.5% to 15.5% (p<0.01) for men and from 16.9% to 15.1% (p<0.01) for women.

The decrease in the percentage of kcals from fat during 1971--1991 is attributed to an increase in total kcals consumed; absolute fat intake in grams increased (5). USDA food consumption survey data from 1989--1991 and 1994--1996 indicated that the increased energy intake was caused primarily by higher carbohydrate intake (6). Data from NHANES for 1971--2000 indicate similar trends. The increase in energy intake is attributable primarily to an increase in carbohydrate intake, with a 62.4-gram increase among women (p<0.01) and a 67.7-gram increase among men (p<0.01). Total fat intake in grams increased among women by 6.5 g (p<0.01) and decreased among men by 5.3 g (p<0.01).

Reported by: JD Wright, MPH, J Kennedy-Stephenson, MS, CY Wang, PhD, MA McDowell, MPH, CL Johnson, MSPH, National Center for Health Statistics, CDC.

Editorial Note:

The increase in caloric intake described in this report is consistent with previously reported trends in dietary intake in the United States (7). USDA survey data for 1977--1996 suggest that factors contributing to the increase in energy intake in the United States include consumption of food away from home; increased energy consumption from salty snacks, soft drinks, and pizza (8); and increased portion sizes (9).

The findings in this report are subject to at least two limitations. First, information on dietary intake is self-reported and subject to recall bias. Second, although the majority of the increase in average energy intake occurred between 1976--1980 and 1988--1994, changes in the 24-hour dietary recall interview method between these two periods might account for some of this difference. Beginning in 1988, dietary recalls were collected for weekend days as well as weekdays because food consumption differs on weekend days. The interview format was revised, and questions were added that might have allowed for collection of more complete dietary intake data.

The latest national dietary data available indicate that the previously reported increase in energy intake has continued, reflecting primarily increased carbohydrate intake. A focus on total energy intake and energy balance (i.e., the balance of energy intake with energy expenditure) is fundamental to preventing and reducing obesity in the United States. Continuing efforts to decrease saturated fat intake are important to reduce the risk for cardiovascular disease and should include assessment of fat intake in grams in addition to fat intake as a percentage of kcals. The energy- and macronutrient-intake trends described in this report should help guide the forthcoming revision of Dietary Guidelines for Americans and reviews of USDA's Food Guide Pyramid and the Healthy People 2010 nutrition objectives.

References

Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesity among US adults, 1999--2000. JAMA 2002;288:1723--7.
U.S. Department of Health and Human Services. The Surgeon General's call to action to prevent and decrease overweight and obesity. Rockville, Maryland: U.S. Department of Health and Human Services, Public Health Service, Office of the Surgeon General, 2001.
U.S. Department of Health and Human Services, U.S. Department of Agriculture. Development of the 2005 Dietary Guidelines for Americans, 6th ed. Available at http://www.health.gov/dietaryguidelines/dga2005/default.htm.
U.S. Department of Health and Human Services. NHANES 1999--2000 addendum to the NHANES III analytic guidelines. Available at http://www.cdc.gov/nchs/data/nhanes/guidelines1.pdf.
Ernst ND, Obarzanek E, Clark MB, Briefel RR, Brown CD, Donato K. Cardiovascular health risks related to overweight. J Am Diet Assoc 1997;97(suppl):S47--S51.
Chanmugam P, Guthrie JF, Cecilio S, Morton JF, Basiotis PP, Anand R. Did fat intake in the United States really decline between 1989--1991 and 1994--1996? J Am Diet Assoc 2003;103:867--72.
Federation of American Societies for Experimental Biology, Life Sciences Research Office. Third Report on Nutrition Monitoring in the United States (vol. 1). Washington, DC: U.S. Government Printing Office, 1995.
Nielsen SJ, Siega-Riz AM, Popkin BM. Trends in energy intake in U.S. between 1977 and 1996: similar shifts seen across age groups. Obes Res 2002;10:370--8.
Nielsen SJ, Popkin BM. Patterns and trends in food portion sizes, 1977--1998. JAMA 2003;289:450--3.

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23) Enhanced endurance in trained cyclists during moderate intensity exercise following 2 weeks adaptation to a high fat diet, Eur J Appl Physiol Occup Physiol. 1994;69(4):287-93

Lambert EV, Speechly DP, Dennis SC, Noakes TD.

Liberty Life Chair of Exercise and Sports Science, University of Cape Town Medical School, Observatory, South Africa.

These studies investigated the effects of 2 weeks of either a high-fat (HIGH-FAT: 70% fat, 7% CHO) or a high-carbohydrate (HIGH-CHO: 74% CHO, 12% fat) diet on exercise performance in trained cyclists (n = 5) during consecutive periods of cycle exercise including a Wingate test of muscle power, cycle exercise to exhaustion at 85% of peak power output [90% maximal oxygen uptake (VO2max), high-intensity exercise (HIE)] and 50% of peak power output [60% VO2max, moderate intensity exercise (MIE)]. Exercise time to exhaustion during HIE was not significantly different between trials: nor were the rates of muscle glycogen utilization during HIE different between trials, although starting muscle glycogen content was lower [68.1 (SEM 3.9) vs 120.6 (SEM 3.8) mmol.kg-1 wet mass, P < 0.01] after the HIGH-FAT diet. Despite a lower muscle glycogen content at the onset of MIE [32 (SEM 7) vs 73 (SEM 6) mmol.kg-1 wet mass, HIGH-FAT vs HIGH-CHO, P < 0.01], exercise time to exhaustion during subsequent MIE was significantly longer after the HIGH-FAT diet [79.7 (SEM 7.6) vs 42.5 (SEM 6.8) min, HIGH-FAT vs HIGH-CHO, P < 0.01]. Enhanced endurance during MIE after the HIGH-FAT diet was associated with a lower respiratory exchange ratio [0.87 (SEM 0.03) vs (SEM 0.02), P < 0.05], and a decreased rate of carbohydrate oxidation [1.41 (SEM 0.70) vs 2.23 (SEM 0.40) g CHO.min-1, P < 0.05].(ABSTRACT TRUNCATED AT 250 WORDS)

24) High-fat diet versus habitual diet prior to carbohydrate loading: effects of exercise metabolism and cycling performance, Int J Sport Nutr Exerc Metab. 2001 Jun;11(2):209-25

Lambert EV, Goedecke JH, Zyle C, Murphy K, Hawley JA, Dennis SC, Noakes TD.

Research Unit for Exercise Science and Sports Medicine in the Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Sports Science Institute of South Africa, Newlands 7725, Cape Town, South Africa.

We examined the effects of a high-fat diet (HFD-CHO) versus a habitual diet, prior to carbohydrate (CHO)-loading on fuel metabolism and cycling time-trial (TT) performance. Five endurance-trained cyclists participated in two 14-day randomized cross-over trials during which subjects consumed either a HFD (> 65% MJ from fat) or their habitual diet (CTL) (30 +/- 5% MJ from fat) for 10 day, before ingesting a high-CHO diet (CHO-loading, CHO > 70% MJ) for 3 days. Trials consisted of a 150-min cycle at 70% of peak oxygen uptake (VaO2peak), followed immediately by a 20-km TT. One hour before each trial, cyclists ingested 400 ml of a 3.44% medium-chain triacylglycerol (MCT) solution, and during the trial, ingested 600 ml/hour of a 10% 14C-glucose + 3.44% MCT solution. The dietary treatments did not alter the subjects' weight, body fat, or lipid profile. There were also no changes in circulating glucose, lactate, free fatty acid (FFA), and b-hydroxybutyrate concentrations during exercise. However, mean serum glycerol concentrations were significantly higher (p < .01) in the HFD-CHO trial. The HFD-CHO diet increased total fat oxidation and reduced total CHO oxidation but did not alter plasma glucose oxidation during exercise. By contrast, the estimated rates of muscle glycogen and lactate oxidation were lower after the HFD-CHO diet. The HFD-CHO treatment was also associated with improved TT times (29.5 +/- 2.9 min vs. 30.9 +/- 3.4 min for HFD-CHO and CTL-CHO, p <.05). High-fat feeding for 10 days prior to CHO-loading was associated with an increased reliance on fat, a decreased reliance on muscle glycogen, and improved time trial performance after prolonged exercise.

26) Dietary cholesterol, cholesterol absorption, postprandial lipemia and atherosclerosis, Can J Clin Pharmacol. 2003 Winter;10 Suppl A:26A-32A (Review)

Huff MW.

Vascular Biology Group, Robarts Research Institute, University of Western Ontario, London. mhuff@uwo.ca

The relationship among dietary cholesterol, cholesterol absorption, the metabolism of cholesterol-rich chylomicron remnants and atherosclerosis is complex; however, recent advances have provided insight into the mechanisms involved. Although dietary cholesterol is an independent risk factor for atherosclerosis, the attributable risk is low compared with dietary variables such as the amount and type of fat. Clinical studies have demonstrated that in humans consuming a typical Western-type diet, decreasing the amount of dietary cholesterol intake results in only small changes in low-density lipoprotein (LDL)-cholesterol and little or no change in the ratio of total cholesterol to high-density lipoprotein cholesterol. These findings are better appreciated when all sources of cholesterol entering the intestinal lumen are considered. Only a third of intestinal cholesterol per day is derived from the diet. Cholesterol from endogenous sources, including the bile and intestinal epithelial cells, represents the majority of cholesterol absorbed and subsequently formed into chylomicrons and secreted into the circulation. There is increasing evidence that postprandial lipoproteins are atherogenic, in particular, cholesterol-rich chylomicron remnants. These lipoproteins have the capacity to enter the arterial wall and promote atherogenesis at several stages of development, including the induction of smooth muscle cells and macrophage foam cell formation. Furthermore, enhanced delivery of chylomicron remnants to the liver decreases hepatic LDL-receptor expression, resulting in increased plasma LDL concentrations. Therefore, the inhibition of cholesterol absorption has become an attractive therapeutic target. There is growing genetic and biochemical evidence that intestinal cholesterol absorption is carrier-mediated, which has facilitated the development and characterization of small molecule inhibitors of this process. Ezetimibe, the first of these new compounds, inhibits intestinal absorption of dietary and biliary cholesterol and lowers total and LDL-cholesterol concentrations in plasma. By inhibiting cholesterol absorption, and possibly by reducing the cholesterol content of chylomicrons, ezetimibe may decrease the atherogenic potential of chylomicron remnants.

28) The paradoxical nature of hunter-gatherer diets: meat-based, yet non-atherogenic.

Cordain L, Eaton SB, Miller JB, Mann N, Hill K.

Department of Health and Exercise Science, Colorado State University, Fort Collins, Colorado, USA. cordain@cahs.colostate.edu

OBJECTIVE: Field studies of twentieth century hunter-gathers (HG) showed them to be generally free of the signs and symptoms of cardiovascular disease (CVD). Consequently, the characterization of HG diets may have important implications in designing therapeutic diets that reduce the risk for CVD in Westernized societies. Based upon limited ethnographic data (n=58 HG societies) and a single quantitative dietary study, it has been commonly inferred that gathered plant foods provided the dominant energy source in HG diets. METHOD AND RESULTS: In this review we have analyzed the 13 known quantitative dietary studies of HG and demonstrate that animal food actually provided the dominant (65%) energy source, while gathered plant foods comprised the remainder (35%). This data is consistent with a more recent, comprehensive review of the entire ethnographic data (n=229 HG societies) that showed the mean subsistence dependence upon gathered plant foods was 32%, whereas it was 68% for animal foods. Other evidence, including isotopic analyses of Paleolithic hominid collagen tissue, reductions in hominid gut size, low activity levels of certain enzymes, and optimal foraging data all point toward a long history of meat-based diets in our species. Because increasing meat consumption in Western diets is frequently associated with increased risk for CVD mortality, it is seemingly paradoxical that HG societies, who consume the majority of their energy from animal food, have been shown to be relatively free of the signs and symptoms of CVD. CONCLUSION: The high reliance upon animal-based foods would not have necessarily elicited unfavorable blood lipid profiles because of the hypolipidemic effects of high dietary protein (19-35% energy) and the relatively low level of dietary carbohydrate (22-40% energy). Although fat intake (28-58% energy) would have been similar to or higher than that found in Western diets, it is likely that important qualitative differences in fat intake, including relatively high levels of MUFA and PUFA and a lower omega-6/omega-3 fatty acid ratio, would have served to inhibit the development of CVD. Other dietary characteristics including high intakes of antioxidants, fiber, vitamins and phytochemicals along with a low salt intake may have operated synergistically with lifestyle characteristics (more exercise, less stress and no smoking) to further deter the development of CVD.

The atherogenic lipoprotein phenotype is characterised by a moderate increase in plasma triglycerides, a decrease in high density lipoprotein cholesterol and the prevalence of smaller denser low density lipoprotein particles. The prevalence of this partially inheritable phenotype is approximately 30% and is a feature of the metabolic syndrome associated with an increased risk for cardiovascular events. The predominance of small dense LDL has been accepted as an emerging cardiovascular risk factor by the adult treatment panel (ATP) III. Key words: small dense LDL; atherogenic lipoprotein
phenotype; coronary heart disease; diabetes

Division of Nutrition, Centers for Disease Control and Prevention, Atlanta, GA 30341-3724, USA. Dxfl@cdc.gov

Although each of the major lipoprotein fractions is composed of various subclasses that may differ in atherogenicity, the importance of this heterogeneity has been difficult to ascertain owing to the labor-intensive nature of subclass measurement methods. We have recently developed a procedure, using proton nuclear magnetic resonance (NMR) spectroscopy, to simultaneously quantify levels of subclasses of very low density (VLDL), low density (LDL), and high density (HDL) lipoproteins; subclass distributions determined with this method agree well with those derived by gradient gel electrophoresis. The objective of the current study of 158 men was to examine whether NMR-derived lipoprotein subclass levels improve the prediction of arteriographically documented coronary artery disease (CAD) when levels of lipids and lipoproteins are known. We found that a global measure of CAD severity was positively associated with levels of large VLDL and small HDL particles and inversely associated with intermediate size HDL particles; these associations were independent of age and standard lipid measurements. At comparable lipid and lipoprotein levels, for example, men with relatively high (higher than the median) levels of either small HDL or large VLDL particles were three to four times more likely to have extensive CAD than were the other men; the 27 men with high levels of both large VLDL and small HDL were 15 times more likely to have extensive CAD than were men with low levels. In contrast, adjustment for levels of triglycerides or HDL cholesterol greatly reduced the relation of small LDL particles to CAD. These findings suggest that large VLDL and small HDL particles may play important roles in the development of occlusive disease and that their measurement, which is not possible with routine lipid testing, may lead to more accurate risk assessment.

31) Effect of mineral oil, sunflower oil, and coconut oil on prevention of hair damage. J Cosmet Sci. 2003 Mar-Apr;54(2):175-92.

Rele AS, Mohile RB.

Research and Development Department, Nature Care Division, Marico Industries Ltd., Mumbai, India.

Previously published results showed that both in vitro and in vivo coconut oil (CNO) treatments prevented combing damage of various hair types. Using the same methodology, an attempt was made to study the properties of mineral oil and sunflower oil on hair. Mineral oil (MO) was selected because it is extensively used in hair oil formulations in India, because it is non-greasy in nature, and because it is cheaper than vegetable oils like coconut and sunflower oils. The study was extended to sunflower oil (SFO) because it is the second most utilized base oil in the hair oil industry on account of its non-freezing property and its odorlessness at ambient temperature. As the aim was to cover different treatments, and the effect of these treatments on various hair types using the above oils, the number of experiments to be conducted was a very high number and a technique termed as the Taguchi Design of Experimentation was used. The findings clearly indicate the strong impact that coconut oil application has to hair as compared to application of both sunflower and mineral oils. Among three oils, coconut oil was the only oil found to reduce the protein loss remarkably for both undamaged and damaged hair when used as a pre-wash and post-wash grooming product. Both sunflower and mineral oils do not help at all in reducing the protein loss from hair. This difference in results could arise from the composition of each of these oils. Coconut oil, being a triglyceride of lauric acid (principal fatty acid), has a high affinity for hair proteins and, because of its low molecular weight and straight linear chain, is able to penetrate inside the hair shaft. Mineral oil, being a hydrocarbon, has no affinity for proteins and therefore is not able to penetrate and yield better results. In the case of sunflower oil, although it is a triglyceride of linoleic acid, because of its bulky structure due to the presence of double bonds, it does not penetrate the fiber, consequently resulting in no favorable impact on protein loss.

32) A randomized double-blind controlled trial comparing extra virgin coconut oil with mineral oil as a moisturizer for mild to moderate xerosis. Dermatitis. 2004 Sep;15(3):109-16

Agero AL, Verallo-Rowell VM.

Department of Dermatology, Makati Medical Center, Makati City, Philippines.

BACKGROUND: Xerosis is a common skin condition (1) characterized by dry, rough, scaly, and itchy skin, (2) associated with a defect in skin barrier function, and (3) treated with moisturizers. People in the tropics have effectively used coconut oil as a traditional moisturizer for centuries. Recently, the oil also has been shown to have skin antiseptic effects. A moisturizer with antiseptic effects has value, but there are no clinical studies to document the efficacy and safety of coconut oil as a skin moisturizer. OBJECTIVE: This study aimed to determine the effectivity and safety of virgin coconut oil compared with mineral oil as a therapeutic moisturizer for mild to moderate xerosis. METHODS: A randomized double-blind controlled clinical trial was conducted on mild to moderate xerosis in 34 patients with negative patch-test reactions to the test products. These patients were randomized to apply either coconut oil or mineral oil on the legs twice a day for 2 weeks. Quantitative outcome parameters for effectivity were measured at baseline and on each visit with a Corneometer CM825 to measure skin hydration and a Sebumeter SM 810 to measure skin lipids. For safety, transepidermal water loss (TEWL) was measured with a Tewameter TM210, and skin surface hydrogen ion concentration (pH) was measured with a Skin pH Meter PH900. Patients and the investigator separately evaluated, at baseline and at each weekly visit, skin symptoms of dryness, scaling, roughness, and pruritus by using a visual analogue scale and grading of xerosis. RESULTS: Coconut oil and mineral oil have comparable effects. Both oils showed effectivity through significant improvement in skin hydration and increase in skin surface lipid levels. Safety was demonstrated through no significant difference in TEWL and skin pH. Subjective grading of xerosis by the investigators and visual analogue scales used by the patients showed a general trend toward better (though not statistically evident) improvement with coconut oil than with mineral oil. Safety for both was further demonstrated by negative patch-test results prior to the study and by the absence of adverse reactions during the study. CONCLUSION: Coconut oil is as effective and safe as mineral oil when used as a moisturizer.

BACKGROUND: There is evidence that offenders consume diets lacking in essential nutrients and this could adversely affect their behaviour. AIMS: To test empirically if physiologically adequate intakes of vitamins, minerals and essential fatty acids cause a reduction in antisocial behaviour. METHOD: Experimental, double-blind, placebo-controlled, randomised trial of nutritional supplements on 231 young adult prisoners, comparing disciplinary offences before and during supplementation. RESULTS: Compared with placebos, those receiving the active capsules committed an average of 26.3% (95% CI 8.3-44.33%) fewer offences (P=0.03, two-tailed). Compared to baseline, the effect on those taking active supplements for a minimum of 2 weeks (n=172) was an average 35.1% (95% CI 16.3-53.9%) reduction of offences (P<0.001, two-tailed), whereas placebos remained within standard error. CONCLUSIONS: Antisocial behaviour in prisons, including violence, are reduced by vitamins, minerals and essential fatty acids with similar implications for those eating poor diets in the community.

Publication Types:

* Clinical Trial
* Randomized Controlled Trial