Chapter Nineteen REDUCING DIETS Flashcards
What unconventional treatment did Alfred Pennington advocate for obesity?
A high-fat, high-protein diet unrestricted in calories
Pennington’s approach was seen as opposing prevailing theories about obesity.
According to Jane Brody, what is a likely outcome of a diet that eliminates high-calorie foods?
Weight loss
Eliminating foods like bread, sweets, and certain fruits leads to reduced calorie intake.
What are the three kinds of writers of news as described by A. J. Liebling?
- The reporter
- The interpretive reporter
- The expert
Liebling’s classification highlights the different levels of insight and authority in journalism.
What role do physicians’ case reports and anecdotal experiences play in medicine according to the text?
They are fundamental but often overshadowed by expert opinions
Experts’ opinions tend to dominate even when conflicting with firsthand experiences.
What did Hilde Bruch report about a fine-boned girl in 1957?
She lost nearly fifty pounds over a summer eating three large portions of meat a day
This case was often dismissed by experts as an anomaly.
What did Blake Donaldson conclude about the diet of prehistoric humans?
They lived almost exclusively on the fattest meat they could kill
This observation led Donaldson to advocate for a high-fat meat diet for weight loss.
What was the core component of Donaldson’s diet for obese patients?
A half-pound of fatty meat—three parts fat to one part lean by calories
This was based on his understanding of prehistoric diets.
What did Pennington’s study of DuPont executives reveal about his diet?
Executives lost between nine and fifty-four pounds, averaging nearly two pounds a week
Notably, they experienced a lack of hunger and increased energy.
What did The Journal of the American Medical Association assert about calorie restriction?
It was the only legitimate way to induce weight loss
JAMA dismissed alternative diets, including Pennington’s high-fat regimen.
What was George Thorpe’s experience with Pennington’s diet?
He experienced rapid weight loss without hunger or weakness
Thorpe’s endorsement challenged the prevailing views on calorie restriction.
What did the 1958 JAMA editorial conclude about high-fat, carbohydrate-restricted diets?
They might endanger health despite potential weight loss
JAMA continued to advocate for balanced diets over restrictive ones.
What did dietitians Margaret Ohlson and Charlotte Young confirm in 1952?
The effectiveness of Pennington’s diet in aiding weight loss
Their observations were significant in the context of the ongoing debate about dietary approaches.
Fill in the blank: According to Donaldson, patients who did not lose weight were those who had a _______.
bread addiction
This term reflects the challenge some patients faced in giving up carbohydrates.
True or False: Pennington’s diet restricted calorie intake.
False
The diet allowed for ad-libitum intake of protein and fat.
What dietary components did Pennington’s regimen limit?
Carbohydrates
No more than eighty calories of carbohydrates were allowed at each meal.
What did clinicians argue against the views of experts regarding Pennington’s diet?
It was successful in a surprisingly large proportion of cases
Local clinicians provided anecdotal evidence supporting the diet’s efficacy.
What did the Lancet initially argue about weight loss diets?
A low calorie intake is the best way to restore body composition
This perspective shifted after further evidence emerged supporting alternative diets.
What diet did Ohlson initially test on four overweight young women?
A twelve-hundred-calorie low-fat diet
This diet was eight hundred to a thousand calories less than what the women normally ate to maintain their weight.
What were the average weight losses of the four women on Ohlson’s initial diet?
Zero, six, seven, and seventeen pounds
The women reported lack of energy and constant hunger during the trial.
What was the composition of the calorie-restricted version of Pennington’s diet?
24% protein, 54% fat, 22% carbohydrates
The diet allowed only fourteen to fifteen hundred calories a day.
How much weight did women lose on Ohlson’s calorie-restricted diet after sixteen weeks?
Between nineteen and thirty-seven pounds
This was an average weight loss of almost three pounds weekly.
What did subjects report about their feelings on the carbohydrate-restricted diet?
A feeling of well-being and satisfaction
Hunger between meals was not a problem.
What did Ohlson observe about her subjects on high-fat, high-protein diets?
Subjects appeared to add muscle or lean-tissue mass
This was contrary to the expected loss of muscle mass in semi-starvation diets.
What were the results of Charlotte Young’s trial at Cornell using Ohlson’s diet?
Subjects lost between nine and twenty-six pounds in ten weeks
They reported not feeling hungry during the diet.
What was the common observation about weight loss in various studies on carbohydrate-restricted diets?
Weight losses of between one and five pounds a week
Even with calorie intakes as low as 650-800 calories per day.
What was the finding of William Leith regarding Pennington’s diet?
Significant weight loss was observed in patients who previously tried low-calorie diets without success
Patients lost between ten and forty pounds on Pennington’s diet.
True or False: Subjects on carbohydrate-restricted diets reported symptoms of semi-starvation.
False
Subjects did not report excessive fatigue, irritability, or extreme hunger.
What hypothesis did Robert Kemp formulate regarding carbohydrate tolerance?
The degree of tolerance for carbohydrate varies from patient to patient
This led to a carbohydrate-restricted, calorie-unrestricted diet.
How many of Kemp’s patients were ‘successfully reduced’ on his diet?
More than seven hundred (49%)
‘Successfully reduced’ means having lost more than 60% of their excess weight.
What did the last decade witness regarding carbohydrate-restricted diets?
A renewed interest in testing these diets as obesity levels have risen
New clinicians began questioning the prevailing wisdom on weight loss.
What was the result of the trials comparing low-fat semi-starvation diets with Pennington-type diets?
The carbohydrate-restricted diet performed at least as well, usually better
This was the case even when caloric content was significantly greater.
Fill in the blank: Ohlson’s version of Pennington’s diet allowed only _______ calories a day.
fourteen to fifteen hundred
What did Ohlson’s subjects prefer over low-fat diets?
High-fat diets with seven to eight hundred calories of fat
These diets resulted in less thought about forbidden foods and better appetite control.
What did six independent teams of investigators set out to test?
Low-fat semi-starvation diets against low-carbohydrate diets
The low-carbohydrate diets are commonly referred to as Atkins diets.
What was the average weight loss after three to six months on low-carbohydrate diets compared to calorie-restricted low-fat diets?
Two to three times greater on low-carbohydrate diets
This was observed in trials involving more than six hundred obese subjects.
What conclusion did the 2003 article by seven physicians from Yale and Stanford make about carbohydrate-restricted diets?
The evidence was insufficient to recommend or condemn these diets
No long-term randomized controlled trials established the safety of these diets.
What was the average weight loss when carbohydrates were restricted to less than sixty grams a day?
Thirty-seven pounds
This was compared to an average of four pounds when carbohydrates were not restricted.
What common assumption about calories does the text challenge?
A calorie is a calorie
The text questions whether this assumption holds true in the context of weight loss.
What did Bruce Bistrian and George Blackburn observe in their patients on low-calorie diets?
Half of them lost at least forty pounds each
This method was reported as extraordinarily effective and safe.
What happens to the success rate of weight loss when carbohydrates are added to low-calorie diets?
The success rate decreases significantly
From a 50% success rate to about 1%.
True or False: Balanced semi-starvation diets are more successful than carbohydrate-restricted diets.
False
Carbohydrate-restricted diets are noted to be more effective.
What factor contributes to the failure of balanced semi-starvation diets?
Hunger
Hunger leads to diet breakage and eventual failure.
What did Walter Bloom’s research on starvation therapy for obesity reveal?
Total starvation and carbohydrate restriction have much in common
Both rely on fat and protein for fuel when carbohydrate reserves are depleted.
What was the conclusion of Ernst Drenick’s starvation study on obese patients?
The ease of tolerating prolonged starvation was astonishing
Hunger sensations disappeared within days of total starvation.
What happens to hunger sensations during total starvation?
They disappear within days
This has implications for weight-loss therapy.
What does the text suggest about the relationship between carbohydrates and hunger?
There is a direct connection between carbohydrates and the experience of hunger
Adding carbohydrates can lead to increased hunger.
What did Alfred Pennington note about carbohydrate-restricted diets?
They generated paradoxes that stimulated thought
These paradoxes challenge existing weight-loss assumptions.
What is a common explanation for the success of carbohydrate-restricted diets?
They create a negative energy balance
This explanation is debated in the context of unrestricted calorie intake.
What did John Yudkin’s research in the 1960s conclude about high-fat diets?
They lead to weight loss by reducing calorie intake
His conclusions were based on evidence from a small sample size.
Fill in the blank: The sensation of hunger is more effectively managed when diets are high in _______.
fat and protein
What did the AMA Council on Food and Nutrition concede about low-carbohydrate diets in 1973?
Some patients lost weight on low-carbohydrate diets ‘unrestricted in calories’
This suggests that calorie restriction may not be the sole mechanism for weight loss.
What paradox does the text highlight about low-fat diets?
They assume that avoiding dense calories leads to lower total calorie intake
This contradicts the experience of those on carbohydrate-restricted diets.
What was Yudkin’s conclusion regarding high-fat diets?
High-fat diets lead to weight loss because they are, in fact, low-calorie diets.
What is the common finding in studies regarding calorie consumption on carbohydrate-restricted diets?
Subjects often reduce their calorie consumption.
True or False: A reduction in calories necessarily causes weight loss.
False
What did Weldon Walker and Sidney Werner report about their subjects’ calorie intake?
Subjects lost significant weight while consuming at least 2700 to 2800 calories a day.
What did B. Rilliet observe in his treatment of obese patients?
He had successes with both 2200-calorie and 3000-calorie versions of the diet.
What is the dilemma regarding weight loss and calorie intake?
Why don’t obese patients lose weight on balanced diets of 2700 or 2800 calories?
What symptoms do individuals experience on carbohydrate-restricted diets?
Hunger, irritability, depression, and lethargy.
What is the suggested reason for appetite suppression on carbohydrate-restricted diets?
Ketosis may cause appetite suppression.
True or False: Ketone bodies have been proven to suppress appetite.
False
What factor is often attributed to the absence of hunger on carbohydrate-restricted diets?
The satiating nature of fat and protein.
Fill in the blank: The best definition of food deficiency is found in the _______.
[consequence of it]
What did Claude Bernard suggest about fixed ideas in experimental medicine?
It is better to know nothing than to hold fixed ideas based on unverified theories.
What misconception does Yudkin’s work challenge?
The inevitability of calories in weight loss.
What did Alfred Pennington investigate regarding weight loss?
Why his patients lost weight on a calorie-unrestricted diet.
Pennington’s analysis was based on the relationship between fuel supply and _______.
[demand at the cellular level]
What did Pennington observe about the appetite of obese individuals?
Their appetite is precisely and delicately regulated.
What happens to metabolism and energy expenditure when obese individuals consciously eat less?
Their metabolism and energy expenditure inevitably decrease.
What did DeWitt Stetten’s article suggest about fatty acid release in obese mice?
It was significantly slower than in lean mice.
What was the consequence of calorie restriction for both lean and obese individuals?
Both become hungry and lethargic due to insufficient nutriment.
What did Pennington find regarding calorie restriction in lean and obese individuals?
Lean tissues are semi-starved by calorie restriction, but obese individuals also experience a similar phenomenon due to a metabolic defect.
What did DeWitt Stetten’s 1943 article reveal about fatty acid release in obese mice?
Fatty acids were released from the fat deposits of congenitally obese mice significantly slower than in lean mice.
What hypothesis did Pennington propose regarding obesity in humans?
Obesity is caused by a suppression of the flow of fat from adipose tissue back into circulation, leading to a metabolic defect.
How does Pennington explain the accumulation of fat in adipose tissue?
If energy enters the fat tissue faster than it exits, the energy stored in the fat tissue increases.
What happens to individuals with a metabolic defect in fat metabolism?
They may feel hungrier or more lethargic, as their adipose tissue does not release calories fast enough to satisfy cellular needs.
What compensatory mechanism does Pennington describe in relation to adipose tissue expansion?
As adipose tissue accumulates fat, its expansion increases the release rate of fat calories back into the bloodstream.
What is the significance of the negative feedback loop in obesity according to Pennington?
The expansion of adipose tissue provides for a more effective release of fat for the energy needs of the body.
What did Pennington observe about energy expenditure during calorie restriction?
Energy expenditure decreases as the body compensates for reduced calorie intake by expending less energy.
What is Pennington’s view on the treatment of obese patients regarding caloric intake?
Clinicians often assume the caloric requirement is fixed, but it varies based on the metabolic defect in obese individuals.
Fill in the blank: Pennington suggested that a more rational form of treatment would focus on _______ to mobilize fat.
[increased mobilization and utilization of fuel]
What dietary approach did Pennington believe could correct the metabolic fault in obesity?
A high-protein, high-fat diet restricted in carbohydrates but not calories.
According to Pennington, what would happen if fat can be mobilized effectively from adipose tissue?
No calorie restriction would be necessary, and weight loss would occur naturally as appetite adjusts.
What was the effect of carbohydrate restriction on metabolic rate in obese individuals, according to Pennington?
It increases metabolic rate and physical activity as energy from fat stores becomes available.
True or False: Pennington’s hypothesis about obesity was widely accepted and tested.
False
What did Pennington speculate was the root cause of obesity?
An inability to metabolize properly a compound called pyruvic acid.
What did Pennington’s observations contribute to the understanding of energy conservation in obesity?
They highlighted that obesity could be a compensatory response to a metabolic defect in fat metabolism.
What did Edward Adolph and Curt Richter demonstrate regarding caloric intake in laboratory animals?
Animals adjust their food intake based on available calories, compensating for changes in nutrient delivery.
Fill in the blank: Pennington argued that chronic defects in fat metabolism could lead to _______ in energy expenditure.
[inadequate]
What did Pennington suggest is necessary for weight reduction?
Mobilization of increased quantities of utilizable fat.
What was one key observation from the yearlong all-meat diet experiment by Du Bois and colleagues?
Participants lost weight while their basal metabolic rates increased.
What was the implication of Pennington’s theory regarding calorie consumption on carbohydrate-restricted diets?
Weight loss occurs without the need for conscious calorie restriction due to increased fat availability.
What year did Ohlson express concerns about high-fat, carbohydrate-restricted diets?
1962
What was Ohlson’s concern regarding the diet’s nutritional adequacy?
It did not meet the recommended daily allowances for essential vitamins.
What types of food did Ohlson include more of in her diet?
More milk, cheese, and eggs.
What was the funding situation for drug studies compared to dietary treatments?
Drug studies had easier access to funding from the pharmaceutical industry, while dietary treatments lacked funding.
In what year did William Dietz report on the success of Bistrian and Blackburn’s diet for Prader-Willi syndrome?
1989
What was the average weight loss for carbohydrate-restricted diets according to the authors?
Eight pounds
What was the average weight loss for higher-carbohydrate diets?
Four pounds
What peculiar criticism did the AMA’s 1973 critique include regarding hunger?
Included ‘anorexia’ as an untoward side effect.
What does ‘anorexia’ refer to in the context of the AMA’s critique?
Loss of appetite
What critical auxiliary word did Yudkin use in his conclusions based on dietary records?
May
What was the accuracy issue with the three-day dietary records used by Yudkin?
Notoriously inaccurate
Who did Ted Van Itallie work with in the 1950s?
Jean Mayer
What reason did Ted Van Itallie give for Mayer’s disregard of prewar German literature on obesity?
Mayer hated the Germans.
