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Fructose may play role in irritable bowel syndrome new
      #23248 - 10/13/03 12:11 PM

Reged: 12/09/02
Posts: 7795
Loc: Seattle, WA

Fructose may play role in irritable bowel syndrome

Globe and Mail Update

A diet high in fructose may contribute to symptoms of irritable bowel syndrome, a study released Monday says.

IBS commonly causes symptoms such as diarrhea, constipation, abdominal discomfort and bloating. Researchers at the University of Iowa Hospitals and Clinics in Iowa City have been investigating the effects of a diet high in fructose (the simple sugar found in honey and many types of fruit) on people suffering from IBS.

The researchers have found that there may be a significant portion of the population who are fructose intolerant, and in previous studies, they found that one-third to one-half of people suffering from IBS symptoms are fructose intolerant.

"Although lactose intolerance is well-known, fructose intolerance is just beginning to be recognized," said one of the study's authors, Dr. Young Choi.

In the study released on Monday, researchers tested 80 patients with suspected IBS and found that 30 were fructose intolerant. Of those 30 patients, half were placed on a diet that eliminated the simple sugar from their diets.

"For those who were compliant, symptoms, such as abdominal pain, bloating and diarrhea, declined significantly,," the study's authors say.

As well, the prevalence of IBS in the study group decreased, the authors said.

Bowel symptoms remained the same among the patients who did not modify their diets, the study says. The authors warn, however, that because of the small sample size, more significant studies are needed to confirm the findings.

However, Dr. Choi said, "a fructose-restricted diet significantly improved symptoms in patients with IBS and fructose intolerance. Fructose intolerance is yet another piece of the IBS puzzle — whose treatment, when adhered to — confers significant benefits."

IBS affects between 10 and 15 per cent of the U.S. population, according to the study's authors.

Approximately 12.1 per cent of the Canadian population, about 2.8 million Canadians, suffer from the condition, according to a study funded by Zelnorm, a prescription drug for IBS sufferers that just became available in Canada this year.

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Fat, Fructose May Contribute to IBS Symptoms new
      #23514 - 10/15/03 03:31 PM

Reged: 12/09/02
Posts: 7795
Loc: Seattle, WA

Fat, Fructose May Contribute to IBS Symptoms

Charlene Laino

Oct. 14, 2003 (Baltimore) — Two new studies exploring the role of diet in irritable bowel syndrome (IBS) suggest that fat and fructose may contribute to symptoms of the gastrointestinal disorder that affects more than 1 in 10 Americans.

One study showed that patients with IBS and fructose intolerance who eliminated fruit and other fructose-rich foods from their diet experienced an improvement in symptoms.

Another study showed that people with functional gastrointestinal disorders, about half of whom had IBS, consumed a diet with a higher proportion of high-fat, low-carbohydrate foods than their healthy counterparts.

Neither study proves cause-and-effect, researchers stressed. But both studies, presented here this week at the 68th annual scientific meeting of the American College of Gastroenterology, point to the need to work with patients to identify possible dietary triggers of gastrointestinal symptoms, they said.

In the first study, Young K. Choi, MD, from the University of Iowa in Iowa City, and colleagues tested 80 patients with suspected IBS; 30 had positive fructose breath tests. The patients were taught to identify foods high in fructose and urged to avoid them.

While not as well known as lactose intolerance, fructose intolerance is common, with previous research by the same investigators showing it affects up to 58% of patients with symptoms of IBS.

After one year, 26 patients were available for a follow-up evaluation that included a structured interview to assess their dietary compliance and symptom patterns. Only 54% of participants reported that they remained on the fructose-restricted diet for a significant amount of time, Dr. Choi reported.

But those who remain on the fructose-restricted program reported significantly less abdominal pain, bloating, and diarrhea than before changing their diets (P < .05), he said. Noncompliant patients showed no improvement in symptoms.

On the ROME I scale, only 43% of patients who complied with the fructose-restricted diet continued to have symptoms of IBS compared with 75% of those who continued to eat fructose-rich foods.

Eleven (79%) of 14 patients who avoided fructose reported a strong correlation between occasional noncompliance and symptoms, the study showed, compared with 1 (8%) of 12 noncompliant patients.

Richard G. Locke, III, MD, associate professor of medicine at the Mayo Clinic in Rochester, Minnesota, questioned whether patients in the study really had IBS. "We used to think people who were intolerant to milk had IBS but now we know they have lactose intolerance," Dr. Locke said. "The same thing could be happening here. It's a matter of labeling."

The important message is to "educate patients that fructose can cause these symptoms," said Yuri A. Saito, MD, MPH, also of the Mayo Clinic. "The general public is not aware of this."

The second study, performed by Dr. Saito and colleagues, from the Division of Gastroenterology and Hepatology at Mayo, enrolled 221 patients, aged 20 to 50 years, about half of whom reported symptoms of functional gastrointestinal disorders on a well-validated self-report bowel disease questionnaire. All of the participants completed the Harvard Food Frequency Questionnaire, and a subset of 53 cases and 58 controls also kept diet diaries for one week.

Of the cases, 46% had IBS, 27% had functional dyspepsia, 20% had both, and the rest had other functional gastrointestinal disorders, Dr. Saito reported.

The Wilcoxon rank sum test showed that patients with functional gastrointestinal disorders reported consuming more fat in their diets: 33.0% of total calories vs. 30.7% for control patients (P < .05). The findings held true for both saturated fat and monounsaturated fat, she said.

Also, carbohydrates accounted for 49.1% of total calories in cases patients compared with 51.9% in control patients (P < .05), the study showed.

No significant differences between the two groups were found for protein, fiber, iron, calcium, niacin, or vitamins B, C, D, or E intake.

Subjects with functional gastrointestinal disease were also significantly more likely to suffer from food allergies than healthy subjects, Dr. Saito reported.

Further studies are needed to determine whether a high-fat, low-carbohydrate diet causes gastrointestinal symptoms or reflects changes that are adaptive, she said.

In the meantime, Dr. Saito said she does not recommend any blanket change in dietary recommendations. Instead, she works with her patients to uncover any foods that make their symptoms worse so they can be eliminated from the diet. "It is important to review my patients' food histories and look for obvious triggers such as excess fructose or sorbitol," she said.

Kevin W. Olden, MD, associate professor of medicine in the Division of Gastroenterology at the Mayo Clinic in Scottsdale, Arizona, agreed. "I advise my patients to eat what they enjoy. If they identify a food that makes them feel sicker, they should not eat that food. But you can't tell everyone not to eat cornflakes." Dr. Olden was not involved with the study.

ACG 68th Annual Scientific Meeting: Abstract 21, presented Oct. 13, 2003; Abstract 547, presented Oct. 14, 2003.

Reviewed by Gary D. Vogin, MD

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Effects of a Low-Fat, High-Carbohydrate Diet on Body Weight new
      #41060 - 01/26/04 05:28 PM

Reged: 12/09/02
Posts: 7795
Loc: Seattle, WA

Vol. 164 No. 2, January 26, 2004

Effects of an Ad Libitum Low-Fat, High-Carbohydrate Diet on Body Weight, Body Composition, and Fat Distribution in Older Men and Women

A Randomized Controlled Trial

Nicholas P. Hays, PhD; Raymond D. Starling, PhD; Xiaolan Liu, MD; Dennis H. Sullivan, MD; Todd A. Trappe, PhD; James D. Fluckey, PhD; William J. Evans, PhD

Arch Intern Med. 2004;164:210-217.

Background The efficacy of ad libitum low-fat diets in reducing body weight and fat in overweight and obese adults remains controversial.

Methods We examined the effect of a 12-week low-fat, high–complex carbohydrate diet alone (HI-CHO) and in combination with aerobic exercise training (HI-CHO + EX) on body weight and composition in 34 individuals with impaired glucose tolerance (20 women and 14 men; mean ± SEM age, 66 ± 1 years). Participants were randomly assigned to a control diet (41% fat, 14% protein, 45% carbohydrates, and 7 g of fiber per 1000 kcal), a HI-CHO diet (18% fat, 19% protein, 63% carbohydrates, and 26 g of fiber per 1000 kcal), or a HI-CHO diet plus endurance exercise 4 d/wk, 45 min/d, at 80% peak oxygen consumption (HI-CHO + EX). Participants were provided 150% of estimated energy needs and were instructed to consume food ad libitum. Total food intake, body composition, resting metabolic rate, and substrate oxidation were measured.

Results There was no significant difference in total food intake among the 3 groups and no change in energy intake over time. The HI-CHO + EX and HI-CHO groups lost more body weight (–4.8 ± 0.9 kg [P = .003] and –3.2 ± 1.2 kg [P = .02]) and a higher percentage of body fat (–3.5% ± 0.7% [P = .01] and –2.2% ± 1.2% [P = .049]) than controls (–0.1 ± 0.6 kg and 0.2% ± 0.6%). In addition, thigh fat area decreased in the HI-CHO (P = .003) and HI-CHO + EX (P<.001) groups compared with controls. High carbohydrate intake and weight loss did not result in a decreased resting metabolic rate or reduced fat oxidation.

Conclusion A high-carbohydrate diet consumed ad libitum, with no attempt at energy restriction or change in energy intake, results in losses of body weight and body fat in older men and women.

From the Nutrition, Metabolism, and Exercise Laboratory, Donald W. Reynolds Department of Geriatrics, University of Arkansas for Medical Sciences and Central Arkansas Veterans Healthcare System, Little Rock. Dr Starling is now with Pfizer Global Research and Development, Groton, Conn. The authors have no relevant financial interest in this article.

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Low Carb Diets are a Prescription for Prebiotics new
      #46411 - 02/24/04 12:49 PM

Reged: 12/09/02
Posts: 7795
Loc: Seattle, WA

Low Carb or Low Fiber Diets are a Prescription
for Prebiotics: Gums are Prebiotics

Dennis T. Gordon, Ph.D.

The Atkins Diet and similar low carbohydrate diets are causing a major change in dietary habits. The Atkins Diet is rapidly winning converts for weight management. Excessive weight gain is a serious public health epidemic; however, strict adherence to the low carbohydrate, high protein diets for more than a few months can cause some serious health complications.

The Atkins Diet curtails the consumption of a variety of foods that provide thousands of health promoting compounds (nutraceuticals) that help prevent many diseases. Also, these diets can provide too much protein, which taxes the kidneys, and too much fat, which leads to higher blood lipid levels and cardiovascular disease. Finally, the Atkins Diet significantly reduces the recommended amount of dietary fiber participants consume.

The U.S. National Academy of Sciences (NAS) recently established the first set of guidelines for dietary fiber intake which suggests that women and men should eat a wide variety of foods to provide 25g and 38g of fiber, respectively per day. At the time of these first guidelines, average consumption was approximately one-half
these recommended amounts. Adherence to a low carbohydrate diet which significantly reduces the variety of foods consumed co uld lower dietary fiber intake to less than 25% of recommended amounts, and this can lead to serious
health complications such as constipation, diverticulosis, and intestinal cancers.

Dietary fiber is simply the carbohydrate portion of the diet that is nondigestible and is commonly described as consisting of insoluble and soluble fractions. As insoluble dietary fiber passes through the intestine, it provides bulk and holds water that aids regular bowel movements, thus preventing constipation. Examples of insoluble dietary fiber are cellulose, hemicellulose, and wheat bran. When insoluble dietary fiber reaches the large intestine, it undergoes partial fermentation.

However, soluble dietary fiber such as guar gum, Acacia (gum arabic), pectin, and alginates undergo almost complete fermentation. Due to the extent of the fermentation, gums contribute 0 net carbohydrates to the diet because the carbohydrate portion is soluble dietary fiber. Once fermented, soluble fiber becomes "the" important source of energy for intestinal bacterial growth.

The relatively new term (1995) used to describe soluble dietary fiber or gums is "prebiotic." A more scientific definition of a prebiotic is "a nondigestible food ingredient that beneficially affects the host by selectively stimulating the growth and/or activity of one or a limited number of bacteria in the colon, and thus improves host health".1

As prebiotics are fermented in the large intestine, more short chain fatty acids (SCFA) (i.e., acetic, propionic, and butyric) are produced. The SCFA decrease the pH
of the large intestine favoring the growth of more non-pathogenic organisms (Lactobacillus and Bifidobacteria sp) compared to pathogenic organisms (i.e., Proteus and Staphylococci sp). These changes in the large intestine, brought about by increased fermentation of prebiotics, leads to increased disease prevention. It's important for food manufacturers to recognize that current fad diets limit food choices and are too low in dietary fiber, and prebiotics explore other avenues for including fiber in the diet. Creatively designed foods that provide complete nutrition are one way to help ease the obesity epidemic.

1 Gibson G., R and Roberfroid M. B.
Dietary modulation of the human colonic
microbiota —introducing the concept
of prebiotic. 1995. J. Nutr., 125:1401–1412.

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McDonald's has documentary beef new
      #46428 - 02/24/04 02:26 PM

Reged: 12/09/02
Posts: 7795
Loc: Seattle, WA

McDonald's has documentary beef

Execs blast unseen movie 'Super Size Me,' emphasize choices

By Delroy Alexander
Tribune staff reporter
Published February 22, 2004

The red-haired clown with a larger-than-life smile has welcomed generations of children to McDonald's. But the bloated mug of a filmmaker soon could scare away health-conscious adults.

In the new documentary "Super Size Me," filmmaker Morgan Spurlock eats only McDonald's food for 30 days and documents his rapidly deteriorating health.

Interspersed with segments about obesity and processed food in the United States, viewers watch Spurlock pack on 25 pounds, ride out wild mood swings and get warnings from doctors about his rising cholesterol levels and liver toxicity. The movie will be released to theaters by the end of May.

The 90-minute movie could cause more people to bring obesity lawsuits against McDonald's Corp., predicts John Banzhaf, a professor at George Washington Law School. A consultant in lawsuits against McDonald's, Banzhaf appears in the documentary and was instrumental in building a case against the tobacco industry.

"What this movie did is show that if you eat there frequently, yes there can be problems," Banzhaf said.

"I would bet a lot of people are working overtime to figure out how to deal with this film," said Larry Kramer, a crisis management expert with Manning Selvage & Lee, who advised Nike boss Phil Knight in 1998 after a documentary showed children making its shoes in Indonesia.

Filmmaker Michael Moore's "The Big One" quickly led to major changes in Nike's operations, including the introduction of a minimum working age of 18 in its Indonesian factories.

Kramer said he likens McDonald's current predicament to a situation he faced in 1993, when he helped burger chain Jack in the Box rebound from a food poisoning outbreak blamed for the deaths of four children.

"We had to provide some perspective on food safety and tell our customers some hard truths," he said. "We told them that most food safety problems actually occurred in the home. I think the challenge that McDonald's faces is to communicate that eating three squares a day at its restaurants is not a healthy pursuit. People have to make smart choices."

In McDonald's case, executives are already in crisis management mode, openly questioning the film's content even though they haven't seen the picture yet.

"Absolutely, I'm a bit carried away," said an irate Ken Barun, Ronald McDonald House Charities president and the man in charge of the company's healthy/active lifestyle initiative.

"The movie is a distortion of reality. I'm sure we'll have more to say after we've seen the film," Barun said.

McDonald's is adamant that the nation's obesity problems are complex and the issues rely heavily on what consumers choose to eat.

"This is really not about McDonald's. It's more about personal responsibility," said Cathy Kapica, McDonald's director of worldwide nutrition who described the film she has yet to see as an exercise in binge eating. "I'm not sure that comes across in the movie."

The company's broader strategy is already clear.

Its executives are stressing personal choice, telling customers to make sensible choices and to limit fatty or sugary foods. McDonald's also is trying to educate consumers about the broader range of offerings it has on its menu. And the company is asking the media to closely examine Spurlock's motives.

"I don't think what we are seeing here has any balance at all," said Barun, who like others at the company has only seen clips and Spurlock interviews.

"We are talking about someone who has obviously gone to excess and exploited a brand that people will relate to in order to make his movie and capitalize on something that is unrealistic. It should be put in the category of the rest of the shock TV that you see. It's a distortion of reality."

Barun's reference to shock TV is a subtle dig at the filmmaker's past. Spurlock was the brains behind a Web-cast and short-lived MTV show in 2000 called "I Bet You Will," which centered on people doing almost anything for money. Often, shows involved bizarre eating stunts.

Filmmaker got no comment

Oak Brook-based McDonald's already may have missed a golden opportunity to get its point across when it opted not to speak with Spurlock. He captures himself in his film persistently trying to get an interview with company executives, following in the footsteps of filmmaker Moore in his "Roger & Me" documentary about General Motors Corp.

Kramer, the crisis management expert, said McDonald's must take authority on the issue of food and nutrition to counter any impact from "Super Size Me."

"They have to be the ones that say, `No, you shouldn't be eating six cheeseburgers a day.' It's a very credible answer and doesn't alienate their core customer that does eat a lot of cheeseburgers."

The company is doing exactly that.

For instance, customers soon will be able to buy an adult Happy Meal, which includes a salad, bottle of water, a pedometer and a diet and activity log designed by nutrition expert Bob Greene.

"We've been putting nutritional information in stores for 20-plus years," Barun said. "The Go Active [Adult Happy Meal] is going to be introduced nationally, and a big campaign is coming to get people to walk and eat more vegetables and fruits."

Barun and Kapica also point to healthier offerings such as grilled chicken, recently introduced salads and the move late last year to an all-white-meat chicken McNugget, a key part of the children's Happy Meal.

The old McNugget drew criticism in an ill-fated obesity lawsuit against McDonald's last year from a judge who described the product as a "McFrankenstein creation of various elements not utilized by the home cook."

No impact on bottom line yet

After the company won the legal battle, in which two overweight teenagers claimed their health problems were related to eating at the chain, criticism of McDonald's and other fast-food chains died down.

Even with the talk of obesity and potential lawsuits, McDonald's bottom line has yet to feel the pinch.

"We are concerned with the increasing debate and what kind of impact it might have, but the sales trends don't show any impact," said Mark Sheridan, a restaurant analyst with Johnson Rice & Co. "People talk healthy but eat what tastes good."

And so far, McDonald's remains reluctant to recommend just how many times a week a burger lover should visit its restaurants.

"It's an individual thing; there's no specific numbers," said Kapica. "It's not where you eat, it's what you eat and, especially, how much you eat."

Copyright © 2004, Chicago Tribune,1,268700.story

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Stress May Lead To Food Allergies new
      #48822 - 03/08/04 06:45 PM

Reged: 12/09/02
Posts: 7795
Loc: Seattle, WA

Stress May Lead To Food Allergies

Feeling stressed? Watch out -- you could be giving yourself food allergies.

Researchers from the University of Amsterdam have found a link between stress and food allergies, as well as other intestinal disorders.

Annette van Kalkeren, a biologist from the university, found that mice that have been subjected to stress have intestines that overreact to certain foods.

Kalkeren investigated the reaction of pieces of mouse intestine to egg albumin, a substance found in eggs. Just like humans, mice can become allergic to the substance. She found that the intestines of mice subjected to prolonged stress had more symptoms of food allergies.

The intestinal wall becomes more permeable under stressful conditions. Harmful substances penetrate the intestinal wall, which causes a panic response by the immune system. That could be the start of an allergy.

During chronic stress, the body's natural defense is weakened and allergens can penetrate deep into the body. Food allergies and various intestinal diseases, such as Crohn's disease, ulcerative colitus and irritable bowel syndrome can in part be caused or enhanced by chronic stress.

But how did the mice get stressed in the first place? Kalkeren exposed them to several "stressful environments -- including cold, extended time in a narrow tube, social isolation, and swimming.

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While health foods may seem expensive, healthy diets save money in the long run new
      #48824 - 03/08/04 06:50 PM

Reged: 12/09/02
Posts: 7795
Loc: Seattle, WA

While health foods may seem expensive, healthy diets save money in the long run

By Ann Betkowski


Everyone is looking for the lose-weight quick solution. Adding to this is the fact that nutritionists are frequently changing their minds on what is good and what is bad for us. If even the experts cannot agree, how are we to make the right choices?

According to Dr. David Katz, author of "The Way to Eat," the nutrition community is nearly universal in its support in a diet rich in grains, fruits and vegetables and restricted in saturated fat and processed foods. Therefore make your commitment strong and stay with it.

"It is easy to say why not just eat whatever I want since the experts cannot agree," Katz said, "but everyone generally agrees that including five fruits and vegetables a day in your diet is best."

Katz reminds us that "in general, if something you hear seems too good to be true, it likely is."

Here are some answers to some common questions regarding healthy eating.

Why are healthy foods more expensive?

Most people believe that healthy food is more expensive than unhealthy food. However, when the costs of the entire diet are considered, eating well costs less than eating poorly.

According to Katz, many healthy foods can be expensive. Many specialty products are made in smaller quantities and so they can be more expensive. Organically grown produce can also be more expensive, but you get what you pay for. These fruits and vegetables tend to be more flavorful and do not include chemicals and pesticides.

However, compared to meat and animal products, plant-based foods are generally less expensive.

"Each time you substitute beans, lentils or tofu for meat, the fiber and nutrient content of the diet goes up, while the fat content and cost go down," Katz said.

"Whole grains are generally inexpensive as well," said Katz. "By increasing the amount of whole grain oats, rice, wheat, couscous and/or barley, you also improve your diet as well as your wallet. The same is true for butter, cream and soda."

Revising your diet to a healthier one can actually be cost-effective.

What is the real word on breakfast?

Breakfast is important but different people are hungry at different times of the day therefore the time to eat breakfast can be different for everyone. According to Katz, let hunger be your guide. If you wake up at 6 or 7 a.m. and are not hungry until 9 or 10 a.m., wait and have your breakfast then instead of having two meals in the morning.

"If you are not hungry first thing in the morning, and have breakfast later when you are, there can be several benefits," Katz said. If you eat breakfast later it could reduce your appetite for lunch. You may then eat less for lunch and have a healthy mid-afternoon snack. That snack may give you the energy you need to exercise and then enjoy a smaller dinner. In other words, having breakfast when you are ready for it can be the most beneficial.

Of course, Katz said, if you are hungry first thing in the morning, then that is when you should eat. However, try to include foods high in fiber, such as whole grain cereals. These tend to maintain energy levels longer than processed foods.

So what does "healthy food" really mean?

Food, in general, tends to be categorized into healthy and unhealthy groups. However, there can be big differences in sugar, fat and calories depending on their particular content. For example, a salad made up of mostly bacon bits, croutons, cold cuts and cheese includes a lot of fat and calories.

He suggests you do not think of food in categories but as the actual foods that you eat. "If you take in too many calories, your weight will go up. If you eat too much saturated fat, your cholesterol will rise," he said.

Therefore, Katz suggests that it is very important to read the labels on all the foods you are eating.

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High fructose corn syrup a major culprit in the nation's obesity crisis new
      #48994 - 03/09/04 11:37 AM

Reged: 12/09/02
Posts: 7795
Loc: Seattle, WA

How sweet it isn't


San Francisco Chronicle

An overweight America may be fixated on fat and obsessed with carbs, but nutritionists say the real problem is much sweeter -- we're awash in sugar.

Not just any sugar, but high fructose corn syrup.

The nation eats more sweetener made from corn than from sugar cane or beets, gulping it down in drinks as well as in frozen food and baked goods. Even ketchup is laced with it.

Almost all nutritionists finger high fructose corn syrup as a major culprit in the nation's obesity crisis. The inexpensive sweetener flooded the American food supply in the early 1980s, just about the time the nation's obesity rate started its unprecedented climb.

The question is why did it make us so fat. Is it simply the Big Gulp syndrome -- that we're eating too many empty calories in ever-increasing portion sizes? Or does the fructose in all that corn syrup do something more insidious -- literally short-wire our metabolism and force us to gain weight?

Loading high fructose corn syrup into increasingly larger portions of soda and processed food has packed more calories into us and more money into food processing companies, say nutritionists and food activists. But some health experts argue that the issue is bigger than mere calories. The theory goes like this: The body processes the fructose in high fructose corn syrup differently than it does old-fashioned cane or beet sugar, which in turn alters the way metabolic-regulating hormones function. It also forces the liver to kick more fat out into the bloodstream.

The end result is that our bodies are essentially tricked into wanting to eat more and at the same time, we are storing more fat.


''One of the issues is the ease with which you can consume this stuff,'' says Carol Porter, director of nutrition and food services at the University of California at San Francisco. ``It's not that fructose itself is so bad, but they put it in so much food that you consume so much of it without knowing it.''

A single 12-ounce can of soda has as much as 13 teaspoons of sugar in the form of high fructose corn syrup. And because the amount of soda we drink has more than doubled since 1970 to about 56 gallons per person a year, so has the amount of high fructose corn syrup we take in. In 2001, we consumed almost 63 pounds of it, up from 1 ½ pounds in the mid-'70s -- a more than 4,000 percent spike, according to the U.S. Department of Agriculture.

The USDA suggests most of us limit our intake of added sugar -- that's everything from the high fructose corn syrup hidden in your breakfast cereal to the sugar cube you drop into your after-dinner espresso -- to about 10 to 12 teaspoons a day. But we're not doing so well. In 2000, we ate an average of 31 teaspoons a day, which was more than 15 percent of our caloric intake. And much of that was in sweetened drinks.

So, the answer is to just avoid soda, right? Unfortunately, it's not that simple, because the inexpensive, versatile sweetener has crept into plenty of other places. A low-fat, fruit-flavored yogurt, for example, can have 10 teaspoons of fructose-based sweetener in one serving.


Because high fructose corn syrup mixes easily, extends shelf-life and is as much as 20 percent cheaper than other sources of sugar, large-scale food manufacturers love it. It can help prevent freezer burn, so you'll find it on the labels of many frozen foods. It helps breads brown and keeps them soft, which is why hot dog buns and even English muffins hold unexpected amounts.

The question remains just how much more dangerous high fructose corn syrup is than other sugars.

Fructose, as the name implies, is the sugar found naturally in fruit. It can be extracted, turned into granules and used like sugar in the kitchen. It used to be considered a healthier alternative to sucrose -- plain old table sugar. It's sweeter, so less is needed to achieve the same taste.

Diabetics use it because fructose doesn't stimulate insulin production, so blood sugar levels remain stable.

The process of pulling sugar from cornstarch wasn't perfected until the early 1970s, when Japanese researchers developed a reliable way to turn cornstarch into syrup sweet enough to compete with liquid sugar. After some tinkering, they landed on a formula that was 55 percent fructose and 45 percent glucose -- sweet enough and cheap enough to make most soda companies jump from liquid sugar to high fructose corn syrup by the 1980s.


Journalist Greg Crister lays out a compelling case against high fructose corn syrup in his 2003 book, Fat Land: How Americans Became the Fattest People in the World. He argues that federal policies that aimed to stabilize food prices and support corn production in the 1970s led to a glut of corn and then to high fructose corn syrup. With a cheaper way to sweeten food, producers pumped up the size and amount of sweet snacks and drinks on the market and increased profits.

Crister writes that despite the food industry's arguments that sugar is sugar, whether fructose or sucrose, no group ``has yet refuted the growing scientific concern that, when all is said and done, fructose . . . is about the furthest thing from natural that one can imagine, let alone eat.''

The latest case against high fructose corn syrup began in earnest a few years ago. Dr. George Bray, principal investigator of the Diabetes Prevention Program at Louisiana State University Medical Center, told the International Congress on Obesity that in 1980, just after high fructose corn syrup was introduced in mass quantities, relatively stable obesity rates began to climb. By 2000, they had doubled.

Further, the American Journal of Clinical Nutrition in 2002 published research that showed that teenagers' milk consumption between 1965 and 1996 decreased by 36 percent, while soda consumption increased by more than 200 percent. Bray argues that without calcium, which nutritionists agree can help the body regulate weight, kids got fatter. He says that he could find no other single combination of environmental or food changes that were as significant to the rise in obesity.

Other studies at UC Davis and the University of Michigan have shown that consuming fructose, which is more readily converted to fat by the liver, increases the fat in the bloodstream in the form of triglycerides.

And unlike other types of carbohydrate made up of glucose, fructose does not stimulate the pancreas to produce insulin. Peter Havel, a nutrition researcher at UC Davis who studies the metabolic effects of fructose, has also shown that fructose fails to increase the production of leptin, a hormone produced by the body's fat cells.

Both insulin and leptin act as signals to the brain to turn down the appetite and control body weight. And in another metabolic twist, Havel's research shows that fructose does not appear to suppress the production of ghrelin, a hormone that increases hunger and appetite.

Other researchers, too, are finding problems with high fructose corn syrup. A study in last month's Journal of the National Cancer Institute suggests that women whose diet was high in total carbohydrate and fructose intake had an increased risk of colorectal cancer. And Dr. Mel Heyman, chief of pediatric gastroenterology and nutrition at UCSF, is seeing sick children whose bodies have been overloaded with fructose from naturally occurring fructose in fruit juice combined with soda and processed food.

''The way the body handles glucose is different from fructose,'' he says. 'It can overload the intestines' ability to absorb carbohydrates by giving it too much fructose. That can cause cramps, bloating and loose stools.''


Like others in the field, he says there is much to discover in how sugar works, but he disagrees that high fructose corn syrup is somehow reprogramming our bodies toward obesity. Rather, he says, we're just eating too much of it.

Nutrition theory holds that the basic make-up of fructose-laced corn syrup is not much different from table sugar. They react about the same in the body, says Dr. Walter Willett, a professor of epidemiology and nutrition at Harvard School of Public Health. ``There are some modest differences in metabolism, but I don't think fructose per se is the culprit.''

Neither do the food companies that use it in copious amounts.

Says Stephanie Childs, a spokesperson for the Grocery Manufacturers Association: ``At the end of the day, how any sweetener affects your weight depends on how many calories you are taking in overall. Overemphasizing one nutrient at the detriment of others is not going to solve the problem.''

Even some leading nutrition reformers aren't convinced that high fructose corn syrup is of itself the issue. The bigger battle, says Michael Jacobson, executive director of the Center for Science in the Public Interest, a consumer advocacy group, is to get added sugars listed on food labels with a percentage of daily value. That means a consumer could look at a package and see that, for example, one soda provides almost all the sugar a person should eat in a day.

''It simply comes down to this,'' he says. ``We're eating too much refined sugars, be it sucrose or high fructose corn syrup or any other refined sugar.''

Heather is the Administrator of the IBS Message Boards. She is the author of Eating for IBS and The First Year: IBS, and the CEO of Heather's Tummy Care. Join her IBS Newsletter. Meet Heather on Facebook!

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Systematic Review: The Role of Different Types of Fibre in IBS new
      #56194 - 03/30/04 02:56 PM

Reged: 12/09/02
Posts: 7795
Loc: Seattle, WA

Systematic Review: The Role of Different Types of Fibre in IBS

This systematic review shows that there is limited and conflicting evidence for the effectiveness of fibre in the treatment of irritable bowel syndrome symptoms. For the measure of efficacy, i.e. the proportion of patients with global irritable bowel syndrome symptom improvement, fibre was significantly better than control. Fibre therapy also showed favourable results in irritable bowel syndrome-related constipation. However, it may increase abdominal pain in some irritable bowel syndrome patients. The effect of psyllium on constipation was based on only two studies: Jalihal and Kurian[25] with a dose of 30 g and Prior and Whorwell[28] with a dose of approximately 5 g. Pooling with other studies with a lower dosage might underestimate the effects of a reasonable dose of psyllium.

The two types of fibre, soluble and insoluble, affected irritable bowel syndrome symptoms differently. Soluble fibre was beneficial to global symptom improvement, whereas insoluble fibre was not more effective than placebo and may, in some irritable bowel syndrome patients, worsen symptoms when compared with a normal diet. In two studies, a considerable effect was found. In one of these, a reasonable dose of psyllium was used.[25] Toskes et al. used calcium polycarbophil, which is a synthetic fibre resistant to bacterial degradation.[29] Pooling of these studies with other psyllium studies that use sub-optimal doses underestimates the treatment effect.

Evidence for the effectiveness of soluble fibre was obtained from the pooled results. Irritable bowel syndrome patients treated with this type of fibre reported 1.3 times more global improvement than controls. The effect of soluble fibre on irritable bowel syndrome-related abdominal pain, however, was controversial. Indeed, the studies that reported on the outcome measure of relief of abdominal pain varied considerably and showed conflicting results.[24,25,28]

The efficacy of insoluble fibre in the treatment of irritable bowel syndrome patients was also controversial. The studies showed that diets with a large amount of insoluble fibre might actually be worse than a normal diet. The clinical improvement of irritable bowel syndrome patients treated with insoluble fibre was no better than that obtained with placebo.[33,34,37,38]

The outcomes used in each of the randomized trials varied considerably. Consequently, several important outcomes were reported in only some of the trials. Moreover, they were measured in different ways. Generic outcomes, such as the quality of life, were not used in any of the trials. In terms of both global irritable bowel syndrome symptom improvement and individual symptom improvement, the studies showed heterogeneous results. The main reason for this may be the small sample sizes studied, which could have produced type II errors. Two studies in our analysis used either a single-blind or an open allocation of intervention,[36,39] whereas it is recommended that double-blind assessment should be used in irritable bowel syndrome trials.[40] However, many difficulties are encountered in the design and execution of trials with dietary intervention. As blinding is difficult in trials evaluating high-fibre dietary advice, we accepted these studies.

Three studies were excluded from our analysis as no data could be extracted to calculate a relative risk. None of these showed a positive response to treatment. This might have given rise to an over-estimation of the effectiveness of fibre.

The majority of patients with irritable bowel syndrome are managed in primary care.[4] Unfortunately, none of the selected studies included patients treated in a primary care setting. This limits the external validity of our results. Irritable bowel syndrome patients in primary care may, in fact, respond differently to dietary therapy than referred patients.[41] Furthermore, primary care patients who respond to treatment with bulking agents are less likely to be referred to a hospital clinic. Moreover, more than half of the symptomatic 'patients' from the general population do not even present to their general practitioner. The efficacy of fibre in this population is unknown.

The role of fibre in the pathophysiology of irritable bowel syndrome remains poorly understood.[42] An increase in the amount of dietary fibre is an almost universal recommendation in the primary care management of irritable bowel syndrome,[3,5] and guidelines on irritable bowel syndrome management for out-clinic patients advise an increase in fibre intake in the event of constipation.[5,43] However, our review showed only limited support for this recommendation.

In summary, our systematic review demonstrates the effectiveness of fibre therapy in irritable bowel syndrome patients, but only in terms of either global symptom improvement or constipation. The effectiveness on individual symptoms is variable. There is no effect of fibre in irritable bowel syndrome-related abdominal pain. Soluble and insoluble fibre have different effects on global irritable bowel syndrome symptoms. Insoluble fibre is probably no better than placebo and may, in some patients, even worsen the clinical outcome. For the development of evidence-based management guidelines, valid clinical studies in primary care patients, focusing on the effectiveness and tolerability of soluble and insoluble fibre, are needed.

Dr J.W.M. Muris, Maastricht University, Department of General Practice, PO Box 616, NL-6200 MD Maastricht, The Netherlands. E-mail:


Aliment Pharmacol Ther 19(3):245-251, 2004. © 2004 Blackwell Publishing

Heather is the Administrator of the IBS Message Boards. She is the author of Eating for IBS and The First Year: IBS, and the CEO of Heather's Tummy Care. Join her IBS Newsletter. Meet Heather on Facebook!

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Low-carb diets increase demand for laxatives
      #69075 - 05/10/04 12:59 PM

Reged: 12/09/02
Posts: 7795
Loc: Seattle, WA

Low-carb diets increase demand for laxatives

Sales of fiber supplements soar as irregularity spreads

The Associated Press

Updated: 5:48 p.m. ET March 30, 2004 PITTSBURGH - The mass of dieters doing away with carbohydrates may be changing the demographics for companies that traditionally have marketed fiber laxatives to the silver-haired crowd.

In an advertising campaign appearing at newsstands, GlaxoSmithKline is offering a "zero-carb solution to a low-carb problem," referring to the irregularity suffered by some people on the Atkins and South Beach diets.

It was the first shot in a marketing blitz that has pharmaceutical companies seeking out consumers who might traditionally be more familiar with hair gel products than fiber laxatives.

GlaxoSmithKline said it is responding to a bump in sales and a surge in calls over the past year to consumer lines regarding Citrucel, its fiber laxative.

Just days after the GlaxoSmithKline ads appeared, Proctor & Gamble fired back, promising in advertisements that their brand, Metamucil, allows users to "Stay regular. The 0 net carb way."

Labels on Citrucel caplets now let the low-carb crowd know the fiber laxative won't set them back. The caplet form has no carbohydrates and can "help you get back on track," according to magazine ads appearing in March editions.

Patrick Seiffert, brand manager for Citrucel, said GlaxoSmithKline is targeting consumers who follow a particular lifestyle and not an age group, but acknowledges that the target audience for the product may be changing, largely because of low-carb dieters.

"About 20 percent of the population is now on a low-carb diet and about a third experience changes in regularity," Seiffert said. "That's about 13 million people. That's significant for us."

The estimated number of people on low-carbohydrate diets varies widely, as does the number of people who suffer adverse effects from eating more meats and cheeses, hallmarks of the diet.

Yet Internet forums dedicated to Atkins and South Beach are clogged with the woes of people who have not replaced the fiber that was once part of their diet.

Heather is the Administrator of the IBS Message Boards. She is the author of Eating for IBS and The First Year: IBS, and the CEO of Heather's Tummy Care. Join her IBS Newsletter. Meet Heather on Facebook!

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