Is veganism as are you all right as “theyre saying”?

We need more research on the diet, say scientists

Katharina Wirnitzer was in the midst of training for the Bike Transalp race, one of the world’s toughest endurance events, when she began investigating whether a vegan diet was suitable for athletes.

The year was 2003 and veganism was a long way from the current boom, which has established it as one of the most in-vogue dietary trends. But Wirnitzer, a athletics scientist at the University of Innsbruck, had become intrigued by the resurgence of ancient hypothesis linking plant-based diets with improved athletic performance.

” The first athletes on strict plant-based diets were gladiators ,” she says.” Roman scripts report that all fighters adhered to gladiatoriam saginam , which was based on plant foods, including large amounts of legumes, heartbeats and grains, and contained little or no animal protein .”

Now, virtually two millennia later, Wirnitzer is one of a handful of researchers trying to get to the bottom of whether veganism couldenhance an athlete’s chances of sporting success. Over the past decade, she has led the NURMI study, the broadest initiative so far investigating the effects of a vegan diet in high-performance, ultra-endurance sports.

NURMI is particularly timely because veganism’s association with various health benefits- from weight loss to decreased risk of inflammatory cancer- has considered the diet rise in popularity in recent years, both amongst the general public and elite sportsmen. The most recent survey by the Vegan Society estimates that there are around 600,000 vegans in the UK– a fourfold increase over the past five years- while high-profile athletes from Lewis Hamilton to Jermain Defoe have begun experimenting with veganism.

Kendrick James Farris, the United States’ sole male weightlifter at the 2016 Rio Olympics. Being vegan is’ almost like having superpowers ‘, he told Ebony magazine. Photograph: Mike Ehrmann/ Getty Images

However, despite the boom in veganism, even the most optimistic scientists caution that there is still much we do not understand about the diet. In particular, little is known about the long-term consequences of veganism and whether it does hold significant advantages over an omnivorous or vegetarian diet.

Portrayals of the diet can be partisan: the recent blockbuster Netflix documentary The Game Changers has since been tainted by revelations that the executive producers are cofounders of a vegan food company and that much of the evidence presented in the film is selective, low-quality and anecdotal. Moreover, as with so many dietary interventions, the search for the truth about veganism is often clouded by the potential fiscal gains- with predictions that the global vegan food market will be worth $24.3 bn by 2026.

This is perhaps unsurprising. Whether it be the trendy city bars offering vegan wine, or the array of new products launching in supermarkets and health food stores, veganism is the wellness industry’s new cash cow. Market-research experts have already predicted that the value of the global vegan food market will reach $ 24.3 bn by 2026. Vegan cheese alone is expected to develop into an industry worth virtually$ 4bn within the next five years.

So what do we really know about veganism and what it can do for our health?

Venus Williams credits turning vegan with helping her to relieve the symptoms of the autoimmune disease Sjogren’s disorder. Photograph: VCG/ Getty Images

The quest to reduce cardiovascular disease

At Sheffield Hallam University, David Rogerson has spent the past decade studying the effects of dietary interventions on physical health. He says that one reason veganism could be good for you is because it can protect against cardiosvascular diseases, by reducing obesity and lowering cholesterol. These chronic illnesses expense the UK around PS9bn a year; veganism may be the solution.

” There’s growing evidence that reduced consumption of animal products, coupled with an increase in plant-based foods, seems to be good for our health ,” says Rogerson.” This is perhaps due to these foods containing plenty of antioxidant phytonutrients and nitrates, while some animal products contain lots of pro-inflammatory fats and lead to the production of a metabolite called TMAO, which has been linked to cardiovascular problems .”

The anti-inflammatory effect of plant-based foods is thought to be the reason why vegan diets appear to relieve symptoms of some auto-immune illness such as rheumatoid arthritis. The tennis player Venus Williams, who suffers from Sjogren’s syndrome, credits turning vegan with mitigating the extreme fatigue associated with the condition, and with enabling her to continue vying at the highest level.

The full picture is rather more complex than it first seems. Scientists have found that a combined group of vegetarians and vegans appeared to have a higher risk of haemorrhagic stroke than did meat-eaters. But owing to the small number of vegans in the study, it is hard to draw firm conclusions.” Possible reasons might be related to lower cholesterol levels or a inadequacy of some nutrients, such as vitamin B12 ,” says Tammy Tong, a researcher in the University of Oxford’s Nuffield Department of Population Health.” Vegans are also at a higher risk of B12-deficiency, since the nutrient is only naturally available from animal foods. Low B1 2 levels may be linked to raised blood levels of homocysteine, which may be linked to higher risk of stroke .”

While vegan lobby groups have claimed that the diet outcomes in a healthier intestine microbiome and reduces the risk of some cancers, compared to meat-based diets, experts say there is little concrete evidence to back this up.” There was one US study which looked at all gastrointestinal-tract cancers blended and discovered no difference in vegans compared with non-vegetarians ,” says Tong.” Two studies have looked at colorectal cancer hazard in vegans and both reported no significant difference compared to non-vegans .”

The reason we still know relatively little is because while the word “vegan” was coined in 1962, for a long time scientific studies classed vegans and vegetarians together. But with increasing quantities of sports-science funding going into studying veganism, it may actually be through athletes, and their endless quest for” faster, higher, stronger”, that we learn most about the diet in the years to come.

The Australian 400 m and 800 m Olympic runner Morgan Mitchell claims that her vegan diet assistances her recovery, weight and immune system. Photograph: Jason McCawley/ Getty Images

High hopes but little proof

The NURMI study follows 8,000 runners from across Europe, including meat eaters, vegans and vegetarians and aims to see whether following a vegan diet over period leads to greater endurance over the half-marathon and marathon distances. In the next few years, NURMI will publish one of the first analyses of how vegan athletes compare to their meat-eating equivalents and, according to Wirnitzer, we are still in the infancy of understanding how our nutritional uptake can boost athletic ability.

” There is huge potential that is still untapped, both in terms of health and performance in sport competition ,” she says.

One of the above reasons athletes across such a range of sports are interested in the vegan diet is because it may boost immunity as well as aiding recovery and rehabilitation from trauma. Plant-based foods such as beetroot are known to contain dietary nitrates that aid blood-flow, and oxygen and nutrient transport through the body.

” Elite athletes are looking at all available legal options to enhance their performance ,” says Richard Brennan, managing board of Athletics Science Consultants, who is studying athletes who have been meat-eaters all their lives, and are now moving towards a vegan diet.” What we’re focusing on are the benefits to overall health which could enhance the training responses in terms of conditioning different energy systems, adapting more effectively to strength and power training programs, and having less time off sick to develop .”

These are the hopes for veganism, but scientists alert that, so far, there have been so few studies of athletes that there is very little evidence to support them. Wirnitzer published a landmark 2014 newspaper that showed that a well-planned vegan diet meets the nutritional requirements of endurance athletes, but we still know virtually nothing about whether it is the optimum diet.

Scientists have raised concerns that the diet is too restrictive for athletes who are travelling the world vying in sporting rivalries. Athletes could become malnourished, be unable to maintain muscle mass and suffer deficiencies in B12( which would lead to fatigue and poor oxygen transport ), calcium and vitamin D.

” There’s the possibility of having lower intakes of these minerals which play a role in bone health ,” says Rogerson.” There is evidence to say that vegans experience greater bone turnover and reduced bone-mineral density, so this could mean that vegans are at an increased risk of bone injury. We also know that female athletes might be at an increased risk of such traumata if they don’t feed enough, so this is potentially a double-whammy .”

Some studies suggest the Mediterranean diet may be more beneficial than a vegan one. Photograph: Alamy

How practical is a vegan lifestyle ?

Concerns about the practicality of veganism extend to the general population. One question is whether vegans can scheme their diet well enough over many years to avoid developing inadequacies. There have been two population studies that have monitored vegans over hour, one following Seventh Day Adventists in the US and Canada, and the EPIC-Oxford study, whichtracked the health of nearly 50,000 meat-eaters, vegetarians and vegans across the UK. Scientists involved in the latter have found that while devouring veggies rich in calcium, such as kale and broccoli, can protect bones, in reality many vegans don’t actually gratify their calcium requirements. As a result, they have found a 30% increased risk of fracture in vegans compared to vegetarians and meat eaters.

” More research is still needed to understand possible differences in fracture risks and whether any differences are related to diet or other factors ,” says Tong.” For example, low BMI has also been linked to higher risks of some fractures and in some studies vegans exhibit lower BMI and bone-mineral density than do vegetarians .”

Because of these concerns, some research groups have begun comparing veganism to other diets rich in plant-based foods, which are associated with many of the same benefits, such as the Mediterranean and New Nordic diets. Earlier this year, researchers at Sheffield Hallam University conducted a pilot study comparing a Mediterranean and vegan diet over a short-term period, with intriguing outcomes. While both diets appeared to offer similar positives in terms of weight-loss and reduced cholesterol, proof was much stronger for a Mediterranean diet when it came to improving blood-vessel health.

” Our findings suggested that the Mediterranean diet improved the route that the endothelium of the small veins run ,” says Markos Klonizakis, one of the scientists who operated the study.” This might not sound important, but it is. This becomes dysfunctional over time so it is crucial for cardiovascular health. The magical of the family of Mediterranean diets is that they are tested and proved over a very long period of time, in a relatively large area of countries around the world. For example, we know that traditionally people in Crete lived long and had low rates of diabetes and cancer .”

So what next for veganism? Scientists across the board agree that we don’t yet know enough to decide conclusively one way or another, but as many point out, the success of any diet ultimately comes down to the eating habits of the individual.

” The success of a vegan diet will rest on the conscientiousness of the individual undertaking it ,” says Rogerson.” It’s restrictive and unless we pay attention to the elements of the diet that it excludes, then we might be putting ourselves at risk of developing deficiency-related problems. It has become easier to follow with vegan-friendly food products in supermarkets, which are fortified with nutrients that can be absent from the diet.

” Another phase is that people who choose to adopt a vegan diet might be more inclined to adopt health-related behaviours than the norm. Such groups might be more inclined to exert and be aware of the nutritional adequacy of the foods they eat. We need to look at this further .”

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Weight loss linked to healthy eating not genetics, study finds

Participants who ate the most vegetables and consumed the fewest processed foods, sugary drinks and unhealthy fats shed the most kilograms

The amount and quality of food and not a person’s genetics will lead to weight loss, a US study has found.

It has been suggested that variations in genetic makeup make it easier for some people to lose weight than others on certain diets.

To test this theory researchers at Stanford University conducted a randomised control trial involving 609 overweight adults, who all underwent genetic and insulin testing before being randomly assigned to either a low-fat or low-carb diet for 12 months.

Gene analysis identified differences are connected with how the body processes fats or carbohydrates. But weight loss averaged around 5kg to 6kg at follow-up regardless of genes, insulin levels or diet type.

What seemed to make a difference was healthy eating, researchers said.

Participants who ate the most vegetables and devoured the fewest processed foods, sugary drinks and unhealthy fats lost the most weight.

Prof Lennert Veerman from the School of Medicine at Griffith University in Queensland said the study presented there was probably no such thing as a diet right for a particular genetic make-up.

” We feed to fill our belly and, if that’s with veggies, we tend to lose weight, whereas if it’s with chocolate or French fries, flushed down with a soda, we gain weight ,” Veerman said.

The study was published Tuesday in the Journal of the American Medical Association.

Participants had 22 health education class during the study and were encouraged to be physically active but the focus was on what they ate.

They were advised to choose high-quality foods but were not given indicated calorie restrictions nor were they provided with specific foods. Outcomes are based on what they reported eating.

Fat intake in the low-fat group averaged 57 grams during the study versus 87 grams beforehand, while carb intake in the low-carb group averaged 132 grams versus 247 grams previously.

Both groups reduced their daily calorie intake by an average of about 500 calories.

The leading Australian nutritionist Dr Rosemary Stanton, from the school of medical sciences at the University of New South Wales, said the “excellent” study highlighted the importance of eating plenty of vegetables.

Stanton advises people to attempt professional help to choose quality foods because the macronutrient content of of a diet” does not really matter “.

” Some previous studies that have damned carbohydrates have not taken note of the foods that rendered it ,” Stanton said.” For instance, lentils and lollies are both’ carbs’ but one is a nutrient-dense high quality food while the other is junk. Simply calling them’ carbs’ does not provide this vital distinction .”

While most diets worked, the real challenge was sticking with them, Veerman said.

” Instead of’ going on a diet’ it would be better to find new, healthier habits ,” he said.

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Dopamine fasting: why Silicon Valley is trying to avoid all forms of stimulation

Its the most recent developments trend in the worlds tech capital. But is it really possible to cut yourself off from everything in life that excites you and can it be any good for you?

They have done biohacking, clean sleeping and the keto diet, but now Silicon Valley types have coined a new health tendency- dopamine fasting. It is thought that depriving yourself of the neurotransmitter, a chemical messenger that motivates us to do things, can help to reboot or rebalance the brain. Fasting might necessitate abstinence from technology, artificial lighting, food, drink, conversation, eye contact- basically anything that an individual discovers inducing. But is there any sense to the fad?

” Retreating from life probably attains life more interesting when you come back to it ,” says David Nutt, director of the neuropsychopharmacology unit in the division of brain sciences at Imperial College London.” Monks have been doing it for thousands of years. Whether that has anything to do with dopamine is unclear .”

It is possible to manipulate the production of dopamine through diet, Nutt says. He mentions the velvet bean, which contains high concentrations of a precursor to dopamine.” There is no question that you can have a dietary influence on the production of dopamine ,” he says. “Starvation would probably reduce dopamine to some extent.”

Dopamine is often thought of as a reward, but Joydeep Bhattacharya, who results the research group of cognitive and neuroscience at Goldsmiths, University of London, points out that dopamine is really” about learning the anticipation of the reward, and not the pleasure itself. It is primarily released in this anticipation phase .”

This could counteract dopamine fasting because abstinence might trigger a greater number of thoughts about the things from which a person is abstaining.” The moment we try to abstain, naturally our brain will crave that- so there will be more of a dopamine release .” Similarly, anyone who abstains and has a sense of occasion about the abstinence would be in danger of triggering the production of dopamine, as would a person who periodically congratulates themselves on their abstinence during the course of its abstinence.

Rather than casting this sort of intense, time-limited disengagement as a dopamine fast, it may be better seen as meditation. But dopamine-related hazards lurk there, too. As Nutt, who has studied the production of dopamine in monks, says:” If you transcend in meditation, you might get euphoria, a release of dopamine .” It would seem nowhere is safe.

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Routine sense of smell tests could be used to spot signs of dementia

Impaired smell in later life can be an early warning of neurodegenerative and heart diseases, research suggests

Olfactory tests could help physicians spot older adults who find themselves in greater risk of developing dementia, researchers say.

The sense of smell is known to deteriorate with age. However, researchers have previously procured it might also hint at health problems: older adults who struggle to identify odours have a greater chance of dying in the near future regardless of how old they are.

Other studies have found older adults who have difficulties in identifying and remembering reeks are more likely to have characteristics linked to a greater risk of developing Alzheimer’s disease even if there is no current sign of cognitive decline.

It is thought the sense of smell is one of the first faculties affected by certain neurodegenerative diseases.

Now experts say they have probed further, and those cancers alone do not explain why a poor sense of smell might bode ill.

” My mistrust is[ the] process of aroma in older adults probably has much broader potential health implications than what we already know about ,” said Prof Honglei Chen, a co-author of the research from Michigan State University. He suggested it could be linked to conditions of the immune system and even psychiatric disorders.

Writing in the Annals of Internal Medicine, researchers in the US and Sweden report how more than 2,200 people aged between 71 and 82 undertook stench identification exams near the turn of the millennium, which were then followed up over 13 years. The test involved participants reeking 12 different common odours, such the aroma of strawberries, and choosing the identity of each from four possible answers.

The team then grouped participants into ” good “, ” moderate” or “poor” sense of smell, depending on how many correct answers they gave. They also looked at the causes of death among participants who passed away during the research period. When the team took into account factors including age, sexuality, race, smoking and general health at the outset, they found that a poor sense of smell was linked to a 46% greater risk of dying within 10 years compared with those ranked as having a good sense of smell.

The researchers concluded that this trend held regardless of the sexuality or race of participants, but the link was only present among those who were in very good health in the early stages of the study.

The researchers say that could be because those in poor health had many factors that might influence the length of their life, overwhelming any effect linked to a poor sense of smell.” On the other hand, poor olfaction among older adults with excellent to good health may be an early warning sign for insidious adverse health conditions that eventually lead to death ,” the authors write.

They observed a poor sense of smell was linked to death from dementia and Parkinson’s cancer, with some signs that poor stench might also be linked to death from cardiovascular disease. There was no link between poor sense of smell and death from cancer or respiratory diseases.

Further analysis revealed 22% of the overall increased risk of demise among those with a poorer sense of smell was down to neurodegenerative diseases, with 6% down to weight loss.

The team said the remaining association with mortality was probably down to health conditions that had not yet been identified as being linked to smell. Once that was unpicked, said Chen, it could be worth adding a stench test to general health screening.

However, others point out here that it was unclear if the results held among younger adults, while the sense of smell was only tested once. What’s more, the apparent link between the sense and mortality could be down to factors that affect both but were overlooked.

Prof Jayant Pinto, from the University of Chicago, who has carried out previous research in the area, welcomed the study.” While we still need to understand what exactly a poor sense of smell is signalling in terms of specific mechanisms that lead to increased risk of demise, it seems clear that impaired olfaction is an early warning sign of both cancers such as Alzheimer’s and Parkinson’s, as well as heart disease ,” he said.

” I’m an advocate of more widespread employ of smell testing in general practice since it can signal these major health problems in the future ,” he added.” Even if we don’t yet have therapies for[ Alzheimer’s or Parkinson’s disease], better scrutiny of such patients might help us care for them and plan for the future for patients and families .”

Read more:

Weight loss linked to healthy eating not genetics, study determines

Participants who ate the most veggies and ingested the fewest processed foods, sugary drinks and unhealthy fats shed the most kilograms

The amount and quality of food and not a person’s genetics will lead to weight loss, a US study has found.

It has been suggested that variations in genetic makeup make it easier for some people to lose weight than others on certain diets.

To test this theory researchers at Stanford University conducted a randomised control trial involving 609 overweight adults, who all underwent genetic and insulin testing before being haphazardly assigned to either a low-fat or low-carb diet for 12 months.

Gene analyses identified differences are connected with how the body processes fats or carbohydrates. But weight loss averaged around 5kg to 6kg at follow-up regardless of genes, insulin levels or diet type.

What seemed to make a difference was healthy eating, researchers said.

Participants who ate the most veggies and ate the fewest processed foods, sugary beverages and unhealthy fats lost the most weight.

Prof Lennert Veerman from the School of Medicine at Griffith University in Queensland said the study demonstrated there was probably no such thing as a diet right for a particular genetic make-up.

” We feed to fill our stomach and, if that’s with vegetables, we tend to lose weight, whereas if it’s with chocolate or French fries, flushed down with a soda, we gain weight ,” Veerman said.

The study was published Tuesday in the Journal of the American Medical Association.

Participants had 22 health education class during the study and were encouraged to be physically active but the focus was on what they ate.

They were advised to choose high-quality foods but were not given suggested calorie limits nor were they supplied with specific foods. Results are based on what they reported eating.

Fat intake in the low-fat group averaged 57 grams during the study versus 87 grams beforehand, while carb intake in the low-carb group averaged 132 grams versus 247 grams previously.

Both groups reduced their daily calorie intake by an average of about 500 calories.

The resulting Australian nutritionist Dr Rosemary Stanton, from the school of medical sciences at the University of New South Wales, said the “excellent” study highlighted the importance of eating plenty of vegetables.

Stanton advises people to attempt professional help to choose quality foods because the macronutrient content of of a diet” does not really matter “.

” Some previous studies that have damned carbohydrates have not taken note of the foods that furnished it ,” Stanton said.” For instance, lentils and lollies are both’ carbs’ but one is a nutrient-dense high quality food while the other is junk. Simply calling them’ carbs’ does not provide this vital distinction .”

While most diets ran, the real challenge was sticking with them, Veerman said.

” Instead of’ going on a diet’ it would be better to find new, healthier habits ,” he said.

Read more:

Don’t be in any doubt- ADHD is an illness and it must be treated | Ann Robinson

Britain is right to take a more cautious approach than the US, but we should be prepared to fund a range of treatments, says GP Ann Robinson

Imagine a neurological condition that affects one in 20 under-1 8s. It starts early, causes significant distress and ache to the child, injuries families and limits the chances of leading a fulfilled life as an adult. One in 20 children are affected but only half of these will get a diagnosis and a fifth will receive treatment. If those stats related to a familiar and well-understood illness, such as asthma, “theres been” little debate about the need to improve intervention rates. But this is attention deficit hyperactivity disorder( ADHD ), and the outcry is muted. If anything, we hear warnings that too many children are being labelled this route, and too many given prescriptions.

In the United States, ADHD is diagnosed at more than twice the incidence in Britain. The true prevalence is likely to be the same on both sides of the Atlantic. So what’s the story? Is the US too gung-ho, or is the UK dragging its heels? Are American doctors too quick to medicate infants, or British physicians too slow?

Emily Simonoff, co-author of a new meta-analysis in the publication the Lancet Psychiatry, says the problem in the UK is” predominantly about undermedication and underdiagnosis “. Her study examined a range of drug treatments compared to placebo, and it shows that methylphenidate( better known by for the purposes of the brand name Ritalin) works best for children and amphetamines for adults.

It can seem counterintuitive that stimulants work for ADHD. In fact, both therapies are thought to increase the activity of the chemicals dopamine and noradrenaline in the brain, neurotransmitters that play a role in executive functions such as learning, planning and exerting control over our behaviour and believes. The side-effects such as agitation, weight loss, sweating, sleep disorder and high blood pressure can occur whether you take the drugs for ADHD or recreationally. The difference is that people with ADHD are more likely to benefit, and prescribed dosages are carefully controlled and monitored. As an NHS GP, I can only prescribe these medications employing a special protocol that lays down follow-up arrangements. The idea that we dole them out in a cavalier manner is just not true.

ADHD isn’t some sort of catch-all term for bad behaviour, but a clearly identifiable defined of symptoms( including inattention, impulsivity and hyperactivity ), with strict diagnostic criteria and evidence-based treatment alternatives. People with neurodevelopmental disorders such as ADHD, autism, dyslexia, dyspraxia and dyscalculia have brains that are structurally and functionally different to those of neurotypical people. It’s a widespread misconception that ADHD equates to disruption in classrooms; a more common presentation is anxiety and difficulty with learn.” A kid with ADHD may be well-behaved and academically able ,” says Tony Lloyd of the ADHD Foundation. Identifying that there is a problem and providing the right subsistence is critical.

So where does the scepticism about ADHD come from? Perhaps it’s an understandable reluctance to label kids while they are still developing, or a wariness about medicalising normal variation in behaviour. Oftsted’s chief inspector, Amanda Spielman, speaks for many when she voices concerns that the narcotics used in the treatment of ADHD are a” chemical cosh”, are overprescribed and disguise bad behaviour that should be managed in other ways.

There is no doubt that rates of prescription for ADHD in the UK have risen significantly since the 1990 s. The prospect of a US-style situation in which one in ten children aged two to 17( rising to one in five sons aged 14 to 18) are diagnosed with ADHD, and two-thirds of those diagnosed are on medication, creates justifiable questions. But this scenario is a long way from current realities in the UK, where the NHS enforces vigorous diagnostic guidelines and, crucially, there are no financial incentives for NHS doctors to write prescriptions.

Caution about the action of psychoactive drugs on developing brains is entirely appropriate. The short-term safety data we have is reassuring, though more research is needed into long-term impacts. But this caution has to be weighed against the harms, if other therapies aren’t suitable or effective, of doing nothing. Without diagnosis and treatment, infants become prone to anxiety, self-harm and school failing. Around a third will continue to have problems into adulthood and some people will only be diagnosed once they are adults.

Earlier this year a Demos report highlighted the social and economic cost to society of adult ADHD, as impulsivity, poor concentration and risk-taking behaviour interfere with work and relationships. The inability to regulate feelings and tendency to become overloaded by external stimulu has been described as” like driving a Ferrari with bicycle brakes “.

Treatment for ADHD doesn’t always or only mean drug; the National Institute for Health and Care Excellence’s guidelines recommend a multimodal approach including support for mothers, cognitive behavioural therapy( CBT) and stress-reduction strategies. Lloyd says the Nice guidelines are great but mostly aren’t being followed. My experience as a GP would certainly back that up. Children tend to be seen quicker than adults, but often the only treatment dedicated is medication, with other interventions such as parenting support and CBT failing to materialise.

The cautious UK approach to ADHD may be preferable to the more enthusiastic US one. But it would be a shame to let scepticism get in the way of good medication. And that entails casting aside any doubt that ADHD is a medical condition, and demanding funding for a range of treatments, including but not limited to drugs. Unfortunately, it seems that is still a long way off.

* Ann Robinson is a GP

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Both low- and high-carb diets can create hazard of early death, study detects

Eating a moderate amount of carbohydrates best for healthy lifespan, say researchers

Eating either a low-carb diet or a high-carb diet creates the risk of an early death, according to a major new study which will dismay the many people who have ditched the likes of bread, rice and potatoes for weight loss or health reasons.

Researchers who pooled the results of eight big studies have found that eating a moderate sum of carbohydrates is best for a healthy lifespan. Less than 40% or more than 70% of calories from carbohydrates carried a higher risk of mortality.

Not all low-carb diets are equal, however. People who ate a lot of meat and fats instead of carbohydrates, such as lamb, chicken, steak, butter and cheese, had a higher mortality risk than those who got their protein and fats from plant-based foods such as avocados, legumes and nuts. Popular weight loss diets such as Atkins and Dukan include a substantial amount of meat-based foods.

Quick guide

Carbohydrates in your diet

Low carb diets have become a trend. Cutting the carbs can lead to weight loss for a few weeks, but while there are bad carbs we don’t need, such as sugary beverages and sweets, there are also good “starchy” carbs that we do, because they are high in fiber and vitamins and minerals and give us a slow and steady release of energy throughout the day. These include wholewheat pasta and flour, vegetables with their skins on, and beans and lentils.

Low carb diet

Low carb diets have become very popular for weight loss, but you have to make up for the loss of filling carbs with extra protein and fats. Low carb diets tend to advocate animal proteins and fats, like steak and cheese. While they don’t include sugary treats and soft drinks, they are also usually light on vegetables and fibre. Popular low carb diets include: Atkins, Paleo, South Beach, Dukan and ketogenic.

High carb diet

Not a weight loss diet, clearly, but a way of life. The general diet of people in Asian countries, particularly those with low incomes, tends to be high in carbs because of the amount of white rice that is eaten. Those in more affluent western countries who eat a lot of carbs are likely to be overdoing the sugary beverages and snacks.

Moderate carb diet

Most people in the western world get around half their calories from carbohydrates, which is how it should be, say nutritionists. That’s 50 -5 5% of your energy from carbs. The issue, however, is over which carbs these are. The famously healthy Mediterranean diet, for example, contains lots of fibre-rich whole grains and beans. A diet in which the carbs come from biscuits and soft drinks and has little in the way of fruit and veg is not good, however moderate the carbohydrate uptake is.

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” Low-carb diets that replace carbohydrates with protein or fat are gaining widespread popularity as a health and weight loss strategy ,” said Dr Sara Seidelmann, a clinical and research fellow in cardiovascular medication from Brigham and Women’s Hospital inBoston, who led the research published in the Lancetpublichealth journal.

” However, our data suggests that animal-based low-carbohydrate diets, which are prevalent in North America and Europe, might be associated with shorter overall life span and should be discouraged. Instead, if one chooses to follow a low-carbohydrate diet, then exchanging carbohydrates for more plant-based fats and proteins might actually promote healthy ageing in the long term .”

Seidelmann, who is both a cardiologist and a nutritionist, told the Guardian the team had published a substantial body of work” to exhaustively answer a question and not simply offer merely one piece of the picture “.

” Nutrition is high up on everybody’s intellect but there is such embarrassment about what we should eat. One day, a study is coming out telling us high carb is better, another day a study is telling us low carb is better .”

Trials to compare low-carb and high-carb diets immediately are not possible, because they have to be carried out over many years and people find it hard to stick to a diet over any duration of period. Instead, her squad carried out observational research with more than 15,400 people, aged 45 to 64, from diverse socio-economic backgrounds from four US communities who were enrolled in the atherosclerosis risk in communities study. Those people filled out questionnaires on their eating patterns on two occasions, six years apart. Their health was followed up for 25 years, allowing for factors that might alter the results, such as smoking, income and diabetes.

These results were pooled with seven other observational studies carried out in various regions of the world, involving a total of more than 430,000 people.

They found that 50 -year-olds eating a moderate carb diet, with half their energy coming from carbohydrates, had a further life expectancy of 33 years, which was four years longer than those on low-carb diets and one year longer than those who feed a high-carb diet.

The writers said they could not prove cause and effect, because of the nature of the studies. However, they said people who embraced western-type diets that heavily restricted carbohydrates often ate fewer veggies, fruit, and grains and more animal proteins and fats. Some of those animal products have been implicated in stimulating inflammatory pathways, biological ageing and oxidative stress, and could be a contributing factor to the increased risk of mortality.

High-carb diets are common in Asian and poorer nations, they said, where people eat a lot of refined carbohydrates such as white rice. Those also contribute to a chronically high glycaemic load and worse metabolic outcomes.

” These findings bring together several strands that ought to have controversial. Too much and too little carbohydrate can be harmful but what counts most is the type of fat, protein, and carbohydrate ,” said Walter Willett, a prof of epidemiology and nutrition at Harvard T H Chan School of Public Health and the co-author of the study.

Low-carb diets are popular for weight loss because they work quite well in the short term, said Seidelmann, and they are usually meat-based. The study was not set up in a way that would make it possible to compare moderate carb with low-carb plant-based diets but, said Seidelmann,” the more plant-based[ the diet was ], the lower the mortality “.

” No facet of nutrition is so heatedly argued on social media than the carb versus fat debate, despite the long term evidence on health benefits firmly supporting the higher carb argument ,” said Catherine Collins, an NHS dietitian.

The” cult of low carb high fat eating” was based on a lifestyle choice and the flimsiest of evidence, she said. Its devotees were” at odds with advice from WHO and government health bodies globally- including the UK’s Public Health England- that recommend a carb intake to provide around half our daily calorie needs “.

She added that it the findings raise questions about the current hyping of low-carb diets for people with diabetes.” The feting and promotion of GPs promoting often bizarre low carb diets to manage diabetes has gained much media traction ,” she said.” If nothing else, this study offer some redress to this one-sided debate, and adds caution to such practice for long term management .”

In a commentary in the publication, Dr Andrew Mente and Dr Salim Yusuf, from McMaster University in Canada, said it was not possible to rule out altogether all the factors that might skewed the results, but that the findings were that logical and moderate carbohydrate intake was likely to be better for people than low or high-carb diets.

” Essential nutrients should be consumed above a minimal level to avoid deficiency and below a maximal level to avoid toxicity. This approach maintains physiological processes and health( ie, a so-called sweet spot ). Although carbohydrates are technically not an essential nutrient( unlike protein and fats ), a certain amount is probably required to meet short-term energy demands during physical activity and to maintain fat and protein uptakes within their respective sweet places ,” they wrote.

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The Collapse of a $40 Million Nutrition Science Crusade

On Monday night Gary Taubes will board his second transatlantic flight in a week–from Zurich to Aspen–then eventually back to Oakland, where he calls home. The crusading science journalist best known for his beef with Big Sugar is beat after four days of nutrition conference glad-handing. But there’s no rest for the down and out. Taubes is on a desperate money-raising mission for the Nutrition Science Initiative–his nonprofit dedicated to improving the quality of nutrition research.

NuSI( pronounced new-see ) launched in September 2012 with much fanfare, including in the pages of WIRED. It rapidly created more than $ 40 million from big-name donors to facilitate expensive, high-risk studies intended to illuminate the root causes of obesity. Taubes and his cofounder, physician-researcher Peter Attia, contended that nutritional science was so inconsistent because it was so expensive to do right. With a goal of raising an additional $ 190 million, they wanted to fund science that enables you to cut the prevalence of obesity in the US by more than half–and diabetes by 75 percent–by 2025.

Rehabilitating the entire field of nutrition research was always a long shot. But six years in, NuSI is nowhere near achieving its lofty ambitions. In fact, the once-flush organization is break, president-less, and all but gone. It’s been three years since it last tweeted, two years since it’s had a real office; today NuSI consists of two part-time employees and an unpaid volunteer hanging around while Taubes tries to conjure a second act.

Because while he’s nearly out of money, Taubes is not yet out of ideas. This time, though, that might not be enough.

When Taubes and Attia first hatched their “Manhattan Project for nutrition, ” they planned to work on it nights and weekends, crowdsourcing monies from the low-carb corners of the internet. They didn’t think it would be too difficult; between a 2002 New York Times cover story titled “What If It &# x27; s All Been a Big Fat Lie ?” and his best-selling book Good Calories, Bad Calories , Taubes had become the country’s anti-sugar agitator-in-chief. Then, in 2011, Taubes received an email from a former natural gas trader named John Arnold who wanted to help.

In May 2012, just weeks after announcing his and his wife’s new charity aimed at reforming iffy areas of science, the John and Laura Arnold Foundation devoted NuSI a $4.7 million seed to be given to do nutrition research right. In 2013 they followed that up with an additional $ 35.5 million commitment over five years, inducing them NuSI’s lead funder.

At the heart of their mission was the decades-old question of whether all calories are, in fact, created equal. The mainstream view is that it’s simply an excess of calories that makes people fat–no matter whether those calories comes here a bagel or a steak or a bowl of broccoli. Taubes and Attia subscribe to a growing minority posture, dubbed the carbohydrate/ insulin or C/ I hypothesis, that argues obesity is caused by an excess of insulin driving energy into fat stores. In other terms, sugar makes people fat.

Taubes and Attia thought those questions needed a more streamlined research approach to get real answers. So they formed NuSI to funnel fund into a rigorous new situate of studies, while leaving scientists with the experimental independence that would shield their results from bias.

With the Arnold money in hand, Taubes and Attia started recruiting top researchers in 2012 to conduct four initial studies. They purposefully brought on people who disagreed with them, like Kevin Hall, a senior examiner at the NIH’s National Institute of Diabetes and Digestive and Kidney Diseases, whose mathematical models predicted that a low-carb, low-insulin diet would have only a tiny impact on calorie-burning. He would head up one of NuSI’s first studies, dubbed the Energy Balance Consortium.

The EBC’s pilot project would lock 17 overweight men inside metabolic wards for two months, feeding them precisely devised snacks and pricking and prodding to see what happened to their bodies on a low-carb diet. If it stimulated them burn calories faster, a follow-up study would do the same exams on a bigger group of people. If the effect was minimal, researchers would then test the effect of low-carb diets on hunger.

Hall was skeptical they would find anything to support the carbohydrate/ insulin hypothesis. But he was assured by the terms of the contract; NuSI would have no control over the pilot study’s design, operation, or reporting. He could build the study he wanted.

At first, things went according to plan. The EBC researchers met with NuSI quarterly to finalize the study’s design and clinical procedures. NuSI signed a consulting agreement with Dr. Jeff Volek–author of the book The Art and Science of Low Carbohydrate Living — to create the diets and menus.

By August 2014, the EBC researchers had preliminary results on their 17 volunteers: The data showed “no significant difference” in energy expenditure. That didn’t mean it was a failure; to the researchers, they had succeeded in verifying the methodology before using it in an even bigger, longer study. “We had to work out these rather complex logistics of get common food sources distributed among many institutions, ” says Rudolph Leibel, one of the consortium scientists working on the pilot at Columbia. “It looked like something the Allies would have organized for all the landings on D-Day.”

But when Hall presented the pilot’s outcomes in person to representatives from NuSI at a meeting in Bethesda in September, they were not so rosy-eyed. NuSI wanted to see the data, and it began providing extensive critiques once they had it.

Taubes in particular had issues with many of the study’s designs, which fed participants a “standard American diet” for four weeks before switching them to an extremely low-carb, or ketogenic, regimen with the same amount of calories. It was supposed to get them to a stable weight, or energy balance, to establish a baseline before running keto. But the subjects all lost weight even before they started cutting out carbs. Taubes contended that was because the standard diet didn’t have enough refined sugary liquors to depict median American consumption.

“From my perspective, the pilot was a failure for several reasons, ” Taubes says. “First, it failed to get people in energy balance in the run-in period, and that was a necessary condition to interpret the findings.” In addition, he points out, the design didn’t include a group of non-dieters, and non-randomized trials do not allow for firm conclusions about causality, conditions that everyone in the group knew going in. In his eyes, all the pilot told them was that their method was flawed. “If this was an animal study, they’d have hurled them out, ” he says. “Euthanized them and started over.”

But NuSI had already spend$ 5 million of the Arnold’s money, and everyone was eager to get to the second phase of the study. As they worked out the details through 2015, the relationship between EBC and NuSI continued to fray. “There was not a real team, ” says Eric Ravussin, EBC’s co-principal investigator and director of Pennington’s Nutrition Obesity Research Center. “As scientists we were in agreement over the pilot results and the new protocols, but NuSI had some concerns. It eventually simply became us versus them.”

According to Hall and Ravussin, NuSI began to push back, in a way that they felt jeopardized their ability to do good science. In April, the EBC researchers sent NuSI an email requesting to re-establish their academic freedom.

Emily Waite

As 2015 turned into 2016, the relationship between the EBC researchers, NuSI, and the Arnold Foundation deteriorated even further. At the end of December, Attia quietly resigned from the organization. Sources close to him say he was unhappy being a full-time fund-raiser; he wanted to get back to research.

NuSI scrambled to fill Attia’s position as chairwoman, first with Christopher Ochner, a psychiatrist at the Icahn School of Medicine at Mount Sinai, and a few months later with Julie Eckstrand, NuSI’s then-director of clinical operations, who has since left. At the beginning of 2016, NuSI’s yearly contract with the Arnold Foundation was replaced by a series of three-month bridge contracts, with marching orders to downsize. The squad of 15 full-time employees and major contractors shrunk to a skeleton crew that could manage the three remaining studies. NuSI shuttered its San Diego headquarters and became a virtual organization.

Things came to a head at a session in January 2016. In front of John Arnold, NuSI directors Taubes and Mark Friedman openly quarreled with Hall and his colleagues about what was really necessary to run a good study. Hall had had enough. At the end of the session he stepped down from his role with the EBC, citing changing expectations about the structure and practise of the NuSI collaboration.

As the remaining researchers continued to clash with NuSI over the summer about the second phase, the pilot outcomes were finally published in the American Journal of Clinical Nutrition in July. They received a lot of media attention, in no small part because Hall said the pilot, along with another study he’d conducted previously, “basically falsify” the theory that sugar makes people fat. By the end of the summer, the Arnold Foundation had decided not to fund the second phase of the study.

After that, NuSI stopped getting checks from the Arnolds. But the foundation didn’t stop funding research into the carbohydrate/ insulin question. That fall they opened their search to the wider world, putting out a call for proposals for “rigorous research projects that will assess the role that sugar and/ or macronutrients are participating in metabolic the replies and fat accumulation.”

The Arnold Foundation declined to respond to specific questions about how it came to end its relationship with NuSI about $14 million short part of its commitment. A spokesperson emailed the following statement: “This research was designed to answer scientific questions in the fields of nutrition and obesity. While the foundation no longer immediately supports NuSI initiatives, we continue to fund work in the field of nutrition science and remain open to further investments in this area. The NuSI project was a worthwhile effort and remains an important health-related issue for Americans today.”

It’s still too soon to assess what NuSI has added to the nutrition science canon. Outcomes from the two outstanding NuSI-backed studies are due later this year. The fourth and largest one, conducted at Stanford, randomized 600 overweight-to-obese topics into low-fat versus low-carb diets for a year and looked at whether or not their weight loss could be explained by their metabolism or their DNA. Published this February in JAMA , the study detected no differences between the two diets and no meaningful relationship between weight loss and insulin secretion. The most significant finding was that it’s hard to stick to a diet for a whole year.

Obesity docs like Yoni Freedhoff, a prof of family medicine at the University of Ottawa, aren’t astounded that NuSI hasn’t sparked an epistemological revolution. “From the outset, their approach was simply that knowledge will be enough to drive behavior, ” says Freedhoff, who has argued that efforts to prove one diet is better than another do a disservice to patients by implying there’s only one right route to lose weight. He’d love to see research dollars be spent instead on studying how to improve adherence to different eating strategies.

Taubes says the fund-raising trip to Zurich went well, though he won’t share specifics. It could just be the plane lag, or it could be the mental burden of having to sing for his supper, but Taubes audios tired. “I say this to my wife all the time:’ Maybe I’m a quack.’ All quacks are sure they’re right. Isn’t that the defining characteristic of a quack? But the fact is that we money four studies, and the three randomized trials were highly successful operationally. One of these has been published in a top journal with interesting results, and I remain hopeful that we will soon see if the last two studies will move some needles. Our sentences have gotten us this far, and despite some frustrations, these questions still seem vitally important to test.”

Taubes is optimistic that NuSI is just evolving into something a bit more humble. Between its current coffers and the agreements he’s working on, he supposes NuSI can stay afloat for several years, eventually supporting more outside research, though on a much more modest scale. He’s get ideas about instituting a scientific oversight committee to make sure everyone agrees on methods and statistical analysis from the outset.

But he’s also starting to think about how to go back to the life he had before NuSI, living conditions of a journalist. He’s get more articles and volumes he still wants to write , not exclusively about sugar. But it’s tricky. “I know I clearly have conflicts that other journalists only don’t have, and that’s a tightrope I haven’t figured out how to walk yet, ” Taubes says. “This nutrition science crusade–right or wrong–expands easily to fill all the time in my life that can be allotted to work. So I’m going to figure out how to partition time better in the future.”

In between flights and conference dinners, he’s been checking his email for notes on an upcoming article about a new kind of observational study that uses genetic variation to mimic a randomized control trial. While the story isn’t strictly are attributable to nutritional science, Taubes now has the kind of conflicts of interest that make publications wary. He’s working with a new editor and a new outlet after his old editor at Science wouldn’t touch it. Taubes founded NuSI to support objective science; now, it &# x27; s his own objectivity he has to defend.

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Silicon Valley Wants to Cash in on Fasting

Like most of the health fads that catch on in Silicon Valley, this one broke through thanks to word-of-mouth–and a Medium post. Entrepreneur Sumaya Kazi extolled its virtues to 650,000 readers, while venture capitalist Phil Libin and others preached about it to anyone who would listen. Their miraculous notion was in fact a very old one: eating nothing at all for long stretches of day. Monthly Google searches for” intermittent fasting ,” which has become a catchall words for various forms of the practice, have risen tenfold over the past three years, to as many as 1 million. That’s about as many as “weight loss” gets, and more than ” diet .” Now comes the next step, as industries try to turn various forms of the furor into profit.

The idea may sound troubling depending on your relationship with food, but paid-for fasting regimens are finding a new audience in the Valley, partly because they’re framed in terms of productivity , not only weight loss.( Fasting falls under the techy-sounding buzzword “biohacking,” like taking so-called smart pills or giving your brain tiny shocks .) There’s a growing body of research and anecdotal evidence depicting a link between periods of noneating and increased focus and output, and perhaps even longer life.” Periods of nutrient regulation do good things ,” says Peter Attia, whose medical practise focuses on the science of longevity.” The subjective benefits are evident pretty quickly, and once people do it, they realize–if this is going to give me any benefit in my performance, then it’s worth it .”

Global search activity for” intermittent fasting”

As measured by Google Trends index*

Data: Google Trends

* Highest phase indexed to 100

As part of a diabetes-prevention program, PlateJoy, a meal-plan subscription app, promotes users to fast to shed pounds and lessen their risk of developing the disease. The company wouldn’t say how many customers it has, but about 20 million people are eligible to get the $230 -a-year coaching and progress-tracking program for free through their health insurer.( Insurers pay PlateJoy when their customers lose weight .) Co-founder Christina Bognet, a former health-care consultant and MIT-trained neuroscientist, says the plan fosters time-restricted feeding, in which practitioners eat only during a window of a few hours every day. Maintaining those restrictions, she says, has helped her keep off the 50 pounds she’s lost in recent years.

” We inform our patients to jump right into it ,” Bognet says.” We’re hearing from people who’ve said,’ I have not been able to get my weight to budge, but now I’m down 7 pounds in two weeks .’ This is life-changing .” Five-year-old PlateJoy is profitable and looking to raise venture capital to supplement a smidgen of early fund from Y Combinator, 500 Startups, and other incubators.

Hvmn( pronounced “human”) pitches clients mostly on productivity and performance. Its chewable coffee cubes and other dietary supplements are supposed to enhance focus and cognitive function. One product contains synthetic versions of ketones, compounds your body generates when it’s fasting long enough to burn fat. Hvmn markets the drink to athletes ($ 99 for three small vials) as a route to boost performance and accelerate recovery.” It’s more efficient fuel for the brain and body ,” says co-founder Geoffrey Woo, though he says they aren’t meant to replace the benefits of fasting.

Formerly known as Nootrobox, Hvmn has attracted more than$ 5 million in venture backing from the likes of former Yahoo! Chief Executive Officer Marissa Mayer and Zynga Inc. founder Mark Pincus. The technology behind its ketone beverage lies in more than a decade of research into supplements for combat troops, work financed by the Defense Advanced Research Projects Agency, the National Institutes of Health, and the University of Oxford.

Woo, who still fasts for 36 hours once a few weeks, also helped start WeFast, a set of Facebook and Slack forums with thousands of members that began as a weekly breakfast for Hvmn employees. Members post advice and encouragement, track their progress, and link to the latest scientific research on fasting.” This will be considered just like exercise ,” Woo says, adding that he expects fasting to become a multibillion-dollar industry.” Our problem is overconsumption, and that means reinstalling a new culture around eating .”

Valter Longo, a professor at the University of Southern California, has studied food restriction and longevity for decades. His research has shown that mice on fasting diets live longer and perform tasks better; that fasting in mice starves cancer cells and aids chemotherapy narcotics; and that a very-low-calorie diet can slow multiple sclerosis by killing off bad cells and producing new ones. He advocates multiday fasting and sells a five-day, $250 diet package that he says simulateds the consequences of a fast. The box, called ProLon, includes soups, drink mixes, breakfast bars, vitamin supplements, and even desserts, but the portions are small enough that the customer will take in only about 1,100 calories on the first day and about 750 on each of the next four.

Since its introduction in 2016, more than 52,000 people have tried ProLon. Longo’s company, L-Nutra, is targeting about $12 million in revenue this year and estimates that sales will more than double next year. L-Nutra and the research behind it have received close to $ 60 million in awards and investment capital, including the use of the NIH, the National Cancer Institute, the National Institute on Aging, and the U.S. Department of Defense. CEO Joseph Antoun says he’s aiming for reimbursement deals similar to PlateJoy’s with insurers and corporate wellness programs; he plans to take the company public within three years.

Even if you don’t remember the Valley’s last few health fads–Soylent, anyone ?–there are plenty of reasons to be skeptical of just how much these products are worth. Female rats on fasting diets has been demonstrated hormonal imbalances and ovary shrinkage. As for humans, there isn’t enough data on the long-term effects for doctors to reach a consensus. What is clear is that restricted-eating schemes can build people more susceptible to anorexia nervosa and other ailments, says Lauren Smolar, director of programs at the National Eating Disorders Association.

” We consistently find cases where people have tried to control their intake of food, and it’s led to an eating disorder ,” she says.” There ends up being this kind of reward feeling they’re going through, which triggers them to continue on this diet. And slowly this feeling of losing control, and not being able to know when to stop, can occur .”

Venture capitalist Libin, who lost 60 pounds fasting, recognises it isn’t for everyone.” It’s just something that works super well for me ,” he says.” I have more energy, more stamina, more mental lucidity. My mood is better–all of this stuff. And I’ve measured all of it .”

BOTTOM LINE – Startups focused on time-restricted feeding and low-calorie meal regimens plan to expand aggressively, but they may be a bit too far ahead of the science.

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