Low-carb diet vis-à-vis balanced diet

Dr. Turin Chowdhury

There is a growing sense of apprehension regarding the foods we take. People are becoming more and more concerned and conscious about their food habit. This indeed is a positive sign. Today we have far more variety of food items, much more variety of food ingredients in our kitchen than ever before. As a result of these changes, the food related problems such as obesity has taken the form of an epidemic.
   On the other hand, to fight this problems diet control issues has arisen among us. In relation to that around us we can see many schools of thoughts regarding the diets. Some are totally commercial in nature, or some are too much scientific to follow. Some promises to bring down the weight in no time, some gives logic against the established phenomenon of dieting. But the ultimate goals of these diets are to bring the excess body weight down. Leading research and medical societies advocate a low-fat, high-carbohydrate, energy-deficient diet to manage weight. Despite these recommendations, diets high in fat and protein and low in carbohydrate remain popular, and several best-selling books endorse this strategy for weight loss.
   
   Low-carb diet
   Among the diet principles, the most common and famously marketed one is the "low-carb diet". Low-carb means low in carbohydrates. Low-carbohydrate diet is based on the general recommendation of reducing nutritive carbohydrates to very low levels. This means reducing consumption of rice, breads, pastas, potatoes, and desserts or other sweet or starchy foods. Processed sugar should be eliminated, or at the very least greatly reduced. Heavily processed grains should be discouraged. On the contrary fat and fat-related food consumption are moderately restricted according to this plan.
   The famous diet ideas which are based on this low carbohydrate principal consists Atkin's Diet, High-Protein Diet, Stillman Diet, Ketogenic Diet, Zone Diet, etc. Whatever the name of these diets - they are based on the same principal of low-carb diet.
   
   Theory behind it
   As a normal natural phenomenon, carbohydrates raise blood sugar levels. In response to the raise in blood glucose our body initiates insulin secretions. Insulin drives blood sugar into the cells and prevents fat breakdown in the body, so we won't burn excess fat and lose weight. The low-carb diets proponents takes up from here. They say that, if carbohydrates raise blood sugar and as a result insulin levels also rise, this will cause weight gain. A decrease in carbohydrate intake will result in lower blood sugar and insulin levels, leading to weight loss. Due to less amount of available glucose, the body breaks down the preserved fat to provide needed energy which will result in weight loss. The aim of low carbohydrate diets is to force the body to use fat as its main energy source. Thus the reduction of fat will lead to weight loss. But the scientists say that some people do lose weight on low-carb diets in the initial stage of the diet following period, but the weight loss probably is not related to blood sugar and insulin levels to any extent.
   
   How it works
   In the short term, most people who go on low carb diets do lose weight and they lose it very quickly. Some factors are thought to contribute to weight loss with low-carb diets:
   Loss of water weight - When we initially decrease your carbohydrate intake, your body burns glycogen. Glycogen contains large amounts of water, so burning glycogen leads to the release of water and increased urination, causing weight loss. But this weight loss does not continue for long.
   Decrease in appetite - Burning fat without carbohydrates creates byproducts called ketones that build up in your bloodstream. When this happens, you may not feel as hungry. Some more developing ketones is very dangerous for diabetic patients, some times it may lead to emergency condition known as diabetic keto-acidosis.
   Reduce in caloric intake - Most low-carb diets, carbohydrates are limited or avoided, thus leading to a significant reduction in calorie intake. Reduction of calorie intake leads towards body weight loss.
   
   Side effects
   Critics against low-carb diet argue that these diets are not without harmful side effects. The lowered intake of dietary fibre, that often accompanies dramatically reduced carbohydrate intake, can result in constipation problems.
   Cutting out the carbohydrates may lead towards missing out on vital nutrients from healthy carbohydrate foods which should be part of any well-balanced diet, especially those from fruits, vegetables and whole grains. Some of this can be remedied by integrating various kinds of offal and fish into the diet. Most low-carb diets emphasise intake of carbohydrates as fresh vegetables instead of cereals and bakery products.
   
   Vital question
   Recent studies seem to indicate that low-carb diets may give some people an edge in losing weight. But can a low-carb diet help you lose weight safely and permanently? Scientists are not that optimistic yet, because there have not been many scientific reports regarding the long-term benefit of low-carb diet.
   
   Balanced diet
   We should also remember that, only being a low-carb or vegetarian does not guarantee high-quality health. Diets can be healthful and nutritionally sound if they are carefully planned to include essential nutrients. A well-planned diet is a healthy way to meet our nutritional needs. However, any diet can be unhealthy if it contains too many calories and not enough important nutrients. In the long run we need balanced diet of mixed type, moderate life style, and regular physical exercise to achieve the goal of good health. Low-carb or not low-carb, eating a well-balanced diet that makes available all the right nutrients generally gives platform for healthy living. Regular exercise and an active lifestyle also help regulate our health and fitness.

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Singapore Swing

Rayyan Kamal

Perceptions of the nightlife in Singapore are quite varied. I have heard it described as "monotonous," "jumping," "rich" and "stale" by different people. It isn't surprising that a country as rigid as Singapore -- where being caught in possession of more than 500g of cannabis will result in the death penalty, where you get caned for stealing, where you get fined for bringing durians (they're a malodorous fruit) into the subway -- might not be a party heaven for the more rambunctious. However, the party scene here is by no means stale.
   Zouk, arguably Singapore's most renowned nightclub, has an international reputation. It has been graced by the presence of such powerhouse DJ's as Fatboy Slim and Moby, I am told. Lonely Planet's classification of the nightclub's music as club/disco/electronic is pretty accurate. It has several floors, most of them playing the same music in variously themed spaces. Though hard to describe physically, I would say I preferred the spaces that were mellower in ambiance. The reason I had so much fun when I went there is probably not due to any of these perks, but, rather, because I went there at the end of my first week of a taxing internship along with my equally tired and ready-to-unwind flat mates.
   Another attraction the Singapore tourism board flaunts to no end is the Night Safari. There are a few walking trails, populated by animals in an open, natural-looking habitats that are kept at a safe distance from the viewer. The "Creatures of the Night Show" was definitely the low point. It's like being in a circus. A squirrel uses his nose to differentiate between two types of fruit that are odourless to humans. A snake "escapes," only to be found in a trap door conveniently placed below one of the seats. Several seals place a few recyclable items in the correct compartments: cans, bottles, plastic. Though some of this might sound amazing, trust me when I say that the exorbitant amount I paid to see a twenty-minute show was not worth the money. To top it all off, it started to rain cats and dogs halfway through the show, but our MC would not allow the spectators to open their umbrellas. "My animals have never seen umbrellas before. They will get scared." The saving grace was the tram ride, which takes you through many different ecosystems that exhibit everything from lions to zebras to giraffes to rhinoceroses to tigers. The highlight of the ride was when the people on my tram got to pet an anteater that happened to be crossing the road as we drove by.
   I should clarify something. I don't think the Night Safari is bad. I just think it's overrated. It's a lesser version of the zoo during the day, in my opinion. At the day zoo you get to see all the same animals plus more. Leopards. Hippopotamuses. Jaguars. Snakes. Even a polar bear. Again, almost none of the animals are caged, or at least it's not easily apparent that they are. This is a far cry from the conventional zoo where all the animals are kept in cubical cages. The day zoo definitely deserves all the praises it receives.
   Rayyan Kamal is a sophomore at Yale University.

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Drug cuts diabetes risk by 60pc

Dr Louise Chang, MD, Salynn Boyles and Miranda Hitti

A widely prescribed drug used to treat type 2 diabetes is also highly effective for preventing the disease, researchers reported last year at a meeting in Copenhagen, Denmark.
   People at high risk for diabetes who took the drug Avandia reduced their risk of developing the disease by 60 per cent in the three-year trial conducted in 21 countries.
   The risk reduction was double that reported with any other drug used for diabetes prevention, and on par with reductions that have been reported in studies examining lifestyle changes alone.
   The potentially landmark findings could usher in a new era of diabetes management similar to that already seen with heart disease, where drug therapies prescribed to prevent the disease become as important as those used to treat it, experts said.
   "If we can prevent diabetes, we may also be able to prevent the serious cardiovascular, eye, kidney, and other health consequences of diabetes," researcher Hertzel Gerstein, MD, tells WebMD.
   
   Millions at risk
   About 20 million Americans have type 2 diabetes, and millions more are considered to be at high risk for developing the disease. As many as 40 per cent of adults in the U.S. between the ages of 40 and 74 - or 41 million people-have prediabetes, according to government estimates, meaning that their ability to process blood sugars, or glucose, is compromised.
   The newly reported trial was designed to find out if treatment with Avandia substantially reduced the chances of developing diabetes.
   It included 5,269 people treated at 191 clinics around the world. The average age of the study participants was 55 and all had evidence of prediabetes with either impaired fasting glucose (blood sugar) or impaired glucose tolerance. Having prediabetes puts you at high risk for developing type 2 diabetes.
   Roughly half were treated with 8 milligrams of Avandia daily and half received placebo. Both groups were also given advice on how to lower their diabetes risk with diet and exercise, but study participants were not required to make lifestyle changes.
   After an average three years of treatment, 306 people taking Avandia had developed diabetes or died from any cause; that compares with 686 of the placebo-treated participants. And treatment with the diabetes drug was found to increase the likelihood that participants would revert from prediabetes to a normal blood sugar status by 70 per cent to 80 per cent compared with placebo.
   In a related trial involving the same patient population, the blood pressure drug Altace was not found to be effective for the prevention of diabetes. But 43 per cent of the people who took the drug reverted to normal glucose levels by the end of the study, compared with 38 per cent of placebo-treated participants. These results will be published in the upcoming issue of The New England Journal of Medicine.
   Gerstein presented findings from both the trials in Copenhagen at the 42nd annual Meeting of the European Association for the Study of Diabetes. The diabetes drug findings were also published in the Sept. 15 issue of the journal The Lancet.
   The study was funded by the Canadian Institute of Health Research, in conjunction with the pharmaceutical company GlaxoSmithKline, which markets Avandia, and King Pharmaceuticals, which markets Altace. GlaxoSmithKline is a WebMD sponsor.
   
   Avandia: Caution
   Not all the news from the Avandia trial was good, however. Fourteen of the people treated with the drug developed heart failure (0.5%), compared with just two people (0.1%) in the placebo arm of the study.
   "Balancing both benefits and risks suggests that for every 1,000 people treated with [Avandia] for three years, about 144 cases of diabeteswill be prevented, with an excess of four to five cases of congestive heart failure," the researchers wrote in The Lancet.
   American Diabetes Association president Larry C. Deeb, MD, tells WebMD that the finding means that the drug is not appropriate for all people at high risk for diabetes.
   "This probably isn't the drug to use in patients who have multiple risk factors for heart failure, and anyone with any risk factors should be monitored closely while they are on it," he says.
   Deeb points out that the reduction in diabetes risk reported by Gerstein and colleagues is almost identical to that seen with modest changes in lifestyle in a major, U.S. government-funded prevention trial.
   
   Avandia: heart risk?
   Study shows 43 per cent more heart attacks with Avandia. Drugmaker says study is flawed. Louise Chang, MD and Daniel J. DeNoon of WebMD Medical News Review said on May 21, 2007 that the diabetes drug Avandia may increase a person's risk of heart attack and death due to heart disease, a new study warns. Avandia maker GlaxoSmithKline says the study is flawed and that better data-some already submitted to the FDA, some from an ongoing clinical trial-show Avandia poses no significant risk to patients' heart health.
   The USFDA says that based on this "contradictory evidence about the risks in patients treated with Avandia," patients taking the drug-especially those who have had heart attacks or who have underlying heart disease-should talk with their doctors about whether to continue taking the drug.
   The new warning comes from an analysis of publicly available, short-term clinical studies comparing Avandia to other diabetes treatments. It shows that Avandia increases heart attack risk by 43 per cent-and increases risk of death from heart disease by 64%.
   However, the overall risk was small. Among the 15,560 Avandia patients there were 86 heart attacks and 39 deaths, compared with 72 heart attacks and 22 deaths among the 12,283 patients not taking Avandia.
   "In susceptible patients, [Avandia] therapy may be capable of provoking myocardial infarction [heart attack] or death from cardiovascular causes after relatively short-term exposure," suggest study investigators Steven Nissen, MD, and Kathy Wolski, MPH. Nissen chairs the Cleveland Clinic's department of cardiovascular medicine; he is past president of the American College of Cardiology.
   
   Benefit and risk
   The FDA in 1999 approved Avandia on the basis of clinical trials showing that the drug could reduce blood-sugar levels in people with type 2 diabetes. Diabetes has been linked to both microvascular problems (problems of tiny blood vessels) such as blindness, kidney failure, and loss of circulation in the extremities. It has also been linked to heart disease.
   But none of the trials on which Avandia was approved showed that the drug actually prevented the greatest threats to people with diabetes: microvascular problems, heart disease, or heart death.
   In a strongly worded editorial accompanying the study, University of Washington researcher Bruce M. Psaty, MD, PhD, says the Nissen study means there's no good reason for most patients to take Avandia.
   "There is little evidence for using this drug," Psaty tells WebMD. "The purpose of reducing blood sugar is to prevent cardiovascular events. Now the possibility of cardiovascular benefit associated with Avandia appears remote-indeed, it appears linked to harm. So the rationale for prescribing it at this time is just not clear."
   Psaty warns patients taking Avandia not to just stop using it. They should continue taking the drug until they can discuss the matter with their doctor.
   "This is not an immediate risk. It is the absence of an expected benefit and the possibility of harm over the years," he says. "Patients should talk with their doctors and see if they are getting the benefit they expected. Doctors can look at the data and say whether there is a compelling reason for them to prescribe this drug. I don't think there is."
   
   Avandia safe, GlaxoSmith says
   GlaxoSmithKline has done its own analysis of Avandia's heart safety data. Using techniques similar to those used in the Nissen study, the GSK study showed about a 30 per cent increase in heart risk to patients taking Avandia.
   But a study of 33,000 patients in a managed-care database showed no increased heart risk in patients taking Avandia. Both this study and the GSK analysis were given to the FDA in August 2006.
   Ongoing, long-term studies also support Avandia safety, says GSK chief medical officer Ronald Krall, MD.
   "I want to be very clear that we are confident in the benefit/risk profile for Avandia. We believe that if it is used according to the directions incorporated into U.S. and European labels, it is an important treatment for patients with type 2 diabetes," Krall says in a news release. "We believe that important evidence coming from long-term studies supports the safety of Avandia."
   Are you taking Avandia?Are you concerned about your heart? Discuss this important diabetes development in the WebMD Diabetes community.
   
   Bone fractures
   More fractures were seen in women taking Avandia, Avandamet, or Avandaryl. WebMD Medical NewsReviewed by Louise Chang, MDFeb. 22, 2007 - Women taking the diabetes drugs Avandia, Avandamet, or Avandaryl may be more likely to fracture their bones than those using other diabetes drugs.
   That's according to the FDA and GlaxoSmithKline, maker of Avandia, Avandamet, and Avandaryl. Those three drugs share the same active ingredient: rosiglitazone.
   Doctors should consider fracture risk when treating diabetic women with Avandia, Avandamet, or Avandaryl, advises the FDA and GlaxoSmithKline, a WebMD sponsor.
   GlaxoSmithKline notified doctors of the possible risk in a letter dated February 2007. That letter is posted on the FDA's web site.
   It explains that possible fracture risk surfaced in a study of 4,351 patients recently diagnosed with type 2 diabetes.
   Patients in the study were randomly assigned to take one of the following diabetes drugs:
   1.Rosiglitazone, the key ingredient in Avandia, Avandamet, and Avandaryl. 2.Metformin, which is sold generically and under the brand name Glucophage. 3.Glyburide, sold generically and under the brand names Diabeta and Micronase. 4.Patients were followed for four to six years as they took their assigned drugs.
   During that time, women taking rosiglitazone were more likely to have bone fractures than women taking either metformin or glyburide. This problem was not seen in men taking rosiglitazone.
   Most of the fractures seen in the women taking rosiglitazone affected bones in the upper arm, hand, or foot.
   Bones often affected by osteoporosis (such as the hip or spine) weren't more likely to fracture in the women on rosiglitazone.
   The study's findings are mirrored in early results from another, ongoing study, according to GlaxoSmithKline. Further research is underway, the drugmaker says. Source: News release, FDA. GlaxoSmithKline letter to Health Care Providers, February 2007.
   Sources: Dream Investigation on Rosiglitazone, The Lancet, Sept. 15, 2006; Hertzel Gerstein, MD, MSc, professor of medicine, McMaster University, Hamilton, Ontario, Canada. Larry C. Deeb, MD, president, American Diabetes Association; medical director, Diabetes Center, National Institute of Diabetes and Digestive and Kidney Diseases. Nissen, S.E. and Wolski, K. The New England Journal of Medicine, early release, May 21, 2007. GlaxoSmithKline (GSK) news conference with Ronald Krall, , vice president of cardiovascular, metabolic and neurology marketing, GlaxoSmithKline. FDA news conference with Robert J. Meyer, MD, Center for Drug Evaluation and Research (CDER).

Results of an ongoing investigation confirm a "strong association" between use of a particular type of contact lens solution - Advanced Medical Optics (AMO) Complete MoisturePlus Multi-Purpose Solution - and increased risk of a rare but serious eye infection called Acanthamoeba keratitis (AK), Reuters reported from New York.
   Earlier this year, the company voluntarily recalled this product and called on consumers to stop using it after data showed a higher risk of eye infections.
   AK is a painful infection of the cornea that can cause corneal scarring and sometimes blindness. Doctors at the University of Illinois at Chicago Cornea Service noticed a sharp increase in the number of AK cases in contact lens wearers beginning in 2003, with a total of 63 cases identified through the end of 2006. This compares to the "two or three cases a year we would normally expect to see," Dr. Charlotte Joslin noted in a university statement.
   They investigated 30 AK cases, comparing them with 39 matched "controls" who wore soft contact lens without developing the infection. Joslin and colleagues found that those with AK infection were significantly more likely to report having exclusively used AMO Complete MoisturePlus Multi-Purpose Solution than those without AK infection (55.2 percent versus 10.5 per cent).
   Users of this particular contact lens solution had a greater than 16-fold higher risk of developing AK.
   However, the researchers note in the American Journal of Ophthalmology that nearly 39 percent of AK cases reported no use of AMO Complete MoisturePlus Multi-Purpose Solution or used it in combination with other solutions, suggesting that this is not the only risk factor for infection.
   The current investigation provides some evidence that re-using contact lens solution, rubbing lenses during cleaning, and showering with lenses on increase the risk of eye infections in contact lens users.
   - American Journal of Ophthalmology.

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ROAMING RACONTEUR

Murdoch to buy Wall Street Journal

Saad Quasem

Theoretically, one of the primary advantages of a democracy is having free access to a neutral media. The word "media" is derived from "mediate," which makes the essential purpose of the media to mediate between events and the general public.
   Experts on the media say, "when it heats, it bleeds" and that is exactly what I wish to follow. All throughout the American press, the common topic is about the takeover of Dow Jones by the media tycoon Rupert Murdoch.
   Dow Jones was founded in 1892 by Charles Dow as a corporate media firm. However, now it is a conglomerate of a gamut of different corporations. The leading media specialty of the business house is Dow Jones Industrial Average. The company provides the stock indices of about the thirty top companies as well as a copious number of other businesses of the New York Stock Exchange. For more than a century, this company has been dutifully providing information on the stock movements of its companies. The world markets are dominated as investors receive news from this medium. The other rather renowned part of that group is the Wall Street Journal, one of the world's leading international newspapers, focusing mainly on economic matters. It provides world class news and is circulated all throughout the world.
   Lately the media tycoon Rupert Murdoch has made a bid to buy off the company for the handsome sum of $5 billion. Australian born Murdoch is also the proud owner of several tabloids that provide unnecessary and rather mundane news. Murdoch's tabloids have often patronized paparazzi, who create hell for stars. The British Sun, American Star and Sky Television are his channels; many of these have apologised the following day for misinforming on several occasions.
   Up until now, the Bancroft family had been in charge of the editorial board of Dow Jones. The Bancroft's took over, after the death of Dow Jones in the 1920's. The family's service to the newspaper is subject to several applauds. The takeover to Murdoch might seem like a sell-off. Reputations such as Murdoch's might ruin the now-fascinating reputation of Dow Jones. The current owners have asked for space in the editorial board; however no actions have been taken so far and the Dow Jones sell out date is nearing every minute.
   This is a bit of concern. It is a possibility that Murdoch would favor his clients and provide stock indices that provide fabricated reports. It could possibly cause a global chaos. The trust we entail in the Wall Street Journal will similarly fade away as well. This takeover will raise further questions about the free press and if they are too free to conduct as they wish and in the process supplying the readers with mocking news. I hope this matter is looked into severely, because I would not buy a Wall Street Journal and wish to see rubbish. I believe that democracy will work at this point to stop this raging issue and work to sustain the press which provides solid, unprejudiced information and in the process draw the line between an intellectual paper and a tabloid inked with gibberish. The New York Times is the most acclaimed international newspaper, which runs by the slogan "all the news that fits to print."

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