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REFERENCES:

Wansink, B. Mindless Eating: Why We Eat More Than We Think, Bantam Books, 2006.

Center for Science in the Public Interest: "New Year's Resolutions."

Framson, C. Journal of the American Dietetic Association, August 2009; vol 109: pp 1439-1444.

Consumer Reports: "6 Secrets of the Slim for Your Diet Plan."

News release, The Endocrine Society.

Kokkinos, A. The Journal of Clinical Endocrinology & Metabolism, published online Oct. 29, 2009.

Michael Breus, Founder of Soundsleep Solutions; author, Good Night: The Sleep Doctor's 4-Week Program to Better Sleep and Better Health.

Sivak, M. Obesity Review, August 2006; vol 7(3): pp 295-6.

Neal Barnard, MD, president, Physicians Committee for Responsible Medicine; adjunct associate professor of medicine, George Washington University School of Medicine.

Judith M. Lukaszuk, PhD, RD, assistant professor, School of Family, Consumer, and Nutrition Sciences, Northern Illinois University.

Elaine Magee,MPH, RD, author Food Synergy, 2008.

Major, G.C. American Journal of Clinical Nutrition, January 2007; vol 85: pp 54-59.

Lukaszuk, J.M. Journal of the American Dietetic Association, October 2007; vol 107: pp 1811-1814.

Ello-Martin, J.A. American Journal of Clinical Nutrition, June 2007; vol 85: pp 1465-1477.

Ledikwe, J.H. American Journal of Clinical Nutrition, May 2007; vol 85: pp 1212-1221.

Katcher, H.I. American Journal of Clinical Nutrition, January 2008; vol 87: pp 79-90.

Public Health Idaho North Central District: "Make One Change to Lose 10 Pounds in a Year." Women, Infants & Children PDF.

USDA National Nutrient Database.

University of Nebraska, Nutrition Education Program: "Think What You Drink."

Carolyn O'Neil, MS, RD, co-author, The Dish on Eating Healthy and Being Fabulous.

Christine Gerbstadt, MD, MPH, RD, spokeswoman, American Dietetic Association.

Dawn Blatner-Jackson, MS, RD, spokeswoman, American Dietetic Association.

2005 U.S. Dietary Guidelines.

American Heart Association.

UCLA Student Nutrition Awareness Campaign: "Calories Count."

Newby, P.K. The American Journal of Clinical Nutrition, June 2005; vol 81(6): pp 1267-74.

Centers for Disease Control and Prevention. "Physical Activity for a Healthy Weight."

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A personal trainer is a fitness professional involved in exercise prescription and instruction. They motivate clients by setting goals and providing feedback and accountability to clients. Trainers also measure their client's strengths and weaknesses with fitness assessments. These fitness assessments may also be performed before and after an exercise program to measure their client's improvements in physical fitness. They may also educate their clients in many other aspects of wellness besides exercise, including general health and nutrition guidelines. Qualified personal trainers recognize their own areas of expertise. If a trainer suspects that one of his or her clients has a medical condition that could prevent the client from safe participation in an exercise program, they must refer the client to the proper health professional for prior clearance.[1]

The scope of practice for a personal trainer is to enhance the components of fitness for the general, healthy population.

Proper exercise prescription may result in improved body composition, physical performance, heart condition and health outcomes.[2] The decision to hire a trainer may be related to a perceived ability to facilitate these factors through proper prescription and instruction or factors related to motivation and adherence. A trainer pays close attention to their client's exercise form, workout routine, and nutrition plan.

Few studies have investigated training for men, however, training in women has been shown to exercise behavior patterns, improve perceptual benefit-to-concern ratio for exercise (decisional balance), and increase confidence to choose exercise in the face of other time demands (scheduling self-efficacy).[3] Personal training results in higher strength, higher workout intensities, and higher perceived exertion during exercise in women. Although women working with personal trainers do self-select heavier loads than women who did not, the loads used are still below recommended training load percentages.[4]

The profession is generally not restricted by venue, and personal trainers may work in fitness facilities, in their personal homes, in client homes, over live video (also called "virtual personal trainers"),[5] or outdoors. Almost all personal trainers and group exercise instructors work in physical fitness facilities, health clubs, and fitness centers located in the amusement and recreation industry or in civic and social organizations.[6] Personal training is not regulated in any jurisdiction in the United States except for Washington D.C. which adopted registration requirements for personal fitness trainers in February 2014.[7]

Personal trainers may specialize in a certain training type, training philosophy, performance type, exercise modality, or client population. In general, most personal trainers develop exercise prescription plans for aerobic exercise, resistance exercise, and/or flexibility training. With aerobic exercise prescription, personal trainers determine the type of exercise, duration of exercise, and frequency of exercise. For resistance exercise prescription, the type of exercise, total session volume, rest period, frequency, and intensity are determined.[8] Personal trainers may also be involved in prescription of stretching routines or other approaches. While some discuss nutrition, ergogenic supplementation, and spiritual practices with clients, there is debate within the industry as to whether it fits within their scope of practice and training qualifications.[9]

Personal trainer accreditation is a process that provides certification of competency as a personal trainer. Qualification standards for personal trainers vary between countries.

In Australia, personal trainers may work independently with suitable insurance or choose to be a member of a registering body (Fitness Australia or Physical Activity Australia). The qualifications levels include; Level 1 - Certificate III in Fitness, Level 2 - Certificate IV in Fitness and Level 3 - Diploma of Fitness. These can be obtained from nationally accredited colleges (TAFE, Australian College of Sport & Fitness, Fitness Industry Training, Australian Institute of Fitness, Australian Fitness Academy). Once working in the industry, trainers who are members of associations are also required to complete short courses to obtain continuing education credit (CEC) points they need to keep their registration. A minimum of 20 CEC points every two years is required. Many personal trainers also have additional qualifications in weight loss, strength training, kid's fitness, and nutrition, which is in part due to the CEC program. CEC courses can cover a wide variety of topics such as different training techniques, nutrition, exercise styles, health conditions, physiology, lifestyle and rehabilitation.[10]

In Brazil, personal trainers must have a bachelor's degree in "Physical Education" (a degree that combines knowledge in the fields of Exercise Science and Healthcare science) and be registered with the Conselho Federal de Educao Fsica (Federal Council of Physical Education), and risk criminal charges if they operate without these two requirements.

In Canada, the main certifying bodies are Canadian Fitness Education Services (CFES), Canadian Fitness Professionals, Certified Personal Trainers Network, and Canadian Society of Exercise Physiology. CSEP requires a diploma or degree in the exercise field, most require experience and/or workshops. Ontario does not have any personal training regulation. Many personal trainers receive a CFES, CanFit Pro certification or an NCCA accredited certification. The National Personal Training Institute is the only private trade school and is a registered College under the Private Career Colleges Act.[11][12]

In the UK, there are several ways to achieve a personal training qualification. Most personal training qualifications are accredited through awarding bodies like CYQ (Central YMCA Qualifications), Active IQ (Active International Qualifications) and City and Guilds. These qualifications are generally delivered by Further Education (FE) establishments like colleges, or by private training providers. Upon successful completion of an accredited awarding body qualification, candidates become eligible for Level 3 REPs(Register of Exercise Professionals)status. University graduates with an appropriate honours degree can also apply to become an approved by REPs through Accreditation of Prior Learning (APL) and Accreditation of Prior Achievement (APA).

REPs is the professional body for the UK health and fitness industry, and does not award qualifications directly. Most health and fitness qualifications endorsed by REPs vary in levels from 1 - 5, 1 being basic GCSE level and 5 being advanced specialized training professionals.[13] For a qualification to become eligible for endorsement by REPs, it must conform to the National Occupational Standards (NOS), which are set at governmental level by the Sector Skills Council (SSC) Skills Active.

There is no legal restriction on the title of Personal Trainer nor any formal body associated with regulating Personal Training.

A number of certifications are available in the U.S., although a number are not accredited. Most require a high school diploma, cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) certification, and some type of examination.[6]

A 2002 investigation evaluated a random sample of 115 personal trainers using the Fitness Instructors Knowledge Assessment (FIKA) (which measures knowledge in nutrition, health screening, testing protocols, exercise prescription, and special populations). The study described that:[14][15]

In partnership with the fitness industry, the International Health, Racquet & Sportsclub Association (IHRSA), which represents over 9,000 health and fitness facilities, started an initiative in 2002 to improve standards for both its own clubs and the industry as a whole. In January 2006, IHRSA implemented a recommendation that its facilities only accept personal trainers with certifications recognized by the National Commission for Certifying Agencies (NCCA) if recognized either by the Council for Higher Education Accreditation (CHEA) and/or the U.S. Department of Education (USDE). As a result, the Distance Education and Training Council (DETC) was recognized by IHRSA as a recognized accreditor of fitness professional certification organizations. Since then, the DETC has accredited several personal trainer certification organizations, including the Aerobics and Fitness Association of America (AFAA) and the International Sports Sciences Association (ISSA) among others. As of August 2012, NASM, ISSA, AFAA, ACSM and NSCA certifications are among the 15 accredited certifications recognized by IHRSA, three of which are accredited by the Distance Education Training Council (DETC).[16][17]

Various organizations within the profession have lobbied for the adoption of a more stringent criteria for certification developed by the NSF International.[18] There remains no national legal restriction on the industry to date except for the District of Columbia (D.C.) which as of February 2014, passed legislation requiring personal fitness trainers to register in that jurisdiction. The law is expected to go into effect in the first half of 2014.

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Fitness

Cover of the November/December 2009 issue of Fitness.

Fitness is a United States-based women's magazine, focusing on health, exercise, and nutrition. It is owned and published by the Meredith Corporation. The editor-in-chief of Fitness is Betty Wong.[2]

Fitness was launched in 1992,[3] and was acquired by the Meredith Corporation from Bertelsmann's Gruner + Jahr in 2005.[4] In 2005, Fitness also launched its web presence, giving readers separate online resources for fitness and health tips alongside the magazine's monthly editorial content.[5] Betty Wong became Editor-in-Chief in September 2008, incorporating several changes to the magazine, creating several new columns and features.[2][6] In 2009, Fitness posted significant ad page gains according to the Publishers Information Bureau, increasing by 18.4% when overall magazine publishers' counts were down 27.9% industry-wide.[2][7] It was recognized for several awards, having been awarded "Most Improved Publication" and best "How-To/Instructional" feature in minOnline's Editorial and Design Awards.[8]

On January 28, 2015, it was reported that Meredith Corp. would acquired Shape Magazine which would be merged with Fitness magazine in May 2015.[9] The Fitness website would continue to operate.[10][11]

Fitness editorial content centers largely on exercise, nutrition, health, and beauty. Fitness also conducts several real-world fitness and health-themed events to promote its brand and raise money for charity, including the Mind, Body, Spirit Games and a half-marathon in conjunction with fellow Meredith publication More magazine.[2][12][13]

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Exp Clin Cardiol. 2004 Fall; 9(3): 200205.

Clinical Cardiology

1Departments of Surgery

2Medicine and

3Physiology, Faculty of Medicine, and

4Faculty of Allied Health Sciences, Kuwait University, Safat;

5Ministry of Health, Safat, Kuwait

Although various studies have examined the short-term effects of a ketogenic diet in reducing weight in obese patients, its long-term effects on various physical and biochemical parameters are not known.

To determine the effects of a 24-week ketogenic diet (consisting of 30 g carbohydrate, 1 g/kg body weight protein, 20% saturated fat, and 80% polyunsaturated and monounsaturated fat) in obese patients.

In the present study, 83 obese patients (39 men and 44 women) with a body mass index greater than 35 kg/m2, and high glucose and cholesterol levels were selected. The body weight, body mass index, total cholesterol, low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol, triglycerides, fasting blood sugar, urea and creatinine levels were determined before and after the administration of the ketogenic diet. Changes in these parameters were monitored after eight, 16 and 24 weeks of treatment.

The weight and body mass index of the patients decreased significantly (P<0.0001). The level of total cholesterol decreased from week 1 to week 24. HDL cholesterol levels significantly increased, whereas LDL cholesterol levels significantly decreased after treatment. The level of triglycerides decreased significantly following 24 weeks of treatment. The level of blood glucose significantly decreased. The changes in the level of urea and creatinine were not statistically significant.

The present study shows the beneficial effects of a long-term ketogenic diet. It significantly reduced the body weight and body mass index of the patients. Furthermore, it decreased the level of triglycerides, LDL cholesterol and blood glucose, and increased the level of HDL cholesterol. Administering a ketogenic diet for a relatively longer period of time did not produce any significant side effects in the patients. Therefore, the present study confirms that it is safe to use a ketogenic diet for a longer period of time than previously demonstrated.

Keywords: Diet, Ketosis, Obesity

Obesity has become a serious chronic disease in both developing and developed countries. Furthermore, it is associated with a variety of chronic diseases (14). It is estimated that in the United States alone approximately 300,000 people die each year from obesity-related diseases (5,6). Different methods for reducing weight using reduced calorie and fat intake combined with exercise have failed to show sustained long-term effects (79). Recent studies from various laboratories (10,11), including our own (12), have shown that a high fat diet rich in polyunsaturated fatty acids (ketogenic diet) is quite effective in reducing body weight and the risk factors for various chronic diseases. The ketogenic diet was originally introduced in 1920 (13). In this diet, the fat to carbohydrate ratio is 5:1. While there was a significant decrease in the weight of obese patients who were on a ketogenic diet (12), the reverse occurred when the diet changed to one high in carbohydrates (14).

It should be noted that the concept that fat can be eaten ad libitum and still induce weight loss in obese subjects is not a recent one (1333). Ketosis occurs as a result of the change in the bodys fuel from carbohydrate to fat. Incomplete oxidation of fatty acids by the liver results in the accumulation of ketone bodies in the body. A ketogenic diet maintains the body in a state of ketosis, which is characterized by an elevation of D-b-hydroxybutyrate and acetoacetate.

Mild ketosis is a natural phenomenon that occurs in humans during fasting and lactation (19,20). Postexercise ketosis is a well-known phenomenon in mammals. Although most of the changes in the physiological parameters induced following exercise revert back to their normal values rapidly, the level of circulating ketone bodies increases for a few hours after muscular activity ceases (21). It has been found that in trained individuals, a low blood ketone level protects against the development of hypoglycemia during prolonged intermittent exercise (22). In addition, ketosis has a significant influence on suppressing hunger. Thus, a ketogenic diet is a good regulator of the bodys calorie intake and mimics the effect of starvation in the body.

It is generally believed that high fat diets may lead to the development of obesity and several other diseases such as coronary artery disease, diabetes and cancer. This view, however, is based on studies carried out in animals that were given a high fat diet rich in polyunsaturated fatty acids. In contrast, our laboratory has recently shown that a ketogenic diet modified the risk factors for heart disease in obese patients (12).

Although various short-term studies examining the effect of a ketogenic diet in reducing the weight of obese patients have been carried out (10), its long-term effects in obese subjects are not known (15). Therefore, the purpose of the present study was to investigate the long-term effects of a ketogenic diet on obesity and obesity-associated risk factors in a large population of obese patients.

The prospective study was carried out at the Academic Department of Surgery, Consultation and Training Centre, Faculty of Medicine, Kuwait University (Jabriya, Kuwait) in 83 obese subjects (39 men and 44 women). The body mass index (BMI) of men and women was 35.91.2 kg/m2 and 39.41.0 kg/m2, respectively. The mean age was 42.61.7 years and 40.61.6 years for men and women, respectively. The mean age, initial height, weight and BMI for all patients are given in . Fasting blood tests were carried out for all of the subjects. Initially, all patients were subjected to liver and renal function tests, and glucose and lipid profiles, using fasting blood samples, and a complete blood count. Thereafter, fasting blood samples were tested for total cholesterol, high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol, triglycerides, blood sugar, urea and creatinine levels at the eighth, 16th and 24th week. In addition, weight and height measurements, and blood pressure were monitored at each visit.

Patient data at baseline before treatment with the ketogenic diet

All 83 subjects received the ketogenic diet consisting of 20 g to 30 g of carbohydrate in the form of green vegetables and salad, and 80 g to 100 g of protein in the form of meat, fish, fowl, eggs, shellfish and cheese. Polyunsaturated and monounsaturated fats were also included in the diet. Twelve weeks later, an additional 20 g of carbohydrate were added to the meal of the patients to total 40 g to 50 g of carbohydrate. Micronutrients (vitamins and minerals) were given to each subject in the form of one capsule per day ().

Composition of the capsule*

Statistical differences between body weight, total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, level of fasting blood sugar, and urea and creatinine levels before and after the administration of the ketogenic diet were analyzed using a paired Students t test using the Stat-view version 4.02 (Abacus Concepts Inc, USA). Weight, BMI and all biochemical parameters are expressed as mean SEM.

The mean initial weight of the subjects was 101.032.33 kg. The weight decreased significantly during all stages of the treatment period. The body weights at the eighth, 16th and 24th week were 91.102.76 kg, 89.393.4 kg and 86.673.70 kg, respectively (). Similar to the loss in body weight, a significant decrease was observed in the BMI of the patients following the administration of the ketogenic diet. The initial BMI, and the BMI after the eighth, 16th and 24th week were 37.770.79 kg/m2, 33.900.83 kg/m2, 33.241.00 kg/m2 and 32.061.13 kg/m2, respectively ().

Reduction in body weight at eight, 16 and 24 weeks following the administration of the ketogenic diet in obese patients. The weights are expressed as mean SEM

Decrease in body mass index at eight, 16 and 24 weeks during the administration of a ketogenic diet in obese patients. The values are expressed as mean SEM

The level of total cholesterol showed a significant decrease from week 1 to week 24 (). The level of HDL cholesterol significantly increased (), whereas LDL cholesterol levels significantly decreased with treatment (). The level of triglycerides decreased significantly after 24 weeks of treatment. The initial level of triglycerides was 2.750.23 mmol/L, whereas at week 24, the level decreased to 1.090.08 mmol/L (). The level of blood glucose significantly decreased at week 24. The initial blood glucose level and its level at the eighth, 16th and 24th week were 7.260.38 mmol/L, 5.860.27 mmol/L, 5.560.19 mmol/L and 5.620.18 mmol/L, respectively (). The changes in the levels of urea () and creatinine () were not statistically significant.

Decreased levels of total cholesterol (expressed as mean SEM) in obese patients at eight, 16 and 24 weeks during the administration of a ketogenic diet

Changes in the level of high density lipoprotein (HDL) cholesterol in obese patients during treatment with a ketogenic diet for a period of 24 weeks. Data are expressed as mean SEM

Changes in the level of low density lipoprotein (LDL) cholesterol during treatment with a ketogenic diet in obese patients at eight, 16 and 24 weeks. The values are expressed as mean SEM

Changes in the level of triglycerides in obese patients during treatment with a ketogenic diet over a period of 24 weeks. The values are expressed as mean SEM

Decreased levels of blood glucose (expressed as mean SEM) in obese patients at eight, 16 and 24 weeks during the administration of a ketogenic diet

Changes in the level of urea in obese patients during a 24-week ketogenic diet. The level of urea is expressed as mean SEM

Changes in the level of creatinine in obese patients during a 24-week ketogenic diet. Values are expressed as mean SEM

Until recently, ketosis was viewed with apprehension in the medical world; however, current advances in nutritional research have discounted this apprehension and increased public awareness about its favourable effects. In humans, ketone bodies are the only additional source of brain energy after glucose (23,24). Thus, the use of ketone bodies by the brain could be a significant evolutionary development that occurred in parallel with brain development in humans. Hepatic generation of ketone bodies during fasting is essential to provide an alternate fuel to glucose. This is necessary to spare the destruction of muscle from glucose synthesis.

A ketogenic diet is clinically and experimentally effective in antiepileptic and antiobesity treatments; however, the molecular mechanisms of its action remain to be elucidated. In some cases, a ketogenic diet is far better than modern anticonvulsants (25). Recently, it has been shown that a ketogenic diet is a safe potential alternative to other existing therapies for infantile spasms (27). It was further shown that a ketogenic diet could act as a mood stabilizer in bipolar illness (28). Beneficial changes in the brain energy profile have been observed in subjects who are on a ketogenic diet (28). This is a significant observation because cerebral hypometabolism is a characteristic feature of those who suffer from depression or mania (28). It has also been found that a ketogenic diet affects signal transduction in neurons by inducing changes in the basal status of protein phosphorylation (29). In another study (30), it was shown that a ketogenic diet induced gene expression in the brain. These studies provide evidence to explain the actions of a ketogenic diet in the brain.

One of the mechanisms of a ketogenic diet in epilepsy may be related to increased availability of beta-hydroxybutyrate, a ketone body readily transported through the blood-brain barrier. In support of this hypothesis, it was found that a ketogenic diet was the treatment of choice for glucose transporter protein syndrome and pyruvate dehydrogenase deficiency, which are both associated with cerebral energy failure and seizures (26).

One argument against the consumption of a high fat diet is that it causes obesity. The major concern in this regard is whether a high percentage of dietary fat promotes weight gain more than a low percentage of fat intake. Because fat has a higher caloric density than carbohydrate, it is thought that the consumption of a high fat diet will be accompanied by a higher energy intake (31). On the contrary, recent studies from our laboratory (12) and many other laboratories (24,3234) have observed that a ketogenic diet can be used as a therapy for weight reduction in obese patients.

It has been found that a sugary diet is the root cause of various chronic diseases of the body. A recent study (35) showed that sugar can accelerate aging. Several recent studies (36,37) have pointed to the fact that a diet with a high glycemic load is independently associated with the development of cardiovascular diseases, type II diabetes and certain forms of cancer. Glycemic load refers to a diet of different foods that have a high glycemic index. Glycemic index is a measure of the elevation of glucose levels following the ingestion of a carbohydrate. The classification of a carbohydrate based on its glycemic index provided a better predictor of risk for coronary artery diseases than the traditional method of classification of carbohydrate into simple or complex forms (38). In other studies (3846), it was shown that the risk of dietary glycemic load from refined carbohydrates was independent of other known risk factors for coronary diseases.

It is now evident that high carbohydrate diets increase fasting plasma triglyceride concentrations (4751) and decrease HDL cholesterol concentrations (5255). These changes are associated with enhanced atherogenesis (55). However, it has been shown that short-term ketogenic diets improve the lipid disorders that are characteristic of atherogenic dyslipidemia (56). It has also been found that sugary drinks decreased blood levels of vitamin E, thus reducing the amount of antioxidants in the body. It has been proven, beyond a doubt, that disrupting the oxidant-antioxidant status of the cell will lead to various diseases of the body (57).

The relation between a high fat diet and cancer is not conclusive. Recent epidemiological studies (17,5860) could not explain a specific causal relationship between dietary fat and cancer. It has been found that altered energy metabolism and substrate requirements of tumour cells provide a target for selective antineoplastic therapy. The supply of substrates for tumour energy metabolism can be reduced by dietary manipulation (eg, ketogenic diet) or by pharmacological means at the cellular level (eg, inhibitors of glycolysis or oxidative phosphorylation). Both of these techniques are nontoxic methods for controlling tumour growth in vivo (61). Sugar consumption is positively associated with cancer in humans and test animals (5861). This observation is quite logical because tumours are known to be enormous sugar absorbers. It has also been found that the risk of breast cancer decreases with increases in total fat intake (16). Further studies on the role of a ketogenic diet in antineoplastic therapy are in progress in our laboratory.

A link between low fat diets and osteoporosis has been suggested. Very low fat diets are considered to be low in calcium content. Women on low fat diets excrete most of the calcium they consume; therefore, they are more prone to osteoporosis. However, a high fat diet can rectify this situation (62).

In the present study, a control population on a low fat diet was not included due to the difficulties in recruiting subjects for a control group. However, several studies (63,64) with appropriate control groups that compared the effect of a low fat diet with a low carbohydrate ketogenic diet have recently been published. In this regard, these two recent studies are comparable with the present study. Brehm et al (23) showed that obese women on a low carbohydrate ketogenic diet lost 8.5 kg over six months compared with 4.2 kg lost by those in the low fat diet group (P<0.001). Twenty-two subjects from the low carbohydrate ketogenic diet and 20 subjects from the low fat diet completed the study, with both groups reducing their energy intake by approximately 450 kcal from the baseline level. In another study performed in 132 severely obese subjects for six months (24), there was greater weight loss in the low carbohydrate ketogenic diet group than in the low fat diet group (5.8 kg versus 1.9 kg, P=0.002). Both of these studies support the findings presented in the present paper.

The data presented in the present study showed that a ketogenic diet acted as a natural therapy for weight reduction in obese patients. This is a unique study monitoring the effect of a ketogenic diet for 24 weeks. There was a significant decrease in the level of triglycerides, total cholesterol, LDL cholesterol and glucose, and a significant increase in the level of HDL cholesterol in the patients. The side effects of drugs commonly used for the reduction of body weight in such patients were not observed in patients who were on the ketogenic diet. Therefore, these results indicate that the administration of a ketogenic diet for a relatively long period of time is safe. Further studies elucidating the molecular mechanisms of a ketogenic diet are in progress in our laboratory. These studies will open new avenues into the potential therapeutic uses of a ketogenic diet and ketone bodies.

6. Thomas PR, editor. Washington: National Academy Press; 1995. Weighing the Options: Criteria for Evaluating Weight-Management Programs.

9. Peni MG. Improving maintenance of weight loss following treatment by diet and lifestyle modification. In: Wadden TA, Van Itallie TB, editors. Treatment of the Seriously Obese Patient. New York: Guilford; 1992. pp. 45677.

11. Yancy WS, Jr, Guyton JR, Bakst RP, Westman EC. A randomized, controlled trial of a low-carbohydrate ketogenic diet versus a low-fat diet for obesity and hyperlipidemia. Am J Clin Nutr. 2002;72:343S.

13. Wilder RM. The effect of ketonemia on the course of epilepsy. Mayo Clin Proc. 1921;2:3078.

58. Kaaks R. Nutrition and colorectal cancer risk: The role of insulin and insulin-like growth factor-1. European Conference on Nutrition and Cancer. International Agency for Research on Cancer and Europe Against Cancer Programme of the European Commission; Lyon, France. June 21 to 21; 2001. A0.14. (Abst)

59. Berrino F, Bellati C, Oldani S, et al. DIANA trial on diet and endogenous hormones. European Conference on Nutrition and Cancer. International Agency for Research on Cancer and Europe Against Cancer Programme of the European Commission; Lyon, France. June 21 to 24; 2001. A0.27. (Abst)

60. Willett WC. Cancer prevention: Diet and risk reduction: Fat. In: DeVita V, Hellman S, Rosenberg S, editors. Cancer: Principles and Practice of Oncology. 5th edn. New York: Lippincott-Raven; 1997. pp. 55966.

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"Kokkai" redirects here. For the Sumo wrestler from Georgia, see Kokkai Futoshi. "Diet of Japan" and "Japanese Diet" redirect here. For information on Japanese food, see Japanese cuisine.

The National Diet (, Kokkai?) is Japan's bicameral legislature. It is composed of a lower house called the House of Representatives, and an upper house, called the House of Councillors. Both houses of the Diet are directly elected under parallel voting systems. In addition to passing laws, the Diet is formally responsible for selecting the Prime Minister. The Diet was first convened as the Imperial Diet in 1889 as a result of adopting the Meiji Constitution. The Diet took its current form in 1947 upon the adoption of the post-war constitution and is considered by the Constitution to be the highest organ of state power. The National Diet Building is located in Nagatach, Chiyoda, Tokyo.

The houses of the Diet are both elected under parallel voting systems. This means that the seats to be filled in any given election are divided into two groups, each elected by a different method; the main difference between the houses is in the sizes of the two groups and how they are elected. Voters are also asked to cast two votes: one for an individual candidate in a constituency, and one for a party list. Any national of Japan at least 20 years of age may vote in these elections,[1] which will be changed to 18 in 2016.[2] Japan's parallel voting system is not to be confused with the Additional Member System used in many other nations.

The Constitution of Japan does not specify the number of members of each house of the Diet, the voting system, or the necessary qualifications of those who may vote or be returned in parliamentary elections, thus allowing all of these things to be determined by law. However it does guarantee universal adult suffrage and a secret ballot. It also insists that the electoral law must not discriminate in terms of "race, creed, sex, social status, family origin, education, property or income".[3]

Generally, the election of Diet members is controlled by statutes passed by the Diet. This is a source of contention concerning re-apportionment of prefectures' seats in response to changes of population distribution. For example, the Liberal Democratic Party had controlled Japan for most of its post-war history, and it gained much of its support from rural areas. During the post-war era, large numbers of people were relocating to the urban centers in the seeking of wealth; though some re-apportionments have been made to the number of each prefecture's assigned seats in the Diet, rural areas generally have more representation than do urban areas.[4] The Supreme Court of Japan began exercising judicial review of apportionment laws following the Kurokawa decision of 1976, invalidating an election in which one district in Hygo Prefecture received five times the representation of another district in Osaka Prefecture. The Supreme Court has since indicated that the highest electoral imbalance permissible under Japanese law is 3:1, and that any greater imbalance between any two districts is a violation of Article 14 of the Constitution.[5] In recent elections the malapportionment ratio amounted to 4.8 in the House of Councillors (census 2005: saka/Tottori;[6] election 2007: Kanagawa/Tottori[7]) and 2.3 in the House of Representatives (election 2009: Chiba 4/Kchi 3).[8]

Candidates for the lower house must be 25 years old or older and 30 years or older for the upper house. All candidates must be Japanese nationals. Under Article 49 of Japan's Constitution, Diet members are paid about 1.3million a month in salary. Each lawmaker is entitled to employ three secretaries with taxpayer funds, free Shinkansen tickets, and four round-trip airplane tickets a month to enable them to travel back and forth to their home districts.[9]

Article 41 of the Constitution describes the National Diet as "the highest organ of State power" and "the sole law-making organ of the State". This statement is in forceful contrast to the Meiji Constitution, which described the Emperor as the one who exercised legislative power with the consent of the Diet. The Diet's responsibilities include not only the making of laws but also the approval of the annual national budget that the government submits and the ratification of treaties. It can also initiate draft constitutional amendments, which, if approved, must be presented to the people in a referendum. The Diet may conduct "investigations in relation to government" (Article 62). The Prime Minister must be designated by Diet resolution, establishing the principle of legislative supremacy over executive government agencies (Article 67). The government can also be dissolved by the Diet if it passes a motion of no confidence introduced by fifty members of the House of Representatives. Government officials, including the Prime Minister and Cabinet members, are required to appear before Diet investigative committees and answer inquiries. The Diet also has the power to impeach judges convicted of criminal or irregular conduct.[3]

In most circumstances, in order to become law a bill must be first passed by both houses of the Diet and then promulgated by the Emperor. This role of the Emperor is similar to the Royal Assent in some other nations; however, the Emperor cannot refuse to promulgate a law and therefore his legislative role is merely a formality.[10]

The House of Representatives is the more powerful chamber of the Diet.[11] While the House of Representatives cannot usually overrule the House of Councillors on a bill, the House of Councillors can only delay the adoption of a budget or a treaty that has been approved by the House of Representatives, and the House of Councillors has almost no power at all to prevent the lower house from selecting any Prime Minister it wishes. Furthermore, once appointed it is the confidence of the House of Representatives alone that the Prime Minister must enjoy in order to continue in office. The House of Representatives can overrule the upper house in the following circumstances:

Under the Constitution, at least one session of the Diet must be convened each year. Technically, only the House of Representatives is dissolved before an election but while the lower house is in dissolution the House of Councillors is usually "closed". The Emperor both convokes the Diet and dissolves the House of Representatives but in doing must act on the advice of the Cabinet. In an emergency the Cabinet can convoke the Diet for an extraordinary session, and an extraordinary session may be requested by one-quarter of the members of either house.[13] At the beginning of each parliamentary session the Emperor reads a special speech from his throne in the chamber of the House of Councillors.[14]

The presence of one-third of the membership of either house constitutes a quorum[13] and deliberations are in public unless at least two-thirds of those present agree otherwise. Each house elects its own presiding officer who exercises the casting vote in the event of a tie. Members of each house have certain protections against arrest while the Diet is in session and words spoken and votes cast in the Diet enjoy parliamentary privilege. Each house of the Diet determines its own standing orders and has responsibility for disciplining its own members. A member may be expelled, but only by a two-thirds majority vote. Every member of the Cabinet has the right to appear in either house of the Diet for the purpose of speaking on bills, and each house has the right to compel the appearance of Cabinet members.

Japan's first modern legislature was the Imperial Diet (, Teikoku-gikai?) established by the Meiji Constitution in force from 1889 to 1947. The Meiji Constitution was adopted on February 11, 1889 and the Imperial Diet first met on November 29, 1890 when the document entered into operation. The Diet consisted of a House of Representatives and a House of Peers (, Kizoku-in?). The House of Representatives was directly elected, if on a limited franchise; universal adult male suffrage was introduced in 1925. The House of Peers, much like the British House of Lords, consisted of high-ranking nobles.[15]

The word diet derives from Latin and was a common name for an assembly in medieval Germany. The Meiji constitution was largely based on the form of constitutional monarchy found in nineteenth century Prussia and the new Diet was modeled partly on the German Reichstag and partly on the British Westminster system. Unlike the post-war constitution, the Meiji constitution granted a real political role to the Emperor, although in practice the Emperor's powers were largely directed by a group of oligarchs called the genr or elder statesmen.[16]

To become law or bill, a constitutional amendment had to have the assent of both the Diet and the Emperor. This meant that while the Emperor could no longer legislate by decree he still had a veto over the Diet. The Emperor also had complete freedom in choosing the Prime Minister and the Cabinet, and so, under the Meiji constitution, Prime Ministers often were not chosen from and did not enjoy the confidence of the Diet.[15] The Imperial Diet was also limited in its control over the budget. While the Diet could veto the annual budget, if no budget was approved the budget of the previous year continued in force. This all changed with the new constitution after World War II.

The proportional representation system for the House of Councillors, introduced in 1982, was the first major electoral reform under the post-war constitution. Instead of choosing national constituency candidates as individuals, as had previously been the case, voters cast ballots for parties. Individual councillors, listed officially by the parties before the election, are selected on the basis of the parties' proportions of the total national constituency vote.[17] The system was introduced to reduce the excessive money spent by candidates for the national constituencies. Critics charged, however, that this new system benefited the two largest parties, the LDP and the Japan Socialist Party (now Social Democratic Party), which in fact had sponsored the reform.[18]

Joint session of the Diet of Japan

Buildings housing the Diet in 1905.

Coordinates: 354033N 1394442E / 35.67583N 139.74500E / 35.67583; 139.74500

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National Diet - Wikipedia, the free encyclopedia

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Access the power of fitness to transform your life. Our gym is your space. From state-of-the-art equipment to expertly designed personal training, our facilities and programming are designed to get you moving.

The 24Life Fitness Philosophy utilizes the integrated approach of 4 Lifestyle Pillars Mindset, Movement, Nourishment and Regeneration to empower members and athletes to achieve their goals. Whether you want to feel better today, run your first race, lose weight or feel the full potential of your strength, we have a movement strategy and program for you.

Our Personal Training Approach

With so many workouts to choose from these days, it can get a little overwhelming. Do you know which exercises are most effective? We do.

Our personalized movement programs, led by certified Personal Trainers (our movement experts), help take the guesswork out of working out. Well partner with you for a fitness plan thats custom-built with your goals in mind. And most importantly, well provide the guidance and inspiration you need to keep going.

Your personalized training program will maximize success from the start by focusing on these four key areas:

Strategy. Your trainer will help identify and develop a movement strategy for success thats tailored to your needs and the results you want.

Expertise. Get one-on-one guidance and coaching from a certified expert on the techniques and exercises that are right for you.

Motivation. Push your workouts further with a fitness professional who knows what it takes to make positive change.

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Book a complimentary Health & Fitness Consultation with one of our movement experts. Whatever your needs and preferences are, our coaches are available to help you every step of the way your personal movement strategy and 24Life awaits. Get started on your 30-day movement program and find your Personal Trainer today.

Get Started with Personal Training

If you are new to training, no worries. Our personal trainers are with you at every step of your fitness journey and will take great care of you! Our trainers will advise and guide you on training option based upon your needs and goals.

Find a gym and Personal Trainers near you:

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Momentum can be a good thing. Click hereto re-sign and get more training sessions with your current trainer.

You can also buy personal training sessions in your club, over the phone or by downloading our app.

In-Club:Visit your local club and speak with a Fitness Manager

Phone:Call us at 1-888-243-5002 (9 am 5 pm PST, Monday Friday)

Mobile App:Download My24 for Android or Download My24 for iPhone

While some members prefer the undivided focus of a one-on-one training session, others feel more inspired with a close friend or in a group. We offer several fitness programs to help everyone find their health and fitness path.

Personal Training:25-minute or 50-minute one-on-one training sessions

Partner Training:50-minute training sessions for two people

GX24 Studio Classes: Fun and friendly group exercise classes

Training Club 24:50-minute small group training sessions (select clubs only)

Find participating clubs and learn more aboutTC24.

Training Program Options

While some members prefer the undivided focus of a one-on-one training session, others feel more inspired with a close friend or in a group. We offer several fitness programs to help everyone find their health and fitness path.

Personal Training: 25-minute or 50-minute one-on-one training sessions

Partner Training: 50-minute training sessions for two people

GX24:Fun and friendly group exercise classes.

Training Club 24: Learn how to succeed inside and outside the gym, knowing that your trainer will be there for you along the way.

Find participating clubs and learn more aboutTC24.

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Arrange a private group fitness class for your group.

We offer private group fitness classes for UW student organizations, UW residence halls and UW departments. Request a class in our facilities (internal event) or in a space provided by your group (external event).

Available class formats include Zumba, Yoga, Powerflow, core training, Tabata, HIIT, Box, Cardio Interval and Group Strength. Rates are $55 per hour and include instruction, space rental, fitness equipment and sound system. Users must have appropriate athletic footwear. Only water is permitted in the activity space and must be in enclosed containers. No other food or drink will be allowed. If you wish to photograph or video record the class, you must obtain prior permission from Rec Sports. To request this service, submit the Group Fitness request form. You will be asked to include the following information:

Rates are $40 per hour. Class formats available include Zumba, yoga, powerflow, core training and tabata. To request this service, submit the Group Fitness request form. You will be asked to include the following information:

Please read through the Rental Policies Manual. Questions about special events and reservations can be sent to Gregory Goar .

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Overview

The aim:

Preventing and lowering high blood pressure (hypertension).

The claim:

A healthy eating pattern is key to deflating high blood pressure and it may not hurt your waistline, either.

The theory:

Nutrients like potassium, calcium, protein and fiber are crucial to fending off or fighting high blood pressure. You dont have to track each one, though. Just emphasize the foods youve always been told to eat (fruits, veggies, whole grains, lean protein and low-fat dairy), while shunning those weve grown to love (calorie- and fat-laden sweets and red meat). Top it all off by cutting back on salt, and voil!

These diets fall within accepted ranges for the amount of protein, carbs, fat and other nutrients they provide.

DASH Diet ranked #1 in Best Diets Overall. 38 diets were evaluated with input from a panel of health experts. See how we rank diets here.

DASH Diet is ranked:

Weight Loss Short-Term

3.2

Weight Loss Long-Term

3.0

First, decide how much you want to read. The National Heart, Lung, and Blood Institute (NHLBI), which helped develop DASH, publishes free guides on the plan. One (PDF here) is 20 pages while another (PDF here) is six. Both take you through the same process of determining how many calories you should eat for your age and activity level, tell you where those calories should come from, and remind you to go easy on salt. Its as simple as that.

[Check out the TLC Diet, which is designed to lower bad LDL cholesterol.]

For a 2,000-calorie diet, you should shoot each day (unless otherwise noted) for 6-8 servings of grains; 4-5 each of veggies and fruit; 2-3 of fat-free or low-fat dairy; 6 or fewer of lean meat, poultry and fish, with one serving being equivalent to an ounce; 4-5 (a week) of nuts, seeds and legumes; 2-3 of fats and oils; and 5 or fewer (a week) of sweets. DASH suggests capping sodium at 2,300 milligrams a day and eventually working to stay at about 1,500 mg.

Its OK to ease into DASH. Try adding just one vegetable serving to a meal, and a fruit serving to another. Go (sort of) vegetarian by preparing two or more meat-free dishes each week. And start using the herbs and spices hiding in the back of the pantry theyll make you forget the salts not on the table. Meanwhile, youll be encouraged to stick to a regular physical-activity program.

As for weight loss, youre advised to ask your doctor about how to best tailor your plan. Because DASH emphasizes so many healthful foods, it can easily support weight loss. Just move more and eat slightly less, says the NHLBI.

Combine eggs, chives and reduced fat cheddar cheese into a quick breakfast that can provide you with a foundation for the day. You may also consider adding veggies, such as spinach or asparagus. (Getty Images)

Breakfast neednt be complicated. Pour a bowl of bran flakes or shredded wheat, douse in low-fat milk and top with blueberries or sliced peaches to sweeten without added sugar. (Getty Images)

Between two slices of whole-wheat bread, and paired with lettuce and tomato, unsalted chicken salad topped with regular Dijon mustard can satisfy without leading to a post-lunch afternoon slump. (iStockPhoto)

From tomatoes to diced carrots and chopped celery, plus red kidney beans or chickpeas this hearty garden in a bowl, which also includes pasta, will satisfy any lunchtime craving. (Getty Images)

For a quick snack on the run, grab a nonfat yogurt with no added sugar for the healthiest option and more protein, choose plain Greek yogurt and add fruit for sweetness. (Getty Images)

For a green and lean dinner, try a leafy salad topped with grilled chicken and strawberries. Dress lightly with oil and vinegar or your favorite vinaigrette dressing. (Getty Images)

Spice it up with this traditional dish featuring roasted pork that incorporates sesame seeds coriander, minced onion and other savory flavoring. Pair with steamed peas. (Getty Images)

Combine eggs, chives and reduced fat cheddar cheese into a quick breakfast that can provide you with a foundation for the day. You may also consider adding veggies, such as spinach or asparagus. (Getty Images)

Breakfast neednt be complicated. Pour a bowl of bran flakes or shredded wheat, douse in low-fat milk and top with blueberries or sliced peaches to sweeten without added sugar. (Getty Images)

Between two slices of whole-wheat bread, and paired with lettuce and tomato, unsalted chicken salad topped with regular Dijon mustard can satisfy without leading to a post-lunch afternoon slump. (iStockPhoto)

From tomatoes to diced carrots and chopped celery, plus red kidney beans or chickpeas this hearty garden in a bowl, which also includes pasta, will satisfy any lunchtime craving. (Getty Images)

For a quick snack on the run, grab a nonfat yogurt with no added sugar for the healthiest option and more protein, choose plain Greek yogurt and add fruit for sweetness. (Getty Images)

For a green and lean dinner, try a leafy salad topped with grilled chicken and strawberries. Dress lightly with oil and vinegar or your favorite vinaigrette dressing. (Getty Images)

Spice it up with this traditional dish featuring roasted pork that incorporates sesame seeds coriander, minced onion and other savory flavoring. Pair with steamed peas. (Getty Images)

Fresh fruits, veggies and whole-grain products are generally pricier than the processed, fatty, sugary foods most Americans consume.

Likely, provided you follow the rules, and especially if you design your plan with a calorie deficit.

Though not originally developed as a weight-loss diet, some studies have looked at DASHs potential to help dieters shed pounds. Heres a closer look at the data:

While it may be difficult to give up your favorite fatty, sugary and salty fare, DASH doesnt restrict entire food groups, upping your chances of sticking with it long-term.

Convenience. Although recipe options are boundless, alcohol is not. The DASH PDF is packed with tips to make it all easier.

Recipes. The NHLBI offers numerous recipes in its 64-page PDF. Otherwise, lots of reputable organizations, like the Mayo Clinic, provide long lists of DASH-friendly recipes.

Eating out. Difficult, since restaurant meals are notoriously salty, oversized and fatty. If you do dine out, NHLBI suggests avoiding salt by shunning pickled, cured or smoked items; limiting condiments; choosing fruits or vegetables instead of soup; and requesting the chef find other ways to season your meal.

Alcohol. Too much can elevate blood pressure and damage the liver, brain and heart. If you drink, do so in moderation thats one drink a day for women, two a day for men. (A drink is considered 12 ounces of beer, 5 ounces of wine or 1 ounces of liquor.)

Time-savers. None, unless you hire somebody to plan your meals, shop for them and prepare them. And you cant pay someone to exercise for you.

Extras. NHLBIs PDF serves up a week of DASH meal plans, offers tips on reading nutrition labels, lists the sodium and potassium content of various foods, and provides exercise ideas.

Fullness. Nutrition experts stress the importance of satiety, the satisfied feeling that youve had enough. DASH emphasizes lean protein and fiber-filled fruits and veggies, which should keep you feeling full even if youve reduced your calorie level slightly to support weight loss.

Taste. Although you may miss salty popcorn and potato chips, your taste buds should eventually adjust. Avoid blandness by getting friendly with herbs and spices.

The panelists applauded the Dietary Approaches to Stop Hypertension (DASH) plan for its nutritional soundness and safety it racked up near-perfect scores in both categories. Endorsed by the federal governments Department of Health and Human Services, the diet is packed with produce and light on saturated fat and salt.

Recommended, especially if you want to lose weight.

[Read: The Case for Exercising Alone.]

To get started, try a 15-minute walk around the block each morning and night, and then slowly ratchet up intensity and duration if you can. Just find activities you like (jazzercise, swimming, gardening), set goals and stick to them.

Read the rest here:
DASH Diet: What To Know | US News Best Diets

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IMAGES PROVIDED BY:

(1) Steve Pomberg / WebMD (2) WebMD (3) Steve Pomberg / WebMD (4) Steve Pomberg / WebMD (5) Steve Pomberg / WebMD (6) Steve Pomberg / WebMD (7) Steve Pomberg / WebMD (8) Steve Pomberg / WebMD (9) Steve Pomberg / WebMD (10) Steve Pomberg / WebMD (11) Pixtal Images (12) Steve Pomberg / WebMD (13) Steve Pomberg / WebMD (14) Steve Pomberg / WebMD (15) Steve Pomberg / WebMD (16) Getty Images (17) Sian Irvine / Dorling Kindersley (18) Steve Pomberg / WebMD (19) Steve Pomberg / WebMD (20) Steve Pomberg / WebMD (21) Pixtal Images (22) Steve Pomberg / WebMD (23) Steve Pomberg / WebMD (24) Steve Pomberg / WebMD (25) Steve Pomberg / WebMD (26) Steve Pomberg / WebMD

REFERENCES:

Kathleen M. Zelman, MPH, RD, LD, director of nutrition, WebMD. Joan Salge Blake, MS, RD, LDN, clinical associate professor, Boston University's Sargent College of Health and Rehabilitation Sciences; spokesperson, American Dietetic Association. Leslie Bonci, MPH, RD, director of sports nutrition, University of Pittsburgh Medical Center. American Dietetic Association: "25 Healthy Snacks for Kids." Edy's Slow-Churned: "Flavor Details." Orville Redenbacher's: "SmartPop Butter Mini Bags 4 - Nutrition Facts." United States Department of Agriculture National Agricultural Library. Herr's Products. "Herr's Products - Whole-Grain Pretzel Sticks." Self Nutrition Data. Dole: "Mango." Chobani Yogurt: "Chobani Yogurt - Products - Non-fat Greek Yogurt."

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