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I have been away for 4 days and so have not had the opportunity to
respond after my posting last week.

I have a few comments to make before I summarize:

1.  My comments were not intended for the benefit of those educated few
who were critical of my effort.  Those who are knowledgeable enough to
understand the biochemistry, dangers, and long-term goals of these
various diets certainly are adequately propared to safely monitor their
own responses to such diets.

2.  Most of the people I work with daily (and I believe, most of the
people who subscribe to this list) are concerned w. finding the best way
to eat for their health and personal well-being.

3.  There is no one diet or modification that can apply to everyone.
If a diet consisting of 80-90% protein from animal sources is beneficial
for one, it won't be beneficial for another. Likewise total vegans....

4.  The danger of pushing extreme dietary modifications on individuals
who do not have the scientific background, time or interest in
researching each dietary fad is that they may not recognize their own
physiological responses to the diet (good or bad, intentioned or
unintentional.)

5.  My comments were directed towards the majority of people bombarded
by information about nutrition daily who do not have the necessary
resources to drastically change their dietary habits, lifestyle and
become hopelessly confused.

So if the scientifically elite responders will recognize that my summary
is probably not meant for them, I will try to more clearly express the
basic "healthy diet" (in my opinion) without being extreme in any way.
I do have some education and experience in helping people cope with
these issues.  I don't think long, intellectual discussions are helpful
to most people using this listserve.

1.  Long-term high-protein diets from animal-based foods (meat, cheese,
eggs) are usually high in saturated fat.  Saturated fat is related to an
increased risk for heart disease, stroke, obesity, diabetes (non-insulin
dependent) and gall-bladder disease. I do not necessarily imply
causation, just relationship.

2.  Very high protein diets (75-80% cals from animal-based protein or
more) by necessity are low-carbohydrate and therefore are usually
deficient in anti-oxidant nutrients and fiber.  (anti-oxidants decrease
risk for certain cancers, heart disease, conditions associated w. aging
such as macular degeneration, arthritis, degenerative joint disease...)

3.  High-sugar (carbohydrate) diets (refined, processed foods) are
associated w. increased risk for the above mentionned conditions as well
as diabetes, obesity.

4.  Decreased activity is strongly related to higher risk for these
degenerative diseases and for excessive weight gain - overweight
individuals are at even higher risk for the above conditions since they
continue to decrease activity due to pain, respiratory and cardiac
problems and the cycle continues because their diets become worse and
worse in an attempt to lose the weight which they believe causes all
their problems.

5.  Osteoporosis risk is increased in persons following long-term
high-protein diets.  Weight-bearing exercise, if consistent, decreases
risk for osteoporosis.

6.  Cholesterol, LDL levels are not good indicators of risk for heart
disease, stroke, HTN, diabetes which means that if your blood lipid
profile (lab work related to cholesterol) is normal, you still may be at
high risk for heart disease and stoke.  Many heart attack victims are
not overweight, do not have diabetes, have normal cholesterol levels in
blood tests.

7. Lowfat diets are not the answer because certain fats are necessary in
the diet and seem to be preventive for the illnesses discussed.
(Fish oil, seafood especially seem to be beneficial-but too much of
anything causes weight gain.)

8.  Any extreme dietary pattern is unlikely to result in improved health
because most people will not maintain a diet that they cannot live with
for a lifetime!  Also, "food" is more to people than a means of altering
their biochemistry, "food" choices are affected by individual
preferences, lifestyle, heredity, race, religious beliefs, food
availability, budget, educational level, upbringing, residence (country
or locality), and obviously physiology.  Each person is a whole picture,
the whole person must be treated, very few people can maintain an
extreme dietary plan that does not fit in with their whole existence and
experience.  So most people, realistically, do not care that a dietary
plan "might" solve all their health, well-being issues for a lifetime if
it doesn't fit in with their lives. Compromises must be made in life
always.

8.  Why would any person living in today's civilized world be remotely
interested in the Inuit diet unless he is willing to eliminate central
heating/cooling, grocery stores (health-food stores, whatever----),
automobiles and planes, TV and the media.  Why would an Inuit diet, so
well suited to inhabitants of "extreme conditions" be even remotely
important to the people reading this list?  Where is the connection
unless we plan to forage and hunt and live in tents?

     {Maybe after Y2K, we'll all reconsider this issue? --   :)  }

9.  Celiacs are often compromised nutritionally and require higher
protein, nutritionally superior diets due to varying levels of
malnutrition - celiacs should never eliminate a whole food group which
is the source of protective vitamins, minerals, fiber.  I usually start
w. about 40% CHO, 30% protein, 30% PUFA, MUFA and adjust as indicated by
the patient's response.  I encourage liberal use of fresh fruits, vegs.
and whole grains. (This is just what seems to work for me and my
patients - it's probably not the only way to improve health and I try to
stay open-minded and informed about research.)

I must say a word about ketosis/ketoacidosis -- I know the difference.

The basic, underlying biochemical mechanism for these two conditions is
the same, the difference (stated simplistically) is in degree.
When carbohydrates are metabolized by most people, the resulting
products are energy, CO2, and H20.  When fats (exogenous or endogenous)
are the main source of energy, the products of metabolism are energy and
ketones. (Very low insulin production results in dehydration unless
precautions are taken.)

Mild ketone buildup in the blood for reasonably short periods is
harmless, for some beneficial (some weight-loss diets, seizure
disorders). Ketones must be removed from the blood-stream before the
levels of ammonia-related toxins can increase to lethal levels however.
For normal people this is no problem.

For those with compromised renal or hepatic function, this can hasten
the development of ARF (acute renal failure.)  The thing about renal (or
hepatic) failure is the lack of symptoms until the condition is
well-advanced.  At that stage, the condition is not reversible and life
must eventually be extended by dialysis, transplant. The concern is that
people not knowledgeable about the dangers will continue the diet much
longer than recommended by proponents of this diet. And the immediate
weight-gain after improperly stopping the diet throws most patients into
a panic -- not everyone following the diet understands the mechanisms.
I'm not saying it's a bad diet for everyone, my concern is for those who
don't understand what they're doing or the consequences.

I am sorry for the misunderstanding about the purpose of my "summary"
last week.  It was meant for the majority of people who just want to be
healthier, feel better and live an enjoyable life without having to
follow highly-restricted eating plans or sacrifice their way of living
too drastically or innappropriately.

Only about 1/3 of responders were strongly PRO-high protein diets.
Others who responded quietly were more inclined to moderation and
increase in activity levels and have personal experiences to back up
their opinions.

I promise to NEVER open a topic so controversial again!! or post at such
length - I don't think that's what this list is about.

Happy holidays to everyone ---

Ruth Arcuri-Kovacs BSN, MS, RD