Rarely,intestinalcancermaydevelopin aperson withMeckel’sdiverticulum,althoughthisoccursmore ofteninadultsthanchildren.
Risks
Theriskofcomplicationsinpatientswhohavenot experiencedsymptomsisnearlyzero.Patientswhoare notexperiencingsymptomsusuallydo notrequire surgicaltreatment.
Without treatment,asymptomatic person with Meckel’sdiverticulum canloseenoughbloodthat he or shegoesinto shock. In somecases,theintestine couldruptureandleakwaste intotheabdomen, increasingtheriskofseriousinfection. Inrarecases, thecomplications associated withMeckel’sdiverticu- lummaybelife-threatening.
Accordingtothe AmericanPediatricSurgical Association,thereisalessthan 2%riskofcomplica- tions associated withsurgicaltreatmentofMeckel’s diverticulum. Post-surgical intestinal blockage from scartissueoccursinjust5%to9%ofpatients.
Gastrointestinalfunctioningandnutritionremain unaffectedaftertreatment forMeckel’sdiverticulum. Aftersurgerytoremovethepouchandany intestinal blockage,symptomswillnotrecur.Theprognosisfor someonewithMeckel’sdiverticulumisexcellent.
Researchandgeneral acceptance
Treatment forapersonwithsymptomsofMeck- el’s diverticulum isfairlystraightforwardandengen- derslittleornomedicalcontroversy.
When physicians are considering treatment options,determining whethertoremoveanasympto- matic Meckel’s diverticulum may be controversial. Someresearchhasindicatedthatagemayplayarole inthedecisiontoremoveaMeckel’s diverticulum.A studyinadultsindicatedthatremovalofasymptomatic diverticulummaybenefitpeopleunder50yearsofage.
Resources
PERIODICALS
McKayR.Highincidenceofsymptomatic Meckel’sdivertic-uluminpatientslessthanfiftyyearsofage:anindicationforresection.AmericanSurgeon,2007Mar73(3):271-5.
SagarJ,Kumar V,ShahDK.Meckel’sdiverticulum:asystematicreview.JournaloftheRoyalSocietyofMedicine,2006Oct;99(10):501-5.
ORGANIZATIONS
AmericanAcademyofPediatrics.141NorthwestPoint
Boulevard, ElkGroveVillage,IL60007-1098.(847)
434-4000.
QUESTIONSTO ASKYOURDOCTOR
• Howseriousismycondition?
• WillIneedsurgerytotreatmycondition?
• Howlongwillittakemetorecoveraftersurgery,andwhatcanIexpectafterrecovery?
• Whatdietarychanges willIneedtomakeaftertreatment?
• Arethereanylong-termchanges IneedtomakeaftersurgeryforMeckel’sdiverticulum?
• My childisundergoing surgery.Are thereany complicationsassociated withpediatric surgery forMeckel’sdiverticulum thatIneedtobe concerned about?
AmericanCollegeofGastroenterology.POBox3099, Alexandria, VA22302.(800)HRT-BURN.<
AmericanGastroenterologicalAssociation. 7910Wood-montAve.,7thFloor, Bethesda,MD 20814. (310)654-
2055.
AmericanPediatricSurgeryAssociation. 60 RevereDrive,Suite500,Northbrook,IL60062.(847)480-9576.
NationalDigestiveDiseasesInformationClearinghouse. 2
InformationWay,Bethesda,MD20892.(800)891-
5389.
AmyL.Sutton
Medifast
Definition
TheMedifastdietisaportion-controlled,low-fat, low-carbohydrate,low-calorie dietplan that utilizes meal replacementfoodsthatareobtainedfromthe Medifast company. These meal replacement foods arenutrient-denseand low-calorie. Asalow-calorie diet, theMedifast dietisintended to produce rapid weightlossatthestart ofaweight-lossprogram for personswhoaremoderately toextremelyobese.
Origins
TheMedifastdietwascreatedandismarketedby JasonPharmaceuticals,basedinOwingsMills,Mary- land. Dr. William Vitale founded the company in
GALE ENCYCLOPEDIAOFDIETS667
Medifast®
Medifast®product / Caloriesper serving / Protein
(g) / Carbohydrates
(g) / Fat
(g) / Cholesterol
(mg) / Sodium
(mg) / Potassium
(mg) / Fiber
(g)
55shakes / 90 / 11 / 13–14 / 0–1 / 0 / 250 / 420–440 / 3
70shakes / 100–110 / 14 / 13–14 / 0.5–1 / 0 / 240–250 / 400–430 / 3
Ready-to-drink / 90 / 11 / 12 / 1–1.5 / 0 / 190–200 / 370–480 / 3
shakes
Appetitesuppression / 100 / 15 / 12 / 0.5–1 / 0 / 210 / 400 / 4
shakes
Diabeticshakes / 90 / 14 / 9–10 / 0.5–1 / 0 / 250 / 400 / 3
Women’shealth / 110 / 14 / 15 / 1 / 0 / 190 / 480 / 4
shakes
Bars / 150–170 / 11 / 18–23 / 3.5 / 0 / 140–170 / 260–310 / 4–5
Diabeticbars / 140 / 10–11 / 23–23 / 4–5.5 / 0 / 160–170 / 320–350 / 4
Soups / 90–110 / 9–11 / 12–19 / 1 / 0 / 290–350 / 400–600 / 3–4
Amountsvary withproductflavors
(IllustrationbyGGSInformationServices/ThomsonGale.)
1980.OriginallyMedifast wasprimarilyamedically- supervisedweightlossprogram. Medifast stilloffers thisoption, butonlyabout10%ofitscustomersnow utilize thedietundermandatorymedicalsupervision. Currently an individual canaccessthetheMedifast dietprogram through Hi-Energy WeightLossCen- ters, at home bytelephone or through the website ( hospitalsorclinics, or through theofficeofahealth careprovider (for example,aphysician,nutritionist,ordietitian).Medi- fastis availableinAsia(India,HongKong,andSin- gapore)asDr.Diet.
Description
Glucoseis generallyregardedasthepreferred energysourceforcellsinthebody,withketosisbeing regardedasthecrisis reactionofthebodytoalackof carbohydratesin the diet. In a diet that does not substantially contribute to blood glucose, the body goesthrough asetofstagesto enter ketosis. After about48hoursthebodystartsusingketonesproduced fromstoredfatsforenergy,releasingfree fattyacids, whilereservingglucoseforimportant needs,thus avoidingthedepletionofthebody’sstoredproteinin themuscles.Theburning offatisthoughttoprovide sufficientlevels ofenergywhilehelpingtoeliminate physicalhunger. Ketosiscanbedeliberately induced through the useofalow-calorie, low-carbohydrate diet, such as the Medifast diet, resulting in rapid weightlossduetotheuseofbodyfatforenergy.
Specifically, the Medifast diet isa weight loss program that reliesonmealreplacementfood prod- uctsthat arepurchased fromJasonPharmaceuticals. Although medicalsupervision oftheMedifast dietis
not required, itisrecommended. There are over50 differentmealsthatadietermaychooseaspartof the diet, including shakes, bars, drinks, oatmeal, chili, soups,andpuddings. Thedailycalorieintake onthe planisbetween800to1,000caloriesperday.During theweightlossphaseofthediet,thedieterfollowsa5
1mealplanthatconsistsoffiveportion-controlled, nutritionally-balancedMedifast mealsplusoneLean
Greenmeal.TheLeanportionoftheLeanGreen mealconsistsofeither:
• fiveouncesofcookedleanbeef,pork,orlamb
• sevenouncesofcookedchicken,turkey,fish,orseafood.
The Green portion ofthe Lean Green meal consistsof:
• Twocupsofsaladgreenswith1/2cupofrawvege- tables (cabbage, spinach, sprouts, celery,radishes, cucumber, pepper, or tomatoand 1-2tablespoons oflow-carbsaladdressing,or
• Oneandone-halfcupsoflow-carbohydratecooked vegetables(Carrots, corn,peas,potatoes, andBrus- selssproutsshouldbeavoidedduringtheweightloss phaseoftheMedifastdiet).
Aperson whochoosestoreplaceallmealswith Medifast food products and to not incorporatethe LeanGreen mealinto their dietmustdosoonly underadoctor’ssupervision.
DuringtheMedifast 51weightlossphase,the dieter eliminatesfruits,dairy,andstarchesbecauseof theirhighcarbohydratecontent. Thesefoodscanbe reintroduced into the diet during the maintenance phase of the Medifast program. The dieter isalso directedtodrinkatleast64ouncesofwater perday and to limittheintake ofother non-caloric liquids,
668GALE ENCYCLOPEDIAOFDIETS
KEYTERMS
Acesulfame potassium —A calorie-free artificial sweetener, alsoknown asAcesulfame K orAceK, and marketed under the trade names Sunett and Sweet One. Acesulfame potassium is 180-200 times sweeter than sucrose (table sugar),assweet asaspartame,abouthalfassweetassaccharin, and one-quarterthesweetnessofsucralose.Likesaccha- rin,ithasaslightly bitteraftertaste,especiallyathigh concentrations.KraftFoodshaspatentedtheuseof sodiumferulateto maskacesulfame’saftertaste. Alternatively, acesulfame Kisoften blended with othersweeteners (usuallysucraloseoraspartame)
Transient ischemic attack (TIA)—Aneurological eventwiththesignsandsymptomsof astroke,but whichgoaway within ashortperiod oftime.Also calledamini-stroke,aTIA isduetoatemporarylack of adequateblood and oxygen (ischemia) to the brain.Thisisoften caused by the narrowing (or, less often, ulceration) of the carotid arteries (the majorarteriesintheneck thatsupplyblood tothe brain). TIAstypically last2to30minutes and can produce problems withvision,dizziness, weakness ortroublespeaking
Deepveinthrombosis(DVT)—Blockageofthedeep veins;particularly common intheleg.
Premenstrualsyndrome (PMS)—Asyndrome that involvessymptomsthatoccurin relationto themen- strualcycle and which interfere withthewoman’s life. The symptomsusuallybegin5to11daysbefore thestartof menstruation andusuallystopwhen menstruationbegins,orshortlythereafter.Symptoms may include headache, swelling of ankles, feet, andhands, backache,abdominalcramps orheavi- ness,abdominal pain, bloating, orfullness,muscle
spasms, breast tenderness, weight gain, recurrent coldsores,acne flare-ups, nausea, constipationor diarrhea, decreased coordination, food cravings, lesstolerance for noisesandlights,andpainful menstruation
Pulmonary embolism—Lodging ofablood clot in thelumen(opencavity)ofapulmonaryartery,caus- ing aseveredysfunctioninrespiratoryfunction.Pul- monaryembolioftenoriginateinthedeeplegveins and travel tothe lungs through blood circulation. Symptoms include sudden shortness of breath, chestpain(worsewithbreathing), and rapid heart andrespiratoryrates
Pycnogenol—Tradenameofacommercial mixture ofbioflavonoids (catechins, phenolic acid, proan, thocyanidins) thatexhibitsantioxidativeactivity
Type1Diabetes—Previously knownasinsulin- dependentdiabetesmellitus,(IDDM)orjuveniledia- betes. Type 1 diabetes isa life-long conditionin which thepancreas stopsmaking insulin. Without insulin, thebody isnotable touseglucose (blood sugar)forenergy.Totreatthedisease,apersonmust injectinsulin,followadietplan,exercisedaily,and testbloodsugarseveraltimesaday.Type1 diabetes usuallybeginsbeforetheageof3.
Type2Diabetes—Previously knownasnoninsulin- dependentdiabetesmellitus(NIDDM)oradult-onset diabetes. Type2diabetes isthemostcommon form ofdiabetesmellitus.About90to95%ofpeoplewho havediabeteshavetype2 diabetes.Peoplewithtype
2diabetes produce insulin, buteitherdonotmake enoughinsulinor theirbodiesdonotusetheinsulin theymake.Mostofthepeoplewhohavethistypeof diabetesareoverweight
althoughadditionalnon-caloricbeverages are allowed. Coffeeandcaffeinateddrinksarelimitedtothreeper day,asthelowcaloriclevel oftheMedifastdietmay increasesensitivitytocaffeine, resultinginanxietyor shakiness.Alcoholicbeveragesarenotrecommended ontheMedifast program, astheyprovideadditional calories withoutnutritionalvalue.Alcoholalsostimu- latestheappetiteaswellasdepletesthebodyofwater.
TheproteinusedinMedifastmealproductsissoy protein, whichasacompleteprotein, provides allof theessentialamino acidsrequired fornutrition.The benefitsofsoyproteininclude:
• potential loweringofbloodcholesterollevels,espe- ciallylevelsofLDLcholesterol
• potentialincreaseinthemineralcontentanddensity ofbones,whichmayprotect againstbonefractures andosteoporosis
• possiblepreventionof hormone-related cancerssuch asbreastcancer,prostate cancer,andcoloncancer
• possible reduction in triglycerides and increase in
HDL cholesterol
• possiblereductionin menopausal symptoms,includ- inghotflashesornightsweats
GALE ENCYCLOPEDIAOFDIETS669
Differentformulationsof theMedifastshakes, Medifast 55and Medifast 70,areusedformenand women.Allofthelow-lactoseshakescontainproteins, vitamins, andminerals. However,Medifast 70hasa higher soyprotein content and ismore suitable for menorforwomenwhoarephysicallyvery active.In addition, thereisaMedifast PlusShakeforAppetite Suppressionavailablethatcontainsan appetite suppresantinaddition toprotein, vitamins,andmin- erals. Therearealsoavarietyoflactose-freeorlow- lactoseproductsavailablefor personswhoarelactose- intolerant.
The dieter isallowed one snack a day on the Medifast diet.ThesesnacksmaybeMedifast snacks purchasedthroughtheprogramorsuchitemsascelery stalks,sugar-freegelatin,sugar-reegum, sugar-free mints,bouillon,sugar-freepopsicles,ordill pickle spears.Medifastproducts aresweetenedwithfructose oracesulfame potassium. Medifast dietproducts do notcontainany stimulants,ephedrine,orherbs.Addi- tional vitamin supplementsarenotrequiredwiththe Medifastprogram, astheMedifastmealsarefortified withvitamins. Thereareabout 3-4gramsoffiberin mostMedifast mealreplacementproducts. Onlyone Medifastbar isallowed per day on thediet, asthe bars are higher incalories than the other Medifast foodproducts.Mealscanbe seasonedwithherbs, seasonings,orspices,buttheuseofcondiments such asketchup, mustard, soyorteriyaki sauce,vinegar, horseradish islimitedtosmallamountsofnot more than3-4condimentsaday.Toaccommodate eatingat restaurantswhilestilladhering totheMedifast diet, thedietercanhavethedailyLeanGreenmeal.
Forpersonswithvariousallergies, Medifast provides informationonallergenspresent inspecific Medifastfoodproducts.These allergensincludewhey, milk, soy, lactose, wheat, eggs,shellfish, tree nuts, peanuts,caffeine,andgluten.
AllMedifast food products meet the standards imposedbytheUnitedStatesFoodandDrugAdmin- istrationforstandards, labeling,andpackaging requirementsfor themarketing and saleofmedical foods,vitamins,andnutritionalproducts. Aspartof themedicalfoodlabeling requirement, eachproduct liststhe name and quantity ofeach ingredient and isidentifiedasaweightmanagement/modifiedfasting orfastingsupplement.Themajorityof Medifast products are certified kosher by The Orthodox Union ofNewYork.Inaddition, thereareanumber ofvegetarianmealsandsnacksavailable.Avegetarian canreplacethemeatportionoftheLeanGreenmeal withsuchitemsaslowfatcheese,eggs oreggsubsti- tute,tofu,cottagecheese,orvegetableburgers.
Thereareseveral specializedMedifastfoodprod- uctsandsupplements thatcanbeusedinconjunction withtheMedifast5 & 1 dietprogram.However,indi- vidualsshouldnotincorporate morethanonekindof supplementintotheirMedifastmealplan.
MedifastPlusforDiabeticsisdesignedtomeetthe nutritionalneedsofpersonswithType2diabetes.This Medifast program canbeusedasasupplement ina weight-lossprogramforapersonwithType2diabetes orasasupplement toadiabetes dietthat hasbeen designedtocontrol blood sugar. TheMedifast food products for diabetics contain lessthan 5grams of sugar per serving, and many of the products have been certifiedasLowGlycemicbytheGlycemic ResearchInstitute.Blood sugar,oraldiabetesmedica- tions,and insulinneedsmust bemonitored periodi- callyandadjusted asneeded.Bloodsugarshouldbe checkedatleasttwotothreetimesaday,especially at thebeginningoftheMedifastprogram.
Medifast PlusforJointHealth isameal-replace- mentsupplement that wasformulated torelievethe symptoms associated with arthritis and poor joint health.MedifastJointHealthShakes containboth glucosamine andchondroitin.ThreeJointHealth ShakesareincludeddailyaspartoftheMedifast 5
1Mealplan.Apersonwhoisalreadytakingmedica-
tionforarthritis shouldconsultwiththeirhealthcare provider before incorporating Joint Health shakes intotheirMedifastdietplan.
Medifast Plus for Women’s Health isa meal- replacement supplement that was formulated to relieve and prevent the symptoms of menopause, suchashot flashesand night sweats.TheWomen’s Health Shakescontain blackcohosh,echinacea,and chaste tree berry. One to three Women’s Health ShakesareincludeddailyaspartoftheMedifast 5
1mealplan. Awomenwhoisalready onHormone
ReplacementTherapyshouldconsultwith theirhealth care provider before incorporating Joint Health shakesintotheirMedifastdietplan.
MedifastPlusforCoronary Health is ameal replacement supplement that wasformulatedtopro- tecttheheartagainstdisease. CoronaryHealthShakes includeCoenzymeQ10, aminoacids,andPycnogenol. Oneto three Coronary Health Shakes are included dailyaspart oftheMedifast 51mealplan. The Coronary HealthShakewasdesignedasapreventive measure,andpersonswith concernsabouttheirheart healthshouldtalktotheirhealthcare providerbefore usingthisMedifastfoodproduct. Itis especially important thatpersonswhoarealreadyonheart medications consult with their health care provider
670GALE ENCYCLOPEDIAOFDIETS
before incorporating Coronary Health shakes into theirMedifastdietplan.Inaddition, dosagelevels of bloodpressuremedicationsmayneedtobeadjustedas apersonlosesweight.
Exerciseisanintegral part oflosingweightand maintaining weightloss.However,apersonwhodoes nothaveanexerciseprogram inplacepriortostarting theMedifastdietshouldwait2-3 weeksbeforebegin- ninganexerciseprogram, inorder toprevent dehy- dration and toprotect muscletissue.Aperson who doesparticipateinanexerciseprogrambeforestarting theMedifast dietshould cuttheexerciseprogram in halfforthefirstseveralweeks, toallowthebodyto adjusttothelowercalorielevels.Asthebodyadjusts, thelengthandintensityofexercisecanbeincreased.
ApersonstaysontheMedifast5& 1planuntil:
• thetargetweighthasbeenmet
• weightlosshasslowedtolessthanthreepounds per month
• the dieter develops a contraindicationto the pro- gram,suchaspregnancy
• thehealth careprovider recommends transitioning intothemaintenance phase
Ifapersonhassignificantweighttolose that necessitatesstayingontheweightlossphaseforlonger thansixteenweeks,theprogram shouldbemonitored byahealthcareprovider.
Duringthetransition phase,aftertheweightloss phaseoftheMedifast diet,caloriesareslowlyadded backintothediettogivethebodytimetoadjust to thenewlevelsofcaloriesandcarbohydrates. Follow- ingthetransition phase,anindividualshoulddevelop aplan tomaintain theweightloss.Insomecases,a person may chosesto continue to include Medifast food products inconjunction withother lowcalorie mealstomaintain ahealthy weight.Persons experi- encingaaweightgainoffive totenpounds maygo backontheMedifast 51planforafewweeksin ordertoreturntotheirtargetweight.
Asof2007,theMedifastdietcostsabout$10/day,
$70/week, or$275/monthwhen purchasingfoodin packages. Costs are higher when purchasing on a per-productbasis.Therearenoenrollment ormem- bershipfeesassociated withtheprogram. TheMedi- fast program hasaweb-based support program for customersthatprovidesthe dieterwithtools,support, andinformationtoassistwithnutrition,exercise,and motivation.Theprogramprovidesalso behaviormod- ification programs. In August 2002Jason Pharma- ceuticals set up a health network subsidiary, Take Shape for Life,that by2007had enrolled over 150
physiciansandmedical professionalstosupervisea network ofqualified health advisorswhoworkwith individualstohelpthemsuccessfully implementtheir Medifastdietplan.
Function
ThepurposeoftheMedifastdietiscreatea calorie deficitthatallowsapersontoburnfatandloseweight whilemaintaining musclemass.TheMedifast dietis mostsuitedforthosepersonswhoneed tolose asig- nificant amount of weight and have had difficulty losingweightwithotherdiets.
Benefits
ManypeopleontheMedifastdietlose anaverage of2-5 pounds perweek.Individual resultsvarybased oninitialweightwhenstarting theprogram, targeted weight-lossgoal,levelofexercise,presenceofmedical conditions, useofmedications, andcompliancewith thedietrequirements.
Precautions
Beforestarting theMedifastdietprogram, aper- sonshouldconsultwitha healthcareprovider.This is especiallyimportantif theperson:
• hasanyseriousmedicalconditions
• isonanymedications, especiallythosefordiabetes
• isage65 orolder
• isundertheageof18
• has50 poundsormoretolose.
All individualstakingprescriptionmedications should periodically meetwiththeir health carepro- vider whileon the Medifast diet to make sure that medication dosages whileon the diet. Persons over theageof 70mustbeunderthesupervisionofahealth care provider when using the Medifast diet. These older people may need a higher caloric intake and mayneedtoadjusttheirdosagesofmedications.
TheMedifastmealsshouldbeeatenevery twoto threehours.Ifamealis missed,therestofthemeals should be eaten closer together, for if a meal is skipped,thenutrients forthedaywillbeinadequate.
Theremaybedifficultiesassociated withtransi- tioning from adietbasedonshakes and soups toa regular diet. Thetransition phase should lastabout four tosixweeksand canbestarted byintroducing foods such as oatmeal for breakfast and fruits for snacks. Due to the low level of caloric intake duringtheweightloss phaseoftheMedifastdiet,itis likelythat somemusclelosswilloccur,sogradually
GALE ENCYCLOPEDIAOFDIETS671
increasing strength training during the transition phaseisrecommended.
Risks
Certainconditionsabsolutelyprohibittheuseofa lowcalorie dietsuchasMedifast. Theseconditions include:
• Mycocardial infarction/heartattack withinprevious threemonths,unstableangina
• Strokesortransient ischemicattacks
• Uncontrolledseizures
• Clottingdisorders
• Type1diabetes(unlessMedifast foodproducts are used to improve nutritionor weightmaintenance, but Medifast isnot recommended asaweightloss program forType1diabetics
• Severe liverorkidneydiseasesthatrequirelow-pro- teindiets
• Activepepticulcerdisease
• Activecancers
• Activethrombophlebitis (orDeepVeinThrombosis (DVT)/Pulmonary Embolism(PE)withinthree months
• Pregnancyorbreast-feeding
• Eatingdisorderssuchasanorexiaorbulimia
• Severe psychiatric illnesses, including history of majordepressionand/or suicideattempts
• Corticosteroidtherapyofgreaterthan20mgperday
• Chronicillicitdruguse,addictions,alcoholism,and/
orsubstanceabuse.
Other conditions may limittheuseofMedifast products andrequiretheclose supervisionofahealth careprovider.Theseconditions include:
• Useofthemedication Lithium(bloodlithiumlevels shouldbemonitored duringtheuseoftheMedifast diet)
• Ahistoryofseizures
• Ahistoryofpepticulcerdisease
• Useofanticoagulantmedications suchascoumadin (bloodtestsshould beperformed todetermine the therapeutic levelofcoumadin required during the useoftheMedifastdiet)
• Overtheageof70(itisrecommended that persons useMedifast products inconjunction witha1,200 calorieperdaydiet)
• Adolescent use(afterpuberty andundertheageof
18,theMedifast dietshouldonlybeusedunderthe careofahealthcareprovider
• Hypothyroidism(theMedifast dietshould onlybe usedunderthedirectsupervision ofthehealthcare provider.Bloodtestsshouldbeconducted through- outtheperiodof thedietandmedicationadjustedas required. Somehealthcareproviderssuggestthat a non-soyMedifastproductbe eatenatthetimeofday thatthethyroidmedicationistaken..
• Gastric by-pass surgery (the Medifast diet can be used inconjunction withgastricbypasssurgerybut calorielevelsmaybeadjusted attherecommenda- tionofthehealthcareprovider.
Manypeople donotexperiencephysicaldiscom- fortontheMedifastprogram.However,some persons maybecomeconstipated,feel dizzy,lightheaded, fatigued,and/or cold,andmaydevelopdryskinand hair.Othereffectsmayincludelegcramps,headaches, hairloss,rashes,gas,diarrhea, badbreath, andexces- sivefeelingsofhunger.For women,therapid weight lossassociated withtheMedifastdietmaycausean increase in levelsof estrogen in the blood stream, which can affect the regularity ofmenstrual cycles, possibly increase symptoms of premenstrual syn- drome(PMS),andcanalsoincreasefertility.
Researchandgeneral acceptance
Morethan15,000 physiciansintheUnitedStates haverecommended Medifast programs totheir patients, andmorethan amillionpersonshaveused theMedifastdietsince1980.TheMedifastdietismost suitable for persons who need to losea significant amount ofweight.TheMedifastdietcanbeeffective, butaswithalldiets,relapsesarecommon. Tomain- tain the weight loss, the useof a fitnessroutine is recommendedtoincreasemetabolismandleanmuscle mass.TheMedifast dietcanalsobeexpensive,espe- ciallywhenon-goingmedicaloversightisincluded.
TheJohnsHopkins WeightManagementCenter inBaltimore, MarylandusesMedifast foodproducts for their verylowcalorie diets. In aclinicalstudy, researchers at Johns Hopkins found that maleslost anaverageof67.41pounds andfemaleslostanaver- ageof47.5pounds after beingontheMedifast pro- gramforsixweeks.
Inan86-week weightloss studyofpersonswith Type2 diabetes,whichwasfundedbyMedifast, researchers from Johns Hopkins Bloomberg School ofPublicHealth foundthat participantsusingMedi- fastlosttwiceasmuchweightandweretwiceascom- pliant asparticipants followingastandard fooddiet basedonthedietaryguidelinesof theAmericanDia- betesAssociation(ADA).Twenty-fourpercentof the Medifast dieters wereable to decrease or eliminate
672GALE ENCYCLOPEDIAOFDIETS
QUESTIONSTO ASKYOURDOCTOR
. Isthistypeoflowcaloriedietappropriateformyweight-lossneeds?
. Whattypesofmedicalmonitoringandoversight doIneed?
. WherecanIfindsupportandinformation?
. WhattypesofsideeffectsshouldIwatchoutfor?
their diabetes medication, compared tozeropercent onthestandard ADAfooddiet.
Asof2007,theNational Institutes ofHealth is sponsoringastudyonenergymetabolismin thepost- obesestateatTheUniversityofVermont. Medifast products arebeingusedastheweightlosstoolinthe study. Thestudyfound that after 8months, partici- pantslost45–65 pounds. OtherusersoftheMedifast dietincludetheShands Teaching Hospital, whichis affiliated with the University ofFlorida, aspart of their adolescentobesitytreatmentprogramandthe Maine State Prison intheirweight-lossprogram for obeseprisoners.
Resources
BOOKS
Davis,Lisa,andMacDonald,Bradley,T.TheSecretisOut:Medifast,WhatPhysiciansHaveAlwaysKnownAboutWeightLoss.OwingsMill,Maryland:Medifast,Inc.,
2006.
ORGANIZATIONS
Medifast, Inc.Telephone:800-209-0878.Website:[
TishDavidson,A.M.
Mediterraneandiet
Definition
The Mediterraneandietisbetter described asa nutritionalmodel or patternof food consumption rather than adietintheusualsenseoftheword.To beginwith,thereismorethanoneMediterraneandiet, ifthephrase isunderstoodtorefertothetraditional foods andeatingpatterns foundinthecountriesbor- dering the MediterraneanSea. Francesco Visioli,a researcher whohaseditedtwobooks onthesubject,
preferstheterm‘‘Mediterraneandiets’’inthepluralto reflectthefactthat‘‘thepopulationsintheMediterra- neanareahave differentcultures,religions,economic prosperity, and [levelsof]education, and all these factorshavesome influenceondietaryhabitsand health.’’Forexample,Visiolinotesthatalcoholintake is very low in the Maghreb (coastal northwestern Africa) because most inhabitantsof the region are Muslim, and consequently cerealgrains figuremore prominently intheirdietthan inmostotherMediter- raneancountries. Inaddition, thedifferencesamong the variousformsoftheMediterraneandietare importantinunderstandingsome oftheresearchstud- iesthathavebeendoneonit,aswillbe describedmore fullybelow.
Origins
Theoriginsofthepattern offood consumption found in Mediterraneancountries go back several millenniaintohistory;descriptionsofmealsin ancient GreekandRomanliteraturewouldnotbeoutofplace incontemporaryMediterranean dietcookbooks.The firstdescription ofthetraditionalMediterraneandiet as itwasfollowedinthemid-twentieth century,how- ever,was notinacookbook; itwas inaresearchstudy fundedbytheRockefellerFoundationandpublished in1953.TheauthorwasLelandAllbaugh,whocarried outastudyoftheislandofCreteasanunderdeveloped area.Allbaughnotedtheheavyuseofoliveoil,whole- grainfoods,fruits,fish, andvegetablesin cookingas wellasthegeographyandotherfeaturesoftheisland.
TheCretanversionof theMediterraneandiet becamethefocusof medicalresearchontheMediter- raneandietfollowingthepublication ofAncelKeys’s SevenCountryStudyin1980.Keys(1904–2004)wasa professor ofphysiology attheUniversityofMinne- sota who had a varied backgroundinbiology and biochemistry before turning to nutritionalmost by accident.HiredbytheArmyin1941 todevelopport- ablerations fortroops incombat, Keyswasrespon- sibleforcreatingwhattheArmythencalledKrations. Hisnextwartimeprojectwasastarvation experiment, whichheconducted inorder to determine thefood needsofstarvingciviliansinwar-torn Europe.Amer- icansoldierswhoweretryingtore-feedrefugeesinthe newlyliberated countries found that there was no reliablemedicalinformationabouttreatingstarvation victims.Keysrecruited36healthymalevolunteersin
1944 whowereconscientiousobjectors,mostofthem fromthehistoricpeacechurches.Forfive monthsthe subjectsweregivenhalf thenormalcalorierequirement ofanadultmaleandaskedtoexercise regularlyona treadmill. Theaverageweightlosswas25% ofbody
GALE ENCYCLOPEDIAOFDIETS673