West J Emerg Med. And you want to do it safely. Archived PDF from the original on September 22, Any diet that emphasizes fast, easy weight loss is one to approach with caution. In , William Banting , a formerly obese English undertaker and coffin maker, published "Letter on Corpulence Addressed to the Public", in which he described a diet for weight control giving up bread , butter , milk , sugar , beer , and potatoes. The Heart Foundation's major concern with many VLCARB diets is not their restriction of carbohydrate or increase in protein, but their high and unrestricted saturated fat content, which may contribute to cardiovascular risk. The NutriSystem Advanced diet is a low glycemic index , high-fiber, and high-protein diet.
Top Diets: The Best Dieting Tips Ever for Weight Loss
There was not enough data available at that time to determine the relative risk of death or of death from heart disease. Metformin has little or no effect on body weight in type 2 diabetes compared with placebo ,  in contrast to sulfonylureas which are associated with weight gain. Metformin treatment of people at a prediabetes stage of risk for type 2 diabetes may decrease their chances of developing the disease, although intensive physical exercise and dieting work significantly better for this purpose.
In a large U. Among younger people with a higher body mass index , lifestyle modification was no more effective than metformin, and for older individuals with a lower body mass index, metformin was no better than placebo in preventing diabetes. Antidiabetic therapy has been proposed as a treatment for polycystic ovary syndrome PCOS , a condition frequently associated with insulin resistance, since the late s. UK and international clinical practice guidelines do not recommend metformin as a first-line treatment  or do not recommend it at all, except for women with glucose intolerance.
Metformin treatment decreases the risk of developing type 2 diabetes mellitus in women with PCOS who exhibited impaired glucose tolerance IGT at baseline. Metformin or clomiphene are both first line treatments for infertility in women with PCOS. Four positive studies of metformin were in women not responding to clomifene, while the population in the negative studies was drug-naive or uncontrolled for the previous treatment. Metformin should be used as a second-line medication if clomifene treatment fails.
The use of metformin during all parts of pregnancy is controversial. Metformin use among women with PCOS before they are pregnant does not appear to reduce abortion risk. Several observational studies and randomized, controlled trials found metformin to be as effective and safe as insulin for the management of gestational diabetes. Nonetheless, several concerns were raised and evidence on the long-term safety of metformin for both mother and child is lacking.
Metformin is safe in pregnancy and women with gestational diabetes treated with metformin have less weight gain during pregnancy than those treated with insulin. Metformin appears to be safe and effective in counteracting the weight gain caused by the antipsychotic medications olanzapine and clozapine. Metformin may reduce the insulin requirement in type 1 diabetes. According to the prescribing information , heart failure in particular, unstable or acute congestive heart failure increases the risk of lactic acidosis with metformin.
Metformin is recommended to be temporarily discontinued before any radiographic study involving iodinated contrast agents, such as a contrast-enhanced CT scan or angiogram , as the contrast dye may temporarily impair kidney function, indirectly leading to lactic acidosis by causing retention of metformin in the body. The most common adverse effect of metformin is gastrointestinal irritation, including diarrhea , cramps, nausea, vomiting, and increased flatulence ; metformin is more commonly associated with gastrointestinal side effects than most other antidiabetic medications.
Metformin has also been reported to decrease the blood levels of thyroid-stimulating hormone in people with hypothyroidism. In a clinical trial of subjects, Gastrointestinal upset can cause severe discomfort; it is most common when metformin is first administered, or when the dose is increased.
The discomfort can often be avoided by beginning at a low dose 1. Long-term use of metformin has been associated with increased homocysteine levels  and malabsorption of vitamin B The most serious potential adverse effect of biguanide use is metformin-associated lactic acidosis MALA.
Though the incidence for MALA is about nine per , person-years,  this is similar to the background incidence of lactic acidosis in the general population. A systematic review concluded no data exists to definitively link metformin to lactic acidosis. Phenformin , another biguanide, was withdrawn from the market because of an increased risk of lactic acidosis rate of per , patient-years.
Lactate uptake by the liver is diminished with metformin administration because lactate is a substrate for hepatic gluconeogenesis , a process that metformin inhibits. In healthy individuals, this slight excess is cleared by other mechanisms including uptake by unimpaired kidneys , and no significant elevation in blood levels of lactate occurs.
Because metformin decreases liver uptake of lactate, any condition that may precipitate lactic acidosis is a contraindication. Metformin has been suggested as increasing production of lactate in the large intestine, which could potentially contribute to lactic acidosis in those with risk factors.
Lactic acidosis is initially treated with sodium bicarbonate , although high doses are not recommended, as this may increase intracellular acidosis. A review of metformin overdoses reported to poison control centers over a five-year period found serious adverse events were rare, though the elderly appeared to be at greater risk. The most common symptoms following overdose include vomiting, diarrhea , abdominal pain, tachycardia , drowsiness, and, rarely, hypoglycemia or hyperglycemia.
Extracorporeal treatments are recommended in severe overdoses. Metformin may be quantified in blood, plasma, or serum to monitor therapy, confirm a diagnosis of poisoning, or assist in a forensic death investigation. Chromatographic techniques are commonly employed. The H 2 -receptor antagonist cimetidine causes an increase in the plasma concentration of metformin by reducing clearance of metformin by the kidneys;  both metformin and cimetidine are cleared from the body by tubular secretion , and both, particularly the cationic positively charged form of cimetidine, may compete for the same transport mechanism.
Metformin also interacts with anticholinergic medications, due to their effect on gastric motility. Anticholinergic drugs reduce gastric motility, prolonging the time drugs spend in the gastrointestinal tract. This impairment may lead to more metformin being absorbed than without the presence of an anticholinergic drug, thereby increasing the concentration of metformin in the plasma and increasing the risk for adverse effects. Metformin's main effect is to decrease liver glucose production.
Metformin decreases high blood sugar , primarily by suppressing liver glucose production hepatic gluconeogenesis. Multiple potential mechanisms of action have been proposed, including; inhibition of the mitochondrial respiratory chain complex I , activation of AMP-activated protein kinase AMPK , inhibition of glucagon-induced elevation of cyclic adenosine monophosphate cAMP with reduced activation of protein kinase A PKA , inhibition of mitochondrial glycerophosphate dehydrogenase , and an effect on gut microbiota.
Activation of AMPK was required for metformin's inhibitory effect on liver glucose production. In addition to suppressing hepatic glucose production, metformin increases insulin sensitivity, enhances peripheral glucose uptake by inducing the phosphorylation of GLUT4 enhancer factor , decreases insulin-induced suppression of fatty acid oxidation ,  and decreases absorption of glucose from the gastrointestinal tract.
Increased peripheral use of glucose may be due to improved insulin binding to insulin receptors. AMPK probably also plays a role in increased peripheral insulin sensitivity, as metformin administration increases AMPK activity in skeletal muscle. The usual synthesis of metformin, originally described in , involves the one-pot reaction of dimethylamine hydrochloride and 2-cyanoguanidine over heat. According to the procedure described in the Aron patent,  and the Pharmaceutical Manufacturing Encyclopedia ,  equimolar amounts of dimethylamine and 2-cyanoguanidine are dissolved in toluene with cooling to make a concentrated solution, and an equimolar amount of hydrogen chloride is slowly added.
Steady state is usually reached in one or two days. Metformin has acid dissociation constant values pKa of 2. The metformin pKa values make metformin a stronger base than most other basic medications with less than 0. Furthermore, the lipid solubility of the nonionized species is slight as shown by its low logP value log 10 of the distribution coefficient of the nonionized form between octanol and water of These chemical parameters indicate low lipophilicity and, consequently, rapid passive diffusion of metformin through cell membranes is unlikely.
As a result of its low lipid solubility it requires the transporter SLC22A1 in order for it to enter cells. More lipophilic derivatives of metformin are presently under investigation with the aim of producing prodrugs with superior oral absorption than metformin.
Metformin is not metabolized. It is cleared from the body by tubular secretion and excreted unchanged in the urine; metformin is undetectable in blood plasma within 24 hours of a single oral dose. The biguanide class of antidiabetic medications, which also includes the withdrawn agents phenformin and buformin , originates from the French lilac or goat's rue Galega officinalis , a plant used in folk medicine for several centuries.
Metformin was first described in the scientific literature in , by Emil Werner and James Bell, as a product in the synthesis of N , N -dimethylguanidine. Interest in metformin resumed at the end of the s. In , metformin, unlike some other similar compounds, was found not to decrease blood pressure and heart rate in animals. Again, research clearly shows that a balance of each of these nutrients is needed and that an excess or deficiency in any of them will cause problems.
This diet can be difficult to stick with long-term, so weight regain can be an issue. The South Beach Diet. The South Beach diet is the newest high-protein, low carbohydrate, and fat-controlled diet.
This diet claims that the cause for obesity "is simple: The faster the sugars and the starches you eat are processed and absorbed into your bloodstream, the fatter you get. The first phase claims to eliminate cravings and kick-start weight loss; the second phase is for long-term, steady weight loss; and the third phase is to be followed for days a year once you have achieved your weight loss goal.
The second and third phases of this diet promote a balanced diet that can be beneficial to your health and weight. These phases promote consistent meal times, healthy snacks and desserts, and water. The meal plans and recipes can be useful for those who need some guidance on what to eat. There are now six other books and an interactive web site supporting this plan.
The theory behind the diet is not the reason you will lose weight if you follow this plan. Weight loss can only occur when you consume fewer calories than your body needs. In the introduction chapter the author makes numerous claims that you do not need to limit the quantity of food that you consume and then provides portion restrictions on many high calorie foods, such as nuts.
It's appealing to hear you can eat unlimited quantities, but weight loss will not be achieved without limitations. The initial phase of this diet should be avoided. This two-week phase claims to produce a weight loss of eight to 13 pounds with severe dietary restrictions; including fruit, dairy, and starches. Phases like this are usually included so people see quick results, but are limited in time because they are not nutritionally balanced and can't be followed for a long period.
It tends to be more discouraging than motivating to lose quickly and to feel like you are "on a diet. It's best to begin slowly and to always consume a nutritionally balanced diet. Eat more, weigh less: Eat More, Weigh Less is one of the few diets developed as a result of research. The primary goal of this diet was to reverse heart disease. The basis for this diet is to consume a high-fiber, low-fat, vegetarian diet with limited amounts of dairy foods.
The goal is to consume primarily complex carbohydrates vegetables, fruit, and whole grains , low total fat primarily from omega-3 fatty acids and limited in saturated fat, and low sugar. Physical activity and stress management are also emphasized. The research does support the health benefits of this diet, and you will lose weight if you stick with the plan. The web site provides recipes and detailed information on nutrition , exercise, and stress management. The primary con to this diet is that it can be extremely limited and difficult for some people to follow.
This limitation is because meat is omitted from the plan. Cutting out an entire food group may be too much of a restriction to maintain over the long-term, so some people do best by modifying this diet to allow for a moderate amount of meat. The high fiber intake may also pose a problem initially.
It's best to slowly increase the amount of fiber you consume so your body can get used to it. The goal is always long-term weight loss and maintenance. This diet does have the research to support it, but it may need modifications to make it work for you. Jenny Craig has become best-known for the celebrities who are followed while losing weight on this diet. They explain how easy it is and how delicious the food is, and you see the results as they are happening.
This diet provides you with your foods and snacks to ensure you consume the exact amount of calories your body needs to lose weight. You add fresh produce and dairy. You meet with a consultant on a weekly basis to discuss your progress, and who will assist you with transitioning to your own food when you are ready to do so. Physical activity is emphasized throughout the diet.
The primary advantage to this diet is that you will lose weight if you eat what you are given. Portion-and-calorie-controlled meals are great tools for long-term weight loss and maintenance. They take away the guesswork of how many calories you consume, they can be nutritionally balanced, they are quick and easy to prepare, and they teach you about healthy portion sizes.
As with all diets, nothing works for everyone, and nothing works forever. The celebrity endorsements are great when they work, but the celebrities who regain their weight once they discontinue this plan are proving that this is not the answer for everyone. Many people prefer to be able to eat food they prepare and do not like the idea of prepackaged foods. The consultants are not professionals in this field. They undergo a training course but are not trained therapists, registered dietitians, or exercise physiologists, so the advice and support that you receive will be limited to what they have been taught to say.
If you are taking any medications or have any health conditions, it is best to work with trained professionals. The NutriSystem Advanced diet is a low glycemic index , high-fiber, and high-protein diet. The prepackaged food is provided for you by ordering online or by calling the toll free number.
This diet does address the three necessary components for successful weight loss and maintenance; diet, physical activity, and behavior. Prepackaged foods can be an effective tool for weight loss. You will be provided with the appropriate number of calories for weight loss without having to worry about counting anything. This will give you the opportunity to learn what appropriate portion sizes are and which foods are necessary for a well-balanced diet based on your specific needs.
The variety of programs based on gender, age, health, and dietary preference is another positive component of this diet.
The Mindset Makeover was developed by one of the leading psychologists in the weight loss field, Gary Foster, Ph. It is designed to "help people learn new behaviors when it comes to weight loss and related lifestyle issues.
You are given access to this and an online account with community support as part of each of the programs. Prepackaged foods are not for everyone and typically not something to use forever. They can be very limiting and create the sense of being "on a diet. Most people find that they only want to use this type of a diet for the short-term or for one or two meals per day. The other negative aspect of this diet is that the prepackaged foods contain the artificial sweeteners Sucaralose and Acesulfame K.
The dietary focus on this diet also has some limitations. The idea of "good carbs" and "bad carbs" is controversial. While there is some truth to the role of glycemic index in hunger, it is not a guaranteed tool for weight management.
Labeling foods as "good" and "bad" creates problems for people trying to develop healthy eating habits. A well-balanced diet requires whole wheat sources of starch, while allowing for some sugar. Weight Watchers has been around for many years. There have been changes to the program, but weekly meetings have remained a part of the plan. The two diet options that are currently available are the Flex Plan and the Core Plan. The Core Plan is based on the science of energy density. Energy density refers to the amount of calories in a given weight of food.
Foods that are considered low energy dense foods have a small amount of calories for a large volume of food for example, vegetable soups, vegetables, and fruit. High energy dense foods provide a lot of calories for a small amount of food for example, oils, butter, cream sauce.
The Core Plan provides a "balanced diet by centering on a list of healthy foods that keep you full longer. The support and information provided online and in-person sets Weight Watchers apart from most diets out there. There are numerous meetings across the country to choose from.
For many people, having a place to weigh-in each week is a key to success. The focus on a balanced diet, exercise, and behavior changes is another advantage to this diet. The goal is to educate people on all three components and assist with both weight loss and maintenance.
The two plans give people an option to find what works best for their own success. Many people have a "been there, done that" attitude when it comes to Weight Watchers. They have tried it, may have had some success, may have even gone back a couple of times, but end up feeling that it can't help them any longer. The group leaders at the meetings are not trained experts; they are former members who have had success with Weight Watchers.
When someone is not having success the options for what to do can be greatly limited by the lack of experience and knowledge of the leader. There is a strong emphasis on weighing in each week. Many people have a difficult time attending a meeting when they are not having success. However, most people will not lose weight every single week, so expecting to do so is a recipe for failure.
The time when people need the support the most is when they are not losing, but most meetings are not set to address this. While there are two diet options, this still may not be enough for everyone. If counting points and following a low-energy dense diet do not work for you, there is no other option left. The best weight loss diet is one that fits your lifestyle and needs, and you can't always get that with this plan.
I also agree to receive emails from MedicineNet and I understand that I may opt out of MedicineNet subscriptions at any time. At the most basic level, food is fuel. It gives you energy to do things. But very few people eat just for that reason. The first step is finding out what your triggers are. Is it stress , anger, anxiety , or depression in a certain part of your life?
Or is food your main reward when something good happens? Next, try to notice when those feelings come up, and have a plan ready to do something else instead of eating.
Could you take a walk? These are the sugars in cookies, cakes, sugar -sweetened drinks, and other items -- not the sugars that are naturally in fruits, for instance. Sugary foods often have a lot of calories but few nutrients.
Be choosy about carbs. You can decide which ones you eat, and how much. Look for those that are low on the glycemic index for instance, asparagus is lower on the glycemic index than a potato or lower in carbs per serving than others.
Whole grains are better choices than processed items, because processing removes key nutrients such as fiber, iron, and B vitamins. There are vegetarian and vegan sources nuts, beans, and soy are a few , as well as lean meat, poultry, fish , and dairy.
Most Americans get enough protein but could choose to get it from leaner sources, so you may already have plenty in your diet. Your exact protein needs depend on your age, gender, and how active you are. Make friends with good fats. The better choices are those in fish , nuts, and seeds, and olive oil or coconut oils.