Which is the ideal regime to become thin?

At first sight this could make sure if it were nutritious and appetizing, to produce an excellent reduction of the weight and diminution of the appetite, the people would feel well and would offer a method to maintain the weight. This one was the objective that I hoped to reach when I began to investigate 30 years ago approximately.

In 1970 I found that 100 the conventional diets of kcal were usually ineffective. In the desperation many directors used the diet of zero calorie (complete starvation) that was observed was very dangerous and caused many deaths. Therefore, a more effective diet was needed one more. The new generation of diets that during my investigations were called diets of very low calories (VLCD´s) was the diets below 800 kcal. The diet of Cambridge is of very low calories.

The diets of very low calories have not been nuevas.1 first was described in 1929, for 70 years in the University of Pittsburg, where only 450 were used nutritional ingredients equivalent to kcal. This was very successful, but forgotten, perhaps because of World War II. During years 70 the scientific activities renewed, mainly in France where Apfelbaum introduced a sodium low egg albumen diet. Then, investigators in the EE.UU and Italy used a consisting of diet thin meat and fish. In Denmark they introduced a protein dust with orange juice. But only 2 groups, one in the EE.UU and ours in the United Kingdom, worked in formulations of diets that contained all the essential nutrients absolutely. These diets of very low nutritionally complete calories, provided sufficient proteins to reconstitute the daily losses; but more important it was sufficient carbohydrate to save protein, moderate mineral cetosis and retention (those that can be lost during a diet of very low calories. These contain fibers to come the cold, besides fats, minerals and vitamins in sufficient amounts to cover the daily needs.

My investigations on the diets of very low calories began in collaboration with doctor Ian Mc Read in the Hospital of Middlesex, London, with the use of a variety of compositions of diets in patients in the hospital. The power content of the diet varied of 0 until near 400 kcal.2 Using only the composition of the diet made sure an excellent loss of weight, and the first patient managed to lose 56 kg in 28 weeks, without no other food. It was very important to determine the optimal amount of carbohydrates. We found that a level enters 30 45 g/d was the best one, because it reduced the loss of proteins and also cetonuria produced one moderate, that was physiologically acceptable. These patients felt well and diminished the appetite.

Many tests were developed to determine the nitrogen balance and the biochemistry clínica.3 On the base of these experiments was descried the formulation of the diet of original Cambridge. This one contains 330 kcal, 34 42 protein g carbohydrate g, 3 fat g and 100% of vitamins and allowed minerals, recommended day per day. This diet first was introduced commercially in the EE.UU in 1980, consisted of a dust to mix with water, to provide in soups or milk diluted in several envelopes.

In 1987 the Ministry of Health of the United Kingdom published a report, based on the evidences of 12 eminent scientists who worked in that field, who recommended slight variations in his composición.4 the recommendation of power content was elevated of 330 kcal and the 40 protein content from 33 to g/d. This one is the formulation of the diet of Cambridge, that is sold in many countries from 1988.5

In the United Kingdom we have a number of different medical systems and in particular are interested in our medical program, that began around ago 7 years. Today almost 300 medical doctor's offices in the National Service of Health exist that operate in clinics of obesity with the exclusive use of the diet of Cambridge. In addition, we have an organization who uses therapeutic groups, along with nurses and doctors. They exist around 300 consulting ones that works with the doctors.

The loss of weight with the use of the diet is excellent. In the women it is of around 2 kg per week and in the men of 3 kg to the week in all the people. The men lose more weight than the women because they have a high metabolism by the increase of their muscular mass. In a study that included 500 patients of feminine sex, treaties in our program of groups of therapy with doctors, the loss average of weight was of 18 kg in 12 weeks. The index of corporal mass was always reduced within the normal rank. A high loss of weight has been obtained in individual subjects. A man in Norway lost 140 kg in 10 months and one lady in South Africa 130 kg in 13 months.

The indirect effect of the diet are few and have low incidence; they consist of slight nauseas, migraines and cold. These can be prevented if they take 2 Ls from water day per day. It is recommended to immediately take a glass from water after consuming the diet to dilute the mineral salts, that can produce nauseas. The water also is necessary to prevent the dehydration, that causes migraines. For the persistent cold an agent of low calories recommends itself like aid to increase the faecal skittle like fybogel.5

The people lose appetite 3 d after taking the diet, because the carbohydrate content, sugar in blood, and insulin is not high. Thus, the normal cycle of glicemia-hipoglicemia that it produces hunger, is broken and the anorexy is developed. One has thought that the high ketones help to the mood of the patients and many people are not depressed and they feel jubilant.

We have investigated anxiously the security of the diet. Only one abnormality exists and is the high plasmatic uric acid level. This means that the susceptible people of drop must continue fulfilling his medicación.3 is no abnormality in the electrocardiograms. During the reduction of the weight, the proteins of weaves fall in all the weaves, because the excess of weight consists of 25% of proteins. In the diet of Cambridge compared with a conventional diet of 1 000 kcal is no excessive loss of proteínas.6

Many critics with the use of the diets of very low calories have existed on the base of which its power content is also bajo.7 Nevertheless, we we think that he is scientifically irrational to think that the power content of a diet means that she is dangerous. The energy comes from 2 sources: of the foods that interfere and the internal reserves. The energy reserves are enormous and has been calculated that a woman of 60 000 kg has almost 115 kcal of reserve in her fatty weave, this is sufficient energy for 80 d. The security of the replacement of foods in the formula of the diets depends more on its composition in micronutrients and macronutrients and not of its power content.

The diets of very low calories have been object of many investigations, by the necessity to demonstrate security. Many scientific publications have been realised on the diet of Cambridge in these years, that at least 6 books and 80 scientific publications have been produced by several autores.5 From 1980 have been used 5 encounter satellites in association with international congresses. Every year is to an increase in the number of publications on the diets of very low calories and the studied patients. From 1975 they have been around 400 publications that include 49 500 patients. It has been considered that more than 20 000 000 of people has used the diets of very low calories in the world. From 1980 in which the complete formula of the diet has been used, deaths have not been registered, which could be attributed to the use of the diets of very low calories. These nutritionally complete diets can be considered like safe.

A very recent evidence of which the rapidity in the loss of weight confers additional positive benefits to the health, independent of the loss of weight exists, especially in diabetics. I believe that to include a diet of very low calories in a program of reduction of the weight it is the most effective and valid dietetic strategy.

We recommended that the diets of very low calories could be used by several weeks and suggested up to 12 weeks is satisfactory. Other people, think that they only could be used intermittently. Nevertheless, scientific reasons do not exist this behavior. The intermittent use offers undesirable effects as an increase in weight caused by a water elevation and glycogen. One of the problems with the intermittent use of the diet is the difficulty to recommence it after interrupted. A great number of studies has shown to the absence of some undesirable effect with the continued use of the very low diets of calorías.5 the diet of Cambridge has many beneficial effects, in particular in the diabetics type II, hiperlipemia and hypertension. In diabetics after 4 weeks submissive the diet of Cambridge there is a fast reduction of the plasma glucose. Doctor Henry, of San Diego, has specialized in the use of the diets of very low calories in diabetics and concluded that they are safe under supervision médica.8, 9 the reduction of the weight is excellent (1 to 3 kg per weeks). The control of glicemia is increased because of the reduction of the production of the glucose by the liver, increase in the action of the insulin in the liver and peripheral weaves and elevation of the insulin secretion. In addition, the hypertension and hiperlipemia are reduced and the treatment provides benefits in the long term.

The use of the diet of Cambridge as unique nutrional source reduces the sanguineous cholesterol to an average of 25% and the triglycerides to an average of 40%. All the patients showed some reduction and the decrease was greater in those with high values initiates to them. The reduction only happens while the patients are using the diet like unique source and when they return to the normal diet, the values increase again but not to the values of pre treatment.

The hypertension is a clear characteristic common in those people with overweight and a reduction in the arterial pressure happens after a short period in the diet, also before the loss of weight is pronounced. This can be because of the diurética action of the diet. In many patients who have been studied, to obtain a normal weight also it has been in a return to the normal values of arterial pressure.

It is important to modify some drugs that are being administered during the use of the Cambridge diet, 5 because the effect of the diet in diabetic and hypertensive patients would have to be with the suspension of the medication of diuréticos and oral hipoglicemiantes, antihypertensive drugs and the reduction of the insulin. The clinical experience in the EE.UU indicates that many of the indirect effect that require clinical attention were the direct result of the continuation of the dose of one or more of these medications in the previous levels.

The diets of very low calories can be very important in long term treatment of the obesity. An appraisable component of the reduction of the long term weight exists if he is associate with the regular accomplishment of physical exercises and behavioural modifications. There are many factors that could be of positive benefit with the use of the diets of very low calories. First, it is important to regularly realise moderate physical activity and the regular participation in a program of reduction of weight. The suitable education concerning the modification of the conduct and the nutrition is also important. It is advocated the maintenance of a low fat diet and carbohydrate discharge with an index under glicemia. But most important of all it is a permanent change in the life style.

One has been that the diet of Cambridge is beneficial for the maintenance of the weight.

In the hospital of Karolinsks in Stockholm, Ryttig and Rassmer studied 60 patients who used the diet of Cambridge during 12 weeks, those that had a reduction of weight 20 average of kg.10 During the following year a group used the diet of Cambridge 2 times to the day and the other group used the diet recommended by dietistas. Both groups had a total of 1 600 kcal/d. The patients who used the diet of Cambridge recovered only 8 kg of weight compared with 12 kg of the group control. There was also a great increase in the arterial pressure in the group that did not use the diet of Cambridge. During the first 12 weeks it happened a diminution in the arterial pressure and this one persisted in the years following in the group with the diets of Cambridge, but not in the group that did not use the diet of Cambridge to maintain the weight.

In conclusion, the diet of Cambridge is very effective when it is used like unique nutritious source, this is clinically proven and insured. It contains all the essential nutrients and she is very appetizing. After 3 d loses the appetite and the people feel well and this also has been observed that is good for the maintenance of the weight when it is used as I supplement. It fulfills all the needs of an ideal dietetic regime for the reduction and the maintenance of the weight.

From 1980 the diet has been approved in many countries of the world but not in Latin America. The number of this magazine describes the use of the diet in Cuba. The work excellently has been carried out and the obtained positive results, induce the hope to use the diet in this part of the new world.

Dr. Allan N. Howard
Downing College, University
of Cambridge, the United Kingdom



BIBLIOGRAPHICAL REFERENCES

·         Howard AN. Historical The development, efficacy and safety of very low calorie diet. Int J Obes 1981; 5: 195-208.

·         McLean B, Parson RL, Howard AN. Clinical and metabolic studies of chemically defined diets in the management of obesity. Metabolism 1974; 23: 645-57.

·         Howard AN, Grant To, Edwards Or, Littlewood ER, McLean I SAW. The treatment of obesity with to very low calorie liquid formulates diet: an in-patient/out-patient comparison using skimmed milk protein ace the chief protein source. Int J Obes 1978; 2: 321-32.

·         Commitee on Medical Aspects of Food Policy. The uses of very low calorie diets in obesity. Report on Health and Social Subjects no. 31, HMSO, London, 1987.

·         Marks J, Howard AN. The Cambridge diet: a manual for professionals of the health published by the CEL. Grandview N Rigton LS17 ODW, UK, 1997.

·         Ryde SJ, Morgan WD, Birks JL, Dutton J. Changes in body composition following to very low calorie diet. BASIC Life Sci 1993; 60: 263-5.
Howard AN. The trial Swansea: its purpose and rationale In: Kreitsman SN, Howard AN, eds. The trial Swansea: body composition and metabolic studies with to very low calorie diet (VLCD) London: Smith-Gordon, 1993: 15-23.

·         Henry RR, Wallace P, Olefsky cm. The effects of weight loss on the mechanisms of hyperglycemia in obese non-insulin-dependent diabetes mellitus. Diabetes 1986; 35: 990-7.

·         Henry RR, Wiest-Kent TA, Scheaffer L, Kolterman OG, Olefsky JM. Metabolic consequences of very low calorie diet therapy in obese non-insulin-denpedent and non-diabetic subjects. Diabetes 1986; 35: 155-64.

·         Ryttig KP, Rossner S. Weight maintenance to after to VLCD weight period and the effects of VLCD supplementation. J Int Med 1995; 236: 299-306.