Valid Health Information PDF

Valid Health Information Intro In this age of technology, where a simple internet search yields millions of results in a second or two, it is important to know how to sift through all of the available information and find something reputable. It is often best to consult with your...

Valid Health Information Intro In this age of technology, where a simple internet search yields millions of results in a second or two, it is important to know how to sift through all of the available information and find something reputable. It is often best to consult with your physician regarding your health status and nutrition concerns; however, this lesson provides guidelines to help you make wise and informed decisions about the information you come across. Quackery The term quackery (U2_Vocab.html) refers to information that is unsupported, untrue, and worth dismissing. Ultimately it is the viewer’s responsibility to determine whether the information presented is valid and worth paying attention to. To help you do so, we have provided a list of “red flags of quackery.” Use these “red flags” when searching the internet for information on any topic but especially about your health and well- being.1 Red Flags Testimonials: Anecdotes are personal stories of conviction that are not backed up by evidence. Nutritional testimonials are especially prevalent among celebrities and blogs. Just because somebody claims that a certain diet or supplement worked for them doesn’t mean there is actual proof that it is effective or safe. If something is not properly tested in a randomized, controlled study, it is impossible to conclude its safety or effectiveness. :  Helps Your Body: These red flags may be more difficult to recognize if you do not have a strong knowledge base for certain subjects, especially those relating to the body. However, the principle remains: there are many processes in your body that are functioning just fine on their own. In truth, if there were something wrong, you would have serious health issues requiring immediate medical attention. Some of these red flags include the terms “detoxification,” “kickstarting,” and “balancing blood pH.” Celebrity Doctor: Pay attention to the author or speaker’s credentials; are they a medical doctor, researcher with a PhD, or something else reputable? The number of followers or viewers or the amount of money someone has does not indicate whether they have a sound understanding of the topic on which they are speaking. Look for data, research results, or evidence included that supports what they are saying. Ancient Wisdom: Many traditions, folklore, theories, and ideas have existed for generations and across cultures; for this reason, it is important to analyze these long- held beliefs in light of recent scientific evidence. Modern technologies and advances are constantly increasing our understanding of the world around us, making it important to modify previously accepted ideas when they no longer stand against overwhelming evidence. Secret Conspiracy: Incredible amounts of online material make claims regarding “best-kept secrets,” “what doctors aren’t telling you,” or “a newly discovered superfood that helps you shed 10 pounds in 1 day.” In most :  every case, if it’s legitimate, you’ll be able to find published material about it from researchers, scientists, medical centers, or medical journals. Miracle Cure-All: If it seems too good to be true, it probably is. If something claims it can drastically change something about your body in a short amount of time, it is either lying or unsafe. Your body has several mechanisms to maintain certain levels of homeostasis, meaning it is not designed to alter itself in major ways overnight. Buy My Book: Not all books and articles should inspire the same level of confidence. Peer-reviewed journal articles are one of the best sources of information. You can find them online from hubs such as Google Scholar or PubMed. Articles from these sites explicitly state what they tested, what their methods were, and the results that came from their study or experiment. Furthermore, other highly qualified researchers (“peers”) review the journals and give validation, which increases our confidence that what we are reading is good information. Toxins: One of the functions of both the liver and the kidneys is to filter substances in our bodies and eliminate them, which function they are incredibly competent at carrying out. As previously mentioned, if these organs weren’t functioning properly, you’d already be seriously ill. Natural: Many people prefer alternative treatments such as oils, leaves, extracts, and similar natural products to cure ailments. This is a personal decision; keep in mind, however, that drugs produced in chemistry labs and prescribed or recommended by physicians are highly tested, and their effects :  and purposes are explicitly given on labels. Don’t always assume that because something is “natural,” or unaltered or unmodified, it is safe or effective. Energy: Many cultures incorporate the alteration or correction of energy fields, chakras, or other forces in attempts to alleviate various health issues. It is much more difficult (if not impossible) to find empirical data for these types of healing methods. If these healing techniques are part of your culture, it may still be worthwhile to consider the physiological processes underlying an illness or issue and address those as well. Hostility to Criticism: Good scientists and researchers seek truth; there’s a red flag when someone is defensive of a claim (especially one that has been disproved) or is aggressive or hostile. Valid Information You should not only know how to spot “bad science” or unreliable information. It is also important to know how to recognize “good science.” If you are familiar with certain guidelines and principles that apply to any situation, you can make educated decisions throughout your long-term use of the internet. Is the information presented as “evidence,” “research,” or as being from a “study” or “experiment”? If so, was it a controlled experiment, meaning they had an untreated subject to compare results to? Was it a longitudinal study, meaning they gathered the data over a long period of time, throughout various stages of the same subject’s life? Did the writer cite other sources that are legitimate or reputable? Do they actually show you the data they collected, or do they ask you to take their word for it? Is it a peer-reviewed article? Is it unbiased? :  When was the last time the information was updated? Who wrote the information? Was it a physician? A blogger? A researcher? Does the website end in.gov,.edu, or.org? These tend to be more reliable because they are not taking money from for-profit organizations, and they are more frequently verified and updated. Additionally, government websites often produce national guidelines that can provide useful information. Do be aware, however, that such websites may not always be up-to-date with current research evidence and that time is required to incorporate new evidence into the most recent guidelines. This explains why national guidelines are different now than they were twenty years ago; the more we explore, the more we discover; therefore we must revise what we once believed were the best recommendations regarding nutrition. For this reason, it is a good idea to look at multiple reliable sources of information and come to your own educated conclusion instead of clinging to one source’s information only. Choosing for Yourself Now that you hold the tools necessary to distinguish nutrition sense from quackery, it is up to you to make educated decisions regarding your health, and especially your diet and eating patterns. You will find millions of websites that claim to have the key or answer to your situation, but you know your situation best and should therefore consider many different factors when making changes to your diet or other health-related behaviors. Specifically in regards to diet, it is important to consider things like phase of life, changes in health condition, dietary preferences and constraints (i.e., allergies), budget, and lifestyle. While keeping these considerations in mind, read the following approaches to dieting and eating habits. Hopefully you will get an idea of how you can create the healthy eating habits that work best for you. :  Different Patterns of Eating You can take many different approaches in terms of eating patterns and habits. One approach is using national guidelines regarding how much of each essential nutrient you should eat, and limitations on things such as sugar and sodium consumption. Some guidelines are specific for certain conditions, such as high blood pressure or diabetes, whereas some are directed more toward the general population. There are also eating patterns that are based on research, though not specifically included in any national standard. Read through the following information and evaluate any pros or cons you might recognize with each approach to healthy eating. MyPlate Diet MyPlate is the USDA’s (United States Department of Agriculture) most current general recommendation for healthy eating patterns. At the Choose My Plate website (https://www.choosemyplate.gov/myplate-daily- checklist-input),2 you provide your age, gender, current level of physical activity, weight, and height, and in turn receive a daily calorie recommendation. There are set guidelines for the number of servings per food group you should consume, and examples of food to eat in each category to meet your target calorie consumption. There is also a checklist to help you track what you’ve eaten. Saturated fat, sodium, and added sugars are limited, and fruits and vegetables take up half the “plate” at mealtime.3 Potential benefits include the Potential concerns may include following: the following: This approach is relatively This approach has set individualized, based on guidelines for daily servings of factors such as weight and each food group, though activity level. certain food groups may need MyPlate provides suggestions to be limited based on on how to meet certain individual factors. nutritional goals. This diet is low in fat, meaning :  Worksheets are available to carbohydrates and sugars may help you track your progress. be overly consumed in its This approach focuses on place (refer back to lesson 2.1, variety, nutrients, and regarding fat). personalization.4 Sugar and carbs may not be sufficiently limited or moderated because of the high grain and fruit consumption of this diet; this may be a problem for individuals with a predisposition to diabetes. DASH Diet DASH stands for Dietary Approaches to Stop Hypertension. You can learn about this diet on websites such as MayoClinic.org or on the National Heart, Lung, and Blood Institute website. This approach is uniquely high in daily servings of fruits (4–5), vegetables (4–5), and low-fat dairy products (2–3). Fatty meat, dairy products, and oils are limited.5 Potential benefits include the Potential concerns may include following: the following: This diet has shown to reduce This diet is low in fat, meaning high blood pressure, which is carbohydrates and sugars may good for your heart, blood be overly consumed in its vessels, and circulation. place (refer back to lesson 2.1, Reducing high blood pressure regarding fat). helps prevent more serious This diet is generalized and complications, such as a doesn’t consider personal stroke or heart disease.6 factors; it is based on a 2000- calorie daily diet. Sugar and carbs may not be sufficiently limited or moderated because of the high :  grain and fruit consumption of this diet; this may be a problem for individuals with a predisposition to diabetes. Ketogenic Ketosis is a physical state where your body uses ketones—a product of fat breakdown—as the primary energy source instead of glucose. By the diet you eat, your body can transition from using glucose to using fat for fuel. A “ketogenic” diet is very low in carbohydrates and higher in fat and protein. Vegetables, nuts, meat, oils, and full-fat dairy are staples, whereas sugars and carbs (fruit and grains or starches) are limited. This diet helps promote weight loss and prevent disease. Possible benefits include the Possible concerns may include following: the following: avoidance of chronic diseases, This diet may be difficult to such as cancer, adhere to because atherosclerosis, stroke, and carbohydrates are typically diabetes more accessible and cheaper. weight loss and avoidance of Acceptable foods in this diet obesity are often perishable, making fewer negative effects them potentially difficult to associated with high sugar keep on hand. consumption Mediterranean Diet The Mediterranean diet is inspired by the eating patterns of Mediterranean countries, and it is often followed to improve heart health and reduce the risk of disease.7 This diet promotes eating mostly plant-based foods, such :  as nuts, seeds, fruits, vegetables, and whole grains.8 Red meat is limited while fish and poultry are recommended at least twice weekly. Red wine and oils are also consumed, the latter replacing butter.9 Potential benefits include the Potential concerns may include following: the following: There is a decreased risk of Sugar and carbs may not be heart disease, cancer, and sufficiently limited or neurological disorders.10 moderated because of the high Oils are frequently consumed, grain and fruit consumption of giving the benefits of fat. this diet; this may be a problem This diet is very flexible in that for individuals with a specific serving size and predisposition to diabetes. numbers are not given. The perishability of plant- based foods may make this diet difficult to adhere to for those who are unable to frequently shop for groceries. This high plant-food diet may be difficult to adhere to for those with food allergies, such as nuts or fruits. Vegetarianism Vegetarianism is characterized by the absence, or reduction, of animal products. There are many different types of vegetarian diets because various preferences govern the allowance of certain types of meat, eggs, dairy, butter, and other animal products.11 People may adhere to this diet for moral, health, or financial reasons, among other things. Potential benefits include the Potential concerns may include following: the following: :  satisfaction that comes with Highly processed foods may moral or religious adherence make up a large portion of the possible health benefits diet, leading to high calorie associated with eating more consumption and adverse plant-based foods health outcomes.12 There may be difficulty obtaining adequate nutrients, especially with regards to protein. Dietary Guidelines for Americans 2015-2020 The Dietary Guidelines for Americans 2015–2020 (https://health.gov/dietaryguidelines/2015/guidelines/executive- summary/#figure-es-1-2015-2020-dietary-guidelines-for-americans-at-a- glan)13 approach to eating isn’t necessarily a type of diet, but provides a list of key recommendations for healthy eating habits, with consideration to calorie intake levels. The recommendations are basically the same as those provided within the MyPlate eating pattern: low-fat dairy, variety in fruits and vegetables, whole grains, and so forth; however, these recommendations don’t provide strict “daily serving” amounts like MyPlate does, and while they do include oils in the healthy eating pattern, there is no respect to the type of oil. Potential benefits include the Potential concerns may include following: the following: Recommendations are flexible This diet is relatively low in fat, in number of daily servings, meaning carbohydrates and allowing for personalization. sugars may be overly Recommendations provide consumed in its place (refer ideas of different foods within back to lesson 2.1 regarding each food group, offering fat). suggestions for ways to obtain Sugar and carbs may not be proper nutrients. sufficiently limited or :  moderated because of the high grain and fruit consumption of this diet; this may be a problem for individuals with a predisposition to diabetes. Weight Loss Even though we’ve seen above that there are a variety of diets with many purposes, many people associate the word “diet” with only one thing: weight loss. Weight loss has always been, and will always be, a hot topic related to diet and exercise, so long as you live in a society that makes thin body types the ideal. This has a level of irony, though, because in terms of evolution, fat is advantageous; it means your body has backup storage of fuel for times of starvation or exertion. In some cultures, fat is valued as an indication of prosperity and not poverty. Nonetheless, unhealthy strategies of weight loss have detrimental effects on personal health and thus warrant conversation. The dangers of fad diets, weight- loss supplements, and severe food restriction are no secret to the general population, but we will briefly review some key points about unhealthy weight-loss strategies and introduce a new approach to weight loss. Obviously we cannot cover every weight-loss concern, method, or approach, but the knowledge you gain from this lesson should enable you to make sound decisions when doing your own research on this topic. Unsustainable and Risky Dieting When it comes to losing weight, many people want a quick fix, but such strategies often produce only short-term results because they are not sustainable. For example, your body needs a certain amount of calories each day just to stay alive, no extra strain or exertion included, so severe calorie restriction, or starvation, can only be maintained for so long before you crash and go back to your old eating habits. I once had a professor :  who explained this principle using the following hypothetical: if you want to eat as much as you can during Thanksgiving dinner, what do you do to prepare? Some students answered that they would exercise, some that they would drink a lot of water leading up to dinner, but pretty unanimously the class agreed that they would skip breakfast and lunch. This professor made the point that if you force yourself to go hungry, you are preparing yourself to binge eat when you finally get the chance. This is one problem many people face when dieting through sheer calorie counting and restriction—often presented as “eat less, exercise more.” You are hungry all the time, which may result in your giving up on healthy changes and bingeing on all the things you’ve been denying yourself. Don’t misinterpret this; I’m not saying calorie restriction doesn’t lead to weight loss. It definitely can. However, it can be a more difficult, frustrating strategy of weight loss because there is also a hormonal aspect to how our body uses and stores fuel; this means that eating less and exercising more doesn’t always accomplish the goal (think back to lesson 2.1, related to the caloric vs. endocrine theories of obesity). You can address both the hormonal and caloric aspect of weight loss by shifting your perspective from “I only get 1500 calories a day” to “I am going to consume the calories I need by eating food that will benefit me the most.” For example, eating protein will help you feel full and provide you with essential nutrients, while eating sugar may lead to a “sugar rush” and an inevitable crash.14 Research involving “ketogenic diets,” which are low in carbohydrates and moderately high in fat and protein, suggest that this pattern of eating helps you feel full, satisfied, and leads to weight loss.15 In short, going hungry isn’t the only option. Besides the issue of sustainability, “fad diets,” the trendy new (though unsupported) ways to lose weight, often have negative health effects related to their extreme nature and lack of proper nutrient obtainment. Long-term health benefits come from lifestyle changes sustained over long periods of time, not harmful and drastic changes adopted temporarily. Be wary of any weight-loss technique that asks you to push your body to extremes such as only eating one food, severely restricting food intake, or exercising multiple times each day, because malnutrition can easily follow. :  Serious effects accompany malnutrition, such as organ failure and compromised body systems (refer to lesson 2.1 on the effects of underweight). Think back to the lesson on exercise where we talked about starting slow and going slow in order to adopt an exercise routine. The same principle applies to changing eating habits: if you start by making smaller, yet meaningful, changes in your diet then build upon that, you will find results that last, without compromising your health. These results have an effect not only on your appearance, but also on your overall health. Researchers have conducted experiments that test other markers of health than just body weight, in individuals who have liposuction procedures. Some results showed that individuals who lost body fat through liposuction surgery alone did not have less of a risk of coronary heart disease (CHD) because there was no effect on its contributing factors—that is, blood pressure or insulin sensitivity (which lack of sensitivity leads to disease).16 The individuals used as a comparison who lost weight due to dietary measures did have improved health measurements and a reduced risk of heart disease.17 The takeaway from this study and section is that losing weight by any means does not mean improving your health. How you choose to treat your body now can affect the rest of your life, so don’t let society’s obsession with being thin override the importance of having a long and healthy life. Diet Pills and Supplements Another dangerous weight-loss strategy is the use of diet pills and supplements (U2_Vocab.html). There are thousands of products that claim to help people lose weight, from raspberries to garcinia cambogia to essential oils. These supplements claim to decrease appetite, reduce the absorption of fat by the body, or increase the use of fat to make energy. Some of these products are safe and helpful (multivitamins), some have no effect, and some of them have very harmful effects. Diet pills are not put through the same strenuous testing to prove effectiveness or safety that over-the-counter and prescription drugs are.18 They do not have to be proven safe before distribution; this means many side effects or reactions :  are discovered only after public consumption.19 If you’re ever in doubt about whether a diet pill or supplement is safe, ask your doctor about it. As a general guideline, avoid anything that is advertised in a different language or through mass email, that claims to cure medical problems, that claims to be an alternative for something illegal, or that seems otherwise suspicious.20 There are probably better and safer weight-loss or maintenance options for your situation that are worth discussing with your health-care provider. Decision-Making Activity Let’s work on a decision-making activity to help solidify these concepts in your mind. In the activity, you’re going to evaluate the weight-loss plans of four peers and family members. You’ll need to evaluate four weight-loss plans in relation to the ideas presented in this lesson. 1. Genesis the Dancer. Genesis is a dancer whose primary style of dance is jazz, but she also likes contemporary ballet. She would describe herself as more of a powerful dancer (explosive) than a style dancer (graceful). During the off-season she gained a little weight, and she wants to lose it during the rehearsal season before the next performance season starts. She has spoken to her doctor, who agreed that losing a few pounds would not be unhealthy for her. Her plan is to change her eating patterns by consuming only foods that are green, yellow, or brown. According to the earthtonesdiet.com website,* foods with colors in the earth-tones range are better for you because they echo the colors found in nature. Her rehearsal season begins next week. She plans to continue the earth-tones diet as her activity level increases with the new season. Next off-season she will do a lot of hiking to compensate for not dancing as much. 2. Abe the Wrestler. Abe is one of the stars on the wrestling team. He placed third at state last year in the 126-pound weight class. His only loss of the season happened in the state semifinal where he lost to the eventual state champion. Because he works long hours in the summertime on a construction site, he wakes up early to do 1.5 :  hours of cardio exercises. His weight concern is that since the end of the wrestling season, he has grown three inches and gained eleven pounds, with much of that new weight coming from his added height. He has been wrestling at 126 pounds and wants to continue to wrestle in the 126-pound weight class because he feels that’s his best chance to get an athletic scholarship. Right now he’s at 135 pounds. This is the first year he feels that he will have trouble keeping his weight at 126. After consulting with his coach, he has determined to cut back on calories by maintaining his current diet but eating slightly smaller portions and skipping dessert. He also plans to do an extra one-hour cardio session every day after work or school to help increase his activity level. 3. Tori the Mother. Tori is a mother of three in her early thirties. She lives next door and is close to you and your family. Before quitting her job to have children, Tori was a nurse at a doctor’s office. She has regular contact with her physician for advice and wellness checkups. Tori is generally healthy and wants to lose some of the weight she retained from her pregnancies. After researching multiple websites and research studies from organizations like MayoClinic.org and health.harvard.edu, she has decided to revise her diet to include more vegetables and fruits and to also substitute healthier items into her recipes and meal planning. She also wants to cut down on processed foods and other nutrient-poor snacks. She’s a regular paid contributor on MommyHealth.com* where she writes health strategies for pregnant women and mothers of small children, being careful to cite recent research from credible sources so readers can do their own research. Tori has had children in diapers for the last eight years and hasn’t done a lot of physical activity, so her plan is to start increasing her physical activity a little each day, starting by walking and increasing her pace little by little over a few months until she can comfortably jog five kilometers (3.1 miles) with her younger children in a jogging stroller. 4. Tomas the Business Owner. Tomas is a business owner who runs a fleet of delivery vans in a city. You have worked for him part time during the summer, helping to plan the delivery routes, which change every day to accommodate a fluctuating customer base. Tomas :  brings a large soda to work every day and spends the morning sipping from the drink to help him wake up and stay energized. Most of the time, Tomas stays in the office, but sometimes he’ll go on a delivery run. He used to lift weights and appears to be relatively fit, but he admits he hasn’t done any physical activity in about a year. He’s carrying a few pounds he’d like to lose. Lately Tomas has been using diet pills to suppress his appetite. He has been searching government websites like the National Institutes of Health and The Centers for Disease Control for his information. He also has gotten information from other sources and has mentioned that one website led him to believe drinking root beer can help reduce food cravings and keep his metabolism up. *not a real website Because you are in this health class, recently some of your friends and family members have been talking to you about health-related topics. Below are four hypothetical situations where people you know are asking what you think about their weight-loss plans. Using the information in this lesson, which one of these people has the best plan for losing weight? 1. Genesis the Dancer 2. Abe the Wrestler 3. Tori the Mother 4. Tomas the Business Owner >> Conclusion :  The overarching theme of this lesson is that of informed decision-making. A myriad of information is available regarding diet and weight loss, which foods to avoid, which foods help prevent disease, and so forth. It is up to you to use the principles and guidelines outlined in this course to make wise decisions about what you read and how you choose to apply the information. Your health is your responsibility, so take the time to check your facts, consult your doctor when necessary, make decisions about your diet and exercise, and modify these decisions accordingly. Recognize how certain health choices make you feel, and let that positively reinforce, or course-correct, your behavior. It may take a while to find eating and health patterns that work for you, but the end result is a healthier and more enjoyable life which you’ve created for yourself. All images on this page © BYU 1. Maki, “The Red Flags of Quakery V2,” (http://sci-ence.org/red-flags2/) Sci-ence.org, January 9, 2012, accessed June 19, 2017, http://sci-ence.org/red-flags2/. 2. Choose My Plate (https://www.choosemyplate.gov/myplate-daily-checklist-input), https://www.choosemyplate.gov/myplate-daily-checklist-inpu 3. “My Plate,” (https://www.choosemyplate.gov/MyPlate) United States Department of Agriculture, last modified April 19, 2017, accessed June 16, 2017, https://www.choosemyplate.gov/MyPlate. 4. “A Brief History of USDA Food Guides,” (https://www.choosemyplate.gov/brief-history-usda-food-guides) United States Department of Agriculture, last modified May 11, 2017, accessed June 16, 2017, https://www.choosemyplate.gov/brief-history-usda-food-guides. “My Plate,” (https://www.choosemyplate.gov/MyPlate) United States Department of Agriculture, last modified April 19, 2017, accessed June 16, 2017, https://www.choosemyplate.gov/MyPlate. 5. “Description of the DASH Eating Plan,” (https://www.nhlbi.nih.gov/health/health-topics/topics/dash) National Heart, Lung, and Blood Institute, last modified September 16, 2015, accessed June 16, 2017, https://www.nhlbi.nih.gov/health/health-topics/topics/dash. 6. “Hypertension,” (http://www.world-heart-federation.org/cardiovascular-health/cardiovascular-disease- risk-factors/hypertension/) World Heart Federation, accessed June 16, 2017, http://www.world-heart- federation.org/cardiovascular-health/cardiovascular-disease-risk-factors/hypertension/. 7. “Mediterranean Diet: A Heart-Healthy Eating Plan,” (http://www.mayoclinic.org/healthy-lifestyle/nutrition- and-healthy-eating/in-depth/mediterranean-diet/art-20047801) Mayo Clinic, March 30, 2017, accessed June 16, 2017, http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in- depth/mediterranean-diet/art-20047801. 8. Ibid. 9. Ibid. 10. Ibid. :  11. “Vegetarian Diet: How to Get the Best Nutrition,” (http://www.mayoclinic.org/healthy-lifestyle/nutrition- and-healthy-eating/in-depth/vegetarian-diet/art-20046446?pg=1) Mayo Clinic, March 16, 2016, accessed June 16, 2017, http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/vegetarian- diet/art-20046446?pg=1. 12. Ibid. 13. Health.gov (https://health.gov/dietaryguidelines/2015/guidelines/executive-summary/#figure-es-1-2015- 2020-dietary-guidelines-for-americans-at-a-glan), https://health.gov/dietaryguidelines/2015/guidelines/executive-summary/#figure-es-1-2015-2020-dietary- guidelines-for-americans-at-a-glan" target="_blank" rel="noopener noreferrer 14. M. Veldhorst et al., “Protein-Induced Satiety: Effects and Mechanisms of Different Proteins,” Physiology & Behavior 94, no. 2 (2008): 300–307, accessed June 7, 2017, doi: 10.1016/j.physbeh.2008.01.003. 15. Alexandra M Johnstone et al., “Effects of a High-Protein Ketogenic Diet on Hunger, Appetite, and Weight Loss in Obese Men Feeding Ad Libitum,” (http://ajcn.nutrition.org/content/87/1/44.short) The American Journal of Clinical Nutrition 87, no. 1 (2008): 44–55, accessed June 7, 2017, http://ajcn.nutrition.org/content/87/1/44.short. Antonio Paoli, “Ketogenic Diet for Obesity: Friend or Foe?,” International Journal of Environmental Research and Public Health 11, no. 2 (2014): 2092 – 2107, accessed June 6, 2017, doi: 10.3390/ijerph110202092. 16. Samuel Klein et al., “Absence of an Effect of Liposuction on Insulin Action and Risk Factors for Coronary Heart Disease,” The New England Journal of Medicine 350 (2004): 2539–2557, accessed June 16, 2017, doi: 10.1056/NEJMoa033179. B. Selma Mohammed et al, “Long-Term Effects of Large-Volume Liposuction on Metabolic Risk Factors for Coronary Heart Disease,” Obesity 16, no. 12 (2008): 2648–2651, accessed June 16, 2017, doi: 10.1038/oby.2008.418. 17. Klein, “Absence of an Effect of Liposuction on Insulin Action and Risk Factors for Coronary Heart Disease.” Mohammed, “Long-Term Effects of Large-Volume Liposuction on Metabolic Risk Factors for Coronary Heart Disease.” 18. “FDA Regulation of Drugs Versus Dietary Supplements,” (https://www.cancer.org/treatment/treatments- and-side-effects/complementary-and-alternative-medicine/dietary-supplements/fda-regulations.html) American Cancer Society, Last modified March 31, 2015, accessed June 16, 2017, https://www.cancer.org/treatment/treatments-and-side-effects/complementary-and-alternative- medicine/dietary-supplements/fda-regulations.html. 19. American Cancer Society, “FDA Regulation of Drugs Versus Dietary Supplements.” 20. Ibid. :