The Cambridge Diet A Manual for Practitioners The Cambridge Diet A Manual for Practitioners by John Marks MA, MD, FRCP Fellow, Tutor and Director of Medical Studies, Girton College, Cambridge, UK and Alan Howard MA, PhD, FRIC Lecturer in Nutritional Research, Department of Medicine, University of Cambridge, Cambridge, UK ~ MTP PRESS LIMITED ..... ~ a member of the KLUWER ACADEMIC PUBLISHERS GROUP ,_ " LANCASTER! BOSTON! THE HAGUE! DORDRECHT 'IIIIIIII Published in the UK and Europe by MTP Press Limited Falcon House Lancaster, England British Library Cataloguing in Publication Data Marks, John, 1924- The Cambridge diet: a manual for practitioners. 1. Reducing diets 2. Physical fitness I. Title II. Howard, AlaI' N. 613.2'5 RM222.2 ISBN-13 978-94-011-8013-9 e-ISBN-13 978-94-011-8011-5 DOl: 10.1007/978-94-011-8011-5 Published in the USA by MTP Press A division of Kluwer Academic Publishers 101 Philip Drive Norwell, MA 02061, USA Copyright © 1986 MTP Press Limited Softcover reprint of the hardcover 1st edition 1986 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior permission from the publishers. Frome and London Contents Foreword Professor I. H. Mills Vll PART I: OBESITY 1 Obesity and its problems 3 2 The physiopathology of obesity 10 3 Methods and problems of weight reduction 20 4 The development of.the Cambridge Diet 32 PART II: THE CAMBRIDGE DIET 5 The composition of the Cambridge Diet and how to use it for weight reduction 39 6 The Cambridge Diet: medical aspects of its use 51 7 The Cambridge Diet: fact and fallacy 62 8 The Cambridge Counsellor System 73 9 Weight maintenance and healthy living 80 10 The Cambridge Diet as a source of nutrition - current situation and future prospects 89 11 The Howard Foundation 97 Appendices: 1 Articles in medical and scientific journals on the Cambridge D~ ~ 2 Books on the Cambridge Diet 101 3 Other papers in medical and scientific publications on very low calorie diets 102 References 106 v Foreword Obesity in affluent countries continues to be a serious problem. When one runs an Obesity Clinic there appears to be an unending series of patients who need help. Our understanding of weight control has been advanced not only by the studies of obese patients but also by our investigation of the problems of weight gain in young women with anorexia nervosa. Just as among obese patients there is the group of 'efficient metabolizers' who can maintain their excessive weight with a calorie intake occasion­ ally as low as 600 kcal per day, so we have demonstrated that among anorexic women there are a few who may fail to gain normal weight with 3500 kcal per day. Some of the latter group may in fact develop T3 (tri-iodothyronine) thyrotoxicosis. One of the major unknown factors is still what determines when patients may be at these extremes. If we knew how to control these extremes we would like, for a time, to switch each to the opposite end of the spectrum. One factor which is becoming apparent from studying people in the machine which continually plots metabolic rate is that the metabolic response to food is a' major factor in determining a person's weight. In general terms there is a tendency for those who are below their ideal weight to have an increased metabolic response to food and those who are above ideal weight to have a reduced metabolic response to food. The normal individual is able to vary his food intake over a con­ siderable range and yet his/her weight stays surprisingly constant. The anorexic young woman has a very poor weight response to increased food intake, whereas most overweight people have a disproportionate weight gain with relatively modest increases in food. Having said that, it is nevertheless true that a considerable number of obese patients have achieved that state by excessive ingestion of calories. Many of them can in fact achieve normal weight by consistent adherence to a food intake around 1000 kcal. Only those who drop their metabolism too much during dieting have to use more severe dieting methods. Our extensive experience of the diet based on milk VlI THE CAMBRIDGE DIET protein, lactose, extra vitamins and minerals has shown that this is a safe and effective dieting procedure. The preparation of the Cambridge Diet has made it much easier for people to use this type of diet. There is, however, another group in whom the liquid only diet is essential. These are the people who have some degree of compulsive eating. This varies from those who have phases, of various lengths, when they cannot stop nibbling when under pressure, to those who have the extreme degree of bingeing seen in the young people with bulimia. For many of these the liquid only diet may be the only effective way to control their bingeing, though getting through the first week is always extremely difficult and sometimes impossible. For them, the return to solid food may again face them with difficult problems. For those who have lost their obesity by dieting, the major problem is always subsequently restricting their calorie intake to keep it in balance with their metabolic use of energy. All too often people think they can return to their previous eating habits and inevitably gain excessive weight. Education in sensible eating to maintain normal weight is extremely important. Since many people diet without con­ sulting their doctors, it might be that the Counsellors trained by Cambridge Nutrition might add to the body of informed opinion to help in the education of the public in eating for more healthy living. Ivor H. Mills, PhD, MD, FRCP, HonFACP Professor of Medicine University of Cambridge September 1986 Vlll .