User:N.deshmukh/sandbox

=== Green Smoothie Cleanse” Causing Acute Oxalate Nephropathy === This paper discusses a case study of a patient who had acute oxalate nephropathy, where oxalate, a substance normally secreted in urine, builds up in the kidneys causing injury . Before using a green smoothie juice cleanse, her kidney appeared to be functioning normally, but ended up developing end-stage renal disease. While this green smoothie cleanse did not cause her end health-outcome, the patient's predisposing risk factors, for example, a gastric bypass, did leave her at a greater risk for such an event, and the patient ended up developing oxalate absorption. The strength of this study is that is shows that there is a reason to be concerned in medical practice about a fad diet like this one, but unfortunately, it is a very weak source, since it is a case study and not a cohort study or meta-analysis, which is widely viewed as a strong and valid source since it combines data from various studies. As a result, this does stand to criticize the fad diet but it isn't a strong enough source to be given credibility.

=== Popular Weight Loss Strategies: a Review of Four Weight Loss Techniques. === In a review of four weight loss techniques, the authors of this paper studied twenty other scientific papers to discuss current weight loss techniques. Among them was "juicing or detoxification diets, intermittent fasting, the paleo diet, and high intensity training". In the discussion of juicing and/or detoxification diets, the reason that weight loss was found to work was that it promotes a low-calorie diet. However, the authors noted that they saw that this weight loss technique was not sustainable, since weight tended to increase once the patient would resume a normal diet. This is a common criticism of many fad diets, including other weight loss techniques that were discussed in this paper; intermittent fasting and the paleo diet. This is a very strong article because it is a review of several papers, some of which are directly related to juicing but others that focus of physiological aspects of the weight loss techniques. This article has potential weaknesses, since it is not an experimental paper but rather a review, but other than that, this is a strong critique of juicing fasts and cleanses. These critiques of the diet is similar to critiques of very low calorie diets, which are shown to be not more effective than low calorie diets (especially because low calorie and very low calorie diets are characteristic diets of patients suffering from anorexia nervosa).

=== Effects of One Week Juice Fasting on Lipid Metabolism: A Cohort Study in Healthy Subjects === This paper is a cohort study on patients that were subjected to a fasting juicing program, with the goal of improving lipid metabolism. The study found that parameters of lipid metabolism worked in a bi-phasic nature. For example, insulin did decrease initially, but eventually increased. This could especially be an issue, since higher insulin levels are usually linked to insulin resistance, and is considered to be a "strong predictor of disease in adults" .The study saw that in the subjects, the parameters they were examining, triacylglycerols (TG), very low-density lipoprotein apolipoprotein B (VLDL apo B), insulin, nonesterified fatty acids (NEFA), low-density lipoprotein (LDL) apo B, and LDL cholesterol, were not sustainably changed. After juice fasting, free cholesterol decreased, LDL cholesterol had only initially increased, TG and VLDL were lower than baseline levels, while NEFA was increased. The benefit of this study was that it was a cohort study with defined measurements to examine the relationships between dependent and independent variables, but the strongest problem with this article was that the cohort was very small, making it not a very generalizable study.

=== Effect of Fruit Juice on Glucose Control and Insulin Sensitivity in Adults: A Meta-Analysis of 12 Randomized Controlled Trials === This article is a meta-analysis of twelve different experimental trials studying fruit juice and glucose control. By studying these studies, the authors were able to include four hundred and twelve subjects. This meta-analysis was done to examine how glycemic control could be managed through fruit juice. The paper found that fruit juice (note: fruit juice not juice cleansing. Juice cleansing is consumed to lose weight or detoxify, while fruit juice is usually drunk as a beverage), was ineffective on fasting glucose and insulin levels. While this is a weak article because it discusses fruit juice rather than a juice cleanse or fast, it is useful because it has the same overall concept in mind; further study of the individual trials could result in extrapolating that juice cleanses have the same overall non effect. For that reason, and since it is a strong meta-analysis, this is a strong con-argument for juicing and juice cleansing/fasting as a fad diet.

= Final Assignment = The final assignment is to write three paragraphs to be added onto the article of juice fasting (Juice fasting).

A main argument of why juice fasting is not considered to be a good dietary technique is because it utilizes a low calorie diet. In a discussion of juice fasting, the reason that juice fasting was found to cause weight loss was that it promotes a low-calorie diet. According to this study, juice fasting promoted a low-calorie diet, just as the paleo diet and the intermittent fasting diet. The study noted that by consuming only juices with the juice fasting diet, followers tend to consume up to 400 calories a day. This fits the high end of what is considered to be a "very low calorie diet". However, this diet is not sustainable ; once a patient resumed their normal diet, their weight returned back to normal.

Researchers found that very low calorie diets like the juicing diet lead to increased levels of cortisol, which contributed to to the regain of weight due to food binging after the diet was completed. Indeed, increased cortisol levels tended to pursue even after the diets ended. Increased cortisol levels lead to rapid weight gain around the midsection of the body, as well as leading to mood swings and irratibility, high blood pressure, and other effects .The benefits of the juicing cleanse/fast are minimal. In a cohort study to examine lipid metabolism following a juice fast, researchers found that while VLDL levels in patients increased compared to initial levels, after 8 days after completing the study, the subjects' parameter levels, including VLDL levels returned to normal levels.

Juicing diets have also been shown to be associated with renal failure due to oxalate nephropathy. This is a risk factor because the main form of oxalate excretion for those undergoing juicing diets is urination. In one case, a patient with additional risk factors, such as a gastric bypass, developed oxalate absorption issues and end-stage renal issues after undergoing a juice fast/cleanse. In another study where a patient went on such a diet for 6 weeks, the patient experienced high renal failure and required dialysis therapy. The low calcium intake that resulted from consuming juicing products exclusively meant that oxaloacetate could not bind to calcium to be properly excreted. As a result, juice fasts should not be followed for longer periods of time by people with risk factors such as kidney issues, especially for too long.