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Home blog Health Benefits Of Intentional Long-Term Weight Loss?

Despite the difficulties inherent in achieving AND maintaining long-term weight loss, the health benefits for those who manage to do so are widely believed to be substantial.

While the health benefits associated with intentional weight loss for some complications of obesity (such as elevated lipids and diabetes) are well documented, high-quality studies to back many other potentialhealth benefits are harder to find.

Just how well (or poorly) theputative health benefits of long-term intentional weight loss are documented for each of the many conditions associated with obesity, is nowdetailed in a comprehensive review of the literature that we justpublished in the Annual Reviews of Nutrition.

The 40 page long review, which includes almost 250 relevant publications, supports the following main findings:

However, there are many other issues where putative benefits of intentional weight loss remain even less clear than with the above.

For many conditions we will likely not know the long-term benefits of obesity treatments till better treatments become available and are tested in affected individuals.

@DrSharma Kananaskis,AB

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The enthusiasm for the low carb diet as a weight loss diet arises in the first few weeks and months when most people experience dramatic weight loss.

What rarely gets mentioned--especially in the miracle weight loss books--is that very few low carb dieters ever get to their weight loss goal, especially those who start out with a lot of weight to lose.

I am enthusiastic about the power of carb restriction to lower blood sugar to normal or near normal levels. I am not as enthusiastic about low carbohydrate dieting as the solution to tough weight loss problems.

Because even the online low carb community tends to believe that people who stall out are "not doing the diet right" and respond to stall posts with that assumption, most people who do stall out long term leave the discussion boards, leaving only those who have succeeded to greet the newbies.

But as someone who stalled out for years on my own weight loss, and someone who has read the boards for years, I am convinced that permanent stalls are the norm and the people who get down to goal the exception--especially among those older than 45.

In this post I'm going to discuss a few reasons why this happens.

1. Thyroid slowing. Long term low carbing causes changes in T3 hormone levels which are often hard to diagnose. It can cause something called "Euthyroid syndrome." I learned about this from Lyle Macdonald's book, The Ketogenic Diet, which has cites to the relevant research. Getting help for this problem is very hard as your TSH will be fine and standard thyroid testing may not pick it up.

Physiologically what seems to happen is that your body responds to months of ketogenic dieting by assuming you are starving--people who are starving are in ketosis all the time too. So it turns down the thermostat to conserve your body mass so you don't die. If this happens to you you'll know it. You'll feel exhausted and dragged out all the time, and the burst of energy most people feel when they start out low carbing will be a distant memory.

Dr. Bernstein reports that many of his patients develop thyroid problems months after starting the LC diet, but he insists this is because they have developed autoimmune thyroid disease. I have to question this. Too many of us with no markers for any kind of autoimmune disease experience this metabolic slowdown on long term low carb diets. Whatever the explanation, once your thyroid slows, you weight loss will slow dramatically.

My take on this now is that it is a good idea to raise your carbohydrate intake over the ketogenic boundary from time to time. Where that boundary is varies from person to person. It's the point where after adding a few more grams of carbohydrate to your intake, you suddenly gain the 3-8 lbs you lost the first three days you were on the diet. That instant weight gain is not fat. It is the weight of the glycogen you've just restored to your liver and muscles.

Watch your calories closely when you raise your carbs this way and you shouldn't gain any weight. In fact if you watch calories and keep carbs just over the boundary while lowering your fat intake you might lose a pound or two.

Note: If you can't keep your blood sugar normal at an intake high enough to get you out of a ketogenic state it might be time to talk to an endocrinologist about safe drugs that can help. I personally maintain now at an intake that varies from 70-110 grams a day (my ketogenic boundary is at about 65 grams a day.) If I stay lower than 50 for six weeks I always develop that half dead feeling again. I need insulin at some of my meals to eat at this level, but I feel a lot better when I do. Metformin along with the insulin keeps me from gaining weight. In fact, I have been losing slowly and steadily over the past six months with the combination of lower fat/higher carbs, insulin and metformin.

2. Fat-induced insulin resistance. There is some interesting research that has been discussed on the Whole Health Source Blog about how, and more importantly, why, palmitic acid, a saturated fat might raise insulin resistance in rodents. There are a lot of other studies over the years that have demonstrated that high saturated fat intakes of all kinds increase insulin resistance too.

While I don't believe that high sat fat intake worsens heart disease or cholesterol, I think it is very possible that, for the reasons that Stephan Guyenet hypothesizes in the Whole Health Source post, long term high saturated fat intake does does increase insulin resistance, and that after many months of eating very high fat/low carb diets this increase in IR can become a huge problem especially when people experience "carb creep."

"Carb creep" is very common. Over time most of us end up eating more carbs than we think we do. A bit more here, a bit there, or perhaps we are eating larger portions of lower carb foods than we realize, so that 4 g intake is 8 g. Do that five times a day and you are eating a lot more carbs than you realize.

The cure for this is to weigh your portions for a while and get accurate carb counts. If you are eating over 60 grams a day, cut back on the saturated fat and see if that helps. I am starting to think the very high fat low carb diet is only appropriate with extremely low carb intake levels.

For those of us eating low carb to control blood sugar, a higher carb intake may be necessary to keep ourselves from experiencing diet burn out. If your blood sugar is under control at a higher carb intake, your health is fine. You may have to compromise on weight loss, though. Or perhaps cut back on the cheese, butter, nuts, meat fat and cream and see if cutting out some of that saturated fat helps.

3. Stalling Is Built Into the System. The 10% factor. High quality research which I've blogged about elsewhere suggests that when people have lost between 10-20% of their starting body weight they will experience metabolic slowdown no matter what diet they use.

When I polled the diabetes community last year about their own diet experiences, the single most often repeated report was that most people who cut carbs could lose and maintain the loss of 20% of their starting weight, but after that, forget it. This is better than Dr. Leibel's results with a mixed diet, where slowdown kicked in at 10%, but it's far less weight loss than most people who embark on a low carb diet hope to lose.

My belief is that if you stall the smartest thing you can do is declare victory and maintain your weight for a few months without attempting to lose more. Make your body feel safe, so your thyroid ramps up a bit and stops worrying about the next famine. If you can't maintain at your partial weight loss, you are not going to be able to maintain if you lose more.

In fact, the sanest goal would be to find the weight level at which you can maintain happily without feelings of deprivation and stay at that weight. Then you might just not become one of the many many low carb dieters who lose 100 lbs and gain back 120. There are far too many of them, most of them blaming themselves for weakness. My guess is it isn't weakness, it's the revenge of a metabolism that has been pushed too far and is now 100% dedicated to preparing you for the next massive famine.

4. Calories Do Count. There is a glorious period when people start their first low carb diet where they do seem to trick the body into dropping crazy amounts of real fat--despite eating relatively high calorie intakes. This passes. Oh, how it passes.

Once you have dropped that initial 10% or so the magic of low carb dieting wears off and the only way most of us (not all, but most) lose any more weight is by cutting back on our food intake.

To lose weight you do have to cut calories below some level which for many of us with metabolic problems or who are older is MUCH lower than what dietitians tell you or what you get when you use online calculators.

After years of thinking I couldn't lose weight cutting calories, I learned I can--thanks to a week long attack of stomach poisoning. It turns out all I have to do is cut my calories down to about 800 a day and I will lose. The calculators tell me I should lose on 1350. The nutritionist told me I should lose on even more than that. Twice this year I've been sick for a week unable to eat and both times I have lost a pound or so eating 800 calories--and most significantly, kept it off later on.

Do I want to keep eating like that to lose more? No. Because if there is one thing I've learned, it is that you maintain your weight loss on a diet only a few hundred calories higher than the one you ate while losing. I have no wish to have to eat 1,000 calories a day for the rest of my life.

Normal Blood Sugar Is The Best Goal To Chase. Most of us started obsessing about weight loss because doctors told us if we lost a lot of weight we'd stop being diabetic. This is absolute hogwash. Go look at my Type 2 Poll if you still believe this. It isn't the weight loss that controls blood sugar it is cutting out the carbs. No matter how thin we get, most of us will see diabetic blood sugars if we eat carbs.

If you understand this, but also understand that maintaining normal blood sugars no matter what you weigh will eliminate diabetic complications including heart disease, you should be able to accept whatever weight loss you can achieve and relax about the rest.

Carb restriction is a powerful tool for achieving normal health. It's a useful approach to weight loss, but like ALL diet approaches, it only goes so far. Yes, there are people who have huge low carb weight loss successes, but for every one of those there are hundreds who stall out at that 20% lost from starting weight. If you can get to even 15% lost, give yourself a big pat on the back, realize you are are normal if you stall, and get to work on maintaining that impressive weight loss for life.

Link:
Diabetes Update: Why Weight Loss Stops on Long Term Low ...

I was recently asked:

Why is resistance training important for long-term weight loss?

In this article, I unravel the answer to this very common fitness question.

Hamster wheel fitness is not the ideal path to weight loss

Many peoplethink more is better when it comes to losing weight. I see it all of the time cardio-hungry men and women who, inrobotic-drone fashion, bypass the weight room to jump ontreadmills and ellipticalsand they do this every day. Their goal? Cramas many long and uncomfortable cardio sessions into theweek as possible.

Often, these people skip weights and focus on the cardio because they think it is the cardio thatwill produce a greater sweat and burn more calories in the least amount of time. They may think,

Do these questions sound familiar to you?

Cardio addicts think this is the answer to losing weight. Sadly, this is not an efficient method to losing nagging muffin tops.

Its not about more. Its about efficiency.

In fact, this pattern can lead to over-training, muscle and joint dysfunction, injury, and fatigue, all of which ork against losing pounds and inches.To have lasting results with weight loss, it is important to make your workouts smart, varied and practicaland resistance training needs to be a part of your fitness program.

Efficient strength training sessions that focus on building muscle mass will aid in producing long-term weight loss success.

So back to the question,

Why is resistance training important for long-term weight loss?

Resistance training is crucial for long-term weight loss and here are some reasons why.

Maintains metabolism

Resistance training is very beneficial when it comes to burning fat. Your muscle tissue is very metabolically active (it is one of the biggest contributors to metabolic rate) and when you lift weights, your body is forced tomaintain its muscle tissue. Thishelps to maintain your metabolism, even if your calorie intake is reduced.

When yousustain, or even slightly increase your metabolism with resistance training, take in less calories, and keep your hormones in check, thebody has to rely on stored body fat as fuel. Over time, this should make you leaner and moretoned.

but if you lose muscle mass (especially by overtraining with cardio and avoiding weights) you will slow your metabolism and impede weight-loss.

Burn calories long after your training session

Some studies have proventhata strength training workout can burn calories for up to 12-48 hours AFTERyour training session!

Starvation leads to sabotage

A lot of people try to starve themselves into weight lossbecause they feel that if theycontrol calories and do cardiovascular exercise as much as possible, the weight will shed. Even some health professionals promote dieting with calorie restriction.Unfortunately, there aredieticians and nutritionists who do not fully understand how strength training works, think that weight loss (or gain) is dictatedby calorie-control, and push this thought onto others.

Sadly, thistheory has become so mainstream. Calories in, calories out. If you have a calorie deficit, youre going to lose weight, if you consume extra calories, you will gain body fat.

While this is true, it is only part of the picture.

Remember, if you perform too much cardio,avoid strength training and restrict calories, you will break down your muscle tissue. Lessmuscle mass leads to a reduction in your overall metabolic rate and this will make sustaining weight-loss very difficult.

Muscles burn calories

Sure, you need a calorie deficit to lose weight, but how does your body actually use calories? It is your lean body mass, that muscle mass underneath your body fat, that burns calories 24/7, allowing you to actually eat more nutrient-dense calories without gaining significant weight.

Mike Adams from http://www.naturalnews.com does a great job explaining this further:

Lets say you happen to be quite obese and you have a high percentage of body fat. Underneath that body fat you actually have a very strong skeleton and strong muscles. Your body has built up those muscles in order to carry all of that extra body fat when you move your body. Just the very act of standing up, walking across a parking lot, going up a flight of stairs or lifting your arms requires more effort when youre overweight, especially if youre obese. So the heavier you are, the stronger your muscles have to be just to allow you to do basic, everyday things.

Now this can actually work to your advantage if you manage to keep all of that muscle mass and bone density in place while you are losing body fat, then you can maintain the high metabolism thats associated with that lean body mass even while you are dropping body fat. But if you starve yourself, youre going to LOSE all the MUSCLE resources you already have. Its a mistake a lot of people make. They try to lose body fat by starving themselves, and as the body fat vanishes from their body, their muscle mass also disappears. Why would the body get rid of muscle mass? Because, frankly, it doesnt need it.

Your body adapts to the need.

les to lift your body. Its almost like doing a leg press every time you get up out of the chair. If you weigh 300 lbs youre doing a 300 lb leg press, you see? Now if you were to drop 150 lbs of body fat and end up at 150 lbs, your body wouldnt need the same amount of leg muscle to lift you. It would eliminate those leg muscles through catabolic action. You see, the body is an adaptive system. It will adapt to whatever loads you place on it. So if you are a heavier person and youre carrying around body fat, then your body will adapt by creating stronger musc

While it eliminates this muscle mass, your metabolism begins to slow. Remember, its the lean body mass thats burning calories day in and day out, even when youre doing nothing. If you reduce that muscle mass by allowing it to go away (by not challenging your muscles), then your metabolism is going to slow. A lot of people end up at a place where theyve lost the body fat and theyre lighter, but its suddenly so much easier to put on body fat. They dont have the muscle mass they once did, theyre not automatically burning calories, and if they overeat just a little bit, theyll start packing on the body fat again. Mike Adams

Improve your lifestyle by adding resistance training to your routine

If you are not already incorporating resistance training into your workouts, start by adding it to your routines this week. Not only will it help with weight loss, but strength training will also:

Equipment is unnecessary use your environment

Using strength equipment (barbells, free-weights, kettlebells, etc.) is great, but is not always necessary. Dont have dumbbells? No problem.Use the resources around you and use your own body for body-weight exercises.

Kick off your shoes, lift a log, carry a large rock, throw a sandbag. Do not be afraid to lift something heavy once in a while. Heavy lifting aids with muscle growth.

When done properly, a resistance training workout combines cardiovascular elements with movement skills. This gives you cardiovascular benefit, helps with endurance and provides you with long-term toning and weight loss successand you dont have to spend hours in a gym completing the workout.

Incorporate natural movement skills into your routine

Work on improving your natural human movement skills. When you move naturally, you strengthen your muscles.If you train with me, you are familiar with natural movement. If you dont, here is a quick overview of some basic human movement skills. The three categories of movement skill are

For me, this type of fitness is MUCH more interesting, challenging and fun than the human hamster wheels found in gyms.

Break away fromconventional cardio and start lifting,crawling, throwing and carrying

Examples of movement skills

Includingnatural movement skills in your fitness routine isvery effective in shedding weight. I cannot even remember the last time I stepped onto a treadmill or elliptical or counted calories. For me, there is no need to do so and my body and sanity is much better without conventional forms of cardio,exercise and calorie restriction/obsession.

Get started with strength training today!

Adding muscle mass to your body is critical for long-term success with weight loss. Resistance training, in the form of bodyweight, free-weight, or natural movement training is essential for this outcome. Strengthtraining sustains and increases your metabolism, burns calories and provides your body with so many health benefits.

If you tend to skip weight training and obsess over cardio, I urgeyou to tear yourself away from your cardio addiction, add resistance training to your exercise programs, eat more cleanly and rid yourself of that muffin top for good!

If you are having trouble getting started, please contact me and I will help you create a kick-ass program! 🙂

I want to hear from you

Let me know your thoughts by commentingin the comment box. I look forward to hearing from you!

Take carenow go lift something heavy!

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The long-term effects of alcohol (ethanol) consumption range from cardioprotective health benefits for low to moderate alcohol consumption in industrialized societies with higher rates of cardiovascular disease[1][2] to severe detrimental effects in cases of chronic alcohol abuse.[3] High levels of alcohol consumption are associated with an increased risk of alcoholism, malnutrition, chronic pancreatitis, alcoholic liver disease and cancer. In addition, damage to the central nervous system and peripheral nervous system can occur from chronic alcohol abuse.[4][5] The long-term use of alcohol is capable of damaging nearly every organ and system in the body.[6] The developing adolescent brain is particularly vulnerable to the toxic effects of alcohol.[7] In addition, the developing fetal brain is also vulnerable, and fetal alcohol spectrum disorders (FASDs) may result if pregnant mothers consume alcohol.

The inverse relation in Western cultures between alcohol consumption and cardiovascular disease has been known for over 100 years.[8] Many physicians do not promote alcohol consumption, however, given the many health concerns associated with it, some suggest that alcohol should be regarded as a recreational drug, and promote exercise and good nutrition to combat cardiovascular disease.[9][10] Others have argued that the benefits of moderate alcohol consumption may be outweighed by other increased risks, including those of injuries, violence, fetal damage, liver disease, and certain forms of cancer.[11]

Withdrawal effects and dependence are also almost identical.[12] Alcohol at moderate levels has some positive and negative effects on health. The negative effects include increased risk of liver diseases, oropharyngeal cancer, esophageal cancer and pancreatitis. Conversely moderate intake of alcohol may have some beneficial effects on gastritis and cholelithiasis.[13] Of the total number of deaths and diseases caused by alcohol, most happen to the majority of the population who are moderate drinkers, rather than the heavy drinker minority.[14] Chronic alcohol misuse and abuse has serious effects on physical and mental health. Chronic excess alcohol intake, or alcohol dependence, can lead to a wide range of neuropsychiatric or neurological impairment, cardiovascular disease, liver disease, and malignant neoplasms. The psychiatric disorders which are associated with alcoholism include major depression, dysthymia, mania, hypomania, panic disorder, phobias, generalized anxiety disorder, personality disorders, schizophrenia, suicide, neurologic deficits (e.g. impairments of working memory, emotions, executive functions, visuospatial abilities and gait and balance) and brain damage. Alcohol dependence is associated with hypertension, coronary heart disease, and ischemic stroke, cancer of the respiratory system, and also cancers of the digestive system, liver, breast and ovaries. Heavy drinking is associated with liver disease, such as cirrhosis.[15] Excessive alcohol consumption can have a negative impact on aging.[16]

Recent studies have focused on understanding the mechanisms by which moderate alcohol consumption confers cardiovascular benefit.[17]

Different countries recommend different maximum quantities. For most countries, the maximum quantity for men is 140g210g per week. For women, the range is 84g140g per week.[citation needed] Most countries recommend total abstinence during pregnancy and lactation.

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Over-consumption of alcohol causes many deaths worldwide. The overall mortality from alcohol use was found to be similar to that of the effect of physical inactivity.[19] A review in 2009 found that "the net effect of alcohol consumption on health is detrimental, with an estimated 3.8% of all global deaths and 4.6% of global disability-adjusted life-years attributable to alcohol."[20]

Extensive research of Western cultures has consistently shown increased survival associated with light to moderate alcohol consumption.[21] A 23-year prospective study of 12,000 male British physicians aged 4878, found that overall mortality was significantly lower in current drinkers compared to non-drinkers even after correction for ex-drinkers. This benefit was strongest for ischemic heart disease, but was also noted for other vascular disease and respiratory disease. Death rate amongst current drinkers was higher for 'alcohol augmentable' disease such as liver disease and oral cancers, but these deaths were much less common than cardiovascular and respiratory deaths. The lowest mortality rate was found for consumption of 8 to 14 'units' per week. In the UK a unit is defined as 10ml or 8g of pure alcohol.[22] Higher consumption increased overall mortality rate, but not above that of non-drinkers.[23] Other studies have found age-dependent mortality risks of low-to-moderate alcohol use: an increased risk for individuals aged 1634 (due to increased risk of cancers, accidents, liver disease, and other factors), but a decreased risk for individuals ages 55+ (due to lower incidence of ischemic heart disease).[24]

This is consistent with other research that found a J-curve dependency between alcohol consumption and total mortality among middle aged and older men. While the mortality rates of ex-drinkers and heavy drinkers are significantly elevated, the all-cause mortality rates may be 15-18% lower among moderate drinkers. Although the definition of a drink varies between studies and countries, this meta-analysis found that low levels of alcohol intake, defined as 1-2 drinks per day for women and 2-4 drinks per day for men, was associated with lower mortality than abstainers.[25] This claim was challenged by another study[26][27] that found that in certain low quality studies occasional drinkers or ex-drinkers were included as abstainers, resulting in the increased mortality in that group. However, the J-curve for total and CHD mortality was reconfirmed by studies that took the mentioned confounders into account.[28][29][30][31] There seems to be little discussion of what proportion of individuals classified as abstainers are those already at greater risk of mortality due to chronic conditions and do not or cannot consume alcohol for reasons of health or harmful interactions with medication.

The observed decrease in mortality of light-to-moderate drinkers compared to never drinkers might be partially explained by superior health and social status of the drinking group;[32] however, the protective effect of alcohol in light to moderate drinkers remains significant even after adjusting for these confounders.[29][31] Additionally, confounders such as underreporting of alcohol intake might lead to the underestimation of how much mortality is reduced in light-to-moderate drinkers.[28][33]

A 2010 study confirmed the beneficial effect of moderate alcohol consumption on mortality.[31] Subjects were grouped into abstainers, light, moderate, and heavy drinkers. The order of mortality rates from lowest to highest were moderate, light, heavy, and abstainers. The increased risk for abstainers was twice the mortality rate as for moderate drinkers. This study specifically sought to control for confounding factors including the problem of ex-drinkers considered as non-drinkers.[31] According to another study, drinkers with heavy drinking occasions (six or more drinks at a time) have a 57% higher all-cause mortality than drinkers without heavy drinking occasions.[34]

Mortality is lowest among young abstainers and highest among young heavy drinkers.[35]

In contrast to studies of Western cultures, research in other cultures has yielded some opposite findings. The landmark INTERHEART Study has revealed that alcohol consumption in South Asians was not protective against CAD in sharp contrast to other populations who benefit from it.[36] In fact Asian Indians who consume alcohol had a 60% higher risk of heart attack which was greater with local spirits (80%) than branded spirits (50%).[37] The harm was observed in alcohol users classified as occasional as well as regular light, moderate, and heavy consumers.[37]

Another large study of 4465 subjects in India also confirmed the possible harm of alcohol consumption on coronary risk in men. Compared to lifetime abstainers, alcohol users had higher blood sugar (2mg/dl), blood pressure (2mm Hg) levels, and the HDL-C levels (2mg/dl) and significantly higher tobacco use (63% vs. 21%).[37]

Many countries collect statistics on alcohol-related deaths. While some categories relate to short-term effects, such as accidents, many relate to long-term effects of alcohol.

One study claims that "excessive alcohol consumption in Russia, particularly by men, has in recent years caused more than half of all the deaths at ages 15-54 years."[38] However, there are some difficulties with this study. For instance the same study also found a protective effect of heavy drinking on breast cancer mortality. This contradicts the well established scientific view that alcohol increases breast cancer risk.[39] On this account in further correspondence it was advised that "careful interpretation of mortality statistics in relation to alcohol use is needed, taking into account other relevant risk factors, incidence, and survival."[40]

The authors replied that "whether or not the apparent shortfall in breast cancer mortality among heavy drinkers is real, it accounts for only about 01% of adult deaths in Russia. Careful interpretation of it is therefore of little relevance to the findings for alcohol and overall mortality".

A governmental report from Britain has found that "There were 8,724 alcohol-related deaths in 2007, lower than 2006, but more than double the 4,144 recorded in 1991. The alcohol-related death rate was 13.3 per 100,000 population in 2007, compared with 6.9 per 100,000 population in 1991."[41] In Scotland, the NHS estimate that in 2003 one in every 20 deaths could be attributed to alcohol.[42] A 2009 report noted that the death rate from alcohol-related disease was 9,000, a number three times that of 25 years previously.[43]

The Centers for Disease Control and Prevention report, "From 20012005, there were approximately 79,000 deaths annually attributable to excessive alcohol use. In fact, excessive alcohol use is the 3rd leading lifestyle-related cause of death for people in the United States each year."[44] A 1993 study estimated US deaths through alcohol at 100,000.[45]

In a 2010 long-term study of an older population, the beneficial effects of moderate drinking were confirmed. Both abstainers and heavy drinkers showed an increased mortality of about 50% over moderate drinkers after adjustment for confounding factors.[46]

Some animal studies have found increased longevity with exposure to various alcohols. The roundworm Caenorhabditis elegans has been used as a model for aging and age-related diseases.[47] The lifespan of these worms has been shown to double when fed 0.005% ethanol, but does not markedly increase at higher concentrations. Supplementing starved cultures with n-propanol and n-butanol also extended lifespan.[48]

A meta-analysis of 34 studies found a reduced risk of mortality from coronary heart disease in men who drank 2 - 4 drinks per day and women who drank 1 - 2 drinks per day.[25] Alcohol has been found to have anticoagulant properties.[49][50]Thrombosis is lower among moderate drinkers than abstainers.[51] A meta-analysis of randomized trials found that alcohol consumption in moderation decreases serum levels of fibrinogen, a protein that promotes clot formation, while it increases levels of tissue type plasminogen activator, an enzyme that helps dissolve clots.[52] These changes were estimated to reduce coronary heart disease risk by about 24%. Another meta-analysis in 2011 found favorable changes in HDL cholesterol, adiponectin, and fibrinogen associated with moderate alcohol consumption.[53]

Also, serum levels of C-reactive protein (CRP), a marker of inflammation and predictor of CHD (coronary heart disease) risk, are lower in moderate drinkers than in those who abstain from alcohol, suggesting that alcohol consumption in moderation might have anti-inflammatory effects.[54][55][56]

Despite epidemiological evidence, many have cautioned against recommendations for the use of alcohol for health benefits. A physician from the World Health Organisation labeled such alcohol promotion as "ridiculous and dangerous".[57][58] One reviewer has noted, "Despite the wealth of observational data, it is not absolutely clear that alcohol reduces cardiovascular risk, because no randomized controlled trials have been performed. Alcohol should never be recommended to patients to reduce cardiovascular risk as a substitute for the well-proven alternatives of appropriate diet, exercise, and drugs."[59] It has been argued[who?] that the health benefits from alcohol are at best debatable and may have been exaggerated by the alcohol industry. Some investigators hold that alcohol should be regarded as a recreational drug with potentially serious adverse effects on health and should not be promoted for cardio-protection.[9]

Nevertheless, a large prospective non-randomized study has shown that moderate alcohol intake in individuals already at low risk based on body mass index, physical activity, smoking, and diet, yields further improvement in cardiovascular risk.[60] Furthermore, a multicenter randomized diet study published in 2013 found that a Mediterranean-diet, which included an encouragement to daily wine consumption in habitual drinkers, led to a dramatic reduction in cardiovascular events.[61]

A prospective study published in 1997 found "moderate alcohol consumption appears to decrease the risk of PAD in apparently healthy men."[62] In a large population-based study, moderate alcohol consumption was inversely associated with peripheral arterial disease in women but not in men. But when confounding by smoking was considered, the benefit extended to men. The study concluded "an inverse association between alcohol consumption and peripheral arterial disease was found in nonsmoking men and women."[63][64]

A study found that moderate consumption of alcohol had a protective effect against intermittent claudication. The lowest risk was seen in men who drank 1 to 2 drinks per day and in women who drank half to 1 drink per day.[65]

Drinking in moderation has been found to help those who have suffered a heart attack survive it.[66][67][68] However, excessive alcohol consumption leads to an increased risk of heart failure.[69] A review of the literature found that half a drink of alcohol offered the best level of protection. However, they noted that at present there have been no randomised trials to confirm the evidence which suggests a protective role of low doses of alcohol against heart attacks.[70] However, moderate alcohol consumption is associated with hypertension.[11] There is an increased risk of hypertriglyceridemia, cardiomyopathy, hypertension, and stroke if 3 or more standard drinks of alcohol are taken per day.[71]

Large amount of alcohol over the long term can lead to alcoholic cardiomyopathy. Alcoholic cardiomyopathy presents in a manner clinically identical to idiopathic dilated cardiomyopathy, involving hypertrophy of the musculature of the heart that can lead to congestive heart failure.[72]

Alcoholics may have anemia from several causes;[73] they may also develop thrombocytopenia from direct toxic effect on megakaryocytes, or from hypersplenism.

Chronic heavy alcohol consumption impairs brain development, causes alcohol dementia, brain shrinkage, physical dependence, increases neuropsychiatric and cognitive disorders and causes distortion of the brain chemistry. At present, due to poor study design and methodology, the literature is inconclusive on whether moderate alcohol consumption increases the risk of dementia or decreases it.[74] Evidence for a protective effect of low to moderate alcohol consumption on age related cognitive decline and dementia has been suggested by some research, however, other research has not found a protective effect of low to moderate alcohol consumption.[75] Some evidence suggests that low to moderate alcohol consumption may speed up brain volume loss.[76] Chronic consumption of alcohol may result in increased plasma levels of the toxic amino acid homocysteine;[77][78] which may explain alcohol withdrawal seizures,[79] alcohol-induced brain atrophy[80] and alcohol-related cognitive disturbances.[81] Alcohol's impact on the nervous system can also include disruptions of memory and learning (see Effects of alcohol on memory), such as resulting in a blackout phenomenon.

Epidemiological studies of middle-aged populations generally find the relationship between alcohol intake and the risk of stroke to be either U- or J-shaped.[82][83][84][85] There may be very different effects of alcohol based on the type of stroke studied. The predominant form of stroke in Western cultures is ischemic, whereas non-western cultures have more hemorrhagic stroke. In contrast to the beneficial effect of alcohol on ischemic stroke, consumption of more than 2 drinks per day increases the risk of hemorrhagic stroke. The National Stroke Association estimates this higher amount of alcohol increases stroke risk by 50%.[86] "For stroke, the observed relationship between alcohol consumption and risk in a given population depends on the proportion of strokes that are hemorrhagic. Light-to-moderate alcohol intake is associated with a lower risk of ischemic stroke which is likely to be, in part, causal. Hemorrhagic stroke, on the other hand, displays a loglinear relationship with alcohol intake."[87]

Alcohol abuse is associated with widespread and significant brain lesions. Alcohol related brain damage is not only due to the direct toxic effects of alcohol; alcohol withdrawal, nutritional deficiency, electrolyte disturbances, and liver damage are also believed to contribute to alcohol-related brain damage.[88] The long-term effects of alcohol on brain chemistry is an important cause of chronic fatigue.[89]

Excessive alcohol intake is associated with impaired prospective memory. This impaired cognitive ability leads to increased failure to carry out an intended task at a later date, for example, forgetting to lock the door or to post a letter on time. The higher the volume of alcohol consumed and the longer consumed, the more severe the impairments.[90] One of the organs most sensitive to the toxic effects of chronic alcohol consumption is the brain. In France approximately 20% of admissions to mental health facilities are related to alcohol-related cognitive impairment, most notably alcohol-related dementia. Chronic excessive alcohol intake is also associated with serious cognitive decline and a range of neuropsychiatric complications. The elderly are the most sensitive to the toxic effects of alcohol on the brain.[91] There is some inconclusive evidence that small amounts of alcohol taken in earlier adult life is protective in later life against cognitive decline and dementia.[92] However, a study concluded, "Our findings suggest that, despite previous suggestions, moderate alcohol consumption does not protect older people from cognitive decline."[93]

Acetaldehyde is produced from ethanol metabolism by the liver. The acetaldehyde is further metabolized by the enzyme acetaldehyde dehydrogenase. A deficiency of this enzyme is not uncommon in individuals from Northeastern Asia as pointed out in a study from Japan.[94] This study has suggested these individuals may be more susceptible to late-onset Alzheimer's disease, however this higher risk is associated with the enzyme deficiency not with alcohol consumption. Individuals with this defect generally do not drink alcohol.

Wernicke-Korsakoff syndrome is a manifestation of thiamine deficiency, usually as a secondary effect of alcohol abuse.[95] The syndrome is a combined manifestation of two eponymous disorders, Korsakoff's Psychosis and Wernicke's encephalopathy, named after Drs. Sergei Korsakoff and Carl Wernicke. Wernicke's encephalopathy is the acute presentation of the syndrome and is characterised by a confusional state while Korsakoff's psychosis main symptoms are amnesia and executive dysfunction.[96]

Essential tremors can be temporarily relieved in up to two-thirds of patients by drinking small amounts of alcohol.[97]

Ethanol is known to activate aminobutyric acid type A (GABAA) and inhibit N-methyl-D-aspartate (NMDA) glutamate receptors, which are both implicated in essential tremor pathology[98] and could underlie the ameliorative effects.[99][100] Additionally, the effects of ethanol have been studied in different animal essential tremor models.

For more details on this topic, see Essential tremor

Chronic use of alcohol used to induce sleep can lead to insomnia: frequent moving between sleep stages occurs, with awakenings due to headaches and diaphoresis. Stopping chronic alcohol abuse can also lead to profound disturbances of sleep with vivid dreams. Chronic alcohol abuse is associated with NREM stage 3 and 4 sleep as well as suppression of REM sleep and REM sleep fragmentation. During withdrawal REM sleep is typically exaggerated as part of a rebound effect.[101]

High rates of major depressive disorder occur in heavy drinkers and those who abuse alcohol. Whether it is more true that major depressive disorder causes self-medicating alcohol abuse, or the increased incidence of the disorder in alcohol abusers is caused by the drinking, is not known though some evidence suggests drinking causes the disorder.[102] Alcohol misuse is associated with a number of mental health disorders and alcoholics have a very high suicide rate.[103] A study of people hospitalised for suicide attempts found that those who were alcoholics were 75 times more likely to go on to successfully commit suicide than non-alcoholic suicide attempters.[104] In the general alcoholic population the increased risk of suicide compared to the general public is 5-20 times greater. About 15 percent of alcoholics commit suicide. Abuse of other drugs is also associated with an increased risk of suicide. About 33 percent of suicides in the under 35s are due to alcohol or other substance misuse.[105]

Social skills are significantly impaired in people suffering from alcoholism due to the neurotoxic effects of alcohol on the brain, especially the prefrontal cortex area of the brain. The social skills that are impaired by alcohol abuse include impairments in perceiving facial emotions, prosody perception problems and theory of mind deficits; the ability to understand humour is also impaired in alcohol abusers.[106]

Studies have shown that alcohol dependence relates directly to cravings and irritability.[107] Another study has shown that alcohol use is a significant predisposing factor towards antisocial behavior in children.[108] Depression, anxiety and panic disorder are disorders commonly reported by alcohol dependent people. Alcoholism is associated with dampened activation in brain networks responsible for emotional processing (e.g. the amygdala and hippocampus).[109] Evidence that the mental health disorders are often induced by alcohol misuse via distortion of brain neurochemistry is indicated by the improvement or disappearance of symptoms that occurs after prolonged abstinence, although problems may worsen in early withdrawal and recovery periods.[110][111][112] Psychosis is secondary to several alcohol-related conditions including acute intoxication and withdrawal after significant exposure.[113] Chronic alcohol misuse can cause psychotic type symptoms to develop, more so than with other drugs of abuse. Alcohol abuse has been shown to cause an 800% increased risk of psychotic disorders in men and a 300% increased risk of psychotic disorders in women which are not related to pre-existing psychiatric disorders. This is significantly higher than the increased risk of psychotic disorders seen from cannabis use making alcohol abuse a very significant cause of psychotic disorders.[114] Approximately 3 percent of people who are alcohol dependent experience psychosis during acute intoxication or withdrawal. Alcohol-related psychosis may manifest itself through a kindling mechanism. The mechanism of alcohol-related psychosis is due to distortions to neuronal membranes, gene expression, as well as thiamin deficiency. It is possible in some cases that alcohol abuse via a kindling mechanism can cause the development of a chronic substance-induced psychotic disorder, i.e. schizophrenia. The effects of an alcohol-related psychosis include an increased risk of depression and suicide as well as psychosocial impairments.[113] However, moderate wine drinking has been shown to lower the risk for depression.[115]

While alcohol initially helps social phobia or panic symptoms, with longer term alcohol misuse can often worsen social phobia symptoms and can cause panic disorder to develop or worsen, during alcohol intoxication and especially during the alcohol withdrawal syndrome. This effect is not unique to alcohol but can also occur with long-term use of drugs which have a similar mechanism of action to alcohol such as the benzodiazepines, which are sometimes prescribed as tranquillizers to people with alcohol problems.[116] Approximately half of patients attending mental health services for conditions including anxiety disorders such as panic disorder or social phobia suffer from alcohol or benzodiazepine dependence. It was noted that every individual has an individual sensitivity level to alcohol or sedative hypnotic drugs and what one person can tolerate without ill health another will suffer very ill health and that even moderate drinking can cause rebound anxiety syndromes and sleep disorders. A person who is suffering the toxic effects of alcohol will not benefit from other therapies or medications as they do not address the root cause of the symptoms.[117]

The impact of alcohol on weight-gain is contentious: some studies find no effect,[118] others find decreased[119] or increased effect on weight gain.

Alcohol use increases the risk of chronic gastritis (stomach inflammation);[3][120] it is one cause of cirrhosis, hepatitis, and pancreatitis in both its chronic and acute forms.

A study concluded, "Mild to moderate alcohol consumption is associated with a lower prevalence of the metabolic syndrome, with a favorable influence on lipids, waist circumference, and fasting insulin. This association was strongest among whites and among beer and wine drinkers."[121] This is also true for Asians. A J-curve association between alcohol intake and metabolic syndrome was found: "The results of the present study suggest that the metabolic syndrome is negatively associated with light alcohol consumption (115 g alcohol/d) in Korean adults". However, "odds ratios for the metabolic syndrome and its components tended to increase with increasing alcohol consumption."[122]

Research has found that drinking reduces the risk of developing gallstones. Compared with alcohol abstainers, the relative risk of gallstone disease, controlling for age, sex, education, smoking, and body mass index, is 0.83 for occasional and regular moderate drinkers (< 25 ml of ethanol per day), 0.67 for intermediate drinkers (25-50 ml per day), and 0.58 for heavy drinkers. This inverse association was consistent across strata of age, sex, and body mass index."[123] Frequency of drinking also appears to be a factor. "An increase in frequency of alcohol consumption also was related to decreased risk. Combining the reports of quantity and frequency of alcohol intake, a consumption pattern that reflected frequent intake (5-7 days/week) of any given amount of alcohol was associated with a decreased risk, as compared with nondrinkers. In contrast, infrequent alcohol intake (1-2 days/week) showed no significant association with risk."[124]

A large self-reported study published in 1998 found no correlation between gallbladder disease and multiple factors including smoking, alcohol consumption, hypertension, and coffee consumption.[125] A retrospective study from 1997 found vitamin C (ascorbic acid) supplement use in drinkers was associated with a lower prevalence of gallbladder disease, but this association was not seen in non-drinkers.[126]

Alcoholic liver disease is a major public health problem. For example in the United States up to two million people have alcohol-related liver disorders.[127] Chronic alcohol abuse can cause fatty liver, cirrhosis and alcoholic hepatitis. Treatment options are limited and consist of most importantly discontinuing alcohol consumption. In cases of severe liver disease, the only treatment option may be a liver transplant from alcohol abstinent donors. Research is being conducted into the effectiveness of anti-TNFs. Certain complementary medications, e.g., milk thistle and silymarin, appear to offer some benefit.[127][128] Alcohol is a leading cause of liver cancer in the Western world, accounting for 32-45% of hepatic cancers. Up to half a million people in the United States develop alcohol-related liver cancer.[129][130] Moderate alcohol consumption also increases the risk of liver disease.[11]

Alcohol abuse is a leading cause of both acute pancreatitis and chronic pancreatitis.[131][132] Alcoholic pancreatitis can result in severe abdominal pain and may progress to pancreatic cancer.[133] Chronic pancreatitis often results in intestinal malabsorption, and can result in diabetes.[134]

Chronic alcohol ingestion can impair multiple critical cellular functions in the lung.[citation needed] These cellular impairments can lead to increased susceptibility to serious complications from lung disease. Recent research cites alcoholic lung disease as comparable to liver disease in alcohol-related mortality.[citation needed] Alcoholics have a higher risk of developing acute respiratory distress syndrome (ARDS) and experience higher rates of mortality from ARDS when compared to non-alcoholics.[citation needed] Despite these effects, a large prospective study has shown a protective effect of moderate alcohol consumption on respiratory mortality.[23]

Research indicates that drinking alcohol is associated with a lower risk of developing kidney stones. One study concludes, "Since beer seemed to be protective against kidney stones, the physiologic effects of other substances besides ethanol, especially those of hops, should also be examined."[135] "...consumption of coffee, alcohol, and vitamin C supplements were negatively associated with stones."[136] "After mutually adjusting for the intake of other beverages, the risk of stone formation decreased by the following amount for each 240-ml (8-oz) serving consumed daily: caffeinated coffee, 10%; decaffeinated coffee, 10%; tea, 14%; beer, 21%; and wine, 39%."[137] "...stone formation decreased by the following amount for each 240-mL (8-oz) serving consumed daily: 10% for caffeinated coffee, 9% for decaffeinated coffee, 8% for tea, and 59% for wine." (CI data excised from last two quotes.).[138]

Long term excessive intake of alcohol can lead to damage to the central nervous system and the peripheral nervous system resulting in loss of sexual desire and impotence in men.[139] This is caused by reduction of testosterone from ethanol-induced testicular atrophy, resulting in increased feminisation of males and is a clinical feature of alcohol abusing males who have cirrhosis of the liver.[140]

Excessive alcohol intake can result in hyperoestrogenisation.[141] It has been speculated that alcohol beverages may contain estrogen like compounds. In men, high levels of estrogen can lead to testicular failure and the development of feminine traits including development of male breasts, called gynecomastia.[142][143] In women, increased levels of estrogen due to excessive alcohol intake have been related to an increased risk of breast cancer.[143][144]

A meta-analysis found with data from 477,200 individuals determined the dose-response relationships by sex and end point using lifetime abstainers as the reference group. The search revealed 20 cohort studies that met our inclusion criteria. A U-shaped relationship was found for both sexes. Compared with lifetime abstainers, the relative risk (RR) for type 2 diabetes among men was most protective when consuming 22 g/day alcohol (RR 0.87 [95% CI 0.761.00]) and became deleterious at just over 60 g/day alcohol (1.01 [0.711.44]). Among women, consumption of 24 g/day alcohol was most protective (0.60 [0.520.69]) and became deleterious at about 50 g/day alcohol (1.02 [0.831.26]).

Because former drinkers may be inspired to abstain due to health concerns, they may actually be at increased risk of developing diabetes, known as the sick-quitter effect. Moreover, the balance of risk of alcohol consumption on other diseases and health outcomes, even at moderate levels of consumption, may outweigh the positive benefits with regard to diabetes.

Additionally, the way in which alcohol is consumed (i.e., with meals or bingeing on weekends) affects various health outcomes. Thus, it may be the case that the risk of diabetes associated with heavy alcohol consumption is due to consumption mainly on the weekend as opposed to the same amount spread over a week.[145] In the United Kingdom "advice on weekly consumption is avoided".

Also, a twenty-year twin study from Finland has shown that moderate alcohol consumption may reduce the risk of type 2 diabetes in men and women. However, binge drinking and high alcohol consumption was found to increase the risk of type 2 diabetes in women. [146] A study in mice has suggested a beneficial effect of alcohol in promoting insulin sensitivity.[147]

Regular consumption of alcohol is associated with an increased risk of gouty arthritis[148][149] and a decreased risk of rheumatoid arthritis.[150][151][152][153][154] Two recent studies report that the more alcohol consumed, the lower the risk of developing rheumatoid arthritis. Among those who drank regularly, the one-quarter who drank the most were up to 50% less likely to develop the disease compared to the half who drank the least.[155]

The researchers noted that moderate alcohol consumption also reduces the risk of other inflammatory processes such as cardiovascualar disease. Some of the biological mechanisms by which ethanol reduces the risk of destructive arthritis and prevents the loss of bone mineral density (BMD), which is part of the disease process.[156]

A study concluded, "Alcohol either protects from RA or, subjects with RA curtail their drinking after the manifestation of RA".[157] Another study found, "Postmenopausal women who averaged more than 14 alcoholic drinks per week had a reduced risk of rheumatoid arthritis..."[158]

Moderate alcohol consumption is associated with higher bone mineral density in postmenopausal women. "...Alcohol consumption significantly decreased the likelihood [of osteoporosis]."[159] "Moderate alcohol intake was associated with higher BMD in postmenopausal elderly women."[160] "Social drinking is associated with higher bone mineral density in men and women [over 45]."[161] However, alcohol abuse is associated with bone loss.[162][163]

Chronic excessive alcohol abuse is associated with a wide range of skin disorders including urticaria, porphyria cutanea tarda, flushing, cutaneous stigmata of cirrhosis, psoriasis, pruritus, seborrheic dermatitis and rosacea.[164]

A 2010 study concluded, "Nonlight beer intake is associated with an increased risk of developing psoriasis among women. Other alcoholic beverages did not increase the risk of psoriasis in this study."[165]

There is a protective effect of alcohol consumption against active infection with H. pylori[166] In contrast, alcohol intake (comparing those who drink > 30g of alcohol per day to non-drinkers) is not associated with higher risk of duodenal ulcer.[167] Excessive alcohol consumption seen in alcoholics is a known risk factor for pneumonia.

A study on the common cold found that "Greater numbers of alcoholic drinks (up to three or four per day) were associated with decreased risk for developing colds because drinking was associated with decreased illness following infection. However, the benefits of drinking occurred only among nonsmokers. [...] Although alcohol consumption did not influence risk of clinical illness for smokers, moderate alcohol consumption was associated with decreased risk for nonsmokers."[168]

Another study concluded, "Findings suggest that wine intake, especially red wine, may have a protective effect against common cold. Beer, spirits, and total alcohol intakes do not seem to affect the incidence of common cold."[169]

In 1988 the International Agency for Research on Cancer (Centre International de Recherche sur le Cancer) of the World Health Organization classified alcohol as a Group 1 carcinogen, stating "There is sufficient evidence for the carcinogenicity of alcoholic beverages in humans.... Alcoholic beverages are carcinogenic to humans (Group 1)."[170] The U.S. Department of Health & Human Services National Toxicology Program in 2000 listed alcohol as a known carcinogen.[171]

It was estimated in 2006 that "3.6% of all cancer cases worldwide are related to alcohol drinking, resulting in 3.5% of all cancer deaths."[172] A European study from 2011 found that one in 10 of all cancers in men and one in 33 in women were caused by past or current alcohol intake.[173][174] The World Cancer Research Fund panel report Food, Nutrition, Physical Activity and the Prevention of Cancer: a Global Perspective finds the evidence "convincing" that alcoholic drinks increase the risk of the following cancers: mouth, pharynx and larynx, oesophagus, colorectum (men), breast (pre- and postmenopause).[175]

Acetaldehyde, a metabolic product of alcohol, is suspected to promote cancer. Typically the liver eliminates 99% of acetaldehyde produced. However, liver disease and certain genetic enzyme deficiencies result in high acetaldehyde levels. Heavy drinkers who are exposed to high acetaldehyde levels due to a genetic defect in alcohol dehydrogenase have been found to be at greater risk of developing cancers of the upper gastrointestinal tract and liver.[176] A review in 2007 found "convincing evidence that acetaldehyde... is responsible for the carcinogenic effect of ethanol... owing to its multiple mutagenic effects on DNA."[177] Acetaldehyde can react with DNA to create DNA adducts including the Cr-Pdg adduct. This Cr-PdG adduct "is likely to play a central role in the mechanism of alcoholic beverage related carcinogenesis."[178] Some have pointed out that even moderate levels of alcohol consumption are associated with an increased risk of certain forms of cancer.[11]

Fetal alcohol syndrome or FAS is a birth defect that occurs in the offspring of women who drink alcohol during pregnancy. Drinking heavily or during the early stages of prenatal development has been conclusively linked to FAS; moderate consumption is associated with fetal damage.[11] Alcohol crosses the placental barrier and can stunt fetal growth or weight, create distinctive facial stigmata, damaged neurons and brain structures, and cause other physical, mental, or behavioural problems.[179] Fetal alcohol exposure is the leading known cause of intellectual disability in the Western world.[180] Alcohol consumption during pregnancy is associated with brain insulin and insulin-like growth factor resistance.[162]

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What Are Medical Expenses?

Medical expenses are the costs of diagnosis, cure, mitigation, treatment, or prevention of disease, and the costs for treatments affecting any part or function of the body. These expenses include payments for legal medical services rendered by physicians, surgeons, dentists, and other medical practitioners. They include the costs of equipment, supplies, and diagnostic devices needed for these purposes.

Medical care expenses must be primarily to alleviate or prevent a physical or mental defect or illness. They do not include expenses that are merely beneficial to general health, such as vitamins or a vacation.

Medical expenses include the premiums you pay for insurance that covers the expenses of medical care, and the amounts you pay for transportation to get medical care. Medical expenses also include amounts paid for qualified long-term care services and limited amounts paid for any qualified long-term care insurance contract.

You can include only the medical and dental expenses you paid this year, regardless of when the services were provided. (But see Decedent under Whose Medical Expenses Can You Include, for an exception.) If you pay medical expenses by check, the day you mail or deliver the check generally is the date of payment. If you use a pay-by-phone or online account to pay your medical expenses, the date reported on the statement of the financial institution showing when payment was made is the date of payment. If you use a credit card, include medical expenses you charge to your credit card in the year the charge is made, not when you actually pay the amount charged.

If you did not claim a medical or dental expense that would have been deductible in an earlier year, you can file Form 1040X, Amended U.S. Individual Income Tax Return, for the year in which you overlooked the expense. Do not claim the expense on this year's return. Generally, an amended return must be filed within 3 years from the date the original return was filed or within 2 years from the time the tax was paid, whichever is later.

You cannot include medical expenses that were paid by insurance companies or other sources. This is true whether the payments were made directly to you, to the patient, or to the provider of the medical services.

Generally, you can deduct on Schedule A (Form 1040) only the amount of your medical and dental expenses that is more than 10% of your AGI. But if either you or your spouse was born before January 2, 1950, you can deduct the amount of your medical and dental expenses that is more than 7.5% of your AGI.

Example.

You are unmarried and were born after January 2, 1950, and your AGI is $40,000, 10% of which is $4,000. You paid medical expenses of $2,500. You cannot deduct any of your medical expenses because they are not more than 10% of your AGI.

You can generally include medical expenses you pay for yourself, as well as those you pay for someone who was your spouse or your dependent either when the services were provided or when you paid for them. There are different rules for decedents and for individuals who are the subject of multiple support agreements. See Support claimed under a multiple support agreement , later, under Qualifying Relative.

You can include medical expenses you paid for your spouse. To include these expenses, you must have been married either at the time your spouse received the medical services or at the time you paid the medical expenses.

Example 1.

Mary received medical treatment before she married Bill. Bill paid for the treatment after they married. Bill can include these expenses in figuring his medical expense deduction even if Bill and Mary file separate returns.

If Mary had paid the expenses, Bill could not include Mary's expenses in his separate return. Mary would include the amounts she paid during the year in her separate return. If they filed a joint return, the medical expenses both paid during the year would be used to figure their medical expense deduction.

Example 2.

This year, John paid medical expenses for his wife Louise, who died last year. John married Belle this year and they file a joint return. Because John was married to Louise when she received the medical services, he can include those expenses in figuring his medical expense deduction for this year.

You can include medical expenses you paid for your dependent. For you to include these expenses, the person must have been your dependent either at the time the medical services were provided or at the time you paid the expenses. A person generally qualifies as your dependent for purposes of the medical expense deduction if both of the following requirements are met.

You can include medical expenses you paid for an individual that would have been your dependent except that:

He or she received gross income of $3,950 or more in 2014,

He or she filed a joint return for 2014, or

You, or your spouse if filing jointly, could be claimed as a dependent on someone else's 2014 return.

A qualifying child is a child who:

Is your son, daughter, stepchild, foster child, brother, sister, stepbrother, stepsister, half brother, half sister, or a descendant of any of them (for example, your grandchild, niece, or nephew),

Was:

Under age 19 at the end of 2014 and younger than you (or your spouse, if filing jointly),

Under age 24 at the end of 2014, a full-time student, and younger than you (or your spouse, if filing jointly), or

Any age and permanently and totally disabled,

Lived with you for more than half of 2014,

Did not provide over half of his or her own support for 2014, and

Did not file a joint return, other than to claim a refund.

The child is in the custody of one or both parents for more than half the year,

The child receives over half of his or her support during the year from his or her parents, and

The child's parents:

Are divorced or legally separated under a decree of divorce or separate maintenance,

Are separated under a written separation agreement, or

Live apart at all times during the last 6 months of the year.

A qualifying relative is a person:

Who is your:

Son, daughter, stepchild, or foster child, or a descendant of any of them (for example, your grandchild),

Brother, sister, half brother, half sister, or a son or daughter of any of them,

Father, mother, or an ancestor or sibling of either of them (for example, your grandmother, grandfather, aunt, or uncle),

Stepbrother, stepsister, stepfather, stepmother, son-in-law, daughter-in-law, father-in-law, mother-in-law, brother-in-law, or sister-in-law, or

Any other person (other than your spouse) who lived with you all year as a member of your household if your relationship did not violate local law,

Who was not a qualifying child (see Qualifying Child, earlier) of any taxpayer for 2014, and

For whom you provided over half of the support in 2014. But see Child of divorced or separated parents , earlier, Support claimed under a multiple support agreement, next, and Kidnapped child under Qualifying Relative in Publication 501.

Example.

You and your three brothers each provide one-fourth of your mother's total support. Under a multiple support agreement, you treat your mother as your dependent. You paid all of her medical expenses. Your brothers repaid you for three-fourths of these expenses. In figuring your medical expense deduction, you can include only one-fourth of your mother's medical expenses. Your brothers cannot include any part of the expenses. However, if you and your brothers share the nonmedical support items and you separately pay all of your mother's medical expenses, you can include the unreimbursed amount you paid for her medical expenses in your medical expenses.

Medical expenses paid before death by the decedent are included in figuring any deduction for medical and dental expenses on the decedent's final income tax return. This includes expenses for the decedent's spouse and dependents as well as for the decedent.

The survivor or personal representative of a decedent can choose to treat certain expenses paid by the decedent's estate for the decedent's medical care as paid by the decedent at the time the medical services were provided. The expenses must be paid within the 1-year period beginning with the day after the date of death. If you are the survivor or personal representative making this choice, you must attach a statement to the decedent's Form 1040 (or the decedent's amended return, Form 1040X) saying that the expenses have not been and will not be claimed on the estate tax return.

Example.

John properly filed his 2013 income tax return. He died in 2014 with unpaid medical expenses of $1,500 from 2013 and $1,800 in 2014. If the expenses are paid within the 1-year period, his survivor or personal representative can file an amended return for 2013 claiming a deduction based on the $1,500 medical expenses. The $1,800 of medical expenses from 2014 can be included on the decedent's final return for 2014.

Following is a list of items that you can include in figuring your medical expense deduction. The items are listed in alphabetical order.

This list does not include all possible medical expenses. To determine if an expense not listed can be included in figuring your medical expense deduction, see What Are Medical Expenses , earlier.

You can include in medical expenses the amount you pay for a legal abortion.

You can include in medical expenses the amount you pay for acupuncture.

You can include in medical expenses amounts you pay for an inpatient's treatment at a therapeutic center for alcohol addiction. This includes meals and lodging provided by the center during treatment.

You can also include in medical expenses amounts you pay for transportation to and from Alcoholics Anonymous meetings in your community if the attendance is pursuant to medical advice that membership in Alcoholics Anonymous is necessary for the treatment of a disease involving the excessive use of alcoholic liquors.

You can include in medical expenses amounts you pay for ambulance service.

You can include in medical expenses the amount you pay for an artificial limb.

You can include in medical expenses the amount you pay for artificial teeth.

You can include in medical expenses the cost of medical supplies such as bandages.

You can include in medical expenses the amount you pay for birth control pills prescribed by a doctor.

You can include in medical expenses the cost of an electronic body scan.

You can include in medical expenses the part of the cost of Braille books and magazines for use by a visually impaired person that is more than the cost of regular printed editions.

You can include in medical expenses the cost of breast pumps and supplies that assist lactation.

You can include in medical expenses the amounts you pay for breast reconstruction surgery, as well as breast prosthesis, following a mastectomy for cancer. See Cosmetic Surgery , later.

You can include in medical expenses amounts you pay for special equipment installed in a home, or for improvements, if their main purpose is medical care for you, your spouse, or your dependent. The cost of permanent improvements that increase the value of your property may be partly included as a medical expense. The cost of the improvement is reduced by the increase in the value of your property. The difference is a medical expense. If the value of your property is not increased by the improvement, the entire cost is included as a medical expense.

Certain improvements made to accommodate a home to your disabled condition, or that of your spouse or your dependents who live with you, do not usually increase the value of the home and the cost can be included in full as medical expenses. These improvements include, but are not limited to, the following items.

Constructing entrance or exit ramps for your home.

Widening doorways at entrances or exits to your home.

Widening or otherwise modifying hallways and interior doorways.

Installing railings, support bars, or other modifications to bathrooms.

Lowering or modifying kitchen cabinets and equipment.

Moving or modifying electrical outlets and fixtures.

Installing porch lifts and other forms of lifts (but elevators generally add value to the house).

Modifying fire alarms, smoke detectors, and other warning systems.

Modifying stairways.

Adding handrails or grab bars anywhere (whether or not in bathrooms).

Modifying hardware on doors.

Modifying areas in front of entrance and exit doorways.

Grading the ground to provide access to the residence.

Only reasonable costs to accommodate a home to a disabled condition are considered medical care. Additional costs for personal motives, such as for architectural or aesthetic reasons, are not medical expenses.

Example.

John has arthritis and a heart condition. He cannot climb stairs or get into a bathtub. On his doctor's advice, he installs a bathroom with a shower stall on the first floor of his two-story rented house. The landlord did not pay any of the cost of buying and installing the special plumbing and did not lower the rent. John can include in medical expenses the entire amount he paid.

You can include in medical expenses the cost of special hand controls and other special equipment installed in a car for the use of a person with a disability.

You can include in medical expenses fees you pay to a chiropractor for medical care.

You can include in medical expenses fees you pay to Christian Science practitioners for medical care.

You can include in medical expenses amounts you pay for contact lenses needed for medical reasons. You can also include the cost of equipment and materials required for using contact lenses, such as saline solution and enzyme cleaner. See Eyeglasses and Eye Surgery , later.

You can include in medical expenses the amount you pay to buy or rent crutches.

You can include in medical expenses the amounts you pay for the prevention and alleviation of dental disease. Preventive treatment includes the services of a dental hygienist or dentist for such procedures as teeth cleaning, the application of sealants, and fluoride treatments to prevent tooth decay. Treatment to alleviate dental disease include services of a dentist for procedures such as X-rays, fillings, braces, extractions, dentures, and other dental ailments. But see Teeth Whitening under What Expenses Are Not Includible, later.

You can include in medical expenses the cost of devices used in diagnosing and treating illness and disease.

Example.

You have diabetes and use a blood sugar test kit to monitor your blood sugar level. You can include the cost of the blood sugar test kit in your medical expenses.

Some disabled dependent care expenses may qualify as either:

You can choose to apply them either way as long as you do not use the same expenses to claim both a credit and a medical expense deduction.

You can include in medical expenses amounts you pay for an inpatient's treatment at a therapeutic center for drug addiction. This includes meals and lodging at the center during treatment.

You can include in medical expenses the amount you pay for eye examinations.

You can include in medical expenses amounts you pay for eyeglasses and contact lenses needed for medical reasons. See Contact Lenses , earlier, for more information.

You can include in medical expenses the amount you pay for eye surgery to treat defective vision, such as laser eye surgery or radial keratotomy.

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Publication 502 (2014), Medical and Dental Expenses

Around the world, millions of people start diets every year. Many people start diets a few times a year, and for some people it may seem as if they are constantly on a diet or enduring an endless cycle of starting a diet and falling of the band wagon. The majority of people who start a diet cannot maintain it for the long term, meaning that even if they reach their goal weight, they are likely to gain the weight back, often with a little extra when they stop the diet and go back to their original eating habits.

This may sound like a lifelong prison sentence of tasteless, uninspiring food and deprivation, but statistics show that most people who lose weight on a diet regain it when they stop. The reason for this is that their diet is simply too restrictive to be maintained. Many fad diets eliminate food groups such as carbs or fat or only allow you to eat specific foods at certain times of the day. This may well help you to reach your goal weight, but you cannot go all your life drinking only meal replacement shakes or eating only high protein, low fat salads. Its simply not sustainable and can completely destroy your social life. Nobody wants to go out for a meal with someone who only picks at a green salad throughout the night.

What is the answer to this? Avoid diets that are unsustainable and do not fit in with your everyday life and instead focus on small, healthy, long-term changes to your diet. Your weight loss may not be fast, but if you persevere you will be able to maintain a healthy weight for life, rather than being back at square one and making New Years resolutions to lose weight all over again the next year.

Many popular diets involve a maintenance phase that is designed to help you maintain your weight loss once you have reached your goal weight. This is usually a more relaxed version of the original diet, with a greater number of foods allowed. The Dukkan Diet for example, ends in a stabilization phase which states you can eat pretty much anything you want as long as one day a week you return to the original diet plan of only lean protein. Whilst these maintenance phases may assist with keeping weight off in the longer term, it still means that you are tied to an eating plan or regime which you are expected to follow for the rest of your life. If the diet is one which fits your eating patterns and is easy to follow and varied, this may be fine, however if it relies on expensive supplements, or eliminating food groups this is still a lot to take on.

There are numerous reasons why people stop dieting. If you do choose to follow a diet that is not sustainable in the long term, it is essential that when you stop the diet for whatever reason, you do not go back to your original habits. You need to adopt a new healthy lifestyle to keep that weight off.

When a person reaches their goal weight, they often stop their diet. Unfortunately many people dont continue with a healthy food intake, but instead celebrate the end of their restrictive diet by eating all the things they have deprived themselves of for the last few months.

This is likely to lead to regain of the lost weight, but also add extra kilos to your frame. As you have less body mass than you had before your diet, your calorie requirements for weight maintenance will have decreased. Therefore if you start to eat the same as you were before your diet, you will quickly gain back the weight and then some.

The important thing to remember when you reach your target weight is that although you cannot stop your diet you can relax it and add in more of the foods you enjoy or have been avoiding, just dont go overboard.

In the first few weeks of a weight loss diet the drop in pounds is usually satisfyingly obvious with each weigh in. This pattern is not sustainable however, and as you continue on your diet, your weight loss is likely to drop off, resulting in a weight plateau. This can be very disheartening and can cause many people to give up on their diet under the belief that it just isnt working anymore, so whats the point.

A plateau will often occur because your new less voluminous body requires less and less calories to maintain weight as your lose weight. Therefore to keep up steady weight loss, you may need to reduce calories further as you lose weight or increase your exercise to burn more. Exercise is the ideal option as this will also increase your muscle mass, leading to a faster metabolic rate and more calories being burnt when the body is at rest.

More here:
How to diet for long term weight loss and not feel like ...

2001 American Society for Clinical Nutrition James W Anderson, Elizabeth C Konz, Robert C Frederich, and Constance L Wood 1From the VA Medical Center, Graduate Center for Nutritional Sciences, University of Kentucky Health Management Resources Weight Management Program, Lexington, and the Departments of Internal Medicine and Biostatistics, University of Kentucky, Lexington. Abstract

Background: Current perception is that participants of a structured weight-loss program regain all of their weight loss within 5 y.

Objective: The objective was to examine the long-term weight-loss maintenance of individuals completing a structured weight-loss program.

Design: Studies were required to 1) have been conducted in the United States, 2) have included participants in a structured weight-loss program, 3) have provided follow-up data with variance estimates for 2 y. Primary outcome variables were weight-loss maintenance in kilograms, weight-loss maintenance as a percentage of initial weight loss, and weight loss as a percentage of initial body weight (reduced weight).

Results: Twenty-nine studies met the inclusion criteria. Successful very-low-energy diets (VLEDs) were associated with significantly greater weight-loss maintenance than were successful hypoenergetic balanced diets (HBDs) at all years of follow-up. The percentage of individuals at 4 or 5 y of follow-up for VLEDs and HBDs were 55.4% and 79.7%, respectively. The results for VLEDs and HBDs, respectively, were as follows: weight-loss maintenance, 7.1 kg (95% CI: 6.1, 8.1 kg) and 2.0 (1.5, 2.5) kg; percentage weight-loss maintenance, 29% (25%, 33%) and 17% (13%, 22%); and reduced weight, 6.6% (5.7%, 7.5%) and 2.1% (1.6%, 2.7%). Weight-loss maintenance did not differ significantly between women and men. Six studies reported that groups who exercised more had significantly greater weight-loss maintenance than did those who exercised less.

Conclusions: Five years after completing structured weight-loss programs, the average individual maintained a weight loss of >3 kg and a reduced weight of >3% of initial body weight. After VLEDs or weight loss of 20 kg, individuals maintained significantly more weight loss than after HBDs or weight losses of <10 kg.

Obesity is a chronic disease that is a major health problem in the United States and is emerging as a health problem in many developed and developing countries (1). Current treatment programs for obese individuals are not very effective over the long term, leading to the common wisdom that persons who successfully lose weight will regain it all within 5 y (2,3).

The combination of very-low-energy diets (VLEDs) with behavior modification represents an important advance in enabling obese individuals to initially lose substantial amounts of weight, typically 2025 kg (4). However, the National Task Force on the Prevention and Treatment of Obesity (5) indicated that long-term maintenance of weight loss after VLEDs is no better than after other forms of obesity treatment. The present meta-analysis critically examines that contention by examining available US reports of weight-loss maintenance from 2 to 5 y after successful weight loss in structured weight-loss programs. Furthermore, because the recommended rate and amount of weight loss is a focus of debate (6), we examined long-term weight-loss maintenance and weight reduction at 5 y after either VLEDs or hypoenergetic balanced diets (HBDs).

In evaluating the literature for studies of weight-loss maintenance, we defined 3 initial inclusion criteria. First, only US studies were evaluated because of differences in weight-management practices and the availability of medical care in different countries. Second, subjects must have participated in a structured weight-loss program instead of in self-help activities. Third, follow-up weights with variance estimates must have been available for 2 y. We performed a thorough literature search by using MEDLINE (National Library of Medicine, Bethesda, MD) for the period of 19701999 to identify candidate studies and also used the ancestry approach (7) by consulting reference lists from single studies and pertinent literature reviews. We reviewed data from primary scientific reports and in review articles. Thirty-one separate published reports (4,8,37) met the initial criteria. We excluded 2 reports (19,22) because they did not provide specific weight-loss information at follow-up times. A study conducted by Wing et al (38) was also excluded from the analysis because the study included only children of persons with type 2 diabetes, a group shown to be atypical of the general population (39).

The primary outcome measures were weight-loss maintenance in kilograms, weight-loss maintenance as a percentage of initial weight loss (percentage weight-loss maintenance), and weight loss as percentage of initial body weight (reduced weight). Follow-up values were assessed at 1, 2, 3, 4, and 5 y. We analyzed results as reported and did not adjust for self-reported weights. Most investigators used VLEDs of <800 kcal/d (3347 kJ/d) or HBDs during the weight-loss phase. One group (34,35) used VLEDs and HBDs for comparison; these groups were considered to be mixed and were not analyzed in either diet group but were included in other comparisons.

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Long-term weight-loss maintenance: a meta-analysis of US ...

Ok, so this is not a new phenomenon and Im sure you have heard it before, Carbs vs Protein

Diets higher in protein. Are they the way forward when is comes to long term weight loss?

According to research bysubstituting simple carbohydrates and replacing with proteincould in fact be more effective then counting calorieswhen it comes to long term weight control.

What are simple carbs? Things to avoid

Starches Refined Grains Sugars ( this is the difficult part)

Examples include:

Bread (made with white flour) Pasta (made with white flour) Table Sugar Fizzy drinks such as Coke Cereals Fruit Juice

Look at the packaging when yourdoing your weekly shop.Anything thats lists sugar, sucrose, fructose, corn syrup, white or wheat flour as ingredients, mostly contain simple carbohydrates and not much else.

Simple carbohydrates actually aid in weight gain, this is because they have a high Glycemic Load. GL is the measure of how much food increases blood sugar over time.

So by introducing more proteins, such as:-

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Long Term Weight Loss Simple? Swapping Carbs for Protein

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DIY HCG was the first online company to sell HCG drops and has continued to work with our customers to bring them the best and most reliable HCG drops and HCG diet information. We use HCG that is manufactured in the United States and that is held to the highest standards in homeopathic supplement creation. Plus, we make sure to give you ONLY products and information that adhere 100% to Dr. Simeons Manuscript: Pounds and Inches, A New Approach to Obesity because we want to make sure that you have only the highest success rate possible while taking the journey of the HCG diet.

If you dont already know, Dr. Simeons was an Italian doctor in the 60s who formulated the HCG diet process. He worked with obese patients of all ages for over 20 years to create the perfect formula for the HCG diet to allow maximum weight loss and maintenance. He tried many, many things before releasing only those that worked in his manuscript for other medical professionals to see. However, since the diet was discovered, many people (patient and doctors alike) have made up their own ways to change the diet and make it so it is easier for their client/customer to lose weight. This may include allowing foods that werent on Dr. Simeons original food list or saying it is okay to use normal lotion/beauty products. However, while it may make the diet and beauty routine less strict, these changes can hinder speed of weight loss and also stop the detoxing effect that the HCG diet is supposed to have on your body and your hypothalamus (see Dr. Simeons Manuscript for more information on this).

So, all of our products and recommendations will follow the strict Dr. Simeons protocol. In fact, we created many of our products specifically for people who are on Phase 2 also known as the VLCD (Very Low Calorie Diet) Phase of the Diet or for those on Phase 3 (also known as the Maintenance Phase) of the HCG diet. Furthermore, we are the home of Linda Prinster, Leanne Mennemeier, and Tiffany Prinster, all creators and authors of successful (and helpful) HCG diet books.

Our specially designed Phase 2 products include: HCG P2 Salad Dressings (Including Citrus Ginger, Vinaigrette, and Sweet Mustard), BBQ Sauce (which is an EXCELLENT addition to your VLCD meals and the ONLY one currently on the market that is allowed while on HCG), Hot Sauce, Spices (Including Lemon Herb Seasoning, All-Purpose Seasoning, Hot Pepper Steak Seasoning, and Louisiana Sweet Seasoning), and we are always adding more food items.

We also offer Phase 2 Safe beauty products. Again, if you are just learning about the diet, you may say Why would I need new beauty products while on the HCG diet? Well, let us tell you.

While on the HCG Diet, you are not allowed to put anything that has any fats or oils in it onto your skin (EXCEPT baby oil, which makes no sense, but thats the rule). So, you need to check all of your make up and items such as soap, shampoo, hair products, LOTIONS, and more before you apply to your skin during the VLCD because if they contain any fats or oils, they WILL stall your weight loss OR make you gain. Dont believe us? Try it yourself. Although, we wouldnt recommend it as it will only slow you down. 🙂

So, we created a line of beauty products to use while you are on the HCG diet that includes Tiffalinas HCG safe lotion, lip balm, shampoo, and conditioner. And although these products arent the most creamy and luxurious products out there, they will help you make it through the VLCD until you can use your normal products again.

Finally, for Phase 3 of the diet, we have developed an Easy Protein line that are snacks and foods that are high in protein and low in carbs, making them a great addition to your HCG Maintenance food list. With these yummy snacks, P3 will feel like a breeze to you.

If you decide that the HCG diet is right for you, good luck! There is so much information to be found about the diet, but it can be easy to get overwhelmed. Just take a deep breath, find some great P2 and P3 recipes, get your shopping done, and find something to distract you as you make your way through this awesome (yet sometimes difficult) weight loss plan.

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HCG Diet Drops | DIY HCG | HCG Weight Loss Drops | Lose ...

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