Tuesday, July 20th 2004

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Starch Stoppers

Tracey Cook's loss might actually be her gain. Trimmer by 30 pounds, Cook knew she wanted to share the low-carb wealth.
In January, she, along with husband Scott and Amy and Steve Perilstein, opened Allegheny County's first store dedicated exclusively to low-carb cravings.

Located in Blawnox, Totally Low Carb, or TLC Foods, hit the market with owners who practice what they preach.

"Oh, yes. We live the lifestyle. You can't sell something if you're not living it," she said with a laugh.

Cook said she's not worried about the "bad press" low-carb diets have drawn of late. "People who are living this lifestyle, they know what it's all about," she said.

The U.S. Department of Agriculture estimates as many as 40 million Americans are going low-carb these days. Why? Because after more than a decade of fat-conscious thinking, Americans are still gaining weight. According to the Centers for Disease Control and Prevention, 61 percent of Pennsylvania adults are overweight or obese; the obesity rate having increased by 92 percent from 1990 to 2002. Further, the CDC reports the added girth may be directly related to increased carbohydrate consumption.

Alarming numbers, to be sure. So much so that many are desperately seeking a "new and improved" way to trim the waistline. Thus, a re-emergence of the carb-slashing concept made famous by the late Dr. Robert Atkins in the 1970s.

"People love a gimmick," said Debbie Hutcheson, clinical nutrition manager at Monongahela Valley Hospital, Washington County. "This is basically no different than the cabbage soup diet or any other diet I've seen come my way."

According to the American Dietetic Association, conventional wisdom says 20-30 percent of daily calories should come from fat; 40-60 percent from carbs; and 20-30 percent from protein. Low-carbers, on the other hand, typically consume 55-65 percent of all calories in the form of fat; less than 20 percent from carbs; and 20-30 percent from protein.

The new trend has created a market for hundreds of "low-carb," "reduced-carb," "carb smart" and "net carb" food items. "They're lowering the carb content of these foods, but check out the calories," noted Theresa E. Shaffer, clinical dietitian at Latrobe Area Hospital, part of the Westmoreland-Latrobe Health Partners. "In many cases, they're very, very high. And to me, calories make a difference."

What does it all mean? The U.S. Food and Drug Administration, which doesn't recognize the "net carb" credo, hopes to put an exact definition on carbohydrate nutrient content by the end of the year.

"There is a lot of confusion," said Dr. Richard Kucera, pulmonary and critical care specialist at Westmoreland Regional Hospital, also part of Westmoreland-Latrobe Health Partners. "Adding to the confusion is the fact that low-carb diets actually do work. But they work for the same reason all diets work: You restrict calories and increase the amount of energy you burn."

Dr. Donald Hensrud, weight management specialist at the Mayo Clinic, agrees. "Calories count. That's the bottom line," he said. "Yes, I agree we need to cut down a little bit on our carb intake, but let's not throw the baby out with the bath water. There is still a place in the diet for high-quality carbohydrate choices."

Low-carb philosophy is based on Atkins' notion that sugar from carbohydrates is responsible for packing on the pounds. The theory says carbohydrates raise blood sugar levels, which then kicks in insulin production. Insulin drives blood sugar into the cells and prevents the body from burning excess fat. The result? Weight gain. Additionally, excessive amounts of carbohydrates in the diet can eventually lead to "insulin resistance," which, if left untreated, is thought to contribute to high cholesterol, heart disease, obesity and type II diabetes.

As a result, diets such as Atkins and South Beach invoke an initial induction phase -- during which the body is weaned from its dependency on carbohydrates for fuel. For Atkins followers, this means consuming primarily meat, eggs, cheese, butter and cream. Grains, beans, fruits, breads, pastas and vegetables are, for the most part, a no-no -- to the tune of 20 grams or less a day. Think one slice of bread.

Fat burning without enough dietary carbohydrates create byproducts called ketones. Ketones build up in the bloodstream, are filtered by the kidneys, and eventually eliminated.

"We've known about ketosis for 100 years," said Kucera. "Ketones are dangerous. We know they affect the brain, the kidneys, the liver. They're not a good thing to have in high quantities."

And while ketones do create some appetite suppression, they can also result in headaches, dehydration, bad breath and nausea. Worse, health care professionals fear bone loss, muscle breakdown and kidney disease as a result of induced ketosis for long periods of time.

"People on very low-carb diets are in a constant state of ketosis," Kucera said. "This is where some goofy things can come into play. And researchers are still trying to sort it all out."

An additional worry is the encouraged use of fats -- both saturated and unsaturated -- from promoters of the Atkins diet. In fact, a lawsuit was filed in May on behalf of Florida businessman Jody Gorran, who claimed the Atkins lifestyle nearly cost him his life.

"We're seeing people who are interpreting the diet in their own way," said Jessica Palombine, registered dietitian at Allegheny General Hospital, part of West Penn Allegheny Health System, in Pittsburgh. "And the mentality is, 'OK, if I cut these carbs, I can eat any kind of protein source I want.' Well, not all of those protein sources are the healthiest choices."

An unfortunate misconception, said Dr. Stuart Trager, medical director for Atkins Nutritionals, Inc., based in New York, "People have routinely focused on that two-week induction period," said Trager. "Clearly, this was never about just eating red meat, bacon and eggs."

Trager blames three "major groups" for fueling many of the misconceptions: low-fat advocates, animal rights activists, and "copycats" such as South Beach.

"Yes, you start out restricting carbohydrates very significantly, but then you add back the right carbohydrates," he said. "And this has always been about getting a balance of protein."

Two randomized trials, published in the May 18 issue of Annals of Internal Medicine, lend support to Atkins' efforts. The trials, each comparing low-carb diets with low-fat diets, found low-carb dieters not only lost weight but had improved triglyceride levels as well as slightly improved High-Density Lipoprotein, or HDL ("good") cholesterol levels.

One yearlong trial took place at the Veterans Affairs Medical Center, in Philadelphia, where researchers followed two groups of 132 obese adults, 83 percent of whom had diabetes or risk factors for heart disease. One group restricted carbohydrate intake to less than 30 grams per day; the other restricted caloric intake by 500 calories, with 30 percent of calories from fat .

At the six-month mark, the low-carb group had lost more weight than the low-fat group. By the 12-month point, triglyceride levels in the low-carb group decreased more and the HDL levels decreased less than they did in the low-fat group. However, both groups lost about the same amount of weight after one year. Changes in Low Density Lipoprotein, or LDL ("bad") cholesterol levels were not significant for either group.

Frederick F. Samaha, one of the authors, was encouraged by the cholesterol readings. "One might have expected total cholesterol to increase as a response to a higher fat intake," he said. "That was certainly what I expected."

But is adding more fat to the American diet a smart thing do to? "It would be counterintuitive for me to say a high-fat diet is going to lower your risk of a heart attack," Samaha said. "Odds are, it's going to increase it."

"In the right people, low-carb is a great way for those who have had no success with anything else to lose weight," added Kucera. "But it really makes me nervous in people over 40 because of heart disease."

Low Carb Sugar Free Hazelnut Cherry Tart
Makes approximately 6 servings

Ingredients Pastry Crust:
1/2 cup - (100 g) soy flour
1/8 tsp - (0.5 ml) salt
2 oz - (60 g) ground roast hazelnuts
2 Tbsp - (30 ml) Steviva Blend or equivalent
2 oz - (50 g) butter
1 egg yolk
2 tsp - (10 ml) water

Ingredients Filling:
4 egg yolks
1/4 cup (50 g) Steviva Blend or equivalent
1 tsp - (5 ml) vanilla extract
1 3/4 cups - (450 ml) cream
3 tsp - (15 ml) gelatine
2 Tbsp - (30 ml) water

Ingredients Topping:
2 lb - (1 kg) no sugar added canned or fresh cherries (lowest glycemic effect) or berries of choice for variety
2 tsp - (10 ml) gelatine
2 tsp - (10 ml) rum

Directions Pastry:
1. Sift soy flour and add all dry ingredients together, with the Steviva Blend or equivalent in the centre, on a pastry board.
2. Add the butter (softened), egg yolk, and water. Work the liquids into the Steviva Blend or equivalent, until it is creamy.
3. Now work in the soy flour mixture, as you would for any sweet pastry.
4. Press the dough into a greased 9 in (22-cm) flan tin. Prick the base of the pastry all over.
5. Refrigerate for 30 mins, then cook in a moderate oven (375F or (190C for 15 to 20 mins (until golden brown)

Directions Filling:
1. Put egg yolks, Steviva Blend or equivalent and vanilla into a bowl and beat until thick and creamy.
2. Heat cream carefully until almost boiling.
3. Combine the two mixtures, beating until smooth, then add the result to the top of a double boiler and simmer until it thickens (STIR CONSTANTLY).
4. Dissolve the gelatine in the water, and add to the cream mixture, stirring well until it is well mixed.
5. Allow this mixture to cool completely before adding to the pastry case. Refrigerate until it sets.

Directions Topping:
1. Soak the cherries in Steviva Blend or equivalent for 20 minutes. Drain and and reserve 1 cup (250 ml) of the syrup.
2. Arrange the pitted cherries artistically over the top of the tart.
3. Put the reserved syrup, gelatine and rum (we usually use cherry brandy or kirsch) into a saucepan and heat (stirring) until gelatine dissolves.
4. Cool the liquid and pour over the cherries. Refrigerate until set.

Don't be put off by the complexity of the recipe -- it is well worth the effort.

Carbohydrates per Serving : 5.02 - Carbohydrates per Serving minus Fiber: 3.92

For More Low Carb and Sugar Free Recipes Go To Steviva Recipes!

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