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Csiro Total Wellbeing Diet

Definition

The CSIRO total wellbeing diet (TWD) is a high-protein, low-fat, moderate-carbohydrate weight-loss and maintenance diet developed by Australia’s national science agency, the Commonwealth Scientific and Industrial Research Organization (CSIRO). It is a very structured, calorie-controlled, and nutritionally balanced diet that includes exercise and large amounts of protein from meat, fish, and poultry.

Origins

The TWD was developed by CSIRO researchers at its Clinical Research Unit in Adelaide, South Australia. The CSIRO research was initiated in response to a large number of inquiries from dieticians concerning popular high-protein diets, whose use did not appear to be supported by scientific evidence. Previous CSIRO research had suggested that high-protein low-fat diets were at least as effective for weight loss as high-carbohydrate low-fat diets.

In research partially funded by Meat and Livestock Australia and Dairy Australia, the CSIRO team, led by Dr. Manny Noakes, developed the TWD for overweight and obese women. Dr. Grant Brinkworth was the exercise/nutrition physiologist on the team. The TWD was the culmination of eight years of research on diet composition, weight loss, and risks for developing diabetes and heart disease, conducted at CSIRO’s Human Nutrition Clinic. In initial clinical studies the researchers claimed to have found clear health benefits and significant weight loss associated with their high-protein low-fat diet. They further claimed that clinical studies showed the diet to be superior to a high-carbohydrate low-fat diet with identical caloric intake, at least in a subset of women.

Meat and Livestock Australia distributed a booklet about the CSIRO diet in a women’s magazine. The publisher Penguin then commissioned Noakes and Dr. Peter Clifton, director of the CSIRO Nutrition Clinic, to write the book, The CSIRO Total Wellbeing DietIt was a runaway bestseller in Australia upon its publication in 2005. A sequel appeared in 2006.

Description

Key components of the TWD

The key components of the TWD are:

  • high amounts of protein from lean meat, fish, and low-fat dairy products
  • moderate amounts of carbohydrates
  • low fat
  • adequate fiber from whole grains, fruits, and vegetables
  • caloric restriction
  • exercise

With the exception of its emphasis on meat, the TWD recommendations follow standard nutritional guidelines. The diet offers a variety of healthy food choices, including large amounts of fruits and vegetables, along with moderate exercise.

The basic daily TWD consists of:

  • lean dinner protein, 7 oz (200 g) raw weight of lean red meat (beef, lamb, veal) four times per week, fish twice per week, chicken once per week
  • lean lunch protein, up to 4 oz (110 g)
  • wholegrain bread, two 1-oz (28-g) slices
  • fruit, two medium pieces
  • high-fiber cereal, 1.5 oz (42 g) or about one cup
  • low-fat dairy, threde servings
  • salad, one-half cup
  • vegetables, four one-half-cup servings
  • oil or margarine, three teaspoons
  • indulgence foods, two servings per week
  • exercise, 30 minutes daily

Levels

The TWD has four different diet levels, which are designed to cover the varying energy requirements of the majority of people. Level 1 is approximately 1,337 calories (5,600 kilojoules) per day. Levels 3 and 4 have higher allowances of lean protein, low-fat dairy, and high-fiber cereal. Before choosing a level, CSIRO recommends that people calculate their basal metabolic rate (BMR), which is based on height, weight, age, and gender. The Harris-Benedict Equation then uses the BMR and a factor based on a person’s activity level to

KEY TERMS

Basal metabolic rate—BMR; the rate of energy consumption when at complete rest.

Calorie—The heat- or energy-producing value of food when it is oxidized in the body; the amount of food having an energy-producing value of one calorie. Also called a large calorie or kilocalorie; equivalent to 4.2 kilojoules.

Carbohydrates—Sugars, starches, and celluloses produced by plants and ingested by animals.

Cholesterol—A steroid alcohol in animal cells and body fluids that controls the fluidity of membranes and functions as a metabolic precursor.

Fiber—Roughage; a complex mixture found in plant foods that includes the carbohydrates cellulose, hemicel-lulose, gum, mucilages, and pectins, as well as lignin.

Glycemic index—GI; a measure of the rate at which an ingested carbohydrate raises the glucose level in the blood.

Glycemic load—GL; a measure of the GI of a given food.

HDL cholesterol—High-density lipoprotein containing cholesterol in a healthy form.

Kilojoule—1,000 joules; a unit equivalent to 0.239 calories.

LDL cholesterol—Low-density lipoprotein containing a high proportion of cholesterol that is associated with the development of arteriosclerosis.

Metabolic rate—The BMR adjusted by an activity factor with the Harris-Benedict Formula to determine total daily energy expenditure in calories or kilojoules.

Omega-3 fatty acids—A type of polyunsaturated fat that may be beneficial for the heart.

Syndrome X—Metabolic syndrome; a metabolic condition characterized by excess abdominal fat, high blood pressure, low HDL cholesterol, high fasting blood-glucose levels, and high blood triglycerides, that may affect at least one in four women and increase their risk of developing type 2 diabetes and heart disease.

Triglycerides—Neutral fats; lipids formed from glyc-erol and fatty acids that circulate in the blood as lipoproteins.

determine daily energy expenditure in calories or kilojoules.

In general the level 1 and 2 plans are suitable for women and the level 3 and 4 plans are suitable for men, who tend to be taller and heavier than women. A basic daily TWD for men consists of:

  • 7-9 oz (200-250 g) raw weight of lean meat, chicken, or fish for dinner
  • 4 oz (110 g) cooked weight of meat, ham, chicken, or tuna for lunch
  • wholegrain bread, two slices
  • fruit, two pieces
  • high-fiber cereal, 1.5 oz (40-50 g)
  • low-fat dairy, three servings
  • vegetables, two cups
  • margarine/oil, four teaspoons
  • one optional glass of wine.

Protein

The TWD calls for a high amount of lean protein to prevent hunger. For dinner the TWD recommends 28 oz (800 g) raw weight of red meat per week or an average of 4 oz (110 g) per day, as well as at least 14 oz (400 g) offish per week, or 2 oz (56 g) per day, and 7 oz (200 g) per week of skinless chicken with the fat removed. The diet calls for another 3.5 oz (100 g) of protein for lunch, based on the cooked weight of processed meat, chicken, or tuna.

An extra serving of dairy can be substituted for 1.7 oz (50 g) of protein at lunch. One dairy serving is:

  • a low-fat or diet yoghurt
  • a dairy dessert, 7 oz (200 g)
  • low-fat milk, 8.5 oz (250 ml)
  • cheddar or other full-fat cheese, 1 oz (28 g)
  • reduced-fat cheese (10% fat), 1.7 oz (50 g).

Carbohydrates

Fruits are limited to 11 oz (300 g) per day, as two servings of unsweetened fresh or canned fruit (5.3 oz, 150 g) or unsweetened juice (5 oz, 150 ml). Equal amounts of dried or frozen fruit, vegetables, or unsweetened vegetable juice (5 oz, 150 ml) may be substituted for one serving of a fruit or vegetable.

Simple sugars and refined carbohydrates are not recommended. Sugar or honey as sweeteners can be used only in small amounts. Small amounts of sweeteners or thickeners can be used occasionally in cooking. One level teaspoon of sugar is equivalent to 10-14 calories (40-60 kilojoules).

Fats

The TWD contains very small amounts of fatty foods and oils. It calls for less than 30% of calories from fat or about 50 g of fat per day. The TWD assumes that low-fat foods contain no more than 3 g of fat per 3.5 oz (100 g) of solid food or 1.5 g of fat per 3.5 oz (100 g) of liquid. Fat-free foods contain no more than 0.15 g of fat per 3.5 oz (100 g). Reduced/low-fat milk contains 1-2% fat and skim/nonfat milk contains less than 0.16% fat.

The TWD recommends that the daily fat allowance be consumed as:

  • canola oil
  • olive oil
  • sunflower oil
  • soft/light margarine
  • avocados
  • nuts and seeds. Two teaspoons of lite margarine is equal to one teaspoon of oil. Three teaspoons of oil is equivalent to 2 oz (56 g) of avocado or 0.7 oz (20 g) of nuts

Snacks

Allowable snacks include:

  • leftover portions from main meals
  • low-calorie soup
  • a cappuccino or cafe latte with skim milk from the milk allowance
  • low-fat yogurt or custard
  • fresh fruit from the fruit allowance

Alcohol

The level 1 TWD allows for two glasses (10 oz, 300 ml) of wine or about 205 calories (860 kilojoules) per week. Equivalent amounts of other alcohol or treats, such as 1.5 oz (40 g) of chocolate, may be substituted. It is suggested that alcohol consumption be kept to a minimum during the first few weeks of the diet because alcohol can increase the appetite. Presuming that other medical conditions do not limit the acceptable alcohol intake, other TWD levels and the maintenance diet allow for increased amounts. However alcohol intake should not exceed the recommended two standard drinks per day for women and four for men.

“Free’ food

The TWD includes a “free’ food list with minimal calories. Diet or low-calorie soups are an optional daily extra. Packet soups containing about 38 calories (160 kilojoules) per serving or vegetable soups made from the “free’ list are appropriate daily. The TWD includes an average of two-two and one-half cups of vegetables or about 14 oz (400 g) per day. Since vegetables tend to be very low in calories, eating more vegetables is acceptable and many vegetables are included in the “free’ list.

Foods that can be consumed as desired include:

  • all green, orange, yellow, red, and most white vegetables, except potatoes and sweet potatoes
  • diet soft drinks, unflavored bottled water, teas, coffee, cocoa
  • stock cubes and clear soups
  • diet jellies
  • oil-free salad dressing
  • sauces such as tomato, chili, and soy
  • condiments
  • garlic
  • lemons
  • herbs and spices

Substitutions and adjustments

Allowable diet adjustments include swapping the mid-day and evening meals or distributing the diet components differently over the course of the day. However the quantities and total intake should be the same each day. Other lean protein food can be substituted for meat. For example, a dinner might include 3.5 oz (100 g) of meat, chicken, or fish and a vegetable protein such as 4.5 oz (130 g) of cooked beans or 3.5 oz (100 g) of tofu. Eggs are protein foods and one egg can be substituted for 1.7 oz (50 g) of lean meat, chicken, turkey, ham, pork, fish, or low-fat cheese. Soy-milk products or low-lactose milk products may be used for the dairy requirement.

Allowable substitutions within food groups include:

  • eggs for other protein
  • non-dairy products for dairy
  • rice or beans for bread
  • toast for cereal
  • frozen, canned, or dried fruit or vegetables for fresh fruit
  • milk or yogurt for other dairy
  • fruit juice for fruit
  • vegetable juice for vegetables
  • avocados or nuts for fats and oils
  • other drinks or snacks for wine.

Wholegrain bread should be high in fiber, containing at least 3 g per serving. Wholegrain means that all of the components of the grain—the bran, germ, and endosperm—are present. One of the two daily slices of bread may be replaced with:

  • one-third-one-half cup of chickpeas, lentils, or beans
  • two pieces of crispbread
  • one medium potato (about 5.3 oz or 150 g)
  • one-third cup of cooked rice or noodles
  • one-half cup of cooked pasta.

A low-fat coffee drink may be substituted for a similar drink such as tea with low-fat milk. Cocoa and herbal tea are on the “free” list.

Vegetarians

Vegetarians can substitute cooked beans or lentils (9 oz, 260 g) or tofu (7 oz, 200 g) for meat, chicken, or fish (7 oz, 200 g). One egg can be substituted for 1.7 oz (50 g) of meat, ham, pork, chicken, turkey, fish, or low-fat cheese. Legumes, including beans, split peas, lentils, and chickpeas, or tofu or other soy products can also be substituted for red meat. Vegetarians can substitute two eggs or 3.5 oz (100 g) of low-fat cheese for the 3.5 oz (100 g) of the lunch protein requirement.

Eating out

When choosing from a restaurant menu the TWD recommends foods that are:

  • grilled
  • steamed
  • poached
  • stir-fried

Foods to be avoided include:

  • deep-fried
  • pan-fried
  • battered
  • crumbed
  • sauces with cheese, oil, butter, or cream
  • fried potatoes.

Maintenance diet.

The weekly menu plans are repeated until the desired weight loss is achieved and then a maintenance plan is implemented. The maintenance plan is the same as the weekly diet plan with the addition of about 120 calories (500 kilojoules) to the diet, as long as weight is not regained. Each week the following foods can be added back in any order:

  • week 1: two slices of wholegrain bread daily
  • week 2: one-half cup cooked rice or pasta
  • week 3: extra milk such as low-fat milk, yogurt, ice cream
  • week 4: an extra potato
  • week 5: an extra snack food
  • week 6: one extra restaurant meal.

Snack choices for the maintenance diet include:

  • 0.7 oz (20 g) of nuts
  • two plain sweet biscuits
  • one-two wholegrain biscuits or crackers and low-fat cheese
  • 2 oz (56 g) of chips in canola or olive oil
  • part of an avocado
  • one fruit bar.

On the maintenance diet the following foods may be exchanged:

  • 8 oz (250 ml) of wine or 2 fl oz (60 ml) of other alcohol for one snack
  • one medium potato with skin, 2 oz (56 g) of fries, or 0.7 oz (20 g) of pretzels for one slice of bread or one piece of fruit
  • three-quarter cup of boiled pasta or rice for two slices of bread
  • 2 oz (56 g) or ten small squares of chocolate for one snack
  • one fruit bar for one piece of fruit.

The books

The CSIRO Total Wellbeing Dietexplains and details the diet and contains over 100 recipes. Book 2includes some revisions and additions:

  • The caloric intake is slightly higher.
  • Calcium intake is increased by an extra daily serving of dairy.
  • Eighty new recipes and substitutions have been added.
  • Twelve weeks of sample menu plans give examples of how to organize the diet.
  • New tips on eating out and packing a lunch are included.
  • A simple, structured, do-anywhere exercise plan has been added.
  • There is a section on maintaining focus on the diet.

Function

The TWD is designed to result in a weight loss of 1-2 lbs (0.5-1 kg) per week. The subsequent maintenance diet is designed to maintain the desired weight. The higher protein in the TWD helps control appetite and prevent muscle loss. The TWD can be used to feed an entire family, although family members who do not need to lose weight may eat more carbohydrates with their meals, such as extra bread, pasta, rice, or potatoes.

Benefits

Because the TWD diet is high in protein, it tends to satisfy hunger and prevent overeating. Men, in particular, seem to appreciate the amount of meat in this diet. It provides nutrients such as iron, zinc, and calcium that may be minimal on a lower-protein diet. There are additional benefits from a high-protein meat diet:

  • Lean red meat is the best source of well-absorbed iron and meat is rich in zinc.
  • Iron and zinc, which help boost the immune system, are more easily absorbed from meat than from plant foods.
  • Meat, poultry, fish, and eggs are excellent sources of vitamin B12, which is not found in plants.
  • Fish and seafood are the best sources of omega-3 fats, which help protect the heart. Beef and lamb are the next best sources.

The TWD can significantly reduce triglycerides and LDL (“bad”) cholesterol. Sustained weight loss, exercise, and moderate alcohol intake can increase HDL (“good”) cholesterol. Therefore CSIRO researchers believe that the high protein in the TWD may help prevent heart disease and type 2 diabetes. Some experts also consider the TWD superior to other diets because it calls for a fiber intake in excess of 28 g per day.

The TWD has other advantages:

  • It includes a large variety of foods.
  • It is a very flexible diet and allows many substitutions.
  • Daily meals can be consumed in any order.
  • Tested recipes and menus are available online.
  • Shopping lists can be downloaded from the CSIRO Website.
  • The TWD is designed for long-term maintenance.

Precautions

Dr. Rosemary Stanton, a leading Australian nutritionist, has pointed out that the high amount of red meat in the TWD contradicts the Australian government”s own recommendations. Whereas the Australian Guide to Healthy Eatingrecommends 2-4 oz (56-112 g) of lean red meat three-four times per week, the TWD prescribes more than twice that amount. Consumers may be confused by these descrepancies. In addition, the trade organization Meat and Livestock Australia provided CSIRO with research funds and heavily promoted the book, suggesting possible conflicts of interest. Vegetarians in particular may have a difficult time following the TWD.

The TWD was based on clinical studies of overweight women, some of whom had metabolic dysfunction. Therefore the advantages of the TWD for men and healthy women are unclear.

CSIRO claims that the TWD is suitable for pregnant and breastfeeding women. However breastfeeding women may need up to 700 extra calories (3,000 extra kilojoules) per day. CSIRO recommends that breastfeeding women should start with level 1 or 2 and include three servings of dairy for calcium. Additional bread and fruit can be added to satiate hunger and increase energy. Furthermore, because of the large amount of fish and seafood in the diet, pregnant women should check for the types of fish that are safe to eat during pregnancy.

The TWD is suitable for overweight children, as long as it includes three units of dairy. However a dietician should adjust the number of calories for the age, size, and activity level of the child.

CSIRO claims that the TWD can be used effectively by people with diabetes, celiac disease (gluten intolerance), fructose intolerance, and irritable bowel syndrome. However diabetics should consult their doctor or dietician before using the TWD. People with gluten intolerance should choose gluten- or wheat-free substitutes or substitute rice, beans, chickpeas, or lentils for bread. Those with irritable bowel syndrome may substitute a lower-fiber cereal and take

QUESTIONS TO ASK YOUR DOCTOR

  • Am I a person who would be expected to lose weight and maintain my health and weight loss on the TWD?
  • Do I have symptoms of “syndrome X”?
  • Should I be eating such a large amount of protein?
  • Should I be eating such a large amount of meat?
  • Have you had other patients try the TWD?
  • Are there other types of diets that I should consider?

psyllium supplements of 30 g per day to obtain adequate fiber. CSIRO recommends that a dietician be consulted if significant adjustments to the diet are required.

The TWD was designed for foods readily available to Australians and assumes the intake of significant amounts of processed foods. It is not suitable for societies and cultures with eating habits that are very different from those of Australians. A high-carbohydrate diet may be better suited to those who prefer to not eat large amounts of protein.

Risks

Although many people find it relatively easy to lose weight on high-protein low-carbohydrate diets during the first few weeks, some people find it difficult to maintain a diet that is high in meat. In addition some dieters find it difficult to maintain low-carbohydrate diets.

Nutritionist Patrick Holford has argued in the prestigious scientific journal Nature that the abnormally high amount of meat in the TWD could lead to long-term health problems, such as breast or prostatecancer, kidney stress, or reduced bone mass. Although some research has suggested that diets high in meat can increase the risk of colon cancer, other research has contradicted this or suggested that the risk is associated only with high-fat processed meat, which is not a part of the TWD.

Research

The TWD is based on research conducted by physicians at CSIRO, a highly-respected organization.

Earlier research had indicated that high-protein diets were at least as good, if not better, for women than high-carbohydrate diets, in terms of weight loss and muscle preservation. As of 2007 CSIRO had completed five studies on the TWD, one funded by Meat and Livestock Australia and one by the dairy industry. The other studies were funded by CSIRO. According to CSIRO, their research proves that the TWD:

  • is safe
  • leads to improved nutritional status
  • results in weight loss
  • lessens the risk factors for diabetes and heart disease

In the initial CSIRO study, 100 overweight and obese women were divided into two groups. One group was placed on a high-protein low-fat diet and the other group on a high-carbohydrate low-fat diet for 12 weeks. The high-protein diet consisted of 34% protein, 20% fat, and 46% carbohydrate. The high-carbohydrate diet consisted of 17% protein, 20% fat, and 63% carbohydrate. The caloric content of each diet was the same. The researchers monitored weight loss, changes in body composition, vitamin-B12 status, bone-turnover markers, and disease-risk factors including LDL cholesterol and triglycerides.

Although on average the women in each group lost the same amount of weight—18-20 lb (8-9 kg)— women with high triglyceride levels lost significantly more weight on the high-protein diet. Only women with high triglycerides lost more abdominal fat than the women on the high-carbohydrate diet. The two groups of women did not differ in the other benchmarks that were examined. The researchers did find that more women dropped off the high-carbohydrate diet and that the women appeared to prefer the high-protein diet.

In subsequent studies CSIRO found that women with symptoms of “syndrome X,” also called metabolic syndrome, a condition that increases the risk of developing heart disease and type 2 diabetes, lost more weight and twice the amount of body fat on a high-protein low-fat diet, as compared with similar women on a high-carbohydrate low-fat diet. It was pointed out in Naturethat the TWD proved superior to the high-carbohydrate diet only for the subpopulation of overweight women with this type of metabolic dysfunction.

General acceptance

The CSIRO Total Wellbeing Diet became the number-one bestselling book in Australia when it appeared in 2005. Over 600,000 copies were sold in the first year, making it the fastest-selling book ever in that country. Since the diet is based on research from Australia”s leading scientific agency and the books were written by internationally known scientists, many consumers have taken its advice very seriously. The scientific team that performed the research was awarded the 2005 CSIRO Research Achievement Medal. However the popularity of the diet has been primarily limited to Australia, in part because Australians tend to eat higher amounts of protein, particularly meat.

Many people object to the amount of meat in the TWD, from a health standpoint, from a cost standpoint, and because of the environmental consequences of producing large quantities of meat.

BOOKS

Noakes, Manny and Peter Clifton. The CSIRO Total Well-being Diet. New York: New American Library, 2005.

Noakes, Manny and Peter Clifton. The CSIRO Total Well-being Diet Book 2. Camberwell, Australia: Penguin and CSIRO, 2006.

PERIODICALS

“CSIRO Diet Referred to PM.” The Age (January 8, 2006). Available online: <http://www.theage.com.au/news/national/csiro-diet-referred-to-pm/2006/01/08/1136655079825.html> Compares the CSIRO diet with the Australian government”s recommendations.

Dennis, Carina. “Diet Book Attacked For Its High-Protein Advice.” Nature 438 (December 29, 2005): 1060-1061.

Minett, Dean. “Return to Basics.” Hospitality (September 1, 2005): 52. Testimonial for the TWD.

Noakes, M., J. B. Keogh, P. R. Foster, and P. M. Clifton. “Effect of an Energy-Restricted, High-Protein, Low-Fat Diet Relative to a Conventional High-Carbohydrate, Low-Fat Diet on Weight Loss, Body Composition, Nutritional Status, and Markers of Cardiovascular Health in Obese Women.” American Journal of Clinical Nutrition 81 (June 2005): 1253-1254. Available online: <http://www.ajcn.org/cgi/content/full/81/6/1298>

The major study on which the TWD was based.

Papadakis, Mary. “Diet Health Fears.” Herald Sun (January 8, 2006). Available online: <http://www.vnv.org.au/Articles/CSIRODiet.htmndashDiet%20health%20fears>

Scrinis, Gyorgy and Rosemary Stanton. “CSIRO”s Total Wellbeing Diet: A Diet Thin on Science.’ The Age (August 29, 2005). Available online: <http://www.theage.com.au/news/opinion/a-diet-thin-on-science/2005/08/28/1125167551089.html>

Stanton, Rosemary, Gyorgy Scrinis, and Stephen Luntz. “Total Wellbeing or TOO MUCH MEAT?/CSIRO Responds.” Australasian Science 26 (October 2005): 37–38.

OTHER

Costain, Lyndel. “The CSIRO Total Wellbeing Diet Under the Spotlight.” Weight Loss Resources, March 16, 2007. <http://www.weightlossresources.co.uk/diet/csiro_total_wellbeing_diet.htm> (March 23, 2007). Review of the TWD.

CSIRO. The Total Wellbeing Diet, August 2003. <http://www.csiro.au/proprietaryDocuments/MLA_diet.pdf> (March 23, 2007). Booklet describing the TWD.

CSIRO Human Nutrition. High Protein Low Carbohydrate Diets: Targeting Who Benefits, October 12, 2004. <http://www.csiro.au/resources/pfkm.html> (March 23, 2007). A 33-slide downloadable Powerpoint presentation on the science behind the TWD.

ORGANIZATIONS

Commonwealth Scientific and Industrial Research Organization (CSIRO). CSIRO Human Nutrition. P.O. Box 10041, Adelaide BC SA 5000, Australia. (61) 8-8305-0607. <http://www.csiro.au/twd>

Dieticians Association of Australia. 1/8 Phipps Close, DEAKON ACT 2600, Australia. (02) 6282-9555. <http://www.daa.asn.au>

The Institute for Optimum Nutrition. Avalon House, 72 Lower Mortlake Road, Richmond, Surrey, England TW9 2JY. (020) 8614-7817. <http://www.ion.ac.uk>

Weight Loss Resources, Ltd. Remus House, Woodston, Peterborough, England, PE2 9JX. 01733 345592, <http://www.weightlossresources.co.uk>

Margaret Alic, PhD


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