Original Paper

Ann Nutr Metab 1999;43:69–79 Received: April 17, 1998

Accepted: January 15, 1999

Consequences of a Long-Term Raw Food

Diet on Body Weight and Menstruation:
Results of a Questionnaire Survey

C. Koebnick C. Strassner I. Hoffmann C. Leitzmann

Institute of Nutritional Science Justus Liebig University of Giessen, Germany

Key Words 12 kg (SE 0.6) for women was observed. Body

Raw food diet W Nutritional deficiency W Body mass index (BMI) was below the normal
mass index W Weight loss W Underweight W weight range (! 18.5 kg/m2) in 14.7% of male
Chronic energy deficiency W Amenorrhea and 25.0% of female subjects and was nega-
tively related to the amount of raw food con-
sumed and the duration of the raw food diet.
Abstract About 30% of the women under 45 years of
Objective: To examine the relationship be- age had partial to complete amenorrhea; sub-
tween the strictness of long-term raw food jects eating high amounts of raw food
diets and body weight loss, underweight and (1 90%) were affected more frequently than
amenorrhea. Methods: In a cross-sectional moderate raw food dieters. Conclusions: The
study 216 men and 297 women consuming consumption of a raw food diet is associated
long-term raw food diets (3.7 years; SE 0.25) with a high loss of body weight. Since many
of different intensities completed a specially raw food dieters exhibited underweight and
developed questionnaire. Participants were amenorrhea, a very strict raw food diet can-
divided into 5 groups according to the not be recommended on a long-term basis.
amount of raw food in their diet (70–79, 80–
89, 90–94, 95–99 and 100%). A multiple linear
regression model (n = 513) was used to eval-
uate the relationship between body weight Introduction
and the amount of raw food consumed. Odds
of underweight were determined by a multi- Raw food diets are mainly vegetarian diet
nomial logit model. Results: From the begin- forms based on the experience of physicians
ning of the dietary regimen an average who were highly engaged in healthful nutrition,
weight loss of 9.9 kg (SE 0.4) for men and such as Bircher-Benner, Waerland and Shel-

© 1999 S. Karger AG, Basel Dr. Corinna Koebnick

ABC 0250–6807/99/0432–0069$17.50/0 Institute of Nutritional Science, Justus Liebig University of Giessen
Fax + 41 61 306 12 34 Wilhelmstrasse 20, D–35392 Giessen (Germany)
E-Mail [email protected] Accessible online at: Tel. +49 641 99 39051, Fax +49 641 99 39049
www.karger.com http://BioMedNet.com/karger E-Mail [email protected]
129.186.138.35 - 1/12/2019 6:35:51 PM
Iowa State University
Downloaded by:
Table 1. Definition of raw food diets health, to prevent illness and to live in a natu-
ral and healthy way for a long time [8, 9].
Raw food diets consist predominantly or exclusively of
Some medical reports suggest a raw food diet
unheated foods, mainly of plant origin (partly also
of animal origin). as therapy for diseases such as allergies, hy-
Some foods are included that require a certain degree pertension and overweight [1, 10–12]. Raw
of heating for their production (e.g. cold-pressed food diets are mostly considered to be a long-
honey and cold-pressed oils) as well as foods that term form of nutrition. However, the Dia-
require a certain amount of heat during their pro-
monds suggest that their raw food diet can
cessing (e.g. dried fruits, dried meat and fish, cer-
tain nuts). additionally decrease body weight [2–5, 8].
Furthermore, cold-smoked produce (e.g. meat and Almost all persons experience drastic
fish) as well as pickled or fermented vegetables can changes in body weight after starting to con-
be included in the raw food diet [20, 36]. sume a raw food diet. The weight loss can be
substantial and often leads to a very low body
weight [8, 9, 13]. Underweight and nutritional
deficiencies in females are related to amenor-
ton, whose writings constitute the origins of the rhea, low bone density and osteoporosis [14–
main raw food diet streams. Today raw food 18]. The aim of the reported study was to
diets are influenced mainly by the Diamonds examine the association between the strict-
and are quite varied forms of nutrition, con- ness of a raw food diet and body weight loss,
sisting mostly of natural foods prepared in underweight and amenorrhea.
unheated, non-mixed meals [1–6]. Staple foods
like meat, dairy products, cereals and cereal Methods
products are largely avoided. Therefore, fruits
and vegetables make up a high percentage of Subjects
the food consumed and have to meet body Following announcements in several German
health magazines (October 1992 to January 1993),
energy needs. A study of the literature shows
1,328 persons classifying themselves as raw food diet-
that raw food diets are subdivided into vegetar- ers were assessed using a short questionnaire sent by
ian and non-vegetarian forms. mail. Of those, 865 persons estimated the amount of
One of the extreme forms of raw food diets raw food in their diet to be more than 70%. This
is instinctotherapy. Its founder, Guy-Claude amount corresponds to the minimum amount of raw
food recommended by several authors [6]. A specially
Burger [3], recommends eating a.o. non-
developed questionnaire was sent to these selected per-
heated meat. A few other authors suggest the sons, of whom 88% responded. Individuals practising
consumption of only small amounts of cooked a raw food diet for ! 4 months or being ! 16 years of
meat. Because of the large amounts of fruits, age or not living in Germany, and who had partici-
the raw food diet according to Wandmaker [5] pated in the pre-test of the questionnaire were ex-
cluded from the study. After this selection 572 persons
is viewed as unbalanced and is therefore not
remained in the study. Complete data sets were evalu-
recommended by the German Nutrition Soci- ated of 513 persons (216 men and 297 women).
ety [7]. The definition of raw food diets ac- For statistical analyses, participants were divided
cording to the Giessen Raw Food Working into 5 groups according to the amount of raw food in
Group is an attempt to develop a basis for their diet. The cutoff points were 70, 80, 90, 95, and
100% of raw food. The diet groups were classified as
comparison of data reported in the literature
meat eaters (n = 253), vegetarians (n = 184) and vegans
(table 1). (n = 135). Vegetarians omit meat and fish, and vegans
The main reasons for practising a raw food additionally avoid dairy products and eggs from their
diet as stated by its followers are to attain diet.

70 Ann Nutr Metab 1999;43:69–79 Koebnick/Strassner/Hoffmann/

Leitzmann
129.186.138.35 - 1/12/2019 6:35:51 PM
Iowa State University
Downloaded by:
Table 2. Determinants of BMI:
multiple linear regression Independent determinants ß Significance
coefficients ordered according
to descending ß (p ! 0.0001, BMI before a raw food diet 0.723 0.000
adjusted R2 = 0.572) Amount of raw food consumed, % –0.144 0.000
Duration of raw food diet 0.075 0.016
Vegan diet group –0.068 0.030
Gender 0.053 0.080
Age –0.019 0.566
Total food intake, g 0.006 0.834

Instruments BMI classification according to Ferro-Luzzi et al. [15]

A short questionnaire was developed as a selection was employed (table 2). A multiple linear regression
instrument. It contained a limited number of questions model for BMI as a dependent factor considers age,
concerning the amount of raw food consumed and the gender, BMI before starting a raw food diet, duration
duration of the raw food diet. To control the validity of of the raw food diet, diet group and total food intake.
the self-estimated amounts of raw food consumed, the Odds ratios of underweight were computed by a multi-
results were compared to the computed amounts of a nomial logit model considering gender and amount of
food frequency questionnaire (FFQ) described below. raw food consumed. Therefore, participants were di-
There was a high correspondence between the amounts vided into 5 groups eating different amounts of raw
of raw food consumed [8]. food: 70–79, 80–89, 90–94, 95–99 and 100%. In the
The main questionnaire focused on the nutrition regression and the logit models of body weight data
behavior and the health situation of individuals con- only persons with complete data sets were included
suming a raw food diet. Body weight data and weight (n = 513). Calculations on amenorrhea were carried
development were assessed retrospectively. The con- out with data from non-pregnant and non-menopausal
cept was based on discussions with several authors of women ! 45 years of age (n = 145). Odds ratios of
books on raw food diets and interviews of raw food amenorrhea were calculated by a multinomial logit
dieters and their self-help groups. Comprehension of model considering the amount of raw food consumed.
the questionnaire was tested with a random sample of To test the fit the loglinear models were compared to
16 raw food dieters drawn from the selected partici- different models including several factors and several
pants that were then excluded from further participa- divisions of the amount of raw food consumed. Only
tion. Questions which were considered misleading or small differences in parameter estimates were ob-
unclear were not included in the final instrument. served [22].
The amounts of raw food consumed were assessed
by the FFQ developed by Aalderink et al. [19], Hoff-
mann [20] and Hoffmann et al. [21] and employed in
the Giessen Wholesome Nutrition Study. Its validity Results
as an instrument of selection was tested for bias by
Hoffmann [20]. The semiquantitative FFQ consisted General Health Behavior and Diseases
of 80 items modified for special demands of raw food
Most of the raw food dieters investigated
diets. The amount of raw food was calculated by the
raw/cooked weight ratio. in this study consumed high amounts of raw
food (1 90%; fig. 1). The mean percentage of
Statistics raw food eaten was 91 B 0.4%, and the aver-
All statistical calculations were performed with the age duration of a raw food diet was 3.7 B 0.25
statistical software package SPSS 8.0. The results are
years. There were only a few participants who
presented as means with the standard error of mean
(B SE). Mean body mass index (BMI) values (weight smoked (2.1%); the raw food dieters con-
(kg)/height (m)2) were calculated separately for females sumed only small amounts of alcoholic bever-
and males after adjusting for age at recruitment. The ages (beer 13 B 2.6 ml/day; wine 9 B 2.0 ml/

Consequences of a Long-Term Raw Ann Nutr Metab 1999;43:69–79 71

Food Diet on Body Weight and
Menstruation
129.186.138.35 - 1/12/2019 6:35:51 PM
Iowa State University
Downloaded by:
 22.0

21.0

BMI (kg/m2)
20.0

19.0

n= 66 103 248 96
70–79 80–89 90–99 100
Amount of raw food consumed (%)

Fig. 1. Cumulative frequency distribution of amount Fig. 2. Error bars of age-adjusted mean BMI B SE
of raw food consumed in male (n = 230) and female divided into groups according to the amount of raw
(n = 342) raw food dieters. food consumed.

Table 3. Fasting periods of investi- (48.7%) and juice fasting (39.2%) were pre-
gated raw food dieters ferred. The main reason for fasting was purifi-
cation (58%). The fasting periods lasted from
%
1 day to several weeks (table 3).
Regular fasting (n = 282) 49.3 Most of the participants changed to a raw
Fasting period, days food diet for health reasons; other reasons did
1 29.8 not play an important role (!10%). About
2–4 27.7 55% changed to a raw food diet because of
5–7 23.8
8–14 12.4
their own disease, and 17% because of a dis-
Several weeks 6.4 ease of a family member. The most important
disorders were diseases of the gut, allergies,
asthma and rheumatism. About 94% of these
participants believed to be closer to recovery
day; spirits 0.1 B 0.0 ml/day) and most of from their disease since change of diet. Most
them (89%) participated in various kinds of participants (98%) were very content with
physical activities. their raw food diet.
Only a few participants (7%) used mineral
or vitamin supplements, 7.9% consumed al- Body Weight Reduction and Amount of
gae products, and 0.6% of the 342 female par- Raw Food Consumed
ticipants took oral contraceptives. Enemas The age-adjusted mean BMI of male par-
were regularly applied by 16.1% of raw food ticipants was 20.7 B 0.2 kg/m2 and of female
dieters, about 25% of them more than once a participants was 20.1 B 0.1 kg/m2. The BMI
week. About half of the participants (n = 282) range showed a tight distribution (95% CI
fasted at least once a year. Total fasting 20.2–20.6 kg/m2). Most participants (73.8%)

72 Ann Nutr Metab 1999;43:69–79 Koebnick/Strassner/Hoffmann/

Leitzmann
129.186.138.35 - 1/12/2019 6:35:51 PM
Iowa State University
Downloaded by:
 23 s

22
s
s

BMI (kg/m2)
21

20 s

19
Groups according to the amount of
18 raw food consumed (%)
s 70–79 90–99
80–89 100

Fig. 3. Age-adjusted mean BMI be- Before Lowest Highest level after Present
raw food diet level change to raw food diet level
fore and during the consumption of
raw food diets.

Table 4. Classification of BMI and distribution of relative body weight in relation to gender and amount of raw
food consumed (%)

Classification by Ferro-Luzzi [15] BMI Raw food dieters

kg/m2
male female 70–79% 80–89% 90–99% 100%

Severe underweight (CED grade III) !16 0.4 1.5 1.3 0.8 0.8 1.9
Moderate underweight (CED grade II) 16.0–16.9 2.2 4.1 2.5 0.8 3.4 6.8
Mild underweight (CED grade I) 17.0–18.4 12.1 19.3 11.4 11.9 17.8 22.3
Normal weight 18.5–24.9 78.3 69.6 69.6 79.4 73.5 67.0
Overweight 25.0–29.9 6.1 3.8 12.7 4.0 4.2 1.0
Obesity 30.0–39.9 0.0 1.2 2.5 0.8 0.4 0.0
Severe obesity 640.0 0.0 0.0 0.0 0.0 0.0 0.0
Missing data 0.9 0.6 0.0 2.4 0.0 1.0
n 230 342 79 126 264 103

had a normal body weight; 6.3% of the men food diet (fig. 2). Most raw food dieters expe-
and 4.8% of the women were overweight; rienced a dramatic loss of body weight after
1.2% of the women and none of the men were changing to a raw food diet. Body weight sta-
obese. Unexpectedly 14.7% of the men and bilized after some time and settled at a level
25.0% of the women were underweight. Of below the initial weight (fig. 3). The mean loss
these, 2.6% of the men and 5.7% of the wom- of body weight from the time of changing to a
en suffered from chronic energy deficiency raw food diet to the time of evaluation was 9.9
(CED) grade II or III (table 4). Participants B 0.4 kg (95% CI 4–20 kg) for male (n = 216)
eating a strict raw food diet showed a lower and 12 B 0.6 kg (95% CI 3–26 kg) for female
BMI than persons consuming a moderate raw (n = 297) participants. There were substantial

Consequences of a Long-Term Raw Ann Nutr Metab 1999;43:69–79 73

Food Diet on Body Weight and
Menstruation
129.186.138.35 - 1/12/2019 6:35:51 PM
Iowa State University
Downloaded by:
 20.0

BMI (kg/m2)
19.0

18.0

n= 86 14 45
Regular Irregular Amenorrhea
Classification of menstruation occurrence

Fig. 4. Classification of menstruation occurrence in Fig. 5. Error bars of mean BMI B SE in relation to
groups according to the amount of raw food consumed classification of menstruation occurrence (n = 145).
(n = 145).

differences between groups according to the Amenorrhea as a Functional Problem of

amount of raw food consumed and loss of Female Raw Food Dieters
body weight (fig. 3). The mean age of non-pregnant and non-
The multiple linear regression model (p ! menopausal women under 45 years of age was
0.0001, adjusted R2 = 0.572) showed that low 32.9 B 0.63 years. Menstruation was stated as
body weight had a strong linear relation being regular in about 60% of the valid an-
(monotonic decrease) to the amount of raw swers. The intensity of menstruation was esti-
food eaten (table 2). The BMI was negatively mated as strong to very strong by 9.1%, as
affected in the vegan group, but was unaf- medium by 53.3% and as weak to very weak
fected by the total food intake. The relations by 37.7% of the women. Approximately 10%
to gender and duration of raw food diet con- had irregular menstruation and 30% claimed
sumption were statistically significant. Fe- to have no or rare menstruation. About 70%
males showed a lower BMI than males, and of female participants noticed a change in
the BMI increased slowly with the duration of menstruation since changing their diet. Of the
raw food diet consumption. Odds of becom- female raw food dieters of childbearing age,
ing underweight calculated by a multinomial 23% suffered from a total absence of men-
logit model (table 5) were 3 times higher for struation. Female participants were divided
strict raw food dieters (100% raw food) and 2 into 3 groups: periodical (n = 87) , irregular
times higher for rather strict raw food dieters (n = 14), and absence of menstruation (n =
(95–99% raw food) than for moderate raw 44). The groups show statistically significant
food dieters (!80% raw food). By including differences in the amounts of raw food con-
the diet group in the logit model, no statisti- sumed (p = 0.008) and in BMI (p = 0.000) but
cally significant effects were observed. Vegans not in age. Women with partial to total amen-
had no significantly higher odds of under- orrhea ate more raw food and had a lower
weight than vegetarians or meat eaters. BMI than the other women (fig. 4, 5).

74 Ann Nutr Metab 1999;43:69–79 Koebnick/Strassner/Hoffmann/

Leitzmann
129.186.138.35 - 1/12/2019 6:35:51 PM
Iowa State University
Downloaded by:
Table 5. Parameter estimates of the multinomial logit model of becoming underweight, goodness-of-fit statistics
and measures of association (reference group: 70–79% amount of raw food)

Factor Odds Estimate1 SE z value2 Asymptotic 95% CI

ratio1
lower upper

Underweight 0.1 –2.3329 0.3670 –6.36 –3.05 –1.61

Gender female 2.3 0.8481 0.2331 3.64 0.39 1.31
Raw food consumed
100% 3.0 1.0923 0.3872 2.82 0.33 1.85
95–99% 2.0 0.7016 0.3632 1.96 –0.01 1.41
90–94% 1.2 0.1762 0.4413 0.40 –0.69 1.04
80–89% 0.8 –0.1832 0.4114 –0.45 –0.99 0.62

Goodness-of-fit statistics (likelihood ratio) significance = 0.7686.

Measures of association: entropy = 0.0586, concentration = 0.0626.
1 Odds ratio = eestimate.
2 Values statistically significantly different from zero (· = 5%) are given in bold (z value 61.96).

Table 6. Parameter estimates of the multinomial logit model of having amenorrhea, goodness-of-fit statistics and
measures of association (reference group: 70–79% amount of raw food)

Factor Odds Estimate SE z value2 Asymptotic 95% CI

ratio1
lower upper

Amenorrhea 0.2 –1.8718 0.7596 –2.46 –3.36 –0.38

Raw food consumed
100% 7.0 1.9408 0.8456 2.30 0.28 3.60
95–99% 2.6 1.0833 0.8209 1.32 –0.53 2.69
90–94% 2.0 0.7087 0.9162 0.77 –1.09 2.50
80–89% 1.8 0.5988 0.8717 0.69 –1.11 2.31

Goodness-of-fit statistics were not calculated due to model saturation.

Measures of association: entropy = 0.0547, concentration = 0.0680.
1 Odds ratio = eestimate.
2 Values statistically significantly different from zero (· = 5%) are given in bold (z value 61.96).

Odds of having amenorrhea calculated by nificant relationship between odds of amenor-

a multinomial logit model (table 6) were 7 rhea and diet group. There were no higher
times higher for strict raw food dieters (100% odds for vegans than for vegetarians or meat
raw food) than for moderate raw food dieters eaters.
(!80% raw food). Inclusion of the diet group
in the logit model showed no statistically sig-

Consequences of a Long-Term Raw Ann Nutr Metab 1999;43:69–79 75

Food Diet on Body Weight and
Menstruation
129.186.138.35 - 1/12/2019 6:35:51 PM
Iowa State University
Downloaded by:
 Discussion in energy stores and in active body tissues
[27]. Decreasing body weight and concomi-
The consumers of raw food diets view their tant undernutrition result in a greater visceral
eating behavior as part of a wholesome life- mass to muscle mass ratio [28].
style concept, including an overall healthy The BMI reflects body energy stores and is
way of life which means more than just an used as an indicator for CED [29–32] since it
alternative diet. Adherents of raw food diets shows a strong correlation with body fat [27,
usually lead a healthy life, i.e. they are physi- 33]. Most participants of the Giessen Raw
cally active, drink little alcohol and do not Food Study had BMI values within the nor-
smoke. This lifestyle shows a preventative mal range; however, 25% of the females and
effect against diseases related to nutrition and 14.7% of the males were below the normal
lifestyle [23, 24]. At present, little is known range – in some cases a BMI reflecting CED
about the consequences of a raw food diet on was observed. Undernutrition affects only a
long-term health. small group of the average German popula-
Fasting periods and regular enemas are tion – 5.6% of the females and 3.8% of the
often recommended by proponents of raw males, mostly under the age of 34 years, are
food diets as a method of body cleansing [6, 8, underweight [34]. The optimum range of BMI
9, 25]. About half of the participating raw which is compatible with good health is 20.1–
food dieters fasted at least once a year, some 25.0 kg/m2 for males and 18.7–23.8 kg/m2 for
of them for several weeks. It is reported that females [15, 27]. Low body weight is often
very long fasting periods (1100 days) can reported for vegetarians and vegans [35], but
result in morphological changes in the cardiac a BMI reflecting CED is rarely observed in
muscle with ECG changes caused by protein contrast to raw food dieters. The main reason
deficiency [26]. Even though none of the par- for a low BMI for raw food dieters is the con-
ticipants of the Giessen Raw Food Study sumption of a strict raw food diet. Further-
fasted for such a long period of time, fasting more, BMI is correlated with the duration of
for them could have been a risk because of the raw food diet and the vegan regimen.
their low energy stores and low body weight, Appleby et al. [36] observed a negative
particularly in association with their low ener- association between BMI and carbohydrate
gy diet. intake and the intake of dietary fiber in low
Most proponents of raw food diets recom- meat eaters. Raw food dieters eat mainly
mend this dietary regimen as a long-term diet. fruits and vegetables. They mostly omit dairy
Only the Diamonds advocate their raw food products, meat, cereals and cereal products
diet also as a therapy for weight loss [2–5, 8, and therefore, their diet contains high
25]. The results of the Giessen Raw Food amounts of dietary fiber and carbohydrates.
Study show a substantial reduction in body Additionally, an insufficient energy supply in
weight for participants during long-term con- 43% of raw food dieters was reported [13, 37].
sumption of a raw food diet. The body weight Very strict raw food dieters have higher odds
first decreases and then usually increases to a of becoming underweight than moderate raw
level below the initial weight. The very conse- food dieters. Therefore, a very strict raw food
quent raw food dieters show a greater loss of diet has to be considered as a risk to health if
body weight than the moderate raw food diet- practised for a long time.
ers. Change in body weight usually indicates a A high percentage of the women (70%) par-
change in energy balance and reflects changes ticipating in the Giessen Raw Food Study had

76 Ann Nutr Metab 1999;43:69–79 Koebnick/Strassner/Hoffmann/

Leitzmann
129.186.138.35 - 1/12/2019 6:35:51 PM
Iowa State University
Downloaded by:
irregularities in their menstruation after rhea increased with the strictness of the raw
changing to a raw food diet. A total absence of food diet. For women of childbearing age
menstruation was observed in 23% of female there may be further consequences for the
raw food dieters of childbearing age. With unborn child in case of pregnancy.
increasing amounts of raw food the BMI de- The absence of obesity in raw food dieters
creased and the odds of having amenorrhea should be seen positively, but their extremely
increased. The participants judged this as a low body weight may be a problem. While an
success of their diet, since proponents of raw energy restriction for many adults consuming
food diets view menstruation as a process of an average Western diet is recommended, a
cleansing. They claim that eating enough raw strict raw food diet cannot guarantee an ade-
food stops menstruation so that the cleansing quate energy supply [20, 37]. A low BMI in
process is no longer required [3, 5, 38]. This raw food dieters indicates low body energy
attitude concerning amenorrhea has no scien- stores and CED. In a mostly vegan diet like
tific basis and ignores the possibility that the raw food diets with low protein and energy
amenorrhea may lead to impaired health. intake, protein metabolism can be affected to
Nutritional deficiencies, low body fat the point of protein energy malnutrition. The
stores, CED and low body weight which is incidence of amenorrhea in female raw food
related to changes in body composition are dieters is also a sign for functional problems
associated with amenorrhea [14, 27, 39–41]. in the long-term consumption of a raw food
Amenorrhea is also observed with eating dis- diet. As shown in this study the main determi-
orders like bulimia and anorexia [17, 41–43]. nant for the BMI and the incidence of amen-
Professional sportswomen often show disor- orrhea is the amount of raw food in the diet.
dered eating habits, amenorrhea, and osteo- On the basis of the data obtained and the
porosis. This is collectively known as the reports in the literature, a strict raw food diet
female athlete triad [44]. An imbalance be- with amounts of raw food over 90% cannot be
tween energy intake and energy expenditure recommended. Studies yet to be published
leads to an energy deficit which is associated with diets containing liberal amounts of raw
with menstrual irregularities and reproduc- food indicate that about half the food eaten in
tive dysfunction in female long distance run- an uncooked form may be optimal for health
ners [45]. under normal conditions.
A low BMI is indicative for CED and is
associated with amenorrhea. Amenorrhea can
result in impaired fertility [16, 27, 42]. When
estrogen levels are low, changes in mineral,
glucose and fat metabolism accompany amen-
orrhea. These metabolic changes affect bone
and cardiovascular health, increasing the risk
of osteoporosis and coronary heart disease in
later life [16, 42]. The maternal BMI is related
to the birth weight of a child [46]. Mothers
from China, India, Ethiopia and Zimbabwe
with a low BMI have babies with low birth
weights [23, 27]. In the female raw food diet-
ers of this study the odds of having amenor-

Consequences of a Long-Term Raw Ann Nutr Metab 1999;43:69–79 77

Food Diet on Body Weight and
Menstruation
129.186.138.35 - 1/12/2019 6:35:51 PM
Iowa State University
Downloaded by:
 References

1 Bircher-Benner M: Ungeahnte Wir- 15 World Health Organisation (WHO): 25 Walker NW: Auch Sie können wie-
kungen falscher und richtiger Ernäh- Energy and protein requirements: der jünger werden, ed 3. Ritterhude,
rung, ed 1. Zürich, Wendepunkt, Report of a joint FAO/WHO/UNU Waldhausen, 1993.
1947. expert consultation. WHO Tech 26 Kasper H: Ernährungsmedizin und
2 Diamond H, Diamond M: Fit fürs Rep Ser 1985;724. Diätetik, ed 8. München, Urban &
Leben – Fit for Life, ed 2. München, 16 Fruth SJ, Worrell TW: Factors asso- Schwarzenberg, 1996.
Goldmann, 1986. ciated with menstrual irregularities 27 Shetty PS, James WPT: Body Mass
3 Burger GC: Die Rohkost-Therapie, and decreased bone mineral density Index. A Measure of Chronic Energy
ed 3. München, Heyne, 1985. in female athletes. J Orthop Sports Deficiency in Adults. FAO Food
4 Shelton HM: Richtige Ernährung Phys Ther 1995;22:26–38. and Nutrition Paper 56. Aberdeen,
mit natürlicher Nahrung, ed 2. Rit- 17 Kopp W, Blum WF, von Prittwitz S, Rower Research Institute, 1994.
terhude, Waldthausen, 1991. Ziegler A, Lubbert H, Emons G, 28 Soares MJ, Shetty P: Basal metabol-
5 Wandmaker H: Willst Du gesund Herzog W, Herpertz S, Deter HC, ic rates and metabolic economy in
sein? Vergiss den Kochtopf, ed 6. Remschmidt H, Hebebrand J: Low chronic undernutrition. Eur J Clin
Ritterhude, Waldthausen, 1991. leptin levels predict amenorrhoea in Nutr 1991;45:363–373.
6 Koebnick C, Strassner C, Leitz- underweight and eating disorders of 29 Ferro-Luzzi A, Sette S, Franklin M,
mann C: Rohkost-Ernährung. Teil females. Mol Psychiatry 1997;2: James WPT: A simplified approach
1: Überblick und Bewertung der 335–340. of assessing adult chronic energy de-
theoretischen Grundlagen. aid-Ver- 18 Mazess RB, Barden HS, Ohlrich ES: ficiency. Eur J Clin Nutr 1992;46:
braucherdienst 1997;42:244–250. Skeletal and body composition ef- 173–186.
7 Deutsche Gesellschaft für Ernäh- fects of anorexia nervosa. Am J Clin 30 James WP: Introduction: The chal-
rung: Stellungnahme zur Rohkost Nutr 1990;52:438–441. lenge of adult chronic deficiency.
nach Helmut Wandmaker; in: DGE- 19 Aalderink J, Hoffmann I, Groene- Eur J Clin Nutr 1994;48(suppl 3):1–
Info, Forschung, Klinik und Praxis. veld M, Leitzmann C: Results of the 9.
1993, pp 77–78. Giessen Wholesome Nutrition 31 Norgan NG, Ferro-Luzzi A: Weight-
8 Koebnick C, Strassner C, Leitz- Study. Food consumption and nu- height indices as estimators of fat-
mann C: Bewertung der Rohkost- trient intake by women adhering to ness in men. Hum Nutr Clin Nutr
Ernährung in der Ernährungsbera- Wholesome Nutrition and women 1982;36C:363–373.
tung. Ern Umschau 1997;44:444– adhering to a mixed diet. Ernäh- 32 Khosla T, Lowe CR: Indices of obe-
448. rungsumschau 1994;41:328–335. sity derived from body weight and
9 Koebnick C, Strassner C, Dörries S, 20 Hoffmann I: Giessener Vollwert-Er- height. Br J Prev Soc Med 1967;21:
Kwanbunjan K, Leitzmann C: Er- nährungsstudie: Untersuchung auf 122–128.
nährungs- und Gesundheitsverhal- Bias am Beispiel von Fettstoffwech- 33 Naidu AN, Rao NP: Body mass in-
ten von Personen mit überwiegen- sel-Parametern. Giessen, Wissen- dex: A measure of the nutritional
der Rohkost-Ernährung. Z Ernäh- schaftlicher Fachverlag, 1994. status in Indian populations. Eur J
rungswiss 1995;34:53. 21 Hoffmann I, Kohl M, Groeneveld Clin Nutr 1994;48(suppl 3):131–
10 Bircher R: Leben und Lebenswerk M, Leitzmann C: Development and 140.
Bircher-Benner. Zürich, Bircher- validation of a new instrument to 34 Kübler W, Anders HJ, Heeschen W,
Benner, 1950. measure food intake. Am J Clin Kohlmeier M (eds): Vera-Schriften-
11 Douglass JM, Rasgon IM, Fleiss Nutr 1994;59(suppl):284. reihe Band II. Niederkleen, Wissen-
PM: Effects of a raw food diet on 22 Ananth CV, Kleinbaum DG: Re- schaftlicher Fachverlag Fleck, 1992.
hypertension and obesity. South gression models for ordinal re- 35 Hahn A, Leitzmann C: Vegetarische
Med J 1985;78:841–844. sponses: A review of methods and Ernährung. Stuttgart, Ulmer, 1996.
12 Waerland A: Health is Your Birth- applications. Am J Epidemiol 1997; 36 Appleby PN, Thorogood M, Mann
right, ed 1. Bern, Blume. 26:1323–1333. JI, Key TJ: Low body mass index in
13 Strassner C, Koebnick C, Leitz- 23 Lindsted K, Tonstad S, Kuzma JW: non-meat eaters: The possible roles
mann C: Rohkost-Ernährung. Teil Body mass index and patterns of of animal fat, dietary fibre and alco-
2: Die Giessener Rohkost-Studie. mortality among Seventh-Day Ad- hol. Int J Obes 1998;22:454–460.
aid-Verbraucherdienst 1997;42: ventist men. Int J Obes 1991;15: 37 Strassner C: Die Giessener Rohkost-
268–274. 397–406. Studie: Ernährungs- und Gesund-
14 Crosignani PG, Vegetti W: A practi- 24 Chang-Claude J, Frentzel-Beyme R: heitsstatus von Rohköstlern unter
cal guide to the diagnosis and man- Dietary and lifestyle determinants besonderer Berücksichtigung von
agement of amenorrhoea. Drugs of mortality among German vege- Protein und Energie. Heidelberg,
1996;52:671–681. tarians. Int J Epidemiol 1993;22: Verlag für Medizin und Gesundheit,
228–236. 1998.

78 Ann Nutr Metab 1999;43:69–79 Koebnick/Strassner/Hoffmann/

Leitzmann
129.186.138.35 - 1/12/2019 6:35:51 PM
Iowa State University
Downloaded by:
38 Rudolph S: So erlebte ich meine 41 Golden NH, Shenker IR: Amenor- 44 Grooms AM: The female athlete
erste Urzeitgeburt. Natürlich Leben rhea in anorexia nervosa. Neuroen- triad. J Fla Med Assoc 1996;83:
1997;1:18–19. docrine control of hypothalmic dys- 479–481.
39 Benson JE, Engelbert-Fenton KA, function. Int J Eat Disord 1994;16: 45 Zanker CL, Swaine IL: The relation-
Eisenman PA: Nutritional aspects of 53–60. ship between serum oestradiol con-
amenorrhoea in the female athlete 42 Mcliver B, Romanski SA, Nippoldt centration and energy balance in
triad. Int J Sport Nutr 1996;6:134– TB: Evaluation and management of young women distance runners. Int
145. amenorrhoea. Mayo Clin Proc 1997; J Sports Med 1998;19:104–108.
40 Copeland PM, Sacks NR, Herzog 72:1161–1169. 46 Giay T, Khoi HH: Use of body mass
DB: Longitudinal follow-up of ame- 43 Selzer R, Caust J, Hibbert M, Bowes index in the assessment of adult nu-
norrhoea in eating disorders. Psy- G, Patton G: The association be- tritional status in Vietnam. Eur J
chosom Med 1995;57:121–126. tween secondary amenorrhoea and Clin Nutr 1994;48(suppl 3):124–
common eating disordered weight 130.
control practices in an adolescent
population. J Adolesc Health 1996;
19:56–61.

Consequences of a Long-Term Raw Ann Nutr Metab 1999;43:69–79 79

Food Diet on Body Weight and
Menstruation
129.186.138.35 - 1/12/2019 6:35:51 PM
Iowa State University
Downloaded by: