I think a steady picture makes a lot of difference.
I have had best results if I hold the iPhone with both hands, and my elbows 
resting on the table.
Glenn
----- Original Message ----- 
From: "Anne Robertson" <[email protected]>
To: "Mac OSX & iOS Accessibility" <[email protected]>
Sent: Wednesday, March 13, 2013 5:17 PM
Subject: OCR with Prizmo on iPhone using StandScan Pro


Hello everyone,

Last week, I received my StandScan Pro, a kind of fold-away box with 
interior lighting, designed to be used with smart phones. Here are the 
results of two scans, one done using the mains adaptor, and the other using 
the portable battery pack.

The scans are double pages from a book whose spine has been bent backwards, 
but not cut.

Cheers,

Anne

The Art and Science of Low Carbohydrate Living quished (because m p pie then 
returned to a 'balanced,,_ -~ relin.
diet), along with many of its associated metabolic benefits '~ainterla% 
Parallel in time to the popularity of VLCDs, Dr. Robert Atkins promoted a 
less energy-restricted approach to a ketogenic diet. His focus Was on 
keeping carbohydrate intake low enough to induce ketosis, but not to 
severely limit (or even count) calories. To achieve this, he advised 
individu.
als to eat protein and fat to satiety while keeping dietary carbohydrates 
low enough to maintain positive urine ketones. It was his view that this 
diet, including vegetables, limited fruit, and vitamin supplements, could be 
followed by the individual outpatient without close medical SUpervi.
sion unless there was a pre-existing complicating condition like diabetes or 
hypertension. For most patients, however, the Atkins diet tended to be only 
a temporary sojourn into nutritional ketosis, whether for want of sweets or 
want of approbation from their friends and doctor.
n
,
owever, in these parallel few decades of the VLCD and Atldns diet, hundreds 
of studies were done, and we learned a great deal about carbohydrate 
restriction. Among these lessons are many which can contribute to the safe 
and sustainable use of carbohydrate restricted diets going forward.
Counting Calories vs Carbs It was Dr. Atkins' contention that when most 
carbohydrate was removed from the diet, heavy people lose weight more 
effectively than by classic balanced calorie restriction. The mechanism was 
(and remains) hotly debated. Claims of reduced metabolic efficiency during 
nutritional ketosis remain unproven. Among other points against this is the 
fact that Steve Phinney's bike racers produced the same power output in 
testing 0~ a stationary bike using the same oxygen consumption after 
adapting to the Inuit diet compared to their test on a high carb diet[23], 
leaving little room for metabolic inefficiency in this group of subjects.
But this argument over the mechanism of weight loss is an acaderoic 
straw.man, In study after study, over the first 3-6 months, people r~a" 
ClinicaIUse°fCarb°hydrateRestricti°n: VeryL°wCal°rieandLowCarbohydrateDiets 
donaized to a low carb diet eaten to satiety lose more Weight and more body 
fat than those assigned to a low fat, calorie restricted diet. A credible 
mechanism to explain this is not hard to find - carbohydrates in our diet 
may offer a short-term sense of increased energy, but they offer little in 
the way of functional satiety.
~e best example of this effect was reported by Dr. Guenther Boden[45] in an 
inpatient study of obese type-2 diabetics. After a week of eating a balanced 
diet to satiety, the subjects were given a low carbohydrate diet consisting 
of most of the same foods, with the exception that they were asked to limit 
their total daily carbohydrate intake to 20 grams. Over the next two weeks, 
their spontaneous nutrient intakes were carefully measured. Interestingly, 
the subject's average daily energy intake dropped from 3100 to 2100 
Calories, and this was all due to the 'missing' carbs.
Despite having the choice to eat more, the protein and fat intakes of these 
subjects remained relatively constant. And despite this 1000 Calorie per day 
deficit, their reported hunger, satisfaction, and energy levels did not 
change appreciably. What did change was their diabetes control - 
dramatically for the better. For more on this topic, see Chapter 15.
But this study was just 2 weeks long. What happens in the longer term? Well, 
the process of full metabolic adaptation to a low carbohydrate diet takes up 
to 6 weeks, so for the first few months, we would expect wellbeing and 
function to get better. But after many months and a major degree of weight 
loss, it is a normal response of the human body to try to limit its losses. 
This is typically achieved by eating more, but what? If dietary carbohydrate 
intolerance led to the choice of a low carbohydrate diet at the outset, why 
lift that restriction? In particular, why add back calories that promote fat 
storage but do not provide functional satiety? Accepting that protein is 
good for us only in moderation, the answer is fat (see Chapters 2 and 16). 
How much fat should you add as you approach Weight maintenance.~ The simple 
answer: "let satiety rule", 163 1~9


-- Made with Prizmo.

Scan 2, using battery

The Art and Science of Low Carbohydrate Living Ketones - To Measure or Not 
As noted m" Chapter 1, nutritional ketosis is defined by ser-um keto ranging 
from 0.5 up to 5 mM, depending on the amounts ^€ ~. aes ~'~ uletary car.
boh#rate and protein consumed. In most people, the Combined intake of 100 
grams of carbohydrate and 100 grams of protein will drive seruna ketones 
well below 0.5 mM. While there is nothing magical about hay.
ing circulating ketones above this threshold level, it does have the practi.
cal value of providing the brain with a virtually limitless, fat-derived 
fuel source. This alternative fuel is eminently more sustainable, 
particularly in the insulin resistant or carbohydrate intolerant individual.
Within a few days of starting on carbohydrate restriction, most people begin 
excreting ketones in their urine. This occurs before serum ket0nes have 
risen to their stable adapted level because un-adapted renal tubules 
actively secrete beta-hydroxybutyrate and acetoacetate into the urine.
This is the same pathway that clears other organic acids like uric acid, 
vitamin C, and penicillin from the serum.
Meanwhile, the body is undergoing a complex set of adaptations in ketone 
metabolism[99]. Beta-hydroxybutyrate and acetoacetate are made in the liver 
in about equal proportions, and both are initially promptly oxidized by 
musde. But over a matter of weeks, the muscles stop using these ketones for 
fuel. Instead, muscle cells take up acetoacetate, reduce it to 
betahydroxybutyrate, and return it back into the circulation. Thus after a 
few weeks, the predominant form in the circulation is beta.hydroxybutyrate' 
which also happens to be the ketone preferred by brain cells (as an aside, 
the strips that test for ketones in the urine detect the presence of 
acetoacetate, not beta-hydroxybutyrate). The result of this process of ket0" 
adaptation is an elegantly choreographed shuttle of fuel from fat cells to 
liver to muscle to brain.
In the kidney, this process ofketo-adaptation is also complex, over ti#, 
urine ketone excretion drops off, perhaps to conserve a valuable enerf/ 
substrate (although urine ketone excretion never amounts to very na#Y wasted 
calories). This decline in urine ketones happens over the s~e 164 
clinicalUseofGarbohydrate Restricti°n: Very 
L°wCalorieandLowCarbohydrateDiets time-course that renal uric acid clearance 
returns to normal (discussed beloW) and thus may represent an adaptation in 
kidney organic acid metabolism in response to sustained carbohydrate 
restriction.
These temporal changes in how the kidneys handle ketones make urine ketone 
testing a rather uncertain if not undependable way of monitoring dietary 
response/adherence. Testing serum for beta-hydroxybutyrate is much more 
accurate but requires drawing blood, and it is expensive because it is not a 
routine test that doctors normally order.
A non-invasive alternative is to measure breath acetone concentration. 
Acetone is produced by the spontaneous (i.e., non-enzymatic) breakdown of 
acetoacetate. Because it is volatile, acetone comes out in expired air, and 
its content is linearly correlated with blood ketone levels. A number of 
businesses have developed prototype handheld devices to measure breath 
acetone, but at the time of this writing, nothing practical is on the 
market.
But whatever test is used, the key question is why do it? Many people are 
able to initiate and follow a low carbohydrate diet just fine without ever 
measuring ketones. Others, however, find an objective measure of nutritional 
ketosis to be reassuring. In some clinical settings, ketone testing is used 
as a measure of'diet compliance'. While this may be useful in the short term 
to keep patients on track in a strictly regimented dietary program, it begs 
the question of how that individual's diet will be managed long term. For 
this purpose, the handheld breath acetone monitors under development hold 
some promise as a guidance tool put into the hands of the individual 
striving to find the right levd of carbohydrate intake for long-term 
maintenance.
Biochemical changes (uric acid, acid/base, dectrolytes, cholesterol 
mobilization)
There are often dramatic but wholly predictable changes that occur in blood 
chemistry values upon initiation of a low carbohydrate diet. As a result, 
and also due to the very limited food intakes of people following very low 
calorie diets, most clinics using them do routine blood tests over the first 
165

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We assume neither liability nor responsibility should something unpredictable 
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