Advanced Mediterranean Diet Blog

Researchers at the University of Wollongong (Australia) reviewed the scientific literature on the role for cereal grains and legumes in weight management.

In this context, ”cereal” refers to “a grass such as wheat, oats, or corn, the starchy grains of which are used as food” (American Heritage Dictionary). 

Here’s their summary:

There is strong evidence that a diet high in whole grains is associated with lower body mass index, smaller waist circumference, and reduced risk of being overweight; that a diet high in whole grains and legumes can help reduce weight gain; and that significant weight loss is achievable with energy-controlled diets that are high in cereals and legumes. There is weak evidence that high intakes of refined grains may cause small increases in waist circumference in women. There is no evidence that low-carbohydrate diets that restrict cereal intakes offer long-term advantages for sustained weight loss. There is insufficient evidence to make clear conclusions about the protective effect of legumes on weight.  

In July, 2008, I blogged about a study in the New England Journal of Medicine that showed better weight loss after two years on the low-carb Atkins diet compared to a low-fat (and higher cereal) diet.  We’re not looking at huge differences here:

• 7.3 lb (3.3 kg) loss for the low-fat group
• 10.1 lb (4.6 kg) loss for the Mediterranean diet group
• 12.1 lb (5.5 kg) loss for the Atkins group 

The Wollongong authors probably didn’t have access to that report.  I suspect they would retract their opinion that “there is no evidence that low-carbohydrate diets that restrict cereal intakes offer long-term advantages for sustained weight loss.”  Could depend on what they consider “long-term.”

I haven’t read the entire article but invite you to do so.

Steve Parker, M.D.

Reference:  Williams, P.G., et al.  Cereal grains, legumes, and weight management: a comprehensive review of the scientific evidence.  Nutrition Reviews, 66(2008): 171-82.

Good Morning!  This is God.

I will be handling all of your problems today.  I will not need your help.   So relax and have a great day!

[I keep a poster of this above my desk.  It’s comforting to re-read it when I start to worry too much.  I hope it does the same for you.]

-Steve Parker, M.D.

I read James Hirsch’s book in 2006 but never got around to reviewing it.  Better late than never?  I give it four stars per Amazon.com’s rating system: “I like it.”

♦   ♦   ♦

If you have diabetes or love someone who is afflicted by diabetes, you’ll benefit from this book. It’s an insider’s view into the world of diabetes, with a predominant focus on type 1 rather than type 2.  Both are covered well.

Look elsewhere for a “how-to” book on managing diabetes.  Cheating Destiny is about emotions, coping strategies, public policy, and history.  Although I’ve been treating diabetes for over two decades, Mr. Hirsch taught me a thing or two.  For instance, did you know . . . that some people with diabetes are offended if you call them diabetics? (They prefer “people with diabetes.”)  That diabetes was considered shameful years ago?  That even the preeminent Joslin Diabetes Clinic loses money and has to be supported by private donations?  That the founder of d-Life TV was a patient of the iconoclastic Dr. Richard Bernstein?  About the exciting story of the discovery of insulin by Fred Banting and Charles Best in 1922?   

The author himself has type 1 diabetes.  The heart-wrenching story of his son’s diagnosis at age 3 showcases Mr. Hirsch’s considerable writing skills. 

To counter the sad and frustrating aspects of diabetes, the book is peppered with  funny anecdotes.  Did you ever duck in to a private booth at a girlie peep show to inject insulin?  Mr. Hirsch has!  [It’s not what you think.]

One undercurrent of the book I take issue with is the implication that the medical profession somehow perpetuates diabetes or purposefully provides inadequate care, because that’s where the money is.  Why work hard to cure diabetes or prevent complications when the profession makes money off the disease and it’s complications?  I don’t see it that way at all.  It is true, however, that preventive care and cognitive medical services (as opposed to invasive procedures) are poorly funded by insurance.  That’s an economic and political problem, not an ethical one in physicians and researchers.
 
Full disclosure:  My defunct outpatient medical practice is mentioned in chapter five.  The author outlines my efforts to provide conscientious care to people with diabetes - mostly type 2 - despite poor funding from insurers (primarily Medicare in my practice at the time).  Poor pay for cognitive services forced me to close my office.  I found Mr. Hirsch to be a thorough and accurate researcher.

[I’m a hospitalist and health blogger now.]

Other highlights of the book are discussions of Dr. Elliott Joslin, an overweight Southern black woman (the Diabetes Queen), intimate details about the type 1 diabetes experience from the patient and family perspective, Dr. Richard Bernstein, insulin pumps, islet cell transplants, origins of the Juvenile Diabetes Research Foundation, Douglas Melton and stem cell research, research rivalries and funding, and inspirational survivor tales.

Mr. Hirsch rightfully criticizes many aspects of the health and medical fields with regards to diabetes.  Thankfully, he never suggests a sweeping government take-over of the healthcare industry.  He urges diabetics - people with diabetes - to take care of their own disease and demand improvements in the current system.

The U.S. already has 24 million people with diabetes and another 54 million with prediabetes.  Approximately one of every three persons born in the U.S. in 2000 will develop diabetes in his or her lifetime, according to the Centers for Disease Control and Prevention.

I agree with Mr. Hirsch that diabetes is “the country’s leading public health crisis,” driven by obesity and the aging of the population.”  This book will help alleviate the damages. 

Steve Parker, M.D.

Disclosure:  I bought this book at Amazon.com.  I was not paid to review it.

Nutrition scientists think that plants have small amounts of numerous “bioactive compounds,” more often referred to as phytonutrients, that protect us against disease.

Many scientific studies have looked at groups of people over time, noting the various foods they eat as well as the diseases they develop.  These are called epidemiologic, ecological, or observational studies.  One finding is that lower rates of heart disease, vascular disease, and cancer are seen in people consuming plant-based diets.  “Plant-based” isn’t necessarily vegetarian or vegan.  The traditional Mediterranean diet, for example, is considered by many to be plant-based because meat and poultry are not prominent compared to plants. 

In contemplating what source of carbohydrates a person with diabetes should eat, I’ve been reviewing the scientific literature to see which sources of carbs might provide the biggest bang for the buck in terms of health and longevity benefits.

Here are some quotes from a 2002 review article in the American Journal of Medicine:

Phenolic compounds, including their subcategory, flavonoids, are present in all plants and have been studied extensively in cereals, legumes, nuts, olive oil, vegetables, fruits, tea, and red wine. Many phenolic compounds have antioxidant properties, and some studies have demonstrated favorable effects on [blood clotting] and [growth of tumors]. Although some epidemiologic studies have reported protective associations between flavonoids or other phenolics and cardiovascular disease and cancer, other studies have not found these associations.

Hydroxytyrosol, one of many phenolics in olives and olive oil, is a potent antioxidant.

Resveratrol, found in nuts and red wine, has antioxidant, [anti-blood-clotting], and anti-inflammatory properties, and inhibits [malignant tumor onset and growth].

Lycopene, a potent antioxidant carotenoid in tomatoes and other fruits, is thought to protect against prostate and other cancers, and inhibits tumor cell growth in animals.

Organosulfur compounds in garlic and onions, isothiocyanates in cruciferous vegetables, and monoterpenes in citrus fruits, cherries, and herbs have [anti-cancer] actions in experimental models, as well as [heart-healthy effects].

In summary, numerous bioactive compounds appear to have beneficial health effects. Much scientific research needs to be conducted before we can begin to make science-based dietary recommendations. Despite this, there is sufficient evidence to recommend consuming food sources rich in bioactive compounds. From a practical perspective, this translates to recommending a diet rich in a variety of fruits, vegetables, whole grains, legumes, oils, and nuts.

The article discusses phytoestrogens—plant chemicals that act in us like the female hormone estrogen—but effects are complex and I suspect we know much more now than we did in 2002 .  Soy products are the best known source of phytoestrogens.

The traditional Mediterranean diet is rich in all of the foods mentioned above, except for tea.  Even the Ketogenic Mediterranean Diet includes the aforementioned foods except for tea (I need to add tea and coffee), cereals, and cherries.

Steve Parker, M.D.

Reference:  Kris-Etherton, P.M., et al.  Bioactive compounds in foods: their role in the prevention of cardiovascular disease and cancer.  American Journal of Medicine, 113 (2002. Supplement 9B): 71S-88S.

Harvard researchers suggest that our food consumption does indeed influence our risk of suffering a stroke.  This matters since stroke is the third leading cause of death in the U.S.

Scientists looked carefully at 121 different studies—published between 1979 and 2004—on the relationship between dietary factors and stroke.  High blood pressure is a major modifiable risk factor for stroke, so it also was considered.  Dietary factors included fats, minerals, animal protein, cholesterol, fish, whole grains, fiber, carbohydrate quality, fruits and vegetables, antioxidants, B vitamins, and dietary patterns.

I quote their conclusions:

Diets low in sodium and high in potassium lower blood pressure which will likely reduce stroke risk.

Consumption of fruits and vegetables, whole grains, folate, and fatty fish are each likely to reduce stroke risk.

A prudent or traditional Mediterranean dietary pattern, which incorporates these individual dietary components as well as intake of legumes and olive oil, may also prevent stroke.

Evidence is limited or inconsistent regarding optimal levels of dietary magnesium, calcium, antioxidants, total fat, other fat subtypes, cholesterol, carbohydrate quality, or animal protein for stroke prevention.

A diet low in sodium, high in potassium, and rich in fruits, vegetables, whole grains, cereal fiber, and fatty fish will likely reduce the incidence of stroke.

Take Home Points

The article abstract does not address the optimal intake amount of these various foods, vitamins, and minerals.  That’s probably not known with any certainty.

The traditional Mediterranean diet incorporates many of these stroke-preventing foods.  The Advanced Mediterranean Diet helps people lose weight while teaching how to eat Mediterranean-style.

The very low-carb Ketogenic Mediterranean Diet includes these stroke-preventing foods and minerals, except for whole grains and a tendency to be low in potassium.  The KMD is high in total fat and animal protien, and potentially high in cholesterol; this study indicates those issues are nothing to worry about in terms of future strokes.

I’ll use articles such as this to recommend long-term food consumption for followers of any future Diabetic Mediterranean Diet.

Steve Parker, M.D.

Reference:  Ding, E.L, and Mozaffarian, D.  Optimal dietary habits for the prevention of stroke. Seminars in Neurology, 26 (2006): 11-23.

This is the beginning of a new day.  You have been given this day to use as you will.  You can waste it or use it for good.  What you do today is important because you are exchanging a day of your life for it.  When tomorrow comes, this day will be gone forever; in its place is something that you have left behind . . . let it be something good.

                                                               -Author unknown

The current issue of the American Journal of Clinical Nutrition includes a meta-analysis of 21 published studies that address whether saturated fat in our diets causes heart attacks and strokes. 

Bottom line?  The accusations against saturated fat are false.

Here’s the authors’ summary:

A meta-analysis of prospective epidemiologic studies showed that there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of coronary heart diseases or cardiovascular disease. 

I’m not aware of any new studies examining this issue, so the authors likely have re-hashed old studies as others have done.

What’s newsworthy is that this watershed science is published in one of the premier nutrition journals. 

Next thing you know, AJCN may review Gary Taubes’ 2007 magnum opus, Good Calories, Bad Calories.

Steve Parker, M.D.

Reference:  Siri-Tarino, Patty, et al.  Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease.  American Journal of Clinical Nutrition, January 13, 2010. doi:10.3945/ajcn.2009.27725

Coffee drinking is associated with lower risk of developing type 2 diabetes, according to a recent issue of Archives of Internal Medicine.  Tea and decaffeinated coffee seem to have the same effect.  Each additional daily cup of coffee reduced the risk by seven percent.

These beverages may have one or more phytochemicals that that alter blood sugar physiology.  [”Phyto” is Greek for “plant.”]  If the experts can figure out which chemicals are involved, it may lead to new drugs to prevent and treat diabetes 10 or 20 years down the road.

In the meantime, don’t feel guilty about drinking two or three cups of coffee a day, especially if you have risk factors for developing type 2 diabetes.  Common risk factors are family history of diabetes, overweight, high-glycemic-index eating, and sedentary lifestyle.

Steve Parker, M.D.

Reference:  Huxley, Rachel, et al.  Coffee, decaffeinated coffee, and tea consumption in relation to incident type 2 diabetes mellitus: A systematic review with meta-analysis.  Archives of Internal Medicine, 22 (2009): 2,053-2,063.

The direct yearly medical cost of being obese in the U.S. is $1,723 per obese person, according to a just-released report in Obesity Reviews.  Being overweight is a relative bargain at $266.

These numbers translate into $114 billion yearly, or five to 10 percent of total healthcare spending.

Not included in the numbers are costs such as lost productivity due to obesity-related illness and replacement or repair of items that wear out or break due to excessive amounts of physical stress.  Not to mention pain and suffering.

Are you overweight or obese?  Find out with an online body mass index calculator. 

Want to do anything about it?  See my “Prepare for Weight Loss” series.

Steve Parker, M.D.

Reference:  Tsai, A.G., et al.  Direct Medical Cost of Obesity in the U.S.A.  Obesity Reviews, online January 6, 2009.  doi: 10.1111/j.1467-789x.2009.00708.x

Age-related macular degeneration is the leading cause of blindness in Americans over 65.  Impaired vision precedes blindness.  A recent study linked consumption of omega-3 fatty acids with 30% lower risk of developing macular degeneration.  Believe me, it’s a lot better to prevent it than try to treat it once present. 

[I have a couple older relatives with macular degeneration, so I pay close attention to the scientific literature.]

What’s the best source of omega-3 fatty acids?  Our friend, the fish.  Especially cold-water fatty fish such as tuna, trout, sardines, herring, mackerel, halibut, and sea bass.  A few plants are also decent sources, but our bodies don’t utilize those omega-3 fatty acids as well as they do from fish.

Note that both the Advanced Mediterranean Diet and Ketogenic Mediterranean Diet feature fish.

Steve Parker, M.D.

Reference:  SanGiovanni, J.P., et al.  Long-chain polyunsaturated fatty acid intake and 12-y incidence of neovascular age-related macular degeneration and central geographic atrophy: AREDS report 30, a prospective cohort study from the Age-Related Eye Disease Study.  American Journal of Clinical Nutrition, 90 (2009): 1,601-1,607. First published October 7, 2009.   doi:10.3945/ajcn.2009.27594