Advanced Mediterranean Diet

I’ve been wondering how U.S. food price inflation and the sky-rocketing cost of gasoline might affect people who are on various diets.  Food spending is somewhat discretionary.  Sure, you have to eat.  But you can choose filet mignon versus beans and rice.  You can fix it yourself or pay someone else to do it.  The same applies to dieting.  Fix food yourself, or buy MREs (meals-ready-to-eat).  You can pay a lot or a little.  And high cost does not always equal high quality.

Forbes magazine ran a good article on January 2, 2008, by Rebecca Ruiz, “How Expensive Is Your Diet?”

Ms. Ruiz evaluated the first-week costs of seven popular weight-loss diets.  She rightly notes that the first week’s cost typically requires the greatest financial investment.  For example, you may have to buy a spice or condiment that you don’t normally have on hand, but it may last you for months.  Her calculation of total costs also include the price of a book or other training materials, membership, and, in the case of the detox diet, a juicer.  Subsequent weeks of the diets are expected to cost substantially less.  Buying the various ingredients for two dozen distinct meals adds up.  Following a single week of the Abs Diet required more than 75 ingedients, while the Weight Watcher’s Flex Plan required more than 100.

Here is what Ms. Ruiz found as the cost of these popular diets for one person, for the first week (in U.S. dollars):

• Weight Watchers:  $388
• Martha’s Vineyard Diet Detox:  $385
• The 5-Factor Diet:  $380
• South Beach:  $323
• The Zone:  $273
• The Abs Diet:  $250
• NutriSystem:  $98 plus unclear amounts of fresh fruits and vegetables

How do these numbers compare with what you normally spend on food?  Only you would know, but many don’t.  The Forbes article says a weekly household grocery bill likely averages about $111, not including alcohol and fast food items.  The U.S. Census Bureau 2008 Statistical Abstract notes that there are 2.57 persons per household (in 2006).  So the average person spends $43 a week on groceries.  [OK, I admit these numbers are already outdated.]  Melinda Fulmer, in a recent article she wrote for MSN Money, notes that the average family of four (two adults and two young children in her case) spends $182 per week for food.  That’s $45 per person.

Nearly all effective weight-loss diets involve caloric restriction of some degree: you eat less than usual.  Wouldn’t you think you’d be spending less than usual on food?

Dr. George Blackburn, Associate Director of the Division of Nutrition at Harvard Medical School, told Ruiz that ”expecting an average consumer to consistently venture beyond their favorite meals or food can be cost prohibitive while also inviting failure.”  Dr. Blackburn said, “We have our golden oldies…You can’t re-engineer these things.  There are three or four favorites, and that’s how you eat most of your meals.”  In my experience people usually have eight to 12 favorite meals that become customary for them.

Ruiz writes that ”Dr. Blackburn advocates developing a familiarity with cooking and meal preparation so that a dieter isn’t reliant on cookbooks, ready-made entrees or what some might call gimmicks.”

Many of the popular diets tell you exactly what you will be eating for the next two to six weeks.  Whatever that is, it’s unlikely to be one of your golden oldies.  One of the great things about the Advanced Mediterranean Diet ($17.95) is that it doesn’t tell you exactly what and when to eat.  You get an extensive list of recommended foods available at your local grocery store, then you decide what to eat, and when.  For example, if one of your golden oldies is pancakes for breakfast, you eat pancakes, but now made with whole wheat flour.  You like sandwiches?  You got sandwiches.   Steak?  Salads?  Yes, those, too.

Forbes magazine is a fascinating financial/lifestyle periodical.  Pick up any copy when you get a chance.  It will be hard to put down, and you’ll learn something useful.

Steve Parker, M.D.

The Dietary Approaches to Stop Hypertension (DASH) diet has been shown to lower blood pressure.  A recent study associated a DASH-style diet with lower incidence of heart attack and stroke.

The DASH diet is low in total and saturated fats and cholesterol, moderate in low-fat dairy products, high in fruits and vegetables, low in salt, low in sweetened beverages, moderate in whole grains, and low in animal protein but has substantial amounts of plant protein from nuts and legumes.

The DASH diet was designed as a healthy way of eating, not a weight-loss diet.  It is promoted by the National Heart, Lung, and Blood Institute for the prevention and treatment of high blood pressure.  It is also included as an example of a healthy diet in the 2005 Dietary Guidelines for Americans.  Yet most people still have never heard of it.

Researchers affiliated with multiple Boston and Atlanta institutions looked at the participants in the massive Nurses Health Study.  88,517 middle-aged women free of stroke, diabetes, and coronary heart disease were followed between 1980 to 2004.  They filled out food frequency questionnaires designed to assess average food intake over the preceding year.  The researchers constructed a DASH diet score and graded all the study participants in terms of adherence or conformity to the ideal DASH diet.

Over the course of the study, there were 2129 cases of nonfatal heart attack, 976 deaths from coronary heart disease, and 2317 strokes.  [If you read the original study, please note that some numerical errors were corrected in a later journal issue.]

Women with the highest adherence to the DASH Diet had 24% lower risk for coronary heart disease, compared with the women who had the lowest conformity.  Again comparing the same two groups for stroke, the high-adherence women had 18% less incidence of stroke.  There were clear trends for less coronary heart disease and stroke as adherence to the DASH diet increased.

Blood samples were analyzed for a subset of participants.  Higher DASH compliance was significantly associated with lower plasma levels of interleukin-6 and C-reactive protein.  These are markers for the inflammation felt to underlie atherosclerosis and cardiovascular disease.  You want avoid high inflammatory markers.  The DASH diet scores in this study were not associated with serum lipid changes, although other DASH studies found lower LDL cholesterol and an undesirable reduction in HDL cholesterol.

The researchers examined causes of death in participants, yet did not report any association - positive, negative, or neutral - with DASH score.  I wonder why?  It’s possible that higher DASH scores were associated with higher overall death rates even though they had fewer heart attacks and strokes.  I imagine they also had access to cancer death statistics.  Why no mention?  Academicians are under pressure to publish research reports.  Are they saving the mortality and cancer data for future articles?  Abscence of all-cause mortality numbers is a major weakness of this study.

The DASH diet is similar in composition to the traditional Mediterranean diet.  The main differences are that the Mediterranean diet ignores salt intake, allows wine and other alcohol, and places more emphasis on olive oil and whole grains.  The Mediterranean diet has numerous supportive studies showing prolonged lifespan and less chronic disease: fewer heart attacks and strokes, less cancer, less dementia.  And very recently the Mediterranean diet was associated with a lower incidence of type 2 diabetes mellitus.

Steve Parker, M.D., author of The Advanced Mediterranean Diet: Lose Weight, Feel Better, Live Longer

References:

Fung, Teresa, et al.  Adherence to a DASH-Style Diet and Risk of Coronary Heart Disease and Stroke in Women.  Archives of Internal Medicine, 168 (2008): 713-720.

Your Guide to Lowering Your Blood Pressure with DASH, from the National Heart, Lung, and Blood Institute

Yesterday’s issue of the New England Journal of Medicine has a well-done study comparing the Mediterranean, low-carb, and low-fat weight-loss diets in an Israeli population over the course of two years.  The researchers conclude that “Mediterranean and low-carbohydrate diets may be effective alternatives to low-fat diets.  The more favorable effects on lipids (with the low-carbohydrate diet) and on glycemic control (with the Mediterranean diet) suggest that personal preferences and metabolic considerations might inform individualized tailoring of dietary interventions.”

How was the study set up?

Moderately obese participants (322) were randomly assigned to one of the three diets: 1) low-fat, calorie-restricted, 2) Mediterranean, calorie-restricted, or 3) low-carbohydrate, non-restricted.  Calories in the low-fat and Mediterranean diets were “restricted” to 1800 per day for the men, 1500 for the women.  Average age of participants was 52, and average body mass index was 31.  [A 5-foot, 10-inch man weighing 216 pounds (98.2 kg) has a BMI of 31.]  Nearly all participants - 277 or 86% of the total - were men.  So there were only 45 women.  Forty-six participants had type 2 diabetes.

The low-fat diet was based on the American Heart Association guidelines of 2000: 30% of calories from fat [this isn’t very low], 10% of calories from saturated fat, cholesterol limited to 300 mg/day.  [The AHA revised their guidelines in 2006.]  Low-fat dieters ”were counseled to consume low-fat grains, vegetables, fruits, and legumes and to limit their consumption of additional fats, sweets, and high-fat snacks.”

The Mediterranean diet was based on the recommendations of Walter Willett and P.J. Skerrett as in their book, Eat, Drink, and be Healthy: The Harvard Medical School Guide to Health Eating.  Mediterranean dieters ate 2 fish meals per week, a handful of nuts daily, 30-45 grams of extra virgin olive oil per day, etc.  [One tablespoon of olive oil is 14 grams.]  The AHA states that “this diet reflects the current recommendations from the American Heart Association.”  There were no specific recommendations regarding alcohol in any of the diets.

The low-carb diet was based on  Atkins’ New Diet Revolution of 2002.  The goal was to provide 20 grams of carbohydrate per day for the 2-month induction phase, with a gradual increase to a maximum of 120 grams daily to maintain weight loss.  Total calories, protein, and fat were not limited.  “Participants were counseled to choose vegetarian sources of fat and protein….”

Whole grains were recommended for the low-fat and Mediterranean cohorts.

All participants worked at the same nuclear research facility in Dimona, Israel.  They were given careful instructions, initially and periodically, regarding the diet to which they were assigned.  Lunch is the main meal of the day in Israel, and they all ate lunch at the facility’s self-service cafeteria, which prompted them to choose the proper food items.  I assume they were told to maintain the diet when off-duty.  Adherence to the diets was assessed by a food-frequency questionnaire.

Findings

• After 24 months, how many participants were still involved?  90% in the low-fat group, 85% in the Mediterranean, 78% in the low-carb.
• There was little change in the usage of medications, and no significant differences among the groups.
• Daily energy intake (calories or kcal) decreased from baseline levels significantly - about 450 calories - in all groups at 6, 12, and 24 months compared with baseline, with no significant differences among the groups in the amount of decrease.
• All groups started with 51% of energy intake (calories) from carbohydrate.
• At 24 months, the low-carb dieters were getting 40% of their daily calories as carbohydrates.  The other two groups were eating 50% of energy intake from carbs. [This still seems like a lot of carbs on the Atkins diet.  A gram of carbs has 4 calories.  The stated carbohydrate goal was a maximum of 120 grams of carbs daily, on a diet of 1800 calories.  So 120 grams of carbohydrate should be 27% of total daily calories.  At no point did the low-carb group reduce their average percentage of calories from carbohydrates under 40%.  OK, maybe be in the first two weeks but those data are not reported.  On an 1800 calorie diet, 40% of calories from carbs would be 180 grams.]
• At 24 months, the low-carb dieters were getting 39% of their daily calories as fat.  The other two groups were in the 30-33% range.
• Baseline fat intake for all groups was 31-32% of total calories, with saturated fat being 10% of the fat calories.
• The low-fat cohort dropped their fat calories from 31 to 30% of total calories, which is essentially no change from baseline percentage.
• At 24 months, the low-carbers were getting 22% of their daily calories from protein.  The other groups were at 19%.  [The low-carb Atkins diet is often criticized as having too much protein.]
• Only the low-carb group made major changes in macronutrient composition of their diet.  Macronutrients are protein, fat, and carbohydrates.  This Atkins group increased saturated fat from 10 to 12% of total calories, reduced carbs from 51 to 40% of calories, increased protein from 19 to 22% of calories, and increased total fat from 32% to 39% or total calories.
• All cohorts lost weight, but losses were greater in the low-carb and Mediterranean groups.  For the 272 participants who completed the full 24 months of intervention, the losses averaged 3.3 kg (7.3 lb) for the low-fat group, 4.6 kg (10.1 lb) for the Mediterraneans, and 5.5 kg (12.1 lb) for the low-carb group.
• Among the 45 women, the low-fat group lost only 0.1 kg (0.22 lb), the Mediterraneans lost 6.2 kg (13.6 lb), and the low-carbers lost 2.4 kg (5.3 lb).  There were only 15, 20, and 10 women in these groups, respectively.
• All groups had significant blood pressure reductions: about 4 mmHg systolic and 1 mmHg diastolic.
• HDL cholesterol (the “good cholesterol”) increased in all groups, 8.4 mg/dl in the low-carb group, about 6.3 in the others.
• LDL cholesterol (the “bad cholesterol”) fell 5.6 mg/dl in the Mediterraneans, 3.0 mg/dl in the low-carbers, and none in the low-fat group.  But these were not statistically significant differences between the groups.
• The ratio of total to HDL cholesterol decreased for all groups, but the relative 20% decrease in the low-carb group was statistically significant compared to the 12% relative decrease in the low-fat group.  The ratio fell 16% in the Mediterranean group.  [The total/HDL ratio is thought to reflect risk of developing atherosclerotic complications.  You want it under 5 to 1, and 3.5 to 1 may be ideal.]
• The level of high-sensitivity C-reactive protein decreased significantly only in the Mediterranean and low-carb cohorts.  [C-reactive protein is felt to be a marker of the systemic inflammation that has a role in atherosclerosis or hardening of the arteries.]
• Thirty-six of the diabetics had adequate lab studies for analysis - about 12 in each diet group.  Only those in the Mediterranean group had a significant decrease in fasting glucose - 33 mg/dl.  The low-fat group had an increase.  Glycated hemoglobin decreased in all three groups although to a significant degree (0.9%) only in the low-carb group.  [High glycated hemoglobin levels reflect poor control of blood sugar levels in diabetics.]
• Insulin levels decreased significantly in all three groups, diabetic or not.  [Abnormally high insulin levels are felt to have adverse health effects.]

Limitations of the study

• Relatively few women, making it difficult to reliably generalize results to women.
• Relatively few people with diabetes, making it difficult to reliably generalize results to people with diabetes.
• Israeli gene pool?  Results not applicable to others?
• No change in physical activity recommended to participants.  Increased exercise should enhance weight loss.

Take-Home Points

• Caloric restriction leads to weight loss.
• Mild degrees of weight loss reduce blood pressure.
• In this study, the low-carb/Atkins and Mediterranean diets were more effective than the “low-fat” diet.
• Atkins dieters can lose weight without counting calories, by limiting carbohydrate intake.
• You gotta wonder if the low-carb group would have been even more successful if they had actually limited carbs to 120 grams daily.
• It’s possible a lower-fat diet may have been more efficacious than the one utilized here.
• This study did not enroll enough women to prove that a calorie-restricted Mediterranean diet is superior to low-fat and Atkins diets.  The greater weight loss - 13.6 pounds for Mediterranean versus 5.3 with Atkins - is suggestive and requires further study.
• The average amounts of weight loss are not much when you think about the effort expended over 24 months of intervention.
• These dieters reportedly reduced their daily caloric intake from baseline levels by about 450 calories, over the course of two years.  Yet they lost relatively little weight.  The numbers do not jive.  Most likely there is a problem with the methodology.  I doubt the average daily calorie deficit was as high as 450.
• The Mediterranean diet seems to have been better for the people with diabetes.  Confirmatory studies are imperative.  Insulin resistance is an important factor in type 2 diabetes.  Monounsaturated fats, which are prominent in olive oil and the Mediterranean diet, are linked to improvement in insulin resistance in other studies.
• For people who need to lose excess fat yet refuse to consciously restrict overall caloric  intake, the low-carb Atkins diet is a reasonable option.
• The traditional Mediterranean diet has demonstrable long-term health benefits: longer lifespan, less cancer (colon, prostate, breast, uterus), reduction of cardiovascular disease, less dementia, and prevention of type 2 diabetes.  The Atkins diet cannot make those claims in 2008.

Steve Parker, M.D., author of The Advanced Mediterranean Diet: Lose Weight, Feel Better, Live Longer

Reference:  Shai, Iris, et al.  Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet.  New England Journal of Medicine, 359 (2008): 229-241.

Additional information and critical analysis:

Dr. Dean Ornish’s analysis in Newsweek online   Dr. Ornish is a leading low-fat diet advocate.

American Heart Association comments on the study in a July 19, 2008, news release

Update on August 23, 2008:

The Mediterranean diet used in this study is based on Walter Willett’s 2001 book, Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating.  From the author:

I wrote this book to show you where the USDA Pyramid is wrong and why it is wrong.  I wanted to offer a new healthy eating guide based of the best scientific evidence, a guide that fixed the fundamental flaws of the USDA Pyramid and helps you make better choices about what you eat.  I also wanted to give you the latest information on new discoveries that shuould have profound effects on our eating patterns. 

Dr. Willett made a conscious decision not to call his new eating plan a Mediterranean diet.  Elsewhere in the book he notes that the Mediterranean diet pyramid promoted by Oldways Preservation and Exchange Trust is a good, evidence-based guide for healthy eating.  The entire book promotes Harvard’s Healthy Eating Pyramid, not the Mediterranean diet per se.

Harvard’s Healthy Eating Pyramid:

So were the Mediterranean dieters in the study at hand even following the Mediterranean diet?  The most glaring difference is Harvard’s lack of emphasis on olive oil.  Of lesser note is Harvard’s recommendation to eat white rice, white bread, potatoes, and refined-flour pasta only sparingly.  However, the researchers for this study directed Mediterranean diet participants to ingest 30-45 grams of olive oil per day.  After comparing the Harvard pyramid with the Oldways Mediterranean pyramid and other Mediterranean diet descriptions, it is fair to say the dieters here were indeed instructed on a Mediterranean diet.  In fact, the Mediterranean diet in this study is quite similar to the Advanced Mediterranean Diet.

Traditional healthy Mediterranean diet pyramid of Oldways Preservation and Exchange Trust:

In a recent blog post I discussed how the Mediterranean diet reduces the incidence of type 2 diabetes in healthy people.  I found another scientific journal article that examined the effect of various lifestyle factors that might influence the onset of type 2 diabetes in a different population: people who have had a recent heart attack.

Dariush Mozaffarian and colleauges studied 8291 Italians who had suffered a heart attack within the previous three months, but who did not have diabetes at the time of the heart attack.  Each study participant was followed for an average of 3.2 years to see if diabetes developed.  The researchers devised a Mediterranean diet score (range 0-15) incorporating consumption of cooked and raw vegetables, fruit, fish  and olive oil.  They also looked at consumption of butter, oils other than olive oil, cheese, wine, and coffee.  Participants’ dietary habits were assessed and scored three times over 1.5 years.  A number of other demographic, clinical, and lifestyle risk-factors were assessed.

The study did not survey other components of the Mediterranean diet, such as legumes, nuts, and grains.  This is a weakness of the study.  I suspect it relates to the fact they were using information from the GISSI-Prevenzione study, which was designed to evaluate fish oil and vitamin E in people who had had a heart attack, and researchers did not want to burden outpatient cardiology offices with full-scale questionnaires.

Over the three years of the study, 12% of participants developed new-onset diabetes, or 3.7% per year.  If not for the recent heart attack, the expected incidence rate for development of diabetes would be roughly 1.2% per year.  An even larger percentage, over 25%, of participants developed impaired fasting glucose, a kind of prediabetes that often develops into full-blown diabetes over time.

Was there anything about the people who developed diabetes that distinguished them from those who did not?  Yes - they tended to have older age, higher body mass index, high blood pressure, and they smoked.  Current smoking was associated with a 60% higher risk.  Every unit of higher body mass index, e.g, going from BMI 26 to 27, increased the risk by 9%.  High blood pressure increased the risk by 22%.

What about Mediterranean diet score?  The higher Mediterranean diet scores - score of 11-15 compared to 0-5 - were associated with 35% lower risk of diabetes.  A reduction in onset of impaired fasting glucose was similar.

The authors cite another study of 2499 patients with stable angina pectoris or remote heart attack (over 6 months perviously).  Twenty-two percent of them (one in five) developed diabetes or impaired fasting glucose over six years of follow-up, a rate of 4.1% per year.

The researchers write:

The lower risk associated with a Mediterranean-type diet suggests that diet could help reduce incidence of prediabetes and diabetes after a myodcardial infarction.  Many, though not all, trials have indicated that a Mediterranean-type diet lowers risk factors linked to insulin resistance and diabetes, including serum triglycerides, HDL cholesterol, systemic inflammation, endothelial function, and insulin sensitivity.  These physiological effects in short-term randomized trials provide biological plausibility for the inverse association between consumption of a Mediterranean-type diet and incidence of [impaired fasting glucose] and diabetes in this study.

What are the take-home points of this study for people - Italians, at least - who have had a recent heart attack?

1. A recent heart attack is a risk factor for development of diabetes and prediabetes.
2. The risk of developing diabetes and prediabetes may be significantly reduced by smoking cessation, prevention of weight gain, and consumption of typical Mediterranean foods.

Patients with both heart attacks and diabetes  have significantly worse outcomes  than people with only one of these conditions.  Since we can prevent many cases heart attack and diabetes through diet modification, why not?

Steve Parker, M.D, author of The Advanced Mediterranean Diet

Reference:  Mozaffarian, Dariush, et al.  Incidence of new-onset diabetes and impaired fasting glucose in patients with recent myocardial infarction and the effect of clinical and lifestyle risk factors.  Lancet, 370 (2007) 667-675.

The current issue of the British Journal of Cancer includes a report associating the traditional Mediterranean diet “…with markedly and significantly reduced overall cancer….”

Researchers from the University of Athens, the International Agency for Research on Cancer, and the Harvard School of Public Health looked at 25,623 participants of the Greek portion of the European Prospective Investigation into Cancer and nutrition (the EPIC study).  Adherence to the Mediterranean diet was assessed with a food-frequency questionnaire.

Cancer developed in 851 participants over an average follow up of 7.9 years.  Non-melanoma skin cancers were not included since they are usually not serious or life-threatening.  The common cancers in men involved the lung, prostate, colon, and stomach.  For women, common cancers were breast, colon, ovary, and uterus.

Participants’ conformity to the Mediterranean diet was graded on a 10-point scale based on consumption of vegetables, legumes, fruits and nuts, cereals, fish, meat and meat products, dairy products, ethanol (alcohol), and the monounsaturated to saturated lipid ratio.  A score of zero indicated minimal adherence; maximal adherence scored a nine.

Every two-point increase in adherence was associated with a 12% reduction in the incidence of overall cancer.  So those participants with greatest conformity to the traditional Mediterranean diet had a dramatically reduced incidence of cancer compared to those with minimal adherence.

The researchers cite three independent studies that found a similar association between the Mediterranean diet and cancer.  The study at hand was not sufficiently powered to determine reliably which specific cancers were reduced with the Mediterranean diet.  Other studies indicate that the reduced cancers are prostate, breast, colon, and uterus.

The researchers surmise that the cancer-reducing benefit of the Mediterranean diet relates to the whole diet rather than to individual components.

Steve Parker, M.D., author of the award-winning Advanced Mediterranean Diet: Lose Weight, Feel Better, Live Longer

Reference:  Benetou, V., et al.  Conformity to traditional Mediterranean diet and cancer incidence: the Greek EPIC cohort.  British Journal of Cancer, 99 (2008): 191-195.

Shelley Wood wrote a brief article for heartwire in which she interviewed several cardiologists regarding the untimely demise of Tim Russert.  Mr. Russert suffered sudden cardiac arrest from a ruptured atherosclerotic plaque in a major heart artery.  In other words, a heart attack.  Prominent cardiologist Eric J. Topol noted that Mr. Russert’s  weight was a major uncontrolled risk factor.

This intersting article that contains much more information than you would see in your typical television or newspaper coverage.  Commentators provide lively debate after the article.

Miranda Hitti wrote a similar article  for WebMD in which she interviewed three prominent cardiologists about the death.  They discuss various cardiac risk factors and strategies for prevention and detection of coronary artery disease.

But in neither article is mentioned a role for the Mediterranean diet, despite proven efficacy in prevention of cardiovascular disease such as heart attacks.  Diet modification too often plays second fiddle to drug therapy, angioplasty, and coronary artery bypass surgery.

My thoughts and prayers are with the Russert family in this time of loss.

Steve Parker, M.D.

References:

Parikh, Parin, et al.  Diets and cardiovascular disease: an evidence-based assessment.  Journal of the American College of Cardiology, 45 (2005): 1,379-1,387.

Gau, Gerald T.  The search for the perfect heart-healthy diet.  Mayo Clinic Proceedings, 78, (2003): 1,329-1,330.

I often talk to people interested in improving their health or losing weight via lifestyle modification, mostly changes in diet and exercise.  Many of them are motivated by health-related facts.  Here is a smattering of facts, starting out worrisome and ending hopeful: 

• 65% of U.S. adults are overweight or obese.  Half are overweight, half are obese. 

• 12% of deaths in the U.S. are due to lack of regular physical activity - 250,000 deaths yearly.

• 11% of U.S. adults have diabetes mellitus.

• 24 million in the U.S. have diabetes.  Another 57 million have pre-diabetes, a condition that increases your risk for diabetes.

• 23% of U.S. adults over 60 have diabetes. 

• 85% of people with type 2 diabetes are overweight.

• 200,000 yearly deaths in the U.S. are due to obesity.

• Excess body fat causes 14 to 20% of all cancer-related deaths in the U.S.

• 550,000 people die yearly of cancer in the U.S. 

• Obesity-related cancers in men: prostate and colorectal.  Obesity-related cancers in women: endometrial (uterine), cervix, ovary, breast.  Both sexes: kidney, esophageal adenocarcinoma.

• 20% of us in the U.S. will die of cancer.

• Lifetime risk of developing invasive cancer in the U.S. is four in 10 (a little higher in men, a little lower in women).

• At least one-half of high blood pressure cases are caused by excess body fat.  Every 20 pounds of excess fat increases blood pressure by two to three points.

• Peak aerobic power (a measure of physical fitness) decreases by 50% between age 20 and 65.

• Middle-aged and older people through regular exercise can increase their aerobic power by 15 to 20%, equivalent to a 10 or 20-year reduction in biological age. 

• Regular aerobic exercise reduces blood pressure by 8 to 11 points.  

• Have you already had a heart attack?  If so, regular exercise reduces the odds of fatal recurrence by 25% and adds two to three years to life.

• The Mediterranean diet is associated with lower incidence of cancer (colon, breast, prostate, uterus), cardiovascular disease (e.g., heart attacks), and dementia (both Alzheimers and vascular types). 

• High fruit and vegetable consumption protects against cancer of the lung, stomach, colon, rectum, oral cavity, and esophagus.  The protective “dose” is five servings a day.

• Coronary artery disease is the cause of heart attacks and many cases of sudden cardiac death.  Legume consumption lowers the risk of coronary artery disease.  The protective dose is four servings of legumes a week. 

• Whole grain consumption is associated with reduced risk of coronary artery disease (e.g., heart attacks), lower risk of death, lower incidence of type 2 diabetes and several cancers.  The protective dose is three servings a day. 

The good news is that we can significantly reduce our risk of premature death and common illnesses such as high blood pressure, cancer, diabetes, coronary artery disease, and dementia.  How?  Weight management, diet modification, and physical activity.     

Steve Parker, M.D., author of the award-winning Advanced Mediterranean Diet 

On June 24, 2008, the Centers for Disease Control released prevalence data for diabetes in the U.S.  Nearly 24 million people now have diabetes, up three percent over just two years.  This is eight percent of the population.  The vast majority of cases are of type 2 diabetes, not the type 1 usually diagnosed in childhood.

Another 57 million people have pre-diabetes, a condition that can turn into full-blown diabetes over time.  The two types of pre-diabetes are “impaired fasting glucose” and “impaired glucose tolerance.”

The CDC broke down diabetes prevalence for various age groups.  Twenty-three percent of people over 60 have diabetes.  Eleven percent of all adults have diabetes.

The 24 million figure includes six million who have diabetes but have not yet been diagnosed.

I expect to see even more diabetes cases in the future as our overweight population ages.

Risk factors for the development of type 2 diabetes include ageing and genetic heritage.  You can’t do anything about those.  But two other major risk factors are under your control: habitual inactivity and excessive body fat.

If you don’t want to be one of these statistics, now you know what you need to do.

Steve Parker, M.D., author of The Advanced Mediterranean Diet

Additional information:

WebMD Diabetes Guide

American Diabetes Association

The Prevention or Delay of Type 2 Diabetes

Does Weight Loss Prevent Type 2 Diabetes?

Mediterranean Diet Reduces Risk of Type 2 Diabetes

Some weight-management gurus advocate a slow eating rate to reduce food intake when on a weight loss diet, but there has never been much proof that it works.  Now there is, at least in healthy normal-weight women.

The Journal of the American Dietetic Association in July, 2008, reported a study in which 30 women were told to eat as much at meals as they wanted, until they were satisfied.  The abstract of the article doesn’t specify, but I assume each participant was studied for several meals and was told to eat either slowly or quickly at different meals.

When eating quickly, the women ate 646 calories per meal.  Eating slowly resulted in 579 calories per meal.  67 calories less per meal doesn’t sound like much, but would quickly add up over time to a substantial calorie deficit which could help with weight loss.  Additionally, satisfaction with the meal was higher under the slow eating condition.

So if you’re watching your weight, why not slow down and enjoy your meals?

Steve Parker, M.D., author of The Advanced Mediterranean Diet

Reference: Andrade, Ana M., Greene, Geoffrey W., and Melanson, Kathleen J.  Eating slowly led to decreases in energy intake within meals in healthy women.  Journal of the American Dietetic Association, 108 (2008): 1,186-1,191.