Advanced Mediterranean Diet

Japanese researchers recently documented that daily vinegar reduces body weight, fat mass, and triglycerides in overweight Japanese adults. 

Beverages containing vinegar are commonly consumed in Japan.  The main component—4 to 8%— of vinegar is acetic acid.  Vinegar can lower cholesterol levels, lower blood pressure, and limit increases in blood sugar after meals. 

Japanese researchers studied the effects of vinegar on 175 overweight—body mass index between 25 and 30—subjects aged 25 to 60.  Men totaled 111; women 64.  Average weight 74.4 kg (164 pounds).  They were divided into three groups that received either a placebo drink, 15 ml apple vinegar (750 mg of acetic acid), or 30 ml apple vinegar (1,500 mg acetic acid).  Placebo and vinegar were mixed into 500 ml of a beverage, half of which was drunk twice daily after breakfast and supper for 12 weeks.  Changes in body fat were measured with CT technology.  Subjects were told to eat  and exercise as usual.   

Results

By the end of the 12 weeks, weight had decreased by 1-2 kg (2.2 to 4.4 pounds) in the vinegar drinkers, with 30 ml of vinegar a bit more effective.  CT scanning showed that the lost weight was fat mass rather than muscle or water.  Triglyceride levels in the vinegar groups fell by about 20%.  The placebo drinkers saw no changes. 

Four weeks after the intervention ended, subjects were retested: values had returned to their baseline, pre-study levels. 

The scientists report that the acetic acid in vinegar inhibits production of fat and may stimulate burning of fat as fuel.  Although vinegar contains many other ingredients, they think the acetic acid is responsible for the observed changes.

My Comments

It’s possible that apple vinegar components other than acetic acid led to the weight loss and lowered triglyceride levels.  Further study could clarify this.

Remember that weight lossed was regained after the vinegar was discontinued.  Would you want to drink the vinegar indefinitely to maintain a loss of 2-4 pounds?  Probably not, unless you like vinegar.  But adding 12 weeks of vinegar to your weight-loss program might be worth it if you’re just preparing for a school reunion or the start of swimsuit season.  

These results may or may not be applicable to non-Japanese races.

This study supports the use of vinaigrette as a salad or vegetable dressing in people trying to lose weight with diets such as the Ketogenic Mediterranean Diet or Advanced Mediterranean Diet.  Vinaigrettes are combinations of olive oil and vinegar, often with various spices added.  If you eat a salad twice a day, it would be easy to add 15 ml (1 tbsp) of vinegar to your diet daily. 

With a little imagination, you could come up with other ways to add 15–30 ml (1–2 tbsp) of vinegar to your diet.

Steve Parker, M.D.

Reference:  Kondo, Toomoo, et al.  Vinegar intake reduces body weight, body fat mass, and serum triglyceride levels in obese Japanese subjects.  Bioscience, Biotechnology, and Biochemistry, 73 (2009): 1,837-1,843.

Did you get enough to eat for Thanksgiving?  Did you gain a pound or two, like me?

Around this time of year, many people start thinking seriously about losing excess weight and getting healthier.  Choosing a weight-loss program is not something to be done on a whim.  That’s a recipe for failure.  So I’ve updated my popular eight-part “Prepare for Weight Loss” series.  After laying some groundwork, it helps you pick a reasonable weight-loss program suited to you. 

Well begun is half done:  It’s as true for weight loss as it is for other projects.

Steve Parker, M.D.

I must give credit to Dr. Robert C. Atkins for popularizing an approach - carbohydrate restriction - that helps people with diabetes control their disease, and likely helps prevent type 2 diabetes in others.  Mary C. Vernon and Jacqueline Eberstein do a great job explaining his program in their 2004 book, Atkins Diabetes Revolution: The Groundbreaking Approach to Preventing and Controlling Type 2 Diabetes. 

On the Amazon.com five-star rating scale, I give this book four stars.

I can best summarize this book by noting that it is the standard Atkins diet with a few modifications: 1) special supplements  2) you add additional carbs to your diet more slowly  3) the warning that diabetics may well end up with a lower acceptable lifetime carbohydrate intake level.

By way of review, the Atkins diet is a very low-carb diet, particularly in the two-week induction phase.  “Very low-carb” means lots of meat, chicken, fish, eggs, limited cheese, and 2-3 cups daily of salad greens and low-carb veggies like onions, tomatoes, broccoli, and snow peas.  After induction phase, you slowly add back carbs on a weekly basis until weight loss stalls, then you cut back on carbs.

As an adult medicine specialist, I have no expertise in pediatrics.  I didn’t read the two chapters related to children.

The authors present “complimentary medicine”in a favorable light.  Unsuspecting readers need to know that much of complementary medicine is based on hearsay and anecdote, not science-based evidence.  In that same vein, the two chapters on supplements for diabetes and heart disease recommend a cocktail of supplements that I’m not convinced are needed.  I don’t know a single endocrinologist or cardiologist prescribing these concoctions.  Then again, I could be wrong.   

Vernon and Eberstein provide two excellent chapters on exercise.

A month of meal plans and recipes are provided for 20, 40, and 60-gram carbohydrate levels.  [The average American is eating 250-300 g of carbs daily.]  The recipes look quick and easy, but I didn’t prepare or taste any of them.

The 5-hour glucose and insulin tolerance test (GTT, paged 61) that Dr. Atkins reportedly ran on all patients who came to him is rarely done in other medical clinics.  This doesn’t mean it’s wrong, but certainly out of the mainstream.  The authors admit that at least a few people will have to count calories - specifically, limit total calories - if the basic program doesn’t control diabetes, prediabetes, and the metabolic syndrome.  Limiting portion size will speed weight loss, they write.

What we don’t know with certainty is, will long-term Atkins aficionados miss out on the health benefits of higher consumption of fruits, vegetables, legumes, and whole grains?  Much of the scientific literature suggests, “Yes.”

What if we compare the long-term outlooks of a diabetic Atkins follower with a poorly controlled diabetic who’s 80 pounds overweight and eating a standard American diet?  The Atkins follower is quite likely to be healthier  and live longer.

Steve Parker, M.D.

Five servings of cod per week led to loss of an extra 3.7 pounds (1.7 kg) over eight weeks, according to a recent research report. 

European researchers noted that cod consumption in a prior study enhanced weight loss.  They wondered if that result could be reproduced, and whether the effect was “dose dependent.”  In other words, would those eating more cod lose more weight than those eating less?

They studied 125 subjects between the ages of 20 and 40, with body mass index between 27.5 and 32.5.  The abstract doesn’t mention sex of the participants.  They were all placed on calorie-restricted diets with identical percentages of protein, fat, and carbohydrate, and were followed for eight weeks.  Researchers divided the subjects into three groups:

1. One group was given 150 g (a little over 5 ounces)  of cod three times weekly
2. Another group was given 150 g cod five times weekly
3. The third group was given no seafood

Average weight loss overall was  11 pounds (5 kg).  The more cod consumed, the greater the weight loss.  Those eating five servings a week averaged 3.7 pounds (1.7 kg) more than the group not eating seafood. 

It’s unclear whether other types of fish would produce similar results.

These results support the prominent role of fish in the Ketogenic Mediterranean Diet. 

Steve Parker, M.D.

Reference:  Ramel, A., et al.  Consumption of cod and weight loss in young overweight and obese adults on an energy reduced diet for 8-weeks.  Nutrition, Metabolism and Cardiovascular Diseases, 19 (2009): 690-696.

In reality, those who repudiate a theory that they had once proposed, or a theory that they had accepted enthusiastically and with which they had identified themselves, are very rare.  The great majority of them shut their ears so as not to hear the crying facts, and shut their eyes so as not to see the glaring facts, in order to remain faitthful to their theories in spite of all and everything.

Nicolas Maurice Arthus

in Philosophy of Scientific Investigation, 1921

Judicious alcohol consumption is linked to lower risk of developing type 2 diabetes: 40% lower risk in women, 13% lower in men. 

Why does this matter? 

• 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. 

The latest issue of Diabetes Care reports the comparison of lifetime abstainers with alcohol drinkers.  The protective “dose” of alcohol is 22–24 grams a day.  I’ll leave it to you to figure out how much alcohol that is.  Prior studies looking at overall health benefits of alcohol indicate that judicious consumption is ≤ one drink daily, on average,  for women, and  ≤ 2 drinks a day for men.

Of course, many people shouldn’t drink any alcohol.  

Steve Parker, M.D.  

Reference:  Baliunas, D., et al.  Alcohol as a risk factor for type 2 diabetes: A systematic review and meta-analysis.  Diabetes Care, 32 (2009): 2,123-2,132.

Just weeks after I reported about fish consumption being linked to higher risk of type 2 diabetes, a different study reports the opposite.

The Norfolk, England, wing of the European Prospective Investigation of Cancer found a 25% lower risk of developing diabetes in adults who ate one or more servings of fish weekly, compared with those who ate less than that.  What kind of fish?  White fish and oily fish. 

Contradictory results like this are not uncommon in the field of science. 

Steve Parker, M.D.

Reference:  Patel, P., et al.  Association between type of dietary fish and seafood intake and the risk of incident type 2 diabetes.  The EPIC-Norfolk cohort study.  Diabetes Care, 32 (2009): 1,857-1,863.

Over half of those hospitalized or dead form swine flu this year in California were obese, according to the November 4 issue of the Journal of the American Medical Association.

What’s obese?  A 5 foot, 4-inch person over 175 pounds or a 5-foot, 10-inch person over 209 pounds.

 I interpret this as yet another reason to lose that excess weight.  Why not get started today?

 Steve Parker, M.D.

Nut consumption is strongly linked to reduced coronary heart disease, with less rigorous evidence for several other health benefits, according to a recent article in the American Journal of Clinical Nutrition.

This is why I’ve included nuts as integral components of the Ketogenic Mediterranean Diet and the Advanced Mediterranean Diet.

Regular nut consumption is associated with health benefits in observational studies of various populations, within which are people eating few nuts and others eating nuts frequently.  Health outcomes of the two groups are compared over time.  Frequent and long-term nut consumption is linked to:

• reduced coronary heart disease (heart attacks, for example)
• reduced risk of diabetes in women (in men, who knows?)
• less gallstone disease in both sexes
• lower body weight and lower risk of obesity and weight gain 

The heart-protective dose of nuts is three to five 1-ounce servings a week.

Steve Parker, M.D.

Reference:  Sabaté, Joan and Ang, Yen.  Nuts and health outcomes: New epidemiologic evidence.  American Journal of Clinical Nutrition, 89 (2009): 1,643S-1,648S.