Advanced Mediterranean Diet

 AAPS is the first national physician group to sue the federal government over the the Democrat’s new healthcare reform law, according to an article at MedPageToday.  The challenge is based on violations of both the Fifth and Tenth Amendments to the U.S. Constitution, which the polititians had taken an oath to uphold. 

The new law will interfere greatly with the patient-physician relationship, inserting politicians and bureaucrats into the middle.  Patients will suffer. 

Steve Parker, M.D. 

Of all the behavioral aspects of diabetes management, none is more important than nutrition.  However, nutritional control is usually not well done by patients and is largely ignored by physicians.

—David K. McCulloch, M.D., Clinical Professor of Medicine, University of Washington

—in “Insulin therapy in type 1 diabetes mellitus,” UpToDate.com, version 17.3, September, 2009

There are no secrets to success.  It is the result of preparation, hard work, learning from failure.

                                                               -Colin Powell

I’ve updated my blogroll.

If you have some spare time, click through to a few and see if they tickle your fancy.    

I find these blogs either educational, amusing, provocative, honest, enlightening, generous, intriguing, pleasurable, reliable, worthwhile, supportive, relaxing, or challenging.  

Of course, by no means do I endorse everything you’ll see there.  Caveat lector. 

Nevertheless, I’m constantly impressed by the quality of writing and information these folks are sharing for our benefit.

Steve Parker, M.D.

It’s here.  It’s online.  It’s free.  It’s…

The Low-Carb Mediterranean Diet

For the last year I’ve been working on a comprehensive adaptation of the Mediterranean diet for people with type 2 diabetes and prediabetes.  Why?  Type 2 diabetics are prone to premature heart attacks, strokes, dementia, and death.  The Mediterranean diet, at least in the general population, prevents those illnesses and prolongs lifespan.  So the Mediterranean diet is a natural for diabetics.

But there’s a problem.  

The relatively high carbohydrate content of the traditional Mediterranean diet has the potential to raise blood sugar levels unacceptably high in people with diabetes.  High blood sugar levels are linked with worse health outcomes.  So, the Mediterranean diet without modification is a double-edged sword.  We’re caught between the horns of a dilemma.  [Insert favorite metaphor here.] 

Last fall, I designed the Ketogenic Mediterranean Diet which incorporates many of the healthy features of the Mediterranean diet while drastically reducing carbohydrate (carb) consumption.  High blood sugar levels drop significantly in most type 2 diabetes on the Ketogenic Mediterranean Diet. 

Many Ketogenic Mediterranean dieters are interested in expanding their carbohydrate options and consumption.  The Low-Carb Mediterranean Diet (LCMD) does that while aiming to control both excess weight and high blood sugar levels in diabetics, prediabetics, metabolic syndrome.  

Non-diabetics on the KMD may continue with it or move on to the LCMD if they wish. 

The Low-Carb Mediterranean diet is the world’s first published low-carbohydrate Mediterranean Diet, by the way.  How low-carb?  The KMD supplies about 5% of energy (calories) as carbohydrate; the LCMD goes to the 10–20% range.  [By way of reference, most people eat around 55% of total calories as carbs.] 

My goal a year ago was to help my personal patients with type 2 diabetes gain the health benefits of the traditional Mediterranean diet: longer lifespan and lower rates of heart attack, stroke, cancer, chronic lung disease, dementia, and Parkinsons disease, for example.  It’s my sincere hope that it benefits others as well.

Steve Parker, M.D.  

Disclaimer:  All matters regarding your health require supervision by a personal physician or other appropriate health professional familiar with your current health status.  Always consult your personal physician before making any dietary or exercise changes.

Update July 8, 2010:  I originally rolled out this new eating program in March, 2010, labelled as the Diabetic Mediterranean Diet, version 1.0.  I re-named it a few days ago. 

Here’s my review of The New Atkins for  a New You, a weight-loss book by Dr. Eric Westman, Dr. Stephen Phinney, and Dr. Jeff Volek released a week ago.  The copyright holder is Atkins Nutritionals, Inc.  Under Amazon.com’s five-star rating system, I give it four stars (”I like it”).  

♦   ♦   ♦ 

The most exciting nutritional medicine development in recent memory is the fact that saturated fat consumption is not a significant cause of heart disease and premature death. The same goes for for total fat and cholesterol.  When enough physicians, nutritionists, and dietitians learn this, low-carb eating will take off like a rocket.

For those unfamiliar with the Atkins diet, it is designed for weight loss via high fat consumption and major carbohydrate restriction.  Protein intake is a bithigher than average.  As long as carbohydrates (carbs) are kept low, other foods are mostly unlimited.  Atkins has four phases.  As you graduate from one phase tothe next, more carbs are allowed, adding some carb sources before others (the Carb Ladder). 

Atkins has been around for years.  It’s not just a weight-loss diet; it’s a lifetime way of eating.

Doctors Westman, Phinney, and Volek are leaders in low-carb nutritional science.  The last time Atkins peaked (2003), we didn’t have the scientific studies backing up safety of the diet.  Now we do, in large part thanks to these guys. 

Physicians see beaucoup patients with overweight-related medical conditions.  We’re not going to recommend a diet that causes heart attacks, strokes, and other major medical complications.  Published research over the last eight years has established the relative safety of very low-carb diets, particularly Atkins.  Low-carb diets may even be healthier than the low-fat, high-carb diet that has been recommended by U.S. public health authorities for the last forty years.  Come to think of it, our current obesity and diabetes epidemics started around that same time.

The book covers nutrition basics, day-to-day practical application of Atkins eating, recipes and detailed meal plans, and the science behind the program.    

What’s New Since Dr. Atkins’ 2002 Book?

• adaptations for vegetarians and vegans
• adaptations for Latinos
• coffee is now OK
• introduction of the term “foundation vegetables” and almost doubling the amount of vegetables allowed in Phase 1: “approximately six cups of salad and up to two cups of cooked vegetables, depending upon the ones you select”
• more flexility, such as the option to skip Phase 1 (induction)
• focus on adequate protein intake, based on your height
• emphasis on getting enough omega-3 fatty acids
• no emphasis on supplements and low-carb products sold by Atkins Nutritionals,Inc.
• diet journals—a personal record of your weight-loss journey—are recommended
• eliminate or minimize “induction flu” and constipation (in Phase 1) by eating at least 1/2 teaspoon of salt daily [I’m skeptical.]
• discussion of the trendy omega-6/omega-3 fatty acid ratio
• favor monounsaturated fatty acids (e.g., olive oil, canola oil) over certain polyunsaturated fats, as in oils from corn, soybeans, sunflower, cottonseed, and peanuts
• no mention of testing urine for ketosis
• more discussion of psychological aspects of weight

The lack of ads for Atkins Nutritionals products is welcome and refreshing.  Too many of the official Atkins books read like infomercials, which diminishes credibility.

A vegetarian or vegan “Atkins diet” is just not something I can visualize.

What Could Have Been Done Better?

• no specific amounts given for these recommended supplements: calcium, vitamin D, omega-3 fats, multivitamin, magnesium and other minerals (except “no iron”).  [Is the idea to encourage a visit the official Atkins website?]
• little guidance for physicians who are to advise diabetics doing Atkins.  Few physicians are familiar enough with the program to make the necessary changes in particular diabetic medications.
• little discussion of the constipation and leg cramps that often accompany very low-carb diets
• the hype on the cover: “How would you like to LOSE UP TO 15 POUNDS IN TWO WEEKS!”  [To their credit, the authors note that such results are not typical.]
• nearly all the measurements are U.S. Customary.  Metric users are out of luck.
• four phases seem a bit much.  The beauty of Atkins Phase 1 is its simplicity. 

My favorite sentence: “White flour is better suited to glue for kindergarten art projects than to nutrition.”

My least favorite sentence: “We can’t stress strongly enough that the best diet for you is one composed of foods you love.”  I love apple pie and Cinnabon cinnamon rolls, but they won’t help me manage my weight.

The only error I found worth mentioning is minor.  The authors state that the American Heart Association recommends consumption of fish three times a week. The official policy is still “at least twice weekly.”

The book is very practical and easily understood by average people.  Most will skip the science chapters at the end.  I know the basic Atkins program works at least short-term; many of my patients have done it.

In summary, the book has nearly everything you need to be successful with the Atkins diet. 

As far as I know, there are no comprehensive long-term studies (e.g., 10+ years) regarding health outcomes of Atkins-style eating.  In other words, does Atkins have any effect on longevity, cancer, heart attacks, strokes, etc.?  But very few of the popular diets have these data either.  The best researched ways of eating in this respect are the Mediterranean diet and vegetarian diets.

Numerous scientific studies document the long-term health benefits of the Mediterranean diet, including improved longevity and lower rates of heart disease, stroke, type 2 diabetes, cancer, and dementia.

Steve Parker, M.D.

Disclosure:  I was given nothing of value for this review by the authors, publisher, or Atkins Nutritionals, Inc.  It was written for the benefit of my patients and readers.

When you sell a man a book, you don’t sell him 12 ounces of paper and ink and glue - you sell him a whole new life.

                                                             - Christopher Morley

Setting a goal of walking 10,000 steps a day could motivate you to become active enough to gain the health benefits of exercise.  You count steps automatically with a pedometer.  Regular exercise also helps keep lost weight from returning.

Thanks to the Internet, you can waste spend lots of time reviewing features of pedometers before you make a purchase. 

Consumer Reports magazine in February, 2009, reviewed pedometers and their #1 Best Buy recommendation was the Omron HJ 112, which you can clip to your belt or waistband, or carry in your purse.  Available for around $15-30 (U.S. dollars). 

No. 2 was the Accusplit AE 170 XGL ($30-35).  The Accusplit AE 170 may be just as good.  The only difference I see is that you can enter specific goals into the XGL. 

The Omron HIP (HJ 150, $20) is also very popular and probably the simplest one to use on this page.

The guys at Obesity Panacea blog recommend the Omron HJ-303 ($35), which you can carry in your pocket instead of clipped to your waistband.

You don’t have to be a marathoner or gym rat to gain most of the health benefits of exercise.  Why not start a walking program today?

Steve Parker, M.D.

Disclosure:  I was not paid to mention these products.  I haven’t owned or used any of them.  If you are a device manufacturer or sales representative and would like me to try your pedometer, please contact me by e-mail.

We’ve been told by the authorities repetitively that eating plenty of fruits and vegetables will lower our risk of cancer.  [As in my last blog post.]  However, a recent study in the American Journal of Clinical Nutrition, says that ain’t so.

Fire up the grill—we’re havin’ steak tonight!

Researchers looked at data from over 450,000 participants (men and women over 50) in the National Institutes of Health—AARP Diet and Health Study.  Diet data was collected by self-administerd questionnaire.  State-level cancer registries identified the cancers that developed during the average follow-up of seven years.

Their conclusions and selected comments:

Intake of fruit and vegetables was generally unrelated to total cancer incidence in this cohort.

However, on the basis of animal studies, human case control and cohort studies, and randomized controlled trials, there is likely no harm associated with the consumption of fruit and vegetables and their consumption may prevent cardiovascular disease.

Indeed, analyses in this cohort and in others that have investigated dietary patterns rich in fruit and vegetables have found reduced risks of colorectal cancer [three references cited] and mortality, including death from cardiovascular disease and all cancers [one reference was cited supporting reduced deaths from CVD and all cancers—a Mediterranean diet study].

As in all good science reports, the researchers compare and contrast their findings with similar published research.  They note that theirs is one of only four large cohort studies that have examined this issue.  Two of the other three (see references below) also found no association between total cancers and fruit and vegetable consumption.  The one that did find a beneficial linkage was the smallest of the four, so not as compelling.

Before this research was published, some experts suggested that adequate fruit and vegetable intake could prevent between 5 and 12% of cancers.

Eat your fruits and vegetables because they taste good, provide myriad nutrients, and may have some other healthful properties.  But not to lower overall cancer risk.  

Steve Parker, M.D.

References:

George, Stephanie, et al.   Fruit and vegetable intake and risk of cancer: a prospective cohort study.  American Journal of Clinical Nutrition, 89 (2009): 347-353. 

Hung, H.C., et al.  Fruit and vegetable intake and risk of major chronic disease.  Journal of the National Cancer Institute, 96 (2004): 1,577-1,584.

Takachi, R., et al.  Fruit and vegetable intake and risk of total cancer and cardiovascular disease [in Japan].  American Journal of Epidemiology, 167 (2008): 59-70.

Benetou, V., et al.  Vegetables and fruit in relation to cancer risk: evidence from the Greek EPIC Cohort Study.  Cancer Epidemiology, Biomarkers, and Prevention, 17 (2008): 387-392.

How many times have you heard how important it is to eat fruits  and vegetables?  Now, is it five or nine servings a day?  Why are fruits and veggies always lumped together?  What does a watermelon have in common with spinach?

The author of a 2004 article in the Journal of Postgraduate Medicine answered some of these questions.  Here are a few quotes from from the summary:

The intake of 400-600 g/d of fruits and vegetables is associated with reduced incidence of many common forms of cancer, and diets rich in plant foods are also associated with a reduced risk of heart disease and many chronic diseases of ageing.

These foods contain phytochemicals that have anti-cancer and anti-inflammatory properties which confer many health benefits. Many phytochemicals are colourful, and recommending a wide array of colourful fruits and vegetables is an easy way to communicate increased diversity of intake to the consumer. For example, red foods contain lycopene, the pigment in tomatoes, which is localized in the prostate gland and may be involved in maintaining prostate health, and which has also been linked with a decreased risk of cardiovascular disease. Green foods, including broccoli, Brussels sprouts and kale, contain glucosinolates which have also been associated with a decreased risk of cancer. Garlic and other white-green foods in the onion family contain allyl sulphides which may inhibit cancer cell growth. Other bioactive substances in green tea and soybeans have health benefits as well.

Consumers are advised to ingest one serving of each of the seven colour groups daily, putting this recommendation within the United States National Cancer Institute and American Institute for Cancer Research guidelines of five to nine servings per day. Grouping plant foods by colour provides simplification, but it is also important as a method to help consumers make wise food choices and promote health.

Asking U.S. consumers to eat one serving from each of seven fruit and vegetable color groups daily is a bit much.  I don’t see that happening.  But the suggestion is a start.  Darya Pino (Summer Tomato blog) probably does it every day, but I don’t know any others.  My simplified message: Eat a variety of colorful fruits and veggies daily.

Note that the very low-carb Ketogenic Mediterranean Diet provides 400 grams of vegetables and fruits daily, and I count seven colors (assuming you allow me to include black olives).  On the KMD document I list avocado, cucumber, and tomato under “vegetables,” but they are indeed fruits.  Heck, I guess olives are fruit, too.

“So, what’s your point, Parker,” you might well ask.  I don’t expect anyone to follow the Ketogenic Mediterranean Diet for life.  When it’s time to move on to a “Diabetic Mediterranean Diet,” I’m considering adding more options: traditional fruits and some colorful vegetables like purple beets, yellow corn, and orange carrots and sweet potatoes.

I still don’t know why “fruits and vegetables” are joined at the hip.  Legumes, grains, and dairy products all rate their very own category.  It’s just not fair.

Steve Parker, M.D.

Reference:  Heber, D.  Vegetables, fruits and phytoestrogens in the prevention of diseases.  Journal of  Postgraduate Medicine, 50 (2004): 145-9.

Update: March 8, 2010

Beth at Weight Maven blog put together a colorful graphic showing the major foods and phytonutrients associated with particular colors, based on Dr. Heber’s work.