Advanced Mediterranean Diet

What’s “aerobic activity”? Just about anything that mostly makes you huff and puff. In other words, get short of breath to some degree. Examples are brisk walking, swimming, golf (pulling a cart or carrying clubs), lawn work, painting, home repair, racket sports and table tennis, house cleaning, leisurely canoeing, jogging, bicycling, jumping rope, and skiing. The possibilities are endless. A leisurely stroll in the shopping mall doesn’t qualify, unless that makes you short of breath. Don’t laugh: that is a workout for many who are obese.

But which aerobic physical activity is best? Glad you asked!

The most important criterion is that it be pleasant for you. If not outright fun, it should be often enjoyable and always tolerable.

Your exercise of choice should also be available year-round, affordable, safe, and utilize large muscle groups. The greater mass and number of muscles used, the more calories you will burn, which is important if you’re trying to lose weight or prevent gain. Compare tennis playing with sitting in a chair squeezing a tennis ball repetitively. The tennis player burns calories much faster. Your largest muscles are in your legs, so consider walking, biking, many team sports, ski machines, jogging, treadmill, swimming, water aerobics, stationary cycling, stair-steppers, tennis, volleyball, roller-skating, rowing, jumping rope, and yard work.

Walking is “just what the doctor ordered” for many people. It’s readily available, affordable, usually safe, and requires little instruction. If it’s too hot, too cold, or rainy outside, you can do it in a mall, gymnasium, or health club.

Another option is instructional exercise DVDs, often featuring either a celebrity or prominent fitness trainer. Many of these programs require only a pair of sneakers and loose clothing. Others include the option of using inexpensive equipment, such as light hand-held weights.

If exercise videos sound appealing, consider one of these: Walk Away the Pounds—Walk Strong, by Leslie Sansone; Tighter Assets With Tamilee: Weight Loss & Cardio, by Tamilee Webb; Burn & Firm—Circuit Training, by Karen Voight; Minna Optimizer—Balanced Blend, by Minna Lessig; Personal Training System, by Denise Austin; Timesaver—Lift Weights to Lose Weight (volumes 1 & 2), Super Slimdown Circuit, and Functionally Fit—Peak Fat Burning, by Kathy Smith. Search for these titles at Amazon.com, where you can read reviews of them by actual users. Although many of these are designed for weight loss, you’ll get a good workout even if you’re at a healthy weight. Several of them also feature strength training.

Another fun option for indoor aerobic exercise is Dance Dance Revolution by Konami. Perhaps you’ve seen a version of this video game in an arcade. You must use a video game console, such as a PlayStation or Xbox, and the Dance Dance Revolution Controller along with your TV screen. The controller is a 32 inch by 36 inch (81 x 91 cm) floor pad partitioned into several large squares. The TV screen shows you which squares to step on in sequence as the music plays, and you rack up points for accurate timing and foot placement. If you enjoy moving to music, it’s more fun than I can describe

The latest indoor computerized exercise gadgets are the Kinect for Microsoft’s Xbox 360, the PlayStation Move, and Wii Fit. Check’em out.

Steve Parker, M.D.

I’m near the end of Week 5 of the regular program but I had to do three weeks of preliminary work before I could start where younger, more athletic people start.  It’s going well and I have no regrets about choosing this plan.

The workouts are taking 30–45 minutes.  My least favorite part is “ESD”: Energy System Development.   Most others call it cardio or aerobics: steady work to get the heart rate up and keep it up for minutes on end.  I don’t like it because it just feels like uncomfortable work.  I’ve been jogging on dirt trails around my house.  In preparation for hot desert weather, I’m trying out my wife’s treadmill.  A speed of five miles per hour and 2% grade will get my heart rate up to 140.  I stayed between 128 and 140 for 30 minutes today. 

Verstegen gives you target heart rates to shoot for.  I’m still in such poor shape that it doesn’t take much exercise to get me up to 120.  You don’t have to run; you could use a bike, elliptical machine, stairclimber, swim, jump rope, etc.  

Doug McGuff disparages the benefits of cardio, but I disagree and think it helps in developing endurance and gaining the long-term benefits of exercise, such as longevity and reduced cardiovascular disease.  If I’m camping with a Boy Scout troop in the wilderness and a medical emergency develops, I suspect a person with strong cardio background will be better able to run for help.

Injury Update

• Left posterior chest pain (soft tissue strain) still there but almost gone, and not interfering with exercise or sleep.

I have some creaking in my knees (aka crepitus) during certain maneuvers, such as lunges, but no pain.  I’m anxious to avoid knee ligament and meniscus injuries.

Steve Parker, M.D.

In the U.S., 24 million people have diabetes, mostly type 2.  That’s one in 10 adults.  The number for those over 60 is two in 10. 

Fifty-seven million have prediabetes; that’s one of every three adults.  Most of them are unaware of it.

The American Diabetes Association offers an online diabetes and prediabetes risk assesment.  Why not check your odds?

Steve Parker, M.D., author of Conquer Diabetes and Prediabetes: The Low-Carb Mediterranean Diet

At my Diabetic Mediterranean Diet blog, I recently noted that regular physical activity prevented or postponed death.  Onward now to other benefits.

Waist Management

Where does the fat go when you lose weight dieting?  Chemical reactions convert it to energy, water, and carbon dioxide, which weigh less than the fat.  Most of your energy supply is used to fuel basic life-maintaining physiologic processes at rest, referred to as resting or basal metabolism.  Basal metabolic rate (BMR) is expressed as calories per kilogram of body weight per hour.

The major determinants of BMR are age, sex, and the body’s relative proportions of muscle and fat.  Heredity plays a lesser role.  Energy not used for basal metabolism is either stored as fat or converted by the muscles to physical activity.  Most of us use about 70 percent of our energy supply for basal metabolism and 30 percent for physical activity.  Those who exercise regularly and vigorously may expend 40–60 percent of their calorie intake doing physical activity.  Excess energy not used in resting metabolism or physical activity is stored as fat.

Insulin, remember, is the main hormone converting that excess energy into fat; and carbohydrates are the major cause of insulin release by the pancreas.

To some extent, overweight and obesity result from an imbalance between energy intake (food) and expenditure (exercise and basal metabolism).  Excessive carbohydrate consumption in particular drives the imbalance towards overweight, via insulin’s fat-storing properties.

In terms of losing weight, the most important metabolic effect of exercise is that it turns fat into weightless energy.  We see that weekly on TV’s “Biggest Loser” show; participants exercise a huge amount.  Please be aware that conditions set up for the show are totally unrealistic for the vast majority of people.

Physical activity alone as a weight-loss method isn’t very effective.  But there are several other reasons to recommend exercise to those wishing to lose weight.  Exercise counteracts the decrease in basal metabolic rate seen with calorie-restricted diets.  In some folks, exercise temporarily reduces appetite (but others note the opposite effect).  While caloric restriction during dieting can diminish your sense of energy and vitality, exercise typically does the opposite.  Many dieters, especially those on low-calorie poorly designed diets, lose lean tissue (such as muscle and water) in addition to fat.  This isn’t desirable over the long run.  Exercise counteracts the tendency to lose muscle mass while nevertheless modestly facilitating fat loss.

How much does exercise contribute to most successful weight-loss efforts?  Only about 10 percent on average. The other 90 percent is from food restriction.

Fountain of Youth

Regular exercise is a demonstrable “fountain of youth.”  Peak aerobic power (or fitness) naturally diminishes by 50 percent between young adulthood and age 65.  In other words, as age advances even a light physical task becomes fatiguing if it is sustained over time.  By the age of 75 or 80, many of us depend on others for help with the ordinary tasks of daily living, such as housecleaning and grocery shopping.  Regular exercise increases fitness (aerobic power) by 15–20 percent in middle-aged and older men and women, the equivalent of a 10–20 year reduction in biological age!  This prolongation of self-sufficiency improves quality of life.

Heart Health

Exercise helps control multiple cardiac (heart attack) risk factors: obesity, high cholesterol, elevated blood pressure, high triglycerides, and diabetes.  Regular aerobic activity tends to lower LDL cholesterol, the “bad cholesterol.”  Jogging 10 or 12 miles per week, or the equivalent amount of other exercise, increases HDL cholesterol (“good cholesterol”) substantially.  Exercise increases heart muscle efficiency and blood flow to the heart.  For the person who has already had a heart attack, regular physical activity decreases the incidence of fatal recurrence by 20–30 percent and adds an extra two or three years of life, on average.

Effect on Diabetes

Eighty-five percent of type 2 diabetics are overweight or obese.  It’s not just a random association.  Obesity contributes heavily to most cases of type 2 diabetes, particularly in those predisposed by heredity.  Insulin is the key that allows bloodstream sugar (glucose) into cells for utilization as energy, thus keeping blood sugar from reaching dangerously high levels.  Overweight bodies produce plenty of insulin, often more than average.  The problem in overweight diabetics is that the cells are no longer sensitive to insulin’s effect.  Weight loss and exercise independently return insulin sensitivity towards normal.  Many diabetics can improve their condition through sensible exercise and weight management.

Miscellaneous Benefits

In case you need more reasons to start or keep exercising, consider the following additional benefits: 1) enhanced immune function, 2) stronger bones, 3) preservation and improvement of flexibility, 4) lower blood pressure by 8–10 points, 5) diminished premenstrual bloating, breast tenderness, and mood changes, 6) reduced incidence of dementia, 7) less trouble with constipation, 7) better ability to handle stress, less trouble with insomnia, 9) improved self-esteem, 10) enhanced sense of well-being, with less anxiety and depression, 11) higher perceived level of energy, and 12) prevention of weight regain.

People who lose fat weight but regain it cite lack of exercise as one explanation.  One scientific study by S. Kayman and associates looked at people who dropped 20 percent or more of their total weight, and the role of exercise in maintaining that loss.  Two years after the initial weight loss, 90 percent of the successful loss-maintainers reported exercising regularly.  Of those who regained their weight, only 34 percent were exercising.

Stay tuned for my specific exercise recommendations.

Steve Parker, M.D.

Researchers note lower risk of asthma symptoms in Greek 10- to 12-year-olds following a traditional Mediterranean diet, according to a recent Journal of the American Dietetic Association.

I reported in 2008 on a Portuguese study that found much improved control of adult asthma in those eating a Mediterranean diet.  Why, I even seem to recall a study that found a lower incidence of asthma in children of mothers who ate Mediterranean-style.

If you’re an overweight adult with asthma, why not look into the Sonoma Diet by Connie Guttersen, or my Advanced Mediterranean Diet?  People with diabetes or prediabetes may do better with the Low-Carb Mediterranean Diet.

Steve Parker, M.D.

To get the full health benefits of regular physical activity, you need to put some effort into it.  A leisurely hour-long stroll in the mall while window-shopping doesn’t pass muster, although that’s better than nothing.

One rough way to gauge whether you’re working hard enough during aerobic exercise is to monitor your heart rate, also known as pulse.  Subtract your age from 220.  The result is your theoretical maximum heart rate in beats per minute.  Your heart rate goal, or target, during sustained aerobic exercise is a pulse that is 60 to 80 percent of your theoretical maximum pulse.  For example: maximum heart rate for a 40-year-old is 180 (220 - 40 = 180), so the target heart rate zone during exercise is between 108 and 144 (60 to 80 percent of 180).  Exceeding the upper end of the target zone is usually too uncomfortable to be sustainable.  Exercise heart rates below the target zone suggest you’re not working hard enough to reap the full long-term benefits of aerobic exercise.

Here’s how to determine your pulse.  After five or 10 minutes of exercise, stop moving and place the tips of your first two fingers lightly over the pulse spot inside your wrist just below the base of your thumb.  Count the pulsations for 15 seconds and multiply the number by four.  The result is your pulse or heart rate.  It will take some practice to find those pulsations coming from your radial artery.  If you can’t find it, ask a nurse or doctor for help.

Like all rules-of-thumb, this target heart rate zone isn’t always an accurate gauge of cardiovascular workout intensity.  For instance, it is of very little use in people taking drugs called beta blockers, which keep a lid on heart rate.

As you become more fit, you’ll notice that you have to work harder to get your heart rate up to a certain level.  This is a sure sign that your heart and muscles are responding to your challenge.  You may also want to monitor your resting heart rate taken in the morning before you get out of bed.  Unfit, sedentary people have resting pulses of 60 to 90.  Athletes are more often in the 40s or low 50s.  Their hearts have become more efficient and just don’t need to beat as often to get the job done.

As you become more fit, you’ll also notice that you have more energy overall and it’s easier to move about and handle physical workloads.  You’ll feel more relaxed and have a sense of accomplishment.  Expect these benefits eight to 12 weeks after starting a regular exercise program.

Steve Parker, M.D.

I still like the program.  Exercises are similar to last week.  Time committment is only 25-40 minutes a day.  Yesterday I set a new personal record as a bowling score—175.  Can I credit Core Performance, or was I just having a good day?  Difficult to be sure, but I suspect the exercise is the reason.

Injury Update

• Left chest pain from soft tissue strain is slowly getting better.
• Right hip pain is gone.

Before this gets boring, I’ll reduce my Core Performance reports to less than weekly. 

Steve Parker, M.D.

I recently read Secrets for a Healthy Diet: What to Eat, What to Avoid, and What to Stop Worrying About by Monica Reinagel (2011).  I give it five stars on Amazon’s rating system (I love it).

This indispensible book cuts through the malarky of nearly all recent nutrition fads, sharing with us the science-based nutrition ideas that prevent disease and prolong life.  If you’re eating the Standard American Diet (SAD), you need this book.  The author gives highly practical suggestions on how to make your diet healthier immediately. 

In short, Ms. Reinagel focuses on minimally processed, whole foods, and preparing your own meals.  But there’s so much more here.  As you might expect, the Mediterranean diet was discussed in very favorably.

I’ve been following Monica Reinagel’s nutrition writing carefully for the last three years.  She knows the nutrition science literature as well as anyone, if not better.

The book starts with an unusually detailed table of contents that helps you find what you’re interested in without wasting time.

As promised by the subtitle, the author tells you what you DON’T need to worry about.  Is mercury in fish a problem?  What about bisphenol-A in plastic containers and canned foods?  Does red meat cause cancer?  Is pesticide residue on our food a problem?  Is salt a killer?  

I stay up to date on nutrition much more than the average physician, but the author introduced me to several new concepts, such as hemp milk, oat milk, and the idea that “pregnant women and small children should avoid cured meats altogether.”  I was particularly interested in her thoughts on the intersection of nutrition and exercise since I recently started an exercise program called Core Performance.

She successfully debunks many nutrition myths, such as 1) the need to eat every 2-3 hours, 2) saturated fat is bad for your heart and arteries, 3) eggs are bad for you (too much cholesterol, you know), 4) grain products are essential for health.

Any deficiencies in the book?  The font size is on the small side for people over 45.  On page 150, vitamin K is confused with vitamin D - undoubtedly a simple misprint.  No mention of the raw milk controversy.  When discussing potassium chloride as a salt substitute, she doesn’t mention the potential risk to people with kidney impairment or taking certain fluid pills. Tips on how to select fresh fish would have been helpful.

In summary, this is a great book for anyone wanting to get healthier via nutrition, but who’s confused by all the recent controversies.  The book is without peer.  If everything you learned about healthy eating was acquired over 10 years ago, you’re way out of date and need this book.  I hope the author does an updated edition every five years or so.

Steve Parker, M.D., author of Conquer Diabetes and Prediabetes: The Low-Carb Mediterranean Diet and The Advanced Mediterranean Diet: Lose Weight, Feel Better, Live Longer.

Disclosure: Other than a free advance review copy of the book from the publisher, I received nothing of value for writing this review.