Advanced Mediterranean Diet

I recently read The New Sonoma Diet: Trimmer Waist, More Energy in Just 10 Days, by Dr. Connie Guttersen, RD, PhD, published in 2010.  Per Amazon.com’s rating system, I give it four stars (I like it).

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The New Sonoma weight-loss method works because it counteracts the major cause of overweight—excessive consumption of sugars and refined starches—through portion control. This Mediterranean-style program is likely to reap the major health benefits of the traditional Mediterranean diet: longer life and less chronic disease (heart attacks, strokes, high blood pressure, diabetes, dementia, and cancer).

Most of the food recommendations herein are consistent with Monica Reinagel’s wonderful new book, Nutrition Diva’s Secrets for a Healthy Diet: What to Eat, What to Avoid, and What to Stop Worrying About. On Sonoma, you’ll eat natural, minimally processed, whole foods.

The primary improvements over the 2005 version of Sonoma are the time-saving and budget-saving strategies. The recipes are easier and quicker. I didn’t try any, but they sound yummy. Dr. Guttersen also exands the “Power Foods” from 10 to 12, adding beans and citrus fruit. I’m glad to see the author addressed many of my criticisms of her great 2005 book. I do miss the old refrigerator-ready pull-out depicting the subdivided plates.

Here’s a brief summary for those unfamiliar with Sonoma. There are three Waves. Wave 1 lasts 10 days and is supposed to break your addiction to sugar and refined flour. Wave 2 lasts until your weight-loss goal is reached, and provides more calories, wine if desired, and more variety. Wave 3 is the lifelong maintenance phase: more fruit and veggies, plus occasional sugary desserts, potatoes, and refined flour. Portion size is controlled either by following her exact recipes or through her plate method. Breakfast fits on a 7″ plate (or 2-cup bowl), while lunch and dinner are on 9″ plates, subdivided into various food groups such as proteins, grains, or veggies. Optional recipes are provided for Wave 1 and the first two weeks of Wave 2.

As in 2005, Dr. Guttersen doesn’t reveal how many calories you’ll be eating. My estimate for Wave 3 is 2000 a day. Less for the earlier Waves.

You’ll find indispensible information on shopping and food preparation. Keeping a food journal is rightfully promoted in certain circumstances. I like the discussion of psychological issues, mindful eating, dining out tips, and weight-loss stalls. The mindful eating portion reminded me of Evelyn Tribole’s Intuitive Eating: A Revolutionary Program That Works and Intuitive Eating: A Practical Guide to Make Peace with Food, Free Yourself from Chronic Dieting, Reach Your Natural Weight.

The author makes a few claims that are either wrong or poorly supported by the scientific literature. Examples include: 1) beans are linked to longer life and reduced heart disease risk, 2) grapes are almost as good as wine for heart protection, 3) the health benefits of spinach “border on the miraculous,” and spinach helps prevent inflammatory conditions such as arthritis and asthma, 4) whole grains prevent stroke, gastrointestinal cancer, and diabetes, 5) adding salt and butter for flavor is unhealthy, 6) medicinal qualities of herbs and spices are well documented, 7) saturated fats “are found exclusively in highly processed food products,” you’ll break a lifetime craving for sugary sweets in Wave 1, 9) 64 ounces of water a day is ideal, 10) exercise significanlty helps most people with weight loss, 11) low-carb eating cannot be maintained because it’s unhealthy and unsatisfying, and 12) saturated fats raise the risk of heart disease.

Much of the book reads like an infomercial; at times I even wondered if it was ghost-written by a marketing professional. The author is unflaggingly optimistic. The testimonials would have more credibility if attributed to full names, not just “Betty” or “Bill.” She overstates the health benefits of the individual Power Foods, which are all plant-derived. I’d like to see cold-water fatty fish on the list.

Dr. Guttersen has great faith in observational studies linking specific foods to health outcomes; I have much less faith. Such studies are far from proof that specific foods CAUSE the outcome. They’re just associations, such as swimsuit sales being linked to warm weather. Warm weather doesn’t cause folks to buy swimsuits; the desire to swim does.

Speaking of associations, a multitude of observational studies link whole grain consumption with 20-25% lower risk of heart disease. We may never have proof of cause and effect because the appropriate study is so difficult. Sonoma recommends two whole grain servings a day, which is the heart-healthy “dose” supported by science.

The author’s discussion of exercise is improved over 2005’s, but is still minimal. Why not refer readers to respected Internet resources? We agree that exercise can help with weight-loss stalls and long-term maintenance of weight loss.

Overall, this is one of the healthiest weight-loss programs available. The average person won’t go wrong with Sonoma. In fact, Sonoma-style eating may be the healthiest of all for the normal-weight general public, with the exception of its avoiding saturated and total fat.

Steve Parker, M.D.

Science-based surgery (usually)

The sciences give a mostly coherent understanding of the world.  Mostly coherent. [They do] give an understanding of the possible, the probable, the improbable and the impossible.  Most of the sciences, unlike parts of medical science,  are not concerned with the impossible.  There is not complementary and alternative physics, or chemistry, or biochemistry, or engineering.  These disciplines compare their ideas against reality, and, if the ideas are found wanting, abandoned.   Perpetual motion is not considered seriously by any academic physicist; if perpetual motion were an alternative medicine it would be offered at a Center by a Harvard Professor of Medicine.

                    —Dr. Mark Crislip, infectious disease specialist,  at Science-Based Medicine, April 8, 2011

Physically active lifestyles are often credited with at least some of the health benefits of the mid-20th century Mediterranean diet.  We in the 21st century don’t necessarily have to be so active, thanks to technologic and scientific advances.  Some choose to make up the deficit by exercising, which isn’t alwaysafe.

To protect you from injury, I recommend that you obtain “medical clearance” from a personal physician before starting an exercise program, especially vigorous physical activity.  A physician is in the best position to determine if your plans are safe for you, thereby avoiding complications such as injury and death.  Nevertheless, most adults can start a moderate-intensity exercise program with little risk.  An example of moderate intensity would be walking briskly (3–4 mph or 4.8–6.4 km/h) for 30 minutes daily. 

Note the metric units; I use both U.S. customary and metric units throughout Conquer Diabetes and Prediabetes: The Low-Carb Mediterranean Diet.  Unfortunately, I used only U.S. customary measurements in The Advanced Mediterranean Diet: Lose Weight, Feel Better, Live Longer.

Men over 40 and women over 50 who anticipate a more vigorous program should consult a physician to ensure safety.  The physician may well recommend diagnostic blood work, an electrocardiogram (heart electrical tracing), and an exercise stress test (often on a treadmill).  The goal is not to generate fees for the doctor, but to find the occasional person for whom exercise will be dangerous, if not fatal.  Those who drop dead at the start of a vigorous exercise program often have an undiagnosed heart condition, such as blockages in the arteries that supply the heart muscle.  The doctor will also look for other dangerous undiagnosed “silent” conditions, such as leaky heart valves, hereditary heart conditions, aneurysms, extremely high blood pressure, and severe diabetes.

But, Doc, what if I have diabetes?

The American Diabetes Association’s Standards of Care—2011 states that routine testing of all diabetics for heart artery blockages before an exercise program is not recommended; the doctor should use judgment case-by-case.  Many diabetics (and their doctors) are unaware that they already have “silent” coronary artery disease (CAD).  CAD is defined by blocked or clogged heart arteries, which reduced the blood flow to the hard-working heart muscle.  Your heart pumps 100,000 times a day, every day, for years without rest.  CAD raises the odds of fainting, heart attack, or sudden death during strenuous exercise.  I recommend a cardiac stress test (or the equivalent) to all diabetics prior to moderate or vigorous exercise programs, particularly if over 40 years old. CAD can thus be diagnosed and treated before complications arise.  Ask your personal physician for her opinion.

But, Doc, I’ve got bad arthritis and poor circulation!

Regardless of age and diabetes, other folks who may benefit from a medical consultation before starting an exercise program include those with known high blood pressure, high cholesterol, joint problems (e.g., arthritis, degenerated discs), neurologic problems, poor circulation, lung disease, or any other significant chronic medical condition.  Also be sure to check with a doctor first if you’ve been experiencing chest pains, palpitations, dizziness, fainting spells, headaches, frequent urination, or any unusual symptoms (particularly during exertion).

Physicians, physiatrists, physical therapists, and exercise physiologists can also be helpful in design of a safe, effective exercise program for those with established chronic medical conditions. 

Steve Parker, M.D.

I did a phone interview a couple weeks ago with Dr. Robert K. Su, author of Carbohydrates Can Kill.  It should be available in podcast form at Dr. Su’s website within the next three months.  Dr. Su is on a mission to educate the public on the dangers of excessive blood sugar levels, whether or not diabetes or prediabetes is present.  Visit Dr. Su’s website for a wealth of information on carbohydrates and their effects on blood sugar levels and health.

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

Michael Pollan is credited with the aphorism, “Eat food.  Not too much.  Mostly plants.”  Tag lines are just good marketing; nothing wrong with that as long as it’s honest.

Bill Gottlieb interviewed me recently on the topic of prediabetes for his upcoming book (Bottom Line’s Breakthroughs in Natural Healing 2012).  Bill had given me a preparatory list of questions, one of which was,”What are the best dietary recommendations? I’m looking for fun, fresh specificity here—along the lines of your book!”  Also, “What’s the best way for a person to implement it—specific, practical, small-step actions that would lead to actually changing the diet?”

We didn’t have a chance to get to those in the interview, but here are some of my thoughts:

• Give up all man-made food*
• Give up all sugar-sweetened sodas and “sports drinks”
• Give up all flour products
• Give up all flours, starches, and added sugars
• Give up deserts

But “giving up” is not a message  people want to hear when contemplating a diet change, even if it’s for their own good.  Nor do they want to hear, “Don’t eat . . .”  “Avoid” and “cut back on” are not specific.  “Forego” works, but is just a euphemism for “give up.” 

“Eat only God-made foods” works for me but might turn off the atheists and agnostics.

Here’s a more marketable catch-phrase that I rather like and claim as my own:

Eat natural food.*

By “natural,” I mean “present in or produced by nature.”  This would not include candy bars, potato and corn chips, soda pop, sports drinks, apple pie, bread and other flour products, cookies, etc.  That still leaves a lot of different foods to eat, including most  of the items on the Low-Carb Mediterranean Diet and Advanced Mediterranean Diet. 

 Whether modern, mass-produced versions of fruits and vegetables are natural is a debate for another day.  I suspect modern corn, for example, is nothing close to the maize cultivated by Native Americans 400  years ago. 

Why the asterisk?  The exceptions to the “eat natural food” rule are red wine, olive oil, and vinegar.  Those are partly natural, partly man-made.  (Where do we get vinegar?)  The red wine and olive oil are potentially healthful, and many of us like vinegar on our  natural salad vegetables.

Eat natural food.

I bet the average person eating the standard American diet would tend to lose excess weight and be healthier by making the switch.

Steve Parker, M.D.

* Exceptions: red wine, olive oil, vinegar

What’s “strength training”? It’s also called muscle-strengthening activity, resistance training, weight training, and resistance exercise.  Examples include lifting weights, work with resistance bands, digging, shoveling, yoga, push-ups, chin-ups, and other exercises that use your body weight or other loads for resistance.

Strength training three times a week increases your strength and endurance, allows you to sculpt your body to an extent, and counteracts the loss of lean body mass (muscle) so often seen during efforts to lose excess weight.  It also helps maintain your functional abilities as you age.  For example, it’s a major chore for many 80-year-olds to climb a flight of stairs, carry in a bag of groceries from the car, or vacuum a house.  Strength training helps maintain these abilities that youngsters take for granted.

According to the U.S. Centers for Disease Control and Prevention: “To gain health benefits, muscle-strengthening activities need to be done to the point where it’s hard for you to do another repetition without help.  A repetition is one complete movement of an activity, like lifting a weight or doing a sit-up.  Try to do 8–12 repetitions per activity that count as 1 set.  Try to do at least 1 set of muscle-strengthening activities, but to gain even more benefits, do 2 or 3 sets.”

If this is starting to sound like Greek to you, consider instruction by a personal trainer at a local gym or health club.  That’s a good investment for anyone unfamiliar with strength training, in view of its great benefits and the potential harm or waste of time from doing it wrong.  Alternatives to a personal trainer would be help from an experienced friend or instructional DVD.  If you’re determined to go it alone, Internet resources may help, but be careful.  Consider “Growing Stronger: Strength Training for Older Adults” (http://www.cdc.gov/physicalactivity/downloads/growing_stronger.pdf).  Don’t let the title turn you off if you’re young—its a good introduction to strength training for folks of any age.  Doug Robb’s blog, HealthHabits, is a wonderful source of strength training advice (http://www.healthhabits.ca/). 

People with diabetes must be particularly cautious before starting a fitness program.

Current strength training techniques are much different than what you remember from high school 30 years ago—modern methods are better.  Some of the latest research suggests that strength training may be even more beneficial than aerobic exercise.

Steve Parker, M.D.