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Advanced Mediterranean Diet » 2011 » August

Archive for August, 2011

Quote of the Day

Monday, August 29th, 2011

 Science-Based Medicine published a recent post on the state of American Psychiatry and mental illness.  It’s well worth a look if you’re interested in such things.  Here’s a quote:

The tally of those who are so disabled by mental disorders that they qualify for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) increased nearly two and a half times between 1987 and 2007—from one in 184 Americans to one in 76.”

Do you believe many mental illnesses are caused by a chemical imbalance in the brain?  It’s such a time-saver for the physician to tell the inquiring patient, “You just have a chemical imbalance.  This drug will help straighten it out.”  Read the post for counter-arguments.

Steve Parker, M.D.

Save $3 on “Conquer Diabetes and Prediabetes” and “Advanced Mediterranean Diet”

Friday, August 26th, 2011

For readers of my blogs, I’m offering a $3.00 (USD) discount off the usual retail price for Conquer Diabetes and Prediabetes: The Low-Carb Mediterranean Diet.  You probably won’t find a better price anywhere—$13.95 plus shipping.  To get the discount, you have to order from CreateSpace and enter this discount code when you order:

9V9B6FML

This is a time-limited offer, so make your decision within the next few days.

The book is available (without the discount) at Amazon.com, which also offers the Kindle edition.  Other e-book formats are available at Smashwords for $9.99 (USD).

If those are all too expensive, explore the Diabetic Mediterranean Diet blog; most of the information is scattered therein.  If you have diabetes or prediabetes, I want you to have this valuable information.

Steve Parker, M.D.

PS: I also authored an award-winning weight-loss book based on the traditional Mediterranean diet, The Advanced Mediterranean Diet: Lose Weight, Feel Better, Live Longer.  For folks with diabetes or prediabetes, Conquer Diabetes is the better choice.  For a limited time, you can also buy The Advanced Mediterranean Diet at a $3.00 discount if you purchase from Createspace: enter the discount code 9V9B6FML.

Waist-Hip Ratio: What Is It, and What’s Yours?

Monday, August 22nd, 2011

A comment left under my recent Diabetic Mediterranean Diet blog post on healthy weight ranges reminded me about the waist-hip ratio.

The risk of heart and vascular disease is more closely linked to distribution of excess fat than with degree of obesity as measured by overall weight or body mass index. Waist-hip ratio (WHR) is a measure of abdominal or central obesity, the type of fat distribution associated with coronary artery disease. A high ratio indicates the android body habitus. To determine your waist-hip ratio:

  1. While standing, relax your stomach—don’t
      pull it in. Measure around your waist mid-
      way between the bottom of the rib cage and
      the top of your pelvis bone. Usually this is at
      the level of your belly button, or an inch
      higher. Don’t go above the rib cage. Keep the
      measuring tape horizontal to the ground and
      don’t compress your skin.
  2. Then measure around your hips at the
      widest part of your buttocks. Keep the tape
      horizontal to the ground and don’t compress
      your skin.
  3. Divide the waist by the hip measurement.
      The result is your waist-hip ratio.

For example, if your waist is 44 inches (112 cm) and hips are 48 inches (122 cm): 44 divided by 48 is 0.92, which is your waist-hip ratio.

Scientists haven’t yet determined the ideal WHR, but it is probably around 0.85 or less for women, and 0.95 or less for men. Ratios above 1.0 are clearly associated with risk of cardiovascular disease such as heart attacks. The higher the ratio, the higher the risk. Compared with body mass index, WHR is a much stronger predictor of coronary artery disease. Several of the other obesity-related illnesses are also correlated with WHR, but the relationship between WHR and cardiovascular disease is particularly strong.

Steve Parker, M.D.

Spanish Ketogenic Mediterranean Diet Cures Metabolic Syndrome

Friday, August 19th, 2011

The very-low-carb Spanish Ketogenic Mediterranean Diet cures metabolic syndrome, according to investigators at the University of Córdoba in Spain. The metabolic syndrome is a collection of clinical factors that are linked to high risk of developing type 2 diabetes and heart disease.  Individual components of the syndrome include elevated blood sugar, high trigylcerides, low HDL cholesterol, high blood pressure,  and abdominal fat accumulation.

Spanish researchers put 26 people with metabolic syndrome on the Spanish Ketogenic Mediterranean Diet for twelve weeks and monitored what happened.  At baseline, average age was 41 and average body mass index was 36.6.  Investigators didn’t say how many diabetics or prediabetics were included.  No participant was taking medication.

What’s the Spanish Ketogenic Mediterranean Diet?

Calories are unlimited, but dieters are encouraged to keep carbohydrate  consumption under 30 grams day.  They eat fish, lean meat, eggs, chicken, cheese, green vegetables and salad, at least 30 ml (2 tbsp) daily of virgin olive oil,  and 200-400 ml of red wine daily ( a cup or 8 fluid ounces  equals 240 ml).  On at least four days of the week, the primary protein food is fish.  On those four days, you don’t eat meat, chicken, eggs, or cheese.  On up to three days a week, you could eat non-fish protein foods but no fish on those days. 

How’s this different from my Ketogenic Mediterranean Diet?  The major differences are that mine includes one ounce (28 g) of nuts daily, less fish overall, and you can mix fish and non-fish protein foods every day.

Regular exercisers were excluded from participation, and my sense is that exercise during the diet trial was discouraged. 

What Were the Results?

Metabolic syndrome resolved in all participants.

Three of the original 26 participants were dropped from analysis because they weren’t compliant with the diet.  Another one was lost to follow-up.  Final analysis was based on the 22 who completed the study.

Eight of the 22 participants had adverse effects.  These were considered slight and mostly appeared and  disappeared during the first week.  Effects included weakness, headache, constipation, “sickness”, diarrhea, and insomnia. 

Average weight dropped from 106 kg (233 lb) to 92 kg (202 lb).

Body mass index fell from 36.6 to 32.

Average fasting blood sugar fell from 119 mg/dl (6.6 mmol/l) to 92 mg/dl (5.1 mmol/l).

Triglycerides fell from 225 mg/dl to 110 mg/dl.

Average systolic blood pressure fell from 142 mmHg to 124.

Average diastolic blood pressure fell from 89 to 76.

So What?

A majority of people labeled with metabolic sydrome continue in metabolic sydrome for years.  That’s because they don’t do anything effective to counteract it.  These researchers show that it can be cured in 12 weeks, at least temporarily, with the Spanish Ketogenic Mediterranean Diet.

Very-low-carb diets are especially good at lowering trigylcerides, lowering blood sugar, and raising HDL cholesterol.  Overweight dieters tend to lose more weight, and more quickly, than on other diets.  Very-low-carb diets, therefore, should be particularly effective as an approach to metabolic syndrome.  It’s quite possible that other very-low-carb diets, such as Atkins Induction Phase, would have performed just as well as the Spanish Ketogenic Mediterranean Diet.  In fact, most effective reduced-calorie weight-loss diets would tend to improve metabolic syndrome, even curing some cases, regardless of carb content

Most physicians recommend that people with metabolic syndrome either start or intensify an exercise program.  The program at hand worked without exercise.  I recommend regular exercise for postponing death and other reasons.

Will the dieters of this study still be cured of metabolic syndrome a year later?  Unlikely.  Most will go back to their old ways of eating, regaining the weight, and moving their blood sugars, triglycerides, and HDL cholesterols in the wrong direction.

Steve Parker, M.D.

Reference: Pérez-Guisado J, & Muñoz-Serrano A (2011). A Pilot Study of the Spanish Ketogenic Mediterranean Diet: An Effective Therapy for the Metabolic Syndrome. Journal of medicinal food PMID: 21612461

Mediterranean Diet Ranked No.2 Overall

Monday, August 15th, 2011

US News and World Report a couple months ago ranked 20 popular diets for weight loss, overall healthfulness,  and diabetes and heart disease management.  Overall best diet was awarded to the DASH diet. Mediterranean came in No.2. The Mayo Clinic has free info on the DASH diet.  Here’s my definition of the Mediterranean diet.

-Steve Parker, M.D.

Research Round-Up

Wednesday, August 10th, 2011

I have a stack of scientific articles I’ve been meaning to review in depth and blog about.  But I have to finally admit I don’t have the time.  Here they are.  Click through for details.

  1. Long-term calorie restriction in humans appears highly effective in reducing atherosclerosis risk factors (lab tests) and actual carotid artery atherosclerosis. Only 18 study subjects, however.
  2. A very-low-carbohydrate diet improved memory in older adults with mild cognitive impairment over six weeks.  Twenty-three subjects were randomized to either high-carb or very-low-carbohydrate diet.  The low-carbers improved verbal memory performance, lost weight, reduced fasting blood sugar and fasting insulin levels.  Ketone levels were positively correlated with memory performance.
  3. A high-fat diet impairs cognitive function and heart energy metabolism in young men.  Sixteen test subjects.  Crossover study design with a five-day high-fat diet deriving 75% of energy from fat, compared to a low-fat diet deriving 23% of energy from fat.  High-fat diet led to impaired attention, speed, and mood.  I’m sure low-carb bloggers have been all over this.  At first blush, it appears they were testing during “induction flu” phase of very-low-carb eating, between days 2 to 7 of a new ketogenic diet.  It takes several weeks to adapt metabolism to running almost entirely on fat rather than standard carbohydrates.  Suspect results would have been different if given time to adapt.
  4. Weight-loss with the laparoscopic gastric banding procedure has poor long-term outcome, according to Belgian surgeons reporting on 82 patients.  Four in 10 patients had major complications.  Nearly half of the 82 patients needed to have the bands removed, and six of every 10 required some kind of re-operation.
  5. Trust me, you DON’T want age-related macular degeneration.  Women, reduce your risk of ARMD with a healthy lifestyle, including regular exercise, avoidance of smoking,  and by eating abundant plant foods (vegetables [including orange and dark leafy green ones], fruits, and whole grains) and limit foods high in fat, refined starches, sugar, alcohol, and oils.  At least according to these researchers. 
  6. Leafy green vegetables and olive oil are linked to reduced heart disease (CHD) in Italian women.  Fruit consumption had no effect.  This is from a subset of the huge EPIC study, following 30,000 women over almost eight years.
  7. The Mediterranean diet protects against metabolic syndrome, reducing risk by about a third according to a huge meta-analysis from Greek and Italian investigators.  It works best in Mediterranean countries. 
  8. The Mediterranean diet was linked to slower rates of cognitive decline in Chicago residents over the course of almost eight years.  The comparison diet was the Healthy Eating Index-2005.  Of the 3,800 participants, about two-thirds were black.  A Manhattan population showed lower risk of dementia when eating Mediterranean-style.

There ya’ go.  This is better than letting the articles just sit in my briefcase for months on end, eventually to be thrown out.

Steve Parker, M.D.

Book Review: Sugar Nation - The Hidden Truth Behind America’s Deadliest Habit and the Simple Way to Beat It

Wednesday, August 3rd, 2011

I recently read Sugar Nation, by Jeff O’Connell, published in 2011.  Per Amazon.com’s rating system, I give it five stars (”I love it”). 

I have one copy of the book to give away to someone with a mailing address in the U.S.  If you’d like it, be the first to e-mail me with the name for “wisps of precipitation streaming from a cloud but evaporating before reaching the ground.”  Two syllables, starts with “v”.  My e-mail is steveparkermdATgmailDOTcom.

Update August 3, 2011: The book was won by John from Richardson, TX. The word is virga.

♦   ♦   ♦

With the U.S. Centers for Disease Control predicting that one of every three citizens born in 2000 will become diabetic, this book is “just what the doctor ordered.”  Already,  one in three of all adults has prediabetes.  The numbers are even scarier if we look at those over 65: HALF have prediabetes, while two in ten have diabetes.  I treat diabetes every day; trust me, you don’t want it.

I agree with O’Connell that over-consumption of sugar and refined starches often leads to type 2 diabetes and prediabetes, particularly when combined with obesity, a sedentary lifestlye, and genetic predisposition.  (Our bodies easily and quickly convert potatoes and refined starches like white flour and white rice into blood sugar.) Yearly sugar consumption in the U.S. was five pounds per person in the 1800s, but is now up to 160 pounds a year. 

O’Connell was motivated to write this because of his personal diagonosis of prediabetes in 2006.  Later he was also diagnosed with reactive hypoglycemia.  Furthermore, his father died of the ravages of type 2 diabetes.  O’Connell’s physician in 2006 didn’t offer much managmement advice, so the author did his own research and shares it with us here.  The author’s personal approach has been a fairly intense exercise program and major reduction in consumption of sugar and other carbohydrates, particularly ones that are quickly converted to blood sugar.  He eats 80 or less grams of carb daily, compared to the average American’s 275 grams.  I agree these management options can be extremely helpful for prediabetes and type 2 diabetes, particularly if applied early in the course of the condition.

O’Connell is critical of most physicians and the American Diabetes Association (ADA) for not knowing about carbohydrate restriction and for inadequately promoting exercise.  He accuses the pharmaceutical industry of having too much influence over physicians and the ADA.  While admitting that “…taking a pill [is] much easier than reengineering the way you lead your life,” he mostly lets patients off the hook in terms of taking control of diet and physical activity.  I can understand that to a degree; physicians should be leading the way.  I don’t see that happening soon.  Patients need to take charge now; many have already done so.  Compared to a five-minute lecture in a doctor’s office, this book will be a much more effective motivator for change.

(Patients taking drugs with the potential to cause hypoglycemia need their doctors’ help adjusting dosages while making these lifestyle changes.)

The author tells us that we in the U.S. spent $12.5 billion on drugs for diabetes in 2007, nearly double the amount spent in 2001.  It’s only going to get worse going forward.  We have 11 classes of drugs for diabetes now.  Surprisingly, we don’t know all of the potential adverse long-term side effects of most of these drugs.  Phenformin was pulled from the U.S. market years ago due to fatal lactic acid build-up.  Earlier this year, rosiglitazone prescribing was greatly restricted in view of adverse heart effects.  If we can effectively address diabetes and prediabetes with diet and exercise, why not?  (Clearly, diet and exercise don’t always work, and type 1 diabetics always need insulin.) 

For those who won’t or can’t exercise regularly, be aware that carb restriction alone is a powerful approach.

I heard more about reactive hypoglycemia a couple decades ago than I do now.  It could be a precursor to type 2 diabetes.  I think physicians lost interest in it because too many people were using it as a excuse for odd behavior when they really didn’t have hypogylcemia.  This book may spark a resurgence in interest.

O’Connell implies that the high revenues generated by diabetic drug manufacturers may not be justifiable.  In fairness, I must point out that the same companies spend hundreds of millions of dollars just to get a drug on the market, and millions more on research for drugs that fail and never see the light of day.

I was glad to see the author mention low-carb beers: Michelob Ultra and MGD 64.  I’ve had trouble finding carb counts on many beers.

O’Connell recommends supplements: leucine, cinnamon, protein powder, chromium, alpha lipoic acid, biotin, magnesium.  I’ve not done in-depth research on most of those.  What I’ve read in the science literature about cinnamon and chromium has not been very positive or definitive.

My favorite sentence: “Along with a low-carb eating plan, a gym memership is the most potent antidote to type 2 diabetes.”

This book was a pleasure to read; professional, well-organized, touching all the right bases in understandable terms.  I can well understand how he makes a living as a journalist. 

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

Disclosure: I don’t know the author.  The publisher’s representative provided me with two free copies of the book, otherwise I recieved nothing of value in exchange for this review.  

What’s a Healthy Weight?

Monday, August 1st, 2011

In the past it was pretty easy to find tables of recommended healthy body weights.  Not so much anymore.  Most of the experts want you calculate your body mass index, recommending the healthy BMI range as 18.5 to 24.9.  I recently spent an hour putting together a healthy weight range based on BMIs.  Since I have many readers outside the U.S., I use both U.S. customary and metric numbers.

Metropolitan Life Insurance Company last published its ideal weight and height table in 1983.  The US Department of Agriculture abondoned its 1995 healthy weight table by the turn of the century recommending BMI calculation instead.  Of note is that the upper end of its weight ranges was a BMI of 25; the lower ends were all BMIs of 19. 

Body Mass Index (BMI) is your weight in kilograms divided by your height in meters squared (kg/m2).  A pound equals 454 kilograms. An inch equals 2.54 centimeters.  There are 100 centimeters in one meter. Thus, a 5-foot, 4-inch woman (1.63 meters) weighing 200 pounds (91 kilograms) has a BMI of 34.2.  Perhaps you’re starting to understand why this weight standard isn’t too popular yet.

 To learn your own BMI but skip the math, use an online calculator.

 To see if your BMI is in the healthy range of 18.5 to 24.9, find your height in the table below, then look to the healhy weight ranges to the right.  Measure your height without shoes and weight without clothes.

Table of Healthy Weight Ranges Based On Body Mass Index: 18.5 to 24.9

       Height               Weight in lb        Weight in kg

5’0” or 152 cm             95 - 128             43.0 - 58.0

5’1” or 155 cm             98 - 132             44.4 - 59.8

5’2” or 157 cm           101 - 137            45.8 - 62.1

5’3” or 160 cm           105 - 141             47.6 - 63.9

5’4” or 163 cm           108 - 146             48.9 - 66.2

5’5” or 165 mc           111 - 150             50.3 - 68.0

5’6” or 168 cm           115 - 155             52.0 - 70.3

5’7” or 170 cm           118 - 160             53.5 - 72.5

5’8” or 173 cm           122 - 164             55.3 - 74.3

5’9” or 175 cm           125 - 169             51.7 - 76.6

5’10” or 178 cm         129 - 174             58.5 - 78.9

5’11” or 180 cm         133 - 179             60.3 - 81.8

6’0”  or 183 cm          137 - 184             62.1 - 83.4

6’1” or 185 cm           140 - 189              63.5 - 85.7

6’2” or 188 cm           144 - 195             65.3 - 88.4

6’3” or 191 cm           148 - 200             67.1 - 90.7

6’4” or 193 cm           152 - 205             68.9 - 92.9

BMIs between 25 and 29.9 designate “overweight” and accurately describe about 35 percent of the United States population.

A BMI of 30 or higher defines “obesity” and indicates high risk for poor health. About 30 percent of us are obese. At a BMI of 35 and above, incidence of death and disease increases sharply.

The BMI concept is helpful to researchers and obesity clinicians, but the number doesn’t mean much yet to the average person on the street and to many physicians. It should be used more widely. (I know, I know: it’s not perfect. Do you have a better, cheap, widely applicable standard?)  Know your BMI. If it’s under 25, any excess fat you carry is unlikely to affect your health and longevity; your efforts to lose weight would be purely cosmetic.

Steve Parker, M.D.


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