Advanced Mediterranean Diet

I just learned that rapper 50 Cent is co-authoring a fitness and nutrition book, Formula 50: A Six-Week Total Body Transformation Plan.

“Total body transformation” sounded familiar.

A quick search at Amazon.com revealed at least 10 books with that phrase in the title; nearly all are fitness or weight-loss books.  Looks like the trend-setter is Hot Point Fitness: The Revolutionary New Program for Fast and Total Body Transformation, by Steve Zim and Mark Laska, published in 2000.

In case you didn’t know, you can’t copyright a book or song title, at least in the U.S.

I’m starting to think my books are titled too modestly.

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

A Paleolithic diet improved metabolic status with respect to cardiovascular and carbohydrate physiology, according to a 2009 study at the University of California San Francisco.

The Paleolithic diet is also referred to as the paleo diet, Stone Age diet, and caveman diet.

Here are the research specifics, all statistically significant unless otherwise noted:

• total cholesterol decreased by 16%
• LDL cholesterol (”bad cholesterol”) decreased by 22% (no change in HDL)
• triglycerides decreased by 35%
• strong trend toward reduced fasting insulin (P=0.07)
• average diastolic blood pressure down by 3 mmHg (no change in systolic pressure)
• improved insulin sensitivity and reduced insulin resistance; i.e., improved glucose tolerance

Methodology

This was a small, preliminary study: only 11 participants (six male, three female, all healthy (non-diabetic), average age 38, average BMI 28, sedentary, mixed Black/Caucasian/Asian).

Baseline diet characteristics were determined by dietitians, then all participants were placed on a paleo diet, starting with a 7-day ramp-up (increasing fiber and potassium gradually), then a 10-day paleo diet.

The paleo diet: meat, fish, poultry, eggs, fruits, vegetables, tree nuts, canola oil [?], mayonnaise [?], and honey.  No dairy legumes, cereals, grains, potatoes.  Caloric intake was adjusted to avoid weight change during the study, and participants were told to remain sedentary.  They ate one meal daily at the research center and were sent home with the other meals and snacks pre-packed.

Compared with baseline diets, the paleo diet reduced salt consumption by half while doubling potassium and magnesium intake.  Baseline diet macronutrient calories were 17% from protein, 44% carbohydrate, 38% fat.  Paleo diet macronutrients were 30% protein, 38% carb, 32% fat.  Fiber content wasn’t reported. 

I’m guessing there were no adverse effects.

Comments

This study sounds like fun, easy, basic science: “Hey, let’s do this and see what happens!”

I don’t know a lot about canola oil, but it’s considered one of the healthy oils by folks like Walter Willett.  It sounds nicer than rapeseed oil.

I agree with the investigators that this tiny preliminary study is promising; the paleo diet has potential benefits for prevention and treatment for metabolic syndrome, diabetes, and cardiovascular disease such as heart attack and stroke.

The researchers mentioned their plans to study the paleo diet in patients with type 2 diabetes.  Any results yet?

Are you working with a physician on a medical issue that may improve or resolve with the paleo diet?  Most doctors don’t know much about the paleo diet yet.  You may convince yours to be open-minded by trying the diet—not always a safe way to go—and showing her your improved clinical results.  Or show her studies such as this.

Steve Parker, M.D.

Reference:  Frassetto, L.A., et al.  Metabolic and physiologic improvements from consuming a paleolithic, hunter-gatherer type diet.  European Journal of Clinical Nutrition, advance online publication, February 11, 2009.   doi: 10.1038/ejcn.2009.4

I’m NOT going to buy a new suit.

I don’t wear suits very often, but I had a meeting with a lawyer recently and wanted to make a good first impression.  You only get one chance to make a first impression.  So I put on a suit I hadn’t worn in a couple years.

The waistline of the suit pants had shrunk about two inches since the last time I wore it.  Very uncomfortable. 

I’m not going to have a seamstress let out the waist so they’ll fit, either. 

What Happened?

For most of the last two years, I’ve been eating 20 to 100 grams of carbohydrate daily.  And exercising pretty regularly.  The last two months have been different.

A little before Halloween, I started eating more carbohydrates and slacking off on my exercise program.  Why?  I’ve been working feverishly on two books that will be out in January.  That cut into my exercise.  Plus, I have a sweet tooth that gets the better of me periodically.  It’s no secret I have a weakness for Cinnabon cinnamon rolls, cookies, candy bars, pie, cake, ice cream, muffins, etc.  I’ve been indulging.  You could call it “carb creep” or just lack of discipline and will power.

My Current Stats

Weight: 173 lb (78.6 kg)

Height: 5-feet, 11.5 inches tall (181 cm)

BMI: 23.8 (in the healthy range)

Waist circumference: 37.25 inches (95 cm) when upright, 35.5 inches supine (90 cm)

If you saw me, you’d agree I just look like a normal-weight, healthy guy.

Prior Stats

Weight on March 6, 2010: 156 lb (70.7 kg)

Waist circumference on October 21, 2009: 34.25 inches (upright?) (87 cm)

What’s My Plan For Fitting Back Into My Pants?

Note that this is not a health issue; it’s vanity and stubbornness.  It’s also easier to get around if I’m not hauling any excess weight.  I’ve no doubt some of my weight gain from 2010 is muscle mass, thanks to Mark Verstegen’s Core Performance fitness program.  I have to think the majority of the extra weight, however, is fat (adipose tissue).

My Weight Goal: 162 lb (73.4 kg).  So just 11 lb (5 kg).

If you don’t know where you’re going, you’ll never get there. Then I’ll decide if that’s too skinny for me. 

Two or three times a week, I’ll do a Verstegen-style workout.  

Did you notice that my favorite fattening foods are all sweet and most contain refined wheat? They have a fair amount of fat, too, but I don’t think that’s the main problem.  They are not protein powerhouses, so protein’s not a culprit.

I think my problem is concentrated sugar and refined starches.  Wheat in particular.  Many folks - probably a majority of the overweight population - have this same problem.  But not everybody.

Could my slacking off on exercise be the primary issue? Yeah, could be, but I don’t think so.

I fully expect I’d lose the weight without exercise if I just went back on the Ketogenic Mediterranean Diet.  But I want the long-term health benefits of exercise.  The Advanced Mediterranean Diet would do the trick, too, but I want to try something different, a more laid-back approach than I’ve ever used in the past.

What’s the best way to eat, in general?  Consider this: Eat Natural Food.  That would pretty much eliminate concentrated sugars and refined starches.  (I don’t consider the sugars in most fruits to be equivalent to the concentrated sugar in table sugar, cookies, muffins, and pies, but it’s debatable.)

Other than physical activity, the other component of my weight-loss effort is to eliminate concentrated sugars and refined wheat products.  The concentrated sugars I turn into fat are in man-made products, not God-made or from nature.  All of my personal fattening foods are seem to be man-made. 

I’m keeping fruit on the menu, although probably not more than one serving a day, if that much.  I don’t eat much now in the way of legumes, potatoes, corn, or peas.  I’ll keep these starches on the menu, too, in low amounts.  They’re nature-made.  I’ll eat cheese but not milk. No limit on low-carbohydrate fruits and vegetables. 

I bet eating this way will get my carb consumption back below 100 g/day.  But I don’t have time to keep a careful record.  Remember that most people in the U.S. eat 225 to 325 grams of carbohydrate daily. 

I’m planning to cheat already: a couple days around Christmas.

This is an experiment I just cooked up today.  Those tight pants were a real eye-opener.  It may turn out I need to get compulsive: keep a food diary, count calories or carb grams, set firm rules, etc.  We’ll see. 

Thanks for reading.

Steve Parker, M.D.

Update December 8, 2011

My household bathroom scale December 7 showed my weight at 175 lb (79.5 kg) compared to 172 lb (78 kg) December 6.  Today, December 8, the scale says 172 lb again (78 kg).This is either normal weight variation or my scale is innacurate.  The average of the three weights is 173 lb (78.6 kg).  It’s typical for weight to vary by 2-3 lb over 24 hours, depending on stomach and intestine contents and state of hydration.  My original post on this topic listed 172 pounds as my current baseline weight.  I changed that today to 173 lb.

Update December 12, 2011

Weight 172.5 lb (78.4 kg)

I’m very excited about a brand new cookbook for folks limiting their consumption of carbohydrates, wheat, and gluten.  It’s a unique collaboration among five chefs (Jennifer Eloff, Maria Emmerich, Carolyn Ketchum, Lisa Marshall, and Kent Altena) and other low-carb luminaries like Jimmy Moore and Dana Carpender.  I was honored to contribute a couple pages myself.  The book is Low-Carbing Among Friends, volume 1. All 325 recipes limit digestible carbohydrates to a maximum of 10 grams; many have five or fewer grams.  This should be great for people with diabetes and anyone trying to manage excess weight with low-carb eating.  All recipes are gluten-free, wheat-free, and sugar-free.

I can’t wait for my copy.  I’m “online friends” with several of the contributors, so I’m familiar with the great quality of their work.  You can get the book at Amazon.com, but I ordered mine from the book’s website, figuring the authors make more profit there.  (If we want good books, we have to support authors.)  It’s not too late to order this as a Christmas present.  Don’t you know someone who could use it?  

Steve Parker, M.D.

Insulin administered via the nasal passages slowed or stabilized mental functioning and functional abilities in a pilot study of people with Alzheimer disease and mild cognitive impairment, according to Seattle-based investigators.

As you probably know, dementia is a huge problem for our aging population, and Alzheimers is the most common form of dementia.  The Mediterranean diet is associated with lower risk of mild cognitive impairment and has long been linked to lower risk of dementia as well as slower mental decline in existing Alzheimer dementia patients.  The Mediterranean diet also seems to prolong life in Alzheimer patients.  So I’m always interested in ways to prevent and treat Alzheimers.  Mild cognitive impairment is often a precursor to Alzhiemer disease.

Methodology

The study involved 104 non-diabetic participants with Alzheimer disease (40) or amnestic mild cognitive impairment (64).  They were randomly assigned to one of three groups: placebo (control group), nasal insulin 20 IU twice daily, or nasal insulin 40 IU twice daily. 

Insulin was delivered through a ViaNase device which releases the insulin in to a chamber covering the nose; the participant breathes regularly for two minutes to pick up the dose.  This insulin goes directly to the central nervous system without affecting blood insulin levels or blood sugar levels.

Mental and functional abilities (for example, activities of daily living) were measured at baseline, then again 2, 4, and 6 months later.  Some of the participants (23) underwent lumbar puncture (for dementia biomarker analysis) and PET brain scans (18).

Comments

This was a well-designed pilot study.

Nasal insulin was well-tolerated.  It’s not commercially available in the U.S.

Regarding the placebo group, I was surprised that the researchers could document mental and functional deterioration over this relatively short-term study (4–6 months).  I’m impressed with the need to treat age-related cognitive decline early and aggressively, when we have something that works.

How would nasal insulin work?  We don’t know for sure, but it seems to relate to insulin’s effect on

• the ability of neurons (brain cells) to communicate with each other through synapses
• modulaton of blood sugar metabolism in the hippocampus and other brain areas
• facilitation of memory
• ß-amyloid peptide

In case you’re wondering, standard subcutaneous injections of insulin can’t be used in studies like this because of the risk of low blood sugar.

I agree wholeheartedly with study authors that “these promising results provide an impetus for longer-term trials of intranasal insulin therapy in adults with amnestic mild cognitive impairment or Alzheimers disease.”

Psychiatrist Emily Deans blogged about this study at Evolutionary Psychiatry September 21, 2001.  Please see her cogent remarks.

Steve Parker, M.D.

Reference:  Craft, Suzanne, et al.  Intranasal insulin therapy for Alzheimer disease and amnestic mild cognitive impairment.  Archives of Neurology, 2011.  doi: 10.1001/archneurol.2011.233

The (Cleveland) Plain Dealer reports the sad and disturbing case of an 8-year-old boy being removed from his family home and placed in foster care simply because government bureaucrats thought his mother didn’t do enough to reduce his weight. He weighed over 200 pounds (91+ kg).

I don’t have all the details of the case.  But this just seems wrong.  Very wrong. 

Kudos to the reporter, Rachel Dissell, for well-done article. 

Steve Parker, M.D.

LCHF Cheese

Dr. Eenfeldt of DietDoctor.com gave a talk at the recent Ancestral Health Symposium in California, on the rationale of the current low-carb, high-fat diet (LCHF) so popular in his home country of Sweden.  It’s very understandable to the general public and is a good introduction to low-carb eating.  The entire YouTube video is 55 minutes; if you’re pressed for time, skip the 10-minute Q&A at the end.

He also discusses the benefits of LCHF eating for his patients with diabetes.

If you reduce carbohydrates, you’re going to replace it with either protein, fat, or both.  As Dr. Eenfeldt recommends, the Ketogenic Mediterranean and Low-Carb Mediterranean Diets replace carbs more with fats than protein.

Steve Parker, M.D.

Parents in hunter-gatherer societies know why kids don’t like to retire alone to a dark room at night, writes Peter Gray, a psychologist:

Until a mere 10,000 years ago we were all hunter-gatherers.  We all lived in a world where any young child, alone, in the dark, would have been a tasty snack for nighttime predators.  The monsters under the bed or in the closet were real ones, prowling in the jungle or savannah, sniffing around, not far from the band’s encampment. A grass hut was not protection, but the close proximity of an adult, preferably many adults, was protection.  In the history of our species, infants and young children who grew frightened and cried out to elicit adult attention when left alone at night were more likely to survive to pass on their genes to future generations than were children who placidly accepted their fate. In a hunter-gatherer culture only a crazy person or an extremely negligent person would leave a small child alone at night, and at the slightest protest from the child, some adult would come to the rescue.

Safer than sleeping alone on the ground

I gotta confess I’d never thought about it this way before.  Makes sense. Read the rest of Dr. Gray’s post.

Steve Parker, M.D.

h/t to Amy Alkon

Exercise is not supposed to be fun.  If it is, then you should suspect that something is wrong.

That quote is from an essay by Ken Hutchins posted at the Efficient Exercise website.

When I was a young man in my 30s, I was jogging 20 miles a week and ran a couple marathons (26.2 miles).  I enjoyed it and didn’t do much else for exercise or overall fitness. I thought I was in pretty good shape.  You can get away with that when you’re 35, but not when you’re 50.  At 57 now, I can’t think of any single recreational activity that can help me maintain the overall strength, functionality, and injury resistance I want and need as I age. 

I’ve come to view exercise as a chore, like flossing/brushing teeth, changing the oil in my car, and sleeping when I’d rather not.  I’ve got my current exercise chore whittled down to an hour three times a week.  OK, sometimes just twice a week.

Skyler Tanner takes a thoughtful and in-depth look at the exercise versus recreation dichotomy at his blog.  If you have comments, more people will see them at his site than here.

Steve Parker, M.D.

The U.S. Centers for Disease Control and Prevention reports this month that the prevalence of self-reported coronary heart disease declined from 6.7% of the population in 2006, to 6% in 2010.  Figures were obtained by telephone survey.  Coronary heart disease, the main cause of heart attacks, remains the No.1 cause of death in the U.S.

Self-reports of heart disease may not be terribly reliable.  However, I remember an autopsy study from Olmstead County, Minnesota, from 2001 that confirmed a lower prevalence of coronary heart disease there.  I wrote about that at the NutritionData.com Heart Health Blog, but those posts may not be around much longer.

The CDC report mentioned also that mortality rates from coronary heart disease have been steadily declining for the last 50 years. 

Improved heart disease morbidity and mortality figures probably reflect better control of risk factors (e.g., smoking, high blood pressure), as well as improved treatments.  I’ve never seen an estimate of the effect of reduced trans fat consumption. 

Obesity is always mentioned as a risk factor for heart disease, yet obesity rates have skyrocketed over the last 40 years.  You’d guess heart disease prevalance to have risen, but you’d have guessed wrong.  In view of high obesity rates, some pundits have even suggested that the current generation of Americans wil be the first to see a decrease in average life span. 

The American Diabetes Association offers a free heart disease risk calculator, if you’re curious about your own odds.  My recollection is that the calculator works whether or not you have diabetes.

Steve Parker, M.D.