Recipe: Steak, Avocado, Olives, and Tomato

Paleobetic diet

I ate mine for breakfast. Who needs bagels, cereal, and donuts?

This meal has only 8 grams of digestible carbohydrate so it works in both the Ketogenic Mediterranean Diet and Low-Carb Mediterranean Diet. It was super-easy to put together because I used leftover steak. But I’ll assume you’re cooking your steak fresh. We bought ours as thinly sliced round steak, about a 1/4-inch thick (0.6 cm). Some places refer to this as a “minute steak” because it cooks so quickly. Minute steak also refers to a piece of beef, usually the round, that’s been pounded flat, about a 1/4-inch thick. Even if you start with raw meat, you can prepare today’s recipe in 10 minutes.

Paleobetic diet

It tastes as good as it looks

Ingredients:

4 oz (113 g) cooked thin round steak (start with 5 oz raw)

1 California (Hass) avocado, standard size (4.5 oz or 127 g), peeled, pitted, and chunked

14 black olives, pitted, medium size (Purist alert: probably highly processed)

1 tomato, medium-size (medium size or 2.5-inch diameter (6,4 cm), or a large roma tomato), cut into wedges

Salt and pepper to taste, or use commercial steak seasoning such as Montreal Steak Seasoning by McCormick (a favorite at the Parker Compound)

Instructions:

Sprinkle your steak with seasoning then cook over medium or medium-high heat in a skillet, about a minute on each side. Or heat your leftover steak in the microwave. If you overcook, it will be tough.

Place all ingredients artfully on a plate and enjoy.

Servings: 1

Nutritional Analysis (via Fitday):

60% fat

12% carbohydrate

28% protein

600 calories

20 g carbohydrate

12 g fiber

8 g digestible carbohydrate

587 mg sodium

1530 mg potassium

Prominent features: Lots of protein, vitamin B6, vitamin B12, copper, iron, niacin, pantothenic acid, phosphorus, selenium, and zinc

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Do Low-Carb Diets Cause Premature Death?

Adult life is a battle against gravity. Eventually we all lose.

Adult life is a battle against gravity. Eventually we all lose.

Japanese researchers say low-carb diets are causing premature death. I’m skeptical.

The potentially healthful side effects linked to low-carb eating include reduced weight, higher HDL cholesterol, and lower triglycerides and blood pressure. The Japanese investigators wondered if the improved cardiovascular risk factors seen with low-carb diets actually translate into less heart disease and death.

How Was the Study At Hand Done?

The best way to test long-term health effects of a low-carb diet (or any diet) is to do a randomized controlled trial. You take 20,000 healthy and very similar people—not rodents—and randomize half of them to follow a specific low-carb diet while the other half all eat a standard or control diet. Teach them how to eat, make damn sure they do it, and monitor their health for five, 10, or 20 years. This has never been, and never will be, done in humans. The Nazis may have done it, but it’s not published. In the old days, we could do this study on inmates of insane asylums or prisons.

What we have instead are observational studies in which people voluntarily choose what they’re eating, and we assume they keep eating that way for five or 10+ years. You also assume that folks who choose low-carb diets are very similar to other people at the outset. You depend on regular people to accurately report what and how much they’re eating. You can then estimate how much of their diet is derived from carbohydrate and other macronutrients (protein and fat), then compare health outcomes of those who were in the top 10% of carb eaters with those in the bottom 10%. (We’ve made a lot of assumptions, perhaps too many.)

Of the observational studies the authors reviewed, the majority of the study participants were from the U.S. or Sweden. So any true conclusions may not apply to you if you’re not in those countries. In looking for articles, they found no randomized controlled trials.

The observational studies estimated carb consumption at the outset, but few ever re-checked to see if participants changed their diets. That alone is a problem. I don’t know about you, but I’ve had significant changes in my diet depending on when I was in college and med school, when I was a bachelor versus married, when my income was higher or lower, and when I had young children versus teenagers. But maybe that’s just me.

The researchers looked at all-cause mortality, deaths from cardiovascular disease, and incidence of cardiovascular disease. They don’t bother to define cardiovascular disease. I assume heart attack, strokes, and peripheral vascular disease. (But aren’t aneurysms, deep vein thrombosis, and pulmonary embolism vascular diseases, too?) Wouldn’t you think they’d carefully define their end-points? I would. Since they were going to all this trouble, why not look at cancer deaths, too?

What Did the Investigators Conclude?

Very low-carbohydrate dieters had a 30% higher risk of death from any cause (aka all-cause mortality) compared to very high-carb eaters. The risk of cardiovascular disease incidence or death were not linked with low-carb diets. Nor did they find protection against cardiovascular disease.

Finally, “Given the facts that low-carbohydrate diets are likely unsafe and that calorie restriction has been demonstrated to be effective in weight loss regardless of nutritional composition, it would be prudent not to recommend low-carbohydrate diets for the time being.”

If Low-Carb Dieters Die Prematurely, What Are They Dying From?

The top four causes of death in the U.S. in 2011, in order, are:

  1. heart attacks
  2. cancer
  3. chronic lower respiratory tract disease
  4. stroke

You’ll note that two of those are cardiovascular disease (heart attacks and stroke). So if low-carb diets promote premature death, it’s from cancer, chronic lung disease, or myriad other possibilities. Seventy-five percent of Americans die from one of the top 10 causes. Causes five through 10 are:

  • accidents
  • Alzheimer disease
  • diabetes
  • flu and pneumonia
  • kidney disease
  • suicide

Problem is, no one has ever linked low-carb diets to higher risk of death from any specific disease, whether or not in the top ten. Our researchers don’t mention that. That’s one reason I’m very skeptical about their conclusion. If you’re telling me low-carb diets cause premature death, tell me the cause of death.

Another frustration of mine with this report is that they never specify how many carbohydrates are in this lethal low-carb diet. Is it 20 grams, 100, 150? The typical American eats 250-300 grams of carb a day. If you’re going to sound the alarm against low-carb diets, you need to specify the lowest safe daily carb intake.

For most of my career—like most physicians—I’ve been wary of low-carb diets causing cardiovascular disease. That’s because they can be relatively high in total fat and saturated fat. In 2009, however, I did my own review of the scientific literature and found little evidence of fats causing cardiovascular disease.

If you’re looking for a reason to avoid low-carb diets, you can cite this study and its finding of premature death. I’m not convinced. I’ll turn it around on you and note this study found no evidence that low-carb diets cause cardiovascular disease. The risk of cardiovascular disease had been the traditional reason for physicians to recommend against low-carb diets.

Steve Parker, M.D.

Reference: Noto, Hiroshi et al. Low-Carbohydrate diets and all-cause mortality: A systematic review and meta-analysis of observational studies. PLoS One, 2013; 8(1): e55050

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Does Diabetes Drug Pioglitazone Prevent Dementia?

Nobody knows. A recent report out of Germany suggests that pioglitazone does prevent dementia, but it’s not a very strong linkage. If it works, I wonder if it’s simply related to better control of blood sugar, which could be accomplished with a variety of means. Pioglitazone (aka Actos) is a type 2 diabetes drug in the TZD class. You could call it an “insulin sensitizer.”

The best popular press report I’ve seen is at Bloomberg.

German researchers went fishing for associations in a huge database of patients and drug usage. Their formal report hasn’t even been published yet. A five-year study was recently initiated to further investigate the possibility that piogoitazone prevents dementia. I doubt this will pan out.

Steve Parker, M.D.

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Does Skipping Breakfast Affect Weight Loss?

It didn’t in this 16-week study. I don’t know what they ate nor how many calories. 

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Recipe: Eggs, Bacon, and Honeydew Melon

 

Bacon, eggs, black coffee, and Cholula hot sauce. A caveman wouldn't recognized any of this except for eggs.
Bacon, eggs, black coffee, and Cholula hot sauce

If you follow nutrition science literature, you’ll see periodic references to “processed meats” like bacon contributing to increased risk of cardiovascular disease, cancer, or premature death. I think the associations are pretty weak. Health-conscious cautious people aren’t going to go hog-wild on processed meats. I don’t. We may never have a definitive science-based resolution of the issue.

If you want to control the degree of processing in your bacon, make your own. The recipe at the link includes pink salt (sodium nitrite), maple syrup, and dark brown sugar. Many other recipes are available. My understanding is that sodium nitrite is a preservative and gives bacon meat that pink color. (Does it contribute to flavor?) If you’re not storing your bacon for a long time, you may not need the pink salt.

In any case, I thoroughly enjoyed three strips of bacon with my eggs recently. Mine was the Kirkland brand from Costco was $3.80/pound (USD). Two slices provide 80 calories (uncooked) and zero grams of carb although, if I recall correctly, it was honey-cured bacon.

Ingredients:

3 large eggs

3 strips of bacon, standard thin slices

Salt and pepper to taste

1/2 cup raw honeydew melon, cubed

Instructions:

Fry the bacon over medium or medium-high heat. If there’s too much grease leftover in the pan after cooking, poor out what you don’t want, for later use or drizzle over your dog’s dry kibble food. Leave a little grease in the pan so your eggs don’t stick. Then fry your eggs over medium heat. Enjoy with raw honeydew, which will cleanse your palate after eating bacon.

You can pay a lot more than $3.80 a pound for bacon
You can pay a lot more than $3.80 a pound for bacon

Servings: One

Nutritional Analysis per Serving: (from FitDay.com)

63 % fat

10 % carbohydrate

26 % protein

319 calories

9 carb grams

1 fiber grams

8 digestible carb grams

845 mg sodium

423 mg potassium

Prominent features: high in B12, riboflavin, selenium, protein, pantothenic acid, and phosphorus. Although this is low in calories, it’s adequately satiating because of the rich protein and fat content. The calorie count will be higher by 50 if you eat all the bacon grease.

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How To Put Out a Grease Fire

Of all the things I cook, bacon is the most likely to end up causing a grease fire. Imagine pouring excess bacon grease out of the frying pan and a little grease dribbles onto the outside of the pan. You set the pan back down on a hot burner, then the excitement starts.

How do you put out a grease fire? I knew water wouldn’t do the trick; my first thought was pour salt on it. That’s wrong! About.com says to simply smother it by putting a metal lid on the pan and turn off the heat. If you can’t find the fitted lid, use a cookie sheet. Fire won’t burn without a supply of oxygen. You could pour baking soda on the fire, but it takes a lotWikihow has more info on putting out a grease fire, mentioning a dry chemical fire extinguisher as a last resort if you’re going to handle the fire yourself. Think safety first.

Grease fire? Put a lid on it and turn off heat. If that fails, try a LOT of baking soda. Or fire extinguisher.

Grease fire? Put a lid on it and turn off heat. If that fails, try a LOT of baking soda. Or fire extinguisher.

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Sitagliptin May Increase Risk of Heart Failure

JACC has the details. Sitagliptin is a DPP-4 inhibitor used to treat type 2 diabetes. It’s sold in the U.S. as Januvia. Note that the alleged higher risk of heart failure is in patients who had a history of prior heart failure. Research findings like this are not always dependable or reproducible. It bears watching, especially if you’re a heart patient.

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