Category Archives: Book Reviews

June 4, 2019 · 5:48 AM

Brief Review of P.D. Mangan’s “Best Supplements for Men”

Death in a bottle?

Best Supplements for Men: for more muscle, higher testosterone, longer life, and better looks was published in 2017. I have the paperback but it’s also available as a Kindle e-book. Per Amazon.com’s rating system, I give it five stars (I love it).

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My favorite sentence in this book is, “If you don’t eat, exercise, and sleep right, the health effects of adding any supplement may be minimal to non-existent.” That sets an honest tone. Also in favor of integrity is that the author doesn’t offer Mangan-branded supplements for sale.

I like this book. I learned a lot from it. I’ve benefited by reading the author’s tweets and blog (Rogue Health and Fitness) for many years. He’s smart and, I believe, honest.

The author supports his assertions with numerous scientific references, organized by chapter at the back of the book. If he cites a study done in mice, he tells you. Human studies admittedly carry more weight.

Have you wondered if protein supplements and creatine are good for muscle strength and energy? Does magnesium increase testosterone levels? Does berberine have beneficial health effects? The answers are here.

The author gives good advice regarding calcium supplements that even most physicians don’t know about.

Great recommendations on food.

No book is perfect, and this one is no different. It has no index. So if you’re curious about turmeric or supplements that control diabetes, you have to scan the whole book. My copy didn’t include references for chapter 11. Page numbers for chapters in the index didn’t match the actual chapter starts. My least favorite sentence in the book was something about Dr. Joseph Mercola being a trustworthy source of health information; he is not (search “mercola” at ScienceBasedMedicine.org).

Again, I like this book, learned much from it, and recommend it to men. If you’re taking lots of supplements now, read this book to find out if they help, harm, or are only good for making expensive urine.

Steve Parker, M.D.

PS: Some personal notes from my reading. Many of the cited studies are “association”-type evidence rather causation. Berberine may help reduce blood sugars in diabetics just as well as metformin. Creatine: Yes, for muscle growth and strength. Magnesium 700 mg/day increases testosterone. Mag oxide may be worthless due to poor absorption. Mangan likes mag citrate but Lexicomp says it’s no better than oxide; absorption “up to 30%.” Citrulline: Yes, for erectile dysfunction, and may help with HTN. DHEA 50 mg/day increases testosterone in men by 50%, but only in men over 70. During fat weight loss, whey protein helps prevent muscle loss. MCT oil may also help (e.g., cook with coconut oil). ASA 81 mg/day seems to prevent some cancers in folks over 55, especially colorectal cancer.

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April 10, 2018 · 4:59 PM

Book Review: “The Diabetes Code: Prevent and Reverse Type 2 Diabetes Naturally”

From Shutterstock.com

Dr Jason Fung is best known for his advocacy of fasting and low-carb eating. I recently read his latest book, The Diabetes Code: Prevent and Reverse Type 2 Diabetes Naturally, published this year.

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I waffled between a four or five-star Amazon.com review, but settled on four-star because 1) I haven’t read all of the pertinent scientific literature, and 2) I’m not sure how feasible the Fung protocol is for the average type 2 diabetic (or PWD if you prefer).

When I mention diabetes or diabetic hereafter, it’s always type 2 diabetes, not type 1.

This book builds on the success of very low-carb eating as a therapeutic approach to type 2 diabetes. But it goes beyond that by advocating frequent prolonged fasts as a potential cure for diabetes. I’m talking about fasting for 30–36 hours at a stretch, for up to three times a week. On non-fasting days, his patients typically eat a low-carb diet, which makes sense to me. Two week-long sample meal plans are provided. Thus far, none of my patients have asked me about fasting. If the underlying science checks out, I’d seriously consider the Fung approach myself if I had T2 diabetes.

The longest fast I’ve done has been 24 hours. That’s pretty easy for me, probably because I eat low-carb, so my fat-burning cellular machinery is ready for action. In bro-science terms, I’m keto-adapted. I have no idea if fasting 36 hours would be any harder than 24. Maybe it’s easier if you’re obese.

Dr Fung shares many clinical vignettes from his Intensive Dietary Management Program in Canada. He doesn’t mention how many of his patients start the program and then drop out because it’s too difficult.

Why the intermittent fasting? Because it seems to be an efficient way to reverse the fat build-up in the liver and pancreas that cause the high blood sugars of diabetes. That fat build-up, in turn, is caused by high insulin levels, according to Dr Fung’s working theory of diabetes causation.

The author says the following is what causes diabetes and prediabetes. First, remember that dietary carbohydrates cause a release of insulin from the pancreas, in order to dispose of the carbohydrate as an immediate source of energy or for storage in the liver and skeletal muscles as glycogen. If the carb is not needed for immediate energy and if the glycogen tanks in liver and muscle are full, the glucose is converted to fat. That fat is ideally stored in specialized fat cells (adipocytes), but can also be stored in the liver and pancreas (called visceral fat). Excessive fat in the liver and pancreas eventually impairs function of those organs. To prevent this overload, cells have to become resistant to insulin’s effects. Diets rich in highly-processed, refined carbohydrates (especially fructose, sucrose, and starches) over-stimulate insulin release from the pancreas. Over time, this causes not only body fat, but also fat build-up in the liver and pancreas, impairing their function.

Intermittent fasting and very low-carb eating directly and immediately ameliorate the high insulin levels that cause diabetes. The fasting allows for extended periods of low insulin, which helps tissues regain or maintain sensitivity to insulin, he says.

Dr Fung rightfully points out that his program should be done under physician supervision, especially if you take drugs that can cause hypoglycemia. I can see patients taking this book to office visits and asking “Doc, can I try this?” Unfortunately, many doctors won’t take the time to read the book.

I wonder if this manifesto was actually written to convince physicians that what we’ve been doing for years is misguided, and that Fung’s approach is the way to go.

My favorite sentence: “…the very low-carbohydrate diet does remarkably well, giving you 71% of the benefits of the fasting without actual fasting.”

My least favorite sentence was regarding side effects (e.g., hunger pangs, muscle cramps, headaches) when starting fasting: “These side effects are often signs that the body is dumping its toxic sugar load.” No, that’s just good ol’ “induction flu,” more recently called keto flu.

I don’t know if Dr Fung’s causation theory of diabetes is correct or not. Maybe Dr Roger Unger’s glucagon-centric hypothesis is the reality. Ultimately what matters is whether his protocol actually reverses diabetes in significant numbers of folks, and does it safely. If the Fung protocol proves widely effective, and I hope it does, a Nobel Prize in Medicine may be in Dr Fung’s future.

Steve Parker, M.D.

 

Disclosures: I was given an Advance Reader’s Copy of the book by the publisher’s representative, otherwise I received no financial or other compensation. I don’t know Dr Fung.

Potential conflict of interest: I am a diet book author and blogger who advocates Mediterranean-style eating and low-carb eating for the general public and diabetics.

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March 15, 2018 · 2:00 AM

Book Review: “Fit With Diabetes”

Front cover

Ginger Vieira introduced me recently to Christel Oerum via email. I was pleased to hear about Christel’s brand new e-book, “Fit With Diabetes.”

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Physical fitness is a major determinant of longevity. It’s truly our only fountain of youth, and it’s available to most everybody. The only way to get and stay physically fit is through regular exercise. Some studies document shorter life spans for PWDs (persons with diabetes). So it’s particularly important for them to maintain a good level of fitness.

I like this e-book and highly recommend it to adults taking insulin for diabetes who need a great physical activity program but don’t know how to go about it. Use of insulin, whether in type 1 or 2 diabetes, significantly complicates exercise due to sometimes mysterious effects on blood sugar. Christel de-mystifies the issue in a clear and science-based manner.

The most dangerous interaction between insulin and exercise is hypoglycemia, although the opposite can be a problem, too. Much of the book is about avoiding dramatic swings in blood sugar, particularly hypoglycemia. Christel teaches the reader how to balance insulin, food, and exercise to keep sugars on an even keel. Aerobic exercise tends to cause hypoglycemia, whereas anaerobic exercise tends to cause high sugar spikes. But your own reaction may be a little different, if not a lot. As you might imagine, monitoring and record-keeping are critical, and Christel shares her own downloadable log.

Trust me, most primary care physicians and many endocrinologists are not going to be much help in the exercise advice department. I only remember one thing my first-ever accountant told me 30 years ago: “No one cares about your money as much as you do.” Likewise, no one cares about your health as much as you do. You’ll have to become your own expert.

The author is like a trusted old friend who’s “been there, done that,” and is sharing freely with you.

Christel has had type 1 diabetes for 21 years and is a diabetes coach. She’s been an avid exerciser since 2010. At that time there were very few resources that addressed vigorous exercise in the setting of T1 diabetes. Learn from her clients’ experience and her own N=1 experimentation so you don’t have to make the same trial-and-error mistakes.

The author works out five days a week. That doesn’t mean you have to. I suspect you can achieve 80–90% of the maximal longevity and other health benefits with just three days a week, maybe two. (Note: I am contradicting several authoritative medical panels!) If you’re sedentary now, two or three days a week should definitely improve your fitness. But you have to exercise right.

Early on, the author talks about how to get motivated for exercise. I like her SMART goal setting-checklist: Goals must be Specific, Measurable, Achievable, Relevant, and Time-bound.

She recommends a combination of aerobic exercise (“cardio”) and weight training. (I wouldn’t be surprised if we find out one day that the right weight-training program alone is good enough.) Christel tells exactly how to get started and maintain both types of exercise. She outlines both home-based and gym-based training programs.

Dietary calories for adults in the U.S. come 16% from protein, 48% from carbohydrates, and 34% from fats. Alternatively, the author recommends dietary calories come 40% from protein, 30% from carbohydrates, and 30% from fats. So 150 carb grams/day if eating 2000 calories, limiting meal carbs to 30 grams. I wonder if most folks will end up closer to 30% protein and 40% fat, especially for those not doing as much exercise as Christel. (Protein is important for muscle building and maintenance.) Many of my patients do well with additional carbohydrate restriction, but most don’t exercise as much as Christel despite my encouragement.

You can easily track your macronutrients and calories at MyFitnessPal.com.

The author shares some recipes and tells you how to get started on the all-important meal-planning and coming up with your own recipes. There’s even a helpful and realistic chapter on loss of excess weight.

As a reviewer, I always feel like I have to pick a few nits, so here it is. Christel says cardio exercise is great for losing weight. That probably true if you’re competing for $250,000 on TV’s Biggest Loser show. But usually exercise contributes at most 10% to a successful weight-loss program. Diet’s is critical. Exercise does help with prevention of weight regain and has many other benefits.

Again, I like this e-book and highly recommend it to adults taking insulin for diabetes who need a great physical activity program but don’t know how to go about it. Get the e-book here.

Of course, get the blessings of your personal healthcare provider before making any changes to your diet, exercise program, or medications.

Steve Parker, M.D.

PS: Disclosure: Christel kindly gave me a copy of the e-book. Otherwise there was not, and will not be, any remuneration for this review.

 

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May 24, 2016 · 2:00 AM

Book Review: Gorilla Mindset: How to dominate and unleash the animal inside you to live a life of health, wealth, and freedom

 

Gorilla-Mindset-book

Lawyer, blogger, and Tweetmaster Mike Cernovich has a new book, Gorilla Mindset: How to dominate and unleash the animal inside you to live a life of health, wealth, and freedom. Per Amazon.com’s rating system, I give it four stars (I like it).

♦  ♦  ♦

I’m an internal medicine specialist. For years, I’ve been struggling with how to convince my patients to exercise regularly and lose excess weight permanently. Why? So they’ll be healthier and live longer. Everyone wants to do that, right? But so few do. Because it’s hard to change lifelong habits to achieve a goal that may be years away. To make the change, you need the right mindset. Yes, it starts in your head.

The old mindset is: “I’ve been fat and lazy for years. I’ll always be fat and lazy. I’ve tried and failed a dozen times to change my lifestyle, and will fail every time.”

What’s the necessary new mindset? “I can do this. I’m not a brainless automaton without free will. I can see that discipline and sacrifice today will pay priceless dividends down the road. I don’t have to be fat just because everyone in my family is. I can overcome temptation. I’m not going to spend time with losers that bring me down. I’ll make new friends, people who live like me and support me. I will not be brainwashed by advertisers and food manufacturers who are only concerned about their profit, not my life. I have a plan for my life, and being fat and lazy aren’t in it.”

I wish I could download and install that into my patients’ brains!

Who created this?

Who created this?

I read this book hoping to pick up some new tips that would help me with my patients that need that mindset shift. And the author did not disappoint. I also ran across several techniques that I already use in my diet books, such as visualization.

Mike Cernovich’s methods include self-talk, posture improvement, mindfulness, focus, visualization, framing, and others. They will help with mindset re-set. The book is a fill-in-the-blank workbook, so buy your own copy and get to work.

The book is explicitly aimed at men. I would say the target demographic age is 16 to 40. The mind-bending methods should work for those over 40. It’s for men wanting more out of life, to rise above the hoi polloi, and willing to do the work.

It’s not a “weight loss book” per se; see the subtitle for details. However, Mr. Cernovich lost weight from 260 to 180 lb (118 to 81 kg). So he knows the struggle. He says, “…it’s almost impossible to maintain high levels of health while eating a diet high in processed foods.” I agree.

I particularly liked the chapter on money and livelihood. Young men need this information. The book is chock full of avuncular advice, so needed these days when too many boys grow up without a masculine role model. (Women, think long and hard about your children before you frivorce your husband.)

A little of the advice herein is California hippy-dippy woo, but it shouldn’t hurt you and may help, even if it doesn’t appeal to me. I’m convinced the author firmly believes in his recommendations and follows his own advice. I’m skeptical about some of the nutritional supplement advice, too; I’d check with P.D. Mangan for his thoughts.

The author hopes Gorilla Mindset becomes a perennial classic. He’s not quite there yet with this edition. He needs a chapter addressing sex/girls/women. Also, many young men need help on how to find a life purpose that motivates them. This isn’t enough: “If you feel unfilled [sic], stop doing whatever it is you’re doing. Try something else. Walk the streets until you’re exhausted. Repeat this every day. When you finally see what you want, your life will change.” My teenage daughter recently took an online occupational aptitude test that really helped give her some direction. My son is next; his interests are superficial and all over the map. Of course, aptitude is nothing without deep interest or passion. Another issue for the next edition: What about God and centuries-old religions?

A watershed moment in the Mike’s adolescence was when his father asked him, “When are you going to get serious?”

I ask you the same.

Steve Parker, M.D.

PS: If you think this review has too many words with vowels, you should see my books. They’re full of ’em.

 

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September 14, 2015 · 2:00 AM

A Review: “Stop the Clock: The Optimal Anti-Aging Strategy”

dementia, memory loss, Mediterranean diet, low-carb diet, glycemic index, dementia memory loss

“I wish we could have read PD Mangan’s book thirty years ago!”

I read P.D. Mangan’s 2015 book, Stop the Clock: The Optimal Anti-Aging Strategy. I give it five stars in Amazon’s rating system. High recommended.

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I approached this book with trepidation. I like PD Mangan even though I’ve never met him. We’ve interacted on Twitter and at our blogs. You can tell from his blogging that he’s very intelligent. I don’t know his educational background but wouldn’t be surprised if he has a doctorate degree. My apprehension about the book is that I was concerned it would be brimming with malarkey and scams. Fortunately, that’s not the case at all.

Twin studies have established that 25% of longevity is genetic. That leaves a lot of lifestyle factors for us to manipulate.

I’m not familiar with the anti-aging scientific literature and don’t expect it will ever be something I’ll spend much time on. But it’s an important topic. I’ll listen to what other smart analysts—like Mr. Mangan—have to say about it.

It’s quite difficult to do rigorous testing of anti-aging strategies on free-living humans. So the best studies we have were done with worms, rodents, and monkeys; the findings may or may not apply to us. For example, long-term calorie restriction—about 30% below expected energy needs—is known to prolong life span in certain worms and rodents, with mixed results in rhesus monkeys. It’s the rare person who would follow such a low-calorie diet for years as an experiment. I doubt I would do it even if proven to give me an extra five years of life. I like to eat.

There are several prominent theories of how and why animals age. The author thinks the major factors are:

  1. oxidative stress
  2. inflammation
  3. a decline in autophagy (perhaps most important)

An effective anti-aging program should address these issues.

In the anti-aging chapter of his book, The South Asian Health Solution, internist Ronesh Sinha says that “Lifestyle practices that reduce excess inflammation in the body will help delay the aging process.” Dr. Sinha is a huge exercise advocate and low-carb diet proponent.

Mr. Mangan makes a convincing argument that a good way to forestall aging is to apply hormetic stress. Hormesis is a phenomenon whereby a beneficial effect (e.g., improved health, stress tolerance, growth, or longevity) results from exposure to low doses of an agent or activity that is otherwise toxic or lethal when given at higher doses.

Needs a bit more hormetic stress

Needs a bit more hormetic stress

In case you’re not familiar with hormesis, here’s a major example. Lack of regular exercise leads is linked to premature death from heart disease and cancer. Starting and maintaining an exercise program leads to greater resistance to injury and disease and longer life span. On the other hand, too much exercise is harmful to health and longevity. We see that in professional athletes and excessive marathon runners. Something about exercise—in the right amount—enhances the body’s intrinsic repair mechanisms. That’s the hormetic effect of exercise; one mechanism is by turning on autophagy.

Autophagy is the body’s natural process for breaking down and removing or recycling worn-out cellular structures. This wearing-out occurs daily and at all ages.

If you’re thinking Mr. Mangan recommends exercise as an anti-aging strategy, you’re exactly right. Especially resistance training and high intensity training. His specific recommendations are perfectly in line with what I tell my patients.

Calorie restriction is another form of hormesis; the body reacts by up-regulating stress defense mechanisms. As a substitute for calorie restriction, the author recommends intermittent fasting. Intermittent fasting increases insulin sensitivity, which leads to enhanced autophagy. Fasting seems perfectly reasonable if you think about it, which very few do. Many of us eat every three or four hours while awake, whether a meal or a snack. If you think about it, that’s not a pattern that would be supported by evolution. In the Paleolithic era, we often must have gone 12–16 hours or even several days without food. Hominins without the resiliency to do that would have died off and not passed their genes down to us.

Steve Parker MD, Advanced Mediterranean DIet

Naturally low-carb Caprese salad: mozzarella cheese, tomatoes, basil, extra virgin olive oil

Another anti-aging trick is a low-carb diet, defined as under 130 grams/day, or under 20% of total calories. It may work via insulin signaling and weight control.

Glutathione within our cells is a tripeptide antioxidant critical for clearing harmful reactive oxygen species (free radicals). We need adequate glutathione to prevent or slow aging. Cysteine is the peptide that tends to limit our body’s production of glutathione. We increase our cysteine supply either through autophagy (which recycles protein peptides) or diet. Dietary sources of cysteine are proteins, especially from animal sources. Whey protein supplements and over-the-counter n-acetyl cysteine are other sources. Fasting is another trick that increases cysteine availability via autophagic recyling.

I don’t recall the author ever mentioning it, but if you hope to maximize longevity, don’t smoke. Even if it has hormetic effects. Maybe that goes without saying in 2015.

When I read a book like this, I always run across tidbits of information that I want to remember. Here are some:

  • those of us in the top third of muscular strength have a 40% lower risk of cancer (NB: you increase your strength through resistance training not aerobics)
  • exercise helps prevent cognitive decline and dementia, at least partially via enhanced autophagy
  • exercise increases brain volume (in preparing to do this review I learned that our brains after age 65 lose 7 cubic centimeters of volume yearly)
  • optimal BMI may be 20 or 21, not the 18.5-25 you’ll see elsewhere (higher BMI due to muscle mass rather than fat should not be a problem)
  • Scientist Cynthia Kenyon: “Sugar is the new tobacco.” (in terms of aging)
  • phytochemicals (from plants, by definition) activate AMPK, a cellular energy sensor that improves stress defense mechanisms and increases metabolic efficiency
  • curcumin (from the spice turmeric) activates AMPK
  • coffee promotes autophagy
  • he does not favor HGH supplementation
  • in the author’s style of intermittent fasting, you’re not reducing overall calorie intake, just bunching your calories together over a shorter time frame (e.g., all 2,500 calories over 6-8 hours instead of spread over 24)
  • mouse studies suggest that intermittent fasting could reduce risk of Alzheimer’s disease and Parkinsons disease
  • consider phytochemical supplements: curcumin, resveratrol, green tea extract
  • calorie-restriction mimetics include resveratrol, curcumin, nicotinamide, EGCG, and hydroxycitrate
  • supplemental resveratrol at 150 mg/day improved memory and cognition in humans

The author provides very specific anti-aging recommendations that could be followed by just about anyone. Read the book for details. Scientists are working feverishly to develop more effective anti-aging techniques. I look forward to a second edition of this book in three to five years.

Steve Parker, M.D.

PS: People with certain medical conditions, such as diabetics taking drugs that can cause hypoglycemia, should not do intermittent fasting without the blessing of their personal physician. If you have any question about your ability to fast safely, check with your doctor.

PPS: If you have diabetes or prediabetes and want to reduce your carbohydrate consumption, consider my Low-Carb Mediterranean Diet or Paleobetic Diet.

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August 16, 2015 · 3:41 AM

Book Review: The South Asian Health Solution

Indian woman cooking chapati

Indian woman cooking chapati

Here’s my review of The South Asian Health Solution: A culturally tailored guide to lose fat, increase energy, avoid disease by Ronesh Sinha, published in 2014.

♦   ♦   ♦

Dr. Sinha practices internal medicine in northern California (Silicon Valley) and has a large dose of South Asians in his clinic. “South Asia” usually encompasses India, Pakistan, Nepal, Bangladesh, Bhutan, Sri Lanka and Maldives. It is home to one fifth of the world’s population. This book pertains mostly to Indians, which is Dr. Sinha’s ethnicity. I live in the Pheonix, AZ, area and we have a fair number of Indian engineers and physicians.

WHY DO SOUTH ASIANS NEED THEIR OWN SPECIAL HEALTH GUIDE?

Because Dr. Sinha says they have unique genetic and cultural issues that predispose them to type 2 diabetes, abdominal obesity, coronary artery disease, high blood pressure, and adverse cholesterol numbers. For example, compared to natives who stay in their home countries, South Asian immigrants to the West have 3–4 times higher prevalence of diabetes, he says. Dr Sinha has a program that he’s convinced will prevent or forestall these medical problems in South Asians.

Dr. Sinha says South Asians eat too many carbohydrates and are too sedentary. Especially those who have moved to the West (e.g., US, UK, Europe, Canada). He notes that the core of the typical South Asian diet is flat breads, lentils, rice, fried crispy snacks (with heart-poisoning trans fats), culminating in 150–200 daily grams of carbohydrate more than he sees in other ethnics in California. Western fast foods, sodas, and sweets compound the problem.

He says “most South Asians are skinny-fat,” meaning skinny legs and arms but with a fat belly from visceral fat. This is also called sarcopenic obesity. The usual “healthy” body mass index (BMI) numbers don’t apply to Asians. The World Health Organisation classifies Asians as underweight if BMI is 18.4 or less, healthy at BMI of 18.5 to 13, overweight at BMI 23.1 to 25, and obese if BMi is over 25. These numbers are lower than those used for non-Asian populations.

Another issue in his South Asian patient population is vitamin D deficiency related to their dark skin (hence, less vitamin D production) and too much time indoors. He says vitamin D deficiency promotes inflammation and insulin resistance. More on this below.

Some South Asians have a K121Q gene mutation that causes insulin resistance, which in turn can cause disease. And whether it’s genetic or not (but I think it is), he says South Asians tend to have higher Lp(a) [aka lipoprotein(a)], which causes early and aggressive coronary artery disease. They also tend to have small dense LDL, leading to a lower-than-expected total cholesterol level which may be deceptively low.

Sinha notes a strong vegetarian preference in Indians but spends almost no time discussing it. From the book, I can’t tell if Indian vegetarians are lacto-ovo-vegetarians, pescetarians, or vegans. The author is not a vegetarian.

Gadi Sagar temple on Gadisar Lake, Jaisalmer, Rajasthan, India

Gadi Sagar temple on Gadisar Lake, Jaisalmer, Rajasthan, India

 

SINHA’S GRAND UNIFICATION THEORY OF DISEASE CAUSATION

So, South Asians, at least in the West, have a high-carb diet, are too sedentary, and have genetic tendencies to heart disease and diabetes. How do these factors cause disease? It’s all tied together with insulin resistance. Insulin is the main hormone that keeps our blood sugar from rising too high after we digest a meal. Insulin drives blood sugar into our body cells to be used as energy or stored as fat or glycogen. If our tissues have insulin resistance, blood sugar levels rise. As a compensatory effort, our pancreas excretes more insulin in to the blood stream than would normally be the case. Whether or not that eventually lowers blood sugar levels, the higher insulin levels themselves can cause toxicity. For example, higher insulin levels raise blood pressure, which damages the cells lining the insides of our arteries, leading to chronic inflammation and atherosclerosis (hardening of the arteries). Some of the arterial damage is mediated through small dense LDL cholesterols (aka type B LDL), which is promoted by high insulin levels (hyperinsulinemia). Insulin resistance also results in a defective and overactive immune system, which further promotes chronic inflammation. This inflammation is “…the root cause of almost every imaginable chronic disease…from heart attacks and strokes to Alzheimers Disease.”

Anyway, this is Dr. Sinha’s hypothesis, and there is some scientific evidence to support it. Sinha says that the concept of insulin resistance “weaves together virtually every chronic ailment currently afflicting South Asians.” That may be a bit hyperbolic: He carves out no exceptions for arthritis, asthma, eczema, migraines, glaucoma, macular degeneration, hearing loss, erectile dysfunction, hepatitis C, prostate enlargement, toenail fungus, or male-pattern baldness.

Dr. Sinha’s Grand Unification Theory of Disease Causation has some support among physicians and scientists, but is by no means universally accepted among them. As for myself, I think he’s over-simplifying (for his readership’s sake?) and getting a bit ahead of the science.

Most clinicians aren’t testing directly for insulin resistance. What are the indirect clues? Belly fat, low HDL cholesterol, high trigylcerides, high blood pressure, prediabetes, and type 2 diabetes. These are components of the metabolic syndrome. Not everybody with one or more of these factors has insulin resistance but many do.

WHAT’S HIS PROGRAM?

If Sinha is correct, the South Asian Health Solution is a “low-insulin lifestyle” achieved through carbohydrate-reduced eating, exercise, and avoidance or resolution of belly fat. These help improve all components of the aforementioned metabolic syndrome. The backbone of the plan is carbohydrate restriction. For low-carb eating, avoid wheat bread and Indian flat breads (e.g., chapatis, naans, parathas, puris, phulkas), aloo (primarily potatoes and starchy vegetables), rice and other grains, beans, and sugar. Keep track of your net carbohydrates (he likes FitnessPal.com, which includes South Asian foods).

If you need to burn off body fat, limit carbs to 50–100 grams/day (digestible or net carbs, I assume). Aim for 100–150 grams/day to maintain health and weight loss.

You might be able to add “safe starches” later: white rice, potatoes. To replace your Indian flat breads, learn how to make them with substitutes for wheat flour: coconut flour or almond flour (no skins) or almond meal (skin included). Recipe on page 347. Rice alternatives are cauliflower “rice,” shredded cabbage, broccoli slaw, chopped broccoli, and chopped carrots.

He likes ghee, extra virgin olive oil, coconut oil, and butter. Avoid high omega-6 fatty acid consumption, as in vegetable oils. Of course, avoid trans fats. Good fats are saturated, monousaturated, and omega-3s.

He provides a few low-carb recipes, surprisingly without specific carb counts: chapatis, microwave bread, cauliflower pizza, coconut cauliflower rice, shredded cabbage sabji, gajar halwa (carrot pudding), and coconut ladoo.

Dr. Sinha doesn’t provide a comprehensive meal plan. He trusts his California South Asians to figure out how and what to eat. They’re smarter than average (he never says that, but that’s been my experience with South Asians in my world).

Dr. Sinha is also a huge proponent of exercise. He’ll tell you about squats, lunges, planks, burpees, yoga, and Tabata intervals. He agrees with me and Franziska Spritzler that “physical activity is the most effective fountain of youth available.”

Steve Parker, M.D., Conquer Diabetes and Prediabetes

Taking a rest from the fountain of youth

 

I skipped some of the chapters due to lack of time and interest: women’s issues (e.g., pregnancy, polycystic ovary syndrome, post-partum depression, osteoporosis), childhood, fatigue and stress management, and anti-aging.

MISCELLANEOUS TIDBITS

  • He likes high-sensitivity CRP testing.
  • His metabolic goals for South Asians are: 1) keep waist circumference under 35 inches (90 cm) in men, under 31 inches (80 cm) in women, 2) keep triglycerides under 100 mg/dl (1.13 mmol/l), 3) keep HDL cholesterol over 40 mg/dl (1.03 mmol/l) for men, and above 50 mg/dl (1.29 mmol/l) for women, 4) keep systolic blood pressure 120 or less, and diastolic pressure 80 or less, 5) keep fasting blood sugar under 100 mg/dl (5.6 mmol/l) and hemoglobin A1c under 5.7%, and 6) keep hs-CRP under 1.0 mg/dl.
  • He says HDL cholesterol helps reduce insulin resistance via apoprotein A-1 (apo A-1), which increases glucose uptake by cells.
  • He likes to follow the triglyceride/HDL ratio. If under 3, it means low risk of insulin resistance being present.
  • He likes to follow total cholesterol/HDL cholesterol ratio: ideal is under 3.5.
  • Statins are way over-used.
  • Ignore total cholesterol level by itself.
  • Stress control and sleep are important.
  • The author had some metabolic syndrome components: high triglycerides, low HDL cholesterol, and type B LDL (small, dense particles).
  • He dislikes the usual-recommended low-fat, low-cholesterol diet.
  • 4 tbsp (60 ml) of extra virgin olive oil daily seems to lower blood pressure.
  • Magnesium supplementation may lower blood pressure.
  • The liver stores about 100 grams of glycogen and muscles store 300–500 grams.
  • Vanaspati is a “cheap ghee substitute” made from vegetable oil and widely used in Indian restaurants and many Indian processed foods. Avoid it since it’s a source of trans fats.
  • Aloo sabji is a potato dish.
  • Traditional Indian herbs/spices include turmeric, cardamon, ginger, and cilantro.
  • Find an Indian medication guide at http://www.medguideindia.com/show_brand.php.
  • Coconut milk is a traditional fat in India.
  • Curry, curry, curry.
  • http://www.pamforg/southasian.
  • http://southasiahealthsolutions.org.
  • Non-alcoholic steatohepatitis (NASH) is quite common in South Asians, seemingly linked to visceral (abdominal) obesity and insulin resistance related to carbohydrates.
  • The book has no specific focus on diabetes.

THUMBS UP OR DOWN?

Overall, I like many of Dr. Sinha’s ideas. They seem to be supported by his experience with his own patients. I trust him. I bet many South Asians and non-Asians eating the Standard American Diet would see improved health by following his low-carb, physically active program.

Steve Parker, M.D.

 

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February 25, 2015 · 12:00 AM

Book Review: The Low Carb Dietitian’s Guide to Health and Beauty

247 pages

247 pages

I just finished reading The Low Carb Dietitian’s Guide to Health and Beauty, written by Franziska Spritzler, RD, CDE, and published in January 2015. CDE, but the way, means Certified Diabetes Educator. Per Amazon’s rating system, I give it five stars (I love it). It’s not written specifically for women with diabetes, but the included recipes are quite consistent with a healthy diabetic diet. Since the author provides the carbohydrate grams with her recipes, you can use them with my Low-Carb Mediterranean Diet and Ketogenic Mediterranean Diet.

*   *   *

This valuable addition to the low-carb literature is unique: No other book covers the beauty and health aspects of low-carb eating specifically in women.

I’m a strong proponent of carbohydrate-restricted eating for weight management and cure or control of certain medical conditions. The great advantages of low-carbing for weight loss are 1) suppression of hunger, and 2) proven greater efficacy compared to other types of dieting. Nevertheless, I wasn’t aware that this way of eating also had potential benefits in terms of beauty maintenance or improvement. The author persuasively makes that case in this ground-breaking book.

Just because she has RD (registered dietitian) behind her name doesn’t mean you just have to take her word for it. Franziska gives us references to the scientific literature if you want to check it out yourself.

The author focuses on health and beauty; the weight loss happens naturally with low-carb eating. That’s a helpful “side effect” since 2/3 of women in the U.S. are overweight or obese.

She covers all the basics of low-carb eating, including the rationale, potential side effects and how to prevent or deal with them, the science of “good fats,” the importance of plant-derived foods and fiber, info on artificial sweeteners, and management of weight-loss stalls.

Then Franziska does something else unique and very helpful. She offers three different eating plans along with a simple test to help determine which is the best for you. The options are 1) low-carbohydrate diet, 2) high-fiber, moderate saturated fat, low-carb diet, and 3) intermittent fasting low-carb diet with weekly treat meal. You can dig right in with a week’s worth of easy meals made from readily available ingredients.

It was interesting for me to learn that the author ate vegan-style and then pescetarian for awhile. In 2011 she was eating the usual doctor-recommended “healthy” low-fat high-fiber diet when life insurance blood work indicated she had prediabetes. So she cut her daily dietary carbs from 150 grams to 50 or less, with subsequent return of the labs to normal ranges.

I only had a few quibbles with the book. For instance, there’s no index, but that’s mitigated by a very detailed table of contents. The font size is on the small side for my 60-year-old eyes. If either of those issues bother you, get the ebook version. “Net carbs” are mentioned briefly before they are defined, which might confuse folks new to low-carbing.

A particular feature that appealed to me is the vegetarian meal options. Low-carb eating is often criticized as being meat-centric. Franziska shows it doesn’t have to be.

I also appreciate that she provides the net carb grams and calorie counts for her meal plans and recipes. All diabetics and many prediabetics need to know the carb grams. Calorie counts come in handy when analyzing the cause of a weight loss stall. Yes, calories still count in weight management.

I don’t think it’s giving too much away to say that the author’s top low-carb beauty foods are avocados, berries, cinnamon, cocoa/dark chocolate, fatty fish, flaxseed, full-fat dairy, green tea, nuts, olives/olive oil, and non-starchy vegetables. I was skeptical at the start of the beauty foods chapter, but Franziska’s scientific references support her recommendations. I’m already eating most of these foods. Now I’m going to try green tea and ground flaxseed (e.g., her flaxseed bread recipe).

The author will also get you going on exercise. I heartily agree with her that exercise is truly a fountain of youth.

Menopausal? The author has your special challenges covered.

If you’re curious about the paleo diet, note that only about a quarter of these recipes are pure paleo. Dairy products disqualify many of them.

Here are a just a few tidbits I picked up, to help me remember them:

  • a blood test called fructosamine reflects blood sugar levels over the previous three weeks
  • you’ll have less wrinkles if you can reduce the advanced glycation end-products (AGEs) in your skin
  • Japanese women on the highest-fat diets have less wrinkling and better skin elasticity
  • soluble fiber from plants helps to reduce appetite, improves blood sugar control, and helps with weight regulation (see her table of high-fiber plants, including soluble and insoluble fiber)
  • seitan is a meat substitute for vegetarians
  • erythritol (an artificial sweetener) may have less gastrointestinal effects (diarrhea, gas, bloating) than many other artificial sweeteners
  • maltitol (another artificial sweetener in the sugar alcohols class) tends to increase blood sugar more than the other sugar alcohols
  • I’m going to try her “sardines mashed with avocados” recipe (Alton Brown popularized sardine-avocado sandwiches, so it’s not as bizarre as it sounds!)

I wouldn’t be surprised if Franziska’s recommendations help men as well as women keep or regain their youthfulness.

Steve Parker, M.D.

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March 31, 2014 · 4:31 PM

Book Review: Zest For Life

A few years ago I read and reviewed Zest For Life: The Mediterranean Anti-Cancer Diet, by Conner Middelmann-Whitney, published in 2011. Per Amazon.com’s rating system, I give it five stars (I love it).

♦   ♦   ♦

The lifetime risk of developing invasive cancer in the U.S. is four in ten: a little higher for men, a little lower for women.  Those are scary odds.  Cancer is second only to heart disease as a cause of death in western societies.  The Mediterranean diet has a well established track record of protecting against cancers of the prostate, colon/rectum, uterus, and breast.  Preliminary data suggest protection against melanoma and stomach cancer, too.  I’m not aware of any other way of eating that can make similar claims.

So it makes great sense to spread the word on how to eat Mediterranean-style, to lower your risk of developing cancer.  Such is the goal of Zest For Life’s author.  The Mediterranean diet is mostly, although by no means exclusively, plant-based.  It encourages consumption of natural, minimally processed, locally grown foods.  Generally, it’s rich in vegetables, fruits, legumes, olive oil, whole grains, red wine, and nuts. It’s low to moderate in meat, chicken, fish, eggs, and dairy products (mostly cheese and yogurt).

Note that one of the four longevity hot spots featured in Dan Buettner’s Blue Zones was Mediterranean: Sardinia.  All four Blue Zones were characterized by plant-based diets of minimally processed, locally grown foods. (I argue that Okinawa and the Nicoya Peninsula dwellers ate little meat simply due to economic factors.)

Proper diet won’t prevent all cancer, but perhaps 10-20% of common cancer cases, such as prostate, breast, colorectal, and uterine cancer.  A natural, nutrient-rich, mostly plant-based diet seems to bolster our defenses against cancer.

Ms. Middelmann-Whitney is no wacko claiming you can cure your cancer with the right diet modifications.  She writes, “…I do not advocate food as a cancer treatment once the disease has declared itself….”

She never brings it up herself, but I detect a streak of paleo diet advocacy in her.  Several of her references are from Loren Cordain, one of the gurus of the modern paleo diet movement.

She also mentions the ideas of Michael Pollan very favorably.

She’s not as high on whole grains as most of the other current nutrition writers.  She points out that, calorie for calorie, whole grains are not as nutrient-rich as vegetables and fruits.  Speaking of which, she notes that veggies generally have more nutrients than fruits. Furthermore, she says, grain-based flours probably contribute to overweight and obesity. She suggests that many people eat too many grains and would benefit by substituting more nutrient-rich foods, such as veggies and fruits.

Some interesting things I learned were 1) the 10 most dangerous foods to eat while driving, 2) the significance of organized religion in limiting meat consumption in some Mediterranean regions, 3) we probably eat too many omega-6 fatty acids, moving the omega-6/omega-3 ratio away from the ideal of 2:1 or 3:1 (another paleo diet principle), 4) one reason nitrites are added to processed meats is to create a pleasing red color (they impair bacterial growth, too), 5) fresh herbs are better added towards the end of cooking, whereas dried herbs can be added earlier, 6) 57% of calories in western societies are largely “empty calories:” refined sugar, flour, and industrially processed vegetable oils, and 7) refined sugar consumption in the U.S. was 11 lb (5 kg) in the 1830s, rising to 155 lb (70 kg) by 2000.

Any problems with the book?  The font size is a bit small for me; if that worries you, get the Kindle edition and choose your size.  She mentions that omega-6 and omega-3 fatty acids are “essential” fats. I bet she meant to say specifically that linolenic and linoleic fatty acids are essential (our bodies can’t make them); linolenic happens to be an omega-3, linoleic is an omega-6.  Reference #8 in chapter three is missing.  She states that red and processed meats cause cancer (the studies are inconclusive).  I’m not sure that cooking in or with polyunsaturated plant oils causes formation of free radicals that we need to worry about.

As would be expected, the author and I don’t see eye to eye on everything.  For example, she worries about bisphenol-A, pesticide residue, saturated fat, excessive red meat consumption, and strongly prefers pastured beef and free-range chickens and eggs.  I don’t worry much.  She also subscribes to the popular “precautionary principle.”

The author shares over 150 recipes to get you started on your road to cancer prevention.  I easily found 15 I want to try.  She covers all the bases on shopping for food, cooking, outfitting a basic kitchen, dining out, shopping on a strict budget, etc.  Highly practical for beginning cooks.  Numerous scientific references are listed for you skeptics.

I recommend this book to all adults, particularly for those with a strong family history of cancer.  But following the author’s recommendations would do more than lower your risk of cancer.  You’d likely have a longer lifespan, lose some excess fat weight,  and lower your risk of type 2 diabetes, dementia, heart disease, stroke, and vision loss from macular degeneration.  Particularly compared to the standard American diet.

Steve Parker, M.D.

Disclosure: The author arranged a free copy of the book for me, otherwise I recieved nothing of value for writing this review.

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December 9, 2013 · 4:24 PM

What’s the Best Diet for Type 2 Diabetics?

DietDoctor has some ideas based on a recent scientific study:

A new exciting Swedish study provides us with strong clues on how a person with diabetes should eat (and how to eat to maximize fat burning). It’s the first study to examine in detail how various blood markers change throughout the day depending on what a diabetic person eats.

The study examined the effects of three different diets in 19 subjects with diabetes type 2. They consumed breakfast and lunch under supervision in a diabetes ward. The caloric intake in the three diets examined was the same, but the diets differed in the following manner:

  1. A conventional low-fat diet (45-56% carbs)
  2. A Mediterranean diet with coffee only for breakfast (= similar to 16:8 intermittent fasting) and a big lunch (32-35% carbs)
  3. A moderate low-carbohydrate diet (16-24% carbs)

All participants tested all three diets, one diet each day in randomized order.

Click through for results. Hint: Carbohydrate restriction works.

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September 23, 2013 · 1:33 AM

Book Review: The Heart Healthy Lifestyle – The Prevention and Treatment of Type 2 Diabetes

I just finished an ebook, The Heart Healthy Lifestyle: The Prevention and Treatment of Type 2 Diabetes by Sean Preuss, published in 2013. Per Amazon.com’s rating system, I give it five stars (I love it).

♦   ♦   ♦

This is an invaluable resource for 1) anyone recently diagnosed with type 2 diabetes or prediabetes, 2) those who aren’t responding well to their current therapeutic regimen, and 3) type 2 diabetics who want to reduce their drug use.

Strength Training Helps Get Excess Blood Sugar Out of Circulation

Strength Training Helps Get Excess Blood Sugar Out of Circulation

Mr. Preuss is a fitness trainer who has worked with many type 2 diabetics. He demonstrates great familiarity with the issues diabetics face on a daily basis. His science-based recommendations are familiar to me since I reviewed many of his references at my blog, Diabetic Mediterranean Diet.

Like me, Mr. Preuss recognizes the primacy of lifestyle modification over drug therapy for type 2 diabetes, as long as drugs can safely be avoided or postponed. The main lifestyle factors are diet and exercise. Too many physicians don’t spend enough time on these, preferring instead to whip out the prescription pad and say, “Here ya go. I’ll see you in three months.”

I have gradually come to realize that most of my sedentary type 2 diabetes patients need to start a work-out program in a gym where they can get some personal attention. That’s Mr. Preuss’s opinion, too. The clearly explained strength training program he recommends utilizes machines most commonly found in a gym, although some home gyms will have them also. His regimen is easily done in 15-20 minute sessions two or three times a week.

He also recommends aerobic activity, such as walking at least several days a week. He recommends a minimum of 113 minutes a week of low intensity aerobic work, citing evidence that it’s more effective than higher intensity effort for improving insulin sensitivity.

I don’t recall specific mention of High Intensity Interval Training. HIIT holds great promise for delivering the benefits of aerobic exercise in only a quarter of the time devoted to lower intensity aerobics. It may be that it just hasn’t been studied in type 2 diabetics yet.

I was glad to see all of Mr. Preuss’s scientific references involved humans, particularly those with type 2 diabetes. No mouse studies here!

Another strength of the book is that Sean tells you how to use psychological tricks to make the necessary lifestyle changes.

The author notes that vinegar can help control blood sugars. He suggests, if you can tolerate it, drinking straight (undiluted) red wine vinegar or apple cider vinegar – 2 tbsp at bedtime or before carbohydrate consumption. I’ve heard rumors that this could be harmful to teeth, so I’d do some research or ask my dentist before drinking straight vinegar regularly. For all I know, it could be perfectly harmless. If you have a definitive answer, please share in the comments section below.

I read a pertinent vinegar study out of the University of Arizona from 2010 and reviewed it at one of my blogs. The most effective dose of vinegar was 10 g (about two teaspoons or 10 ml) of 5% acetic acid vinegar (either Heinz apple cider vinegar or Star Fine Foods raspberry vinegar).  This equates to two tablespoons of vinaigrette dressing (two parts oil/1 part vinegar) as might be used on a salad.  The study authors also say that “…two teaspoons of vinegar could be consumed palatably in hot tea with lemon at mealtime.”

The diet advice herein focuses on replacement of a portion of carbohydrates with proteins, healthy oils, and vegetables.

I highly recommend this book. And sign up for Mr. Preuss’s related tweets at @HeartHealthyTw.

Steve Parker, M.D.

Disclosure: Mr. Preuss gave me a free copy of the book, otherwise I have received no monetary compensation for this review.

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