Category Archives: Book Reviews

Book Review: The Blue Zones

Here’s my review of  The Blue Zones: Lessons for Living Longer From the People Who’ve Lived the Longest, a 2008 book by Dan Buettner.  I give the book four stars on Amazon.com’s five-star system (“I like it”). 

♦   ♦   ♦

The lifestyle principles advocated in The Blue Zones would indeed help the average person in the developed world live a longer and healthier life.  The book is a much-needed antidote to rampant longevity quackery.  Dan Buettner’s idea behind the book was “discovering the world’s best practices in health and longevity and putting them to work in our lives.”  He succeeds. 

Mr. Buettner assembled a multidisciplinary team of advisors and researchers to help him with a very difficult subject.  Do people living to 100, scattered over several continents, share any characteristics?  Do those commonalities lead to health and longevity? 

They studied four longevity hot spots (Blue Zones):

  • Okinawa islands (Japan)
  • Barbagia region of Sardinia (an island off the Italian mainland)
  • Loma Linda, California (a large cluster of Seventh Day Adventists)
  • and the Nicoya Peninsula (Costa Rica). 

Research focused on people who lived to be 100. 

Until recently, two of the Blue Zones—the Nicoyan Peninsula and Sardinia—were quite isolated, with relatively little influence from the outside world. 

Mr. Buettner et al identify nine key traits that are associated with longevity and health in these cultures.  Of course, association is not causation, which Mr. Buettner readily admits.  He draws more conclusions from the data than would many (most?) longevity scientists.  Scientists can wait for more data, but the rest of us have to decide and act based on what we know today.  Here are the “Power Nine”:

  1. regular low-intensity physical activity
  2. hari hachi bu (eat until only 80% full—from Okinawa)
  3. eat more plants and less meat than typical Western cultures
  4. judicious alcohol, favoring dark red wine
  5. have a clear purpose for being alive (a reason to get up in the morning, that makes a difference)
  6. keep stress under control
  7. participate in a spiritual community
  8. make family a priority
  9. be part of a tribe (social support system) that “shares Blue Zone values”

Of these, I would say the available research best supports numbers 1, 4, 7, 8, and the social support system.

I doubt that hari hachi bu (eat until you’re only 80% full) will work for us in the U.S.  It’s never been tested rigorously.  The idea is to avoid obesity.  

The author believes that average lifespan could be increased by a decade via compliance with the Power Nine.  And these would be good, relatively healthy years.  Not an extra 10 years living in a nursing home.

Appropriately and early on, Mr. Buettner addresses the issue of genetics by mentioning a single study of Danish twins that convinces him longevity is only 25% deterimined by genetic heritage.  Environment and lifestyle choices determine the other 75%.  I believe he underestimates the effect of genetics. 

Over half the population of the Nicoya Peninsula Blue Zone are of Chorotega Indian descent, not from Spanish Conquistadores.  Would a Danish twin study have much tosay about Chorotega Indians’ longevity?  We don’t know, but I’m skeptical.  Also, the Sardinians and Okinawans would seem to have centuries of a degree of inbreeding, too, according to Buettner’s own documentation. 
 
Do the Adventists tend to marry and breed with each other (like Mormons), thereby concentrating longevity genes?  You won’t find the question addressed in the book.

Because I think genetics plays a larger role in longevity than 25%, I’d estimate that the healthy lifestyle choices in this book might prolong life by six or seven years instead of 10.  But I’m splitting hairs.  I don’t have any better evidence than Mr. Buettner, just a hunch plus years of experience treating diseased and dying patients.

These four Blue Zones do share a mostly plant-based diet of natural foods with minimal processing.  Two of the populations—the Okinawans and Costa Ricans—didn’t seem to have any choice.  Heavy meat consumption just wasn’t an option available to them.  Rather than promoting a low-meat plant-based diet, it might be more accurate to conclude that “you don’t have to eat a lot of meat, chicken, or fish to live a long healthy life.”

In other words, it may not matter how much meat you eat as long as you eat the healthy optimal level of fruits, vegetables, and whole grains.  It’s a critical difference not addressed in this book except among the Adventists.

Even if you could live an extra two years as a vegan, I’m sure many people would choose to eat meat anyway.  By the way, this book conflates vegan, lacto-vegetarian, lacto-ovo vegetarian, near-vegetarian, and vegetarian into one: vegetarian.  It’s a common problem when considering the health aspects of vegetarianism.  They are not necessarily the same.   

By the same token, plenty of my patients have told me they don’t like any kind of exercise and they won’t do it, even if it would give them an extra two years of life.  What many don’t realize is that from a functional standpoint, regular exercise makes their bodies perform as if they were ten years younger.  There’s a huge difference between the age of 80 and 70 in terms of functional abilities.

Why read the book now that you have the Power Nine?  To convince you to change your unhealthy ways, and indispensible instruction on how to do so.

Steve Parker, M.D.

Disclosure:  The publisher’s representative did not pay me for this review, nor ask for a favorable review.  They offered me a review copy and three give-aways, and I accepted.  I figure the cost of the books to the publisher was $16 USD total.  I gave away the books through my Advanced Mediterranean Diet Blog.  Cost of shipping the books to the winners came out of my pocket.

3 Comments

Filed under Book Reviews, Vegetarian Diet

Mediterranean Cookbooks for Health and Longevity

Who knows where this is?

Here are some Christmas gift book suggestions for someone trying to eat healthier via the Mediterranean diet.

  • The Mediterranean Heart Diet: How It Works and How to Reap the Health Benefits, with Recipes to Get You Started by Helen V. Fisher.
    [More than 140 delicious and healthy recipes from an experienced cookbook author and a doctorate-level clinical nutrition specialist.] 
  • The Mediterranean Diet by Marissa Cloutier and Eve Adamson.  [The Mediterranean-style recipes here get you close to an ovo-lacto-vegetarian diet.  The authors complicate the Oldways-Willett Mediterranean Pyramid and promote soy milk products.  Nevertheless, this is “good eats.”]
  • The Mediterranean Kitchen by Joyce Esersky Goldstein.
  • The Essential Mediterranean: How Regional Cooks Transform Key Ingredients into the World’s Favorite Cuisines by Nancy Harmon Jenkins. 
  • Mediterranean Diet Cookbook: A Delicious Alternative for Lifelong Health by Nancy Harmon Jenkins.  Updated in 2008 as The New Mediterranean Diet Cookbook
  • Mediterranean Cooking by Paula Wolfert.

Steve Parker, M.D.

2 Comments

Filed under Book Reviews

Book Review: Good Calories, Bad Calories

Here’s my  review of good Calories, Bad Calories: Challenging the Conventional Wisdom on Diet, Weight Control, and Disease, by Gary Taubes, 2007.  I give it five stars on Amazon.com’s five-star system (“I love it”).

♦   ♦   ♦

This brilliant book deserves much wider currency among physicians, dietitians, nutritionists, and obesity researchers.  The epidemic of overweight and obesity over the last 30 years should make us question the reigning theories of obesity treatment and prevention.  Taubes questioned those theories and pursued answers wherever the evidence led.  He shares in GCBC his eye-opening, even radical, well-reasoned findings. 

Ultimately, this tome is an indictment of the reigning scientific community and public nutrition policy-makers of the last four decades.  That explains why, twoyears after publication, this serious, scholarly work has not been reviewed by the New England Journal of Medicine, the Journal of the American Medical Association, the American Journal of Clinical Nutrition , and the Journal of the American Dietetic Association (as of August, 2009).

In Part 1, Taubes examines the scientific evidence for what he calls the fat-cholesterol hypothesis.  More commonly known as the diet-heart hypothesis, it’s the idea that dietary fat (especially saturated fat) and cholesterol clog heart arteries, causing heart attacks.  Taubes finds the evidence unconvincing.  He’s probably right.

Part 2, The Carbohydrate Hypothesis, revives and older theory from the mid-twentieth cenury that is elsewhere called the Cleave-Yudkin carbohydrate theory of dental and chronic systemic disease.  In the carbohydrate theory,  high intake of sugary foods, starches, and refined carbhohyrates leads first to dental disease (cavities, gum inflammation, periodontal disease) then, later, to obesity and type 2 diabetes, coronary heart disease, perhaps even cancer and Alzheimer’s Disease.  These are, collectively, the “diseases of civilization.”

Part 3 tackles obesity and weight regulation.  Taubes writes that “…fattening and obesity are caused by an imbalance—a dysequilibirium—in the hormonal regulation of adipose [fat] tissue and fat metabolism.”  Think of the transformation of a skinny 10-year-old girl into a voluptuous young woman.  It’s not over-eating that leads to curvaceous fat deposits, growth of mammary tissue, and increase in height; it’s hormonal changes beyond her control. 

The primary hormonal regulator of fat storage is insulin, per Taubes.  Elevated insulin levels lead to storage of food energy as fat.  Carbohydrates stimulate insulin secretion and make us fat. 

Although it’s a brilliant book, by no means do I agree with all Taubes’ conclusions.  For instance, if carbohydrates cause heart disease, why is glycemic index only very weakly associated with coronary heart disease in men?  It’s way too early to blame cancer and Alzheimers on carbohydrates.  Primitive cultures may not exhibit many of the diseases of civilization because their members die too young.  Taubes is clearly an advocate of low-carb eating.  Why didn’t he directly address the evidence that fruits, vegetables, and whole grains in the right amounts are healthy?

I have to give Taubes credit for thinking “outside the box.”  His search for answers included reviews of esoteric literature and interviews with scientists in the fields of genetics, athropology, public policy, physiologic psychology, and paleontology, to name a few.

Towards the end of the book, Taubes describes a Mediterranean-style or “prudent” diet that is popular these days.  After five years of research for his book, he says that whether a very low-carb meat diet is healthier than a prudent diet “… is still anybody’s guess.”  It’s hard for me to put aside numerous observational studies associating health benefits with legumes, fruits, vegetables, and wholegrains.  So my “guess” is that the Mediterranean-style diet is healthier.  Perhaps the answer is different for each individual.  Heck, maybe the answer is low-carb Mediterranean.  Both Taubes and I are prepared to accept either result when we have proof-positive data.    

Taubes doesn’t base his opinions on late-breaking scientific results.  Instead, his research findings mostly span from 1930 to 1980, especially 1940-1960.  Once the fat-cholesterol (diet-heart) hypothesis took root around 1960 and blossomed in the 1970s, these data were ignored by the entrenched academics and policy-makers of the day. 

To be fair, I’ve got to mention this is not light reading.  A majority of people never read another book after they graduate high school.  Of those who do, many (like me) will have to look up the definition of “tautology,” “solecism,” etc. 

I was taught in medical school years ago that “a calorie is a calorie is a calorie.”  Meaning: if you want to lose excess weight, it doesn’t matter if you cut calories from fat, protein, or carbohydrates.  I really wonder about that now.

Steve Parker, M.D 

Additional Reading

Bray, George A.  Viewpoint: Good Calories, Bad Calories by Gary TaubesObesity Reviews, 9 (2008): 251-263.

Taubes, Gary.  Letter to Editor: Response to Dr. George Bray’s review of Good Calories, Bad CaloriesObesity Reviews, 10 (2008): 96-98.

5 Comments

Filed under Book Reviews, Carbohydrate, Causes of Diabetes, coronary heart disease, Overweight and Obesity

Book Review: Atkins Diabetes Revolution

I must give credit to Dr. Robert C. Atkins for popularizing an approach – carbohydrate restriction – that helps people with diabetes control their disease, and likely helps prevent type 2 diabetes in others.  Mary C. Vernon and Jacqueline Eberstein do a great job explaining his program in their 2004 book, Atkins Diabetes Revolution: The Groundbreaking Approach to Preventing and Controlling Type 2 Diabetes

On the Amazon.com five-star rating scale, I give this book four stars.

I can best summarize this book by noting that it is the standard Atkins diet with a few modifications: 1) special supplements  2) you add additional carbs to your diet more slowly  3) the warning that diabetics may well end up with a lower acceptable lifetime carbohydrate intake level.

By way of review, the Atkins diet is a very low-carb diet, particularly in the two-week induction phase.  “Very low-carb” means lots of meat, chicken, fish, eggs, limited cheese, and 2-3 cups daily of salad greens and low-carb veggies like onions, tomatoes, broccoli, and snow peas.  After induction phase, you slowly add back carbs on a weekly basis until weight loss stalls, then you cut back on carbs.

As an adult medicine specialist, I have no expertise in pediatrics.  I didn’t read the two chapters related to children.

The authors present “complimentary medicine”in a favorable light.  Unsuspecting readers need to know that much of complementary medicine is based on hearsay and anecdote, not science-based evidence.  In that same vein, the two chapters on supplements for diabetes and heart disease recommend a cocktail of supplements that I’m not convinced are needed.  I don’t know a single endocrinologist or cardiologist prescribing these concoctions.  Then again, I could be wrong.   

Vernon and Eberstein provide two excellent chapters on exercise.

A month of meal plans and recipes are provided for 20, 40, and 60-gram carbohydrate levels.  [The average American is eating 250-300 g of carbs daily.]  The recipes look quick and easy, but I didn’t prepare or taste any of them.

The 5-hour glucose and insulin tolerance test (GTT, paged 61) that Dr. Atkins reportedly ran on all patients who came to him is rarely done in other medical clinics.  This doesn’t mean it’s wrong, but certainly out of the mainstream.  The authors admit that at least a few people will have to count calories – specifically, limit total calories – if the basic program doesn’t control diabetes, prediabetes, and the metabolic syndrome.  Limiting portion size will speed weight loss, they write.

What we don’t know with certainty is, will long-term Atkins aficionados miss out on the health benefits of higher consumption of fruits, vegetables, legumes, and whole grains?  Much of the scientific literature suggests, “Yes.”

What if we compare the long-term outlooks of a diabetic Atkins follower with a poorly controlled diabetic who’s 80 pounds overweight and eating a standard American diet?  The Atkins follower is quite likely to be healthier  and live longer.

Steve Parker, M.D.

 

 

1 Comment

Filed under Book Reviews

Book Review: 21 Life Lessons From Livin’ La Vida Low-Carb

Here’s my review of Jimmy Moore’s new book, 21 Life Lessons From Livin’ La Vida Low-Carb: How the Healthy Low-Carb Lifestyle Changed Everything I Thought I Knew.  I rate it five stars, Amazon.com’s highest rating.

♦   ♦   ♦

Thinking about quitting your low-carb lifestyle?  Read this book first.

Jimmy Moore is a leading advocate for low-carb eating.  His purpose with this book is to educate, encourage, and inspire overweight people to begin or maintain their own low-carb journey.  And he succeeds in spades.

Mr. Moore assumes the reader already knows how to do low-carb eating.  If you don’t, I’m sure Mr. Moore would recommend Dr. Atkins New Diet Revolution as the single best source.  As with all diets, low-carb eating has a high drop-out rate.  Most people lose some weight then return to their old way of eating, gaining the weight back.

Even as the author of a balanced, calorie-restricted diet book, I’ll admit that many people have had phenomenal success with low-carb diets, without caloric restriction.  Mr. Moore is one of those: 180 pounds (82 kg) weight loss in one year, and sustained over five years.  Could he be lying?  Sure.  But my gut feeling is he’s not. 

This book is not only a survey of the low-carb world covering the last decade, its an autobiography.  He shares his traumatic upbringing and the frustrating premature death of his morbidly obese brother from heart disease.  You’ll learn about Mr. Moore’s movie career alongside George Clooney.  I was also surprised to learn that Mr. Moore lost 170 pounds (77 kg) in 1999, not on a low-carb diet, but a low-fat one!  Then what happened?  I won’t spoil it for you.  Mr. Moore also owns up to his regrettable and embarrassing affiliation with the Kimkins diet in 2007.

The only weak chapter is the one on childhood obesity.  Mr. Moore moves away from his previous science- and evidence-based arguments, using personal opinion and anecdote more often.  This partly reflects the fact that childhood obesity hasn’t been studied nearly as much as the adult version.

I particularly like Mr. Moore’s review of the scientific evidence in favor of low-carb eating.  The science was inspired and driven by the low-carb craze of 1998-2004.  But the study results weren’t published until after the fad peaked.  So most people aren’t familiar with the science.  Mr. Moore presents it in very understandable terms, which is a gift.

As heavily invested as he is in low-carb eating, does Mr. Moore condemn other methods of weight management?  By no means.  He repeatedly writes: “The point is to find the proven nutritional plan that works for you, follow that plan as exactly as prescribed by the author, and then stick to it for the rest of your life.” 

Steve Parker, M.D.

Additional information: Jimmy Moore’s Livin’ La Vida Low-Carb Blog

Comments Off on Book Review: 21 Life Lessons From Livin’ La Vida Low-Carb

Filed under Book Reviews