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Which Pedometer Should I Get?

Setting a goal of walking 10,000 steps a day could motivate you to become active enough to gain the health benefits of exercise.  You count steps automatically with a pedometer.  Regular exercise also helps keep lost weight from returning.

Thanks to the Internet, you can waste spend hours reviewing features of pedometers before you make a purchase. 

Consumer Reports magazine in February, 2009, reviewed pedometers and their #1 Best Buy recommendation was the Omron HJ 112, which you can clip to your belt or waistband, or carry in your purse.  Available for around $15-30 (U.S. dollars). 

No. 2 was the Accusplit AE 170 XLG ($30-35).  The Accusplit AE 170 is probably just as good.  The only differences I see are that you can enter specific goals into the XLG and it tracks your progress and the time you’re moving. 

The Omron HIP (HJ 150, $20) is also very popular and probably the simplest one to use on this page.

The guys at Obesity Panacea blog recommend the Omron HJ-303 ($35), which you can carry in your pocket instead of clipped to your waistband.

You don’t have to be a marathoner or gym rat to gain most of the health benefits of exercise.  Why not start a walking program today?

Steve Parker, M.D.

Disclosure:  I was not paid to mention these products.  I haven’t owned or used any of them.  If you are a device manufacturer or sales representative and would like me to try your pedometer, please contact me by e-mail.

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What Is Normal Blood Sugar?

Lately I’ve been thinking about which carbohydrates might be added to the Ketogenic Mediterranean Diet to make it healthier yet remain diabetic-friendly.  Carbohydrates—some more than others—tend to elevate blood sugars in diabetics.  If I’m going to recommend adding carbs to the KMD, I have to give some idea what an acceptable blood sugar response would be.  An excessive rise in blood sugar level would necessitate eliminating that carbohydrate, reducing the serving size, or changing the diabetic medication regimen (increase a dose or add a new drug?) 

First off, I’ve reviewed what constitutes blood sugar levels in healthy non-diabetics before and after meals.  Those levels might give us some idea what to shoot for in diabetics. 

The following numbers refer to average blood sugar (glucose) levels in venous plasma, as measured in a lab.  Portable home glucose meters measure sugar in capillary whole blood.  Many, but not all, meters in 2010 are calibrated to compare directly to venous plasma levels.

Fasting blood sugar after a night of sleep and before breakfast: 85 mg/dl (4.72 mmol/l)

One hour after a meal: 110 mg/dl (6.11 mmol/l)

Two hours after a meal: 95 mg/dl (5.28 mmol/l)

Five hours after a meal: 85 (4.72 mmol/l)

(The aforementioned meal derives 50–55% of its energy from carbohydrate)

♦   ♦   ♦

Ranges of blood sugar for young healthy non-diabetic adults:

Fasting blood sugar: 70–90 mg/dl (3.89–5.00 mmol/l)

One hour after a typical meal: 90–125 mg/dl (5.00–6.94 mmol/l)

Two hours after a typical meal: 90–110 mg/dl (5.00–6.11 mmol/l)

Five hours after a typical meal: 70–90 mg/dl (3.89–5.00 mmol/l)

♦   ♦   ♦

Another way to consider normal blood sugar levels is to look at a blood test called hemoglobin A1c, which is an indicator of average blood sugar readings over the prior three months.  The average healthy non-diabetic adult hemoglobin A1c is 5% and translates into an average blood sugar of 100 mg/dl (5.56 mmol/l).  This will vary a bit from lab to lab.  Most healthy non-diabetics would be under 5.7%.

What Level of Blood Sugar Defines Diabetes and Prediabetes?  

According to the 2007 guidelines issued by the American Association of Clinical Endocrinologists:

Prediabetes (or impaired fasting glucose): fasting blood sugar 100–125 mg/dl (5.56–6.94 mmol/l)

Prediabetes (or impaired glucose tolerance): blood sugar 140–199 mg/dl (7.78–11.06 mmol/l) two hours after ingesting 75 grams of glucose

Diabetes: blood sugar 200 mg/dl (11.11 mmol/l) or greater two hours after ingesting 75 grams of glucose

Diabetes: random blood sugar 200 mg/dl (11.11 mmol/l) or greater, plus symptoms of diabetes

For my current thoughts on blood sugar goals for diabetics and prediabetics, please see the bottom half  of my “What is Normal Blood Sugar” page.

Steve Parker, M.D.

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New Year’s Traditions and Superstitions

Eat black-eyed peas on New Year’s Day for good luck in the coming year, at least if you live in the southern U.S. where I grew up.  In the Deep South, add pork and collard greens.

In some parts of Italy they eat lentils instead, for financial prosperity.  Lentils look  a bit like coins. 

In Greece, January 1 is St. Basil’s day.  He was the forefather of the Greek Orthodox church.  At midnight on New Year’s eve, the head of the household cuts vassilopitta (St. Basil’s cake).  Whoever gets the piece with the embedded silver or gold coin will be lucky for the next year. 

In Spain and Portugal, they eat 12 grapes, one grape at each stroke of the clock or bell at midnight New Year’s eve.  Assuming you don’t choke, you gain 12 months of prosperity and luck. 

Inhabitants in some regions of Portugal eat salt cod on New Year’s eve for good luck. 

In Mexico, if someone gives you red underwear and you have it on at midnight New Year’s eve, you’ll experience love that year.  Yellow underwear brings a good job, work, or prosperity.  Carry suitcases outside and around your house at midnight, and you’ll travel in the coming year.

My children were born in Pensacola, Florida—the Deep South for sure.  I’m picking up a can of black-eyed peas today. 

Here’s wishing you a happy and healthy New Year!

Steve Parker, M.D.

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Healthy Eating Guide from Darya Pino

Darya Pino is a scientist, San Francisco foodie and advocate of local, seasonal foods

Darya Pino, founder of Summer Tomato, has generously offered her new guide, “How to Get Started Eating Healthy,” to anyone who wants it, gratis.

I’ve not read the guide yet, but I’m very familiar with Darya’s work at Summer Tomato.  I’m sure her guide is well done and her suggestions would be a vast improvement over the standard American diet (SAD). 

Steve Parker, M.D.

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Thinking About a Weight Loss New Years’ Resolution?

Did you get enough to eat for Thanksgiving holiday?  Did you gain a pound or three, like me?

Around this time of year, many people start thinking seriously about losing excess weight and getting healthier.  Choosing a weight-loss program is not something to be done on a whim.  That’s a recipe for failure.  So I’ve updated my popular eight-part “Prepare for Weight Loss” series.  After laying some groundwork, it helps you pick a reasonable weight-loss plan suited to you. 

Well begun is half done:  It’s as true for weight loss as it is for other projects.

Steve Parker, M.D.

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What About the Paleo Diet?

Paleo diets have been increasingly popular over the last few years.  The idea is that, for optimal health, we should be eating the things that we are evolutionarily adapted to eat.  Those foods pre-date the onset of large-scale agriculture 10-12,000 years ago.  So grains and modern fruits and vegetables play little or no role in someone who has “gone paleo.”

My recollection from college courses years ago is that average lifespan in paleolithic times was perhaps 25-30 years, or less.  If you’re going to die at 25, it may not matter if you eat a lot of  wooly mammath, berries, insects, cholesterol, saturated fats, Doritos, Ding Dongs, or Cheetos.  The diseases of civilization we worry about today—coronary heart disease, high blood pressure, cancer, dementia, type 2 diabetes, etc.—don’t usually appear until after age 30.  Paleolithic Man worried more about starvation.

Jenny Ruhl, at her Diabetes Update blog, recently put much more critical thought than I into the concept of paleo diets.  Recommended reading.    

Steve Parker, M.D. 

Extra credit

For purposes of discussion, let’s assume that human evolution actually occurred over millions, or at least hundreds of thousands, of years.  In other words, assume that God didn’t make Adam and Eve in human form in one day.

The theory of evolution proposes that genes that allow an animal to live and reproduce more vigorously in a particular environment will be passed on to the animal’s offspringNature will select those genes to spread through the animal population over time, assuming the environment doesn’t change.  The offspring with those genes will be able to compete with other animals more successfully for food, shelter, and mates.  Factors that promote the persistence and inheritance of specific genes are called “selection pressure.”

Here’s an example of selection pressure.  Remember when you were in grade school on the playground, some people could naturally run faster than others?  Were you one of the fast ones?  If you’ve never seen it for yourself, take my word for it: Some people are naturally gifted with athletic genes.

Let’s say you and I are outside collecting berries and nuts in paleolithic times.  A saber-toothed tiger spots us and charges, hungry for a meal.  You don’t have to outrun the tiger: you just have to outrun me.  I’m slower than you, and get eaten.   I can no longer pass on my slow-running genes to the next generation.  You live another day and pass on your fast-running genes to your children. 

Viola!  Natural selection, via selection pressure, has promoted your genes over mine.

[The tiger also passes on her genes since she was fast and smart enough to catch me, preventing starvation of her and her offspring.] 

[I’m 99% sure I wrote the preceeding few paragraphs originally about a year ago.  My notes, however, hint that they may have been written by Dr. J., a regular contributor at CalorieLab.  Dr. J., let me know if I’ve plagiarized you and I’ll give you full credit and delete my writing.]

The paleo diet rationale seems to be based on an evolutionary argument: Certain foods were available to us during 99% of our evolution, so our bodies are adapted to work optimally with them.  For example, humans/humanoids/higher primates who were not suited to the available food did not survive and reproduce, so their genes were not passed on to us.

For most of human existence, maximum lifespan was probably 25-30 years, on average. If that’s as long as you’re going to live, it may not matter much what you eat. Eat paleo, vegetarian, McDonald’s, Atkins, or Mediterranean. Most diet-related conditions except overweight and under-nutrition are not going to be an issue before age 30. 

[The modern paleos argue that infant and childhood mortality were extremely high in paleolithic times.  If you survived childhood, you could easily live to be 50+.]

But now we live to be 80, long enough for diet-related diseases to appear. We have cancer, heart attacks, and strokes that paleo man never saw because he died of trauma or infection or starvation. We even see the expression of genes that were not subjected to survival or selection pressure: Alzheimers disease, Huntingtons chorea, some breast cancers, etc.  People with genes for these diseases reproduce before the genes do their damage.

In other words, we carry genes that don’t matter if you die at age 30. If you live longer, they express themselves, and I believe we can modify their expression through diet and lifestyle. And not necessarily the paleo diet.

I’m still thinking it through.

For the other side of the argument, visit Mark’s Daily Apple, At Darwin’s Table, or read Dr. Loren Cordain’s The Paleo Diet.

-Steve

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Happy World Diabetes Day!

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Flag of the United Nations

This is World Diabetes Day.  See the International Diabetes Federation website for details

Steve Parker, M.D.

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Recommended Supplements for the Ketogenic Mediterranean Diet

I’ve finalized—at least for now—the latest supplements for dieters on the Ketogenic Mediterranean Diet, and tinkered with the original plan: Version 2.0 is published.

Daily supplements:

  • 1 or 2 plain Centrum multivitamin/multimineral supplements (two if over 250 lb or 114 kg)
  • Magnesium oxide 250 mg
  • Calcium carbonate 500 mg elemental calcium  (500 mg twice daily if over 250 lb or 114 kg)
  • Extra vitamin D to reach total of 1,000–1,200 IU (each Centrum has 400 IU)
  • Potassium gluconate 2,750 mg (450 mg elemental potassium) or Morton Salt Substitute (potassium chloride) ¼ tsp (1.2 g)
  • If prone to constipation: sugar-free Metamucil powder 1–2 rounded tsp (5.8–11.6 g) in water
  • At least three quarts or liters of water

The published version 2.0 of KMD has a misprint: “1,000–2,ooo IU of vitamin D.”  Should be 1,000–1,200 IU.  I’ll fix it soon and label it version 2.1. 

Steve

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Linus Pauling Institute’s Micronutrient Information Center

MPj03862020000[1]I found a free source of science-based information on various dietary micronutrients: the Linus Pauling Institute’s Micronutrient Information Center.  If you have questions about zinc, manganese, molybdenum, coenzyme Q10, calcium, vitamin D, or other micronutrients, you’ll probably find the answers there.

Steve Parker, M.D.

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Greek Yogurt

Greek yogurt

Greek yogurt

Isaac recently inquired about Greek yogurt.  [This is a Mediterranean diet website, after all.]  I admitted I didn’t know much about it.  As luck would have it, Corinne Dobbas reviewed Greek yogurt at her Green Grapes Blog today.  Take a look.  Greek yogurt is much lower in carbs than standard store-bought yogurts, so it may well fit into a low-carb diet.

Steve Parker, M.D.

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