Category Archives: Vegetarian Diet

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.

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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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Filed under Book Reviews, ketogenic diet, Overweight and Obesity, Vegetarian Diet

Dr. Harriet Hall Slaughters Vegan Sacred Cows

diabetic mediterranean diet

“Listen to Dr. Greger!”

I ran across some nutrition-advice videos of Dr Michael Greger six months ago and started following his twittering.  It didn’t take me long to figure out he favors a vegetarian or vegan diet. Dr. Harriet Hall at Science-Based Medicine has Dr. Greger in her crosshairs, challenging many of his claims.  Well worth a read.  An excerpt:

Vegans tell us the Inuit, who lived almost exclusively on food of animal origin, had a short life span. That’s not true. Statistics on the Inuit between 1822 and 1836 showed that their average life expectancy was about the same as that of European peasants of the time who ate a diet overwhelmingly based on bread. 25% of Inuit lived past 60, and some lived into their 80s and 90s.

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Filed under Uncategorized, Vegetarian Diet

Dr. Sigurdsson’s Thoughts on the Best Diet for Diabetes

"Vegan? Vegetarian? Mediterranean? Low-Carb? ADA? Low GI?  SAD?

“Vegan? Vegetarian? Mediterranean? Low-Carb? ADA? Low GI? SAD?

Remember that recent report on the best diet for diabetes from American Journal of Clinical Nutrition?  I didn’t think so.  Here’s Dr. Axel Sugurdsson’s summary:

Ajala and coworkers conclude that their review provides evidence that modifying the amount of macronutrients can improve glycemic control, weight and lipids in type 2 diabetes. In their analysis, low carbohydrate diets appeared to provide superior weight loss, better control of blood glucose, and better lipid profile, compared with low fat diets. The authors also conclude that vegan and vegetarian diet may improve glucose control and promote weight loss in type 2 diabetes.

Here’s the verbatim conclusion of the researchers from the article abstract:

Low-carbohydrate, low-GI, Mediterranean, and high-protein diets are effective in improving various markers of cardiovascular risk in people with diabetes and should be considered in the overall strategy of diabetes management.

No mention of vegan and vegetarian diets per se.

And now Dr. Sigurdsson’s concluding opinion:

What is the best diet for diabetes?  Although, there is probably not a simple answer,  the question reflects one of the main challenges of modern medicine. It is likely that our dietary recommendations will have to be tailored to the needs of the individual. A one-size-fits-all approach is unrealistic. Although not providing any definitive answers, the study by Ajala and coworkers is an important contribution to our understanding of this highly important issue.

Read the rest.

I’ve reviewed some of the literature supporting vegetarian diets for diabetes.  I’ve seen some evidence that the paleo diet may be beneficial.  Regular readers here know that I currently favor a carbohydrate-restricted Mediterranean-style diet for control of diabetes.

Steve Parker, M.D.

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Filed under Carbohydrate, Mediterranean Diet, Vegetarian Diet

Reverse Diabetes in 30 Days With a Raw Vegan Diet. Really?

I wanted to share a link with you that’s a review of a documentary called “Simply Raw: Reversing Diabetes in 30 Days.”  It’s at Science-Based Medicine.

The guys over at Science-Based Medicine take a look at the evidence for and against such ideas as reiki, Chinese bloodletting, Chinese medicinehomeopathy, vaccines, vaccines and autism, integrative oncology, holistic medicine, naturopathy, complementary and alternative medicine, quackademic medicine, chelation therapy, and chiropractic.

Steve Parker, M.D. 

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Filed under Vegetarian Diet

Individual Response to Weight-Loss Diet May Depend on Genes

Dieters with particular genetic make-up respond better or worse to specific types of weight-loss diets, suggest researchers who presented data at the 2010 Cardiovascular Disease Epidemiology and Prevention /Nutrition, Physical Activity, and Metabolism conference.  Findings are preliminary, but may explain the common phenomenon of two people going on the same diet, but only one achieving good results. 

I’ll bet you can imagine several other explanations.

Several years ago, the “A to Z” study compared the weight loss of 311 overweight women on one of four diets:  Atkins (low-carb), Ornish (very low fat, vegetarian), Learn (low-fat), and Zone (moderate carb restriction, high protein, moderate fat).  Atkins was a bit better than the other diets, in terms of long-term (one year) weight loss.  But within each diet group, some women lost 40–50 pounds (18–23 kg), whereas others gained over 10 pounds (4.5 kg).

Stanford University researchers obtained DNA from 138 of the 311 women and noted the occurence of three genes—ABP2, ADRB2, and PPAR-gamma—that had previously been shown to predict weight loss via diet-gene interactions.  For example, a particular mix of these genes predict better weight loss with a low-fat diet; a different mix predicts more loss with a low-carb diet.

Women who had been randomly assigned to one of the A to Z diets tended to lose much more weight if they happened to have the gene mix appropriate for that diet (compared to those on the same diet with the wrong gene mix).  The difference, for example, might be loss of 12 pounds versus two pounds.

The lead researcher, Dr. Mindy P. Nelson, told TheHeart.Org that the proportion in the general population genetically predisposed to the low-fat versus low-carb approach is about 50:50.

Take-Home Points

These results, again, are preliminary; additional testing is necessary for confirmation.  If they had been able to test the DNA of the other 178 women in the A to Z study, the results could have been either stronger or shown no diet-gene interaction.  The study hasn’t even been published in a peer-reviewed journal yet.

Men may or may not be subject to similar diet-gene interaction.

If a genetic test is ever clinically available to tell a dieter which type of weight-loss diet would be more successful, it will likely be cheaper to just try a particular diet first and see if it works over 4–6 weeks.  Successful long-term weight loss is like smoking cessation—most smokers try 5–7 different times or methods before hitting on one that works for them.

This potential diet-gene interaction could be a major finding that will stop the arguing about which is the single best way to lose excess fat.  Many paths may lead to the mountaintop. 

Steve Parker, M.D.

Reference:  O’Riordan, Michael.  Dieting by DNA?  Popular diets work best by genotype, reseach shows.  HeartWire by TheHeart.Org, March 8, 2010.

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Filed under Carbohydrate, Fat in Diet, ketogenic diet, Vegetarian Diet, Weight Loss

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.

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Filed under Book Reviews, Vegetarian Diet

Are Vegetarian Diets Any Good For Diabetes?

Plant-based diets may offer special benefits to people with diabetes, according to a recent review article by U.S. researchers who reviewed the pertinent English language literature published since 1966.  They found 116 potentially relevant articles, 10 of which were directly related to diabetes management and glucose control.

The authors failed to define “vegetarian” early on.  Some vegetarians eat eggs, some eat cheese, some drink milk.  I assume vegans eat no animal products whatsoever.  On the last page of the review the authors write that a vegetarian “does not eat meat, fish, or poultry” although it’s not clear if that applies throughout the review.  There are many references to “low-fat vegetarian” diets, with little or no mention of moderate- or high-fat vegetarian diets.

The authors often refer to vegetarian diets as “plant-based.”  No doubt, they are.  But even the healthy Mediterranean diet is considered plant-based, while clearly not vegetarian.

It’s also unclear whether they focused on type 1 or type 2 diabetes.  My sense is, probably type 2.

Here are the major points: 

  1. Are vegetarians less likely to develop diabetes?  Observational studies have found a lower prevalence of diabetes among vegetarians compared to non-vegetarians, especially among Seventh Day Adventists.  In other studies, meat consumption is linked to higher risk of diabetes among women. 
  2. Do vegetarian diets help control diabetes?  Several small studies showed that low-fat near-vegetarian and vegan diets improved glucose control and insulin sensitivity and reduced diabetes medication use, compared with a traditional diabetes diet – which is typically low-fat and high-carb.  I’m not sure, but I assume that the intervention diets were not heavy in refined, processed carbohydrates, but instead consisted of natural whole plant foods.  “Weight loss accounts for much although not all, of the effect of plant-based diets on glycemic control,” they write.
  3. Heart disease is quite common in older diabetics.  Do vegetarian diets offer any cardiac benefits?  They cite Dr. Ornish’s Lifestyle Heart Trial of a low-fat vegetarian diet and intensive lifestyle intervention: smoking cessation, stress management (meditation?), mild exercise, and group meetings.  Dr. Ornish’s program reduced LDL cholesterol by 37%, reversed heart artery blockages in 82% of participants, and found 60% lower risk of cardiac events compared to the control group. Dr. Ornish’s Multisite Lifestyle Cardiac Intervention Program also documented impressive cardiac results at 12 weeks, but had no control group.  Dr. Caldwell Esselstyne is also mentioned in this context.
  4. Vegetarian diets are linked to lower blood pressure, which may help prolong life and prevent heart attacks and strokes.
  5. Antioxidant-rich foods like fruits and vegetables—common in the Mediterranean diet and vegetarian diets—may lower cardiovascular disease risk. 
  6. People with diabetes are at risk for impaired kidney funtion.  In women with impaired baseline kidney funtion, high animal protein intake is associated with continued kidney deterioration. 
  7. A small study showed dramatic improvement in type 2 diabetics with painful neuropathy over 25 days on a low-fat vegan diet and a daily 30-minute walk.  Many participants were able to reduce diabetes drug dosages.
  8. Do any diabetes advocacy associations endorse vegetarian diets for people with diabetes?  The American Dietetic Association deems that vegetarian and vegan diets, if well-planned, are nutritionally adequate. I don’t know the position of the American Diabetes Association.  Vegetarians need planning to get adequate vitamin D, B12, and calcium.
  9. “Low-fat vegetarian and vegan diets do not require individuals to limit energy or carbohydrate intake….”  If true (and these guys should know), that might broaden the diet’s appeal.
  10. I saw no mention of decreased overall mortality in vegetarians.

My Comments

Have you heard of the Physicians Committee for Responsible Medicine?  Their president is Neal Barnard, the lead author of the study at hand.  He has a new book on reversal of diabetes with a low-fat vegetarian diet.

The authors cite a journal article (reference #16) in support of plant-based diets, but the article doesn’t mention a vegetarian or vegan diet—it’s high-carb, high-fiber diet.  I didn’t review all 92 of their references to see if any others were misleading.

“Plant-based diets” must be a euphemism for vegetarian diets.  Too many people shut down when you talk to them about vegetarian diets.

I won’t rule out the possibility that vegetarian/vegan diets may be helpful in management of diabetes.  Such diets are, of course, 180 degrees different from the very low-carb diets I’ve reviewed favorably in these pages!  Both models, ideally, move away from the over-processed, concentrated carbohydrates so prevalent in Western culture.  Perhaps that’s the unifying healthy theme, if there is one. 

Or different sub-types of diabetes respond better to particular diets.

I heartily agree with the authors that larger clinical trials of vegetarian diets in diabetics are needed.  I’d love to see a long-term randomized controlled trial comparing a very low-carb diet diet with a low-fat vegetarian diet.  That’s the best way to settle which is better for diabetics: vegetarian or low-carb.

It’ll never be done.

Has a vegetarian diet helped control your diabetes?

Steve Parker, M.D.

Reference:  Barnard, Neal, et al.  Vegetarian and vegan diets in type 2 diabetes managementNutrition Reviews, 67(2009): 255-263.   doi: 10.1111/j.1753-4887.2009.00198.x

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Filed under coronary heart disease, Diabetes Complications, Vegetarian Diet