December 14, 2011 · 3:30 AM

What About “The Biggest Loser”?

Probably not watching The Biggest Loser

Dr. Barry Sears (Ph.D., I think) recently wrote about a lecture he attended by a dietitian affiliated with “The Biggest Loser” TV show.  She revealed the keys to weight-loss success on the show.  Calorie restriction is a major feature, with the typical 300-pounder (136 kg) eating 1,750 calories a day.  On my Advanced Mediterranean Diet, 300-pounders get 2,300 calories (men) or 1,900 calories (women). 

Although not stressed by Dr. Sears, my impression is that contestants exercise a huge amount. 

Go to the Sears link above and you’ll learn that all contestants are paid to participate.  In researching my Conquer Diabetes and Prediabetes book, I learned that the actual Biggest Loser wins $250,000 (USD).  Also, “The Biggest Loser” is an international phenomenon with multiple countries hosting their own versions, with different pay-off amounts.  A former Biggest Loser, Ali Vincent, lives in my part of the world and still has some celebrity status.

This TV show demonstrates that the calories in/calories out theory of body weight still applies.  Including the fact that massive exercise can help significantly with weight loss.  In real-world situations, exercise probably contributes only a small degree to loss of excess weight.  The major take-home point of the show, for me, is that you can indeed make food and physical activity choices that determine your weight.

Most of us watch too much

I know losing 50 to 10o pounds of fat (25–45 kg) and keeping it off for a couple years is hard; most folks can’t do it.  Do you think you’d be more successful if I gave you $250,ooo for your success?

Steve Parker, M.D.

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December 7, 2011 · 4:50 AM

Your Tax Dollars At Work: FDA Warns HCG Marketers

 

"It's been three months. That HCG should kick in right about now."

Ooooh!  I’m sure they’re shaking in their boots.

I ran across a patient in the emergency department a couple months ago who coincidentally happened to be taking over-the-counter HCG oral drops for help with weight loss.  She didn’t ask my opinion, so I didn’t give it.

Now the FDA has sent a stern warning letter to seven HCG diet marketers to cease and desist.  I started seeing ads for homeopathic oral HCG at least a year ago.  And the FDA is just now getting around to the letters?

The Science-Based Medicine blog can teach you about homeopathy.

Here’s a snippet from the first FDA link above:

Miller explains that HCG was first promoted for weight loss in the 1950s. “It faded in the 1970s, especially when it became apparent that there was a lack of evidence to support the use of HCG for weight loss,” she says.

The diet has become popular again and FDA and FTC are taking action on illegal HCG products. “You cannot sell products claiming to contain HCG as an OTC drug product. It’s illegal,” says Brad Pace, team leader and regulatory counsel at FDA’s Health Fraud and Consumer Outreach Branch. “If these companies don’t heed our warnings, they could face enforcement actions, legal penalties or criminal prosecution.” 

You think these HCG marketers didn’t know from the git-go that what they were doing was illegal?

I’d have thought the FDA already had enough poop to start enforcement actions.

But what do I know?

Steve Parker, M.D.

 

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December 5, 2011 · 2:00 AM

What About Insulin Pumps?

Ever wonder what it’s like to get your insulin via a pump?  Tim at Shoot Up or Put Up shares his year’s worth of pump experience with the world.  Tim must have type 1 diabetes. He lives in the U.K., so you’ll see blood sugar levels in mmol/l instead of the U.S. standard of mg/dl.  To convert mmol/l to mg/dl, multiply by 18.

Steve Parker, M.D.

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December 3, 2011 · 12:35 AM

Does Olive Oil Protect Against Stroke?

Older adults with high olive oil consumption have a lower risk of stroke, according to French investigators.

The Mediterranean diet, rich in olive oil, has long been linked to lower rates of stroke and other health benefits.  The French researchers wondered stroke prevention might be attibutable to higher olive oil consumption.  Triglyceride esters of oleic acid comprise the majority of olive oil, and oleic acid blood levels reflect olive oil consumption. 

Have you heard of monounsaturated fatty acids?  Oleic acid is one.

Methodology

Over 7,000 older adults without history of stroke were surveyed with regards to olive oil consumption.  Oleic acid plasma levels were measured in over a thousand of the study participants.  Over the course of five years, 175 strokes occurred.

Compared with those who never used olive oil, those with the highest consumption had a 41% lower risk of stroke.  The researchers made adjustments for other dietary variables, age, physical activity, and body mass index.

In looking at the plasma oleic acid levels, those in the highest third of levels had 73% lower risk of stroke compared to those in the lowest third.

Comments

Results suggest that the olive oil in the Mediterranean diet  may help explain the diet’s protection against stroke.  They also support my inclusion of olive oil in the Low-Carb Mediterranean Diet and Advanced Mediterranean Diet.

Steve Parker, M.D.

Reference:  Samieri, C. et al.  Olive oil consumption, plasma oleic acid, and stroke incidence: the Three-City Study.  Neurology, Published online before print June 15, 2011, doi: 10.1212/WNL.0b013e318220abeb

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December 1, 2011 · 7:11 AM

The Wonders of Olive Oil

Laura Dolson has posted a good article on olive oil: health benefits, types, selection, storage, and cooking tips.

–Steve

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November 28, 2011 · 3:07 AM

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 medicine, homeopathy, 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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November 19, 2011 · 11:52 AM

Gluten-Free, Wheat-Free, Sugar-Free: “Low-Carbing Among Friends”

Low Carbing Among Friends: Low-carb and Gluten-free V1 (Low Carbing Among Friends, Volume-1)I’m very excited about a brand new cookbook for folks limiting their consumption of carbohydrates, wheat, and gluten.  It’s a unique collaboration among five chefs (Jennifer Eloff, Maria Emmerrich, Carolyn Ketchum, Lisa Marshall, and Kent Altena) and other low-carb luminaries like Jimmy Moore and Dana Carpender.  I was honored to contribute a couple pages myself.  The book is Low-Carbing Among Friends, volume 1.

All 325 recipes limit digestible carbohydrates to a maximum of 10 grams; many have five or fewer grams.  This should be great for people with diabetes and anyone trying to manage excess weight with low-carb eating.  All recipes are gluten-free, wheat-free, and sugar-free.

I can’t wait for my copy.  I’m “online friends” with several of the contributors, so I’m familiar with the great quality of their work.  You can get the book at Amazon.com, but I ordered mine from the book’s website, figuring the authors make more profit there.  (If we want good books, we have to support authors.)  It’s not too late to order this as a Christmas present.  Don’t you know someone who could use it?  

Steve Parker, M.D.

 

 

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November 10, 2011 · 2:31 AM

Is Exercise Supposed To Be Fun?

Exercise is not supposed to be fun.  If it is, then you should suspect that something is wrong.

That quote is from an essay by Ken Hutchins posted at the Efficient Exercise website.

When I was a young man in my 30s, I was jogging 20 miles a week and ran a couple marathons (26.2 miles).  I enjoyed it and didn’t do much else for exercise or overall fitness. I thought I was in pretty good shape.  You can get away with that when you’re 35, but not when you’re 50.  At 57 now, I can’t think of any single recreational activity that can help me maintain the overall strength, functionality, and injury resistance I want and need as I age. 

I’ve come to view exercise as a chore, like flossing/brushing teeth, changing the oil in my car, and sleeping when I’d rather not.  I’ve got my current exercise chore whittled down to an hour three times a week.  OK, sometimes just twice a week.

Skyler Tanner takes a thoughtful and in-depth look at the exercise versus recreation dichotomy at his blog.  If you have comments, more people will see them at his site than here.

Steve Parker, M.D.

 

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November 8, 2011 · 2:00 AM

How Are Green and Black Olives Different?

Laura Dolson over at About.com explains the differences and briefly discusses olive processing in a recent post.

Olives, of course, are time-honored components of the Mediterranean diet.  I’ve had a few good crops in my backyard here in Arizona.

Steve Parker, M.D.

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November 6, 2011 · 8:32 PM

Severe Carb Restriction in Type 2 Diabetes

U.K. researchers found major metabolic improvements in obese type 2 diabetics following a very low-carbohydrate diet, compared to a low-fat portion-controlled diet.  The latter is a standard recommendation in the U.S. for overweight type 2 diabetics.
 
This study is an oldie (2005) but a goodie.
 
Methodology
 
The investigators randomly assigned 102 poorly controlled diabetics to follow one of the two diets for three months.  Participants had average weights of 224 pounds (102 kg),  body mass index 36, age 58, hemoglobin A1c’s of 9%.  Half of them were men.  About 40% of the diabetics in both groups were on unspecified oral diabetic drugs; 20% were on insulin and 40% were using a combination of the two.  Sulfonylurea was mentioned, but not metformin. 
 
Participants were randomly assigned to either a low-fat portion-controlled weight-loss diet or a low-carbohydrate diet.  The goal with the low-carb diet was “up to 70 g of carbohydrate per day,” including at least a half a pint of milk and one piece of fruit.  (Is a UK pint the same as in the US?).  Increased physical activity was recommended to both groups. 
 
Only 79 of the 102 participants made it through the three-month diet intervention.  Drop-out rate was the same for both groups.
 
What Did They Find?
 
(Differences are statistically significant unless otherwise noted.)
Weight loss for the low-carb group was 3.55 kg (7.8 lb) compared to only 0.92 kg (2 lb) for the low-fat cohort.
 
The total/HDL cholesterol ratio improved for the low-carb group (absolute decrease of 0.48 versus 0.10). 
 
Hemoglobin A1c and systolic blood pressure tended to decrease more for the low-carb group, but did not reach statistical significance.  For instance, HgbA1c dropped 0.55% (in absolute terms) for the low-carb group, and 0.23% for the low-fat group.  Lower HgbA1c indicates improved blood sugar control.
 
Caloric intake was not different between the groups (about 1350 cals/day by diet recall method).
 
The low-carb group reduced carbs to 109 g/day compared to 168 g in the  low-fat cohort.
 
The low-carb group consumed 33% of energy as carbs compared to 45% for the low-fat group.
 
The low-carb group consumed 40% of energy as fat compared to 33% in the low-fat cohort.
 
Protein intake was 26% of energy for the low-carbers compared to 21% for the low-fatters.
 
Absolute saturated fatty acid intake was higher for the low-carbers, but still considered moderate.
 
Insulin dose was reduced in about 85% of the insulin users in the low-carb group but in only 22% of the low-fat group.  Oral diabetic pill use was unchanged in both groups.
 
Comments
 
This is a classic research report that I cited in Conquer Diabetes and Prediabetes: The Low-Carb Mediterranean Diet.
 
The improved total/HDL cholesterol ratio in the low-carbers may reduce risk of heart and vascular disease.  These investigators didn’t look at LDL particle size.  Other studies have found that low-carb eating tends to shift LDL cholesterol (bad stuff) from small dense particles to light fluffy particles, which are thought to be less harmful to arteries.
 
The authors considered reduction of carbs to 109 grams a day to be “severe.”  That compares to 275 grams a day eating by the typical U.S. citizen.  I agree that a reduction of carbs by two-thirds is major restriction.  Dr. Richard Bernstein and I consider severe restriction to be 20–30 grams, or perhaps up to 50 g.
 
I suspect the improved metabolic numbers in the low-carbers would have been even more dramatic if they had reduced carbs well below 100 grams a day.  The Ketogenic Mediterranean Diet reduces digestible carbs to 20–30 grams daily.  Many diabetics start losing control of their blood sugars when daily carbs exceed 60–80 grams.
 
Low-carb diets often yield better weight loss than low-fat calorie-restricted diets, as was seen here.  This is often attributed to lower calorie consumption on the low-carb diets.  These investigators didn’t see that here.
 
Low-carb diets are often criticized as being hard to stick with.  The low-carbers here didn’t have any more drop-outs than the low-fat group.  Granted, it was only a three-month study.
 
Based on what we know today, the reduced need for insulin in these patients was entirely predictable. 
 
The authors had some concern about the higher relative saturated fatty acid consumption in the low-carbers.  In 2011, we know that’s not much, if any, cause for concern.
 
 
 
 
Reference: Daly, M.E., et al.  Short-term effects of severe dietary carbohydrate-restriction advice in Type 2 diabetes—a randomized controlled trial.  Diabetic Medicine, 23 (2006): 15-20.  doi: 10.1111/j.1464-5491.2005.01760.x

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