July 11, 2011 · 2:00 AM

Healthy Weight Ranges

In the past it was pretty easy to find tables of recommended healthy body weights.  Not so much anymore.  Most of the experts want you calculate your body mass index, recommending the healthy BMI range as 18.5 to 24.9.  I just spent an hour putting together a healthy weight range based on BMIs.  Since I have many readers outside the U.S., I use both U.S. customary and metric numbers.

Metropolitan Life Insurance Company last published its ideal weight and height table in 1983.  The US Department of Agriculture abondoned its 1995 healthy weight table by the turn of the century recommending BMI calculation instead.  Of note is that the upper end of its weight ranges was a BMI of 25; the lower ends were all BMIs of 19. 

Body Mass Index (BMI) is your weight in kilograms divided by your height in meters squared (kg/m2).  A pound equals 2.2 kilograms. A pound equals about 454 grams (453.6 to be exact). An inch equals 2.54 centimeters.  There are 100 centimeters in one meter. Thus, a 5-foot, 4-inch woman (1.63 meters) weighing 200 pounds (91 kilograms) has a BMI of 34.2.  Perhaps you’re starting to understand why this weight standard isn’t too popular yet.

 To learn your own BMI but skip the math, use an online calculator.

 To see if your BMI is in the healthy range of 18.5 to 24.9, find your height in the table below, then look to the healhy weight ranges to the right.  Measure your height without shoes and weight without clothes.

Table of Healthy Weight Ranges Based On Body Mass Index: 18.5 to 24.9

       Height               Weight in lb        Weight in kg

5’0” or 152 cm             95 – 128             43.0 – 58.0

5’1” or 155 cm             98 – 132             44.4 – 59.8

5’2” or 157 cm           101 – 137            45.8 – 62.1

5’3” or 160 cm           105 – 141             47.6 – 63.9

5’4” or 163 cm           108 – 146             48.9 – 66.2

5’5” or 165 mc           111 – 150             50.3 – 68.0

5’6” or 168 cm           115 – 155             52.0 – 70.3

5’7” or 170 cm           118 – 160             53.5 – 72.5

5’8” or 173 cm           122 – 164             55.3 – 74.3

5’9” or 175 cm           125 – 169             51.7 – 76.6

5’10” or 178 cm         129 – 174             58.5 – 78.9

5’11” or 180 cm         133 – 179             60.3 – 81.8

6’0”  or 183 cm          137 – 184             62.1 – 83.4

6’1” or 185 cm           140 – 189              63.5 – 85.7

6’2” or 188 cm           144 – 195             65.3 – 88.4

6’3” or 191 cm           148 – 200             67.1 – 90.7

6’4” or 193 cm           152 – 205             68.9 – 92.9

BMIs between 25 and 29.9 designate “overweight” and accurately describe about 35 percent of the United States population.

A BMI of 30 or higher defines “obesity” and indicates high risk for poor health. About 30 percent of us are obese. At a BMI of 35 and above, incidence of death and disease increases sharply.

The BMI concept is helpful to researchers and obesity clinicians, but the number doesn’t mean much yet to the average person on the street and to many physicians. It should be used more widely. (I know, I know: it’s not perfect.  Do you have a better, cheap, widely applicable alternative?)  Know your BMI. If it’s under 25, any excess fat you carry is unlikely to affect your health and longevity; your efforts to lose weight would be purely cosmetic.

Steve Parker, M.D.

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July 9, 2011 · 10:42 AM

Dr. Jay Wortman Chooses Ketogenic Diet for His Type 2 Diabetes

 The Low Carb Diabetic blog posted a video of Dr. Jay Wortman discussing treatment of his own type 2 diabetes with a very-low-carb ketogenic diet.  Well worth a listen if you’re skeptical about whether it works.

Steve Parker, M.D.

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July 8, 2011 · 2:00 AM

Quote of the Day

White flour is better suited to glue for kindergarten art projects than to nutrition.

    —Drs. Westman, Phinney, and Volek in The New Atkins for a New You

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July 5, 2011 · 2:00 AM

Book Review: The Art and Science of Low Carbohydrate Living

I just finished reading The Art and Science of Low Carbohydrate Living: An Expert Guide to Making the Life-Saving Benefits of Carbohydrate Restriction Sustainable and Enjoyable, by Stephen Phinney, M.D., Ph.D., and Jeff Volek, Ph.D. published this year.  I give it four stars per Amazon.com’s rating system ( I like it).

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The authors medicalize overweight and obesity by naming the cause of most cases to be “carbohydrate intolerance,” along the lines of lactose intolerance and gluten intolerance.  Given the myriad illnesses and shortened lifespan associated with obesity, medicalizing it isreasonable.  Ask Gary Taubes why we get fat, and he’ll say it’s excessive consumption of carbohydrates, especially sugars and refined flours.  Ask Phinney and Volek, and they’ll say “carbohdyrate intolerance.”  For them, the “treatment” is avoidance of carbs.

If a patient asks me why he’s fat, I guess I’d prefer to say “you have carbohydrate intolerance,” rather than “you eat too many carbs.”  It’s less confrontational and doesn’t blame the patient.

So how many of us in the U.S. have carbohydrate intolerance?  The authors estimate a hundred million or more – about a third of the total poplulation, or more, who could directly benefit from carbohydrate restriction.  I agree.

Before reading this book, I was convinced that carbohydrates are indeed major contributors to overweight and obesity, especially concentrated sugars and refined grains.  The authors cite much of the pertinent scientific/medical literature. 

Gary Taubes made the same case in his brilliant book, Good Calories, Bad Calories.  Dr. Robert Atkins argued the same in Dr. Atkins New Diet Revolution.  The problem is that many healthcare providers such as physicians and dietitians are biased against those sources.  Physicians resist a non-physician such as Taubes giving them advice about the practice of medicine.  And most physicians over 45 still labor under the misconception that dietary cholesterol and total and saturated fat are major-league killers, so they’ve already dismissed Dr. Atkins and don’t have time to get caught up to date on the recent research.

Phinney and Volek have wisely targeted this work towards healthcare providers such as physicians, so it’s somewhat technical and clinical.  Both have Ph.D.s and Phinney is also an M.D.  The authors are respected researchers who thoroughly review the science behind low-carb eating.  They explain how high blood pressure, metabolic syndrome, type 2 diabetes, and other conditions are related to carb consumption.

I rate the book four stars instead of five only because it’s a little pricey at $29 (US).

Smart nutrition- and fitness-minded folks will also benefit from a reading.  For a more consumer-oriented book, I recommend the authors’ The New Atkins for a New You or Taubes’ Why We Get Fat.

Steve Parker, M.D.

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July 2, 2011 · 10:13 PM

Nutty Treatment for Diabetes

Mixed Nuts Improve Diabetes

Eating nuts improves blood sugar control and cholesterol levels in type 2 diabetics, according to a recent research report in Diabetes Care.

Canadian researchers randomized 117 type 2 diabetics to eat their usual types of food, but also to be sure to eat either

  •  mixed nuts (about 2 ounces a day)
  •  muffins (I figure one a day)
  • or  half portions of each. 

They did this daily for three months.  Compared to the muffin group, the full nut group ate quite a bit more monounsaturated fatty acids.  (I don’t have full study details because I have access only to the article abstract.)

Results

Hemoglobin A1c, a reliable measure of blood sugar control, fell by 0.21% in the mixed nut group.  That’s a move in the right direction.  LDL cholesterol, the “bad cholesterol” linked to heart and vascular disease, also dropped significantly. 

So What?

The investigators suggest that replacement of certain carbohydrates with 2 ounces of daily mixed nuts is good for people with type 2 diabetes.

I must mention that nuts are  a mandatory component of the Ketogenic Mediterranean Diet  and the Low-Carb Mediterranean Diet, and a recommended option on the Advanced Mediterranean Diet. 

Steve Parker, M.D.

References:  Jenkins, David J.A., et al.  Nuts as a replacement for carbohydrates in the diabetic diet.  Diabetes Care, June 29, 2011.  doi: 10.2337/dc11-0338

PS: The lead author of this study is the same David Jenkins of glycemic index fame.

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June 27, 2011 · 5:20 AM

Exercise, Part 11: Target Heart Rate

To get the full health benefits of regular physical activity, you need to put some effort into it.  A leisurely hour-long stroll in the mall while window-shopping doesn’t pass muster, although that’s better than nothing.

One rough way to gauge whether you are working hard enough during aerobic exercise is to monitor your heart rate, also known as pulse.  Subtract your age from 220.  The result is your theoretical maximum heart rate in beats per minute.  Your heart rate goal, or target, during sustained aerobic exercise is a pulse that is 60 to 80 percent of your theoretical maximum pulse.  For example: maximum heart rate for a 40-year-old is 180 (220 – 40 = 180), so the target heart rate zone during exercise is between 108 and 144 (60 to 80 percent of 180).  Exceeding the upper end of the target zone is usually too uncomfortable to be sustainable.  Exercise heart rates below the target zone suggest you’re not working hard enough to reap the full long-term benefits of aerobic exercise.

Here’s how to determine your pulse.  After five or 10 minutes of exercise, stop moving and place the tips of your first two fingers lightly over the pulse spot inside your wrist just below the base of your thumb.  Count the pulsations for 15 seconds and multiply the number by four.  The result is your pulse or heart rate.  It will take some practice to find those pulsations coming from your radial artery.  If you can’t find it, ask a nurse or doctor for help.

Like all rules-of-thumb, this target heart rate zone isn’t always an accurate gauge of cardiovascular workout intensity.  For instance, it is of very little use in people taking drugs called beta blockers, which keep a lid on heart rate.

As you become more fit, you’ll notice that you have to work harder to get your heart rate up to a certain level.  This is a sure sign that your heart and muscles are responding to your challenge.  You may also want to monitor your resting heart rate taken in the morning before you get out of bed. Unfit, sedentary people have resting pulses of 60 to 90.  Athletes are more often in the 40s or low 50s.  Their hearts have become more efficient and just don’t need to beat as often to get the job done.

As you become more fit, you’ll also notice that you have more energy overall and it’s easier to move about and handle physical workloads. You’ll feel more relaxed and have a sense of accomplishment. Expect these benefits eight to 12 weeks after starting a regular exercise program.

Steve Parker, M.D.

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June 24, 2011 · 2:00 AM

Finally Settled: Alcohol Consumption Linked to Lower Rates of Death and Heart Attack

Canadian and U.S. researchers report that moderate alcohol consumption seems to reduce 1) the incidence of coronary heart disease, 2) deaths from coronary heart disease, and 3) deaths from all causes.  Reduction of death from all causes is a good counter-argument to those who say alcohol is too dangerous because of deaths from drunk driving, alcoholic cirrhosis, and alcohol-related cancers such as many in the esophagus. 

Remember, we’re talking here about low to moderate consumption: one drink a day or less for women, two drinks or less a day for men.  That’s a max of 12.5 grams of alcohol for women, 25 g for men.  No doubt, alcohol can be extremely dangerous, even lethal.  I deal with that in my patients almost every day.  Some people should never drink alcohol.

The recent meta-analysis in the British Medical Journal, which the authors say is the most comprehensive ever done, reviewed all pertinent studies done between 1950 and 2009, finally including 84 of the best studies on this issue.  Thirty-one of these looked at deaths from all causes.

Compared with non-drinkers, drinkers had a 25% lower risk of developing coronary heart disease (CHD) and death from CHD.  CHD is the leading cause of death in develop societies.

Stroke is also considered a cardiovascular disease.  Overall, alcohol is not linked to stroke incidence or death from stroke.  The researchers did see strong trends toward fewer ischemic strokes  and more hemorrhagic strokes (bleeding in the brain) in the drinkers.  So the net effect was zero. 

Compared with non-drinkers, the lowest risk of death from any cause was seen in those consuming 2.5 to 14.9 g per day (one drink or less per day), whose risk was 17% lower.  On the other hand, heavy drinkers (>60 g/day) had 30% higher risk of death. 

In case you’re wondering, the authors didn’t try to compare the effects of beer versus wine versus distilled spirits. 

On a related note, scientists at the Medical University of South Carolina found that middle-aged people who took up the alcohol habit had a lower risk of stroke and heart attack.  Wine seemed to be more effective than other alcohol types.  They found no differences in overall death rates between new drinkers persistent non-drinkers, perhaps because the study lasted only four years and they were following only 442 new drinkers.  

This doesn’t prove that judicious alcohol consumption prevents heart attacks, cardiac deaths, and overall deaths.  But it’s kinda lookin’ that way.

Steve Parker, M.D.

 References:  Ronksley, Paul, et al.  Association of alcohol consumption with selected cardiovascular disease outcomes: a systematic review and meta-analysis.  British Medical Journal, 2011;342:d671    doi: 10.1136/bmj.d671

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June 21, 2011 · 11:21 AM

Mediterranean Diet for Diabetes

In 2009, Current Diabetes Reports published “The usefulness of a Mediterranean-based diet in individuals with type 2 diabetes,” by Catherine M. Champagne, Ph.D., R.D., L.D.N.  Unfortunately, the full article isn’t available to you at no cost.  But I read it.  Her article is a review of available scientific evidence related to the Mediterranean diet as applied to a diabetic population.  Here’s a quote:

This diet is a viable treatment option; advisors should stress not only adherence to a fairly traditional Mediterranean eating plan but also a lifestyle that includes sufficient physical activity.

I’ve been publishing my series on exercise here in dribs and drabs for the last several months.

Dr. Champagne was very favorably impressed with the DIRECT trial of Shai et al, which I covered extensively elsewhere.  DIRECT compared three diets over 24 months: Atkins, Mediterranean/calorie-restricted, and low-fat/calorie-restricted.  Mind you, it was a weight loss study, but a fair number of diabetics participated.  Mediterranean-style eating showed the most beneficial effects for diabetics. 

The author also mentions evidence that a modified Mediterranean diet may help counteract the build-up of fat in the liver, seen in up to 70% of type 2 diabetics.  I wrote recently about how a very-low-carb diet beat the low-fat diet so often recommended for this condition (hepatic steatosis or non-alcoholic fatty liver disease).

ResearchBlogging.orgIf you want full online access to Champagne’s 6-page article, you can purchase it for $34 (USD) at SpringerLink.  I cite many of the same scientific sources and provide a whole lot more in my 216-page Conquer Diabetes and Prediabetes: The Low-Carb Mediterranean Diet, at Amazon.com for $16.95 or $9.99 (the Kindle edition) or in multiple ebook formats from Smashwords.

Steve Parker, M.D.

Reference: Champagne, Catherine (2009). The usefulness of a Mediterranean-based diet in individuals with type 2 diabetes. Current Diabetes Reports DOI: 10.1007/s11892-009-0060-3

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June 15, 2011 · 2:00 AM

Book Review: Zest For Life – The Mediterranean Anti-Cancer Diet

I recently read Zest For Life: The Mediterranean Anti-Cancer Diet, by Conner Middelmann-Whitney.  I give it five stars per Amazon.com’s rating system.

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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 prostate.  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 Ms. Conner Middelmann-Whitney.  The Mediterranean diet is mostly, although by no means excusively, plant-based.  It encourages consumption of natural, minimally processed, locally grown foods.  Generally, it’s rich in vegetables, fruits, legumes, oive 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 defense 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, 4) one reason nitrites are added to processed meats is to create an 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) per person 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 as “essential” fats. I bet she meant to say 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, or at least are strongly linked; in my view, 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.  She also subscribes to the “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 with normal carbohydrate metabolism, 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, vision loss from macular degeneration, and obesity.  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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June 12, 2011 · 2:00 AM

Book Review: Which Comes First, Cardio or Weights?

I just read Which Comes First, Cardio or Weights?: Fitness Myths, Training Truths, and Other Surprising Discoveries from the Science of Exercise by Alex Hutchinson, published in 2011.  Per Amazon.com’s rating system, I give it five stars (I love it).

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Since starting Mark Verstegen’s Core Performance workout program four months ago, I’ve developed a serious interest in exercise.  I stumbled across one of Alex Hutchinson’s helpful (and recommended) blogs: Sweat Science.  That’s where I heard about this book.

Mr. Hutchinson uses a Q & A format to address 113 debatable issues facing people who exercise regularly.   The questions are independent although grouped according to subject matter, such as “Nutrition and Hydration.”  This is great for those who have time only for snippets of reading (bathroom reading, for example).

High-intensity interval training (HIIT) is a particular interest of mine lately.  I see it as way to replace five hours a week of traditional cardio (aerobic) training with just one hour.  The author gives a nice description of HIIT and succinctly and accurately summarizes the science in support of it, along with the risks.

Mr. Hutchinson typically answers controversial questions with the best available evidence from current scientific research.  Rarely, he has to depend simply on expert concensus, which is less reliable.  I envision a new edition every five years or so.

The book is easy to read.  The style is congenial and witty.  Contrary to a recent publishing trend, the font size is reasonably large. 

The audience for this is folks who have made a commitment to make regular physical activity part of their lifestyle.    Trust me, I’m a doctor: the guys at the gym and Internet sources are quite often wrong on these issues. 

If you refuse to do more than just stroll in the neighborhood for 30 minutes a day, you don’t need the book.  But I urge you to consider challenging yourself to do more.   

Steve Parker, M.D.

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