“It is easier to change a man’s religion than to change his diet.”
Quote of the Day
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Everything You Ever Wanted to Know About Olives But Were Afraid to Ask…
Olives and olive oil are iconic components of the the Mediterranean diet. Nutrition Diva Monica Reinagel has a wonderful post about olives and olive oil. What are the best olives to eat? How are olives processed? Are olives more heathful than olive oil? Click through for the answers.
-Steve Parker, M.D.
Filed under Mediterranean Diet
What About Triglycerides?
Great source of marine omega-3 fatty acids
Circulation recently published the American Heart Association Scientific Statement: Triglycerides and Cardiovascular Disease. I’ve not read the full document, but here are a few tidbits I’ll share:
- Triglycerides (TGs) are not direclty atherogenic; they are a biomarker for cardiovascular risk
- Optimal fasting TGs are under 100 mg/dl (1.1 mmol/l)
- Normal nonfasting TGs are under 200 mg/dl (2.3 mmol/l)
- If levels are high, treatment focuses on intensive therapeutic lifestyle change
- To reduce high TGs, diet modifications include reduction of “simple carbohydrates” like added sugars and fructose by replacing with unsaturated fats, implementing a Mediterranean-style diet, reduction of saturated fat and trans fat consumption, increased marine omega-3 fatty acid intake
- To reduce high TGs in the setting of overweight and obesity, aim for loss of 5 or 10% of body weight
- To reduce high TGs, do aerobic exercise at least twice weekly
From my quick scan, I didn’t see much effort to push drugs on people with triglycerides under 500 mg/dl (5.6 mmol/l).
Thanks to Circulation for making this available to the public at no charge.
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Quote of the Day
Science-Based Medicine published a recent post on the state of American Psychiatry and mental illness. It’s well worth a look if you’re interested in such things. Here’s a quote:
“
The tally of those who are so disabled by mental disorders that they qualify for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) increased nearly two and a half times between 1987 and 2007—from one in 184 Americans to one in 76.”
Do you believe many mental illnesses are caused by a chemical imbalance in the brain? It’s such a time-saver for the physician to tell the inquiring patient, “You just have a chemical imbalance. This drug will help straighten it out.” Read the post for counter-arguments.
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Research Round-Up
I have a stack of scientific articles I’ve been meaning to review in depth and blog about. But I have to finally admit I don’t have the time. Here they are. Click through for details.
- Long-term calorie restriction in humans appears highly effective in reducing atherosclerosis risk factors (lab tests) and actual carotid artery atherosclerosis. Only 18 study subjects, however.
- A very-low-carbohydrate diet improved memory in older adults with mild cognitive impairment over six weeks. Twenty-three subjects were randomized to either high-carb or very-low-carbohydrate diet. The low-carbers improved verbal memory performance, lost weight, reduced fasting blood sugar and fasting insulin levels. Ketone levels were positively correlated with memory performance.
- A high-fat diet impairs cognitive function and heart energy metabolism in young men. Sixteen test subjects. Crossover study design with a five-day high-fat diet deriving 75% of energy from fat, compared to a low-fat diet deriving 23% of energy from fat. High-fat diet led to impaired attention, speed, and mood. I’m sure low-carb bloggers have been all over this. At first blush, it appears they were testing during “induction flu” phase of very-low-carb eating, between days 2 to 7 of a new ketogenic diet. It takes several weeks to adapt metabolism to running almost entirely on fat rather than standard carbohydrates. Suspect results would have been different if given time to adapt.
- Weight-loss with the laparoscopic gastric banding procedure has poor long-term outcome, according to Belgian surgeons reporting on 82 patients. Four in 10 patients had major complications. Nearly half of the 82 patients needed to have the bands removed, and six of every 10 required some kind of re-operation.
- Trust me, you DON’T want age-related macular degeneration. Women, reduce your risk of ARMD with a healthy lifestyle, including regular exercise, avoidance of smoking, and by eating abundant plant foods (vegetables [including orange and dark leafy green ones], fruits, and whole grains) and limit foods high in fat, refined starches, sugar, alcohol, and oils. At least according to these researchers.
- Leafy green vegetables and olive oil are linked to reduced heart disease (CHD) in Italian women. Fruit consumption had no effect. This is from a subset of the huge EPIC study, following 30,000 women over almost eight years.
- The Mediterranean diet protects against metabolic syndrome, reducing risk by about a third according to a huge meta-analysis from Greek and Italian investigators. It works best in Mediterranean countries.
- The Mediterranean diet was linked to slower rates of cognitive decline in Chicago residents over the course of almost eight years. The comparison diet was the Healthy Eating Index-2005. Of the 3,800 participants, about two-thirds were black. A Manhattan population showed lower risk of dementia when eating Mediterranean-style.
There ya’ go. This is better than letting the articles just sit in my briefcase for months on end, eventually to be thrown out.
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Spanish Ketogenic Mediterranean Diet Cures Metabolic Syndrome
The very-low-carb Spanish Ketogenic Mediterranean Diet cures metabolic syndrome, according to investigators at the University of Córdoba in Spain.
The metabolic syndrome is a collection of clinical factors that are linked to high risk of developing type 2 diabetes and heart disease. Individual components of the syndrome include elevated blood sugar, high trigylcerides, low HDL cholesterol, high blood pressure, and abdominal fat accumulation.
Spanish researchers put 26 people with metabolic syndrome on the Spanish Ketogenic Mediterranean Diet for twelve weeks and monitored what happened. At baseline, average age was 41 and average body mass index was 36.6. Investigators didn’t say how many diabetics or prediabetics were included. No participant was taking medication.
What’s the Spanish Ketogenic Mediterranean Diet?
Calories are unlimited, but dieters are encouraged to keep carbohydrate consumption under 30 grams day. They eat fish, lean meat, eggs, chicken, cheese, green vegetables and salad, at least 30 ml (2 tbsp) daily of virgin olive oil, and 200-400 ml of red wine daily ( a cup or 8 fluid ounces equals 240 ml). On at least four days of the week, the primary protein food is fish. On those four days, you don’t eat meat, chicken, eggs, or cheese. On up to three days a week, you could eat non-fish protein foods but no fish on those days.
How’s this different from my Ketogenic Mediterranean Diet? The major differences are that mine includes one ounce (28 g) of nuts daily, less fish overall, and you can mix fish and non-fish protein foods every day.
Regular exercisers were excluded from participation, and my sense is that exercise during the diet trial was discouraged.
What Were the Results?
Metabolic syndrome resolved in all participants.
Three of the original 26 participants were dropped from analysis because they weren’t compliant with the diet. Another one was lost to follow-up. Final analysis was based on the 22 who completed the study.
Eight of the 22 participants had adverse effects. These were considered slight and mostly appeared and disappeared during the first week. Effects included weakness, headache, constipation, “sickness”, diarrhea, and insomnia.
Average weight dropped from 106 kg (233 lb) to 92 kg (202 lb).
Body mass index fell from 36.6 to 32.
Average fasting blood sugar fell from 119 mg/dl (6.6 mmol/l) to 92 mg/dl (5.1 mmol/l).
Triglycerides fell from 225 mg/dl to 110 mg/dl.
Average systolic blood pressure fell from 142 mmHg to 124.
Average diastolic blood pressure fell from 89 to 76.
So What?
A majority of people labeled with metabolic sydrome continue in metabolic sydrome for years. That’s because they don’t do anything effective to counteract it. These researchers show that it can be cured in 12 weeks, at least temporarily, with the Spanish Ketogenic Mediterranean Diet.
Very-low-carb diets are especially good at lowering trigylcerides, lowering blood sugar, and raising HDL cholesterol. Overweight dieters tend to lose more weight, and more quickly, than on other diets. Very-low-carb diets, therefore, should be particularly effective as an approach to metabolic syndrome. It’s quite possible that other very-low-carb diets, such as Atkins Induction Phase, would have performed just as well as the Spanish Ketogenic Mediterranean Diet. In fact, most effective reduced-calorie weight-loss diets would tend to improve metabolic syndrome, even curing some cases, regardless of carb content.
Most physicians recommend that people with metabolic syndrome either start or intensify an exercise program. The program at hand worked without exercise. I recommend regular exercise for postponing death and other reasons.
Will the dieters of this study still be cured of metabolic syndrome a year later? Unlikely. Most will go back to their old ways of eating, regaining the weight, and moving their blood sugars, triglycerides, and HDL cholesterols in the wrong direction.
Reference: Pérez-Guisado J, & Muñoz-Serrano A (2011). A Pilot Study of the Spanish Ketogenic Mediterranean Diet: An Effective Therapy for the Metabolic Syndrome. Journal of medicinal food PMID: 21612461
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Filed under ketogenic diet, Mediterranean Diet, Overweight and Obesity
Waist-Hip Ratio: How to Determine, and What It Means
High WHR
A comment left under my recent post on healthy weight ranges reminded me about the waist-hip ratio.
The risk of heart and vascular disease is more closely linked to distribution of excess fat than with degree of obesity as measured by overall weight or body mass index. Waist-hip ratio (WHR) is a measure of abdominal or central obesity, the type of fat distribution associated with coronary artery disease. A high ratio indicates the android body habitus. The Journal of the American College of Cardiology two months ago reported that heart patients (coronary artery disease) with “central obesity” had a greater risk of death. A high WHR is one measure of central obesity.
To determine your waist-hip ratio:
1. While standing, relax your stomach—don’t
pull it in. Measure around your waist mid-
way between the bottom of the rib cage and
the top of your pelvis bone. Usually this is at
the level of your belly button, or an inch
higher. Don’t go above the rib cage. Keep the
measuring tape horizontal to the ground and
don’t compress your skin.
2. Then measure around your hips at the
widest part of your buttocks. Keep the tape
horizontal to the ground and don’t compress
your skin.
3. Divide the waist by the hip measurement.
The result is your waist-hip ratio.
For example, if your waist is 44 inches (112 cm) and hips are 48 inches (122 cm): 44 divided by 48 is 0.92, which is your waist-hip ratio.
Scientists haven’t yet determined the ideal WHR, but it is probably around 0.85 or less for women, and 0.95 or less for men. Ratios above 1.0 are clearly associated with risk of cardiovascular disease such as heart attacks. The higher the ratio, the higher the risk. Compared with body mass index, WHR is a much stronger predictor of coronary artery disease. Several of the other obesity-related illnesses are also correlated with WHR, but the relationship between WHR and cardiovascular disease is particularly strong.
Filed under Overweight and Obesity
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.
Filed under Overweight and Obesity
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.
Filed under ketogenic diet
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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