Is Olive Oil Less Healthy When Used for Cooking?

Cooking doesn’t destroy much of olive oil’s healthy properties, according to registered dietitian Karen Collins in a recent guest post at CalorieLab.

I’ve been wondering about this since olive oil plays such a prominent role in the Advanced Mediterranean and Ketogenic Mediterranean Diets.  I use room-temperature olive oil on my salads and vegetables, but also use it  to sauté vegetables, eggs, and meat. 

Olive oil is the major fat in the traditional Mediterranean diet.  It has heart-healthy and perhaps anti-cancer action related to monounsaturated fat and phenolic compounds that have antioxidant and anti-inflammatory properties.

Steve Parker, M.D.

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Quote of the Day

Therefore I tell you, do not worry about your life, what you will eat or drink; or about your body, what you will wear.  Is not life more important than food, and the body more important than clothes? 

Look at the birds of the air; they do not sow or reap or store away in barns, and yet our heavenly Father feeds them.  Are you not much more valuable than they? 

Who of you by worrying can add a single hour to his life?

                                                                 Matthew 6: 25-27  (New International Version)

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Book Review: Atkins Diabetes Revolution

I must give credit to Dr. Robert C. Atkins for popularizing an approach – carbohydrate restriction – that helps people with diabetes control their disease, and likely helps prevent type 2 diabetes in others.  Mary C. Vernon and Jacqueline Eberstein do a great job explaining his program in their 2004 book, Atkins Diabetes Revolution: The Groundbreaking Approach to Preventing and Controlling Type 2 Diabetes

On the Amazon.com five-star rating scale, I give this book four stars.

I can best summarize this book by noting that it is the standard Atkins diet with a few modifications: 1) special supplements  2) you add additional carbs to your diet more slowly  3) the warning that diabetics may well end up with a lower acceptable lifetime carbohydrate intake level.

By way of review, the Atkins diet is a very low-carb diet, particularly in the two-week induction phase.  “Very low-carb” means lots of meat, chicken, fish, eggs, limited cheese, and 2-3 cups daily of salad greens and low-carb veggies like onions, tomatoes, broccoli, and snow peas.  After induction phase, you slowly add back carbs on a weekly basis until weight loss stalls, then you cut back on carbs.

As an adult medicine specialist, I have no expertise in pediatrics.  I didn’t read the two chapters related to children.

The authors present “complimentary medicine”in a favorable light.  Unsuspecting readers need to know that much of complementary medicine is based on hearsay and anecdote, not science-based evidence.  In that same vein, the two chapters on supplements for diabetes and heart disease recommend a cocktail of supplements that I’m not convinced are needed.  I don’t know a single endocrinologist or cardiologist prescribing these concoctions.  Then again, I could be wrong.   

Vernon and Eberstein provide two excellent chapters on exercise.

A month of meal plans and recipes are provided for 20, 40, and 60-gram carbohydrate levels.  [The average American is eating 250-300 g of carbs daily.]  The recipes look quick and easy, but I didn’t prepare or taste any of them.

The 5-hour glucose and insulin tolerance test (GTT, paged 61) that Dr. Atkins reportedly ran on all patients who came to him is rarely done in other medical clinics.  This doesn’t mean it’s wrong, but certainly out of the mainstream.  The authors admit that at least a few people will have to count calories – specifically, limit total calories – if the basic program doesn’t control diabetes, prediabetes, and the metabolic syndrome.  Limiting portion size will speed weight loss, they write.

What we don’t know with certainty is, will long-term Atkins aficionados miss out on the health benefits of higher consumption of fruits, vegetables, legumes, and whole grains?  Much of the scientific literature suggests, “Yes.”

What if we compare the long-term outlooks of a diabetic Atkins follower with a poorly controlled diabetic who’s 80 pounds overweight and eating a standard American diet?  The Atkins follower is quite likely to be healthier  and live longer.

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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Modern Heart Disease Found in Ancient Egyptian Mummies

HeartWire on November 23, 2009, reported the discovery of atherosclerosis (hardening-of-the-arteries) in Egyptian mummies 3000 years old. 

So it appears that atherosclerosis in not just a disease of modern civilization, as suggested by some.

Steve Parker, M.D.

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Quote of the Day

The urge to simplify a complex scientific situation so that physicians can apply it to their patients and the public embrace it has taken precedence over the scientific obligation of presenting the evidence with relentless honesty.

                                            —Gary Taubes, in Good Calories, Bad Calories  (2007)

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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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Low-Carb Ketogenic Diet for Overweight Diabetic Men: A Pilot Study

A low-carb ketogenic diet in patients with type 2 diabetes was so effective that diabetes medications were reduced or discontinued in most patients, according to U.S. researchers.  The 2005 report recommends that similar dieters be under close medical supervision or capable of adjusting their own medication, because the diet lowers blood sugar  dramatically. 

Methodology

Twenty-eight overweight people with type 2 diabetes were placed on the study diet and followed for 16 weeks.  Seven people dropped out, so the analysis involved 21, of which 20 were men—the study was done at a Veterans Administration clinic.  Thirteen were caucasian, eight were black.  Average age was 56; average body mass index was 42.  The seven dropouts were unable to come to the scheduled meetings or couldn’t follow the diet.  No dropout complained of adverse effects of the diet.

Results

Participants were instructed on the Atkins Induction Phase diet, which daily includes:

  • under 20 g carbohydrate
  • one cup of low-carb vegetables
  • two cups of salad greens
  • four ounces of hard cheese
  • unlimited meat, poultry, fish, eggs, shellfish
  • a multivitamin

At the outset, diabetes medication dosages were reduced in this general fashion: insulin was halved, sulfonyureas were halved or discontinued.  If the participant were taking a diuretic (fluid pill), low doses were discontinued; high doses were halved.

Study subjects returned every two weeks for diet counseling and medication adjustment (based on twice daily glucose readings and episodes of hypoglycemia).  Food cravings and/or good progress on weight goals triggered a 5-gram (per day) weekly increase in carbohydrate allowance.  In other words, if a participant’s weight loss goal was 20 pounds and he’d already lost 10, he could increase his daily carbs during the next week from 20 to 25 g.  Carbs could be increased weekly by five gram increments as long as weight loss progressed.  [This is typical Atkins.]   Food records were analyzed periodically.   

Results

  • hemoglobin A1c decreased from an average baseline of 7.5% down to 6.3% (a 1.2% absolute decrease and 16% relative drop)
  • the absolute hemoglobin A1c decrease was at least 1.0% in half of the participants
  • diabetic drugs were reduced in 10 patients, discontinued in seven, and unchanged in four
  • average body weight decreased by 6.6%, from 131 kg (288 lb) to 122 kg (268 lb)
  • triglycerides decreased 42%, while cholesterols (total, HDL, and LDL) didn’t change significantly
  • no change in blood pressures
  • average fasting glucose decreased by 17% (by week 16)
  • uric acid decreased by 10%
  • no serious adverse effects occurred
  • one hypoglycemic event involved EMS but was treated without transport
  • only 27 of 151 urine ketone measurements  were greater than trace

My Comments

The degree of improvement in hemoglobin A1c—our primary gauge of diabetes control—is equivalent to that seen with many diabetic medications.  I see many overweight diabetics on two or three drugs and a standard “diabetic diet,” and they’re still poorly controlled.  This diet could replace the expense and potential adverse effects of an additional drug.   

In August this year I blogged about a study comparing the Atkins diet with a traditional low-fat diet in overweight diabetic black women in the U.S.  As measured at three months, the Atkins diet proved superior for weight loss and glucose control.

This study at hand is small, but certainly points to the effectiveness of an Atkins-style very low-carb ketogenic diet in overweight men with type 2 diabetes.

Steve Parker, M.D.

Yancy, William, et al.  A low-carbohydrate, ketogenic diet to treat type 2 diabetes [in men].  Nutrition and Metabolism, 2:34 (2005).   doi: 10.1186/1743-7075-2-34

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Fish With Omega-3 Fatty Acids Reduce Risk of Blindness

Age-related macular degeneration is the leading cause of blindness in Americans over 65.  Impaired vision precedes blindness.  A recent study linked consumption of omega-3 fatty acids with 30% lower risk of developing macular degeneration.  Believe me, it’s a lot better to prevent it than try to treat it once present. 

[I have a couple older relatives with macular degeneration, so I pay close attention to the scientific literature.]

What’s the best sources of omega-3 fatty acids?  Our friend, the fish.  Especially cold-water fatty fish such as tuna, trout, sardines, herring, mackerel, halibut, and sea bass.  A few plants are also decent sources, but our bodies don’t utilize those omega-3 fatty acids as well as they do from fish.

Note that the Ketogenic Mediterranean Diet has a prominent role for fish.

Steve Parker, M.D.

Reference:  SanGiovanni, J.P., et al.  Long-chain polyunsaturated fatty acid intake and 12-y incidence of neovascular age-related macular degeneration and central geographic atrophy: AREDS report 30, a prospective cohort study from the Age-Related Eye Disease Study.  American Journal of Clinical Nutrition, 90 (2009): 1,601-1,607. First published October 7, 2009.   doi:10.3945/ajcn.2009.27594

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