November 17, 2019 · 4:48 PM

What’s a Reasonable Rate of Weight Loss?

paleobetic diet, low-carb, diabetic diet, paleo diet

Java had to lose weight when he developed metabolic syndrome

P.D. Mangan posted a good article on the risks of rapid weight loss. I agree with him that a max of 1–2 pounds a week is a reasonable weight-loss goal, and that a bit more than that is OK in the first week but highly inadvisable for the long run. Most folks do well if they settle into one pound a week.

From P.D.:

Slower Metabolism

A slower metabolism is another side effect of losing weight too quickly; since your body’s metabolism is essentially determining how much fuel you are needing to burn every day based on your activities and food intake, dropping calories out of your diet can considerably lower your metabolism. While this might not seem like a big deal, it is! A lower metabolism essentially causes your body to burn fewer calories each day than it typically would, and some research even shows up to a 23% decrease in calories that are burned each day. This doesn’t always go away when you stop losing weight quickly, either, your metabolism might take a while to get back on track and burning appropriately, which could affect your health and weight for a long time.

Muscle Loss

Lastly, your body could end up losing muscle as part of your quick weight loss routine. Granted, eliminating calories from your diet will have you lose weight, yes, but aside from a lot of that weight being water, some of it can also be muscle. A recent study done with people on a 500 calorie diet versus a 1250 calorie diet showed significant results; by the end of the trial, the participants on the 500 calorie diet lost six times more muscle than those on the 1250 calorie diet – an astounding loss in muscle in just a five-week span of time.

Source: Risks of Losing Weight Too Quickly – Rogue Health and Fitness

Steve Parker, M.D.

low-carb mediterranean diet

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November 15, 2019 · 7:00 AM

Mediterranean Diet Reduces Need For Diabetes Medications

diabetic mediterranean diet, Steve Parker MD

Pharmacist counting pills

From Diabetes Care:

OBJECTIVE

To examine the effects of two Mediterranean eating plans (Med-EatPlans) versus a low-fat eating plan on the need for glucose-lowering medications.

RESEARCH DESIGN AND METHODS

From the Prevención con Dieta Mediterránea (PREDIMED) trial, we selected 3,230 participants with type 2 diabetes at baseline. These participants were randomly assigned to one of three eating plans: Med-EatPlan supplemented with extra-virgin olive oil (EVOO), Med-EatPlan supplemented with mixed nuts, or a low-fat eating plan (control). In a subgroup (15%), the allocation was done in small clusters instead of using individual randomization, and the clustering effect was taken into account in the statistical analysis. In multivariable time-to-event survival models, we assessed two outcomes: 1) introduction of the first glucose-lowering medication (oral or injectable) among participants on lifestyle management at enrollment and 2) insulin initiation.

RESULTS

After a median follow-up of 3.2 years, in multivariable analyses adjusting for baseline characteristics and propensity scores, the hazard ratios (HRs) of starting a first glucose-lowering medication were 0.78 (95% CI 0.62–0.98) for Med-EatPlan + EVOO and 0.89 (0.71–1.12) for Med-EatPlan + nuts, compared with the control eating plan. After a median follow-up of 5.1 years, the adjusted HRs of starting insulin treatment were 0.87 (0.68–1.11) for Med-EatPlan + EVOO and 0.89 (0.69–1.14) for Med-EatPlan + nuts compared with the control eating plan.

CONCLUSIONS

Among participants with type 2 diabetes, a Med-EatPlan + EVOO may delay the introduction of new-onset glucose-lowering medications. The Med-EatPlan did not result in a significantly lower need for insulin.

Source: Effects of a Mediterranean Eating Plan on the Need for Glucose-Lowering Medications in Participants With Type 2 Diabetes: A Subgroup Analysis of the PREDIMED Trial | Diabetes Care

Steve Parker, M.D.

low-carb mediterranean diet

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November 14, 2019 · 7:00 AM

Mediterranean Diet and Good Blood Sugar Levels Improve Brain Function in Type 2 Diabetes

MRI scan of brain

From Diabetes Care:

CONCLUSIONS

Both adhering to a Mediterranean diet and effectively managing type 2 diabetes may support optimal cognitive function. Healthy diets, in general, can help improve memory function among adults without type 2 diabetes.

Source: The Mediterranean Diet and 2-Year Change in Cognitive Function by Status of Type 2 Diabetes and Glycemic Control | Diabetes Care

Steve Parker, M.D.

low-carb mediterranean diet

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November 13, 2019 · 11:19 AM

Mediterranean Diet May Prevent Gestational Diabetes

You can’t tell if she has gestational diabetes just by looking

From Newsweek:

Eating a Mediterranean diet while pregnant could prevent women at risk of gestational diabetes from developing the condition, a study has found.The women who took part in the study followed a Mediterranean-style diet, by eating more nuts, extra virgin olive oil, fish, white meat and pulses; while cutting their levels of red meat, butter, margarine, and cream. Researchers also asked the women to avoid sugary drinks, fast food, and those high in animal fats.

Source: Eating Mediterranean Diet During Pregnancy Could Cut Gestational Diabetes Risk: Study

Steve Parker, M.D.

low-carb mediterranean diet

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November 12, 2019 · 10:57 PM

Is It the Olive Oil That Make the Mediterranean Diet So Healthy?

I like this Newman’s Own dressing. First ingredient is olive oil blend, unlike most commercial vinaigrettes that first list water or canola oil. In 2019 they changed the formula and I don’t like it as much.

C-reactive protein and interleukin-6 are measurable blood markers of inflammation in our bodies. Inflammation may be the cause of diseases like hypertension, strokes, hardening of the arteries (atherosclerosis), and heart attacks. One theory holds that if you can reduce the level of the inflammatory markers, your risk of the aforementioned illnesses will be lower.

Olive oil is a key component of the healthy Mediterranean diet. Could that healthfulness be mediated by anti-inflammatory effects of olive oil?

Fr0m the journal Nutrition:

[Randomized controlled trials] reveal beneficial effects of olive oil by reducing levels of inflammation markers. Olive oil taken on a regular basis can be a good dietary fat alternative, especially to manage IL-6 [interleukin-6]. However, further research is required to clarify the effects of olive oil consumption on inflammation comparing to other fats. Moreover, olive oil daily dosage, different time-length intervention and follow-up periods should be taken into consideration.

Source: Is olive oil good for you? A systematic review and meta-analysis on anti-inflammatory benefits from regular dietary intake – ScienceDirect

These researchers found no consistent effect of olive oil on C-reactive protein (CRP).

Steve Parker, M.D.

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November 12, 2019 · 6:21 PM

Ascension Shared Confidential Healthcare Info on Millions with Google

…according to Daily Mail:

Lawyers, medical professionals and tech experts have reacted with a mixture of horror and fury after it emerged that Google has been secretly acquiring sensitive medical data on millions of people without their knowledge or consent.

Questions were immediately raised around the ethics of the data-gathering operation – code-named Project Nightingale – as well as the security of patient data after the program was first reported on Monday.

Others called for an immediate change to privacy laws after Google and Ascension, the healthcare organization it has partnered with, boasted that the scheme is completely legal.

Dr. Robert Epstein, an author, medical researcher and former editor-in-chief at Psychology Today, summed up the mood when he tweeted: ‘You can’t make this s*** up. #BeAfraid.’

Source: Furious backlash after it emerges Google has secretly amassed healthcare data on millions of people | Daily Mail Online

The “confidential” date reportedly included names, dates of birth, lab results, diagnoses, and hospitalization records.

Thanks, Ascension. How much did you make off the deal?

I’ve increasingly noticed that I have to depend on Daily Mail or other non-U.S. sources for news that “the powers that be” apparently don’t want me to hear about.

Steve Parker, M.D.

PS: Keep your sensitive healthcare data out of Google’s and Ascension’s clutches by getting healthier.

PPS: I wonder if Google will censor this post by keeping it out of search results. Nah, my readership isn’t big enough. It would naturally show up on page 46 of results, and nobody goes that far down.

low-carb mediterranean diet

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November 11, 2019 · 2:34 AM

Are Oral Bacteria the Cause of Alzheimer’s Dementia?

Several respected researchers think that Alzheimer’s dementia may primarily be an infectious disease, particularly related to gum bacteria.

From MedScape:

LOS ANGELES — As more disappointing results emerge from anti-amyloid drug trials in Alzheimer’s disease (AD), there is growing interest in novel treatment approaches for this condition.

One such approach is based on the hypothesis that Porphyromonas gingivalis (Pg), the bacteria involved in periodontal disease, may cause AD. The biopharmaceutical company Cortexyme Inc is testing this theory with an investigational agent COR388, which targets gingipains, the toxic proteases released by Pg.  Early results show the drug is well tolerated and promising in terms of biomarker findings. Organizers hope that a phase 2/3 trial of the treatment now under way will provide definitive efficacy results.

Source: Gum Disease Bacteria a Novel Treatment Target for Alzheimer’s?

Steve Parker, M.D.

PS: The Mediterranean diet had been shown to reduce the risk of dementia.

low-carb mediterranean diet

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November 10, 2019 · 1:42 AM

Fitness Training at Midlife and Beyond

You won’t see her at your home gym

From American Partisan:

If you have chronic pain or have been out of the gym a long time, build up volume (number of sets x number of reps x weight) slowly.  Pick weights you can lift without pain and increase weight and volume in pain-free steps.  The great thing about weight training is it allows you to easily control training variables in a safe, measurable, and repeatable manner while building work capacity and strength.  If one exercise hurts, substitute for another.  For example, if it hurts to back squat, substitute for a front squat….Right now, for example, I’ve built up a bit of pain in my biceps so I’ve substitute pull-ups for chin-ups which seem to take the stress off my biceps due to the weird angle between my upper and lower arms.

Cardio is built-up in a similar manner.  If one thing hurts, do something else or do it only within a pain-free time-interval and intensity to prevent pain flare-ups.  Develop a large variety of ways of doing cardio rather than do the same thing every day since training benefits heavily from novelty.  For example, you can use the assault bike one day, the agility ladder the next, barbell complexes a third day, and agility ladders a fourth day.  If you’re very overweight, start with walking.

Source: Fitness through midlife | American Partisan

I would add: Advance work load slowly. It took you years to get out of shape. What’s the rush? Progressing too quickly leads to injuries.

The article recommends a book by Bill Hartman called All Gain No Pain. The numerous five-star reviews (and very few with lesser stars) at Amazon.com seem a bit fishy to me due to over-the-top praise and few details. Do you have an opinion on the book?

Steve Parker, M.D.

low-carb mediterranean diet

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November 8, 2019 · 9:45 AM

Higher Plasma Levels of Omega-3 Fatty Acids Linked to Lower Rate of Heart Failure

Salmon is a rich source of omega-3 fatty acids

Cold-water fatty fish are a great source of healthy omega-3 fatty acids, one of which is EPA (eicosapentaenoic acid).

Here’s the abstract from JACC: Heart Failure:

Objectives

The aim of this study was to determine if plasma eicosapentaenoic acid (EPA) abundance (%EPA) is associated with reduced hazard for primary heart failure (HF) events in the MESA (Multi-Ethnic Study of Atherosclerosis) trial.

Background

Clinical trials suggest that omega-3 polyunsaturated fatty acids (ω3 PUFAs) prevent sudden death in coronary heart disease and HF, but this is controversial. In mice, the authors demonstrated that the ω3 PUFA EPA prevents contractile dysfunction and fibrosis in an HF model, but whether this extends to humans is unclear.

Methods

In the MESA cohort, the authors tested if plasma phospholipid EPA predicts primary HF incidence, including HF with reduced ejection fraction (EF) (EF <45%) and HF with preserved EF (EF ≥45%) using Cox proportional hazards modeling.

Results

A total of 6,562 participants 45 to 84 years of age had EPA measured at baseline (1,794 black, 794 Chinese, 1,442 Hispanic, and 2,532 white; 52% women). Over a median follow-up period of 13.0 years, 292 HF events occurred: 128 HF with reduced EF, 110 HF with preserved EF, and 54 with unknown EF status. %EPA in HF-free participants was 0.76% (0.75% to 0.77%) but was lower in participants with HF at 0.69% (0.64% to 0.74%) (p = 0.005). Log %EPA was associated with lower HF incidence (hazard ratio: 0.73 [95% confidence interval: 0.60 to 0.91] per log-unit difference in %EPA; p = 0.001). Adjusting for age, sex, race, body mass index, smoking, diabetes mellitus, blood pressure, lipids and lipid-lowering drugs, albuminuria, and the lead fatty acid for each cluster did not change this relationship. Sensitivity analyses showed no dependence on HF type.

Conclusions

Higher plasma EPA was significantly associated with reduced risk for HF, with both reduced and preserved EF. (Multi-Ethnic Study of Atherosclerosis [MESA]; NCT00005487)

Source: Predicting Risk for Incident Heart Failure With Omega-3 Fatty Acids | JACC: Heart Failure

Steve Parker, M.D.

PS: All my diets recommend cold-water fatty fish.

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November 1, 2019 · 3:23 AM

Is Cinnamon a Legitimate Treatment for Diabetes?

What type of cinnamon is this?

Be aware that there are several types of cinnamon.

Pharmacist Scott Gavura writes at Science Based Medicine:

Given the consequences of diabetes, self-management is something I want to encourage, not discourage. Without a commitment from the patient to take an active role in managing their diabetes, any treatment plan is doomed to fail. So is self-treatment with dietary supplements a wise idea? There’s an array available, and patients regularly ask about the latest treatment “Big Pharma doesn’t want you to know about”. That treatment used to be chromium. Ginseng was popular for a time, too. Fenugreek and bitter melon are used as well. One of the most persistently popular treatments is cinnamon. Like any other herbal remedy, most sources will tell you that it’s been used for “thousands of years” as a medicinal herb. As a treatment for diabetes, I have my doubts. While reports of diabetes go back to 1552 BCE, the ability to measure the effectiveness of any diabetes treatment only goes back a few decades. Interest in cinnamon as a treatment seems to have started with in vitro tests but gained some plausibility in 2003, when a study from Alam Khan suggested several grams of cassia cinnamon per day could lower fasting blood glucose. Khan randomized Type 2 diabetes to 1g, 3g, or 6g of cinnamon for 40 days. All three groups improved their fasting blood glucose, and blood lipid levels, but there was no effect on A1C.Like trials with any other supplement or herbal product, the primary question we must answer is “What exactly was studied?” The cinnamon you have in your kitchen may be a single species of plant or a mix of different cultivars. Ceylon cinnamon (Cinnamommum verum) is more commonly found in the West. Cassia cinnamon (Cinnamomum aromaticum) is the version of cinnamon that’s been studied in trials. The chemical hydroxychalcone has been identified as a potential active ingredient, which is believed to modify the sensitivity of cells to insulin, enhancing their uptake. If that’s the true mechanism of action, then it would work in a manner similar to that of the drugs Avandia, Actos, and metformin (Glucophage). Given the active ingredient (or ingredients) have not yet been definitively isolated, the issue of studying cinnamon is problematic. There’s no way to assess the potency of any batch, which complicates any evaluation. And that may be a reason why the research with cinnamon is inconsistent, and on balance, not impressive.

While the Khan study looked promising, supplementary studies have failed to consistently show beneficial effects.

Source: How effectively does cinnamon treat diabetes? – Science-Based Medicine

Steve Parker, M.D.

low-carb mediterranean diet

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