June 14, 2019 · 8:48 AM

Does High Protein Diet Help With Weight Loss?

Sous vide chicken and sautéed sugar snap peas. Chicken is a good source of high biologic value protein.

P.D. Mangan makes the case for high-protein diets for those hoping to shed pounds of fat:

In humans, data collected from 38 different trials of food consumption that used widely varying intakes of protein, from 8 to 54% of energy, showed: “Percent dietary protein was negatively associated with total energy intake (F = 6.9, P < 0.0001) irrespective of whether carbohydrate (F = 0, P = 0.7) or fat (F = 0, P = 0.5) were the diluents of protein. The analysis strongly supports a role for protein leverage in lean, overweight and obese humans.”

In obese humans, substitution of carbohydrate with protein leads to far greater weight loss, nearly twice as much.

In a human trial, decreasing the percentage of protein in food from 15% to 10% led to increased calorie intake of 12%. However, increasing the protein percentage from 15 to 25% did not affect calorie intake, which shows that humans may target a certain amount of protein, and eat no more or less when they get it.

There’s more at the link.

Source: Higher Protein for Greater Weight Loss – Rogue Health and Fitness

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June 11, 2019 · 1:49 PM

Dr Maria Muccioli: The Low-Carb Diabetes Revolution (Part I) – Type 1 Diabetes 

Published at Diabetes Daily:

Not long ago, low-carbohydrate diets were considered to be on the fringes of medically-recommended strategies for diabetes control. Long regarded as a “fad diet” and with the health effects often called into question, many patients were routinely discouraged from attempting such an approach. However, in recent years, as more and more research demonstrated the potential benefits of a low-carbohydrate approach for people with diabetes and prediabetes, we have seen a rapid change in the nutritional guidelines and the professional recommendations for patients.

At the 79th American Diabetes Association (ADA) Scientific Sessions, we saw a symposium addressing the changes in the nutrition consensus report for adults with diabetes. Notably, a one-size-fits-all approach is no longer recommended, with experts suggesting now that various eating strategies and macronutrient distributions can work well for patients from a nutritional and glycemic control perspective. Moreover, low-carbohydrate diets were explicitly addressed as a relevant and effective strategy, that is “garnering more attention and support”, as per Dr. William S. Yancy, MD, MHS, who chaired the symposium titled “Providing Options – Using a Low-Carbohydrate or Very Low-Carbohydrate Diet with Adults with Type 1 Diabetes, Type 2 Diabetes or Prediabetes”. In this series, we explore the research and surrounding conversations regarding low-carbohydrate approaches for these distinct patient subgroups.

RTWT!

Source: The Low-Carb Diabetes Revolution (Part I): Type 1 Diabetes (ADA 2019) – Diabetes Daily

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June 10, 2019 · 12:52 PM

From Vox: Why Do Diets Fail…or Succeed?

Julia Belluz has interesting article at Vox regarding low-fat and low-carb diet success over the course of 12 months. Her focus is on a few individuals who participated and were outliers.

As I read this, I was reminded that successful long-term weight management starts and ends in the kitchen. It also took me back to 2009, when I determined that low-carb diets were just as legitimate as low-fat.

I don’t recall the author mentioning the typical pattern with 12-month weight loss studies: most folks lose significant weight in the first few months, then at six months they start gaining it back. Cuz they go back to their old eating habits. Sure, diets don’t work………..if you don’t follow them.

From Ms. Belluz:

As a longtime health reporter, I see new diet studies just about every week, and I’ve noticed a few patterns emerge from the data. In even the most rigorous scientific experiments, people tend to lose little weight on average. All diets, whether they’re low in fat or carbs, perform about equally miserably on average in the long term.

But there’s always quite a bit of variability among participants in these studies. Just check out this chart from a fascinating February study called DIETFITS, which was published in JAMA by researchers at Stanford.

The randomized controlled trial involved 609 participants who were assigned to follow either a low-carb or a low-fat diet, centered on fresh and high-quality foods, for one year. The study was rigorous; enrollees were educated about food and nutrition at 22 group sessions. They were also closely monitored by researchers, counselors, and dietitians, who checked their weight, waist circumference, blood pressure, cholesterol, and other metabolic measures throughout the year.

Overall, dieters in both groups lost a similar amount of weight on average — 11 pounds in the low-fat group, 13 pounds in the low-carb group — suggesting different diets perform comparably. But as you can see in the chart, hidden within the averages were strong variations in individual responses. Some people lost more than 60 pounds, and others gained more than 20 during the year.

Read the whole thing. It’s not long.

Source: Why do dieters succeed or fail? The answers have little to do with food. – Vox

The DIETFITS Trial

Steve Parker, M.D.

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June 8, 2019 · 11:52 AM

Does the Mediterranean Diet Actually Prevent Chronic Diseases?

 

Told ya so!

A couple PhD nutritionists with the University of Arizona Cancer Center reviewed the literature for or against the healthfulness of the Mediterranean diet in 2017. They agree with me that the health claims hold up to scrutiny. From the abstract:

A large body of research data suggests that traditional dietary habits and lifestyle unique to the Mediterranean region (Mediterranean diet, MD) lower the incidence of chronic diseases and improve longevity. These data contrast with troubling statistics in the United States and other high income countries pointing to an increase in the incidence of chronic diseases and the projected explosion in cost of medical care associated with an aging population. In 2013, the MD was inscribed by UNESCO in the “Representative List of the Intangible Cultural Heritage of Humanity.” The 2015–2020 Dietary Guidelines for Americans included the MD as a healthy dietary pattern. Therefore, specific objectives of this article are to provide an overview of the nutritional basis of this healthful diet, its metabolic benefits, and its role in multiple aspects of disease prevention and healthy aging.

Source: Mediterranean Diet and Prevention of Chronic Diseases

Steve Parker, M.D.

Low-Carb Mediterranean Diet, front cover

 

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June 7, 2019 · 5:03 PM

Mediterranean Diet Improves Brain Function in Type 2 Diabetes

I don’t know if the study at hand is valid or not. The abstract is poorly written. The study population was Boston Puerto Ricans only, so may not apply to other ethnic groups. I’m not paying $35 to get access to the full article. Diabetes Self-Management has coverage that will be more digestible than the abstract below.

OBJECTIVE To determine associations of a Mediterranean diet score (MeDS) with 2-year change in cognitive function by type 2 diabetes and glycemic control status and contrast it against other diet quality scores.

RESEARCH DESIGN AND METHODS We used data from the longitudinal Boston Puerto Rican Health Study (n = 913; 42.6% with type 2 diabetes at 2 years). Glycemic control at baseline was categorized as uncontrolled (hemoglobin A1c ≥7% [53 mmol/mol]) versus controlled. Two-year change in glycemic control was defined as stable/improved versus poor/declined. We defined MeDS, Healthy Eating Index, Alternate Healthy Eating Index, and Dietary Approaches to Stop Hypertension scores. Adjusted mixed linear models assessed 2-year change in global cognitive function z score, executive and memory function, and nine individual cognitive tests.

RESULTS Higher MeDS, but no other diet quality score, was associated with higher 2-year change in global cognitive function in adults with type 2 diabetes (β ± SE = 0.027 ± 0.011; P = 0.016) but not without (P = 0.80). Similar results were noted for Mini-Mental State Examination, word recognition, digit span, and clock drawing tests. Results remained consistent for individuals under glycemic control at baseline (0.062 ± 0.020; P = 0.004) and stable/improved over 2 years (0.053 ± 0.019; P = 0.007), but not for uncontrolled or poor/declined glycemic control. All diet quality scores were associated with higher 2-year memory function in adults without type 2 diabetes.

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.

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June 7, 2019 · 3:26 AM

From 2003: Oral Magnesium Supplementation Improves Insulin Sensitivity and Metabolic Control in Type 2 Diabetes

Not the magnesium used in the study at hand

The study was done in northern Mexico and all participants were taking glibenclamide, a sulfonylurea known as glyburide in the U.S. Importantly, study participants had low blood magnesium levels at the outset.

So if you’re not a hypomagnesemic Mexican taking glibenclamide, results may not apply to you.

Nevertheless, results were impressive. Compared to the control group, magnesium supplementation…

  • reduced insulin resistance
  • fasting glucose was 144 mg/dl (185 in controls)
  • Hemoglobin A1c was 8% (10% in controls)

The experiment lasted 16 weeks and the specific form of magnesium used was magnesium chloride solution.

Maybe we should be checking magnesium levels more often. BTW, magnesium supplements are difficult for our bodies to absorb. I know of at least three magnesium compounds: oxide, citrate, and chloride. There are probably others. Degree of absorption varies from one to the other. Adding a supplement on top of kidney impairment could cause toxicity.

The researchers conclude:

Oral supplementation with MgCl2 solution restores serum magnesium levels, improving insulin sensitivity and metabolic control in type 2 diabetic patients with decreased serum magnesium levels.

Source: Oral Magnesium Supplementation Improves Insulin Sensitivity and Metabolic Control in Type 2 Diabetic Subjects | Diabetes Care

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June 5, 2019 · 1:50 AM

THIS May Be Why Americans Are Fat

Your average Americans

There’s no shortage of speculation as to why 70% of us in the U.S. are overweight or obese. A few possibilities include:

  • we’re too sedentary
  • we eat too many carbohydrates
  • we eat too much fat
  • our foods are over-processed
  • we eat away from home too often
  • we eat too many industrial seed oils
  • our water and food are contaminated with persistent organic pollutants that disrupt our endocrine systems

I was reading an article at Nutrition Today and came across this graph of calorie consumption change from 1971 to 2004 (or 2000?):

The verbal summary is from this article cited by the cited by the Nutrition Today authors: During 1971—2000, a statistically significant increase in average energy intake occurred. For men, average energy intake increased from 2,450 kcals to 2,618 kcals, and for women, from 1,542 kcals to 1,877 kcals. So men’s daily calorie intake went up by 168, and women’s by 335.

The original article I read states, alternatively, that men’s daily caloric consumption rose from 2450 to 2693, a gain of 243. I can’t explain the discrepancy between 243 and 168, nor why 2004 is in the graph instead of 2000.

Maybe you don’t think an extra 168 calories a day is much. If you believe in the validity of the Energy Balance Equation, those 168 daily calories will turn into  17.5 pounds of fat in a year unless you “burn them off” somehow. If you weigh 150 lb (68 kg), you can burn those 168 calories by doing a daily 15-minute jog at 5.5 mph (8.9 km/hr). But you ain’t gonna do that, are you?! (I’m not getting into a debate about validity of the equation now; for another perspective, read Lyle McDonald.)

But year 2000 was a long time ago. How much are Americans eating now? According to a 2016 report from Pew Research Center:

Broadly speaking, we eat a lot more than we used to: The average American consumed 2,481 calories a day in 2010, about 23% more than in 1970. That’s more than most adults need to maintain their current weight, according to the Mayo Clinic’s calorie calculator. (A 40-year-old man of average height and weight who’s moderately active, for instance, needs 2,400 calories; a 40-year-old woman with corresponding characteristics needs 1,850 calories.)

Bottom line? We’re eating more than we did in 1970. Which could explain why we’re fat. Unless we’re burning more calories than we did in 1970, which I doubt.

Steve Parker, M.D.

PS: In scientific literature, kcal is what everybody else calls a calorie.

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June 4, 2019 · 5:48 AM

Brief Review of P.D. Mangan’s “Best Supplements for Men”

Death in a bottle?

Best Supplements for Men: for more muscle, higher testosterone, longer life, and better looks was published in 2017. I have the paperback but it’s also available as a Kindle e-book. Per Amazon.com’s rating system, I give it five stars (I love it).

*  *  *

My favorite sentence in this book is, “If you don’t eat, exercise, and sleep right, the health effects of adding any supplement may be minimal to non-existent.” That sets an honest tone. Also in favor of integrity is that the author doesn’t offer Mangan-branded supplements for sale.

I like this book. I learned a lot from it. I’ve benefited by reading the author’s tweets and blog (Rogue Health and Fitness) for many years. He’s smart and, I believe, honest.

The author supports his assertions with numerous scientific references, organized by chapter at the back of the book. If he cites a study done in mice, he tells you. Human studies admittedly carry more weight.

Have you wondered if protein supplements and creatine are good for muscle strength and energy? Does magnesium increase testosterone levels? Does berberine have beneficial health effects? The answers are here.

The author gives good advice regarding calcium supplements that even most physicians don’t know about.

Great recommendations on food.

No book is perfect, and this one is no different. It has no index. So if you’re curious about turmeric or supplements that control diabetes, you have to scan the whole book. My copy didn’t include references for chapter 11. Page numbers for chapters in the index didn’t match the actual chapter starts. My least favorite sentence in the book was something about Dr. Joseph Mercola being a trustworthy source of health information; he is not (search “mercola” at ScienceBasedMedicine.org).

Again, I like this book, learned much from it, and recommend it to men. If you’re taking lots of supplements now, read this book to find out if they help, harm, or are only good for making expensive urine.

Steve Parker, M.D.

PS: Some personal notes from my reading. Many of the cited studies are “association”-type evidence rather causation. Berberine may help reduce blood sugars in diabetics just as well as metformin. Creatine: Yes, for muscle growth and strength. Magnesium 700 mg/day increases testosterone. Mag oxide may be worthless due to poor absorption. Mangan likes mag citrate but Lexicomp says it’s no better than oxide; absorption “up to 30%.” Citrulline: Yes, for erectile dysfunction, and may help with HTN. DHEA 50 mg/day increases testosterone in men by 50%, but only in men over 70. During fat weight loss, whey protein helps prevent muscle loss. MCT oil may also help (e.g., cook with coconut oil). ASA 81 mg/day seems to prevent some cancers in folks over 55, especially colorectal cancer.

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May 31, 2019 · 5:07 PM

Which Foods Make Us Fat?

At my other Advanced Mediterranean Diet website, a few years ago I asked visitors to answer a poll question. 2,367 responded thusly:

What single food category makes you gain the most fat weight?Fatty foods like bacon, butter, oils, nuts:
5%
Protein-rich foods: meat, eggs, fish:
0%
Sugary sweet items:
23%
Starches: bread, potatoes, peas, corn:
16%
Carbohydrates:
30%
Pastries, cake, pie, cookies:
25%
Other:
1%

Total Votes: 2367

Yes, I know it’s not a scientific poll, but it’s something. I’m not surprised at the results. I’m wishing I’d offered nuts as a choice since there are at least a few folks who gain weight on nuts, perhaps not realizing that nut calories are mostly from fat. To participate in the poll, click the link above.

Steve Parker, M.D.

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May 29, 2019 · 5:10 PM

Certain Blood Pressure Medications May Injure or Impair Athletes

Not that serious…yet

Seriously athletic folks, particularly those in sports with high aerobic demand, should avoid these BP drug classes:

  • Diuretics (they predispose to dehydration)
  • Beta blockers (they may decrease exercise tolerance via slowing of heart rate)

Better choices for athletes are:

  • Angiotensin converting enzyme inhibitors (ACEIs)
  • Angiotensin II receptor blockers (ARBs)
  • long-acting dihydropyridine calcium channel blockers

These latter drugs are not likely to affect athletic performance or cause other complications. If you can’t figure out which class of drug you take, ask your physician, pharmacist, or Dr Google.

Steve Parker, M.D.

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