December 13, 2012 · 2:54 AM

14 Little-Known Weight-Loss Tips

“Look…the soda’s not for me, OK?”

 

These have worked for lots of my patients.  Take what works for you and discard the rest.

  1. Plan on grocery shopping, meal preparation, and taking meals to your workplace.
  2. Keeping a record of your food consumption is often the key to success.
  3. Accountability is another key.  Do you have a friend or spouse who wants to lose weight?  Start the same program at the same time and support each other.  That’s one of many ways to have accountability.
  4. If you tend to over-eat or snack too much, floss and brush your teeth after you’re full.  You’ll be less likely to go back for more anytime soon.
  5. Eat at least two or three meals daily.  Eat breakfast every day.  Ignore the diet gurus who say you must eat every two or three hours.
  6. Eat slowly and allow yourself time to enjoy your food; you’ll be a better judge of when your’re full.
  7. Don’t eat while watching TV.
  8. Give yourself a specific reward for every 10 pounds (4.5 kg) of weight lost.  Consider a weekend get-way, jewelry, new clothes, an evening at the theater, a professional massage, etc.  Choose the reward in advance, to give you something to work toward.
  9. Don’t start a diet during a time of stress.
  10. Maintain a consistent eating pattern throughout the week and year.
  11. If you know you’ve eating enough at a meal to satisfy your nutritional requirements yet you still feel hungry, drink a large glass of water and wait a while.  Or try a sugar-free psyllium fiber supplement: three grams of fiber in 8 oz (240 ml) of water.
  12. Weigh yourself frequently: daily during your active weight-loss phase and during the first two months of your maintenance-of-weight-loss phase.  Weekly thereafter.
  13. Be aware that you’ll probably regain five or 10 pounds (2.3 or 4.5 kg) of fat now and then.  That’s normal.  Just get back on your original weight-loss plan for a month or two.
  14. Tell your housemates you’re on a diet and ask for their support.  You may also need to tell your co-workers and others with whom you spend significant time.  If they care about you, they’ll be careful not to tempt you off the diet.

Indispensable?  OK, maybe that’s a little over the top.  But each of these tips has  proven indispensable to at least one of my patients.

Steve Parker, M.D.

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December 8, 2012 · 4:34 AM

In T2 Diabetes, Which Comes First: High Insulin Levels or Insulin Resistance?

pancreas, liver, insulin, woman, teacher, books, diabetes, cause of diabetes

I couldn’t find a decent picture of a liver or pancreas, so this will have to do….

Excessive insulin output by the pancreas (hyperinsulinemia) is the underlying cause of type 2 diabetes, according to a hypothesis from Walter Pories, M.D., and G. Lynis Dohm, Ph.D.  The cause of the hyperinsulinemia is a yet-to-be-identified “diabetogenic signal” to the pancreas from the gastrointestinal tract.

This is pretty sciencey, so you’re excused if you stop reading now.  You probably should.

They base their hypothesis on the well-known cure or remission of many cases of type 2 diabetes quite soon after roux-en-y gastric bypass surgery (RYGB) done for weight loss.  (Recent data indicate that six years after surgery, the diabetes has recurred in about a third of cases.)  Elevated fasting insulin levels return to normal within a week of RYGB and remain normal for at least three months.  Also soon after surgery, the pancreas recovers the ability to respond to a meal with an appropriate insulin spike.  Remission or cure of type 2 diabetes after RYGB is independent of changes in weight, insulin sensitivity, or free fatty acids.

Bariatric surgery provides us with a “natural” experiment into the mechanisms behind type 2 diabetes.

The primary anatomic change with RYGB is exclusion of food from a portion of the gastrointestinal tract, which must send a signal to the pancreas resulting in lower insulin levels, according to Pories and Dohm.

Why would fasting blood sugar levels fall so soon after RYGB?  To understand, you have to know that fasting glucose levels primarily reflect glucose production by the liver (gluconeogenesis).  It’s regulated by insulin and other hormones.  Insulin generally suppresses gluconeogenesis.  The lower insulin levels after surgery should raise fasting glucose levels then, don’t you think?  But that’s not the case.

Pories and Dohm surmise that correction of hyperinsulinemia after surgery leads to fewer glucose building blocks (pyruvate, alanine, and especially lactate) delivered from muscles to the liver for glucose production.  Their explanation involves an upregulated Cori cycle, etc.  It’s pretty boring and difficult to follow unless you’re a biochemist.

The theory we’re talking about is contrary to the leading theory that insulin resistance causes hyperinsulinemia.  Our guys are suggesting it’s the other way around: hyperinsulinemia causes insulin resistance.  It’s a chicken or the egg sort of thing.

If they’re right, Pories and Dohm say we need to rethink the idea of treating type 2 diabetes with insulin except in the very late stages when there may be no alternative.  (I would add my concern about using insulin secretagogues (e.g., sulfonylureas) in that case also.)  If high insulin levels are the culprit, you don’t want to add to them.

We’d also need to figure out what is the source of the “diabetogenic signal” from the gastrointestinal tract to the pancreas that causes hyperinsulinemia.  A number of stomach and intestinal hormones can affect insulin production by the pancreas; these were not mentioned specifically by Pories and Dohm.  Examples are GIP and GLP-1 (glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1).

Keep these ideas in mind when you come across someone who’s cocksure that they know the cause of type 2 diabetes.

Steve Parker, M.D.

Reference:  Pories, Walter and Dohm, G. Lynis.  Diabetes: Have we got it all wrong?  Hyperinsulinism as the culprit: surgery provides the evidence.  Diabetes Care, 2012, vol. 35, p. 2438-2442.

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December 5, 2012 · 2:01 AM

What’s Dr. Bernstein Got Against Tomatoes?

Eat greens for vitamin K

Looks reasonable to me

Dr. Richard Bernstein cautions his diabetic patients and readers of Diabetes Solution to keep a tight lid on consumption of tomatoes.  An excerpt from page 149:

If you have them uncooked in salad, limit yourself to one slice or a single cherry tomato per cup of salad.

His concern is that tomatoes will raise your blood sugar too high.

That doesn’t make sense to me.  A 3-inch diameter tomato has 7 grams of carbohydrate, 2 of which are fiber.  So the digestible carb count is only 5 grams.  That’s not much.  So do tomatoes have a high glycemic index?  Unlikely, although it’s hard to be sure.  Good luck finding a reliable GI for tomatoes on the Internet.

I think Dr. Bernstein’s wrong about this one, which is rare.  I suppose it’s possible that tomatoes deliver some other substance to the bloodstream that interferes with carbohydrate metabolism, but Dr. Bernstein doesn’t mention that.

Do tomatoes play havoc with your blood sugars?

Steve Parker, M.D.

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December 3, 2012 · 1:04 PM

Dietitians’ Views on Mediterranean Diet for Diabetes

An eating pattern similar to the traditional Mediterranean diet can be integrated with existing national guidelines for the management of diabetes, blood pressure, and cholesterol. Existing data suggest that the Mediterranean diet has health benefits, including improved glycemic control and reduced cardiovascular risk, and may offer benefits to diabetes patients and clinicians alike in terms of palatability, ease of explanation and use, and promotion of improved health.

Olive oil and vinegar

Olive oil and vinegar

This excerpt is from an article by three dietitians writing in Diabetes Spectrum in 2009.  Click through for details if interested.

—Steve

Reference:  doi: 10.2337/diaspect.24.1.36  Diabetes Spectrum January 1, 2011 vol. 24, no. 1, p.36-40

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December 1, 2012 · 2:00 AM

QOTD: Why Do We Work?

Independence Hall: The U.S. Declaration of Independence was approved here on July 4, 1776

Independence Hall: The U.S. Declaration of Independence was approved here on July 4, 1776 (not much to do with Scotsman Adam Smith)

“It is not from the benevolence of the butcher, the brewer, or the baker that we expect our dinner, but from their regard to their own interest.”

—Adam Smith

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November 29, 2012 · 5:40 AM

Low-Carb Research Update

“What about that recent study in American Journal of Clinical Nutrition…?”

As much as possible, I base my nutrition and medical recommendations on science-based research published in the medical literature.  Medical textbooks can be very helpful, but they aren’t as up-to-date as the medical journals.

In the early 2000s, a flurry of research reports demonstrated that very-low-carb eating (as in Dr. Atkins New Diet Revolution) was safe and effective for short-term weight management and control of diabetes.  I was still concerned back then about the long-term safety of the high fat content of Atkins.  But 80 hours of literature review in 2009 allowed me to embrace low-carbohydrate eating as a logical and viable option for many of my patients.  The evidence convinced me that the high fat content (saturated or otherwise) of many low-carb diets was little to worry about over the long run.

By the way, have you noticed some of the celebrities jumping on the low-carb weight-management bandwagon lately?  Sharon Osbourne, Drew Carey, and Alec Baldwin, to name a few.

My primary nutrition interests are low-carb eating, the Mediterranean diet, and the paleo diet.  I’m careful to stay up-to-date with the pertinent scientific research.  I’d like to share with you some of the pertinent research findings of the last few years.

Low-Carb Diets

  • Low-carb diets reduce weight, reduce blood pressure, lower triglyceride levels (a healthy move), and raise HDL cholesterol (another good trend).  These improvements should help reduce your risk of heart disease.  (In the journal Obesity Reviews, 2012.)
  • Dietary fat, including saturated fat, is not a cause of vascular disease such as heart attacks and atherosclerosis (hardening of the arteries).  (Multiple research reports.)
  • If you’re overweight and replace two sugary drinks a day with diet soda or water, you’ll lose about four pounds over the next six months.  (American Journal of Clinical Nutrition, 2012.)
  • United States residents obtain 40% of total calories from grains and added sugars.  Most developed countries are similar.  Dr. Stephan Guyenet notes that U.S. sugar consumption increased steadily “…from 6.3 pounds [2.9 kg] per person per year in 1822 to 107.7 pounds [50 kg] per person in 1999.  Wrap your brain around this: in 1822 we ate the amount of added sugar in one 12-ounce can of soda every five days, while today we eat that much sugar every seven hours.”
  • A very-low-carb diet improves the memory of those with age-related mild cognitive impairment. Mild cognitive impairment is a precursor to dementia.  (University of Cincinnati, 2012.)
  • High-carbohydrate and sugar-rich diets greatly raise the risk of mild cognitive impairment in the elderly. (Mayo Clinic study published in the Journal of Alzheimers’ Disease, 2012.)
  • Compared to obese low-fat dieters, low-carb dieters lose twice as much fat weight.  (University of Cincinnati, 2011.)
  • Diets low in sugar and refined starches are linked to lower risk of age-related macular degeneration in women.  Macular degeneration is a major cause of blindness.  (University of Wisconsin, 2011.)
  • A ketogenic (very-low-carb) Mediterranean diet cures metabolic syndrome (Journal of Medicinal Food, 2011.)
  • For type 2 diabetics, replacing a daily muffin (high-carb) with two ounces (60 g) of nuts (low-carb) improves blood sugar control and reduces LDL cholesterol (the “bad” cholesterol). (Diabetes Care, 2011.)
  • For those afflicted with fatty liver, a low-carb diet beats a low-fat diet for management. (American Journal of Clinical Nutrition, 2011.)
  • For weight loss, the American Diabetes Association has endorsed low-carb (under 130 g/day) and Mediterranean diets, for use up to two years. (Diabetes Care, 2011.)
  • High-carbohydrate eating doubles the risk of heart disease (coronary artery disease) in women.  (Archives of Internal Medicine, 2010.)
  • One criticism of low-carb diets is that they may be high in protein, which in turn may cause bone thinning (osteoporosis).  A 2010 study shows this is not a problem, at least in women.  Men were not studied.  (American Journal of Clinical Nutrition.)
  • High-carbohydrate eating increases the risk of developing type 2 diabetes (American Journal of Clinical Nutrition, 2010.)
  • Obesity in U.S. children tripled from 1980 to 2000, rising to 17% of all children.  A low-carb, high-protein diet is safe and effective for obese adolescents.  (American Journal of Clinical Nutrition, 2010.)

Mediterranean Diet

The traditional Mediterranean diet is well established as a healthy way of eating despite being relatively high in carbohydrate: 50 to 60% of total calories.  It’s known to prolong life span while reducing rates of heart disease, cancer, strokes, diabetes, and dementia.  The Mediterranean diet is rich in fresh fruits, vegetables, nuts and seeds, olive oil, whole grain bread, fish, and judicious amounts of wine, while incorporating relatively little meat.  It deserves your serious consideration.  I keep abreast of the latest scientific literature on this diet.

  • Olive oil is linked to longer life span and reduced heart disease.  (American Journal of Clinical Nutrition, 2012.)
  • Olive oil is associated with reduced stroke risk.  (Neurology, 2012).
  • The Mediterranean diet reduces risk of sudden cardiac death in women.  (Journal of the American Medical Association, 2011.)
  • The Mediterranean diet is linked to fewer strokes visible by MRI scanning.  (Annals of Neurology, 2011.)
  • It reduces the symptoms of asthma in children.  (Journal of the American Dietetic Association, 2011.)
  • Compared to low-fat eating, it reduces the incidence of type 2 diabetes by 50% in middle-aged and older folks.  (Diabetes Care, 2010.)
  •  A review of all available well-designed studies on the Mediterranean diet confirms that it reduces risk of death, decreases heart disease, and reduces rates of cancer, dementia, Parkinson’s disease, stroke, and mild cognitive impairment.  (American Journal of Clinical Nutrition, 2010.)
  • It reduces the risk of breast cancer.  (American Journal of Clinical Nutrition, 2010.)
  • The Mediterranean diet reduces Alzheimer’s disease.   (New York residents, Archives of Neurology, 2010).
  • It slows the rate of age-related mental decline.  (Chicago residents, American Journal of Clinical Nutrition, 2010.)
  • In patients already diagnosed with heart disease, the Mediterranean diet prevents future heart-related events and preserves heart function.  (American Journal of Clinical Nutrition, 2010.)

Clearly, low-carb and Mediterranean-style eating have much to recommend them.  Low-carb eating is particularly useful for weight loss and management, and control of diabetes, prediabetes, and metabolic syndrome.  Long-term health effects of low-carb eating are less well established.  That’s where the Mediterranean diet shines.  That’s why I ask many of my patients to combine both approaches: low-carb and Mediterranean.  Note that several components of the Mediterranean diet are inherently low-carb: olive oil, nuts and seeds, fish, some wines, and many fruits and vegetables.  These items easily fit into a low-carb lifestyle and may yield the long-term health benefits of the Mediterranean diet.  If you’re interested, I’ve posted on the Internet a Low-Carb Mediterranean Diet that will get you started.

Steve Parker, M.D.

Disclaimer:  All matters regarding your health require supervision by a personal physician or other appropriate health professional familiar with your current health status.  Always consult your personal physician before making any dietary or exercise changes.

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November 25, 2012 · 2:00 AM

This Is the Best Time Ever to Have Diabetes

Here’s a quote from a recent Diabetes Care:

Improved therapeutics and health care delivery have brought remarkable declines in the incidence of … complications, with a 50% reduction in amputations from their peak in 1997 and ∼35% reduction in the incidence of end-stage renal disease. Similarly, 10-year coronary heart disease risk dropped from 21% in 2000 to 16% in 2008.

Nevertheless, diabetes remains the leading cause of blindness, renal failure, nontraumatic lower-limb amputation, in adults 18 to 65 years of age.  We gotta stay after it!

The essay by Dr. Robert Ratner also notes 79 million Americans with prediabetes.  They need my Conquer Diabetes and Prediabetes book.  It’s only $9.99 (USD), a drop in the ocean compared to the $174 billion spent on diabetes in 2007 in the U.S.

—Steve

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November 23, 2012 · 2:00 AM

Do You Really Need to Restrict Salt Consumption?

Unfairly demonized?

The American Council on  Science and Health has a brief review of the latest research on salt restriction, and it’s not supportive of population-wide sodium restriction.  On the other hand, salt-restriction proponents believe it would reduce strokes, heart attacks, heart failure, and premature death.  I’ve been a salt-restriction skeptic for a couple decades.

Remember, table salt molecules contain one sodium atom and one chloride atom.  Salt-restricted and low-sodium diets are usually designated by the amount of sodium, not salt.

That being said, I do believe some individuals have elevated blood pressure related to relatively high sodium intake.  This may apply to one of every five adults with high blood pressure.  To find out if you’re one of the five, you could go on a low-sodium diet—1.5 to 3 grams a day—for one or two months and see what it does to your blood pressure.  Get your personal physician’s blessing first.

Steve Parker, M.D.

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November 22, 2012 · 1:05 AM

Happy Thanksgiving!

Godspeed = May God prosper you

It’s a wonderful holiday for my U.S.A. readers, started by the Pilgrims in 1621.

Godspeed,

—Steve

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November 20, 2012 · 6:35 PM

Is Your Blood Sugar Meter Accurate?

David Mendosa reviewed some reviews on home blood glucose monitor accuracy and reproducibility.  He was motivated by a recent review in Consumer Reports.  You’ll want to click through his links for details.  The last time I looked into this, I learned that a device could receive FDA approval if it could measure accuracy to within 20% of the actual blood sugar value as determined by a laboratory machine.  For a blood sugar of 200 mg/dl (11.1 mmol/l), the home device could give you a value anywhere between 160 and 240 mg/dl (8.9 to 13.3 mmol/l).  That doesn’t exactly inspire confidence, does it?

—Steve

 

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