September 3, 2012 · 6:25 AM

What To Do When Your Weight Loss Progress Mysteriously Stops

“I’m doing everything I’m supposed to. Or am I?”

It’s common on any weight-loss program to be cruising along losing weight as expected, then suddenly the weight loss stops although you’re still far from goal weight.  This is the infamous and mysterious stall.

Once you know the reason for the stall the way to break it becomes obvious.  The most common reasons are:

  1. You’re not really following the full program any more; you’ve drifted off the path, often unconsciously
  2. Instead of eating just until you’re full or satisfied, you’re stuffing yourself
  3. You need to start or intensify an exercise program
  4. You’ve developed an interfering medical problem such as adrenal insufficiency (rare) or an underactive thyroid; see your doctor
  5. You’re taking interfering medication such as a steroid; see your doctor
  6. You’re strength training program is building new muscle that masks ongoing loss of fat (not a problem!)

If you still can’t figure out what’s causing your stall, do a nutritional analysis of one weeks’ worth of eating, with a focus on daily digestible carb (net carbs) and calorie totals.  You can do this analysis online at places like FitDay (http://fitday.com/) or Calorie Count (http://caloriecount.about.com/).  Perhaps you’re eating many more calories than you thought. Or you may find you’ve been sabotaged by “carb creep”: excessive dietary carbs have insidiously invaded you.  Even if you’re eating very-low-carb, it’s still possible to have excess body fat, even gain new fat, if you eat too many calories from protein and fat.  It’s not easy, but it’s possible.

Steve Parker, M.D.

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September 1, 2012 · 5:15 AM

Quote of the Day

Has anyone even bothered to ask why the tuna are eating mercury?

—Jim Gaffigan

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August 29, 2012 · 4:00 AM

Six Weeks to OMG: A Book Review

I heard about this book before it was available in the U.S. and I thought it had the potential to be huge here.  So I read Six Weeks to OMG: Get Skinnier Than All Your Friends by Venice Fulton, published in 2012.  Per Amazon.com’s rating system, I give it two stars (“I don’t like it”).

♦   ♦   ♦

Judging from the wording and writing style, this book was written for not-too-bright girls and women from 12 to 22 years old.  Others need not bother with it.

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Will it work for weight loss?  Yes, even without the author’s three cornerstone gimmicks: 1) Skip breakfast, but eat three meals daily, 2) Black coffee one or two cups every morning, and 3) Cold-water baths at 59 to 68°F for up to 15 minutes.  There’s no good scientific data to support those prescriptions.

The diet will work because it restricts your consumption of items that make us fat: concentrated sugars and refined starches.  It’s a low-carbohydrate diet—up to 60, 90, or 120 grams a day, depending on how fast you want to lose.

The diet consists mostly of high-protein animal-derived foods, low-carb vegetables, and up to three pieces of fruit daily.  Do not exceed 40 grams of carbohydrate per meal, even less is better, the author says.  Grains and dairy products aren’t mentioned much; it’s easy to blow your carb limit with them.  High-carb vegetables are listed, so you can avoid them.

Mr. Fulton emphasizes some important, valid points.  High protein consumption helps control appetite.  Trans fats are bad.  Eat cold-water fatty fish twice weekly.  Eat off a small plate (maximum of 9-inch diameter).  No snacking.  He says good things about weight training, while failing to mention it’s more much important long-term maintenance than for active weight loss.

He says some things that are just plain wrong, such as 1) everyone can be skinny, 2) there are only eight essential amino acids, 3) exercise is fairly helpful with weight loss, and 4) weight training just once every 10 days is adequate.

I’ll confess I didn’t read every word of the book.  The writing style is just too irritating unless you’re a not-too-bright 12 to 22-year-old.  For instance, every page had at least four exclamation marks!

Here are some of the dumbed-down sentences that unintentionally made me laugh out loud:

  • “The key to success is understanding stuff.”
  • “If you have problems controlling your appetite, the main reason is that you eat too often.”
  • “The person in the mirror, that’s you.”
  • “Human beings are part of the universe.  And that’s full of laws.  The laws of physics, chemistry and biology are three well-known laws.”

If you want a low-carb weight loss diet, you’re better off with Protein Power, The New Atkins For a New You, or the Low-Carb Mediterranean Diet.  A low-carb diet specifically for diabetics is my Conquer Diabetes and Prediabetes.

Steve Parker, M.D.

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August 27, 2012 · 2:00 AM

Quote of the Day

The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.

— Tenth Amendment to the U.S. Constitution

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August 26, 2012 · 2:00 AM

Kidney Stones on the Rise

“Ah hah! There it is, stuck in the ureter.”

MedPage Today in May, 2012, reported a substantial increase (70%) in the prevalence of kidney stones in the U.S. over the last two decades. Stone prevalence rose from 5.2% to 8.8% of the population.  Prevalence was based on the periodic National Health and Nutrition Examination Survey, which asked participants, “Have you ever had kidney stones?”

Stone prevalence began rising even earlier.  Again according to the third NHANES, prevalence increased from 3.8 percent in the period 1976 to 1980 to 5.2 percent in the years 1988 to 1994.

Older studies estimated that one in 10 men and one of every 20 women will have at least one painful stone by the age of 70.

What are kidney stones make of?  

Three out of four patients with kidney stones form calcium stones, most of which are composed primarily of calcium oxalate or, less often, calcium phosphate.  Pure uric acid stones are less than 10 percent of all stones.

Why the increased stone prevalence?  Does diet count?

Unfortunately, the article doesn’t offer any speculation as to why kidney stones are more prevalent.  Kidney stones have a genetic component, but our genes have changed very little over just two decades.  I wonder if diet plays a role.

UpToDate.com reviewed diet as a risk factor for kidney stones.  Some quotes:

There are several dietary factors that may play an important role in many patients: fluid, calcium, oxalate, potassium, sodium, animal protein, phytate, sucrose, fructose, and vitamin C intake. Lower intake of fluid, calcium, potassium, and phytate and higher intake of sodium, animal protein, sucrose, fructose, and vitamin C are associated with an increased risk for calcium stone formation. The type of beverage may also influence the risk. The effect of calcium intake is paradoxical, with a decreased risk with increased dietary calcium and an increased or no change in risk with calcium supplements.

The combination of dietary factors may also have a significant impact upon stone risk. As an example, the Dietary Approaches to Stop Hypertension (DASH) diet is high in fruits and vegetables, moderate in low-fat dairy products, and low in animal protein. Based upon an analysis of three large cohorts, adherence to a DASH-style diet lowered the risk for kidney stones among men, older women, younger women, high body mass index (BMI) individuals, and low BMI individuals. Thus, the DASH diet is a reasonable option in the attempt to reduce the risk of stone recurrence.

Higher sucrose [table sugar] intake is associated with an increased risk of stone formation in younger and older women.
Standard advice to prevent initial and recurrent kidney stones is to avoid low urine output.  Do that by drinking plenty of fluid.
Although I pay about $400 a year for access to UpToDate, they offer free public access to some of the website.  Here’s the UpToDate poop sheet on kidney stones.
Extra credit:  Medical conditions that predispose to kidney stones include primary hyperparathyroidism, obesity, gout, diabetes, and medullary sponge kidney.

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August 25, 2012 · 8:28 AM

A Dietitian’s View of Ketogenic Diets

You get it?

Registered Dietitian Franziska Spritzler recently reviewed the concept of low-carb ketogenic diets.  She thinks they are a valid approach to certain clinical situations.  Among dietitians, this puts her in a small but growing minority.

I hesitate to mention this, but I will anyway.  Many, if not most, dietitians too easily just go along with the standard party line on low-carb eating: it’s rarely necessary and quite possibly unhealthy.  Going along is much easier than doing independent literature review and analysis.  I see the same mindset among physicians.

Franziska breaks the mold.

Steve Parker, M.D.

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August 24, 2012 · 8:39 AM

“Doc, How Long Will I Live With My Type 1 Diabetes?”

Type 1 diabetics diagnosed in childhood and born between 1965 and 1980 have an average life expectancy of 68.8 years.  That compares to a lifespan average of 53.4 years for those born between 1950 and 1964.  The figures are based on Pittsburgh, PA, residents and published in a recent issue of Diabetes.

Elizabeth Hughes, one of the very first users of insulin injections, lived to be 73.  She started on insulin around 1922.

Average overall life expectancy in the U.S. is 78.2 years—roughly 76 for men and 81 for women.

Don’t be too discouraged if you have diabetes: you have roughly a 50:50 chance of beating the averages, and medical advances will continue to lengthen lifespan.

Steve Parker, M.D.

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August 21, 2012 · 1:00 AM

New Analysis Finds Low-Carb Diets Reduce Heart Disease Risk Factors

Obesity Reviews just published details of a recent meta-analyis of low-carbohydrate diet effects on cardiovascular risk factors.

A systematic review and meta-analysis were carried out to study the effects of low-carbohydrate diet (LCD) on weight loss and cardiovascular risk factors (search performed on PubMed, Cochrane Central Register of Controlled Trials and Scopus databases). A total of 23 reports, corresponding to 17 clinical investigations, were identified as meeting the pre-specified criteria.

Over a thousand obese patients were involved.  By eating low-carb, average body weight decreased by 7 kg (15 lb), body mass index dropped by 2, blood pressure dropped by 3-4 mmHg, triglycerides decreased by 30 mg/dl, hemoglobin A1c dropped by 0.21% (absolute decrease), insulin levels fell by 2.23 micro IU/ml, while HDL cholesterol rose by 1.73 mg/dl.  LDL cholesterol didn’t change.

The authors conclusion:

Low-carboydrate diet was shown to have favourable effects on body weight and major cardiovascular risk factors; however the effects on long-term health are unknown.

I haven’t see the full text of the article yet, so I don’t know the carbohydrate level under review.  I bet it’s under 50 g of digestible carb daily.  My Low-Carb Mediterranean Diet starts at 20-30 grams a day.

Steve Parker, M.D.

Reference:  Santos, F.L., et al. Systematic review and meta-analysis of clinical trials of the effects of low carbohydrate diets on cardiovascular risk factors. Obesity Reviews. Article first published online: 20 AUG 2012. DOI: 10.1111/j.1467-789X.2012.01021.x

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August 20, 2012 · 2:00 AM

Six Weeks of Hillfit

Last January I wrote a favorable review of Chris Highcock’s Hillfit strength training program for hikers.  A few months ago I actually followed the the program for six weeks, and I still like it.  It’s an eye-opener.

See my prior review for details of the program.  Briefly, you do four exercises (requiring no special equipment) for fifteen minutes twice a week.  Who doesn’t have time for that?

Wanna arm wrestle?

I did modify the program a bit.  I included high-intensity intervals on a treadmill twice weekly, right after my Hillfit exercises.  Here’s the 15-minute treadmill workout: 3 minute warm-up at 5.3 mph, then one minute fast jogging at 7–8 mph, then one minute of easy jog at 5.3 mpg. Alternate fast and slow running like that for 6 cycles.  So my total workout time was 30 minutes twice weekly.

Why the treadmill HIIT (high intensity interval training)?  For endurance.  I’m still not convinced that strength training alone is adequate for the degree of muscular and cardiopulmonary endurance I want.  I’m not saying it isn’t adequate.  That’s a self-experiment for another day.  In 2013, I’m planning to hike Arizona’a Grand Canyon rim to rim with my son’s Boy Scout troop.  That’s six or eight miles down, sleep-over, then six or eight  miles back up the other side of the canyon.  That takes strength and endurance.

One part of the program I wasn’t good at: Chris recommends taking about 10 seconds to complete each exercise motion.  For example, if you’re doing a push-up, take 10 seconds to go down to the horizontal position, and 10 seconds to return up to starting position with arms fully extended.  I forgot to do it that slowly, taking five or six seconds each way instead.

I’ve preached about the benefits of baseline and periodic fitness measurements.  Here are mine, before and after six weeks of Hillfit and treadmill HIIT:

  • weight: no real change (168 lb or 76.2 kg rose to 170 lb or 77.3 kg)
  • body mass index: no change (23.3)
  • resting heart rate and blood pressure: not done
  • maximum consecutive push-ups: 30 before, 34 after
  • maximum consecutive pull-ups: 7 before, 8 after
  • maximum consecutive sit-ups: 30 before, 37 after
  • time for one-mile walk/run: 8 minutes and 45 seconds before, down to 8 minutes and 35 seconds after
  • vertical jump (highest point above ground I can jump and touch): 108.75 inches or 276 cm before, to 279.5 cm after
  • waist circumference: no real change (92 cm standing/87 cm supine before, 92.5 cm standing/87.5 cm supine after)
  • biceps circumference: no real change (33 cm left and 33.5 cm right before; 33 cm left and 33 cm right after)
  • calf circumference: 39.5 cm left and 39 cm right, before; 38.5 cm left and 37 cm right, after (not the same child measuring me both times)
  • toe touch (stand and lock knees, bend over at waist to touch toes: 7.5 inches (19 cm) above ground before, 8.5 inches (22 cm) after

If these performance numbers seem puny to you, please note that I’m 57-years-old.  I’m not sure exactly where I stand among others my age, but I suspect I’m in the top half.  I’m fit enough to be in the U.S. Army (I’m not in it, however).  I’m sure I could do much better if I put in the time and effort.  My goal right now is to achieve or maintain a reasonable level of fitness without the five hours a week of exercise recommended by so may public health authorities.

Take-Home Points

Overall, this program improved my level of fitness over six weeks, with a minimal time commitment.  I credit Hillfit for the gains in push-ups, pull-ups, sit-ups, and perhaps vertical jump.

My time on the one-mile run didn’t improve much, if at all.  This fits with my preconceived notion that strength training might not help me with leg muscle  and cardiopulmonary endurance.

The Hillfit exercise progressions involve adding weights to a backpack (aka rucksack or knapsack) before you start the exercise.  I’m already up to 80 lb (36 kg) extra weight on the modified row, and 85 lb (39 kg) on the hip extensions.  That’s getting unwieldy and straining the seams of my backpack.  I can’t see going much higher with those weights.

I expect I could easily maintain my current level of fitness by continuing Hillfit and HIIT treadmill work at my current levels of intensity.  In only one hour per week.  Not bad at all.

It’s possible I could get even stronger if I stuck to the program longer, or slowed down my movements to the recommended 10 seconds each way.

The key to muscle strength gain with Hillfit seems to be working the muscles steadily, to near-exhaustion over 90 seconds, gradually adding a higher work load as the days or weeks pass.

I’m setting Hillfit aside for now, only because I want to start a new self-experiment.

Hillfit is an excellent time-efficient strength training program for those with little resistance-training background, or for those at low to moderate levels of current fitness.

Steve Parker, M.D.

Note to self:

When doing a mile run on the treadmill, I tend to start out too fast, then burn out and have to slow down.  That may be impairing my performance.  Next time, start at 7 mph for a couple minutes then try to increase speed.  Running a mile at 7 mph takes nine minutes.  A mile at 7.5 mph takes 8 minutes.  A mile at 8 mph takes 7 minutes and 30 seconds.

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August 19, 2012 · 7:50 PM

Quote of the Day

A general dissolution of principles and manners will more surely overthrow the liberties of America than the whole force of the common enemy. While the people are virtuous they cannot be subdued; but when once they lose their virtue then will be ready to surrender their liberties to the first external or internal invader.

             —Samuel Adams, 1779

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