Advanced Mediterranean Diet

From this day forward, my Advanced Mediterranean blogging will be at Advanced Mediterranean Life.  Why not check it out and sign up for e-mail notification of new posts or subscribe to the new RSS feed now, when you’re thinking about it?  Those options are at the upper right corner of the new blog home.

Why the change?  I don’t have the tech skills to update the software at this site.  The new Wordpress.com format is much more user-friendly and esthetically pleasing.

This old URL will be running indefinitely.  Which means it could disappear tomorrow, but I doubt it.  After all, much of my writing links back here.  I’ll manually move some of my favorite posts over to the new blog over time.

Many thanks for your readership!

Steve Parker, M.D.

A number of my patients and blog readers have asked for a more comprehensive presentation of the Ketogenic Mediterranean Diet. The KMD, as you may be aware, is the basis for the Low-Carb Mediterranean Diet.  Both of them are in Conquer Diabetes and Prediabetes: The Low-Carb Mediterranean Diet.

Odd cover, huh?

The new book is geared for folks who don’t have diabetes, but want to lose weight with a very-low-carb diet.  It’s called KMD: Ketogenic Mediterranean Diet.  Readers of Conquer Diabetes and Prediabetes will get nothing out of the new book: they’ve seen it all before.  Here’s the book description from Amazon.com:

Dr. Steve Parker presents the world’s first low-carbohydrate Mediterranean diet. Nutrition experts for years have recommended the healthy Mediterranean diet. It’s linked to longer life span and reduced rates of heart attack, stroke, cancer, diabetes, and dementia. Dr. Parker (M.D.) has modified the Mediterranean diet to help you lose excess weight while retaining most of the healthy foods in the traditional Mediterranean diet. What’s the secret? Cut back on the fattening carbohydrates such as concentrated sugars and refined starches.

You’ll discover how to manage your weight without exercise, without hunger, without restricting calories, while eating fish, meat, chicken, vegetables, fruits, wine, olive oil, nuts, and cheese.

The book includes advice on how to avoid weight regain, instruction on exercise, a week of meal plans, special recipes, a general index, a recipe index, and scientific references. All measurements are given in both U.S. customary and metric units. This low-carbohydrate Mediterranean diet is included also in Dr. Parker’s Advanced Mediterranean Diet (2nd edition) and Conquer Diabetes and Prediabetes. Are you finally ready to lose weight while eating abundantly and without counting calories?

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KMD: Ketogenic Mediterranean Diet is available for purchase at Amazon.com (Kindle edition here, also) or Barnes and Noble (Nook version here).  The ebook version is available in multiple formats at Smashwords. 

Steve Parker, M.D.

Katie Matlack at Software Advice has a software wishlist for Apple iPads and iPhones.

• Diabetes Risk Calculator
• Spirometry (for measuring lung function)
• Electrocardiogram (heart electrical tracing) and interpretation

The heart tracing app in particular appeals to me since so many of us have brief palpitations that come and go without warning.  By the time you get to your doctor’s office or emergency department, it’s over.  When your palpitation starts, you could record your heart rhythm almost immediately, sharing with your doctor later.

Already on my iPhone I have a medical calculator (about 100 equations) and infectious disease book that I use several times a week.

Katie Matlack at Software Advice, an online resource, has a software wishlist for Apple iPads and iPhones.

If you’re interested in these apps, leave a comment at Katie’s blog.

Steve Parker, M.D.

I  recently read The Smarter Science of Slim, by Jonathan Bailor and published in 2012.   Per Amazon.com’s rating system, I give it four stars (”I like it”).

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Mr. Bailor’s weight-management diet avoids grains, most dairy, oils, refined starches, added sugars, starchy veggies, corn, white potatoes.  You eat meat, chicken, eggs, some fruit, nuts, seeds, and copious low-starch vegetables.  No limit on food if you eat the right items.   

It’s high-fiber, high-protein, moderate-fat, moderate-carb (1/3 of calories from carbohydrate,  1/3 from protein, 1/3 from fat).  He considers it Paleo (Stone Age) eating even though he allows moderate legumes and dairy (fat-free or low-fat cottage cheese and plain Greek yogurt).

Will it lead to weight lose? Quite probably in a majority of followers, especially those eating the standard, low-quality American diet.  When it works, it’s because you’ve cut out the fattening carbohydrates so ubiquitous in Western societies.  The protein and fiber will help with satiety.  Is it a safe eating plan?  Yes.

(For those with diabetes needing to lose weight, I prefer a lower carbohydrate content in the diet, something like Conquer Diabetes and Prediabetes: The Low-Carb Mediterranean Diet.  For non-diabetics, is Smarter Science better than my Advanced Mediterranean Diet 2nd Edition?  Of course not, silly!)

I don’t recall any recipes or specific meal plans.  You put your own meals together following his guidelines.

Our major points of agreement:
 - Exercise isn’t terribly helpful as a weight-loss technique for most folks.
 - We’re overweight because we eat too many starches and sweets.
 - Natural, minimally processed foods are healthier than man-made highly refined items.
 - No need to emphasize “organic” /grass-fed beef/free-range chicken.
 - We don’t do enough high-quality exercise.

I have a few problems with the book:
  - It says we’re eating less.  U.S. caloric consumption over the last several decades has increased by about 150 cals (630 kJ) a day for men and 300 cals (1260 kJ) for women.  The author seems to contradict himself at one point by favorably quoting Hilda Bruch’s writing that “…overeating is observed with great regularity” in the obese. 
  - Scary graphs showing increasing instances of heart disease and diabetes over time aren’t helpful because they ignore population growth.  The population-adjusted diabetes rate is indeed increasing whereas heart disease rates are decreasing.
  - It says the Calories In/Calories Out theory of overweight has been proven wrong.  This is by no means true.  It just hasn’t helped us much to reverse the overweight epidemic.  Sure, it’s often said that if you just cut a daily tablespoon of butter out of your diet, you’d lose 11 lb (5 kg) in a year, all other things being equal.  Problem is, all other things are never equal.  In reality, we replace the butter with something else, or we’re slightly less active.  So weight doesn’t change or we gain a little.
  - It says the “eat less, exercise more” mantra has been proven wrong as a weight loss method.  Not really.  See above.  And watch an episode of TV’s “The Biggest Loser.”  Exercise can burn off fat tissue.  The problem is that we tend to overeat within the next 12 hours, replacing the fat we just burned. I agree with the author that “eat less, exercise more” is extremely hard to do, which is the reason it so often fails over the long run.  As Mr. Bailor writes elsewhere: “Hard to do” plus “do not want to do” generally equals “it’s not happening.”  Mr. Bailor would say the reason it ultimately fails is because of a metabolic clog or dysregulation. 
  - He says there’s no relationship between energy (calorie) consumption and overweight.  Not true.  Need references?  Google these: PMID 15516193, PMID 17878287, PMID 14762332.  The author puts too much faith in self-reports of food intake, which are notoriously inaccurate.  And obese folks under-report consumption more than others (this is not to say they’re lying). 
  - Mr. Bailor’s assessments too often rely on rat and mice studies.
  - By page 59, I had found five text sentences that didn’t match up well with the numeric bibiographic references (e.g., pages 48, 50, 59).
  - S. Boyd Eaton is thrice referred to as S. Boyd.
  - How did he miss the research on high intensity interval training by Tabata and colleagues in 1996?  Gibala is mentioned often but he wasn’t the pioneer.
  - Several diagrams throughout the book didn’t print well (not the author’s fault, of course).
  - In several spots, the author implies that HIS specific eating and exercise program has been tested in research settings.  It hasn’t.

Mr. Bailor’s exercise prescription is the most exciting part of the book for me.  His review of the literature indicates you can gain the weight-management and health benefits of exercise with just 10 or 20 minutes a week.  NOT the hour a day recommended by so many public heath authorities.  And he tells you how to do the exercises without a gym membership or expensive equipment.  That 20 minutes is exhausting and not fun.  You have fun in all the hours you saved.  If this pans out, we’re on the cusp of a fitness revolution.  Gym owners won’t be happy.  Sounds too good to be true, doesn’t it?

One component of the exercise program is high intensity interval training (HIIT), which I’m recently convinced is better than hours per week of low-intensity “cardio” like jogging. Better in terms of both fitness and weight management.

The resistance training part of the program focuses on low repetitions with high resistance, especially eccentric slow muscle contraction.  This is probably similar to programs recommended by Doug McGuff. John Little, Chris Highcock, and Skyler Tanner.  I’m no authority on this but I’m trying to learn.  By this point in the book, I was tired of looking up his cited references (76 pages!).  I just don’t know if this resistance training style is the way to go or not.  I’ll probably have to just try it on myself. 

I admire Mr. Bailor’s effort to digest and condense decades of nutrition and exercise research.  He succeeds to a large degree.

Steve Parker, M.D.
 

God, help us figure this out

A few months ago, several of the bloggers/writers I follow were involved in an online debate about two competing theories that attempt to explain the current epidemic of overweight and obesity.  The theories:

1. Carboydrate/Insulin (as argued by Gary Taubes)
2. Food Reward (as argued by Stephan Guyenet)

The whole dustup was about as interesting to me as debating how may angels can dance on the head of pin. 

Regular readers here know I’m an advocate of the Carboydrate/Insulin theory.  I cite it in Conquer Diabetes and Prediabetes: The Low-Carb Mediterranean Diet and The Advanced Mediterranean Diet: Lose Weight, Feel Better, Live Longer (2nd edition).  But the Food Reward theory also has validity.  They’re both right, to an extent.  They’re not mutually exclusive.  The Food Reward theory isn’t as well publiziced as Carbohydrate/Insulin.

Dr. Guyenet lays out a masterful defense of the Food Reward theory at his blog.  Mr. Taubes presents his side here, here, here, here, and here.  If you have a couple hours to wade through this, I guess I’d start with Taubes’ posts in the order I list them.  Finish with Guyenet. 

You’d think I’d be more interested in this.  I’m still not.

Moving from theory to real world practicality, I do see that limiting consumption of concentrated refined sugars and starches helps with loss of excess body fat and prevention of weight regain.  Not for everbody, but many.  Whether that’s mediated through lower insulin action or through lower food reward, I don’t care so much. 

Steve Parker, M.D.

h/t Dr. Emily Deans

I just read ”Low-Carbing Among Friends, Volume 1″ by Jennifer Eloff, Maria Emmerich, Carolyn Ketchum, Lisa Marshall, and Kent Altena.

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If you’re serious about low-carb eating, you’ll want this book.  Five well-known low-carb cooks and chefs present many of their best recipes in a straightforward format.  All 300+ recipes are gluten-free, wheat-free, and sugar-free.  I read through over half of the recipes and understood all the instructions; I’m confident I could make anything in this book.

Some of of the recipe ingredients will be a little hard to find. You may have to order a few of them online, and the authors tell you where to order. Unless you’re just dabbling in low-carb eating, you’ll want to stock up on some of these anyway. 

I have an incurable sweet tooth.  I like to share my cooking with my wife, but she has, um, (ahem)… ”gastrointestinal problems” with my usual non-caloric sweetener, Splenda.  That’s not very common, but is a well-known phenomenon.  I was glad to learn herein that erythritol is a trouble-free alternative, GI-wise.

One thing I miss about standard high-carb eating is baked sugary items like cakes and muffins.  Sure, I’ve read that if you stay away from those for four to six months, you’ll lose your desire.  Not me.  And I tried.  In my next stretch of days off, I’m making a batch of Jennifer Eloff’s Splendid Gluten-Free Bake Mix and spending some time in the kitchen!

Not being previously familiar with him, I was particularly impressed with Kent Altena’s background.  Starting at over 400 pounds (182+ kg), he lost over 200 pounds (91+ kg) and reenlisted in the U.S. National Guard and started running marathons (26.2 miles)!  Thank you for your service to our country, Mr. Altena.

The book is laced with commentary from low-carb proponents, including Dana Carpender, Jimmy Moore, Dr. John Briffa, Dr. Andreas Eenfeldt, Dr. Robert Su, and me.  I am honored to have been invited.

By the way, recipe measurements are given in both U.S. customary and metric units, which non-U.S. residents will appreciate.  Serving size nutrient analysis includes digestible carb grams (aka net carbs).  All recipe carb counts are under 10 g; most are under 5 g.  All of these would jibe with my KMD: Ketogenic Mediterranean Diet.  

If you’re tired of eating the same old things, I’m sure you’ll find many new dishes here that will become time-honored classics in your household.

Steve Parker, M.D.

Disclosure: As a supporter of low-carb eating, I contributed two pages to the book.  I did not and will not recieve any remuneration, and I purchased my own copy of the book.

PS: Recipes I want to try: Cinnamon Swirl Cookies, Green Bean and Bacon Salasd, Gingerbread Biscotti, Tuan Burgers, Blueberry Muffins, Pecan Sun-Dried Tomato and Bacon Cauli-Rice, Spicy Shrimp with Avocado Dressing, 24-Hour Chili, Harvest Pancakes, Breakfast Casserole, Bacon Wrapped Jalapeno Poppers, Stuffed Mushrooms, Broccoli Bacon Salad, Seven Layer Salad, Sausage Quiche, Low-Carb Pancakes, Stuffed Hamburgers, Eggplant Parmeson, Flax Bread, Splendid Gluten-Free Bake Mix, and Mock Danish.

Rapper Fat Joe is in a YouTube video talking about his 100-lb (45 kg) weight loss by eating low-carb.  He’s not doctor, but he knows a lot about preventing diabetes and heart disease.  He’s livin’ it.

Steve Parker, M.D.

h/t Tom Naughton

I saw the author of Choose to Lose on a rerun of Dr. Oz yesterday.  Then I checked the book’s sales rank at Amazon.com (22nd overall—a blockbuster in my view).  (Don’t get me wrong; I’m not in the habit of watching Dr. Oz.)  Here’s my review of 2012’s Choose to Lose: The 7-Day Carb Cycle Solution, by Chris Powell.  I give it three stars per Amazon.com’s five-star system.

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Will it work?  Certainly for some, quite possibly a majority.  Like most published programs, it’ll work for for you if you work the program.  Question is, can you do it?

The underlying idea is to alternate high-carb and low-carb eating days, which supposedly revs up your metabolism and tricks your body into thinking it’s not on a diet so it won’t go into self-preservation starvation mode.  Mr. Powell calls this carb cycling.

The high-carb days are also low-fat, and the low-carb days are low-calorie.  Actually, both days are reduced-calorie if your goal is the most dramatic results.  A moderate calorie deficit is built into the program.  Women get about 1350 calories; men around 1700.  Those levels are lower than necessary. Other than that, it appears you’ll get all the other nutrients you need, which is good.

I can see how the diet would work for some because it drastically reduces consumption of our most fattening carboydrates.  Loser Choosers aren’t supposed to eat baked goods, white flour, refined sugar, beer, candy, chips (crisps, for those in the UK), conventional breads, cookies, crackers, ice cream, sugar-sweetened beverages, corn syrup, and milk.  I suspect if we all stopped eating those right now, the overweight rate in the U.S. would drop by at least 10% in the next 12 months.

The author allows no wheat or white rice except for whole wheat bread and pasta.  Potatoes, peas, and corn made it to the “approved” list.  You eat mostly natural, minimally processed foods (yay!).

I don’t know Mr. Powell, but he comes off as earnest, honest, compassionate, experienced, and intelligent.  He’s not a scammer.  Mr. Powell has more faith than I do in the benefits of exercise for weight loss.  He notes that nutrition is more important.  We agree that exercise is often critical for prevention of weight regain.  He barely, if at all, mentions the benefits of exercise in prevention of disease and prolongation of longevity.  His well-illustrated exercise recommendations are  a good start for fitness beginners.  He wants you to exercise for 10-30 minutes on six days a week, doing a combo of cardio intervals and body weight resistance training.  No expensive equipment to buy.

Carb cycling like this is supposed to “boost your metabolism to burn fat quickly.”  It does not, to any clinically meaningful extent.  Nor is carb cycling mentioned in this year’s massively referenced The Smart Science of Slim.  Contrary to the author’s opinion, neither eating five meals a day nor eating carboydrates revs up your metabolism.

Mr. Powell provides some helpful mind tricks to prepare you for a lifestyle change.

My favorite sentence: “Success doesn’t just happen.  It’s a result of the 4 Ps of action: Planning, Preparation, Performance, Persevance.”

My least favorite sentence: “Water is imperative for loosing [sic] weight.”  A close second was: “Alcohol is a powerful diuretic (it flushes water out of your system), so it dehydrates you, causing water retention and bloating for one to three days after you drink.”  Huh?

I like his incorporation of cheat meals, although he allows more than I would.  To his credit, the all-important maintenance phase is covered well.

Mr. Powell recommends supplementing with probiotics and digestive enzymes, being unaware of their uselessness for most dieters.

I note that Amazon sells Choose to Lose by Dr. Ron and Nancy Goor, and The Carb Cycling Diet by Dr. Roman Malkov.  Coincidence ? 

In terms of complexity, the program is about average. 

I wonder if you’d do just as well by swearing off the fattening carbohydrates I listed above.  If you’re looking to lose weight, you could do a lot worse than Choose to Lose.  And you could do better.

Steve Parker, M.D.

Contrary to my plans, I didn’t work out at all over the last week.  I’ve been working on some projects I’ll reveal in the near future.

Any eating transgressions?  Sure: about 10 pieces of left-over Christmas chocolates and a six-inch Subway sandwich.

I’ve had almost no wheat over the last five weeks.  Anyone with gluten intolerance or sensitivity or allergy would expect to have seen some improvement in his health.  I didn’t.  I’m blessed with good health to start with.

Current Weight: 170.5 lb (77.5 kg)

Starting Weight five weeks ago: 173 lb (78.6 kg)

Waist Circumferenc: pending

I’m not dropping anymore weight.  Two and a half pounds down ain’t too shabby for simply cutting way back on sugar and wheat.  I may have subconsciously restricted overall calories, too. 

Not sure what I’ll do to fit back into those suit pants.  Lots of options.  May start exercising more consistently.  I’m now a Personal Fitness merit badge counselor for my son’s Boy Scout troop, so I have to set a good example.

Exercise is good for me anyway.

Steve Parker, M.D.

U.S. obesity rate over last 40 years

Beth Mazur over at Weight Maven has posted a lecture by Dr. Stephan Guyenet in which he outlines the changes in American diet over the last 100 years.  It’s only 16 minutes long.  You may  find an explanation for our excess weight problem. 

Steve Parker, M.D.