Advanced Mediterranean Diet

Gastric bypass is the most common bariatric surgery in the U.S.  The odds of dying from that procedure are roughly 1 in 200.  Thousands of people sign on the dotted line for it every year.  Why do they take that risk?

A recent study out of Sweden shows that people who undergo various bariatric surgeries reduce their risk of death over the next 11 years by 25%.

In the Swedesh Obese Subjects Study, 2010 subjects underwent bariatric surgery and 2037 received conventional treatment.  Overall mortality was recorded over the next 11 years.  Only three of the subjects were lost to follow-up (unknown whether alive or not).  The average body mass index (BMI) for all subjects was 41.

Out of the conventional treatment group, 126 died.  In the surgery group, only 101 died.  Average weight change in the conventional treatment group was up or down only 2%.  People in the surgery group were given one of three operations: gastric bypass, vertical-banded gastroplasty, or banding.  After 10 years, average weight loss of the groups was 25%, 16%, and 14%, respectively.

Over the course of 11 years, people in the surgery group had 25% less chance of dying when compared to the conventional treatment group.  The most common causes of death were heart attacks and cancer.

Even better results were found back in the U.S.  Researchers in Utah looked at mortality rates of 7925 patients who had undergone gastric bypass surgery between 1984 and 2002.  They compared death rates to a control group (also 7925 people) of obese people who applied for driver’s licenses.  Subjects were matched for sex, body mass index, and age.  Average BMI of the surgical group was 45.

Over the course of seven years, there were 321 deaths in the control group and 213 in the surgery group.  Deaths from any cause were reduced by 40% in the surgery group, compare to the control group.  Surgery patients had less death from cardiovascular disease, diabetes, and cancer.

Surgery is definitely a roll of the dice.  Now you know why people play the game.

Steve Parker, M.D., author of The Advanced Mediterranean Diet: Lose Weight, Feel Better, Live Longer   www.AdvancedMediterraneanDiet.com

References:

Sjostrom, Lars, et al.  Effects of Bariatric Surgery on Mortality in Swedish Obese Subjects.  New England Journal of Medicine, 357 (2007):  741-752.

Adams, Ted, et al.  Long-Term Mortality after Gastric Bypass Surgery.  New England Journal of Medicine, 357 (2007): 753-761. 

Obesity is a well-known cause of adverse health effects, even premature death.  Much less is known about the effect of obesity on income.  I found only one evidence-based study on the issue.  The journal article is dry and difficult reading unless you are an economist.

Obesity is defined as a body mass index over 30.  For a person 5-feet, 4-inches tall, a BMI of 30 translates to 174 pounds.  For a person 5-feet, 10-inches tall, a BMI of 30 is 208 pounds.

Baum and Ford at Middle Tennessee State University analyzed data in the National Longitudinal Study of Youth (12,686 survey respondents).  They found that “both men and women experience a persistent obesity wage penalty over the first two decades of their careers.”  The degree of this penalty is in the range of 0.7 to 6.3%.  In other words, the wages of obese people were lower than other workers, and this effect is more pronounced for women than for men.  As best I can tell, obese women earned about 4% less, and obese men about 2% less on a yearly basis.

Although these percentages are relatively small, I expect the wage differential over the course of a career would be quite impressive due to compounding.  Unfortunately, the authors do not run the numbers for us.  Nor do they have firm explanations as to why obese people earn less.

In 1981, survey respondents had an average weight of 145 pounds.  By 1998, average weight had increased to 175.

If health concerns are not sufficient motivation to keep body mass index under 30, we now have an economic reason.

Steve Parker, M.D., author of The Advanced Mediterranean Diet: Lose Weight, Feel Better, Live Longer    www.AdvancedMediterraneanDiet.com

Reference: Baum, Charles L. and Ford, William F.  The wage effects of obesity: a longitudinal study.  Health Economics, 13 (2004): 885-899.

I was reading Emilia Klapp’s blog today and she sparked my curiosity about the standard advice to drink eight glasses (8-oz each) of water a day.

It turns out there is little, if any, scientific support for the advice.  Note carefully that the “8×8″ skeptics have a particular population in mind: healthy adults living in temperate climates who have sedentary lifestyles.  If you make a living digging ditches with a shovel in the hot sun in a dry climate, you will need much more than eight glasses.

There may be particular people with medical problems who will benefit from higher-than-average water consumption.  Follow your personal physician’s advice.

I noticed immediately when I moved from humid Florida to the dry Arizona desert that I was thirstier and needed to drink more water.  Listen to your body and use common sense.

If you are watching your weight, be sure to avoid liquids with excessive calories.  Zero-calorie water is hard to beat under most circumstances.

Steve Parker, M.D., author of The Advanced Mediterranean Diet: Lose Weight, Feel Better, Live Longer   www.AdvancedMediterraneanDiet.com

References:

Valtin, Heinz.  “Drink at least 8 glasses of water a day.”  Really?  Is there scientific evidence for ’8×8′?”  American Journal of Physiology - Regulatory, Integrative and Comparative Physiology.  283 (2002): 993-1,004 

Snopes.com

The Mediterranean diet was originally found to be a healthy diet by comparing populations who followed the diet with those who didn’t.  The result?  Mediterranean diet followers had less cardiovascular disease, less cancer, and longer life.

Over the last 10 years, researchers have been clarifying exactly how and why this might be the case.  A recent study in Finland is a typical example.

The traditional Mediterranean diet has an abundance of fresh fruit, including berries.  Berries are a rich source of polyphenols and vitamin C, substances with the potential to affect metabolic and disease processes in our bodies.

The Finnish researchers studied 72 middle-aged subjects, having half of them consume moderate amounts of berries, and half consume a placebo product over 8 weeks.  Compared with the placebo group, the berry eaters showed inhibited platelet funtion, a 5% increase in HDL cholesterol (the “good” cholesterol), and a 7-point drop in systolic blood pressure.

What does platelet function have to do with anything?  Platelets are critical components of blood clots.  Blood clots can stop life-threatening bleeding, but also contribute to life-threatening heart attacks and strokes.  Inhibition of platelet function can decrease the occurence of blood clots that cause heart attacks and strokes.  That’s why millions of people take daily aspirin, the best known platelet inhibitor.

Cardiovascular disease is a group of conditions that include high blood pressure, heart attacks, poor circulation, and strokes.  Berry consumption in this small Finnish study resulted in favorable changes in blood pressure, HDL cholesterol, and platelet function.  These changes would tend to reduce the occurence and severity of cardiovascular disease.

So berries don’t just taste good, they’re good for us.  If price is a concern, focus on the berries that are in season or use frozen berries.

Steve Parker, M.D., author of The Advanced Mediterranean Diet: Lose Weight, Feel Better, Live Longer   www.AdvancedMediterraneanDiet.com

Reference: Erlund, I., et al, Favorable effects of berry consumption on platelet function, blood pressure, and HDL cholesterol.  American Journal of Clinical Nutrition, 87 (2007): 323-331.

Claims that “diets don’t work” are based on the assumption that any weight lost is simply gained back quickly.

The Endocrine Society met in Toronto in June of 2007.  Experts presented data on maintenance of weight loss by overweight people.  What percentage of people who lost 10% of their weight kept the weight off for one year?  About 20%.  Not great, but better than many would expect.  That’s a 200-pounder losing down to 180 and staying at 180 pounds for a year.  This degree of weight loss will improve many cases of high blood pressure, knee arthritis, and type 2 diabetes mellitus.

The U.S. Centers for Disease Control and Prevention reports even better data.  Almost 60% of 1,310  people in the National Health and Nutrition Examination Survey who lost 10% of body weight maintained 95% of the loss for one year.

How do they keep the weight off?  Characteristics of “successful losers” include a low-calorie diet (probably 1,6oo-1,800 on average), weighing at least once per week, and burning about 2,600 calories per week in physical activity.  [A 150-pound person expends 1260 calories a week by walking 3-4 mph for 30 minutes daily.]

Many successful losers cycle through weight loss and gain several times before determining which combination of diet and physical activity ultimately works for them.

So, don’t give up!

Steve Parker, M.D, author of The Advanced Mediterranean Diet: Lose Weight, Feel Better, Live Longer   www.AdvancedMediterreaneanDiet.com

References:

McGuire, M.T., et al.  International Journal of Obesity, 23[12] (1999): 1,314-1,319.

Weiss, E.C., et al.  American Journal of Preventive Medicine, 33[1] (2007): 34-40.