Advanced Mediterranean Diet

The headline above accompanied a May 14, 2008, article in my local paper, The East Valley Tribune.  It’s an Associated Press article by Linda A. Johnson.

Data were collected by Medco Health Soultions Inc., a pharmacy benefits manager.  The numbers reveal that 51% of Americans with health insurance are taking one or more prescriptions for a chronic medical condition.  Such drugs are usually taken daily.  Sadly, drug users include one in four children and teenagers.  In the 65 or older category, three out of four are users; and 25% of seniors take five or more drugs regularly.

Popular drugs include those used to lower high blood pressure and cholesterol - problems linked to obesity, diabetes, and heart disease.

Dr. Daniel Jones, president of the American Heart Association, said, “Unless we do things to change the way we’re managing health in this country…things will get worse instead of getting better.”  I’m sure Dr. Jones has specific helpful ideas, but none were mentioned by the article author.

Dr. Robert Epstein, chief medical officer at Medco, said, “Honestly, a lot of it is related to obesity.”  “We’ve become a couch potato culture [and] it’s a lot easier to pop a pill” than to exercise regularly or diet.

Many common illnesses are caused or aggravated by overweight and lack of regular physical activity.  Examples include type 2 diabetes, high blood pressure, high cholesterol, heart attacks, strokes, knee arthritis, several cancers, dementia, asthma, gastroesophageal reflux disease, and obstructive sleep apnea.

People are increasingly concerned about the escalating cost of healthcare and health insurance.  As the U.S. presidential election heats up, we will be hearing more from the candidates about their prescriptions for controlling healthcare costs.  Hillary Clinton may even propose a government take-over of the healthcare industy.

If we have free will - and I think we do - we can reduce the expenses of the aforementioned conditions by losing our excess weight and exercising regularly.  No politicians are needed for that, and we can start today.  If successful, we will spend less on drugs and other medical care while reducing suffering and prolonging life.

Sedentary lifestlyes and overweight are the elephants in the room that no politician will mention.  That would require a politically incorrect call for personal responsibility, which doesn’t win votes.

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

I was honored May 10, 2008, by the Arizona Book Publishers Association.  My Advanced Mediterranean Diet received a Glyph Award for best book on health/wellness/nutrition.

Writing is a solitary avocation.  Having poured my heart and soul into the book over the last few years, I thought it was a good and worthwhile book.  It’s great to have the validation of impartial judges.  Thank you, ABPA!

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

While physical activity alone seldom results in significant and sustained weight loss, maintaining weight loss without physical activity is nearly impossible.

The quote above is from James Early, M.D., Clinical Associate Professor, Department of Preventive Medicine and Public Health, University of Kansas School of Medicine-Wichita (Wichita, Kansas), as printed in Clinical Cornerstone, 2007, volume 8, No. 3, page 69.

It’s a simple truth, one that bears repeating, as the truth too often is submerged in a roiling sea of misinformation and trivia.

Exercise is extremely important for the vast majority of people who want to lose weight and keep it off, but it’s encouraging to know that it is possible to be successful if you don’t want to or can’t exercise.

This second quote is from the first edition of Thin For Life: 10 Keys to Success From People Who Have Lost Weight and Kept It Off, by Anne Fletcher, page 20.  Out of the 160 “weight-control masters” studied by Anne, 70% exercised three or more times per week.  Nine percent told her they didn’t exercise at all.

But what kind of exercise helps with weight management?  The most important criterion is that it be pleasant for you.  If not outright fun, it should be often enjoyable and always tolerable.  Your exercise of choice should also be available year-round, affordable, safe, and utilize large muscle groups.  The greater mass and number of muscles used, the more calories you will burn.  Compare tennis playing with sitting in a chair squeezing a tennis ball repetitively.  The tennis player burns calories much faster. Your largest muscles are in your legs, so consider walking, biking, many team sports, ski machines, jogging, treadmill, swimming, water aerobics, stationary cycling, stair-steppers, tennis, volleyball, roller-skating, rowing, jumping rope, yardwork, housework, etc.  What?  You don’t find housework pleasant?  At least try it once with upbeat music blaring in the background.  Walking is “just what the doctor ordered” for many people.  It is readily available, affordable, usually safe, and requires little instruction.  If it’s too hot, too cold, or rainy outside, you can do it in a mall, gymnasium, or health club.

Another option is instructional exercise DVDs and videotapes, featuring either a celebrity or prominent fitness trainer.  Early leaders in this field 20–30 years ago included Richard Simmons, Jane Fonda, and Cindy Crawford.  Many of these programs require only a pair of sneakers and loose clothing.  Others include the option of using inexpensive equipment, such as light hand-held weights.  If exercise videos sound appealing, you can’t go wrong with one of these: Supersweatin’ Party Off the Pounds, by Richard Simmons; Walk Away the Pounds—Walk Strong, by Leslie Sansone; Tighter Assets With Tamilee: Weight Loss & Cardio, by Tamilee Webb; Burn & Firm—Circuit Training, by Karen Voight; Minna Optimizer—Balanced Blend, by Minna Lessig; Personal Training System, by Denise Austin; Timesaver—Lift Weights to Lose Weight (volumes 1 & 2), Super Slimdown Circuit, and Functionally Fit—Peak Fat Burning, by Kathy Smith.  Search for these titles at Amazon.com, where you can read reviews of them by actual users.

Another fun option for high-tech indoor exercise is Dance Dance Revolution by Konami.  Perhaps you have seen a version of this video game in an arcade.  You must use a video game console, such as a PlayStation or Xbox, and the Dance Dance Revolution Controller along with your TV screen.  The controller is a 32 inch by 36 inch floor pad partitioned into several large squares.  The TV screen shows you which squares to step on in sequence as the music plays, and you rack up points for accurate timing and foot placement.  Each supplied tune can be danced at numerous skill levels, from easy to expert. Trust me; it’s more fun than I can describe.  If you enjoy moving to music, time flies as you focus concentration on the TV display.  Some versions of the game have a workout mode that tracks your calories burned.  If you already have a video game console, you pay about $150 for the controller and game disc.  As always, check for compatibility of all components before purchasing.

For additional help with your exercise program, check out Physical Activity for Everyone and Shape Up America!

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

At the beginning of my 24-year medical career, egg consumption was condemned as a cause of heart attacks.  Heart attacks can kill.  How did eggs kill?  It was thought to be related to the cholesterol content - 200 mg per egg - leading to higher serum cholesterol levels, which clogged arteries (atherosclerosis), leading to heart attacks.

Ten years ago the pendulum began to swing the other direction: Egg consumption didn’t seem to matter much, if at all.

The evidence is usually collected in observational, epidemiologic studies of large groups of people.  The groups are analyzed in terms of overall health, food intake (e.g., how many eggs per week), healthy lifestyle factors, etc.  Egg consumption of the group is broken down, for example, into those who never eat eggs, eat 1-4  eggs per week, eat 5-10 per week, or over 10 eggs weekly.  A group is followed and re-analyzed over 10-20 years and rates various diseases and causes of death are recorded.  Researchers don’t follow just 25 people like this over time.  You need thousands of participants to find statistically significant differences.

The debate about eggs was re-opened (although never really closed) by the publication in April, 2008, of an article in The American Journal of Clinical Nutrition.  Scientists of the Physicians’ Health Study suggest that consumption of seven or more eggs weekly is associated with significantly increased risk, over 20 years, of all-cause mortality.  Interestingly, this level of consumption did not cause heart attacks or strokes.  Study participants, by the way, were 21,327 Harvard-educated male physicians.  5,169 deaths occurred during 20 years of follow-up.  If you’re not a Harvard-educated male physician, the study results may not apply to you.

When physicians with diabetes  - type 2’s mostly, I assume -  were analyzed separately, consumption of even less than seven eggs per week was associated with higher all-cause mortality.

Several other observational studies looking at this same issue have found no association between egg consumption and cardiovascular disease, heart attacks, and all-cause mortality.

Bottom line?  If you worry about egg consumption, limit to 7 or less per week.  If you have type 2 diabetes, limit to 4 or less per week.

Remember, all the cholesterol is in the yolk.  Try making an omelet using the whites only.  But in our lifetimes you will never see an observational study looking at egg white consumption and mortality rates.

I’m still not convinced egg consumption is worth losing sleep over.  “More studies are needed…”

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

References:

Djousse, L. and Gaziano, J. M.  Egg consumption in relation to cardiovascular disease and mortality: the Physicians’ Health Study.  American Journal of Clinical Nutrition, 87 (2008): 964-969.

Dawber, T.R, et al.  Eggs, serum cholesterol, and coronary heart disease.  American Journal of Clinical Nutrition, 36 (1982): 617-625.

Nakamura, Y., et al.  Egg consumption, serum cholestrol, and cause-specific and all-cause mortality: the National Integrated Project for Prospective Observation of Non-communicable Disease and Its Trends in the Aged, 1980.  American Journal of Clinical Nutrition, 80 (2004): 58-63.