Advanced Mediterranean Diet

A recent study suggests a protective effect of the Mediterranean diet for cutaneous melanoma.  This is the first study to examine melanoma’s association with the Mediterranean diet.

Melanoma is the seventh most common cancer in Americans, and the most common fatal malignancy among young adults.  Lifetime risk of developing melanoma is one in 71.  Incidence of melanoma in the white U.S. population has more than tripled in the last 20 years.  In 2008 in the U.S., 62,000 new cases of melanoma are expected.

The researchers in Rome, Italy, used a hospital-based case-control method including 304 cases of melanoma and 305 matched controls who did not have melanoma.  Information on sun exposure, skin pigmentation, smoking, medical history, and socio-demographic characteristics was collected.

The researchers report:

After careful control for several sun exposure and pigmentary characteristics, we found a protective effect for weekly consumption of fish, shellfish, fish rich in omega-3 fatty acids, daily tea drinking and high consumption of vegetables in particular carrots, cruciferous and leafy vegetables and fruits, in particular citrus fruits.

[For the sake of clarity, I have omitted odds ratios and confidence intervals.  Odds ratios for many of these associations were around 0.50, meaning half the risk of developing melanoma.]

Conclusion overall:  Our findings suggest that some dietary factors present in the Mediterranean diet might protect from cutaneous melanoma.

Prior studies have demonstrated lower incidence of breast, colon, prostate, and uterus cancer in people who adhere to the traditional Mediterranean diet.  Note also that death rates from cancer are lower.  We can probably add melanoma to the list of cancers prevented with a Mediterranean-style diet, although I would have more confidence if the current study had included more participants.

Steve Parker, M.D.

Reference:  Fortes, C., et al.  A protective effect of the Mediterraenan diet for cutaneous melanoma.  International Journal of Epidmiology, 37 (2008): 1,018-1,029.

The European Medicines Agency today suspended prescription-writing for the weight-loss drug rimonabant, sold in Europe since 2006 as Acomplia.

Why?  Too many psychiatric side effects.

About a year ago, the Food and Drug Administration rejected the manufacturer’s request to sell it in the U.S., citing psychiatric concerns.

Consider caloric restriction and physical activity as an alternative.  Not as easy as popping a pill, but effective nevertheless, with psychiatric benefits.

Steve Parker, M.D.

In January this year, I blogged about twice-convicted felon Kevin Trudeau, the author of Weight Loss Cures “They” Don’t Want You To Know About.  In November, 2007, Trudeau was found in contempt of court for violating a 2004 injunction that forbid him from making false claims in infomercials.  The Court found that Trudeau had made false claims in his infomercial for the aforementioned book.

Almost a year later, the  (U.S.) Federal Trade Commission on October 6, 2008, announced Judge Robert Gittleman’s sanctions:

In his August [2008] ruling, the court banned Trudeau “or any person acting in concert with him, from participating in the production or publication of any informercial for any product, including books, in which Mr. Trudeau or any related entity has an interest, for a period of three years from the date of this order.”  The court oalso imposed a judgment against Trudeau of more than $5 million dollars [sic]

Then why am I still seeing his infomercials for another of his books, Debt Cures “They” Don’t Want You To Know About?

Trudeau’s hardcover weight-loss book continues to sell well at Amazon.com.  The Amazon website notes that the mass market paperback version will be available in December, 2008.

From the FTC’s news release:

The judge stated that “the Infomercial[s] falsely and intentionally led thousands (probably hundreds of thousands) of consumers to believe that the Weight Loss Book would describe an ‘easy,’  ’simple’ protocol that, once ‘finished’ would allow the consumer to ‘eat anything’ he or she wants.”

Caveat emptor, indeed, baby.

Steve Parker, M.D.

Additional Resources:

Weighing the Evidence in Diet Ads, from the Federal Trade Commission

Ridiculous Infomercial Reviews.  You’ll laugh out loud at these reviews of Kevin Trudeau, Extenze, ShamWow, Dual Action Cleanse, and your other favorites.

Among people over 65, consumption of tuna/other fish is associated with preserved blood flow to the brain, according to a recent research report in the journal Neurology.

“Silent” brain infarcts - tiny strokes that are not obvious - are very common with advancing age.  If a group of people 65 and older is MRI scanned and found to have no strokes, MRI scans performed five years later will show tiny strokes in 20% of them.  Almost 90% of these new strokes are simply incidental findings without clinically evident stroke or transient ischemic attack.

As the authors point out:

Subclinical infarcts and white matter abnormalities are considered to be of vascular origin, presumably resulting from occlusion of small arteries in the brain and subsequent ischemia.

These subclinical strokes, along with brain white matter abnormalities, are not benign.  They are associated eventually with impairment in thinking and behavior, and with higher risk of future obvious stroke.

Eating tuna or other broiled or baked fish tends to raise plasma omega-3 fatty acid levels and is associated with lower stroke risk and dementia and Alzheimer disease.  Researchers wondered if fish consumption affected the risk of subclinical brain infarcts or other subclinical brain abnormalities.

Methodology

Scientists studied 3,660 participants over 65 years old in the Cardiovascular Health Study, by MRI scanning, lab testing, physical exam, and food frequency questionnaire.  Five years later, 2,313 were rescanned.   Hospital and clinic records were reviewed.  Participants were men and women in four U.S. communities.  Fish intake was classified as to whether tuna, other broiled or baked fish, and fried fish or fish sandwiches (fish burgers).  In a subset of participants, blood levels of omega-3 fatty acids were measured.

Conclusions of the Scientists

Among older adults, modest consumption of tuna/other fish, but not fried fish, was associated with lower prevalence of subclinical infarcts and white matter abnormalities on MRI examinations.  Our results add to prior evidence that suggest that dietary intake of fish with higher eicosapentaenoic acid [EPA] and docosahexaenoic acid [DHA] content, and not fried fish intake, may have clinically important health benefits.

…the results of the present article support the growing evidence that the type of fish meal consumed is important for obtaining the health benefits of fish consumption.

Discussion

The fish with higher omega-3 fatty acids, such as EPA and DHA, are the cold-water fatty fish such as   albacore tuna, salmon, trout, sardines, anchovies, herring, halibut, sea bass, swordfish, and mackerel.  These are sometimes referred to as dark meat fish or oily fish.  These are the same types of fish most closely associated with lower rates of coronary artery disease and sudden cardiac death.

The types of fish used in fish sticks, fish burgers, and other fried fish meals are typically low in omega-3 fatty acids.

If you choose to eat fish for the health benefits, aim for two servings per week of cold-water fatty fish.  The Friday night all-U-can-eat fried catfish buffet doesn’t cut it.

Steve Parker, M.D.

Reference:  Virtanen, J.K., et al.  Fish consumption and risk of subclinical brain abnormalities on MRI in older [U.S.] adults.  Neurology, 71 (2008): 439-446.

The American Council on Science and Health recently published a skeptical article on organic food benefits.

I’m neither endorsing nor repudiating their positions, but they are certainly worth serious consideration.

With the looming global financial “crisis,” the organic food industry is in for a rough time since “organic” food is significantly more expensive than regular food.

Caveat emptor, baby.

Steve Parker, M.D.

I’m a crusader for the Mediterranean diet.

It saddens me to see patients with medical conditions and illnesses that I know could have been largely prevented by regular physical activity and eating the right foods.  If the horse is already out of the barn, many medical conditions can be treated, and sometimes cured, by the right combination of diet and exercise.  That’s why I wrote The Advanced Mediterranean Diet: Lose Weight, Feel Better, Live Longer, published by Vanguard Press in 2008.

If not available at your local bookstore, you can now browse a considerable portion of the book at Google Book Search.  For the search term, use “Advanced Mediterranean” or “Steve Parker, M.D.”

Kudos to Google for providing this free service.  We now have a library or bookstore literally at our fingertips.

Steve Parker, M.D.

The U.S. Department of Health and Human Services yesterday released its 2008 Physical Activity Guidelines for Americans, touted as the first-ever such guidelines published by the federal government.

For substantial health benefits, HHS recommends that adults:

• do aerobic and strength training for at least 10 minutes at a time, at least three days a week.
• at least two days a week, do muscle strengthening exercises with all major muscle groups, working each muscle group 8-12 times per session.
• exercise at least 2.5 hours a week at a moderate intensity level. What’s”moderate”?  While exercising, you can talk but not sing.  Examples are brisk walking, hiking, bicycle riding, general gardening.  Or…
• exercise at least 75 minutes a week at vigorous intensity. “Vigorous” means you can say only a few words without stopping to catch your breath.  Examples are jumping rope, jogging or running, soccer, basketball, swimming laps, or hiking uphill or with a heavy backpack.

Visit the aforementioned Physical Activities website for details and recommendations on implementation.

If you have lost a significant amount of excess fat weight, you may have to do substantially more exercise than recommended above to keep the weight off.  Women, for example, should aim for 55 minutes a day on five days per week.  Don’t shoot me; I’m only the messenger.

Steve Parker, M.D.

Lancet Oncology this week published a report associating worse prostate cancer outcomes - death, that is - with overweight, obesity, and hyperinsulinemia.

Researchers looked at data from the respected Physicians’ Health Study, finding 2,546 men who developed prostate cancer during many years of observation.  Of these men, 38.8% were overweight (body mass index 25-30) and 3.4% were obese (BMI over 30).

[For definitions of overweight and obesity, and to calculate your body mass index, click here.]

Compared with normal-weight men (BMI under 25) who developed prostate cancer, overweight men with prostate cancer were one-and-a-half times more likely to die from the cancer.  Obese men with prostate cancer were two-and-a-half times more likely to die.

A blood test called C-peptide is a marker of insulin resistance and hyperinsulinemia.  Obesity is often accompanied by high insulin levels and insulin resistance.  Overweight, not so much.  Eight hundred twenty-seven of the men with prostate cancer had C-peptide levels drawn at baseline, before diagnosed with cancer.  Men with the highest C-peptide levels were almost two-and-a-half times more likely to die of prostate cancer than men with the lowest C-peptide levels.

Study participants having both excess body weight and high C-peptide levels had the worst outcome.

Prostate cancer is the most common invasive cancer in U.S. men, with about 185,000 cases diagnosed every year.  It is one of the cancers that is apparently prevented by following the traditional Mediterranean diet for years.  The other prevented cancers are breast, uterus, and colorectal.  Obesity predisposes men to cancer of the prostate, colon, rectum, kidney, and esophagus.

The study at hand suggests that if you are overweight or obese and then develop prostate cancer, you have a greater risk of dying from the cancer compared with healthy-weight men.  Given that prostate cancer is so common, why not cut your risk of getting it and dying from it by controlling your weight with a Mediterranean-style diet?

Steve Parker, M.D., author of The Advanced Mediterranean Diet 

Reference:  Ma, Jing, et al.  Prediagnostic body mass index, plasma C-peptide concentration, and prostate cancer-specific mortality in men with prostate cancer: a long-term survival analysis.  Lancet Oncology, online publication October 6, 2008.  DOI: 10.1016/S1470-2045(08)70235-3

The New York Times on September 23, 2008, ran an article on the decline of the traditional Mediterranean diet in the Mediterranean region, focusing on Crete.  Children there have become alarmingly overweight and are showing the consequences: diabetes, high cholesterol, fatty liver, etc.  Greek physicians are predicting this overweight generation will have shorter life spans and poorer health than their parents.

The United Nations recently released a report documenting that Greeks are the fattest European nation, with 75% of adults overweight or obese.

Why are the Cretan children gaining weight?  Experts cited in the article implicate the replacement of the traditional Mediterranean diet with convenience and fast foods long available to us in the U.S.: over-processed, refined foods like candy, ice cream, refined flour, American-style pizza, hamburgers, cheese macaroni, etc.  Lower physical activity levels also play a role.  Other Mediterranean countries are seeing the same cultural shift.

Steve Parker, M.D.

Additional resources:  Do-It-Yourself Mediterranean Weight-Loss Program