Advanced Mediterranean Diet

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.

Ooooh!  I’m sure they’re shaking in their boots.

I ran across a patient in the emergency department a couple months ago who coincidentally happened to be taking over-the-counter HCG oral drops for help with weight loss.  She didn’t ask my opinion of it, so I didn’t give it.

Now the FDA has sent a stern warning letter to seven HCG diet marketers to cease and desist.  I started seeing ads for homeopathic oral HCG at least a year ago.  And the FDA is just now getting around to the letters?

The Science-Based Medicine blog can teach you about homeopathy.

Here’s a snippet from the first FDA link above:

Miller explains that HCG was first promoted for weight loss in the 1950s. “It faded in the 1970s, especially when it became apparent that there was a lack of evidence to support the use of HCG for weight loss,” she says.

The diet has become popular again and FDA and FTC are taking action on illegal HCG products. “You cannot sell products claiming to contain HCG as an OTC drug product. It’s illegal,” says Brad Pace, team leader and regulatory counsel at FDA’s Health Fraud and Consumer Outreach Branch. “If these companies don’t heed our warnings, they could face enforcement actions, legal penalties or criminal prosecution.” 

You think these HCG marketers didn’t know from the git-go that what they were doing was illegal?

I’d have thought the FDA already had enough poop to start enforcement actions.

But what do I know?

Steve Parker, M.D.

  Dr. Barry Sears (Ph.D., I think) recently wrote about a lecture he attended by a dietitian affiliated with “The Biggest Loser” TV show.  She revealed the keys to weight-loss success on the show.  Calorie restriction is a major feature, with the typical 300-pounder (136 kg) eating 1,750 calories a day.  On my Advanced Mediterranean Diet, 300-pounders get 2,300 calories (men) or 1,900 calories (women). 

Although not stressed by Dr. Sears, my impression is that contestants exercise a huge amount. 

Go to the link above and you’ll learn that all contestants are paid to participate.  In researching my Conquer Diabetes and Prediabetes book, I learned that the actual Biggest Loser wins $250,000 (USD).  Also, “The Biggest Loser” is an international phenomenon with multiple countries hosting their own versions, with different pay-off amounts.  A former winner, Ali Vincent, lives in my part of the world and still has some celebrity status.

This TV show demonstrates that the calories in/calories out theory of body weight still applies.  Including the fact that massive exercise can help significantly with weight loss.  In real-world situations, exercise probably contributes only a small degree to loss of excess weight.  The major take-home point of the show, for me, is that you can indeed make food and physical activity choices that determine your weight.

Most of us watch too much

I know losing 50 to 10o pounds of fat (25–45 kg) and keeping it off for a couple years is hard; most folks can’t do it.  Do you think you’d be more successful if I gave you $250,ooo for your success?

Steve Parker, M.D.

LCHF Cheese

Dr. Eenfeldt of DietDoctor.com gave a talk at the recent Ancestral Health Symposium in California, on the rationale of the current low-carb, high-fat diet (LCHF) so popular in his home country of Sweden.  It’s very understandable to the general public and is a good introduction to low-carb eating.  The entire YouTube video is 55 minutes; if you’re pressed for time, skip the 10-minute Q&A at the end.

He also discusses the benefits of LCHF eating for his patients with diabetes.

If you reduce carbohydrates, you’re going to replace it with either protein, fat, or both.  As Dr. Eenfeldt recommends, the Ketogenic Mediterranean and Low-Carb Mediterranean Diets replace carbs more with fats than protein.

Steve Parker, M.D.

US News and World Report a couple months ago ranked 20 popular diets for weight loss, overall healthfulness,  and diabetes and heart disease management.  Overall best diet was awarded to the DASH diet. Mediterranean came in No.2. The Mayo Clinic has free info on the DASH diet.  Here’s my definition of the Mediterranean diet.

-Steve Parker, M.D.

I just finished reading The Art and Science of Low Carbohydrate Living: An Expert Guide to Making the Life-Saving Benefits of Carbohydrate Restriction Sustainable and Enjoyable, by Stephen Phinney, M.D., Ph.D., and Jeff Volek, Ph.D. published this year.  I give it four stars per Amazon.com’s rating system (I like it).

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The authors medicalize overweight and obesity by naming the cause of most cases to be “carbohydrate intolerance,” along the lines of lactose intolerance and gluten intolerance.  Given the myriad illnesses and shortened lifespan associated with obesity, medicalizing it is reasonable.  Ask Gary Taubes why we get fat, and he’ll say it’s excessive consumption of carbohydrates, especially sugars and refined flours.  Ask Phinney and Volek, and they’ll say “carbohdyrate intolerance.”  For them, the “treatment” is avoidance of carbs.  I also referred to carbohydrate intolerance in my 2011 book, Conquer Diabetes and Prediabetes.

If a patient asks me why he’s fat, I guess I’d prefer to say “you have carbohydrate intolerance,” rather than “you eat too many carbs.”  It’s less confrontational and doesn’t blame the patient.

So how many of us in the U.S. have carbohydrate intolerance?  The authors estimate a hundred million or more - about a third of the total poplulation, or more, who could directly benefit from carbohydrate restriction.  I agree.

Before reading this book, I was convinced that carbohydrates are indeed major contributors to overweight and obesity, especially concentrated sugars and refined grains.  The authors cite much of the pertinent scientific/medical literature. 

Gary Taubes made the same case in his brilliant book, Good Calories, Bad Calories.  Dr. Robert Atkins argued the same in Dr. Atkins New Diet Revolution.  The problem is that many healthcare providers such as physicians and dietitians are biased against thosesources.  Physicians resist a non-physician such as Taubes giving them advice about the practice of medicine.  And most physicians over 45 still labor under the misconception that dietary cholesterol and total and saturated fat are major-league killers, so they’ve already dismissed Dr. Atkins and don’t have time to get caught up to date on the recent research.

Phinney and Volek have wisely targeted this work towards healthcare providers such as physicians, so it’s somewhat technical and clinical.  Both have Ph.D.s and Phinney is also an M.D.  The authors are respected researchers who thoroughly review the science behind low-carb eating.  They explain how high blood pressure, metabolic syndrome, type 2 diabetes, and other conditions are related to carb consumption.

I rate the book four stars instead of five only because it’s a little pricey at $29 (US).

Smart nutrition- and fitness-minded folks will also benefit from a reading.  For a more consumer-oriented book, I recommend the authors’ The New Atkins for a New You or Taubes’ Why We Get Fat.

Steve Parker, M.D.

I recently read Zest For Life: The Mediterranean Anti-Cancer Diet, by Conner Middelmann-Whitney.  I give it five stars per Amazon.com’s rating system.

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The lifetime risk of developing invasive cancer in the U.S. is four in ten: a little higher for men, a little lower for women.  Those are scary odds.  Cancer is second only to heart disease as a cause of death in western societies.  The Mediterranean diet has a well established track record of protecting against cancers of the prostate, colon/rectum, uterus, and prostate.  Preliminary data suggest protection against melanoma and stomach cancer, too.  I’m not aware of any other way of eating that can make similar claims. 

So it makes great sense to spread the word on how to eat Mediterranean-style, to lower your risk of developing cancer.  Such is the goal of Ms. Conner Middelmann-Whitney.  The Mediterranean diet is mostly, although by no means excusively, plant-based.  It encourages consumption of natural, minimally processed, locally grown foods.  Generally, it’s rich in vegetables, fruits, legumes, oive oil, whole grains, red wine, and nuts.  It’s low to moderate in meat, chicken, fish, eggs, and dairy products (mostly cheese and yogurt).

Note that one of the four longevity hot spots featured in Dan Buettner’s Blue Zones was Mediterranean: Sardinia.  All four Blue Zones were characterized by plant-based diets of minimally processed, locally grown foods.  (I argue that Okinawa and the Nicoya Peninsula dwellers ate little meat simply due to economic factors.)

Proper diet won’t prevent all cancer, but perhaps 10-20% of common cancer cases, such as prostate, breast, colorectal, and uterine cancer.  A natural, nutrient-rich, mostly plant-based diet seems to bolster our defense against cancer.

Ms. Middelmann-Whitney is no wacko claiming you can cure your cancer with the right diet modifications.  She writes, “…I do not advocate food as a cancer treatment once the disease has declared itself….” 

She never brings it up herself, but I detect a streak of paleo diet advocacy in her.  Several of her references are from Loren Cordain, one of the gurus of the modern paleo diet movement.  She also mentions the ideas of Michael Pollan very favorably.

She’s not as high on whole grains as most of the other current nutrition writers.  She points out that, calorie for calorie, whole grains are not as nutrient-rich as vegetables and fruits.  Speaking of which, she notes that veggies generally have more nutrients than fruits.  Furthermore, she says, grain-based flours probably contribute to overweight and obesity.  She suggests that many people eat too many grains and would benefit by substituting more nutrient-rich foods, such as veggies and fruits.

Some interesting things I learned were 1) the 10 most dangerous foods to eat while driving, 2) the significance of organized religion in limiting meat consumption in some Mediterranean regions, 3) we probably eat too many omega-6 fatty acids, moving the omega-6/omega-3 ratio away from the ideal of 2:1 or 3:1, 4) one reason nitrites are added to processed meats is to create an pleasing red color (they impair bacterial growth, too), 5) fresh herbs are better added towards the end of cooking, whereas dried herbs can be added earlier, 6) 57% of calories in western societies are largely “empty calories:” refined sugar, flour, and industrially processed vegetable oils,  and 7) refined sugar consumption in the U.S. was 11 lb (5 kg) in the 1830s, rising to 155 lb (70 kg) by 2000.

Any problems with the book?  The font size is a bit small for me; if that worries you, get the Kindle edition and choose your size.  She mentions that omega-6 and omega-3 fatty acids are “essential” fats. I bet she meant to say that linolenic and linoleic fatty acids are essential (our bodies need them but can’t make them); linolenic happens to be one of the omega-3s, linoleic is an omega-6.  Reference #8 in chapter three is missing.  She states that red and processed meats cause cancer (the studies are inconclusive).  I’m not sure that cooking in or with polyunsaturated plant oils causes formation of free radicals that we need to worry about.

As would be expected, the author and I don’t see eye to eye on everything.  For example, she worries about bisphenol-A, pesticide residue, saturated fat, excessive red meat consumption, and strongly prefers pastured beef and free-range chickens and eggs.  I don’t worry.  She also subscribes to the “precautionary principle.”

The author shares over 150 recipes to get you started on your road to cancer prevention.  I easily found 15 I want to try.  She covers all the bases on shopping for food, cooking, outfitting a basic kitchen, dining out, shopping on a strict budget, etc.  Highly practical for beginning cooks.  Numerous scientific references are listed for you skeptics.

I recommend this book to all adults, particularly for those with a strong family history of cancer.  But following the author’s recommendations would do more than lower your risk of cancer.  You’d likely have a longer lifespan, lose some excess fat weight,  and lower your risk of type 2 diabetes, dementia, heart disease, stroke, vision loss from macular degeneration, and obesity.  Particularly compared to the standard American diet.  What are you waiting for?  Let’s get cookin’!

Steve Parker, M.D.

Disclosure: The author arranged a free copy of the book for me, otherwise I recieved nothing of value for writing this review.

I recently read Carbohydrates Can Kill, by Robert K. Su, M.D., written in 2009.  Per Amazon.com’s rating system, I give it four stars ( I like it).

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Many developed Western societies have a love affair with carbohydrates, particularly concentrated sugars and highly processed grains and starches.  The U.S. is a good example.  Our skyrocketing rates of overweight and obesity (68% of adults) are testament to that.  Obesity is strongly linked to cancer, high blood pressure, heart attacks, diabetes, strokes, and premature death.  It’s not too much of a stretch to blame carbohydrates for at least a portion of these diseases and others.  Dr. Robert Su thoroughly reviews these connections in Carbohydrates Can Kill.

Blissfully unaware of his prediabetes

Blocked heart arteries are the No.1 cause of death in developed countries.  A growing trend among the experts is to abandon the theory that total and saturated fats cause heart disease, pointing instead to excessive consumption of sugars and processed grains and other starches.  Dr. Su makes a fairly convincing case for the carbohydrate theory of heart disease.  He’s also convinced that carbs cause high blood pressure, dementia, many cancers, diabetes, overweight, perhaps even most diseases. 

This book addresses overweight, adverse health effects of obesity, nutrition and digestion in detail, and numerous scientific studies supporting his ideas.

One of the most interesting things to me was Dr. Su’s personal medical story.  At age 62, he found himself 40 pounds (18 kg) overweight, blood pressure 205/63, and having apparent reversible heart pains (angina) when stressed or exercising.  The combination of salt restriction and exercise didn’t help.  Reducing carbs to 60-70 g/day and continued exercise (walking and stair-climbing) did the trick, helping him lose 30 pounds and controlling angina and high blood pressure.  I expected him at any time to reveal he had a heart attack, stroke, or heart bypass surgery, but he dodged those bullets.  His problems at 62 were a wake-up call.  He didn’t want to end up prematurely dead or disabled, a burden to his family and unable to spend quality time with them.  So he undertook major lifestyle changes.  Very inspirational. 

In addition to a medical degree, Dr. Su has a degree in pharmacy.  He knew he’d be put on multiple drugs if he went to a doctor for treatment of his symptoms.  Like me, he’s wary of drug side effects and wanted to avoid them, opting for diet and exercise instead.  He gambled and won.  I’m sure at least a few others would not be so lucky.

Dr. Su cites evidence that high blood sugars cause inflammation, which can predispose to cancer.  Diabetics do indeed have a higher risk of certain cancers, yet he didn’t mention that diabetics have a lower risk of prostate cancer. 

Dr. Su is anti-alcohol.  The studies are mixed on the overall health effects of alcohol, but the bulk of the studies link low-to-moderate consumption of alcohol with less cardiovascular disease and longer lifespan.  Clearly, heavy drinking can be lethal.

Like all books, CCK isn’t perfect.  First, it could have used better editing to eliminate grammatical errors and wordiness.  Next, I suspect Dr. Su is getting a little ahead of the science when he states that “….most diseases, if not all, are directly or indirectly caused by too much blood sugar.”  If carbohydrates are so deadly (mediated via high blood sugar), why do the Kitavan’s of Melanesia have such low rates of heart attack, stroke, overweight, and diabetes, despite a diet deriving 69% of total calories from carbohydrates?  (Calories from carbohydrates in the U.S. are about 50% of the total.)  Granted, Kitavan’s carbs are mostly unrefined.  Could the Kitavans be genetically protected from carb toxicity? 

So, what do we do if carboydrates are so dangerous?  Dr. Su recommends limiting carb consumption to a maximum of 100 grams a day.  (By way of reference, average U.S. carb consumption is 250 grams a day.)  Simple sugars and highly processed grains and starches should be avoided.  Additionally, he recommends a yearly glucose tolerance test to determine fasting blood sugar, then blood sugar readings every 15-20 minutes after an unspecified meal for two or three hours.  I wonder if a single hemoglobin A1c blood test would suffice.  I agree with Dr. Su that fasting blood sugars should be under 110 mg/dl (6.1 mmol/l)—if not lower—and all blood sugars after meals under 150 mg/dl (8.3 mmol/l).

Dr. Su is a tireless advocate for carbohydrate-restricted eating.  Visit his website: carbohydratescankill.com.  If his diet and exercise ideas were widely adopted in the U.S., we’d be a healthier country.  This book is a worthy read for anyone with overweight, obesity, diabetes, prediabetes, or otherwise enamored of concentrated sugars and highly processed grains and other starches.  Note that one of every three U.S. adults has prediabetes, including half of all those over 65, and most of them are unaware.

Steve Parker, M.D.

With a suspicion that the Dukan Diet may be the next diet fad in the U.S., I reviewed The Dukan Diet: 2 Steps to Lose the Weight, 2 Steps to Keep It Off Forever by Pierre Dukan (2011, first American edition).  On Amazon.com’s rating system, I give it two stars.

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Think of Dukan as a Low-Fat Atkins Diet.

The Dukan Diet is apparently very popular in Europe.  It’s comprised of four phases. The Attack Phase, also called “Pure Protein,” lasts usually two to seven days.  Eat all you want from the protein-rich food list, mostly skinless chicken, low-fat meat, fish, and nonfat dairy.  No carbs at all except for the dairy.  The Cruise Phase is next: Alternate Pure Protein days with proteins and non-starchy vegetables until you’re at your goal weight.  Eat all you want from the low-carb veggie list.  Consolidation Phase lasts five days for every pound lost.  Eat more variety but limited quantities: two slices of whole grain bread, one portion each of fruit and cheese daily, one or two servings of starchy carbs (e.g., legumes, flour, cereals), plus two “celebration meals” a week, carefully defined.  Proteins and low-carb veggies are still unlimited.  Finally, the Permanent Stabilization Phase is lifelong and similar to Consolidation Phase, but requires one Pure Protein day per week, such as Thursdays.  Also, take no stairs or elevators.  All phases include prescribed servings of oat bran.

During the active weight loss phases, this diet is low-fat, low-carb, and high-protein. You don’t have to count carb grams, fat grams, or calories.  Presumably, Dr. Dukan has done all that for you, although he never shares the average calories consumed nor the macronutrient breakdown (i.e., what percentage of calories are derived from protein, fat, or carbs). The latter two phases are still very low-fat but allow a bit more carbs.

I liked this book more than I expected.  It’s obvious the author has copious experience with dieters, especially women.  The writing is clear.  He’s a serious, earnest man, not a charlatan.  Although some will criticize the book’s repetitiveness, it’s a proven educational technique.  For weight management, Dr. Dukan and I agree that 1) weighing daily is good, 2) abstinence from sugar rarely eliminates the longing for sweets, 3) artificial no-calorie sweeteners are OK, 4) the 4-7 pound weight loss in Attack Phase is mostly water, not fat, 5) discipline and willpower are important, 6) after losing weight, you’ll regain it if you ever return to your old ways, and 7) a realistic weight goal is essential. 

Dr. Dukan recommends at least 20-30 minutes a day of walking.  He provides little information on resistance training, although increasing evidence supports it as a great weight control measure.  I wish he’d mentioned high intensity interval training (HIIT).

The book contains numerous recipes, including a week of menus for the Attack Phase.  Disappointingly, none of the recipes include nutritional analysis.

You’ll find an index.  It doesn’t list glycogen.  Insulin, a primary fat-storage hormone, is mentioned on only one page, one sentence.

This is one fat-phobic diet.  In Dr. Dukan’s view, “fat in food is the overweight person’s most deadly enemy.”  All fat consumption contributes to fatness, and animal fats “pose a potential threat to the heart.”  It seems Dr. Dukan never got the memo that total and saturated fat content of foods have little, if anything, to do with heart or other cardiovascular disease. While criticizing Dr. Atkins’ diet for demonizing carbohydrates, Dr. Dukan demonizes fats.  Yet Dr. Dukan does all he can to banish both carbohydrates and fats from his weight loss phases. 

Dr. Dukan makes several erroneous statements, including 1) all food is made up of only three nutrients, 2) all alcoholic beverages are high in carbohydrates, 3) all shellfish are carbohydrate-free, 4) he implies that when dieting or fasting, we convert much of our fat into glucose, 5) there are no indispensable fats, 6) fat is bad for the cardiovascular system, 7) vinegar is the only food containing sour taste, fruit is the only natural food containing rapid-assimilation sugars, 9) “Anyone who loses and regains weight several times becomes immune to dieting,” 10) weight loss releases into the bloodstream artery-toxic fat and cholesterol, 11) many overweight folks are unusually good at extracting calories from food, 12) some people can gain weight even while they sleep, 13) exercise is vitally important for losing weight, and 14) the Atkins diet raises triglycerides and cholesterol levels dangerously.

Will the diet work?  I’m sure many have lost weight with it and kept it off.  It does, after all, limit two of the major causes of excess weight: sugars and refined starches. 

In considering rating this book two or three stars, I asked myself if I’d recommend it to one of my patients looking to lose weight.  Initially I had concern that the diet may be deficient in essential fatty acids since it’s so fat-phobic.  “Essential” means necessary for life and health.  Then I figured that the body’s own fat stores would provide adequate essential fatty acids, at least in the first two phases.  The later stages, I’m not so sure.  Carefully choosing specific foods would eliminate the risk, but how many people know how to do that?  Separate from that potential drawback, there are other diets that are better, such as The New Atkins Diet for a New You, Protein Power, The Advanced Mediterranean Diet, the Ketogenic Mediterranean Diet (free on the Internet), and The New Sonoma Diet.  You’ll have no risk of fatty acid deficiency with those.

 If you limit carbs, there’s just no need for fat-phobia.

Steve Parker, M.D.

I recently read The New Sonoma Diet: Trimmer Waist, More Energy in Just 10 Days, by Dr. Connie Guttersen, RD, PhD, published in 2010.  Per Amazon.com’s rating system, I give it four stars (I like it).

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The New Sonoma weight-loss method works because it counteracts the major cause of overweight—excessive consumption of sugars and refined starches—through portion control. This Mediterranean-style program is likely to reap the major health benefits of the traditional Mediterranean diet: longer life and less chronic disease (heart attacks, strokes, high blood pressure, diabetes, dementia, and cancer).

Most of the food recommendations herein are consistent with Monica Reinagel’s wonderful new book, Nutrition Diva’s Secrets for a Healthy Diet: What to Eat, What to Avoid, and What to Stop Worrying About. On Sonoma, you’ll eat natural, minimally processed, whole foods.

The primary improvements over the 2005 version of Sonoma are the time-saving and budget-saving strategies. The recipes are easier and quicker. I didn’t try any, but they sound yummy. Dr. Guttersen also exands the “Power Foods” from 10 to 12, adding beans and citrus fruit. I’m glad to see the author addressed many of my criticisms of her great 2005 book. I do miss the old refrigerator-ready pull-out depicting the subdivided plates.

Here’s a brief summary for those unfamiliar with Sonoma. There are three Waves. Wave 1 lasts 10 days and is supposed to break your addiction to sugar and refined flour. Wave 2 lasts until your weight-loss goal is reached, and provides more calories, wine if desired, and more variety. Wave 3 is the lifelong maintenance phase: more fruit and veggies, plus occasional sugary desserts, potatoes, and refined flour. Portion size is controlled either by following her exact recipes or through her plate method. Breakfast fits on a 7″ plate (or 2-cup bowl), while lunch and dinner are on 9″ plates, subdivided into various food groups such as proteins, grains, or veggies. Optional recipes are provided for Wave 1 and the first two weeks of Wave 2.

As in 2005, Dr. Guttersen doesn’t reveal how many calories you’ll be eating. My estimate for Wave 3 is 2000 a day. Less for the earlier Waves.

You’ll find indispensible information on shopping and food preparation. Keeping a food journal is rightfully promoted in certain circumstances. I like the discussion of psychological issues, mindful eating, dining out tips, and weight-loss stalls. The mindful eating portion reminded me of Evelyn Tribole’s Intuitive Eating: A Revolutionary Program That Works and Intuitive Eating: A Practical Guide to Make Peace with Food, Free Yourself from Chronic Dieting, Reach Your Natural Weight.

The author makes a few claims that are either wrong or poorly supported by the scientific literature. Examples include: 1) beans are linked to longer life and reduced heart disease risk, 2) grapes are almost as good as wine for heart protection, 3) the health benefits of spinach “border on the miraculous,” and spinach helps prevent inflammatory conditions such as arthritis and asthma, 4) whole grains prevent stroke, gastrointestinal cancer, and diabetes, 5) adding salt and butter for flavor is unhealthy, 6) medicinal qualities of herbs and spices are well documented, 7) saturated fats “are found exclusively in highly processed food products,” you’ll break a lifetime craving for sugary sweets in Wave 1, 9) 64 ounces of water a day is ideal, 10) exercise significanlty helps most people with weight loss, 11) low-carb eating cannot be maintained because it’s unhealthy and unsatisfying, and 12) saturated fats raise the risk of heart disease.

Much of the book reads like an infomercial; at times I even wondered if it was ghost-written by a marketing professional. The author is unflaggingly optimistic. The testimonials would have more credibility if attributed to full names, not just “Betty” or “Bill.” She overstates the health benefits of the individual Power Foods, which are all plant-derived. I’d like to see cold-water fatty fish on the list.

Dr. Guttersen has great faith in observational studies linking specific foods to health outcomes; I have much less faith. Such studies are far from proof that specific foods CAUSE the outcome. They’re just associations, such as swimsuit sales being linked to warm weather. Warm weather doesn’t cause folks to buy swimsuits; the desire to swim does.

Speaking of associations, a multitude of observational studies link whole grain consumption with 20-25% lower risk of heart disease. We may never have proof of cause and effect because the appropriate study is so difficult. Sonoma recommends two whole grain servings a day, which is the heart-healthy “dose” supported by science.

The author’s discussion of exercise is improved over 2005’s, but is still minimal. Why not refer readers to respected Internet resources? We agree that exercise can help with weight-loss stalls and long-term maintenance of weight loss.

Overall, this is one of the healthiest weight-loss programs available. The average person won’t go wrong with Sonoma. In fact, Sonoma-style eating may be the healthiest of all for the normal-weight general public, with the exception of its avoiding saturated and total fat.

Steve Parker, M.D.