What’s the Healthiest Way of Eating?

Amby Burfoot has an article that asks, “what is the healthiest diet?” His answer comes from the Journal of Nutrition. Looks like there are four winners. Quoting Mr. Burfoot:

They differ slightly in the degree to which they favor, or disfavor, certain foods and food types, such as the following:

  • The Healthy Eating Index 2010: Considers low-fat dairy products a plus.
  • The Alternative Healthy Eating Index 2010: Considers nuts/legumes a plus, as well as moderate alcohol consumption. Trans fats, sugary beverages, salt, and red meat get a minus.
  • The Alternate Mediterranean Diet: Considers fish, nuts/legumes, and moderate alcohol a plus; red meat, a minus.
  • The DASH Diet: Considers low-fat dairy and nuts/legumes a plus; sugary beverages, salt, and red meat get a minus.

I think the Mediterranean diet has the most and best data to support it.

Steve Parker, M.D.


Recipe: Santa Fe Soup

We’ve been eating this for years at the Parker Compound. It’s one of my daughter’s favorites in autumn and winter. Can’t remember how we came up with it.

This soup is heavy with the musical fruit: beans. You’ll have to determine your own gas threshold level; most folks have no problem with a 1-cup serving.


1 lb (454 g) ground beef, raw, lean (85 percent lean, 15 percent fat)

½ (120 ml) cup onion, diced

1 garlic clove, diced

ground pepper

1 packet (2 oz or 57 g) Hidden Valley Original Ranch Salad Dressing and Seasoning mix

1 16-oz (454 g) can black beans (Bush’s Best)

1 16-oz (454 g) can light red kidney beans (Bush’s Best)

1 16-oz (454 g) can dark red kidney beans (Bush’s Best)

1 28-oz (790 g) can tomatoes, diced (Hunt’s)

2 packets McCormick Original Taco Seasoning Mix

1 15¼-oz (454 g) can white corn (Del Monte Fresh Cut)

1 15¼-oz (454 g) whole kernel yellow corn (Del Monte Fresh Cut)

4 oz (120 ml) water

½ tbsp (7 ml) sour cream per serving

1 sprinkle of fresh-cut chives per serving


In a 5- or 6-quart (5 liter) pot, brown the crumbled ground beef (i.e., pan-fry without oil) along with the garlic, onion, and pepper to taste. When finished cooking, drain and discard the excess fluid. Add the Ranch Seasoning and Taco Seasoning, then mix well. Next add the beans, corn, and tomatoes along with all the juices in the cans. Add 4 oz water. Simmer for 1½ hours. Serve 1 cupful in a bowl with ½ tbsp sour cream in the center, then sprinkle with chives.


Servings per batch: 17 1-cup servings

Advanced Mediterranean Diet box breakdown: 2 veggies, ½ protein  (or simply count as 1 protein). 200 calories.

Laparoscopic Bariatric Surgery: Gastric Bypass Yields Greater Weight Loss But Higher Complications Compared to Banding

Click for details. Try the Advanced Mediterranean Diet first!

We’re Eating 500 More Calories Per Day Than We Did in the 1970s

The U.S. adult population in the 1970s ate an average of 2400 calories a day. By the 2000s, our calories were up to 2900.

Putting a face on the statistics

Putting a face on the statistics

What did average adult weight do as we increased daily calories by 500? Increased by 8.6 kg, from 72.2 to 80.6 kg. In U.S. units, that’s a 19 lb gain, from 159 to 178 lb.

Children increased their average intake by 350 cals/day over the same time frame.

If I recall correctly, I’ve seen other research suggesting the daily calorie consumption increase has been more like 150 to 350 per day (lower end for women, higher for men).

Details are in the American Journal of Clinical Nutrition.

The study authors don’t say for sure why we’re eating more, but offhand mention an “obesogenic food environment.”  They don’t think decreased physical activity is the cause of our weight gain; we’re fatter because we eat too much.

Steve Parker, M.D.

h/t Ivor Goodbody

Still Taking Fish Oil Supplements? Think Again

Salmon is one the the cold-water fatty fish loaded with omega-3 fatty acids

Salmon is one the the cold-water fatty fish loaded with omega-3 fatty acids

I’ve been sitting on this research report a few years, waiting until I had time to dig into it. That time never came. The full report is free online (thanks, British Medical Journal!). I scanned the full paper to learn that nearly all the studies in this meta-analysis used fish oil supplements, not the cold-water fatty fish the I recommend my patients eat twice a week. If you’re taking fish oil supplements on your doctor’s advice, don’t stop without consulting her.

Here’s the abstract:

Objective: To review systematically the evidence for an effect of long chain and shorter chain omega 3 fatty acids on total mortality, cardiovascular events, and cancer.

Data sources: Electronic databases searched to February 2002; authors contacted and bibliographies of randomised controlled trials (RCTs) checked to locate studies.

Review methods Review of RCTs of omega 3 intake for 3 6 months in adults (with or without risk factors for cardiovascular disease) with data on a relevant outcome. Cohort studies that estimated omega 3 intake and related this to clinical outcome during at least 6 months were also included. Application of inclusion criteria, data extraction, and quality assessments were performed independently in duplicate.

Results: Of 15 159 titles and abstracts assessed, 48 RCTs (36 913 participants) and 41 cohort studies were analysed. The trial results were inconsistent. The pooled estimate showed no strong evidence of reduced risk of total mortality (relative risk 0.87, 95% confidence interval 0.73 to 1.03) or combined cardiovascular events (0.95, 0.82 to 1.12) in participants taking additional omega 3 fats. The few studies at low risk of bias were more consistent, but they showed no effect of omega 3 on total mortality (0.98, 0.70 to 1.36) or cardiovascular events (1.09, 0.87 to 1.37). When data from the subgroup of studies of long chain omega 3 fats were analysed separately, total mortality (0.86, 0.70 to 1.04; 138 events) and cardiovascular events (0.93, 0.79 to 1.11) were not clearly reduced. Neither RCTs nor cohort studies suggested increased risk of cancer with a higher intake of omega 3 (trials: 1.07, 0.88 to 1.30; cohort studies: 1.02, 0.87 to 1.19), but clinically important harm could not be excluded.

Conclusion: Long chain and shorter chain omega 3 fats do not have a clear effect on total mortality, combined cardiovascular events, or cancer.

Steve Parker, M.D.

Reference: Hooper, Lee et al. Risks and benefits of omega 3 fats for mortality, cardiovascular disease, and cancer: systematic review. BMJ  2006;332:752-760 (1 April), doi:10.1136/bmj.38755.366331.2F (published 24 March 2006).

Ebola Link Love for Healthcare Professionals

"Go back! This is a quarantine zone."

“Go back! This is a quarantine zone.”

As a hospitalist, I may be called by an emergency department physician today with the following scenario.

“Hey, Steve, I’ve got an admission for you. The patient just got off the plane at Sky Harbor and drove straight here with flu-like symptoms. He was in Liberia 10 days ago. This might be Ebola.”

Universal biohazard symbol

Universal biohazard symbol

My first inclination might be to run in the opposite direction from the ER and leave the hospital. But I probably won’t.

I’ve never seen a case of Ebola. At this point, very few U.S. doctors and hospitals  have experience with it. I don’t remember anything about Ebola from medical school—for all I know it didn’t even existed back then.

In preparation for that call from the emergency department, here are some links for pertinent info, until I can memorize it all. Many of these links are to the U.S. Centers for Disease Control and Prevention and should be (better be) updated soon.

World Health Organization Guidelines on Personal Protective Equipment (October, 2014). This document is more detailed and probably a bit more stringent than the CDC’s advice, although the two have much overlap. A few points to remember:

  • use nitrile gloves instead of latex
  • medical/surgical mask must be fluid-resistant (e.g, “surgical N95 respirator”; if not surgical, it may not be water-resistant
  • either fluid-resistant gown or coveralls, covered by a waterproof apron
  • wear waterproof boots

World Health Organization Guidelines on Both Direct and Non-direct Care to Ebola Patients (September, 2014). Non-Direct care includes waste management, lab activities, movement and burial of human remains, etc.

The Nebraska Ebola Method: This dynamic and evolving course will provide videos, media, and guidelines as used in Nebraska to care for Ebola patients. The materials share current processes being used to safely care for patients with this dangerous, highly infectious disease. The course will be updated frequently to disseminate lessons learned.

A Detailed Ebola Case Report From Germany Published in NEJM. “Staff members…were protected by pressurized suits…that were equipped with ventilators with high-efficiency particulate air filters to provide fresh air supply with a maximum airflow of 160 liters per minute….” Does your hospital have these? “Decontamination [of healthcare workers] in the airlock is performed by two shower-cycles with 2% perchloric acid for 2 minutes and a residence time of 7 minutes. Finally acid residues are rinsed by showering with water.”

Lessons Learned Treating Ebola Patients at Emory University Hospital (pdf). Video of same presentation (didn’t work on my Mac).

An Emergency Physician Ponders the Reality of a Serious Infectious Pandemic and Suggests Management Outside of Traditional Healthcare Facilities

New York Times Oct. 15, 2014, article on CDC intensifying (Oct. 4) their initially lax healthcare worker infection control guidelines


Infection Prevention and Control Recommendations for Hospitalized Patients with Known or Suspected Ebola Virus Disease in U.S. Hospitals (I’m not sure these are adequate as of Oct. 15, 2014)

Generic 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings

Interim Guidance for Environmental Infection Control in Hospitals for Ebola Virus

Donning and Removing Personal Protective Equipment

Personal Protective Equipment Training Demonstration Video from GNYHA. One way to do it, which may or may not be adequate.

Ebola Overview for Clinicians in U.S. Healthcare Settings

Algorithm for Evaluation of the Traveler Returned From Ebola-Affected Areas

Checklist for Patients Being Evaluated For Ebola in the U.S.


2008 Doctors Without Borders Practical Guidelines on Ebola and other Filoviruses

University of Nebraska Medical Center’s Biosafety Level 4 Facility Guidelines for Donning and Doffing Personal Protective Equipment Around Viral Hemorrhagic Fever Patients (these took 30-60 seconds to load on my computer)

Steve Parker, M.D.

Hazmat-suited healthcare worker in a decontamination shower

Hazmat-suited healthcare worker in a decontamination shower

Updated: November 3, 2104, 2345 hrs

Recipe: Beef Soup, Asparagus, and Blackberries

low-carb diet, paleobetic diet, diabetic diet


The entree is a cross between stew and soup. Stoup?

Since I provide the recipe’s carbohydrate grams in the nutritional analysis below, you can fit this into the Ketogenic Mediterranean Diet and Low-Carb Mediterranean Diet, as well as the Advanced Mediterranean Diet.


2 lb (0.9 kg) stew meat, lean, bite-sized chunks (tenderized by the butcher if able)

1 garlic clove, finely minced

6 sprigs cilantro, de-stemmed, whole leaves

2 oz (58 g) sweet onion, diced (1/2 of a small onion)

1/4 of a medium-size green bell pepper, de-seeded, diced (medium bell pepper weighs about 5.5 oz or 155 g)

8 oz (227 g) canned tomato sauce

2.5 cups (590 ml) water

1.25 tsp (6.2 ml) table salt

freshly ground black pepper to taste (1/4 tsp or 1.2 ml?)

16 oz (454 g) fresh raw asparagus, no larger in diameter than your little finger, with any dry or woody stalk cut off and discarded

1.5 tbsp extra virgin olive oil

7.5 oz (213 g) raw blackberries


Stoup first. In a frying pan or electric skillet, place the stew meat, cilantro, garlic, bell pepper, onion, and cook over medium heat (350º F or 177º C) until the meat is done. Then add the tomato sauce, two cups of the water, one tsp of the salt, and pepper to taste. Simmer for two hours, then add a half cup water to replace evaporation loss.

low-carb diet, paleobetic diet, diabetic diet

Cooking stew meat. NOTE: this is double the amount the recipe calls for.

paleobetic diet, low-carb diet, diabetic diet

Meat is done and the “gravy” has magically appeared

low-carb diet, diabetic diet, paleobetic diet

Appearance after addition of the tomato sauce and 2 cups water

Now the asparagus. Preheat oven to 400º F or 204º C. Place asparagus on a cooking sheet covered with foil, brush the asparagus with the olive oil, then lightly salt (1/4 tsp?) and pepper to taste. (If you don’t mind cleaning up, just use a baking dish without the foil.) Roast in oven for 8–15 minutes; thicker asparagus takes longer. It’s hard to tell when it’s done just by looking; if it’s still hard, it’s not done. Click for another post I wrote on cooking asparagus and brussels sprouts.

paleobetic diet, low-carb diet, diabetic diet

Asparagus roasted at 400 degrees F for 12 minutes

Enjoy the berries for desert.

low-carb diet, diabetic diet, paleobetic diet

2.5 oz or 1/2 cup of blackberries

Servings: 3 [one serving is 1.5 cups (355 ml) of soup, a third of the asparagus (5 oz (140 g), and 2.5 oz (70 g) berries]

Advanced Mediterranean Diet boxes: 2 veggies, 2 fats, 1 protein

Nutritional Analysis per Serving:

40 % fat

12 % carbohydrate

48 % protein

590 calories

19 g carbohydrate

8.5 g fiber

10.5 g digestible carb

1,557 mg sodium

1,778 mg potassium

Prominent features: Rich in protein, B6, B12, copper, iron, niacin, phosphorus, selenium, and zinc

low-carb diet, paleobetic diet, diabetic diet

The fresh cilantro is a nice touch