Monthly Archives: April 2012

DASH Diet Reduces Risk of Heart Disease and Stroke in Women

Posted on April 20, 2012 | Comments Off on DASH Diet Reduces Risk of Heart Disease and Stroke in Women

U.S News and World Report recently ranked the DASH diet as the No.1 Healthiest Diet.  Today I partly explain why.

The Dietary Approaches to Stop Hypertension (DASH) diet has been shown to lower blood pressure.  Another study associated a DASH-style diet with lower incidence of heart attack and stroke.

The DASH diet is low in total and saturated fats and cholesterol, moderate in low-fat dairy products, high in fruits and vegetables, low in salt, low in sweetened beverages, moderate in whole grains, and low in animal protein but has substantial amounts of plant protein from nuts and legumes.

The DASH diet was designed as a healthy way of eating, not a weight-loss diet.  It is promoted by the National Heart, Lung, and Blood Institute for the prevention and treatment of high blood pressure.  It is also included as an example of a healthy diet in the 2005 Dietary Guidelines for Americans.  Yet many people still have never heard of it.

Researchers affiliated with multiple Boston and Atlanta institutions looked at the participants in the massive Nurses Health Study.  88,517 middle-aged women free of stroke, diabetes, and coronary heart disease were followed between 1980 to 2004.  They filled out food frequency questionnaires designed to assess average food intake over the preceding year.  The researchers constructed a DASH diet score and graded all the study participants in terms of adherence or conformity to the ideal DASH diet.

Over the course of the study, there were 2129 cases of nonfatal heart attack, 976 deaths from coronary heart disease, and 2317 strokes.  (If you read the original study, please note that some numerical errors were corrected in a later journal issue.)

Women with the highest adherence to the DASH Diet had 24% lower risk for coronary heart disease, compared with the women who had the lowest conformity.  Again comparing the same two groups for stroke, the high-adherence women had 18% less incidence of stroke.  There were clear trends for less coronary heart disease and stroke as adherence to the DASH diet increased.

Blood samples were analyzed for a subset of participants.  Higher DASH compliance was significantly associated with lower plasma levels of interleukin-6 and C-reactive protein.  These are markers for the inflammation felt to underlie atherosclerosis and cardiovascular disease.  You want to avoid high inflammatory markers.  The DASH diet scores in this study were not associated with serum lipid changes, although other DASH studies found lower LDL cholesterol and an undesirable reduction in HDL cholesterol.

The researchers examined causes of death in participants, yet did not report any association – positive, negative, or neutral – with DASH score.  I wonder why?  It’s possible that higher DASH scores were associated with higher overall death rates even though they had fewer heart attacks and strokes.  I imagine they also had access to cancer death statistics.  Why no mention?  Academicians are under pressure to publish research reports.  Are they saving the mortality and cancer data for future articles?  Abscence of all-cause mortality numbers is a major weakness of this study.

The DASH diet is similar in composition to the traditional Mediterranean diet.  The main differences are that the Mediterranean diet ignores salt intake, allows wine and other alcohol, and places more emphasis on olive oil and whole grains.  The Mediterranean diet has numerous supportive studies showing prolonged lifespan and less chronic disease: fewer heart attacks and strokes, less cancer, less dementia.  And very recently the Mediterranean diet was associated with a lower incidence of type 2 diabetes mellitus.

Steve Parker, M.D.

References:

Fung, Teresa, et al.  Adherence to a DASH-Style Diet and Risk of Coronary Heart Disease and Stroke in Women.  Archives of Internal Medicine, 168 (2008): 713-720.

Your Guide to Lowering Your Blood Pressure with DASH, from the National Heart, Lung, and Blood Institute

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Random Notes on Fitness

Posted on April 19, 2012 | 2 comments

About couple years ago, I was thinking about putting together a fitness program for myself.  My goals were endurance, strength, less low back aching, flexibility, longevity, and being able to get on my horse bareback without a mounting block or other cheat.

I spent quite a bit of time at Doug Robb’s HeathHabits site.  He has a post called The “I don’t have time to workout” Workout.  I ran across some paper notes I made during my time there.  Doug recommended some basic moves to incorporate: air squat, Hindu pushup, dragon flag, shuffle of scissor lung, Spiderman lung, hip thrust/bridge, swing snatch, dumbbell press, Siff lunge, jumping Bulgarian squat, band wood chops, leg stiff leg deadlift.  Click the link to see videos of most of these exercises.  The rest you can find on YouTube.

Another post is called “Do you wanna get big and strong? -Phase 1”.  The basic program is lifting weights thrice weekly.  Monday, work the chest and back.  Tuesday, legs and abs/core.  Friday, arms and shoulders.

  • Chest exercises: presses (barbell or dumbell, incline, decline, flat, even pushups with additional resistance  – your choice
  • Back: chins or rows
  • Legs: squats or deadlifts
  • Arms and shoulders: dips, presses, curls

Doug is a personal trainer with a huge amount of experience.  He’s a good writer, too, and gives away a wealth of information at his website.

Around this same time of searching a couple years ago, I ran across Mark Verstegen’s Core Performance, Mark Lauren’s book “You Are Your Own Gym,”  and Mark Sisson’s free fitness ebook that also  features bodyweight exercises.

Lauren is or was a Navy Seal trainer.  His plan involves 30 minutes of work on four days a week and uses minimal equipment.  Lots of good reviews at Amazon.com.

Newbies to vigorous exercise should seriously consider using a personal trainer.

Steve Parker, M.D.

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Exercise Prevents Death

Posted on April 19, 2012 | 1 comment

January 1 this year, many folks made New Years’ resolutions to start exercising in conjunction with their other resolution to lose excess weight. I’ve got bad news for them.

Exercise is overrated as a pathway to major weight loss. Sure, a physically inactive young man with only five or 10 pounds (2 to 4 kg) to lose might be able to do it simply by starting an exercise program. That doesn’t work nearly as well for women. The problem is that exercise stimulates appetite, so any calories burned by exercise tend to be counteracted by increased food consumption.

“Should I go with aerobic or strength training….?”

On the other hand, exercise is particularly important for diabetics and prediabetics in two respects: 1) it helps in avoidance of overweight, especially after weight loss, and 2) it helps control blood sugar levels by improving insulin resistance, perhaps even bypassing it.

Even if it doesn’t help much with weight loss, regular physical activity has myriad general health benefits. First, let’s look at its effect on death rates.

EXERCISE PREVENTS DEATH

As many as 250,000 deaths per year in the United States (approximately 12% of the total) are attributable to a lack of regular physical activity. We know now that regular physical activity can prevent a significant number of these deaths.

Exercise induces metabolic changes that lessen the impact of, or prevent altogether, several major illnesses, such as high blood pressure, coronary artery disease, diabetes, and obesity. There are also psychological benefits. Even if you’re just interested in looking better, awareness of exercise’s other advantages can be motivational.

The traditional Mediterranean diet of the mid-20th century may owe some of it’s healthfulness to a physically active lifestyle.

Exercise is defined as planned, structured, and repetitive bodily movement done to improve or maintain physical fitness.

Physical fitness is a set of attributes that relate to your ability to perform physical activity. These attributes include resting heart rate, blood pressure at rest and during exercise, lung capacity, body composition (weight in relation to height, percentage of body fat and muscle, bone structure), and aerobic power.

Aerobic power takes some explanation. Muscles perform their work by contracting, which shortens the muscles, pulling on attached tendons or bones. The resultant movement is physical activity. Muscle contraction requires energy, which is obtained from chemical reactions that use oxygen. Oxygen from the air we breathe is delivered to muscle tissue by the lungs, heart, and blood vessels. The ability of the cardiopulmonary system to transport oxygen from the atmosphere to the working muscles is called maximal oxygen uptake, or aerobic power. It’s the primary factor limiting performance of muscular activity.

Aerobic power is commonly measured by having a person perform progressively more difficult exercise on a treadmill or bicycle to the point of exhaustion. The treadmill test starts at a walking pace and gets faster and steeper every few minutes. The longer the subject can last on the treadmill, the greater his aerobic power. A large aerobic power is one of the most reliable indicators of good physical fitness. It’s cultivated through consistent, repetitive physical activity.

Physical Fitness Effect on Death Rates

Regular physical activity postpones death.

Higher levels of physical fitness are linked to lower rates of death primarily from cancer and cardiovascular disease (e.g., heart attacks and stroke). What’s more, moving from a lower to a higher level of fitness also prolongs life, even for people over 60.

Steve Parker, M.D.

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Why Should I Care About Target Heart Rate?

Posted on April 18, 2012 | Comments Off on Why Should I Care About Target Heart Rate?

To get the full health benefits of regular physical activity, you need to put some effort into it. A leisurely hour-long stroll in the mall while window-shopping doesn’t pass muster, although that’s better than nothing.

One rough way to gauge whether you’re working hard enough during aerobic exercise is to monitor your heart rate, also known as pulse. Subtract your age from 220. The result is your theoretical maximum heart rate in beats per minute. Your heart rate goal, or target, during sustained aerobic exercise is a pulse that is 60 to 80 percent of your theoretical maximum pulse. For example: maximum heart rate for a 40-year-old is 180 (220 – 40 = 180), so the target heart rate zone during exercise is between 108 and 144 (60 to 80 percent of 180). Exceeding the upper end of the target zone is usually too uncomfortable to be sustainable. Exercise heart rates below the target zone suggest you’re not working hard enough to reap the full long-term benefits of aerobic exercise.

Here’s how to determine your pulse. After five or 10 minutes of exercise, stop moving and place the tips of your first two fingers lightly over the pulse spot inside your wrist just below the base of your thumb. Count the pulsations for 15 seconds and multiply the number by four. The result is your pulse or heart rate. It will take some practice to find those pulsations coming from your radial artery. If you can’t find it, ask a nurse or doctor for help.

Like all rules-of-thumb, this target heart rate zone isn’t always an accurate gauge of cardiovascular workout intensity. For instance, it is of very little use in people taking drugs called beta blockers, which keep a lid on heart rate.

As you become more fit, you’ll notice that you have to work harder to get your heart rate up to a certain level. This is a sure sign that your heart and muscles are responding to your challenge. You may also want to monitor your resting heart rate taken in the morning before you get out of bed. Unfit, sedentary people have resting pulses of 60 to 90. Athletes are more often in the 40s or low 50s. Their hearts have become more efficient and just don’t need to beat as often to get the job done.

As you become more fit, you’ll also notice that you have more energy overall and it’s easier to move about and handle physical workloads. You’ll feel more relaxed and have a sense of accomplishment. Expect these benefits eight to 12 weeks after starting a regular exercise program.

Steve Parker, M.D.

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Anti-Aging and Other Metabolic Benefits of Exercise

Posted on April 17, 2012 | 4 comments

At my Diabetic Mediterranean Diet blog, I recently noted that regular physical activity prevented or postponed death. Onward now to other benefits.

Waist Management

Where does the fat go when you lose weight dieting? Chemical reactions convert it to energy, water, and carbon dioxide, which weigh less than the fat. Most of your energy supply is used to fuel basic life-maintaining physiologic processes at rest, referred to as resting or basal metabolism. Basal metabolic rate (BMR) is expressed as calories per kilogram of body weight per hour.

The major determinants of BMR are age, sex, and the body’s relative proportions of muscle and fat. Heredity plays a lesser role. Energy not used for basal metabolism is either stored as fat or converted by the muscles to physical activity. Most of us use about 70 percent of our energy supply for basal metabolism and 30 percent for physical activity. Those who exercise regularly and vigorously may expend 40–60 percent of their calorie intake doing physical activity. Excess energy not used in resting metabolism or physical activity is stored as fat.

Insulin, remember, is the main hormone converting that excess energy into fat; and carbohydrates are the major cause of insulin release by the pancreas.

To some extent, overweight and obesity result from an imbalance between energy intake (food) and expenditure (exercise and basal metabolism). Excessive carbohydrate consumption in particular drives the imbalance towards overweight, via insulin’s fat-storing properties.

In terms of losing weight, the most important metabolic effect of exercise is that it turns fat into weightless energy. We see that weekly on TV’s “Biggest Loser” show; participants exercise a huge amount. Please be aware that conditions set up for the show are totally unrealistic for the vast majority of people.

Physical activity alone as a weight-loss method isn’t very effective. But there are several other reasons to recommend exercise to those wishing to lose weight. Exercise counteracts the decrease in basal metabolic rate seen with calorie-restricted diets. In some folks, exercise temporarily reduces appetite (but others note the opposite effect). While caloric restriction during dieting can diminish your sense of energy and vitality, exercise typically does the opposite. Many dieters, especially those on low-calorie poorly designed diets, lose lean tissue (such as muscle and water) in addition to fat. This isn’t desirable over the long run. Exercise counteracts the tendency to lose muscle mass while nevertheless modestly facilitating fat loss.

How much does exercise contribute to most successful weight-loss efforts? Only about 10 percent on average. The other 90 percent is from food restriction.

Fountain of Youth

Regular exercise is a demonstrable “fountain of youth.” Peak aerobic power (or fitness) naturally diminishes by 50 percent between young adulthood and age 65. In other words, as age advances even a light physical task becomes fatiguing if it is sustained over time. By the age of 75 or 80, many of us depend on others for help with the ordinary tasks of daily living, such as housecleaning and grocery shopping. Regular exercise increases fitness (aerobic power) by 15–20 percent in middle-aged and older men and women, the equivalent of a 10–20 year reduction in biological age! This prolongation of self-sufficiency improves quality of life.

Heart Health

Exercise helps control multiple cardiac (heart attack) risk factors: obesity, high cholesterol, elevated blood pressure, high triglycerides, and diabetes. Regular aerobic activity tends to lower LDL cholesterol, the “bad cholesterol.” Jogging 10 or 12 miles per week, or the equivalent amount of other exercise, increases HDL cholesterol (“good cholesterol”) substantially. Exercise increases heart muscle efficiency and blood flow to the heart. For the person who has already had a heart attack, regular physical activity decreases the incidence of fatal recurrence by 20–30 percent and adds an extra two or three years of life, on average.

Effect on Diabetes

Eighty-five percent of type 2 diabetics are overweight or obese. It’s not just a random association. Obesity contributes heavily to most cases of type 2 diabetes, particularly in those predisposed by heredity. Insulin is the key that allows bloodstream sugar (glucose) into cells for utilization as energy, thus keeping blood sugar from reaching dangerously high levels. Overweight bodies produce plenty of insulin, often more than average. The problem in overweight diabetics is that the cells are no longer sensitive to insulin’s effect. Weight loss and exercise independently return insulin sensitivity towards normal. Many diabetics can improve their condition through sensible exercise and weight management.

Miscellaneous Benefits

In case you need more reasons to start or keep exercising, consider the following additional benefits: 1) enhanced immune function, 2) stronger bones, 3) preservation and improvement of flexibility, 4) lower blood pressure by 8–10 points, 5) diminished premenstrual bloating, breast tenderness, and mood changes, 6) reduced incidence of dementia, 7) less trouble with constipation, 7) better ability to handle stress, 8) less trouble with insomnia, 9) improved self-esteem, 10) enhanced sense of well-being, with less anxiety and depression, 11) higher perceived level of energy, and 12) prevention of weight regain.

People who lose fat weight but regain it cite lack of exercise as one explanation. One scientific study by S. Kayman and associates looked at people who dropped 20 percent or more of their total weight, and the role of exercise in maintaining that loss. Two years after the initial weight loss, 90 percent of the successful loss-maintainers reported exercising regularly. Of those who regained their weight, only 34 percent were exercising.

Steve Parker, M.D.

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Getting Started With Strength Training

Posted on April 16, 2012 | Comments Off on Getting Started With Strength Training

What’s “strength training”? It’s also called muscle-strengthening activity, resistance training, weight training, and resistance exercise. Examples include lifting weights, work with resistance bands, digging, shoveling, yoga, push-ups, chin-ups, and other exercises that use your body weight or other loads for resistance.

Strength training three times a week increases your strength and endurance, allows you to sculpt your body to an extent, and counteracts the loss of lean body mass (muscle) so often seen during efforts to lose excess weight. It also helps maintain your functional abilities as you age. For example, it’s a major chore for many 80-year-olds to climb a flight of stairs, carry in a bag of groceries from the car, or vacuum a house. Strength training helps maintain these abilities that youngsters take for granted.

According to the U.S. Centers for Disease Control and Prevention: “To gain health benefits, muscle-strengthening activities need to be done to the point where it’s hard for you to do another repetition without help. A repetition is one complete movement of an activity, like lifting a weight or doing a sit-up. Try to do 8–12 repetitions per activity that count as 1 set. Try to do at least 1 set of muscle-strengthening activities, but to gain even more benefits, do 2 or 3 sets.”

If this is starting to sound like Greek to you, consider instruction by a personal trainer at a local gym or health club. That’s a good investment for anyone unfamiliar with strength training, in view of its great benefits and the potential harm or waste of time from doing it wrong. Alternatives to a personal trainer would be help from an experienced friend or instructional DVD. If you’re determined to go it alone, Internet resources may help, but be careful. Consider “Growing Stronger: Strength Training for Older Adults” (http://www.cdc.gov/physicalactivity/downloads/growing_stronger.pdf). Don’t let the title turn you off if you’re young—its a good introduction to strength training for folks of any age. Doug Robb’s blog, HealthHabits, is a wonderful source of strength training advice (http://www.healthhabits.ca/).

People with diabetes must be particularly cautious before starting a fitness program.

Current strength training techniques are much different than what you remember from high school 30 years ago—modern methods are better. Some of the latest research suggests that strength training may be even more beneficial than aerobic exercise.

Steve Parker, M.D.

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Words to Live By

Posted on April 15, 2012 | Comments Off on Words to Live By

Michael Pollan is credited with the aphorism, “Eat food. Not too much. Mostly plants.” Tag lines are just good marketing; nothing wrong with that as long as it’s honest.

Bill Gottlieb interviewed me last year on the topic of prediabetes for his upcoming book (Bottom Line’s Breakthroughs in Natural Healing 2012). Bill had given me a preparatory list of questions, one of which was,”What are the best dietary recommendations? I’m looking for fun, fresh specificity here—along the lines of your book!” Also, “What’s the best way for a person to implement it—specific, practical, small-step actions that would lead to actually changing the diet?”

We didn’t have a chance to get to those in the interview, but here are some of my thoughts:

  • Give up all man-made food*
  • Give up all sugar-sweetened sodas and “sports drinks”
  • Give up all flour products
  • Give up all flours, starches, and added sugars
  • Give up deserts

But “giving up” is not a message people want to hear when contemplating a diet change, even if it’s for their own good. Nor do they want to hear, “Don’t eat . . .” “Avoid” and “cut back on” are not specific. “Forego” works, but is just a euphemism for “give up.”

“Eat only God-made foods” works for me but might turn off the atheists and agnostics.

Here’s a more marketable catch-phrase that I rather like and claim as my own:

Eat natural food.*

By “natural,” I mean “present in or produced by nature.” This would not include candy bars, potato and corn chips, soda pop, sports drinks, apple pie, bread and other flour products, cookies, etc. That still leaves a lot of different foods to eat, including most of the items on the Low-Carb Mediterranean Diet and Advanced Mediterranean Diet.

Whether modern, mass-produced versions of fruits and vegetables are natural is a debate for another day. I suspect modern corn, for example, is nothing close to the maize cultivated by Native Americans 400 years ago.

Why the asterisk? The exceptions to the “eat natural food” rule are red wine, olive oil, and vinegar. Those are partly natural, partly man-made. (Where do we get vinegar?) The red wine and olive oil are potentially healthful, and many of us like vinegar on our natural salad vegetables.

Eat natural food.

I bet the average person eating the standard American diet would tend to lose excess weight and be healthier by making the switch.

Steve Parker, M.D.

* Exceptions: red wine, olive oil, vinegar

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Book Review: The New Sonoma Diet

Posted on April 14, 2012 | 1 comment

Last year I 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).

The New Sonoma Diet: Trimmer Waist, More Energy in Just 10 DaysMost 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,” 8) 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.

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Book Review: The Dukan Diet

Posted on April 13, 2012 | 2 comments

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, 8) 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.

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Mediterranean Diet Linked to Fewer Strokes

Posted on April 12, 2012 | Comments Off on Mediterranean Diet Linked to Fewer Strokes

The Mediterranean diet reduces the risk of strokes seen on brain MRI scans, according to a study last year in Annals of Neurology.

Brain researchers at various U.S. institutions studied a multi-ethnic population in upper Manhattan (the WHICAP cohort). Average age of the 707 study participants was 80. Baseline diet was determined by a questionairre. A Mediterranean diet score was calculated to quantify adherence—or lack thereof—to the Mediterranean diet. Participants without dementia at baseline underwent MRI scanning initially, then again an average of six years later.

What Did They Find?

One third of participants had MRI evidence for a stroke. Higher adherence to the Mediterranean diet was linked to significantly lower odds of stroke. Compared to those eating least like the Mediterranean diet, those with the highest adherence had 37% lower odds of an stroke being found on MRI scan. Those with medium adherence had 20% lower odds.

So What?

This is the first study to show such an association between strokes on an MRI scan and the Mediterranean diet. Be aware that you can find a stroke on an MRI scan in someone who thought they were perfectly healthy; in other words a clinically silent stroke. The authors note only one previous report finding lower risk of clinically obvious stroke with the Mediterranean diet, in women—I thought there were more.

This same group of researchers had previously demonstrated that higher compliance with the Mediterranean diet is linked to lower risk of Alzheimers disease and mild cognitive impairment.

If I wanted to protect my brain from stroke, I’d be sure follow a Mediterranean-style diet, keep my blood pressure under 140/90 mmHg, stay physically active, keep my weight under control, and not smoke. The Advanced Mediterranean Diet combines weight management, exercise, and the Mediterranean diet.

Steve Parker, M.D.

Reference: Scarmeas, N., Luchsinger, J., Stern, Y., Gu, Y., He, J., DeCarli, C., Brown, T., & Brickman, A. (2011). Mediterranean diet and magnetic resonance imaging-assessed cerebrovascular disease Annals of Neurology, 69 (2), 257-268 DOI: 10.1002/ana.22317

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