Monthly Archives: June 2012

“Doc, I Hardly Eat Anything And I Still Can’t Lose Weight!”

Posted on June 2, 2012 | 4 comments

Every now and then an overweight patient tells me he can’t lose weight even though his typical daily food intake is two pieces of plain toast, a cup of grapes, a hard-boiled egg, and three celery stalks. That’s 530 calories. Most adults eat between 1200 to 3000 calories a day.

Even if he lays around on a couch all day watching TV with a remote control channel changer, I know my patient’s basal metabolism requires at least 1,000 calories daily to keep him alive. He says he’s eating only 530. His body must have, and will get, the extra 470 calories from his fat stores. Over time, he must lose weight as his body converts his fat into basal metabolic energy to keep him alive.

Yet he swears he’s not losing weight, and, in fact, may be gaining. I don’t believe he’s lying to me. What’s going on here?

The answer is suggested by a study published in the New England Journal of Medicine. Ten similar “diet resistant” obese people – nine women, one man, average weight 189 pounds (86 kg) – were carefully studied by a team of researchers. They were taught to record all food intake over time in a diary. When the foods eaten were totaled up, average self-reported intake was 1,000 calories daily.

A highly accurate method of measuring calorie expenditure, called “doubly labeled water,” proved that average calorie intake was actually 2,000 calories daily. Furthermore, they over-reported their physical activity by 50 percent. The authors of the study note that while many people under-report their caloric intake, the degree of under-reporting is greater in obese people. They admit that “the mechanisms responsible for this phenomenon are not well understood.”

Their conclusion:

People who just can’t lose weight despite “severe calorie restriction” are in fact eating more calories than they think.

How can we overcome this tendency? One solution is to keep a food journal.

Steve Parker, M.D.

Reference: Lichtman, Steven, et al. Discrepancy between self-reported and actual caloric intake and exercise in obese subjects. New England Journal of Medicine, 327 (1992): 1,893-1,898.

4 Comments

Posted in Weight Loss

Mediterranean Diet Reduces Risk of Mild Cognitive Impairment

Posted on June 1, 2012 | 1 comment

Mild Cognitive Impairment (MCI) is considered a precursor to dementia, although it does not always lead to dementia.

A study published in 2009 in the Archives of Neurology indicates that adherence to the Mediterranean diet reduces both the risk of developing MCI and the risk of MCI conversion to Alzheimer dementia.

Methodology

1,393 residents of a multi-ethnic community in New York were enrolled in the study. They were mentally normal at baseline and followed for an average of 4.5 years.

Another 482 residents were identified as having Mild Cognitive Impairment at baseline, and were followed an average of 4.3 years.

All participants were screened for cognitive impairments and surveyed to get an idea of usual food intake. Researchers used a 10-point scale to describe an individual participant’s adherence to the Mediterranean diet. The higher the score, the greater the participant’s adherence. Participants were then divided into thirds (tertiles) based on whether adherence was low, medium, or high. Average age of study subjects on entry was 77.

Results

275 of the 1,393 participants who were mentally normal at baseline developed Mild Cognitive Impairment over the 4.5 years of follow-up. Compared to those participants in the lowest third of Mediterranean diet adherence, those in the middle third had 17% less risk of developing MCI, and those in the highest third had 28% less risk.

Of 482 participants with Mild Cognitive Impairment at baseline, 106 later developed Alzheimer disease. Compared with participants in the lowest third of adherence, those in the middle third had 45% less risk of developing Alzheimer disease, and those in the highest third had 48% less risk.

Comments From the Study Authors

. . . potentially beneficial effects for mild cognitive impairment or mild cognitive impairment conversion to Alzheimer’s disease have been reported for alcohol, fish, polyunsaturated fatty acids (also for age-related cognitive decline) and lower levels of saturated fatty acids.

The Mediterranean diet tends to improve cholesterol levels, overall blood vessel function, reduce inflammation, and lower blood sugar levels, all of which could help preserve brain function.

My Comments

No surprise here.

The traditional Mediterranean diet has long been associated with lower risk of developing dementia, both Alzheimer and vascular dementia. Vascular dementia results from multiple strokes or poor blood flow to the brain. Since Mild Cognitive Impairment precedes Alzheimer dementia, it makes sense that the Mediterranean diet could help prevent both.

The lead author of the study at hand, Dr. Scarmeas, also reported in 2007 that the Mediterranean diet also prolongs life in established Alzheimer patients.

Steve Parker, M.D.

Reference: Scarmeas, Nikolaos, et al. Mediterranean Diet and Mild Cognitive Impairment. Archives of Neurology, 66 (2009): 216-225.

Additional Resource: Oldways’ Mediterranean diet information

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Posted in Dementia

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