Category Archives: Metabolic Syndrome

Night Shift Work Is Dangerous

Not very pertinent, but a cool picture

Not very pertinent, but a cool picture

Shift work can kill you.

I’ve seen studies associating night shift work with T diabetes in Japanese men, higher breast cancer rates, more metabolic syndrome, and higher heart disease risk in men.

Now we have evidence for higher diabetes rates in women who do shift work”

“Our results suggest that an extended period of rotating night shift work is associated with a modestly increased risk of type 2 diabetes in women, which appears to be partly mediated through body weight. Proper screening and intervention strategies in rotating night shift workers are needed for prevention of diabetes.”

Source: PLOS Medicine: Rotating Night Shift Work and Risk of Type 2 Diabetes: Two Prospective Cohort Studies in Women

Action Plan: P.D. Mangan has some ideas.

Also, reduce your risk of cancer, heart disease, and diabetes with the Mediterranean diet.

Steve Parker, M.D.

PS: If you get one of my books, stay safe and read it during the day.

Sugar (and Fructose) Restriction May Be the Key to Eliminating Metabolic Syndrome and Reducing Heart Disease

Dr. Axel Sigurdsson is a cardiologist and blogger who writes about heart disease. A recent post of his considered the role of sugar, including fructose, in metabolic syndrome and coronary artery disease. He does a great job translating scientific research for consumption by the general public. For example:

“Lustig studied 43 obese children (ages 8-19) with metabolic abnormalities typical of the metabolic syndrome. All were high consumers of added sugar in their diets (e.g. soft drinks, juices, pastries, breakfast cereals, salad dressings, etc.).

The children were fed the same calories and percent of each macronutrient as their home diet; but within the carbohydrate fraction, the added sugar was removed, and replaced with starch. For example, pastries were taken out, and bagels put in; yogurt was taken out, baked potato chips were put in; chicken teriyaki was taken out, turkey hot dogs were put in. Whole fruit was allowed.After ten days, diastolic blood pressure fell, insulin resistance decreased, liver tests improved, and triglycerides, LDL cholesterol, and HDL cholesterol all improved.”

Source: Medical Practice

PS: All of my diets combat metabolic syndrome.

Steve Parker MD, Advanced Mediterranean Diet

Two diet books in one

Metabolic Syndrome: A Thumbnail Sketch

metabolic syndrome, low-carb diet, diabetes, prediabetes

He’s at high risk for metabolic syndrome

“Metabolic syndrome” may be a new term for you. It’s a collection of clinical features that are associated with increased future risk of type 2 diabetes and atherosclerotic complications such as heart attack and stroke. One in six Americans has metabolic syndrome. Diagnosis requires at least three of the following five conditions:

  • high blood pressure (130/85 or higher, or using a high blood pressure medication)
  • low HDL cholesterol:  under 40 mg/dl (1.03 mmol/l) in a man, under 50 mg/dl (1.28 mmol/l) in a women (or either sex taking a cholesterol-lowering drug)
  • triglycerides over 150 mg/dl (1.70 mmol/l) (or taking a cholesterol-lowering drug)
  • abdominal fat:  waist circumference 40 inches (102 cm) or greater in a man, 35 inches (89 cm) or greater in a woman
  • fasting blood glucose over 100 mg/dl (5.55 mmol/l)

What To Do About It

Metabolic syndrome and simple excess weight often involve impaired carbohydrate metabolism. Over time, excessive carbohydrate consumption can turn overweight and metabolic syndrome into prediabetes, then type 2 diabetes.  Carbohydrate restriction directly addresses impaired carbohydrate metabolism naturally. When my patients have metabolic syndrome, some of my recommendations are:

  • weight loss, often via a low-carb diet (but most any reasonable diet may also work)
  • carbohydrate-restricted diet if blood sugars or triglycerides are elevated
  • regular exercise, a combination of strength and aerobic training

If these are effective, the patient can often avoid costly drugs and their potential adverse effects.

Ask your doctor what she thinks.

Steve Parker, M.D.

Mediterranean Diet Reduces Risk of Metabolic Syndrome

…in Europeans, according to a recent research report in Nutrition, Metabolism and Cardiovascular Disease. The study at hand lasted over six years and involved over 3,000 participants.

Learn about metabolic syndrome.

Mediterranean Diet + Nuts = Reversal of Metabolic Syndrome

An article published in 2008 by Bloomberg.com presents results of a scientific study in Spain that showed reduction in “metabolic syndrome” by the Mediterranean diet supplemented with nuts. CBSnews.com, Reuters, and others helped spread the news. The Bloomberg article was written by Nicole Ostrow.

Metabolic syndrome is a constellation of clinical factors that are associated with increased risk of type 2 diabetes and atherosclerotic complications such as heart attack and stroke. (Sometimes metabolic sydrome is called Syndrome X, which I sorta like. Oh, the mystery!) One in six Americans have the syndrome. Diagnosis requires at least three of the following five conditions:

  • High blood pressure (130/85 or higher, or using a high blood pressure medication)
  • Low HDL cholesterol: under 40 mg/dl in a man, under 50 in a women (or either sex taking a cholesterol-lowering drug)
  • Triglycerides over 150 mg/dl (or taking a cholesterol-lowering drug)
  • Abdominal fat: waist circumference 40 inches or greater in a man, 35 inches or greater in a woman
  • Fasting blood glucose over 100 mg/dl

The scientific study at hand is part of the PREDIMED study being conducted in Spain. For this portion of the study, 1,224 participants at high risk for cardiovascular disease were randomized to follow a 1) low-fat diet (considered the control group), 2) Mediterranean diet plus 1 liter virgin olive oil per week, or 3) Mediterranean diet plus 30 gm daily of mixed nuts.

Note that the nuts used in this study were walnuts, almonds, and hazelnuts. Half of all nuts were walnuts; a quarter of the nuts were almonds and a quarter were hazelnuts.

Participants were 55-80 years old, and 61% had metabolic syndrome at baseline. Participants could eat all they wanted, and there was no increase in physical activity for any of the groups. Participants were given instructions at baseline and quarterly.

After one year of intervention, the prevalence of metabolic syndrome was reduced by 14% in the Mediterranean diet plus nuts group compared to the control, low-fat diet group. The Mediterranean diet plus extra olive oil group reduced prevalence of metabolic syndrome by 7%, but this did not reach statistical significance (P=0.18).

New cases of metabolic syndrome continued to develop at about the same rate in all three groups. I.e., incident rates were not significantly different. So, the lower prevalence of metabolic syndrome after one year reflected reversion or clearing of the syndrome in many people who had it at baseline. Compared to the control group, people in the nutty group were 70% more likely to resolve their metabolic syndrome. Individuals in the oily group were 30% more likely than controls to resolve the condition.

(Feel free to consult a dictionary for definitions of “prevalence” and “incidence.”)

The researchers conclude that:

A traditional Mediterranean diet enriched with nuts could be a useful tool in the management of the metabolic syndrome.

My Comments:

Thirty grams (daily) of nuts is a decent-sized snack of about 180 calories. Thirty grams of almonds formed a heap in the palm of my hand, not touching my fingers. This is more than the “two tablespoons” reported by CBSnews.com December 9.

If you have metabolic syndrome, you might want to try reversing it with all the usual methods (e.g., lose excess fat weight, exercise more) along with a traditional Mediterranean diet enriched with 30 gm of mixed nuts daily. As usual, check with your personal healthcare provider first. Be aware that many of them won’t know about this study.

The puzzling thing to me is: If the Mediterranean diet plus extra nuts is so effective in reversing metabolic syndrome, why didn’t that study cohort see fewer new cases of metabolic syndrome?

Steve Parker, M.D.

Additional reference: Salas-Salvado, Jordi, et al. Effect of a Mediterranean Diet Supplemented With Nuts on Metabolic Syndrome Status: One-Year Results of the PREDIMED Randomized Trial. Archives of Internal Medicine, 168 (2008): 2,449-2,458.

Spanish Ketogenic Mediterranean Diet

Ever heard of the Spanish Ketogenic Mediterranean Diet? It looks like a low-carb quasi-Mediterranean diet.

Researchers with the University of Cordoba in Spain studied 40 subjects eating a low-carb “Mediterranean” diet for 12 weeks. The results were strikingly positive.

Methodology

A medical weight loss clinic was the source of 40 overweight subjects, 22 males and 19 females, average age 38, average body mass index 36.5, average weight 108.6 kg (239 lb). These folks were interested in losing weight, and were not paid to participate.

Nine subjects were not included in the final analysis due to poor compliance with the study protocol (3), the diet was too expensive (1), a traumatic car wreck (1), or were simply lost to follow-up (4). So all the data are pooled from the 31 subjects who completed the study.

Blood from all subjects was drawn just before the study began and again after 12 weeks of the diet.

Study diet: Low-carbohydrate, high in protein [and probably fat, too], unlimited in calories. Olive oil was the main source of fat (at least 30 ml daily). Maximum of 30 grams of carbohydrates daily as green vegetables and salad. 200-400 ml daily of red wine. The authors write:

Participants were permitted 3 portions (200 g/portion) of vegetables daily: 2 portions of salad vegetables (such as alfalfa sprouts, lettuce, escarole, endive, mushrooms, radicchio, radishes, parsley, peppers, chicory, spinach, cucumber, chard and celery), and 1 portion of low-carbohydrate vegetables (such as broccoli, cauliflower, cabbage, artichoke, eggplant, squash, tomato and onion). 3 portions of salad vegetables were allowed only if the portion of low-carbohydrate vegetables were not consumed. Salad dressing allowed were: garlic, olive oil, vinegar, lemon juice, salt, herbs and spices.

The minimum 30 ml of olive oil were distributed unless in 10 ml per principal meal (breakfast, lunch and dinner). Red wine (200–400 ml a day) was distributed in 100–200 ml per lunch and dinner. The protein block was divided in “fish block” and “no fish block”. The “fish block” included all the types of fish except larger, longer-living predators (swordfish and shark). The “no fish block” included meat, fowl, eggs, shellfish and cheese. Both protein blocks were not mixed in the same day and were consumed individually during its day on the condition that at least 4 days of the week were for the “fish block”.

Trans fats (margarines and their derivatives) and processed meats with added sugar were not allowed.

Vitamin and mineral supplements were given.

Subjects measured their ketosis state every morning with urine ketone strips.

Results (averaged)

  • Body weight fell from 108.6 kg (239 lb) to 94.5 kg (209 lb), or 2.5 pounds per week
  • Body mass index fell from 36.5 to 31.8
  • Systolic blood pressure fell from126 to 109 mmHg
  • Diastolic blood pressure fell from 85 to 75 mmHg
  • Total cholesterol fell from 208 to 187 mg/dl
  • LDL chol fell from 115 to 106 mg/dl
  • HDL chol rose from 50 to 55 mg/dl
  • Fasting glucose dropped from 110 to 93 mg/dl
  • Triglycerides fell from 219 to 114 mg/dl
  • No significant differences in male and female subjects
  • No adverse reactions are mentioned

Researchers’ Conclusions

The SKMD [Spanish Ketogenic Mediterranean Diet] is safe, an effective way of losing weight, promoting non-atherogenic lipid profiles, lowering blood pressure and improving fasting blood glucose levels. Future research should include a larger sample size, a longer term use and a comparison with other ketogenic diets.

My Comments

The researchers called this diet “Mediterranean” based on olive oil, red wine, fish, and vegetables.

What’s “Not Mediterranean” is the paucity of carbohydrates (including whole grains); lack of yogurt, nuts, and legumes; and the high meat/protein intake.

The emphasis on olive oil, red wine, and fish could make this healthier than other ketogenic diets.

Ketogenic diets are notorious for high drop-out rates compared to other diets. But several studies suggest greater short-term weight loss for people who stick with it. Efficacy and superiority are little different from other diets as measured at one year out.

Many of the metabolic improvements seen here might be duplicated with loss of 30 pounds (13.6 kg) over 12 weeks using any reasonable diet.

Average fasting blood sugars in these subjects was 109 mg/dl. Although not mentioned by the authors, this is in the prediabetes range. The diet reduced average fasting blood sugar to 93, which would mean resolution of prediabetes. Dropping body mass index from 36 to 32 by any method would tend to cure prediabetes.

Elevated blood sugar is one component of the “metabolic syndrome.” Metabolic syndrome was recently shown to be reversible with a Mediterranean diet supplemented with nuts.

If you’re thinking about doing something like this, get more information and be sure to get your doctor’s approval first.

My Ketogenic Mediterranean Diet has much in common with the study at hand. One of several major differences is that it’s user-friendly and ready to implement as soon as you have your physician’s clearance. It’s posted at the Diabetic Mediterranean Diet Blog.

Steve Parker, M.D.

Addendum:

In April, 2008, had a delightful conversation with Jimmy Moore, of Livin’ La Vida Low-Carb fame regarding this study. I reviewed this article in preparation.  It struck me that the Spanish Ketogenic Mediterranean Diet is probably higher in protein and lower in fat than many other ketogenic weight-loss diets. Since fish is emphasized over other animal-derived foods, it’s likely also lower in saturated fat. (In low-carb diets, carbohydrates are substituted with either fats or proteins.)

References and Additional Reading:

Perez-Guisado, J., Munoz-Serrano, A., and Alonso-Moraga, A. Spanish Ketogenic Mediterranean diet: a healthy cardiovascular diet for weight loss. Nutrition Journal, 2008, 7:30. doi:10.1186/1475-2891-7-30 I like the idea behind Nutrition Journal. From the publisher’s website:

Nutrition Journal aims to encourage scientists and physicians of all fields to publish results that challenge current models, tenets or dogmas. The journal invites scientists and physicians to submit work that illustrates how commonly used methods and techniques are unsuitable for studying a particular phenomenon. Nutrition Journal strongly promotes and invites the publication of clinical trials that fall short of demonstrating an improvement over current treatments. The aim of the journal is to provide scientists and physicians with responsible and balanced information in order to improve experimental designs and clinical decisions.

With the advent of the Internet, has dawned a new way to exchange information and to publish biomedical journals. BioMed Central has been a pioneer in online publishing with Nutrition Journal being one of its many journals. Publication in Nutrition Journal offers many advantages over traditional paper publications; the journal offers free access to its articles; high quality and rapid peer-review; immediate publication; and most importantly, universal access to its content from virtually any place in the world.

Bravata, D.M., et al. Efficacy and safety of low-carbohydrate diets: a systematic review. Journal of the American Medical Association, 289 (2003): 1,837-1,850.

Gardner, C.D., et al. Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A TO Z Weight Loss Study: a randomized trial. Journal of the American Medical Association, 297 (2007): 696-677.

Stern, L., et al. The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: one-year follow-up of a randomized trial. Annals of Internal Medicine, 140 (2004): 778-785.

Shai, Iris, et al. Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet. New England Journal of Medicine, 359 (2008): 229-241.

Spanish Ketogenic Mediterranean Diet Cures Metabolic Syndrome

The very-low-carb Spanish Ketogenic Mediterranean Diet cures metabolic syndrome, according to investigators at the University of Córdoba in Spain. The metabolic syndrome is a collection of clinical factors that are linked to high risk of developing type 2 diabetes and heart disease. Individual components of the syndrome include elevated blood sugar, high trigylcerides, low HDL cholesterol, high blood pressure, and abdominal fat accumulation.

Spanish researchers put 26 people with metabolic syndrome on the Spanish Ketogenic Mediterranean Diet for twelve weeks and monitored what happened. At baseline, average age was 41 and average body mass index was 36.6. Investigators didn’t say how many diabetics or prediabetics were included. No participant was taking medication.

What’s the Spanish Ketogenic Mediterranean Diet?

Calories are unlimited, but dieters are encouraged to keep carbohydrate consumption under 30 grams day. They eat fish, lean meat, eggs, chicken, cheese, green vegetables and salad, at least 30 ml (2 tbsp) daily of virgin olive oil, and 200-400 ml of red wine daily ( a cup or 8 fluid ounces equals 240 ml). On at least four days of the week, the primary protein food is fish. On those four days, you don’t eat meat, chicken, eggs, or cheese. On up to three days a week, you could eat non-fish protein foods but no fish on those days.

How’s this different from my Ketogenic Mediterranean Diet? The major differences are that mine includes one ounce (28 g) of nuts daily, less fish overall, and you can mix fish and non-fish protein foods every day.

Regular exercisers were excluded from participation, and my sense is that exercise during the diet trial was discouraged.

What Were the Results?

Metabolic syndrome resolved in all participants.

Three of the original 26 participants were dropped from analysis because they weren’t compliant with the diet. Another one was lost to follow-up. Final analysis was based on the 22 who completed the study.

Eight of the 22 participants had adverse effects. These were considered slight and mostly appeared and disappeared during the first week. Effects included weakness, headache, constipation, “sickness”, diarrhea, and insomnia.

Average weight dropped from 106 kg (233 lb) to 92 kg (202 lb).

Body mass index fell from 36.6 to 32.

Average fasting blood sugar fell from 119 mg/dl (6.6 mmol/l) to 92 mg/dl (5.1 mmol/l).

Triglycerides fell from 225 mg/dl to 110 mg/dl.

Average systolic blood pressure fell from 142 mmHg to 124.

Average diastolic blood pressure fell from 89 to 76.

So What?

A majority of people labeled with metabolic sydrome continue in metabolic sydrome for years. That’s because they don’t do anything effective to counteract it. These researchers show that it can be cured in 12 weeks, at least temporarily, with the Spanish Ketogenic Mediterranean Diet.

Very-low-carb diets are especially good at lowering trigylcerides, lowering blood sugar, and raising HDL cholesterol. Overweight dieters tend to lose more weight, and more quickly, than on other diets. Very-low-carb diets, therefore, should be particularly effective as an approach to metabolic syndrome. It’s quite possible that other very-low-carb diets, such as Atkins Induction Phase, would have performed just as well as the Spanish Ketogenic Mediterranean Diet. In fact, most effective reduced-calorie weight-loss diets would tend to improve metabolic syndrome, even curing some cases, regardless of carb content.

Most physicians recommend that people with metabolic syndrome either start or intensify an exercise program. The program at hand worked without exercise. I recommend regular exercise for postponing death and other reasons.

Will the dieters of this study still be cured of metabolic syndrome a year later? Unlikely. Most will go back to their old ways of eating, regaining the weight, and moving their blood sugars, triglycerides, and HDL cholesterols in the wrong direction.

Steve Parker, M.D.

Reference: Pérez-Guisado J, & Muñoz-Serrano A (2011). A Pilot Study of the Spanish Ketogenic Mediterranean Diet: An Effective Therapy for the Metabolic Syndrome. Journal of medicinal food PMID: 21612461