What Do Dietitians Think About Ketogenic Diets?

Posted on December 23, 2012 | Comments Off on What Do Dietitians Think About Ketogenic Diets?

You get it?

Registered Dietitian Franziska Spritzler recently reviewed the concept of low-carb ketogenic diets.  She thinks they are a valid approach to certain clinical situations.  Among dietitians, this puts her in a small but growing minority.

One of your weight-loss choices in my Advanced Mediterranean Diet (2nd Edition) is a ketogenic diet.  Here’s the basic program.

I hesitate to mention this, but I will anyway.  Many, if not most, dietitians too easily just go along with the standard party line on low-carb eating: it’s rarely necessary and quite possibly unhealthy.  Going along is much easier than doing independent literature review and analysis.  I see the same mindset among physicians.

Franziska breaks the mold.

Steve Parker, M.D.

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QOTD: Joshua Brown On Email

Posted on December 16, 2012 | Comments Off on QOTD: Joshua Brown On Email

Email is totally out of control and needs to be made illegal effective immediately. It is the worst thing that’s ever happened to humanity. Unless you consider the alternative – phone calls – which I view as an act of violence. “Why is he calling me? What emergency necessitated his dialing my number and waiting for it to ring, what utter atrocity required the disruptively instantaneous back-and-forth of a voice conversation?” But I digress…

Here’s the thing you have to know about emails in 2012: It’s okay to ignore them. Even the ones from people you know. I started doing that this fall and you know what’s gone wrong? Nothing. No lost friendships, no hard feelings, no missed business opportunities, no miscommunications. It’s all good. So which emails do you respond to and which do you ignore? Simple! When you see an email, ask yourself “is ignoring this going to keep me up at night and make me feel as though I’ve been careless or sloppy or cruel?”  If the answer is yes, then deal with the email! If not, ignore it. It’s okay, if the person sending it knows you, then they’ll accept that you’re busy or think maybe you never got it (the spam folder ate my homework). This frees you up to respond to clients, vendors, business partners and close friends and acquaintances with whom you’re actively dialoging or making plans.

So don’t make all these dumbass folders and files you’re never going to use, just start blowing emails off as they come in. A wise man once said that your inbox is like a To Do list that someone else makes for you. To which I say, no thanks. I make my own To Do list, the needs and wants and tasks of others come after the tasks that are important to my clients and my practice.

As for what should replace the email, I vote for the Twitter direct message. No one will DM you annoying or wasteful communiques if you’re following each other on Twitter. PR people can be blocked, never mind any “safe unsubscribe” email spam ritual – you can get rid of a PR sea-creature whom you’ve accidentally followed forever with a Twitter unfollow.  As soon as they start allowing attachments on Twitter and slightly longer messaging, I’m going to start replacing as many email convo’s as possible with it.

—Joshua M. Brown

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U.S. Life Expectancy: Overall Versus Type 1 Diabetes

Posted on December 15, 2012 | Comments Off on U.S. Life Expectancy: Overall Versus Type 1 Diabetes

Type 1 diabetics diagnosed in childhood and born between 1965 and 1980 have an average life expectancy of 68.8 years.  That compares to a lifespan average of 53.4 years for those born earlier, between 1950 and 1964.  The figures are based on Pittsburgh, PA, residents and published in a recent issue of Diabetes.

Elizabeth Hughes, one of the very first users of insulin injections, lived to be 73.  She started on insulin around 1922.

Average overall life expectancy in the U.S. is 78.2 years—roughly 76 for men and 81 for women.

Don’t be too discouraged if you have diabetes: you have roughly a 50:50 chance of beating the averages, and medical advances will continue to lengthen lifespan.

Steve Parker, M.D.

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QOTD: Rule of Lawyers

Posted on December 13, 2012 | Comments Off on QOTD: Rule of Lawyers

Americans could once boast proudly that their system set the benchmark for the world; the United States was the rule of law. But now what we see is the rule of lawyers, which is something different.

—Niall Ferguson

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Study Finds Low-Carb Diet Reduces Heart Disease Risk Factors

Posted on December 8, 2012 | Comments Off on Study Finds Low-Carb Diet Reduces Heart Disease Risk Factors

Obesity Reviews just published details of a recent meta-analyis of low-carbohydrate diet effects on cardiovascular risk factors.

A systematic review and meta-analysis were carried out to study the effects of low-carbohydrate diet (LCD) on weight loss and cardiovascular risk factors (search performed on PubMed, Cochrane Central Register of Controlled Trials and Scopus databases). A total of 23 reports, corresponding to 17 clinical investigations, were identified as meeting the pre-specified criteria.

Over a thousand obese patients were involved.  By eating low-carb, blood pressure dropped by 3–4 mmHg, average body weight decreased by 7 kg (15 lb), body mass index dropped by 2, triglycerides decreased by 30 mg/dl, hemoglobin A1c dropped by 0.21% (absolute decrease), insulin levels fell by 2.23 micro IU/ml, while HDL cholesterol rose by 1.73 mg/dl.  LDL cholesterol didn’t change.

The authors conclusion:

Low-carboydrate diet was shown to have favourable effects on body weight and major cardiovascular risk factors; however the effects on long-term health are unknown.

I haven’t see the full text of the article yet, so I don’t know the carbohydrate level under review.  I bet it’s under 50 g of digestible carb daily.  My Low-Carb Mediterranean Diet starts at 20-30 grams a day.

Steve Parker, M.D.

Reference:  Santos, F.L., et al. Systematic review and meta-analysis of clinical trials of the effects of low carbohydrate diets on cardiovascular risk factors. Obesity Reviews. Article first published online: 20 AUG 2012. DOI: 10.1111/j.1467-789X.2012.01021.x

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Book Review: The Oldways 4-Week Mediterranean Diet Menu Plan

Posted on December 5, 2012 | Comments Off on Book Review: The Oldways 4-Week Mediterranean Diet Menu Plan

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I’ve been an admirer of Oldways for many years. They tirelessly advocate for a way of eating that demonstrably lengthens lifespan while reducing rates of heart disease, stroke, cancer, diabetes, and dementia. Especially when compared to the standard American diet.

I’m very pleased to see Oldways present a four-week plan that helps the average person incorporate Mediterranean diet principles into daily life. These recipes are simple, practical, and delicious. No need for exotic ingredients or culinary classes!

Get started soon. You won’t regret it.

Steve Parker, M.D.

Disclosure: Olways provided me with a free pre-publication review copy of the book.

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Could the Paleo Diet Prevent Tooth Decay?

Posted on December 3, 2012 | Comments Off on Could the Paleo Diet Prevent Tooth Decay?

The truth is that tooth decay is a relatively new phenomenon. Until the rise of agriculture roughly 10,000 years ago, THERE WAS NO TOOTH DECAY IN HUMANS.  Let that sink in for a moment. Humanity is 2,500,000 years old.  For the fist 2,490,000 years no one ever had a cavity.  If we understand that tooth decay started when people started farming instead of hunting and gathering for a living clearly you realize that tooth decay is a disease or mismatch between what you are eating and what your body expects you to eat.  If we examine the past as prologue it becomes clear that the path to proper health starts in the mouth and the answers are so simple that not only did a Cave Man do it.  They perfected it.

—John Sorrentino in a blog post August 6, 2012

PS: The paleo diet is also referred to as the Paleolithic, Cave Man, Stone Age, ancestral, primal, or hunter-gatherer diet.

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Exercise Does and Doesn’t Help With Weight Loss

Posted on December 1, 2012 | Comments Off on Exercise Does and Doesn’t Help With Weight Loss

With regards to TV’s “The Biggest Loser” show:

The show’s 24-week regimen consists of approximately 4 hours of daily exercise, including 1 hour of intense resistance, 1 hour of intense aerobic activity, and 2 hours of moderate aerobic activity (for example, walking), along with a caloric  intake of at least 70% of estimated resting daily energy expenditure, explained Dr. [Robert] Huizenga, who is a former team physician to the L.A. Raiders football team.

exercise for weight loss and management, dumbbells

If you’re not familiar with resistance training, a personal trainer is an great idea

This is an excerpt from “The Biggest Loser Pushes Envelope on Diabetes,” in Internal Medicine News, vol. 45, No.11, page 17.

In a previous post about The Biggest Loser, I’d written that I didn’t know how much they exercised.

For purposes of discussion, let’s assume the documented major weight losses of Biggest Loser contestants is not simply due to caloric restriction.

Dr. Huizenga shared some of his experience at the recent annual meeting of the American Association of Clinical Endocrinologists.  In a study of 35 Biggest Loser participants, about half had prediabetes or type 2 diabetes.  Hemoglobin A1c, a measure of blood sugar control, fell significantly in this subset.  Three of the six with diabetes were able to stop metformin early on.  By week 29 of the study, average body mass index for the entire group had fallen from 46 to 29.

Yes, exercise helps with weight loss.  But most folks aren’t willing or able to exercise vigorously for four hours a day.  Physical activity is more important for maintenance of weight loss, when it demands much less time.

Steve Parker, M.D.

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Exercises For Low Back Pain

Posted on November 29, 2012 | 2 comments

Flexibility and strengthening exercises help to reduce the pain and disability of chronic nonspecific low back pain.  Hoping to find a simple straightforward program to suggest to you, I reviewed “Exercise-based therapy for low back pain” at UpToDate.com.

Unfortunately, I didn’t find much.

By the way, exercises don’t help with acute low back pain (under 4 weeks duration).

You need to work with your personal physician for a diagnosis and treatment plan.  I’m not your doctor.  He may well refer you to a physical therapist, which is a good idea.

Some factoids from UpToDate:

  • low back pain is the most common musculoskeletal disorder worldwide
  • 85% of us experience low back pain at some point
  • in the U.S., yearly total cost of low back pain exceeds $100 billion

Here’s a quote that may shock you:

For most patients with low back pain, a specific etiology [cause] cannot be established with certainty.

I bet your doctor, chiropractor, or massage therapist never told you that.

The UpToDate folks suggest a combination of core strengthening (especially abdominal and trunk extension), directional preference (e.g., McKenzie method), general physical fitness, flexion and extension movements, aerobics, and functional restoration programs.  Some studies found benefit with Alexander technique, yoga, Pilates, and tai chi.

They didn’t mention Dr. John Sarno (“Your pain is from repressed anger”) or the Five Tibetan Rituals.

I hate to leave you empty-handed, so take this:

Again, if low back pain is a significant issue for you, it’s a good idea to work with a physical therapist.

What’s worked for you?

Steve Parker, M.D.

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QOTD: Warren G. Harding and Recession

Posted on November 23, 2012 | Comments Off on QOTD: Warren G. Harding and Recession

The White House

[U.S. President Warren G.] Harding inherited an absentee presidency and one of the sharpest recessions in American history.  By July 1921 it was all over and the economy was booming again.  Harding had done nothing except cut government expenditure….

—Paul Johnson, in his book, Modern Times, 1983 & 1991

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