Reduce Your Cancer Risk Starting Today

Posted on July 25, 2012 | Comments Off on Reduce Your Cancer Risk Starting Today

In 2007, the World Cancer Research Fund and the American Institute for Cancer Research jointly published a report having the potential to reduce cancer rates by at least a third, if their recommendations were adopted.  A multinational team of 21 respected experts was charged with analyzing over 7,000 studies relating to diet, exercise, body weight, and cancer.  The panel assumes everyone already knows to avoid smoking and chewing tobacco.  Here are their 10 basic recommendations:

1.  Be as lean as possible within the normal range of body weight (BMI or body mass index of 18.5 to 24.9).  Being overweight or obese promotes certain cancers.

2.  Be physically active every day.  Example: 30 minutes of brisk walking.

3.  Limit consumption of energy-dense (high-calorie) foods.  Avoid sugary drinks.  Water is the best alternative to sugary drinks.  Natural fruit juice is a reasonable fruit serving, but limit to one daily.

4.  Eat mostly foods of plant origin.  Fill at least two-thirds of your plate with vegetables, fruits, whole grains, and beans.

5.  Limit intake of red meat and avoid processed meats.  Red meats are beef, pork, and lamb.  Limit to 18 ounces of cooked red meat per week.

6.  For pure cancer avoidance, don’t drink alcohol.  The panel recognizes, however, that alcohol likely helps in prevention of coronary heart disease.  If you drink alcohol for heart benefits, limit to two drinks daily if you are a man, and one daily if you are a woman.

7.  Limit consumption of salt (associated with stomach cancer).  Avoid moldy cereals and legumes (molds produce aflatoxins which cause liver cancer).

8.  Aim to meet nutritional needs through food intake rather than supplements.

9.  Mothers should breast-feed for six months (at least?).  Children should be breast-fed.

10.  Cancer survivors should still follow the recommendations for prevention of cancer.

Much of this is consistent with my book, The Advanced Mediterranean Diet: Lose Weight, Feel Better, Live Longer (2nd Edition).  The AMD is a diet/weight loss book, with little reason to seriously address breast-feeding and cancer survivors.  The association between salt intake and stomach cancer is news to me.  Stomach cancer is not very common in the United States, where I and most of my audience live.  Overweight people following the Advanced Mediterranean Diet will be far ahead of the game if they get their BMI just down to 24.9.  I’m not convinced 18.5 would be any healthier, and many studies suggest the opposite.

Steve Parker, M.D.

References: Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective

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Overweight Youth Point To Increase In Heart Disease

Posted on July 24, 2012 | Comments Off on Overweight Youth Point To Increase In Heart Disease

No doubt you have noticed the expanding girths of  U.S. yoots.  What are the health implications?  Research published in the New England Journal of Medicine suggests a disturbing answer.

Heavy youths tend to stay heavy as they age.  Researchers looked at the incidence of overweight adolescents in the year 2000 and then estimated the prevalence of obesity in the year 2020.  Thirty to 44% of 35-year-olds in 2020 are expected to be obese.

Using computer simulation, investigators estimated that by 2035 the prevalence of coronary heart disease will increase by 5 to 16% because of the increased obesity.  In other words, the increasing obesity in these young and middle-aged adults will result in over 100,000 excess cases of coronary heart disease.

That is, if current trends continue.  But I see nothing on the horizon likely to alter that societal trend in the near future.  I’m doing my part.  How about you?

Steve Parker, M.D.

References:  Bibbins-Domingo, K, et al.  Adolescent Overweight and Future Adult Coronary Heart Disease.  New England Journal of Medicine, 357 (2007): 2,371-2,379.

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It’s Not Too Late to Get Healthier, Even if Middle-Aged

Posted on July 23, 2012 | Comments Off on It’s Not Too Late to Get Healthier, Even if Middle-Aged

Are your eventual health problems a matter of fate by the time you reach middle age?

A study from the Medical University of South Carolina asked whether middle-aged folks could improve their health and longevity by making healthful changes in lifestyle.  15,708 study participants, ages 45-64, were surveyed with regards to four “healthy lifestyle” components, namely:

  • five or more fruits and vegetables daily
  • regular exercise
  • healthy weight range (BMI 18.5-29.9)
  • no current smoking

When first surveyed, 8.5% of the participants had all four of the healthy lifestyle components.  When surveyed six years later, 8.4% of the remainder had adopted these four healthy lifestyle features.  Overall death rate and cardiovascular disease events were monitored over the next four years.  Compared to the study participants who did not adopt a healthy lifestyle, the new adopters had a 40% lower incidence of death from all causes and 35% less cardiovascular disease events.

So middle-aged people can improve their longevity and avoid cardiovascular disease by making healthy lifestyle changes.  These improvements are very significant in degree and comparable to, if not better than, results seen with many expensive medications and invasive medical procedures.

Why not make some changes today?

Steve Parker, M.D.

References: King, Dana E., et al.  Turning Back the Clock: Adopting a Healthy Lifestyle in Middle Age.  American Journal of Medicine, 120(2007): 598-603.

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Book Review: Six Weeks to OMG

Posted on July 22, 2012 | Comments Off on Book Review: Six Weeks to OMG

I heard about this book before it was ever available in the U.S. and I thought it had the potential to be huge here.  So I read Six Weeks to OMG: Get Skinnier Than All Your Friends by Venice Fulton, published in 2012.  Per Amazon.com’s rating system, I give it two stars (“I don’t like it”).

♦   ♦   ♦

Judging from the wording and writing style, this book was written for not-too-bright girls and women from 12 to 22 years old.  Others need not bother with it.

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Will it work for weight loss?  Yes, even without the author’s three cornerstone gimmicks: 1) Skip breakfast, but eat three meals daily, 2) Daily cold-water baths at 59 to 68°F for up to 15 minutes, and 3) Black coffee one or two cups every morning.  There’s no good scientific data to support those prescriptions.

The diet will work because it restricts your consumption of items that make us fat: concentrated sugars and refined starches.  It’s a low-carbohydrate diet—up to 60, 90, or 120 grams a day, depending on how fast you want to lose.

The diet consists mostly of high-protein animal-derived foods, low-carb vegetables, and up to three pieces of fruit daily.  Do not exceed 40 grams of carbohydrate per meal, even less is better, the author says.  Grains and dairy products aren’t mentioned much; it’s easy to blow your carb limit with them.  High-carb vegetables are listed, so you can avoid them.

Mr. Fulton emphasizes some important, valid points.  High protein consumption helps control appetite.  Trans fats are bad.  Eat cold-water fatty fish twice weekly.  Eat off a small plate (maximum of 9-inch diameter).  No snacking.  He says good things about weight training, while failing to mention it’s more much important long-term maintenance than for active weight loss.

He says some things that are just plain wrong, such as 1) everyone can be skinny, 2) there are only eight essential amino acids, 3) exercise is fairly helpful with weight loss, and 4) weight training just once every 10 days is adequate.

I’ll confess I didn’t read every word of the book.  The writing style is just too irritating unless you’re a not-too-bright 12 to 22-year-old.  For instance, every page had at least four exclamation marks!

Here are some of the dumbed-down sentences that unintentionally made me laugh out loud:

  • “The key to success is understanding stuff.”
  • “If you have problems controlling your appetite, the main reason is that you eat too often.”
  • “The person in the mirror, that’s you.”
  • “Human beings are part of the universe.  And that’s full of laws.  The laws of physics, chemistry and biology are three well-known laws.”

If you want a low-carb weight loss diet, you’re better off with Protein Power, The New Atkins For a New You, or the Low-Carb Mediterranean Diet.

Steve Parker, M.D.

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Think Diets Don’t Work? Think Again

Posted on July 22, 2012 | Comments Off on Think Diets Don’t Work? Think Again

Claims that “diets don’t work” are based on the assumption that any weight lost is simply gained back quickly.

The Endocrine Society met in Toronto in June of 2007.  Experts presented data on maintenance of weight loss by overweight people.  What percentage of people who lost 10% of their weight kept the weight off for one year?  About 20%.  Not great, but better than many would expect.  That’s a 200-pounder losing down to 180 and staying at 180 pounds for a year.  This degree of weight loss will improve many cases of high blood pressure, knee arthritis, and type 2 diabetes mellitus.

The U.S. Centers for Disease Control and Prevention reports even better data.  Almost 60% of 1,310  people in the National Health and Nutrition Examination Survey who lost 10% of body weight maintained 95% of the loss for one year.

How do they keep the weight off?  Characteristics of “successful losers” include a low-calorie diet (probably 1,6oo-1,800 on average), weighing at least once per week, and burning about 2,600 calories per week in physical activity.  (A 150-pound person expends 1260 calories a week by walking 3-4 mph for 30 minutes daily.)

Many successful losers cycle through weight loss and gain several times before determining which combination of diet and physical activity ultimately works for them.

So don’t give up!

Steve Parker, M.D,

References:

McGuire, M.T., et al.  International Journal of Obesity, 23[12] (1999): 1,314-1,319.

Weiss, E.C., et al.  American Journal of Preventive Medicine, 33[1] (2007): 34-40.

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Berry Science

Posted on July 21, 2012 | Comments Off on Berry Science

The Mediterranean diet was originally found to be a healthy diet by comparing populations who followed the diet with those who didn’t.  The result?  Mediterranean diet followers had less cardiovascular disease, less cancer, and longer life.

Over the last 15 years, researchers have been clarifying exactly how and why this might be the case.  A study from Finland is a typical example.

The traditional Mediterranean diet has an abundance of fresh fruit, including berries.  Berries are a rich source of polyphenols and vitamin C, substances with the potential to affect metabolic and disease processes in our bodies.

The Finnish researchers studied 72 middle-aged subjects, having half of them consume moderate amounts of berries, and half consume a placebo product over 8 weeks.  Compared with the placebo group, the berry eaters showed inhibited platelet funtion, a 5% increase in HDL cholesterol (the “good” cholesterol), and a 7-point drop in systolic blood pressure.

What does platelet function have to do with anything?  Platelets are critical components of blood clots.  Blood clots can stop life-threatening bleeding, but also contribute to life-threatening heart attacks and strokes.  Inhibition of platelet function can decrease the occurence of blood clots that cause heart attacks and strokes.  That’s why millions of people take daily aspirin, the best known platelet inhibitor.

Cardiovascular disease is a group of conditions that include high blood pressure, heart attacks, poor circulation, and strokes.  Berry consumption in this small Finnish study resulted in favorable changes in blood pressure, HDL cholesterol, and platelet function.  These changes would tend to reduce the occurence and severity of cardiovascular disease.

So berries don’t just taste good, they’re good for us.  If price is a concern, focus on the berries that are in season or use frozen berries.

Steve Parker, M.D.

Reference: Erlund, I., et al, Favorable effects of berry consumption on platelet function, blood pressure, and HDL cholesterol.  American Journal of Clinical Nutrition, 87 (2007): 323-331.

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Informercial Superstar Found In Contempt of Court

Posted on July 20, 2012 | 1 comment

Kevin Trudeau, author of The Weight Loss Cure “They” Don’t Want You to Know About and numerous other books, has been in trouble with the law over many years.

The twice-convicted felon was banned in 2004 from using infomercials to sell most products except for books and other publications.  The exception required that he not make false claims in infomercials.  The 2004 settlement regarding false claims also required him to pay $2 million.

Informercials for the aforementioned book began running in 2006.  In the commercials, Trudeau claims that his weight-loss plan is easy, simple, and you can do it at home.  “When you’re done, eat whatever you want and you don’t gain weight back.”

In reality, the book describes a complicated system involving daily intramuscular injections of human chorionic gonadotrophin (HCG), a prescription drug not approved by the U.S. FDA for weight loss.  You’ll have great difficulty finding a U.S. physician willing to prescribe this.  (The FDA last year told HCG marketers to cease and desist.)  The plan involves specialized cleanses and supplements.  One phase involves eating only 500 calories per day for 21 to 45 days, which is considered severe caloric restriction even for someone on a diet.  (Most people eat 1,500-2,5000 cal/day to maintain weight.)  Trudeau recommends 15 “colonics”  from a licensed colon therapist.  The book lists severe dietary prohibitions for life.

Trudeau’s felony convictions were in the 1990s: depositing bad checks, and credit card fraud.

On November 16, 2007, U.S. District Court Judge Robert W. Gettleman found Trudeau in comtempt of court for violating the 2004 injunction.

Trudeau’s Weight Loss Cure made it onto bestseller lists of the New York Times, the Wall Street Journal, and USA Today.

Go figure.

Steve Parker, M.D.

References:

FTC, plaintiff v. Kevin Trudeau et al, FTC news release 9/14/07

U.S. District Court for Northern District of Illinois, Eastern Division, File # 032 3064, Civil Actions # 03 C3904 and 98-C-0168.

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How to Prevent Heart Attacks in Women

Posted on July 19, 2012 | Comments Off on How to Prevent Heart Attacks in Women

Researchers studied 24,444 Swedish women over the course of 6.2 years, analyzing dietary patterns, healthy lifestyle choices, and body weight.  Information on the women was obtained mostly by surveys at the start and end of the study.  The women were aged 48 to 83 at the start of the study and were free of diabetes mellitus, cardiovascular disease, cancer, and coronary artery disease.

Heart attacks in the study cohort were identified in the Swedish Hospital Discharge Registry and the Cause of Death Registry.  Over the course of six years there were 308 heart attacks.

The study authors noted a greatly reduced incidence of heart attacks in women with the following characteristics:

  1. high consumption of fruits, vegetables, whole grains, legumes, and fish
  2. moderate consumption of alcohol
  3. avoidance of overweight, especially abdominal fat (waist-hip ratio < 0.85)
  4. physically active (at least 40 minutes daily of walking or bicycling and 1 hour weekly of leisure-time exercise
  5. non-smokers

Women meeting these criteria had a 92% lower risk of having a heart attack!  Such women were only 5% of the cohort, however.  I suspect the physical activity criterion knocked a lot of women out of the super heart-healthy subset.

The authors conclude that “most [heart attacks] in women may be preventable by consuming a healthy diet and moderate amounts of alcohol, being physically active, not smoking, and maintaining a healthy weight.”

I see little reason to doubt that these findings apply to the typical woman in the U.S. or Europe, and not just to Swedes.  The traditional Mediterranean diet of the mid-20th century fulfills the dietary prescription for a healthy heart.  The Advanced Mediterranean Diet incorporates these healthy diet and lifestyle choices while simultaneously working to control weight.

Steve Parker, M.D.

Reference:  Akesson, Agneta, et al.  Combined Effect of Low-Risk Dietary and Lifestyle Behaviors in Primary Prevention of Myocardial Infarction in Women.  Archives of Internal Medicine, 167 (2007): 2,122-2,127.

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Prevention of Weight Regain Is NOT Impossible

Posted on July 18, 2012 | Comments Off on Prevention of Weight Regain Is NOT Impossible

I often hear from the general public, and even my physician colleagues, that losing weight and keeping it off is a hopeless goal.  So, why try?

Because it’s not hopeless.

The March 12, 2008, edition of the Journal of the American Medical Association includes an article from the Weight Loss Maintenance Collaborative Research Group.  Researchers identified a group of 1,032 overweight or obese adults who lost at least 8.8 pounds (4 kg) during a 6-month weight loss program.  These adults had high blood pressure, blood lipid abnormalities, or both.  38% were African American and 63% were women.

Average weight of the group before losing weight was 213 pounds (96.7 kg).  The weight-loss program consisted of 20 weekly group sessions, exercise goal of 180 minutes per week (26 minutes per day, usually walking), reduced caloric intake, and adoption of the Dietary Approaches to Stop Hypertension eating pattern.  The goal rate of weight loss was 1 or 2 pounds per week (0.45 to 0.91 kg per week).  Study subjects were taught how to keep records of their caloric intake and physical activity.

Except for the weekly group sessions, this program is similar to the Advanced Mediterranean Diet.

So each of these folks lost at least 8.8 pounds on this program.  Researchers followed them over the next 30 months to see how much weight would be regained.  Average weight loss for the entire group actually was 19 pounds (8.6 kg).  As expected, many people did regain weight over the next 30 months, between 6 and 9 pounds on average.  Of course, some individuals lost much more weight initially, and didn’t gain any back.  Some regained all of the lost weight, plus extra.

Overall, 42% of participants “maintained at least 4 kg [8.8 pounds] of weight loss compared with entry weight…” over the 30 months of follow-up.  37% remained at least 5% below their initial weight.

The “5%” figure stands out, for me, because we see improvement in obesity-related medical problems with loss of just 5 to 10% of body weight.

The authors cite studies indicating that “each kilogram [2.2 pounds] of weight loss is associated with a decrease in systolic blood pressure of 1.0 to 2.4 mmHg and a reduction of incident diabetes of 16%.”

To summarize the weight changes:  Study participants weighed 213 pounds before the behavioral weight-loss program.  Average weight loss was 19 pounds, down to 194 pounds.  Average weight regain over 30 months was in the range of 6 to 9 pounds.  Participants were still pretty big, but 37% of them probably saw some improvement in their medical status.

A huge amount of effort went into this study, on the part of both researchers and study participants.  Nevertheless, average results are relatively modest.  Keep in mind, however, that the numbers are averages, and you are not average.  I’m sure some of the participants went from 220 pounds down to 150 pounds and stayed there.  That could be you.

Steve Parker, M.D.

Reference: Svetkey, Laura et al.  Comparison of Strategies for Sustaining Weight Loss: The Weigth Loss Maintenance Randomized Controlled Trial.  Journal of the American Medical Association, 299 (2008): 1,139-1,148.

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FDA Approves Qsymia for Weight Loss

Posted on July 18, 2012 | 4 comments

“These are flying off the shelves!”

On July 17, 2012, the U.S. Food and Drug Administration approved the combination of phentermine and topiramate for weight loss and management.  They will be marketed in the U.S. as Qsymia.  Don’t ask me how to pronounce it.

The drugs individually had been approved by the FDA years ago for other purposes, so we already know a lot about them.  If memory serves me, phentermine alone is FDA-approved for weight loss, but only for up to 12 weeks.

The press releases from the FDA and Vivus, Inc., don’t say how long the combo drug can be used.  I’m guessing up to one year since that’s how long the clinical trials lasted.

Who Can Take Qsymia?

Obese adults with a body mass index 30 or higher.  Or overweight adults with BMI 27 or higher if they have one or more weight-related condition such as high blood pressure, type 2 diabetes, or high cholesterol.

You Should NOT Take Qsymia If You Have or Are:

  • Pregnant
  • Glaucoma
  • Overactive thyroid
  • Recent stroke
  • Recent unstable heart disease

If I Take the Pill, Do I Still Have to Exercise and Watch My Calories?

Yes.

What’s the Dose?

Phentermine 7.5 mg and topiramate 46 mg daily.  A double strength pill (15 + 92 mg) is available for select patients.

Final Thoughts

Lorcaserin (Belviq) is a weight loss drug approved by the FDA within the last month.  These are the first new weight loss drugs on the U.S. market since 1999.

Abbott voluntarily withdrew Meridia (sibutramine) from the U.S. market in 2010 due to concern about it causing heart attacks and strokes.

In 2008, the European Medicines Agency withdrew prescription-writing for the weight-loss drug rimonabant, citing concern about psychiatric side effects.

Between 1997 and 2007, five weight-loss drugs were removed from various markets around the world due to safety or effectiveness considerations: phenylpropanolamine HCl, dexfenfluramine HCl (e.g., Redux), fenfluramine HCl (Pondimin), diethylpropion HCl (Tenuate), and phentermine HCl (e.g., Ionamin).

It’s unknown whether weight-loss drug therapy reduces the morbidity and mortality of obesity over the long run.

I’ll wait at least two or three years before giving these new drugs to my patients—I’ve seen too many drugs withdrawn from the market because of adverse effects showing up years after drug approval.

Without permanent changes in lifestyle, lost weight is likely to return after you stop taking any weight-loss pill.

Clearly, drugs are no panacea.

Steve Parker, M.D.

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