Prepare For Weight Loss, Part 4: Starting New Habits

Posted on June 10, 2012 | Comments Off on Prepare For Weight Loss, Part 4: Starting New Habits

You already have a number of good habits that support your health and make your life more enjoyable, productive, and efficient. For example, you brush your teeth and bathe regularly, put away clean clothes in particular spots, pay bills on time, get up and go to work every day, wear your seat belt, put your keys or purse in one place when you get home, balance your checkbook periodically.

At one point, these habits took much more effort than they do now. But you decided they were the right thing to do, made them a priority, practiced them at first, made a conscious effort to perform them on schedule, and repeated them over time. All this required discipline. That’s how good habits become part of your lifestyle, part of you. Over time, your habits require much less effort and hardly any thought. You just do it.

Your decision to lose fat permanently means that you must establish some new habits, such as regular exercise and reasonable food restriction. You’ve already demonstrated that you have self-discipline. The application of that discipline to new behaviors will support your commitment and willpower.

Steve Parker, M.D.

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Prepare For Weight Loss, Part 3: Free Will

Posted on June 9, 2012 | Comments Off on Prepare For Weight Loss, Part 3: Free Will

The only way to lose excess fat weight is to cut down on the calories you take in, increase your physical activity, or do both.

Oh, sure. You could get a leg amputated, develop hyperthyroidism or out-of-control diabetes, or have liposuction or bariatric surgery. But you get my drift.

Although the exercise portion of the energy balance equation is somewhat optional, you must reduce food intake to lose a significant amount of weight. Once you reach your goal weight you will be able to return to nearly your current calorie consumption, and even higher consumption if you have increased your muscle mass and continue to be active.

Are you be able to reduce calorie intake and increase your physical activity temporarily? It comes down to whether we have free will. Free will is the power, attributed especially to humans, of making free choices that are unconstrained by external circumstances or by an agency such as divine will.

Will is the mental faculty by which one chooses or decides upon a course of action; volition.

Willpower is the strength of will to carry out one’s decisions, wishes, or plans.

If we don’t have free will, you’re wasting time trying to lose weight through dieting; nothing will get your weight problem under control. Even liposuction and weight-reduction stomach surgery will fail in time if you are fated to be fat. The existence of free will is confirmed for me by my education in religion and philosophy, my intuition, and most prominently, by my experience. I have seen hundreds of my patients lose weight and keep it under control. I didn’t do it for them. No other person, pill, or agency did it for them. They didn’t achieve success by being passive victims of external circumstances. They cut back on calories and increased activity levels through strength of will. They did it.

Read about other success stories at The National Weight Control Registry.

You can enhance your willpower and commitment to losing weight by learning about:

Steve Parker, M.D.

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Prepare For Weight Loss, Part 2: The Energy Balance Equation

Posted on June 8, 2012 | Comments Off on Prepare For Weight Loss, Part 2: The Energy Balance Equation

An old joke from my medical school days asks, “How many psychiatrists does it take to change a light bulb?” Only one, but the light bulb must want to change.

How many weight-loss programs does it take before you lose that weight for good? Only one, but…

Where does the fat go when you lose weight dieting? Metabolic reactions convert it to energy, water, and carbon dioxide, which weigh less than 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. Even at rest, a kilogram of muscle is much more metabolically active than a kilogram of fat tissue. So muscular lean people sitting quietly in a room are burning more calories than are fat people of the same weight sitting in the same room.

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.

If you want to lose excess weight and keep it off, you must learn the following equation:

The energy you eat,

minus the energy you burn in metabolism and activity,

determines your change in body fat.

Or, more succinctly:

Energy Intake minus Energy Expenditure Equals Change in Energy Stores

This is the Energy Balance Equation.

Energy is measured in calories. For example, if you eat 2,000 calories of energy daily, but burn up 2,300 calories daily, you will have a negative energy balance and your fat stores will go down. That is, you lose weight.

Now, a pound of body fat contains 3,500 calories, so you have a way to go before you lose a pound on the bathroom scale.

Overweight and obesity result from an imbalance between energy intake and expenditure.

It’s just that simple. The degree of this imbalance is quite small. Over the course of a year, you will gain three and a half pounds of fat just by adding a teaspoon of butter to your dinner roll every day, assuming all other variables are unchanged. Simply avoid a 10 minute walk daily for a year and you will gain five and a half pounds. Taking the walk and avoiding the teaspoon of butter sound easy, and they are, but if not done you will gain 35 pounds over the course of five years.

While we don’t have much control over our basal metabolic energy requirements (roughly 1,200–1,500 calories daily), many of us are able to adjust food intake and activity levels to strike a happy balance in the energy equation, minimizing unwanted fat. For a lucky few, that desirable balance is automatic and unconscious. The rest of us have to think about it, work at it, make it a priority at times.

Right now your balance is tipped in favor of excess energy stores (fat). It will soon be tipped in the other direction. You will convert fat to energy and lose weight in the process. Once you achieve your goal weight, the energy equation must be balanced again.

There is no doubt that the energy balance equation applies to you. People who swear they can’t lose weight on extreme low-calorie diets have been locked up (with consent) in university medical center metabolic wards with access to food strictly controlled by staff. On appropriate calorie-restricted diets, everyone loses weight. When an exercise program is added, they lose more weight.

Steve Parker, M.D.

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Prepare For Weight Loss, Part 1: Motivation

Posted on June 7, 2012 | Comments Off on Prepare For Weight Loss, Part 1: Motivation

New Years Day 2013 will be here before you know it. And with it comes New Years Resolutions, often including loss of excess weight. 10 PM December 31, with a couple glasses of champagne on-board, is not the best time to flippantly add “4. Lose weight starting tomorrow” to your resolution list. That’s a set-up for failure.

Success requires careful forethought. Questions beg for answers.

Which of the myriad weight-loss programs will I follow? Can I design my own program? Should I use a diet book? Sign up for Nutri-System, Weight Watchers, or Jenny Craig?

Should I stop wasting my time dieting and go directly to bariatric surgery?

Can I simply cut back on sodas and chips? What should I eat? What should I not eat?

Do I need to start exercising? What kind? How much? Do I need to join a gym? What methods are proven to increase my odds of success?

How much weight should I lose?

Should I use weight-loss pills or supplements? Which ones?

What’s the easiest, most effective way to lose weight? Is there a program that doesn’t require willpower?

Now, what were those “top 10 super-power foods” that melt away the fat? Am I ready to get serious and stick with it this time?

Today I start a eight-part series: Prepare for Weight Loss. The series will answer many of these questions and get you teed up for success. Teed up like a golfer ready to hit his first shot on hole #1 of an 18-hole course. [For non-golfers: a tee is a little wooden stick the golfer places his ball on top of for the first shot of any hole.]

We start with Motivation.

Immediate, short-term motivation to lose weight may stem from an upcoming high school reunion, swimsuit season, or a wedding. You want to look your best. Maybe you want to attract a mate or keep one interested. Perhaps a boyfriend, co-worker, or relative said something mean about your weight. These motivators may work, but only temporarily. Basing a lifestyle change on them is like building on shifting sands. You need a firmer foundation for a lasting structure. Without a lifestyle change, you are unlikely to vanquish a chronic overweight problem. Proper long-term motivation may grow from:

  • the discovery that you feel great and have more energy when you are lighter and eating sensibly
  • the sense of accomplishment from steady progress
  • the acknowledgment that you have free will and are responsible for your weight and many aspects of your health
  • the inspiration from seeing others take charge of their lives successfully
  • the admission that you have some guilt and shame about being fat, and that you like yourself more when you’re not fat [I’m not laying shame or guilt on you; many of us do it to ourselves.]
  • the awareness of overweight-related adverse health effects and their improvement with even modest weight loss.

Appropriate motivation will support the commitment and willpower that will be needed soon.

Steve Parker, M.D.

PS: I’m thinking of how Dave Ramsay, when he’s counseling people who have gotten way overhead in debt, tells them they have to get mad at the debt. Then they can attack it. Maybe you have to get mad at your fat. It’s your enemy, dragging you down, trying to kill you. Now attack it!

Updated December 19, 2009

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Mediterranean Diet and Lifestyle Associated With Reduced Alzheimer Dementia

Posted on June 6, 2012 | Comments Off on Mediterranean Diet and Lifestyle Associated With Reduced Alzheimer Dementia

Alzheimer disease is a progressive brain disorder resulting in memory loss, personality change, functional impairments, and a decline in various types of thinking (e.g., math ability, problem-solving, spatial orientation). It is the most common form of dementia in the eldery, causing about 70% of cases and afflicting four million people in the U.S.

TheBostonChannel.com recently published a news release from Beth Israel Deaconess Medical Center on how to prevent Alzheimers Disease. It is a Q&A interview with Dr. Daniel Press, neurologist and Alzheimer specialist.

Dr. Press made favorable comments about the Mediterraean diet and pointed out that avoidance of obesity and diabetes may also help prevent Alzheimer disease. Regular aerobic exercise, 30 minutes daily, also seems to be protective. The potential protective effect of alcohol consumption was not mentioned.

For details on how to accomplish all this, see the Do-It-Yourself Mediterranean Diet, the Alzheimer disease prevention article at WebMD.com, or The Advanced Mediterranean Diet book.

Steve Parker, M.D.

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Fat Cell Turnover: Implications for Weight Loss

Posted on June 5, 2012 | Comments Off on Fat Cell Turnover: Implications for Weight Loss

The number of fat cells in our bodies is constant throughout adult life for both lean and overweight people. When adults gain fat weight, it’s because our individual fat cells store more fat, thereby enlarging. We don’t gain more fat cells. Conversely, when we lose weight, the fat cells shrink.

Our number of fat cells is set during childhood and adolescence. Lean individuals generally have fewer fat cells than overweight people.

In many living tissues, individual cells gradually die off and are replaced by new cells. For example, we shed dead skin cells all the time, but they are replaced just as quickly by new skin cells. A red blood cell lives three months then dies and is replaced. The percentage of cells that die and are replaced over a period of time is called “turnover.”

Researchers in Stockholm recently studied the turnover of fat cells in humans. They measured turnover by analysing the incorporation of carbon-14 derived from nuclear bomb tests in genomic DNA. They found that 10% of fat cells die off and are renewed yearly at all adult ages in both skinny and overweight people.

So what?

Well, if 10% of your fat cells die every year, what if you could prevent them from being replaced with new ones? You would lose weight, as long as your remaining fat cells didn’t swell with more stored fat. Next year, another 10% of your fat cells die, and so on.

How can we prevent dead fat cells from being replaced by new ones? Nobody knows . . . yet. You can bet that pharmaceutical companies are thinking about this.

But I wouldn’t hold my breath. Pharmaceutical intervention will not be available for at least eight to 10 years, if ever.

We already have available, in 2009, a tried and true method for reducing fat mass: Eat Less, Move More.

Steve Parker, M.D.

Reference: Spalding, K.L., et al. Dynamics of fat cell turnover in humans. Nature, 453 (2008): 783-787. Epub May 4, 2008. PMID: 18454136.

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Health Benefits of Dark Chocolate

Posted on June 4, 2012 | Comments Off on Health Benefits of Dark Chocolate

Theobroma cacao, the cocoa tree, has been cultivated in Central and South America for over 3000 years. Cocoa is derived from the tree’s seed, also known as the cocoa bean.

Chocolate is a product of the processed cocoa bean. Sweet chocolate is chocolate combined with sugar. Milk chocolate is sweet chocolate combined with milk powder or condensed milk. Dark chocolate typically has no added dairy products, has at least 65% cocoa content, and has much more of the potentially healthy chemicals from the cocoa bean as compared with milk chocolate. White chocolate is cocoa butter (aka cacao fat), milk solids, and sugar without the cocoa solids or mass; in many countries it is not considered chocolate.

It’s been a little over 10 years since we first read in a medical journal about cocoa and chocolate as potential sources of antioxidants for health. What have we learned since then?

Phytochemicals are chemicals produced by plants, and there are hundreds of thousands of them. Polyphenols are a subset of phytochemicals. Flavonoids, with strong antioxidant properties, are a subset of polyphenols. And a subset of flavonoids, called flavonols, have particularly potent biological effects in humans. Prominent flavonols in dark chocolate are flavan-3-ol, catechin, and epicatechin. Also metabolically active are proanthocyanidins, which are polymeric condensation products of flavan-3-ol.

Are you bored yet? Have I convinced you of my authority on the subject? Say yes, or I’ll keep going! [Please say yes: I’m boring myself!]

Note that some chocolate manufacturers process the cocoa beans to remove some of the polyphenols, which reduces bitterness or pungency.

Other rich sources of flavonols are wine, tea, and various fruits and berries.

How could dark chocolate, especially its flavonoids, be healthful?

  • Flavonoids are antioxidants that protect from injury caused by free radicals
  • Enhanced nitric oxide production, leading to relaxation of arteries (vasodilation), leading to reduced blood pressure: up to 6 mmHg systolic and 3 mmHg diastolic
  • Elevation of HDL cholesterol, with no effect on total and LDL cholesterol
  • Inhibition of platelet aggregation and activation, leading to fewer blood clots that cause heart attacks and strokes
  • Decreased inflammation
  • Reduction of C-reactive protein, a marker of inflammation
  • Decreased neutrophil (white blood cell) activation. White blood cells play a role in inflammation
  • Decreased LDL cholesterol oxidation, leading to fewer atherosclerotic complications
  • Improved function of the cells that line blood vessels (endothelium)
  • Possible enhanced insulin sensitivity
  • May act as anti-carcinogens and neuro-protective agents
  • May act as an antidepressant

Note also that low-fat natural non-alkalized cocoa powder is also a rich source of antioxidant flavonoids.

Bottom line? Dark chocolate, especially because of flavonoids, may well be protective against cardiovascular disease such as heart attacks and strokes.

[Did you notice I’m waffling . . . may be protective.]

What’s in dark chocolate other than flavonoids?

A 40 gram serving of a fine dark chocolate bar has:

  • Calories: 200
  • Calories from fat: 150
  • Fiber: 4.5 grams (dark chocolate is a good source of fiber on a “per calorie” basis)
  • Sugar: 11 grams
  • Saturated fats: 10 grams

But aren’t saturated fats bad for me?

The fats in dark chocolate are 1/3 oleic (healthy monounsaturated, as in olive oil), 1/3 stearic (saturated, but no effect on cholesterol levels, unlike some other saturated fats), and 1/3 palmitic (saturated, and could increase cholesterol levels and heart risk). So it’s sort of a wash.

[I’m not getting into the diet-heart hypothesis now. Don’t bait me.]

What’s the healthy “dose” of dark chocolate?

No one is sure. It’s certainly no more than 100 grams (3.5 ounces) a day, and the optimal dose may be as low as 20 grams every three days. If you eat too much, it will make you fat. 100 grams is 500 calories; that’s probably way too much. Even if you start eating 20 grams – 100 calories – every three days, you will gain weight unless you give up some other food or exercise a little more.

Parker, why are you waffling?

Because no one has ever done a study to see if adding dark chocolate actually reduces death rates or sickness from specific diseases in humans. I think it probably does, but who knows for sure? Nobody. What we need is a randomized, controlled trial of dark chocolate as a supplement in 10,000 middle-aged adults followed over the course of 10 years. I’d sign up for that in a heartbeat. Just don’t give me the placebo.

Steve Parker, M.D.

Additional Resources:

Clay Gordon, author of the book Discover Chocolate, kindly critiqued an early version of this blog post here. If the link doesn’t work, go to The Chocolate Life and search “Health Benefits of Chocolate” in the Forums.

References:

Erdman, J.W., et al. Effects of cocoa flavanols on risk factors for cardiovascular disease. Asian Pacific Journal of Clinical Nutrition, 17 supplement 1 (2008): 284-287.

Farouque, H.M, et al. Acute and chronic effects of flavanol-rich cocoa on vascular function in subjects with coronary artery disease: a randomized double-blind placebo-controlled study. Clinical Science, 111 (2006): 71-80.

Heptinstall, S., et al. Cocoa flavanols and platelet and leukocyte function: recent in vitro and ex vivo studies in healthy adults. Journal of Cardiovascular Pharmacology, 47 supplement 2 (2006): S197-205.

Keen, C.L., et al. Cocoa antioxidants and cardiovascular health. American Journal of Clinical Nutrition, 81 supplement 1 (2005): 298S-303S.

Mehrinfar, R. and Frishman, W.H. Flavanol-rich cocoa: a cardioprotective nutraceutical. Cardiology Reviews, 16 (2008): 109-115.

Engler, M.B, and Engler, M.M. The emerging role of flavonoid-rich cocoa and chocolate in cardiovascular health and disease. Nutrition Reviews, 64 (2006): 109-118.

Lippi, G. et al. Dark chocolate: consumption for pleasure or therapy? Journal of Thrombosis and Thrombolysis, September 23, 2008 (Epub ahead of print).

Hooper, L, et al. Flavonoids, flavonoid-rich foods, and cardiovascular risk: a meta-analysis of randomized controlled trials. American Journal of Clinical Nutrition, 88 (2008): 38-50.

Cooper, K.A., et al. Cocoa and health: a decade of research. British Journal of Nutrition, 99 (2007): 1-11. Epub August 1, 2007.

Aron, P.M., and Kennedy, J.A. Flavon-3-ols: nature, occurrence and biological activity. Molecular Nutrition and Food Research, 52 (2008): 79-104.

Buijsse, B, et al. Cocoa intake, blood pressure, and cardiovascular mortality [in men]: the Zutphen Elderly Study. Archives of Internal Medicine, 166 (2006): 411-417.

Ding, E.L., et al. Chocolate and prevention of cardiovascular disease: a systematic review. Nutrition and Metabolism, 3 (2006): 2.

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If Dark Chocolate Is Healthy, What’s The Right Dose?

Posted on June 3, 2012 | Comments Off on If Dark Chocolate Is Healthy, What’s The Right Dose?

Antioxidant flavonoids and other phytonutrients in dark chocolate are thought possibly to improve health, primarily through reduction in cardiovascular diseases such as heart attacks and strokes. I previously blogged about these and other potential health benefits of dark chocolate.

In terms of a medicinal agent, we have not been sure of the therapeutic “dose.” A recent study out of Italy provides a clue.

Researchers at Catholic University, Campobasso, Italy, surveyed residents in southern Italy regarding chocolate intake and measured their C-reactive protein (CRP) levels. CRP is a marker of inflammation and a predictor of coronary artery disease such as heart attacks. Generally, higher levels of CRP are associated with higher risk of heart attacks. If you have a choice, go for lower levels of CRP.

Methodology

Participants in the study were selected by simple random sampling from city hall registries and were at least 35 years old. Researchers were looking for healthy people, so the following were excluded from the study: those who reported known cardiovascular disease, eating a special diet, or on drug therapy for high blood pressure, diabetes, or adverse blood lipids. Twenty percent of initial recruits refused to participate. Of the 10,994 initial recruits, 4,849 men and women made it into the final study.

Of the 4,849 subjects, two subgroups were identified: 1) a control group of 1,317 (27%) who never ate any type of chocolate, and 2) a test group of 824 (17%) subjects who regularly ate dark chocolate only.

Interviewers administered questionnaires to the subjects to document clinical and personal information such as dietary habits, socioeconomic status, physical activity, medical history, risk factors for cardiovascular disaese and tumors, family history of cardiovascular disease, drug use, etc.

Regarding chocolate consumption, participants were asked about frequency – daily, weekly, or monthly – of a “standard dose” (20 grams) and about type of chocolate: milk, dark, nut chocolate, or any type. Someone eating more than one type of chocolate was classified as “any type.”

Other measurements: blood pressure, weight, height, waist circumference, blood glucose, serum lipids (various cholesterols and triglycerides), and high-sensitivity C-reactive protein.

Findings

Age-adjusted CRP levels were lower in dark chocolate users (1.13 mg/L) than in the nonconsumers of chocolate (1.30 mg/L).

Dark chocolate eaters were divided into thirds: the lowest third of average consumption, the middle third, and the highest third. The lowest third ate under 19 grams per week. The middle third ate between 19 and 47 grams per week. The highest third ate over47 grams per week. The chocolate-related reduction in CRP was lost in people who were in the highest third (or tertile), i.e., eating more than 47 grams a week or 20 grams every three days. People in the lowest tertile of dark chocolate consumption had a CRP reduction the same as the middle third.

Systolic blood pressure in dark chocolate consumers was 3 mmHg lower than the pressure in nonconsumers. No difference in diastolic pressures.

Discussion

The researchers cite two clinical trials that investigated the effect of cocoa on markers of inflammation but did not find any association. They wonder if those studies enrolled too few participants, or whether the relatively high doses of chocolate masked the effect. In the present study, the lowering of CRP was seen in consumption of up to 20 grams every three days, but seemed to disappear at higher doses.

The authors write that:

. . . regular intake of small amounts of dark chocolate . . . consumption should have no harmful effect on anthropometric variables such as BMI [body mass index] and waist:hip ratio and can be viewed as a promising behavioural approach to lower, in a quite pleasant way, cardiovascular risk factors at a general population level.

According to data reported in apparently healthy American men and women, ranges of serum CRP measured in our nonchocolate consumer population would belong to a “moderate” risk estimate quintile, whereas the ranges found in dark chocolate consumers would be classified as a “mild” risk estimate. For the decrease in serum CRP values from moderate to mild quintile, the relative risk of suffering a future cardiovascular event would apparently decrease by 26% in men and 33% in women.

The authors are careful to point out that this study does not prove that low-dose dark chocolate lowers CRP levels. It’s an association. “Additional studies are necessary to explain the mechanisms linking dark chocolate consumption and regulation of serum CRP concentrations.”

My Comments

The healthy dose of dark chocolate may be quite small: no more than 20 grams every three days, and perhaps quite a bit less. This is not much by U.S. standards. The serving size listed on many bars here is 40 grams. Forty grams has about 200 calories. Twenty grams twice a week translates to 29 calories a day.

The authors of this study don’t address whether 40 grams a week would be just as healthy as 80 grams every two weeks.

Eating more, on average, than 20 grams every three days may entirely wipe out the healthy effects. This effect is like wine’s: a little is probably good for you, too much is either neutral or harmful.

I’m sorry to be so wishy-washy on this issue, but that’s the state of the science today. The study at hand may help us optimize dark chocolate’s effect on C-reactive protein. But dark chocolate’s other healthy effects may require other doses, higher or lower.

The next step is to take 20,000 middle-aged people, give half of them various doses of scheduled dark chocolate, give the other half placebos, then record rates of diseases and death over the next 10 years. Who would pay for this multi-million dollar study? Either government or chocolate manufacturers.

Steve Parker, M.D.

Reference: Di Giuseppe, Romina, et al. Regular Consumption of Dark Chocolate Is Associated with Low Serum Concentrations of C-Reactive Protein in a Healthy Italian Population. Journal of Nutrition, 138 (2008): 1,939-1,945.

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Comments Off on If Dark Chocolate Is Healthy, What’s The Right Dose?

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“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

1 Comment

Posted in Dementia

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