Something Fishy

Posted on April 27, 2012 | Comments Off on Something Fishy

Fish is a major feature of my Ketogenic Mediterranean Diet as well as a healthy component of the traditional Mediterranean diet.

Darya Pino over at Summer Tomato wrote about eating fish: health aspects, which are best to eat, shopping, and sustainability. I recommend it to you, even though I don’t agree with everything. For instance, I think in general the risk of mercury contamination is overblown. (I know that’s little consolation for those few who have suffered mercury poisoning from fish.)

Steve Parker, M.D.

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Book Review: Why We Get Fat

Posted on April 26, 2012 | Comments Off on Book Review: Why We Get Fat

Gary Taubes’ latest book is Why We Get Fat: And What To Do About It. I give it five stars per Amazon.com’s ranking system (I love it).

♦ ♦ ♦

At the start of my medical career over two decades ago, many of my overweight patients were convinced they had a hormone problem causing it. I carefully explained that’s rarely the case. As it turns out, I may have been wrong. And the hormone is insulin.

Mr. Taubes wrote this long-awaited book for two reasons: 1) to make the ideas in his 2007 masterpiece (Good Calories, Bad Calories) more accessible to the public, and 2) to speed up the process of changing conventional wisdom on overweight. GCBC was the equivalent of a college-level course on nutrition, genetics, history, politics, science, physiology, and biochemistry. Many nutrition science geeks loved it while recognizing it was too difficult for the average person to digest.

Paradigm Shift

The author hopes to convince us that “We don’t get fat because we overeat; we overeat because we’re getting fat.” We need to think of obesity as a disorder of excess fat accumulation, then ask why the fat tissue isn’t regulated properly. A limited number of hormones and enzymes regulate fat storage; what’s the problem with them?

Mr. Taubes makes a great effort convince you the old “energy balance equation” doesn’t apply to fat storage. You remember the equation: eat too many calories and you get fat, or fail to burn up enough calories with metabolism and exercise, and you get fat. To lose fat, eat less and exercise more. He prefers to call it the “calories-in/calories-out” theory. He admits it has at least a little validity. Problem is, the theory seems to have an awfully high failure rate when applied to weight management over the long run. We’ve operated under that theory for the last half century, but keep getting fatter and fatter. So the theory must be wrong on the face of it, right? Is there a better one?

So, Why DO We Get Fat?

Here is Taubes’s explanation. The hormone in charge of fat strorage is insulin; it works to make us fatter, building fat tissue. If you’ve got too much fat, you must have too much insulin action. And what drives insulin secretion from your pancreas? Dietary carbohydrates, especially refined carbs such as sugars, flour, cereal grains, starchy vegetables (e.g., corn, beans, rice, potatoes), liquid carbs. These are the “fattening carbs.” Dozens of enzymes and hormones are at play either depositing fat into tissue, or mobilizing the fat to be used as energy. It’s an active process going on continously. Any regulatory derangement that favors fat accumulation will CAUSE gluttony (overeating) or sloth (inactivity). So it’s not your fault.

What To Do About It

Cut back on carb consumption to lower your fat-producing insulin levels, and you turn fat accumulation into fat mobilization.

Before you write off Taubes as a fly-by-night crackpot, be aware that he’s received three Science-in-Society Journalism Awards from the National Association of Science Writers. He’s a respected, professional science writer. Having read two of his books, it’s clear to me he’s very intelligent. If he’s got a hidden agenda, it’s well hidden.

One example illustrates how hormones control growth of tissues, including fat tissue. Consider the transformation of a skinny 11-year-old girl into a voluptuous woman of 18. Various hormones make her grow and accumulate fat in the places we now see curves. The hormones make her eat more, and they control the final product. The girl has no choice. Same with our adult fat tissue, but with different hormones. If some derangement is making us grow fatter, it’s going to make us more sedentary (so more energy can be diverted to fat tissue) or make us overeat, or both. We can’t fight it. At not least very well, as you can readily appreciate if look at the people around you at any American shopping mall.

This’N’That

Taubes’s writing is clear and persuasive. He doesn’t beat you over the head with his conclusions. He lays out a logical series of facts and potential connections and explanations, helping you eventually see things his way. If insulin controls fat storage by building and maintaining fat tissue, and if carboydrates drive insulin secretion, then the way to reduce overweight and obesity is carbohydrate-restricted eating, especially avoiding the fattening carbohydrates. I’m sure that’s true for many folks, perhaps even a majority.

If you’re overweight and skeptical about this approach, you could try out a very-low-carb diet for a couple weeks or a month at little expense and risk (but not zero risk). If Mr. Taubes and I are right, there’s a good chance you’ll lose weight. At the back of the book is a university-affiliated low-carb eating plan.

If cutting carb consumption is so critical for long-term weight control, why is it that so many different diets—with no focus on carb restriction—seem to work, if only for the short run? Taubes suggests it’s because nearly all diets reduce carb consumption to some degree, including the fattening carbs. If you reduce your total daily calories by 500, for example, many of those calories will be from carbs. Simply deciding to “eat healthy” works for some people: stopping soda pop, candy bars, cookies, desserts, beer, etc. That cuts a lot of fattening carbs right there.

Losing excess weight or controlling weight by avoiding carbohydrates was the conventional wisdom prior to 1960, as documented by Mr. Taubes. Low-carb diets for obesity date back almost 200 years. The author attributes many of his ideas to German internist Gustav von Bergmann (1908).

Taubes discusses the Paleolithic diet, mentioning that the average paleo diet derived about a third of total calories from carbohdyrates (compared to the standard American diet’s 55% of calories from carb). My prior literature review found 40-45% of paleo diet calories from carbohydrate. I’m not sure who’s right.

Minor Bone of Contention RE: Coronary Heart Disease

Mr. Taubes provides numerous scientific references to back his assertions. I checked out one in particular because it didn’t sound right. Some background first.

Reducing our total fat and saturated fat consumption over the last 40 years was supposed to lower our LDL cholesterol, thereby reducing the burden of coronary heart disease, which causes heart attacks. Instead, we’ve experienced the obesity epidemic as those fats were replaced by carbohydrates. Taubes mentions a 2009 medical journal article by Kuklina et al, in which Taubes says Kuklina points out the number of heart attacks has not decreased as we’ve made these diet changes. Kuklina et al don’t say that. In fact, age-standardized heart attack rates have decreased in the U.S. during the last decade.

Furthermore, autopsy data document a reduced prevalence of anatomic coronary heart disease in people aged 20-59 from 1979 to 1994, but no change in prevalence for those over 60. The incidence of coronary heart disease decreased in the U.S. from 1971 to 1998 (the latest reliable data). Death rates from heart disease and stroke have been decreasing steadily over the last 40 years in the U.S.; coronary heart disease death rates are down by 50%. I do agree with Taubes that we shouldn’t credit those improvements to reduced total and saturated fat consumption. [Reduced trans fat consumption may play a role, but that’s off-topic.]

I think Mr. Taubes would like to believe that coronary artery disease is either more severe or unchanged in the last few decades because of low-fat, high-carb eating. That would fit nicely with some of his theories, but it’s not the case. Coronary artery disease is better now thanks to a variety of factors, but probably not diet (setting aside the trans-fat issue).

Going Forward

Low-carb dieting was vilified over the last half century partly out of concern that the accompanying high fat consumption would cause premature heart attacks, strokes, and death. We know now that total dietary fat and saturated fat have little to do with coronary heart disease and atherosclerosis (hardening of the arteries), which sets the stage for a resurgence of low-carb eating.

I advocate Mediterranean-style eating as the healthiest, in general. It’s linked with prolonged life and lower risk of heart disease, stroke, dementia, diabetes, and cancer. On the other hand, obesity is a strong risk factor for premature death and development of heart disease, stroke, diabetes, and cancer. If consistent low-carb eating cures the obesity, is it healthier than the Mediterranean diet? Maybe so. Would a combination of low-carb and Mediterranean be better? Maybe so. I’m certain Mr. Taubes would welcome a decades-long interventional study comparing low-carb with the Mediterranean diet. But that’s probably not going to happen in our lifetimes.

Gary Taubes rejects the calories-in/calories-out theory of overweight that hasn’t done a very good job for us over the last 40 years. Taubes’s alternative ideas deserve serious consideration.

Steve Parker, M.D.

References:

Coronary heart disease autopsy data: American Journal of Medicine, 110 (2001): 267-273.

Reduced heart attacks: Circulation, 12 (2010): 1,322-1,328.

Reduced incidence of coronary heart disease: www.UpToDate.com, topic: “Epidemiology of Coronary Heart Disease,” accessed December 11, 2010.

Death rates for coronary heart disease: Journal of the American Medical Association, 294 (2005): 1,255-1,259.

Disclosure: I don’t know Gary Taubes. I requested from the publisher and received a free advance review copy of the book. Otherwise I received nothing of value for this review.

Disclaimer: All matters regarding your health require supervision by a personal physician or other appropriate health professional familiar with your current health status. Always consult your personal physician before making any dietary or exercise changes.

Update April 22, 2013:

As mentioned above, WWGF was based on Taubes’ 2007 book, Good Calories, Bad Calories. You may be interested in a highly critical review of GCBC by Seth at The Science of Nutrition.

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Vitamins Slow Rate of Brain Shrinkage in Elderly

Posted on April 25, 2012 | Comments Off on Vitamins Slow Rate of Brain Shrinkage in Elderly

A cocktail of three common B vitamins slowed the rate of brain shrinkage over two years in elderly patients with mild cognitive impairment, according to researchers at the University of Oxford.

As a hospitalist, I see 10 or 20 brain scans every week. A healthy 40-year-old brain nicely fills out the allotted space in the skull. Most 70-year-old brains have an obvious degree of shrinkage. Those with the most shrinkage typically have worse mental functioning, often diagnosed clinically as dementia, or its precursor, mild cognitive impairment (MCI).

The medical term for brain shrinkage is brain atrophy. It reflects loss of brain cells or decrease in brain cell size. I see A LOT of atrophied brains and impaired mental functioning—aka cognition—in the elderly.

Not everybody with atrophy has mental impairment; healthy brains slowly atrophy with age. Alzheimer’s disease patients atrophy quickly; MCI patients atrophy at an intermediate rate. MCI patients converting over the years to Alzheimer’s show a faster rate of atrophy.

Mild cognitive impairment affects 14 to 18% of those over age 70 (five million in the U.S.). Half of these convert to Alzheimer’s disease or another dementia within five years. We desperately need a way to prevent or slow that conversion.

That’s why I was excited to see a research report in which brain atrophy was slowed with three simple daily vitamins: folic acid 0.8 mg, B12 0.5 mg, and B6 20 mg. The investigators will report later on whether the vitamins helped prevent mental decline.

These three vitamins are involved in homocysteine metabolism; they decrease blood levels of homocysteine. Read elsewhere if you want the boring details.

Methodology

Oxford area participants were at least 70 years of age and had mild cognitive impairment but not dementia. Blood homocysteine levels were drawn periodically. Participants were randomized to take either placebo (83 subjects) or the daily vitamins (85 subjects) for two years. MRI scans were done periodically to determine brain volume. Tests of mental functioning were done periodically. More subjects were in the study at the outset but some dropped out and others didn’t have technically adequate MRI scans.

Results

After adjustment for age, the annual rate of brain atrophy was 30% less in the vitamin group compared to placebo.

For the placebo group, the rate of brain atrophy was clearly related to baseline homocysteine levels: higher homocysteine, faster atrophy.

Although the study was not powered to detect an effect of treatment on cognition (findings to be reported separately), in a post hoc analysis, we noted that final cognitive test scores were correlated to the rate of atrophy.

Atrophy appears to be a major determinant of cognitive decline in this population.

There were no significant safety issues and no differences in adverse events between the groups.

The vitamin group lowered homocysteine levels by 32% compared to placebo.

Reduction in brain shrinkage rate was best in those with a higher baseline homocysteine level (over 13 micromol/L); those with the lowest baseline levels (<9.5 micromol/L) showed no effect of vitamin therapy. [In the U.S., 13% of those over 60 have concentrations over 13 micromol/L, whereas the median is 10 micromol/L.]

Comments

Although this is small study, I’m excited about the future clinical implications. The results need to be replicated. I can’t wait to hear from this group regarding the details of mental functioning tests. If preservation of brain function or other practical benefits don’t accompany a slower rate of atrophy , it’s no use taking the vitamins.

A 2008 study found no clinical benefit with a similar vitamin mix in Alzheimer’s patients with mild to moderate disease. In other words, the rate of mental decline was no different than the placebo group. Average homocysteine level was 9.16 micromole/L and fell by 30% during the 18-month-long study. Even those with the highest homocysteine levels showed no benefit. Perhaps B vitamins need to be started much earlier in the disease process to be effective.

The time may come where we screen all 60-year-olds for above-average homocysteine levels, starting them on the vitamin cocktail.

One caveat, however. Ten years ago doctors were quite excited about preventing heart disease events (e.g., heart attacks, cardiac deaths) and strokes in people with high homocysteine levels. We knew that high levels were associated with cardiac events and strokes, and we knew the B vitamins would lower the blood levels. We learned a couple years ago that B vitamin therapy actually didn’t help heart patients or those at high risk for heart disease. Nor do the vitamins prevent strokes. (If you’re a heart patient still taking Foltx, ask your cardiologist if it’s OK to stop it now.)

Steve Parker, M.D.

References:

Smith, A., Smith, S., de Jager, C., Whitbread, P., Johnston, C., Agacinski, G., Oulhaj, A., Bradley, K., Jacoby, R., & Refsum, H. (2010). Homocysteine-Lowering by B Vitamins Slows the Rate of Accelerated Brain Atrophy in Mild Cognitive Impairment: A Randomized Controlled Trial PLoS ONE, 5 (9) DOI: 10.1371/journal.pone.0012244

Aisen, P.S., et al. High-dose B vitamin supplementation and cognitive decline in Alzheimer disease: A randomized controlled trial. Journal of the American Medical Association, 300 (2008): 1,774-1,783.

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Low-Carb Diets Killing People?

Posted on April 24, 2012 | Comments Off on Low-Carb Diets Killing People?

Animal-based low-carb diets are linked to higher death rates, according to a study in the Annals of Internal Medicine. On the other hand, a vegetable-based low-carb diet was associated with a lower mortality rate, especially from cardiovascular disease.

As always, “association is not causation.”

Since I created the Low-Carb Mediterranean Diet, it’s just a matter of time before someone asks me, “Haven’t you heard that low-carb diets cause premature death?” So I figured I’d better take a close look at the new research by Fung and associates.

It’s pretty weak and unconvincing. I have little to add to the cautious editorial by William Yancy, Matthew Maciejewski, and Kevin Schulman published in the same issue of Annals.

The study at hand was observational over many years, using data from the massive Nurses’ Health Study and Health Professionals’ Follow-up Study. To find the putative differences in mortality, the researchers had to compare the participants eating the most extreme diets. The 80% of study participants eating in between the extremes were neutral in terms of death rates.

They report that “…the overall low-carbohydrate diet score was only weakly associated with all-cause mortality.” Furthermore,

These results suggest that the health effects of a low-carbohydrate diet may depend on the type of protein and fat, and a diet that includes mostly vegetable sources of protein and fat is preferable to a diet with mostly animal sources of protein and fat.

In case you’re wondering, all these low-carb diets derived between 35 and 42% of energy (total calories) from carbohydrate, with an average of 37%. Anecdotally, many committed low-carbers chronically derive 20% of calories from carbohydrate (100 g of carb out of 2,000 calories/day). The average American eats 250 g of carb daily, 50-60% of total calories.

Yancy et al point out that “Fung and coworkers did not show a clear dose-response relationship in that there was not a clear progression of risk moving up or down the diet deciles.” If animal proteins and fats are lethal, you’d expect to see some dose-response relationship, with more deaths as animal consumption gradually increases over the deciles.

The Fung study is suggestive but certainly not definitive. Anyone predisposed to dietary caution who wants to eat lower-carb might benefit from eating fewer animal sources of protein and fat, and more vegetable sources. Fung leaves it entirely up to you to figure out how to do that. Compared to an animal-based low-carb diet, the healthier low-carb diet must subsitute more low-carb vegetables and higher-fat plants like nuts, seeds, seed oils and olive oil, and avocadoes, for example. What are higher-protein plants? Legumes?

You can see how much protein and fat are in your favorite vegetables at the USDA Nutrient Database.

The gist of Fung’s study dovetails with the health benefits linked to low-meat diets such as traditional Mediterranean and DASH. On the other hand, if an animal-based low-carb diet helps keep a bad excess weight problem under control, it too may by healthier than the standard American diet.

See the Yancy editorial for a much more detailed and cogent analysis. As is so often the case, “additional studies are needed.”

Steve Parker, M.D.

Reference: Fung, Teresa, et al. Low-carbohydrate diets and all-cause and cause specific mortality: Two cohort studies. Annals of Internal Medicine, 153 (2010): 289-298.

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“But Doc, I’m Too Heavy to Exercise!”

Posted on April 23, 2012 | 4 comments

I’ve written elsewhere about the death-defying aspect of exercise and myriad other health benefits of regular physical activity.

Very heavy folks potentially have more to gain in terms of health and longevity compared to skinny people. So it’s a cruel irony that the heavier you are, the harder it is exercise. At some point even light exercise becomes impossible.

Average-height women tipping the scales at about 280 pounds (127 kg) and men at 360 pounds (164 kg) aren’t going to be able to jog around the block, much less run a marathon. These weights are 100 percent over ideal or healthy levels. An actual “exercise program” probably won’t be possible until some weight is lost simply through very-low-carb eating, calorie restriction, or bariatric surgery. The initial exercise goal for you may just be to get moving through activities of daily living and perhaps brief walks and calisthenics while sitting in a chair.

“I’ll get started after I finish this cigarette.”

Markedly obese people who aren’t up to the aforementioned extreme weights can usually tolerate a low-intensity physical activity program. At 50 percent over ideal weight, an average-height woman of 210 pounds (95 kg) is carrying 70 excess pounds (32 kg) of fat. Her male counter-part lugs around 90 pounds (41 kg) of unnecessary fat. This weight burden causes dramatic breathlessness and fatigue upon exertion, and makes the joints and muscles more susceptible to aching and injury.

If you’re skinny, just imagine trying to walk or run a mile carrying a standard five-gallon (19 liter) water cooler bottle, which weighs only 43 pounds (19.5 kg) when full. The burden of excess fat makes it quite difficult to exercise.

If you’re markedly obese, several tricks will enhance your exercise success. I want you to avoid injury, frustration, and burn out. Start with light activity for only 10 or 15 minutes, gradually increase session length (e.g., by two to four minutes every two to four weeks) and increase exercise intensity only after several months. Your joints and muscles may appreciate easy, low-impact exercises such as stationary cycling, walking, swimming, and pool calisthenics/water aerobics.

You may also benefit from the advice of a personal fitness trainer arranged through a health club, gym, or YMCA/YWCA. Check out several health clubs before you join. Some of them are primarily meat markets for beautiful slender yuppies. You may feel more comfortable in a gym that welcomes and caters to overweight people. Hospitals are increasingly developing fitness centers with obese orthopedic, heart, and diabetic patients in mind.

Steve Parker, M.D.

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Ketogenic Diet for Alzheimers Disease?

Posted on April 22, 2012 | 2 comments

Ketogenic diets have seen a resurgence in the last two decades as a treatment for childhood epilepsy, particularly difficult-to-control cases not responding to drug therapy. It works, even in adults. That’s why some brain experts are wondering if ketogenic diets might be helpful in other brain disorders, such as Alzheimer’s disease and Parkinson’s disease.

I’ll save you some time and just give you the conclusion of a 2006 scientific article I read: maybe, but it’s way too soon to tell.

The article is called “Neuroprotective and disease-modifying effects of the ketogenic diet,” from researchers at the National Institutes of Health’s National Institue of Neruological Disorders and Stroke. Sounds promising doesn’t it?

The article goes into detail about how the ketogenic diet might be good for brain health. Dr. Emily Deans would be very interested in that, but most of my readers not. Two-and-a-half pages on non-human animal studies, too.

What is this “Ketogenic diet” used for epilepsy?

The most common ketogenic diet for childhood epilepsy is the one developed by Wilder in 1921. It was a popular treatment for epilepsy in the 1920s and 1930s. Fats provide 80 to 90% of the calories in the diet, with sufficient protein for growth, and minimal carbohydrates. Since carbs are in short supply, the body is forced to use fats as an energy source, which generates ketone bodies—acetoacetate, acetone, beta-hydroxybutyrate, largely from the liver.

So what?

Not much. This article may have been written to stimulate future research, and I hope it does. I just searched PubMed for “ketogenic diet AND Alzheimer” and came up with nothing new since 2006.

Could the Ketogenic Mediterranean Diet prevent or alleviate Alzheimer’s disease? At this point, just flip a coin.

Steve Parker, M.D.

Reference: Gasior M, Rogawski MA, & Hartman AL (2006). Neuroprotective and disease-modifying effects of the ketogenic diet. Behavioural pharmacology, 17 (5-6), 431-9 PMID: 16940764

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Prevalence Figures for Diabetes and Prediabetes

Posted on April 21, 2012 | 1 comment

In January of 2011, the U.S. Centers for Disease Control and Prevention released the latest estimates for prevalence of diabetes and prediabetes. The situation is worse than it was in 2008, the last figures available.

  • Nearly 27% of American adults age 65 or older have diabetes (overwhelmingly type 2)
  • Half of Americans 65 and older have prediabetes
  • 11% of U.S. adults (nearly 26 million) have diabetes (overwhelmingly type 2)
  • 35% of adults (79 million) have prediabetes, and most of those affected don’t know it

The CDC estimates that one of every three U.S. adults could have diabetes by 2050 if present trends continue.

The press release from the CDC mentions that physical activity and avoidance of overweight will prevent some cases of diabetes. I believe that limiting consumption of refined carbohydrates like sugar and flour would also help.

Those who already have diabetes and prediabetes should consider carbohydrate-restricted Mediterranean-style eating, as in Conquer Diabetes and Prediabetes: The Low-Carb Mediterranean Diet.

Steve Parker, M.D.

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DASH Diet Reduces Risk of Heart Disease and Stroke in Women

Posted on April 20, 2012 | Comments Off on DASH Diet Reduces Risk of Heart Disease and Stroke in Women

U.S News and World Report recently ranked the DASH diet as the No.1 Healthiest Diet.  Today I partly explain why.

The Dietary Approaches to Stop Hypertension (DASH) diet has been shown to lower blood pressure.  Another study associated a DASH-style diet with lower incidence of heart attack and stroke.

The DASH diet is low in total and saturated fats and cholesterol, moderate in low-fat dairy products, high in fruits and vegetables, low in salt, low in sweetened beverages, moderate in whole grains, and low in animal protein but has substantial amounts of plant protein from nuts and legumes.

The DASH diet was designed as a healthy way of eating, not a weight-loss diet.  It is promoted by the National Heart, Lung, and Blood Institute for the prevention and treatment of high blood pressure.  It is also included as an example of a healthy diet in the 2005 Dietary Guidelines for Americans.  Yet many people still have never heard of it.

Researchers affiliated with multiple Boston and Atlanta institutions looked at the participants in the massive Nurses Health Study.  88,517 middle-aged women free of stroke, diabetes, and coronary heart disease were followed between 1980 to 2004.  They filled out food frequency questionnaires designed to assess average food intake over the preceding year.  The researchers constructed a DASH diet score and graded all the study participants in terms of adherence or conformity to the ideal DASH diet.

Over the course of the study, there were 2129 cases of nonfatal heart attack, 976 deaths from coronary heart disease, and 2317 strokes.  (If you read the original study, please note that some numerical errors were corrected in a later journal issue.)

Women with the highest adherence to the DASH Diet had 24% lower risk for coronary heart disease, compared with the women who had the lowest conformity.  Again comparing the same two groups for stroke, the high-adherence women had 18% less incidence of stroke.  There were clear trends for less coronary heart disease and stroke as adherence to the DASH diet increased.

Blood samples were analyzed for a subset of participants.  Higher DASH compliance was significantly associated with lower plasma levels of interleukin-6 and C-reactive protein.  These are markers for the inflammation felt to underlie atherosclerosis and cardiovascular disease.  You want to avoid high inflammatory markers.  The DASH diet scores in this study were not associated with serum lipid changes, although other DASH studies found lower LDL cholesterol and an undesirable reduction in HDL cholesterol.

The researchers examined causes of death in participants, yet did not report any association – positive, negative, or neutral – with DASH score.  I wonder why?  It’s possible that higher DASH scores were associated with higher overall death rates even though they had fewer heart attacks and strokes.  I imagine they also had access to cancer death statistics.  Why no mention?  Academicians are under pressure to publish research reports.  Are they saving the mortality and cancer data for future articles?  Abscence of all-cause mortality numbers is a major weakness of this study.

The DASH diet is similar in composition to the traditional Mediterranean diet.  The main differences are that the Mediterranean diet ignores salt intake, allows wine and other alcohol, and places more emphasis on olive oil and whole grains.  The Mediterranean diet has numerous supportive studies showing prolonged lifespan and less chronic disease: fewer heart attacks and strokes, less cancer, less dementia.  And very recently the Mediterranean diet was associated with a lower incidence of type 2 diabetes mellitus.

Steve Parker, M.D.

References:

Fung, Teresa, et al.  Adherence to a DASH-Style Diet and Risk of Coronary Heart Disease and Stroke in Women.  Archives of Internal Medicine, 168 (2008): 713-720.

Your Guide to Lowering Your Blood Pressure with DASH, from the National Heart, Lung, and Blood Institute

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Random Notes on Fitness

Posted on April 19, 2012 | 2 comments

About couple years ago, I was thinking about putting together a fitness program for myself.  My goals were endurance, strength, less low back aching, flexibility, longevity, and being able to get on my horse bareback without a mounting block or other cheat.

I spent quite a bit of time at Doug Robb’s HeathHabits site.  He has a post called The “I don’t have time to workout” Workout.  I ran across some paper notes I made during my time there.  Doug recommended some basic moves to incorporate: air squat, Hindu pushup, dragon flag, shuffle of scissor lung, Spiderman lung, hip thrust/bridge, swing snatch, dumbbell press, Siff lunge, jumping Bulgarian squat, band wood chops, leg stiff leg deadlift.  Click the link to see videos of most of these exercises.  The rest you can find on YouTube.

Another post is called “Do you wanna get big and strong? -Phase 1”.  The basic program is lifting weights thrice weekly.  Monday, work the chest and back.  Tuesday, legs and abs/core.  Friday, arms and shoulders.

  • Chest exercises: presses (barbell or dumbell, incline, decline, flat, even pushups with additional resistance  – your choice
  • Back: chins or rows
  • Legs: squats or deadlifts
  • Arms and shoulders: dips, presses, curls

Doug is a personal trainer with a huge amount of experience.  He’s a good writer, too, and gives away a wealth of information at his website.

Around this same time of searching a couple years ago, I ran across Mark Verstegen’s Core Performance, Mark Lauren’s book “You Are Your Own Gym,”  and Mark Sisson’s free fitness ebook that also  features bodyweight exercises.

Lauren is or was a Navy Seal trainer.  His plan involves 30 minutes of work on four days a week and uses minimal equipment.  Lots of good reviews at Amazon.com.

Newbies to vigorous exercise should seriously consider using a personal trainer.

Steve Parker, M.D.

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Exercise Prevents Death

Posted on April 19, 2012 | 1 comment

January 1 this year, many folks made New Years’ resolutions to start exercising in conjunction with their other resolution to lose excess weight. I’ve got bad news for them.

Exercise is overrated as a pathway to major weight loss. Sure, a physically inactive young man with only five or 10 pounds (2 to 4 kg) to lose might be able to do it simply by starting an exercise program. That doesn’t work nearly as well for women. The problem is that exercise stimulates appetite, so any calories burned by exercise tend to be counteracted by increased food consumption.

“Should I go with aerobic or strength training….?”

On the other hand, exercise is particularly important for diabetics and prediabetics in two respects: 1) it helps in avoidance of overweight, especially after weight loss, and 2) it helps control blood sugar levels by improving insulin resistance, perhaps even bypassing it.

Even if it doesn’t help much with weight loss, regular physical activity has myriad general health benefits. First, let’s look at its effect on death rates.

EXERCISE PREVENTS DEATH

As many as 250,000 deaths per year in the United States (approximately 12% of the total) are attributable to a lack of regular physical activity. We know now that regular physical activity can prevent a significant number of these deaths.

Exercise induces metabolic changes that lessen the impact of, or prevent altogether, several major illnesses, such as high blood pressure, coronary artery disease, diabetes, and obesity. There are also psychological benefits. Even if you’re just interested in looking better, awareness of exercise’s other advantages can be motivational.

The traditional Mediterranean diet of the mid-20th century may owe some of it’s healthfulness to a physically active lifestyle.

Exercise is defined as planned, structured, and repetitive bodily movement done to improve or maintain physical fitness.

Physical fitness is a set of attributes that relate to your ability to perform physical activity. These attributes include resting heart rate, blood pressure at rest and during exercise, lung capacity, body composition (weight in relation to height, percentage of body fat and muscle, bone structure), and aerobic power.

Aerobic power takes some explanation. Muscles perform their work by contracting, which shortens the muscles, pulling on attached tendons or bones. The resultant movement is physical activity. Muscle contraction requires energy, which is obtained from chemical reactions that use oxygen. Oxygen from the air we breathe is delivered to muscle tissue by the lungs, heart, and blood vessels. The ability of the cardiopulmonary system to transport oxygen from the atmosphere to the working muscles is called maximal oxygen uptake, or aerobic power. It’s the primary factor limiting performance of muscular activity.

Aerobic power is commonly measured by having a person perform progressively more difficult exercise on a treadmill or bicycle to the point of exhaustion. The treadmill test starts at a walking pace and gets faster and steeper every few minutes. The longer the subject can last on the treadmill, the greater his aerobic power. A large aerobic power is one of the most reliable indicators of good physical fitness. It’s cultivated through consistent, repetitive physical activity.

Physical Fitness Effect on Death Rates

Regular physical activity postpones death.

Higher levels of physical fitness are linked to lower rates of death primarily from cancer and cardiovascular disease (e.g., heart attacks and stroke). What’s more, moving from a lower to a higher level of fitness also prolongs life, even for people over 60.

Steve Parker, M.D.

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