Another Physician Discovers the Ketogenic Mediterranean Diet

Posted on May 24, 2019 | Comments Off on Another Physician Discovers the Ketogenic Mediterranean Diet

Colin Champ, M.D., published an article on his version of a Ketogenic Mediterranean Diet.

“The Study Participants – The Mediterannean Ketogenic Lifestyle

Regardless, the study was a massive success, as it allowed 40 overweight individuals with an average BMI of 37 to switch from their diabetes-provoking diet containing over 50% carbohydrates for 12 weeks. Ketosis was apparently confirmed via ketone strips in the morning. This concerns me, because if they were urine strips, after 2-3 weeks they would have been inaccurate. Once again, we must question whether it was a ketogenic diet or simply a very low-carbohydrate diet. Yet, the proof is it the pudding as the Spanish Ketogenic dieters experienced an average reduction in bodyweight from 240 to 208 lbs. Most importantly, there was a clear loss of fat over muscle. Blood pressure dropped, blood lipids improved, triglycerides divebombed as they were cut in half, blood sugar dropped by almost 20 mg/dl, and HDL cholesterol – a difficult number to budge – rose significantly. Take note, as expected, the largest reduction overall was the massive drop in triglycerides, which is especially important as elevated triglycerides are strongly associated with an increased risk of stroke, heart disease, and cancer.

Globally, all of these changes are desired. The question I pose, is can we take this a step further to encourage a full-blown Mediterranean Ketogenic Diet? I have been following what I consider a Mediterranean Ketogenic Diet for years by combining the cultural and social aspects of my Southern Italian heritage along with the scientific approach of the ketogenic diet. Sounds complicated? It’s not. In fact, it is so simple, that I have distilled it down to seven steps that are so simple, your great-grandfather likely followed most of them (mine certainly did).”

Source: The Mediterranean Ketogenic Lifestyle – Colin Champ

Compare with my version.

Odd cover, huh?

Steve Parker MD, Advanced Mediterranean Diet

The KMD is also here

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Posted in Ketogenic Mediterranean Diet

At Five Years Out, Gastric Bypass is as Effective in Adolescents as in Adults 

Posted on May 23, 2019 | Comments Off on At Five Years Out, Gastric Bypass is as Effective in Adolescents as in Adults 

From The New England Journal of Medicine:

Adolescents and adults who underwent gastric bypass had marked weight loss that was similar in magnitude 5 years after surgery. Adolescents had remission of diabetes and hypertension more often than adults.

Note, however,

Three adolescents (1.9%) and seven adults (1.8%) died in the 5 years after surgery. The rate of abdominal reoperations was significantly higher among adolescents than among adults (19 vs. 10 reoperations per 500 person-years, P=0.003).

Source: Five-Year Outcomes of Gastric Bypass in Adolescents as Compared with Adults | NEJM

Steve Parker MD, Advanced Mediterranean Diet

Not linked to any deaths as far as I know

 

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Posted in Bariatric Surgery

Low-Carb Mediterranean Diet Beats Low-Fat Diet for Reducing Liver Fat

Posted on May 22, 2019 | Comments Off on Low-Carb Mediterranean Diet Beats Low-Fat Diet for Reducing Liver Fat

From the study abstract:

Methods

In an 18-month weight-loss trial, 278 participants with abdominal obesity/dyslipidemia were randomized to low-fat (LF) or Mediterranean/low-carbohydrate (MED/LC+28g walnuts/day) diets with/without moderate physical activity (PA). HFC and abdominal fat-depots were measured using magnetic-resonance-imaging at baseline, after 6 (sub-study, n=158) and 18-months.

Results

Of 278 participants [age=48yr;88% men; body-mass-index=30.8kg/m2; mean HFC =10.2%,(range:0.01%-50.4%)], retention rate was 86.3%. %HFC substantially decreased after 6 [-6.6% absolute-units (-41% relatively)] and 18-months [-4.0% absolute-units (-29% relatively);p<0.001 vs. baseline]. Reduction of HFC associated with decreases in VAT beyond weight loss. After controlling for VAT loss, decreased %HFC remained independently associated with reductions in serum gamma-glutamyl-transferase and alanine-aminotransferase, circulating chemerin, and HbA1c (p<0.05). While reduction of HFC was similar between PA groups, compared to LF diet, MED/LC induced a greater %HFC decrease (p=0.036) and greater improvements in cardiometabolic risk parameters (p<0.05), even after controlling for VAT changes. Yet, the greater decreases induced by MED/LC compared to LF diets in triglycerides, TG/HDL ratio and cardiovascular risk score were all markedly attenuated when controlling for HFC changes.

Source: The Beneficial effects of Mediterranean diet over low-fat diet may be mediated by decreasing hepatic fat content – Journal of Hepatology

h/t DietDoctor

Here’s a low-carb Mediterranean diet:

Steve Parker MD, Advanced Mediterranean Diet

Two diet books in one

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Posted in Liver Disease

Sitting is the new smoking? No, it’s worse than that: Not exercising worse is for your longevity than smoking, diabetes AND heart disease

Posted on May 22, 2019 | Comments Off on Sitting is the new smoking? No, it’s worse than that: Not exercising worse is for your longevity than smoking, diabetes AND heart disease
exercise for weight loss and management, dumbbells

At least he’s trying…

I’ve long advocated that life-and health-insurance companies base their premiums on results of individual treadmill exercise tests or similar. Here’s why.

From CNN:

We’ve all heard exercise helps you live longer. But a new study goes one step further, finding that a sedentary lifestyle is worse for your health than smoking, diabetes and heart disease.

Dr. Wael Jaber, a cardiologist at the Cleveland Clinic and senior author of the study, called the results “extremely surprising.”

“Being unfit on a treadmill or in an exercise stress test has a worse prognosis, as far as death, than being hypertensive, being diabetic or being a current smoker,” Jaber told CNN. “We’ve never seen something as pronounced as this and as objective as this.”

Source: Not exercising worse for your health than smoking, diabetes and heart disease – CNN

Most folks can improve their fitness by exercising regularly. But what about nonresponders?

Steve Parker, M.D.

PS: All of my weight-loss books recommend and teach you how to improve your level of fitness.

Steve Parker MD, Advanced Mediterranean Diet

Two diet books in one

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Posted in Exercise, Longevity

High cholesterol doesn’t cause heart disease. Say what?

Posted on May 20, 2019 | Comments Off on High cholesterol doesn’t cause heart disease. Say what?

Plaque unrelated to cholesterol

From The Irish Times:

There is no evidence that high levels of total cholesterol or of “bad” cholesterol cause heart disease, according to a new paper by 17 international physicians based on a review of patient data of almost 1.3 million people.

The authors also say their review shows the use of statins – cholesterol lowering drugs – is “of doubtful benefit” when used as primary prevention of cardiovascular disease.

The authors include Galway-based Prof Sherif Sultan, professor of the International Society for Vascular Surgery; Scottish-based Dr Malcolm Kendrick, author of The Great Cholesterol Con; and Dr David M Diamond, a US-based neuroscientist and cardiovascular disease researcher.

Prof Sultan said millions of people all over the world, including many with no history of heart disease, are taking statins “despite unproven benefits and serious side effects”.

Source: ‘No evidence’ high cholesterol causes heart disease, say doctors

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Posted in Heart Disease

Another Sacred Cow Slaughtered: Omega-3 Fatty Acids Have No Effect on Cardiovascular Disease or Longevity

Posted on May 15, 2019 | 1 comment

Salmon, a cold-water fatty fish, is a rich source of omega-3 fatty acids

That headline is the conclusion of a Cochrane systematic review of the evidence. As you read the summary below, be aware that the main omega-3 fatty acids are alpha-lenolinic acid (ALA), docosahexaenoic acid (DHA), and eicosapentaenoic acid (EPA).

From Cochrane Library:

Increasing EPA and DHA has little or no effect on all‐cause deaths and cardiovascular events (high‐quality evidence) and probably makes little or no difference to cardiovascular death, coronary deaths or events, stroke, or heart irregularities (moderate‐quality evidence, coronary events are illnesses of the arteries which supply the heart). EPA and DHA slightly reduce serum triglycerides and raise HDL (high‐quality evidence).

Eating more ALA (for example, by increasing walnuts or enriched margarine) probably makes little or no difference to all‐cause or cardiovascular deaths or coronary events but probably slightly reduce cardiovascular events, coronary mortality and heart irregularities (moderate/low‐quality evidence). Effects of ALA on stroke are unclear as the evidence was of very low quality.

There is evidence that taking omega‐3 capsules does not reduce heart disease, stroke or death. There is little evidence of effects of eating fish. Although EPA and DHA reduce triglycerides, supplementary omega‐3 fats are probably not useful for preventing or treating heart and circulatory diseases. However, increasing plant‐based ALA may be slightly protective for some heart and circulatory diseases.

Source: Omega‐3 fatty acids for the primary and secondary prevention of cardiovascular disease – Abdelhamid, AS – 2018 | Cochrane Library

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Posted in Heart Disease, Longevity

The Uncertainty Of Nutrient Absorption

Posted on May 14, 2019 | 1 comment

 

IMG_2935From Bix, the Fanatic Cook…

It is just about impossible to anticipate how much, say, calcium we will absorb from a meal or a pill. It depends upon a number of variables which themselves can be difficult to measure, including but not limited to: our calcium status, how much calcium is in the meal or pill, what the calcium is bound to, how acidic the internal environment is, what our vitamin D status is, how much of the calcium binding protein is in place, how much of and what type of fiber is present, the presence of other divalent cations like zinc or magnesium, the condition of the intestinal brush border.

The amount of calcium (or any nutrient, I’m using calcium as an example) consumed and the amount absorbed is not a linear relationship. That is, eating 100 mg of calcium does not mean 100 mg gets absorbed. One thing that is known – the more calcium we eat, the less we absorb; and the less we eat, the more we absorb.

***

Compounding the uncertainty, nutrient content varies within food – the same type of food. In this study:

Calcium and Magnesium Concentration of Inbred and Hybrid Broccoli Heads, Journal of the American Society for Horticultural Science, 2000

Farnham et al. found significant variability among broccoli varieties for calcium and magnesium. Broccoli purchased at random across the US varied by as much as 2-fold for these elements.

Here’s a study that shows almost a three-fold difference in calcium content among several varieties of kale and collards. It also shows significant year-to-year variability for the same variety:

Variability In Elemental Accumulations Among Leafy Brassica Oleracea Cultivars And Selections, Journal of Plant Nutrition, 2005

And yet, data bases and nutrient tables give calcium content in a cup of cooked kale to 2 decimal places!

Source: The Uncertainty Of Nutrient Absorption | Fanatic Cook

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Is Sodium Restriction to 2,300 mg/day Really Necessary?

Posted on April 29, 2019 | Comments Off on Is Sodium Restriction to 2,300 mg/day Really Necessary?

I’m still not convinced that severe sodium restriction is necessary or even possible for most people

U.S public health authorities recommend maximum daily sodium consumption of 2.3 grams a day, in order to prevent cardiovascular disease. But a 2018 multi-country study published in Lancet supports a much different and higher maximum sodium intake level:

Sodium intake was associated with cardiovascular disease and strokes only in communities where mean intake was greater than 5 g/day. A strategy of sodium reduction in these communities and countries but not in others might be appropriate.

The researchers also found, “All major cardiovascular outcomes decreased with increasing potassium intake in all countries.”

Click for a list of potassium-rich foods from a .gov website.

You’ll find several cold-water fatty fish there.

My Advanced Mediterranean Diet recommends the fish but you’ll find no sodium restriction advice.

Source: Urinary sodium excretion, blood pressure, cardiovascular disease, and mortality: a community-level prospective epidemiological cohort study – The Lancet

Steve Parker MD, Advanced Mediterranean Diet

Two diet books in one

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Posted in Heart Disease, Stroke

Are Drugs the Solution to Your Unhealthy Lifestyle?

Posted on April 24, 2019 | 1 comment
paleobetic diet, low-carb diet, diabetic diet

“This is much easier than exercising and losing 30 pounds!”

Fiona Godlee, editor-in-chief of the British Medical Journal, has a heretical short article at BMJ. I recommend you read the whole thing. It starts thusly:

More than half of adults aged over 45 will be labelled as hypertensive if new US guidelines are adopted, concludes a study in The BMJ this week (doi:10.1136/bmj.k2357). This equates to 70 million people in the US and 267 million people in China being eligible for antihypertensive drugs, a marked increase on already high rates of drug treatment for high blood pressure. Furthermore, the study calculates that 7.5 million people in the US and 55 million in China would be advised to start drug treatment, while 14 million in the US and 30 million in China would be advised to receive more intensive treatment. The evidence from trials indicates some benefit from drugs in terms of reduced risk of stroke and heart disease, but is mass medication really what we want?

Hypertension is just one of the many heads of the lifestyle disease hydra. Another is type 2 diabetes. Once thought to be irreversible and progressive, it is now known to be potentially reversible through weight loss. This is the cautious conclusion of the review by Nita Forouhi and colleagues (doi:10.1136/bmj.k2234), part of our series on the science and politics of nutrition (bmj.com/food-for-thought). Whether by calorie or carbohydrate restriction, weight loss has been shown to improve glycaemic control, blood pressure, and lipid profile and is the key to treatment and prevention of type 2 diabetes, they say.

She goes on to talk about fatty liver disease (NASH) and offers an alternative, of sorts, to pills. Good luck with that.

We’re supposed to eat more fruit, right?

Someone needs to figure out how to put healthy lifestyle in a pill.

Source: Pills are not the answer to unhealthy lifestyles | The BMJ

Steve Parker MD, Advanced Mediterranean Diet

Two diet books in one

 

 

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Posted in High Blood Pressure

Effects of Greek orthodox christian church fasting on serum lipids and obesity

Posted on March 30, 2019 | 1 comment

Dead whole fish aren’t very appealing to many folks

Not mentioned often in scientific articles is the potential contribution of fasting to the health benefits of the Mediterranean diet.  What sort of fasting?

“Orthodox Christian holy books recommend a total of 180–200 days of fasting per year. The faithful are advised to avoid olive oil, meat, fish, milk and dairy products every Wednesday and Friday throughout the year. Additionally, there are three principal fasting periods per year: i) a total of 40 days preceding Christmas (meat, dairy products and eggs are not allowed, while fish and olive oil are allowed except on Wednesdays and Fridays), ii) a period of 48 days preceding Easter (Lent). During Lent fish is allowed only two days whereas meat, dairy products and eggs are not allowed. Olive oil consumption is allowed only at weekends, iii) a total of 15 days in August (the Assumption) when the same dietary rules apply as for Lent with the exception of fish consumption which is allowed only on August 6th. Seafood such as shrimps, squid, cuttlefish, octopus, lobsters, crabs as well as snails are allowed on all fasting days throughout the year. The Greek Orthodox fasting practices can therefore be characterized as requiring a periodic vegetarian diet including fish and seafood.”

Source: Effects of Greek orthodox christian church fasting on serum lipids and obesity

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Posted in Longevity