Tag Archives: low carb diet

Improve Metabolic Syndrome with Paleolithic Diet

…according to an article at American Journal of Clinical Nutrition.

shutterstock_268538780

 

“Metabolic syndrome” may be a new term for you. It’s a collection of clinical features that are associated with increased future risk of type 2 diabetes and atherosclerotic complications such as heart attack and stroke. You can lower your risk of these conditions by reversing your metabolic syndrome.

One in six Americans has metabolic syndrome. Diagnosis requires at least three of the following five conditions:

  • high blood pressure (130/85 or higher, or using a high blood pressure medication)
  • low HDL cholesterol: under 40 mg/dl (1.03 mmol/l) in a man, under 50 mg/dl (1.28 mmol/l) in a women (or either sex taking a cholesterol-lowering drug)
  • triglycerides over 150 mg/dl (1.70 mmol/l) (or taking a cholesterol-lowering drug)
  • abdominal fat: waist circumference 40 inches (102 cm) or greater in a man, 35 inches (89 cm) or greater in a woman
    fasting blood glucose over 100 mg/dl (5.55 mmol/l)
  • fasting blood glucose over 100 mg/dl (5.55 mmol/l)

I don’t plan on reading the full text of the report because it’s a meta-analysis and I’ve likely reviewed the four component studies already at my Paleo Diabetic blog. Here are the results:

Four RCTs [randomized controlled trials] that involved 159 participants were included. The 4 control diets were based on distinct national nutrition guidelines but were broadly similar. Paleolithic nutrition resulted in greater short-term improvements than did the control diets (random-effects model) for waist circumference (mean difference: −2.38 cm; 95% CI: −4.73, −0.04 cm), triglycerides (−0.40 mmol/L; 95% CI: −0.76, −0.04 mmol/L), systolic blood pressure (−3.64 mm Hg; 95% CI: −7.36, 0.08 mm Hg), diastolic blood pressure (−2.48 mm Hg; 95% CI: −4.98, 0.02 mm Hg), HDL cholesterol (0.12 mmol/L; 95% CI: −0.03, 0.28 mmol/L), and fasting blood sugar (−0.16 mmol/L; 95% CI: −0.44, 0.11 mmol/L). The quality of the evidence for each of the 5 metabolic components was moderate. The home-delivery (n = 1) and dietary recommendation (n = 3) RCTs showed similar effects with the exception of greater improvements in triglycerides relative to the control with the home delivery. None of the RCTs evaluated an improvement in quality of life.

Ways to improve or cure metabolic syndrome include the paleo diet, Mediterranean diet, low-carb diets, ketogenic diets, and exercise. Losing excess fat weight with any reasonable diet would probably work. Enhance effectiveness with exercise.

Steve Parker, M.D.

Reference:Eric W Manheimer,  Esther J van Zuuren, Zbys Fedorowicz, and Hanno Pijl. Paleolithic nutrition for metabolic syndrome: systematic review and meta-analysis. AJCN. First published August 12, 2015, doi: 10.3945/​ajcn.115.113613

Book Review: “Stop the Clock: The Optimal Anti-Aging Strategy”

dementia, memory loss, Mediterranean diet, low-carb diet, glycemic index, dementia memory loss

“I wish we could have read PD Mangan’s book thirty years ago!”

I read P.D. Mangan’s 2015 book, Stop the Clock: The Optimal Anti-Aging Strategy. I give it five stars in Amazon’s rating system. High recommended.

♦   ♦   ♦

I approached this book with trepidation. I like PD Mangan even though I’ve never met him. We’ve interacted on Twitter and at our blogs. You can tell from his blogging that he’s very intelligent. I don’t know his educational background but wouldn’t be surprised if he has a doctorate degree. My apprehension about the book is that I was concerned it would be brimming with malarkey and scams. Fortunately, that’s not the case at all.

Twin studies have established that 25% of longevity is genetic. That leaves a lot of lifestyle factors for us to manipulate.

I’m not familiar with the anti-aging scientific literature and don’t expect it will ever be something I’ll spend much time on. But it’s an important topic. I’ll listen to what other smart analysts—like Mr. Mangan—have to say about it.

It’s quite difficult to do rigorous testing of anti-aging strategies on free-living humans. So the best studies we have were done with worms, rodents, and monkeys; the findings may or may not apply to us. For example, long-term calorie restriction—about 30% below expected energy needs—is known to prolong life span in certain worms and rodents, with mixed results in rhesus monkeys. It’s the rare person who would follow such a low-calorie diet for years as an experiment. I doubt I would do it even if proven to give me an extra five years of life. I like to eat.

There are several prominent theories of how and why animals age. The author thinks the major factors are:

  1. oxidative stress
  2. inflammation
  3. a decline in autophagy (perhaps most important)

An effective anti-aging program should address these issues.

In the anti-aging chapter of his book, The South Asian Health Solution, internist Ronesh Sinha says that “Lifestyle practices that reduce excess inflammation in the body will help delay the aging process.” Dr. Sinha is a huge exercise advocate and low-carb diet proponent.

Mr. Mangan makes a convincing argument that a good way to forestall aging is to apply hormetic stress. Hormesis is a phenomenon whereby a beneficial effect (e.g., improved health, stress tolerance, growth, or longevity) results from exposure to low doses of an agent or activity that is otherwise toxic or lethal when given at higher doses.

Needs a bit more hormetic stress

Needs a bit more hormetic stress

In case you’re not familiar with hormesis, here’s a major example. Lack of regular exercise leads is linked to premature death from heart disease and cancer. Starting and maintaining an exercise program leads to greater resistance to injury and disease and longer life span. On the other hand, too much exercise is harmful to health and longevity. We see that in professional athletes and excessive marathon runners. Something about exercise—in the right amount—enhances the body’s intrinsic repair mechanisms. That’s the hormetic effect of exercise; one mechanism is by turning on autophagy.

Autophagy is the body’s natural process for breaking down and removing or recycling worn-out cellular structures. This wearing-out occurs daily and at all ages.

If you’re thinking Mr. Mangan recommends exercise as an anti-aging strategy, you’re exactly right. Especially resistance training and high intensity training. His specific recommendations are perfectly in line with what I tell my patients.

Calorie restriction is another form of hormesis; the body reacts by up-regulating stress defense mechanisms. As a substitute for calorie restriction, the author recommends intermittent fasting. Intermittent fasting increases insulin sensitivity, which leads to enhanced autophagy. Fasting seems perfectly reasonable if you think about it, which very few do. Many of us eat every three or four hours while awake, whether a meal or a snack. If you think about it, that’s not a pattern that would be supported by evolution. In the Paleolithic era, we often must have gone 12–16 hours or even several days without food. Hominins without the resiliency to do that would have died off and not passed their genes down to us.

Steve Parker MD, Advanced Mediterranean DIet

Naturally low-carb Caprese salad: mozzarella cheese, tomatoes, basil, extra virgin olive oil

Another anti-aging trick is a low-carb diet, defined as under 130 grams/day, or under 20% of total calories. It may work via insulin signaling and weight control.

Glutathione within our cells is a tripeptide antioxidant critical for clearing harmful reactive oxygen species (free radicals). We need adequate glutathione to prevent or slow aging. Cysteine is the peptide that tends to limit our body’s production of glutathione. We increase our cysteine supply either through autophagy (which recycles protein peptides) or diet. Dietary sources of cysteine are proteins, especially from animal sources. Whey protein supplements and over-the-counter n-acetyl cysteine are other sources. Fasting is another trick that increases cysteine availability via autophagic recyling.

I don’t recall the author ever mentioning it, but if you hope to maximize longevity, don’t smoke. Even if it has hormetic effects. Maybe that goes without saying in 2015.

When I read a book like this, I always run across tidbits of information that I want to remember. Here are some:

  • those of us in the top third of muscular strength have a 40% lower risk of cancer (NB: you increase your strength through resistance training not aerobics)
  • exercise helps prevent cognitive decline and dementia, at least partially via enhanced autophagy
  • exercise increases brain volume (in preparing to do this review I learned that our brains after age 65 lose 7 cubic centimeters of volume yearly)
  • optimal BMI may be 20 or 21, not the 18.5-25 you’ll see elsewhere (higher BMI due to muscle mass rather than fat should not be a problem)
  • Scientist Cynthia Kenyon: “Sugar is the new tobacco.” (in terms of aging)
  • phytochemicals (from plants, by definition) activate AMPK, a cellular energy sensor that improves stress defense mechanisms and increases metabolic efficiency
  • curcumin (from the spice turmeric) activates AMPK
  • coffee promotes autophagy
  • he does not favor HGH supplementation
  • in the author’s style of intermittent fasting, you’re not reducing overall calorie intake, just bunching your calories together over a shorter time frame (e.g., all 2,500 calories over 6-8 hours instead of spread over 24)
  • mouse studies suggest that intermittent fasting could reduce risk of Alzheimer’s disease and Parkinsons disease
  • consider phytochemical supplements: curcumin, resveratrol, green tea extract
  • calorie-restriction mimetics include resveratrol, curcumin, nicotinamide, EGCG, and hydroxycitrate
  • supplemental resveratrol at 150 mg/day improved memory and cognition in humans

The author provides very specific anti-aging recommendations that could be followed by just about anyone. Read the book for details. Scientists are working feverishly to develop more effective anti-aging techniques. I look forward to a second edition of this book in three to five years.

Steve Parker, M.D.

PS: People with certain medical conditions, such as diabetics taking drugs that can cause hypoglycemia, should not do intermittent fasting without the blessing of their personal physician. If you have any question about your ability to fast safely, check with your doctor.

PPS: If you need to lose weight on a low-carb diet, consider my Advanced Mediterranean Diet or Ketogenic Mediterranean Diet.

What Really Was William Banting’s Diet?

Banting thought salmon was too fatty

Banting eschewed salmon (too fatty?)

I’ve been reading about Banting’s diet for at least five years. Thanks to Tim Noakes in South Africa, it’s seeing a mini-surge in popularity. William Banting published his Letter on Corpulence in 1863. Eating like him to lose weight is sometimes referred to as “Banting.” It’s one form of a low-carb diet and considered a precursor to the Atkins diet.

Form your own opinion of what William Banting may have eaten by reading these:

In terms of macronutrient calories, here’s my rough back-of-the-envelope synthesis of Banting’s diet:

  • 20–25% carbohydrate
  • 25% protein
  • 20–25% fat
  • 25% alcohol
  • 1800–2000 total calories

For the 200 lb (91 kg) man that Banting was, 2000 calories would almost certainly have been a calorie-restricted diet. Leigh estimated he was eating at least 2800 cals/day at baseline before losing weight. I don’t doubt that.

In summary, Banting drank a lot of alcohol (even more than on the Ketogenic Mediterranean Diet), and ate fairly low-fat, moderately carb-restricted, and relatively high protein. In other words: low cal, low carb, low fat, high protein, high alcohol.

His weight loss, assuming it wasn’t a hoax, came from calorie restriction. Something about that combination of macronutrients apparently allowed him to stick with the program and maintain a 50-lb weight loss. Protein is particularly satiating. Your mileage may vary.

I’m concerned that 25% of calories from alcohol would displace more healthful micronutrients.

Steve Parker, M.D.

PS: William Banting was a distant relative of Frederick Banting, the co-discoverer of insulin in 1921.

How Many Years Does Obesity Cut From Lifespan?

Are you tired of this stock photo yet?

Are you tired of this stock photo yet?

MedPageToday has the details. A quote:

In a computer modeling study, very obese men lost just over 8 years of life compared with normal-weight men, and very obese women lost as many as 6 years, Steven Grover, PhD, of McGill University, and colleagues reported online in the Lancet Diabetes and Endocrinology.

They also found that very obese men and women (defined as a body mass index [BMI] of 35 and higher) lost about 19 years of healthy life, defined as living free of chronic disease such as diabetes and cardiovascular disease.

Note that “very obese” in this context has a specific definition: body mass index 35 or higher. Calculate yours.

The number of life years lost to obesity and disease were highest for those who were very obese in young adulthood and presumably stayed obese for years. In other words, becoming very obese at age 60 is not as dangerous as at 25.

I first got interested in weight loss in the 1990s when I had an office-based primary care medical practice. It was obvious that many of the medical problems I was treating were related to years of obesity. Believe me, you’re much better off preventing those problems via diet and exercise.

In the 1990’s, both Dr. Dean Ornish’s vegetarian diet and Dr. Robert Atkins low-carb diet were very popular, and you couldn’t find any two diets that were more polar opposites. And do you remember Susan Powter and her “Stop the Insanity” diet? My desire to lead my patients onto the right path resulted in the first edition of my Advanced Mediterranean Diet.

Click for The Lancet study abstract.

Steve Parker, M.D.

Brian Burgers With Brussels Sprouts, Tomato, and Pistachios

diabetic diet, low-carb diet, paleobetic diet

Brian burger and bacon Brussels sprouts

Here’s another meal recipe from my stepson. We put it together originally for a low-carb diet, such as the Ketogenic Mediterranean Diet. But since I provide the nutritional analysis below, it also works with the Advanced Mediterranean Diet.

This makes three servings. You’ll want to make the Bacon Brussels Sprouts to serve with other meals, so I’ve provided an additional nutritional analysis for those alone. Enjoy!

Ingredients:

13 oz (370 g) ground beef, 85% lean

1/2 tbsp (7.5 ml) Tessemae’s All Natural Dressing-Marinade-Dip “Southwest Ranch,” or A1 Steak Sauce or balsamic vinaigrette or AMD vinaigrette (Brian recommends the Tessemae’s Dressing)

1.7 oz (50 g) onion, diced coarse or fine

1 garlic clove, diced

1/8 tsp (0.5 ml) paprika

1–2 pinches of salt (pinch = 1/16 tsp)

pepper to taste (a pinch or 2?)

1/4 tsp (1.2 ml) dried rosemary, crumbled or crushed

1/2 large egg, whisked to blend white and yolk

3 oz (85 g) lettuce

1 lb (450 g) Brussels sprouts (cut and discard bases if desired, probably doesn’t matter),   shredded

8 oz (225 g) bacon (6.5 regular (not thick) 8-inch strips), diced

3 tbsp (45 ml) water

1.5 large tomatoes, sliced

4.5 oz pistachio nuts

diabetic diet, paleobetic diet, low-carb diet

Prepping the bacon; use a sharp knife

Instructions:

First cook the bacon in a pan over medium–high heat until done. Don’t discard the grease.

Next do your Brussels sprouts prep (shredding). It will take a few minutes to shred it with a knife. Set those aside.

diabetic diet, paleobetic diet, low-carb diet

Brian slaving away. Thanks, dude!

Start on the burgers now. Place the ground beef in a bowl then add your chosen sauce or vinaigrette, onion, egg, garlic, paprika, rosemary, salt, and pepper. Mix thoroughly by hand. Divide the mess into three patties of equal size. Fry or grill over medium heat until done, about 10 minutes.

diabetic diet, paleobetic diet, low-carb diet

Steaming in progress

As soon as the burgers are plopped on the heat, start steaming the shredded sprouts thusly. Take a pan with a lid, add 3 tbsp (45 ml) of the bacon grease and the 3 tbsp of water, then heat that up for a minute or two over medium to high heat. Then throw in the shredded sprouts, salt and pepper to taste (probably unnecessary), and cover with a lid. Immediately reduce heat to medium and cook for 4–6 minutes. The sprouts will soften up as they cook. Gently shake the pot every minute while steaming to prevent contents from sticking to the pan. If necessary, remove the lid and stir while cooking, but this may increase your cooking time since you release hot steam whenever you remove the lid. When the sprouts are done, remove from heat and add the remaining bacon and bacon grease, then blend.

Bacon has been added and blended after the sprouts are cooked

Bacon has been added and blended in after the sprouts are cooked

Serve the burger on a bed of lettuce (1 0z). Enjoy tomato and pistachios on the side. Serving sizes are below.

Number of Servings: 3 (one burger patty, 1 oz (30 g) lettuce, 1 cup (240 ml) of sprouts, 1/2 tomato or a third of all the slices, 1.5 oz (40 g) pistachio nuts)

Advanced Mediterranean Diet boxes: 2 veggies, 1 protein, 4 fats

Nutritional Analysis per Serving:

58% fat

17% carbohydrate

25% protein

740 calories

32 g carbohydrate

12 g fiber

20 g digestible carbohydrate

827 mg sodium

1,802 mg potassium

Prominent features: Rich in fiber, protein, vitamin B6, B12, C, copper, iron, manganese, niacin, pantothenic acid, phosphorus, riboflavin, selenium, thiamine, and zinc.

Nutritional Analysis for Bacon Brussels Sprouts: (1 cup, no added salt):

Advanced Mediterranean Diet boxes: 1 veggie, 1 fat, 1/4 protein

47% fat

28% carbohydrate

26% protein

180 calories

14 g carbohydrate

6 g fiber

8 g digestible carbohydrate

530 mg sodium

709 mg potassium

Prominent features: mucho vitamin C.

diabetic diet, paleobetic diet, low-carb diet

Brian likes his burger wrapped in 2 oz of lettuce

Book Review: The Low Carb Dietitian’s Guide to Health and Beauty, by Franziska Spritzler

247 pages

247 pages

I just finished The Low Carb Dietitian’s Guide to Health and Beauty,
written by Franziska Spritzler, RD, CDE, and published last month. CDE, but the way, means Certified Diabetes Educator. Per Amazon’s rating system, I give it five stars (I love it).

*   *   *

This valuable addition to the low-carb literature is unique: No other book covers the beauty and health aspects of low-carb eating specifically in women.

I’m a strong proponent of carbohydrate-restricted eating for weight management and cure or control of certain medical conditions. The great advantages of low-carbing for weight loss are 1) suppression of hunger, and 2) proven greater efficacy compared to other types of dieting. Nevertheless, I wasn’t aware that this way of eating also had potential benefits in terms of beauty maintenance or improvement. The author persuasively makes that case in this ground-breaking book.

Just because she has RD (registered dietitian) behind her name doesn’t mean you just have to take her word for it. Franziska gives us references to the scientific literature if you want to check it out yourself.

The author focuses on health and beauty; the weight loss happens naturally with low-carb eating. That’s a helpful “side effect” since 2/3 of women in the U.S. are overweight or obese.

She covers all the basics of low-carb eating, including the rationale, potential side effects and how to prevent or deal with them, the science of “good fats,” the importance of plant-derived foods and fiber, info on artificial sweeteners, and management of weight-loss stalls.

Then Franziska does something else unique and very helpful. She offers three different eating plans along with a simple test to help determine which is the best for you. The options are 1) low-carbohydrate diet, 2) high-fiber, moderate saturated fat, low-carb diet, and 3) intermittent fasting low-carb diet with weekly treat meal. You can dig right in with a week’s worth of easy meals made from readily available ingredients.

It was interesting for me to learn that the author ate vegan-style and then pescetarian for awhile. In 2011 she was eating the usual doctor-recommended “healthy” low-fat high-fiber diet when life insurance blood work indicated she had prediabetes. So she cut her daily dietary carbs from 150 grams to 50 or less, with subsequent return of the labs to normal ranges.

I only had a few quibbles with the book. For instance, there’s no index, but that’s mitigated by a very detailed table of contents. The font size is on the small side for my 60-year-old eyes. If either of those issues bother you, get the ebook version. “Net carbs” are mentioned briefly before they are defined, which might confuse folks new to low-carbing.

A particular feature that appealed to me is the vegetarian meal options. Low-carb eating is often criticized as being meat-centric. Franziska shows it doesn’t have to be.

I also appreciate that she provides the net carb grams and calorie counts for her meal plans and recipes. All diabetics and many prediabetics need to know the carb grams. Calorie counts come in handy when analyzing the cause of a weight loss stall. Yes, calories still count in weight management.

I don’t think it’s giving too much away to say that the author’s top low-carb beauty foods are avocados, berries, cinnamon, cocoa/dark chocolate, fatty fish, flaxseed, full-fat dairy, green tea, nuts, olives/olive oil, and non-starchy vegetables. I was skeptical at the start of the beauty foods chapter, but Franziska’s scientific references support her recommendations. I’m already eating most of these foods. Now I’m going to try green tea and ground flaxseed (e.g., her flaxseed bread recipe).

The author will also get you going on exercise. I heartily agree with her that exercise is truly a fountain of youth.

Menopausal? The author has your special challenges covered.

If you’re curious about the paleo diet, note that only about a quarter of these recipes are pure paleo. Dairy products disqualify many of them.

Here are a just a few tidbits I picked up, to help me remember them:

  • a blood test called fructosamine reflects blood sugar levels over the previous three weeks
  • you’ll have less wrinkles if you can reduce the advanced glycation end-products (AGEs) in your skin
  • Japanese women on the highest-fat diets have less wrinkling and better skin elasticity
  • soluble fiber from plants helps to reduce appetite, improves blood sugar control, and helps with weight regulation (see her table of high-fiber plants, including soluble and insoluble fiber)
  • seitan is a meat substitute for vegetarians
  • erythritol (an artificial sweetener) may have less gastrointestinal effects (gas, bloating, diarrhea) than many other artificial sweeteners
  • maltitol (another artificial sweetener in the sugar alcohols class) tends to increase blood sugar more than the other sugar alcohols
  • I’m going to try her “sardines mashed with avocados” recipe (Alton Brown popularized sardine-avocado sandwiches, so it’s not as bizarre as it sounds!)

I wouldn’t be surprised if Franziska’s recommendations help men as well as women keep or regain their youthfulness.

Steve Parker, M.D.

Recipe: Natchez Eggs

kk

This particular batch contained Bacon Bits

Natchez Eggs is an old family recipe.  It’s sort of an egg casserole, good for breakfast.  We tend to dust off this recipe when we have house guests—it feeds many people at once, quickly and easily.

It’s not in The Advanced Mediterranean Diet (2nd Edition) or KMD: Ketogenic Mediterranean Diet, although it’s compatible with both of those.

Note my use of both U.S. customary and metric measurements, which I also use in the books. I have no idea how much it costs to ship a book from the U.S. to New Zealand, but the e-book versions (AMD or KMD) have no shipping charges.

The low carbohydrate content of this dish is a bonus if you have diabetes, prediabetes, or metabolic syndrome.

kk

Note the light brown crust which tells you it’s probably finished cooking

Ingredients

Cheese, shredded (four-cheese mexican blend), 8 0z (224 g)
Sour cream, 16 oz (448 g)
Green chiles, diced, canned, 8 oz net weight (224g)
Eggs, large, 10 (50 g each)

Preparation

Pre-heat oven to 350°F (175°C).  Mix eggs thoroughly in a blender for 3–4 minutes on medium speed, then pour into bowl.  Coat a baking dish (9 x13 inches, or 22 x 34 cm) with butter, vegetable oil, PAM or no-stick baking spray.  Whisk eggs and sour cream together in bowl.  Drain excess water from the chile cans, then spread chiles evenly on the bottom of a dish, then layer the cheese evenly on top.  Next, ladle or pour the eggs/sour cream on top.  Bake for about 30 minutes, until the eggs are firm, not runny, and you see patches of thin light brown crust.

Number of Servings

12 servings of 4 oz or 110 g each.  Leftovers hold up well in refrigerator for eating over the next few days.

Nutrient Analysis

A serving has 3 grams of digestible carbohydrate, 200 calories, 140 calories from fat, 8 grams of saturated fat, 10 grams of protein, 210 mg cholesterol, 4 grams of carboydrate, 1 gram of fiber (so only 3 grams of digestible carb).

Advanced Mediterranean Diet boxes: 1 fat and 1/2 protein

Options

After you add the cheese layer, sprinkle layer of  Hormel Real Crumbled Bacon (4 oz or 112 g) before finishing up with the  egg mixture.  This adds 33 calories and zero carbs per serving.  Or just serve with bacon on the side (my preference).  An alternative to the Hormel product is to cook and crumble your own bacon (12 oz or 340 g uncooked weight).  Using too much bacon will overwhelm the other flavors.  Experiment with different cheeses.

You can also tweak it if you wish with additional ingredients such as diced bell peppers or chopped green onions (chives). I wouldn’t add more than one ingredient per batch. I wonder if small chunks of broccoli would work.

Steve Parker, M.D.