Archive for the ‘Dieting’ Category

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low-carb and low-fat diets

Friday, August 27th, 2010

I just finished reading a study which came out in the American College of Physicians journal, the “Annals of Internal Medicine.” I must say I’m a bit underwhelmed. A little over 300 obese subjects without diabetes or high blood pressure were followed for two years at three academic institutions. bout half were put on a diet similar to the Adkins diet, starting out with eating a small amount of low-glycemic index vegetables (I’d include spinach, broccoli, radishes and asparagus in this group, and not corn, squash, potatoes or yams), in other words foods your body can’t rapidly convert to sugars. Later they got more veggies and some fruit and finally added whole grains and dairy products.

The other group got a calorie restricted diet and limited their fat intake. Both groups received behavioral therapy in groups. A multitude of measurements were made at intervals (lipids, weight, blood pressure).

At the six month mark, the low-carb group had more adverse, but relatively minor symptoms (bad breath, constipation, dry mouth, hair loss). At the one year mark the average weight loss in both groups was the same (11%); ditto at two years (7%). The low-carb group had increased HDLs averaging a 23% increase after two years.

So why am I somewhat underwhelmed? I guess I’m happy that the low-carb group raised their HDL (good lipid) numbers, but other than that there wasn’t much difference between the two groups. Both regained weight in the second year, ending up roughly 15-16 pounds down from their starting weights of about 220 pounds. Yet this was in a closely followed bunch of folk with academic centers doing the study, and, for that matter, excluding obese subjects with the obesity-related diseases we worry about.

So I don’t think we’re there yet, in terms of helping the third of our population that is obese and not being taken studied in this detailed fashion. I was frankly hoping for more.

Posted in Dieting, Obesity, medically-oriented background info | No Comments »

Gluten-free diets for weight-loss? Not unless you’ve got Celiac Disease!

Tuesday, August 24th, 2010

We know several people who are on gluten-free diets for Celiac Disease (CD), but until this morning I hadn’t been aware that others regarded this as a weight-loss method. So let’s go back to what gluten is and what problems it causes.

Basically gluten is a protein from three grains, wheat, barley and rye. It’s often found in baked goods. Many people, in fact apparently an increasing number of people, are sensitive to gluten and should avoid consuming gluten-containing products. An article in the Journal “Gastroenterology” July 2009 by a Mayo Clinic group headed by Dr. Joseph Murray found a four-fold increase in undiagnosed CD between groups tested ~1950 and current age-matched groups.

But it’s considerably more complicated than that. Some people are extremely sensitive to gluten. If they ingest it in any form, and gluten is ubiquitous, found in lip gloss, on envelope flaps, in soy sauce and ketchup, they develop an autoimmune reaction and are said to have Celiac Disease. Three million Americans are felt to have this entity which can lead to a multitude of very serious complications.

But, like those of us who say we’re lactose sensitive, there are at least three varieties of what people think of as gluten sensitivity. Perhaps twenty million in the US are felt to have milder gluten issues without full-blown Celiac Disease; not a lot is known about this group. In a similar fashion, I’m lactose intolerant, but, I can drink a small amount of milk without developing major problems.

Then there’s a smaller number who are actually allergic to something in wheat and can develop severe symptoms, including asthma or shock, after eating wheat products. Again, I know individuals who, after drinking milk, end up with severe problems; they’re actually allergic to another milk protein.

So recently there’s been a host of gluten-free products developed; those are very helpful and appropriate for people with CD, but others have seized upon the concept of using these foods as a weight-loss tool. The short answer is Don’t! Many of the new gluten-free food products are high in carbs, fat and calories and relatively low in fiber, iron and vitamins.

There’s an excellent review of CD in “Scientific American, July 27,2009, that I was able to print out from an online source. The author is Dr. Alessio Fasano who heads the University of Maryland Center for Celiac Research. His group has found a substance called zonulin that increases gut permeability and is working with tests for an antibody that may be a biomarker for gluten sensitivity.

So the gluten-free diet may not be the only answer for patients with CD and researchers are working hard to find other treatments. In the meantime, for the rest of us, that diet is clearly not the way to lose weight.

Posted in Dieting, Weight Loss, medically-oriented background info | 1 Comment »

The China Study; time to change my diet?

Wednesday, July 21st, 2010

We were on a trip recently and stopped for three days to visit some relatives we seldom get to see. He’s a physician, past department chair at a highly regarded clinic/academic center and is working on a major research project in four countries, one of which is China. They’ve altered their dietary pattern in a very significant manner since we last saw them, four years ago. I asked for the background data on their new diet and purchased two books, the first of which is “The China Study,” by T. Colin Campbell, PhD and his youngest son, Thomas M. Campbell II.

Dr. Campbell, an emeritus named-chair professor at Cornell, has been a long-term major figure in the area of nutrition and was involved in a large-scale research project involving scientists from China, the US and England. They did blood-work and gave out questionnaires to 6,500 adults in rural and semi-rural areas of China as well as performing urine tests, three-day dietary measurements and analysis of food samples.

The resultant book emphasizes health differences between people in China on a mostly to exclusively vegetarian diet and those of us who eat what has been termed the Western Diet, one rich in meat and dairy products, relatively low in vegetables and fruit. Dr. Campbell strongly advocates our switching to an exclusively plant-based diet and details how the “Diseases of Affluence,” especially heart attacks, diabetes Type 2, some cancers, and obesity are related to nutrition.

I also looked at Dr. Campbell’s impressive bio and, as well, read some of the critiques of his conclusions. I think the book is well worth reading and enjoyed Dr. Campbell’s article in “The Huffington Post,” published today (7-21-2010). In it he calls for an NIH Institute of Nutrition. I would agree that our Western Diet, rich in fats, sugar and salt, is a major cause of overweight and many assocated diseases. I would disagree that some of the specific conclusions in “The China Study” have been conclusively proven. I’d love to see a new NIH branch which could fund studies to prove or disprove those conclusions.

I’d recommend you read the book and judge for yourself.

Posted in Dieting, Healthly lifestyle, Healthy eating, Healthy food shopping, Life Expectancy, medically-oriented background info | No Comments »

The 2010 Dietary Guidelines

Wednesday, June 16th, 2010

I was reading the papers this morning (our local newspaper + “The Wall Street Journal” + the New York Times breaking news) and saw an interesting article in the local paper titled “Four Steps to Fighting Obesity.” It even had a box titled “Putting limits on sodium.” Well that certainly got my attention and led me to a great website: www.dietaryguidelines.gov.

It seems a 13-member advisory committee (called the DGAC) of health and nutrition experts was set up by the two relevant government agencies, the Department of Agriculture (USDA) and Health and Human Services (HHS). They’ve been working a couple of years and their charge was to update, if necessary (and I’m sure it is) the 2005 Dietary Guidelines.

The website led me to a very large document and thus far I’ve read the nine-page Executive Summary and printed off another thirty-two pages on “Sodium, Potassium and Water.” I’ll read that section later, but the overview made me decide to pause in my posts on Omega-3s and point you toward the 2010 guidelines. At this stage the public has thirty days to comment on them before it’s made final. I doubted it will change much, but a professor of nutrition posted on “The Atlantic” website some comments that made me wonder.

First this set of dietary guidelines has to be reviewed every five years, by Congressional fiat. Then the professor, Marion Nestle, has written a book titled “Food Politics: How the Food Industry Influences Nutrition and Health.” I just ordered a paperback copy of her revised edition and also a copy of her book, “What to Eat.” She doesn’t think the guidelines change much from version to version

I’ll await the final version of the 2010 DGAC Report, but in a nutshell they’re recommending we get our dietary sodium intake way down (70% of us need to go to 1,500 mg/day), eat less saturated fat. exercise more, avoid junk food, and follow Michael Pollan’s advice: “Eat food. Mostly plants. Not too much.”

I’m doing that already; we got our first “Couple Veggie Share” delivery Monday from our local CSA
and will soon be starting on our “fruit share.” What I want to see is the final ideas on how the vast majority of us can also eat healthy, affordable fresh fruits and vegetables. Now if the committee can solve that quandary and convince Americans to follow the Dietary Guidelines, we may get somewhere.

So here’s the problem (and perhaps the answer): We’ve got to do something and soon. The issue starts with kids and what they eat; if we don’t find a way to change that, we’re not doing our primary job as parents and grandparents and citizens.

The

Posted in Dieting, Healthly lifestyle, Healthy eating, medically-oriented background info | 1 Comment »

Protecting your arteries

Saturday, June 5th, 2010

I read an article in the “Wall Street Journal” dated June 1, 2010. The subtitle was “How to Turn Back
the Clock when your blood vessels grow old before you do” and that really caught my eye. Most of the article wasn’t anything new; you can prevent or lessen damage to your arteries by some combination of eating a healthy diet, controlling your weight, sticking the meds your physician gives you for heart or blood pressure and not smoking.

Okay, so I already knew all that and so should you, whether you actually “walk the walk” or just talk about doing so as so many of us do. Over the years I’ve quit smoking (when I was a third year medical student and saw a cancer patient smoking through his tracheoestomy), decided, progressively,to lose weight (I’m now under 150 pounds consistently, allowing myself to bounce up and down a few pounds; my max weight, many years ago was 218), eaten a more healthy diet (just got a notice from our local CSA that our weekly “couples veggie share” and “fruit share” will start on the 14th and made sure my blood pressure was controlled

The striking data here appeared in the journal “Circulation” last August, co-authored by a professor of preventive cardiology at Northwestern. Men and women, in his study, who followed the precepts I’ve mentioned above, could have arteries that were equivalent to those of people 14 to 21 years younger. The flip side was certainly true also. A 35-year-old man who does the exact opposite (smokes, doesn’t exercise, has diabetes (probably Type 2 and obesity related) and abnormal cholesterol levels), may have arteries equivalent to those of a 76-year-old.

Your heart, if your resting heart rate is ~70, beats about 100,000 times a day; every time it does so it exposes your arteries to wear and tear. So I had an EKG done last week. My resting heart rate is 53, down from higher levels before I started to exercise regularly. There were no signs of heart damage on the cardiogram and my own personal physician said a while back, “Peter, you’ve gradually increased your exercise level over the years; now you’re doing the equivalent of a stress test every day.”

I think I’m on the right track, but I spent time yesterday with a friend whose belly overflowed his belt buckle. I mentioned that I thought he might want to read my blog and he said, “I weighed 174 in high school and I’m only at 185 now.”

The problem is where the weight is distributed. Many of us had more muscle mass and less belly fat in high school. We may weigh the same, or nearly so, but still be at considerable risk for heart disease and other blood vessel problems.

I’ve taken four and a half inches off my waist measurement; is it time for you to do the same?

Posted in Dieting, Exercise possibilities, Healthly lifestyle, Healthy eating, medically-oriented background info | 2 Comments »

Another good book

Friday, May 14th, 2010

I recently ordered a book by Susan Yager with the intriguing title The Hundred year Diet: America’s Voracious Appetite For Losing Weight. I’m waiting for the book to come in, but the quote in The Wall Street Journal‘s book review section was enough to hook me. It mentioned a prior WSJ article with a great line from a physician saying, “If there were a drug with the same benefits as exercise, it would instantly be the standard of care.”

Yager’s book traces our preoccupation with dieting from the early 19th century to the present. Now we’re tracking our calories, watching out for high-fructose corn syrup, but prior fads had us on high protein diets, chewing our food and chewing it and chewing it before we finally swallowed the mouthful, avoiding this food or that.

I’m waiting for Yager’s relatively slim volume (it’s only 260 pages in length), but in a few minutes I’m going to go to the gym and ride a recumbent bike for 65 minutes (or more) until I’m past the 20 miles/650 calorie mark. I’ll do some stretches and work on a few machines, but for sure I’m going to ride the bike.

Lynnette in the meantime will be out walking. A recent book by Miriam Nelson and Jennifer Ackerman with the title of “The Strong Woman’s Guide to Total Health” suggests brisk walking for an  hour a day. Nelson was the co-chair of the group that authored the 2008 Physical Activity Guidelines for Americans and directs a center at Tufts which concentrates on obesity prevention.

So there’s two approaches to losing weight. I don’t believe in “fad diets.” I do believe in eating less and doing more. Our diet increasingly focuses on more fruits and vegetables and we’re looking in to the options with a local CSA (community-sponsored agriculture) organization. We can purchase an “egg share,” a vegetable share,” a winter vegetable share,” and/or a “fruit share.”

Here are the concepts that appeal to me strongly: buy local, eat more of the good stuff and find some form of exercise that you’re capable of and will do on a regular basis. Carve some time for it out of your busy life. Eat slower. Enjoy your dining companions conversation. Drink some water before that first bite. Serve really small portions of anything you crave that is obviously fattening.

Stay away from fad diets.

Posted in Dieting, Healthly lifestyle, Healthy eating, medically-oriented background info | 2 Comments »

So what should I weigh?

Tuesday, April 27th, 2010

I’ve been reading some of the background material  from one of the articles that appeared in The Wall Street Journal 4-27-2010, in the “Personal Journal” section which today featured Health and Wellness. There were several controversies in other articles: I scanned two: chocolate as a potential antidepressant vs. chocolate being consumed more by those who are depressed; sun-lovers and benefits from sun exposure vs. shade-seekers and harmful effects from excess sun exposure.

The one I was most interested in was titled ”A Case for Those Extra 10 Pounds.” This one seemed aimed at those who are carrying a little extra in the hips and thighs, rather than the belly. It quoted lots of medical data suggesting there might even be some benefit to a “few extra pounds,” an increase in estrogen production  and an accompanying decrease in osteoporosis risk; a Dermatology article was quoted as saying that women who are overweight appear younger than those who are of normal weight or underweight.

So let’s go back to basics. One third of all adult Americans are frankly obese, not just a few pounds overweight. They clearly have a higher risk of a number of serious diseases. Many of those in the middle ground between normal weight and obesity, i.e., those who are termed “overweight,” carry excess belly fat as well as extra poundage in the thighs and buttocks. I see this all the time in the men’s locker room at our gym; my wife says she also notes the same in women. Those folk are also at risk of cardiovascular disease, high blood pressure and, according to some sources, even some types of cancer.

On the other hand, in general, it’s not healthy to be underweight People who are underweight may be so because of underlying diseases such as cancer. I should, of course, note that some people who are very slender may be perfectly healthy and are thin because of lifelong exercise (long distance runners come to mind).

We all tend to look for excuses and to rationalize our issues away. So if you’re lean around the midsection and carry a little extra elsewhere, perhaps you are okay. But I’d suggest you should take a good hard look at your waistline before concluding that you’re one of the folk who can safely carry some excess pounds or not.

Posted in Dieting, Exercise possibilities, Life Expectancy, medically-oriented background info | No Comments »

Blog ahead in Spring…

Sunday, April 18th, 2010

We’ll be heading down to Colorado Springs on Thursday for the Pikes Peak Writers Conference (and my 69th birthday dinner with cousins). So instead of writing blog posts on Tuesday and Friday, as I normally do, this week I decided to “blog ahead.”

Two articles in our local paper got my attention recently. One I’ll pair with an article and also with an accompanying editorial comment from the Annals of Internal Medicine, but that can wait till Wednesday as I’ve not yet fully digested (no pun intended) the dietary advice from the three sources.

Today I wanted to mention a local initiative from the Food Bank for Larimer County, one of our favorite non-profits. I’ve worked volunteer shifts there when I belonged to a Rotary Club and my wife and I always give the Food Bank one of our larger yearly donations when we start figuring out what we can manage to give to charities.

The organization’s director, Amy Pezzani, said in the paper that the Food Bank had 32,000 more visits in 2009 than in 2008. One fifth of our kids in the county are receiving food through schools, food stamps or the Food bank itself.

Yet data collected by other groups says that in that same time period, more than half of our Larimer County residents fall into the overweight and obese groups and one fourth of our students in the K-12 category (I didn’t see any statistics for Colorado State University students).

Now the Food Bank has combined their need for more food with our region’s excess weight issue. A national TV show gave the local folk the idea of a “Pound for Pound Challenge and Pezzani and her crew have gotten over 700 local residents to pledge to lose nearly 20 pounds each by July. So far, they were up to a 13,000-pound pledge and they’re aiming at 50,000 pounds.

Each participant joins the challenge by registering online with a local ZIP code and gives the Food Bank a small donation equivalent to the number of pounds they plan to lose. Pezzani said the 50,000 pound goal would be the the equivalent of two truckloads of food. At the time the article was written, Colorado was ranked 12th in the country in the contest with 135,000 pounds being pledged and Larimer County was third in the state.

Talk about a win-win situation. This idea should be publicized even more widely than it already has. Spread the word.

Posted in Dieting, Weight Loss | 1 Comment »

Pushing the edge: a hodgepodge

Friday, April 16th, 2010

I wrote recently about Springfield’s horseshoe sandwiches using them as one example of things in our society’s food frenzy that I don’t want to join in. Since then I’ve run into a number of other examples and, fortunately, some opposition to these. I’m going to quickly describe a few of the trends I view as potentially dangerous for those of us who want to stay slim (or become slender) and remain healthy.

One article described how high-end restaurants are experiencing a boom, in some case having up to 30% more business. I read that with perhaps a touch of envy, but decided that the trend for fancy dining came from abundant crops and cheaper prices for strawberries, wild mushrooms,and some varieties of carrots.  Those things I can buy for myself in the farmer’s market or the supermarket

My greater concern came from reading two articles on foods being offered for sale that offer much greater risks than fancy restaurant meals. One was on bushmeats, illegally-imported flesh that comes from bats, monkeys and rodents…considered by some to be delicacies and apparently smuggled into the NYC area. Now you may not live near the New York City so this may appear to be of distant interest, but those strange meats have been found to contain a strain of a virus that is distantly related to HIV and many scientists think that consuming such products is how humans first came to be infected with HIV.

Then there’s the unpasteurized milk debate. Public health officials (my Dad was one of those), are absolutely against drinking “raw milk,” though its advocates claim it has many health benefits lost when the milk is pasteurized, defined as being heated enough to kill harmful bacteria.  In March the FDA reported twelve cases of sickness in the Midwest that apparently were tied to a dairy selling “raw milk.” The agency is reviewing its policy on hard cheeses made from raw milk. At present you can purchase those if they are aged sixty days or more. Fresh cheeses made from raw milk have also been linked to disease out breaks.

So you make your choices and decide for yourself. There’s a range of food available from the exotic to the expensive to the somewhat mundane. Just remember, to start with, that prior to 1938, when pasteurization became the norm, cow’s milk was responsible for a quarter of all water- and food-borne illness. And bushmeat may have led to our current HIV epidemic. As for fancy restaurants, I’ll save them for special occasions.

Posted in Dieting, Healthly lifestyle, Life Expectancy | No Comments »

Subtle messages

Wednesday, April 7th, 2010

I was leafing through The Wall Street Journal this morning, quickly, as I got up late, will read a book for my men’s book club most of the morning and then go to Loveland, eight miles south, to lunch at a restaurant I’ve never eaten at before. I’m going there to meet a writer friend whose book I’ve been proofreading.  I saw the headlines in the front section of the paper and will return to them later, but was struck by an article in the last section, the one called “Personal Journal.”

The article’s title was “What Your TV is Telling You to Do.” That caught my attention so I read the whole thing. It’s about NBC’s use of the technique of “behavior placement.” Instead of trying to sell you a specific product by having the star of a show drink, eat or use it, this idea is to show you a kind of behavior you may then decide, consciously or unconsciously, to emulate.

The thing that’s different here is that some NBC’s shows are now sending you messages, or rather signals, to recycle, exercise and eat right. Presumably they’re not just doing this because it’s the right thing, but, in part in least, because it will help them sell ads. TV has enormous power to get huge numbers of viewers to do something, because their favorite character does it.

In this case the stars of various shows will be exercising or eating healthy food choices. I’m going to wait and see what the outcome is and maintain a goodly amount of skepticism, but the overall concept is one I love.

For years we’ve been sold, via ads (which I mute and many who use Tivo skip), products that by no stretch of the imagination could be termed healthy choices. Now, finally, someone is going to try to influence us to make better choices. I’m all for it.

Posted in Dieting, Exercise possibilities, Healthly lifestyle, Healthy eating | 1 Comment »

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