Low-Carb Diets Improve Cardiovascular Disease Risk Factors

This Shrimp Salad is truly low-carb

A meta-analysis by Chinese investigators found that low-carb diets improve cardiovascular risk factors. Specifically: body weight (lowered), triglycerides (lowered), HDL-cholesterol (raised), blood pressure (lowered systolic and diastolic, but less than 2 points).

Additionally, they found increases in total cholesterol  and HDL-cholesterol. Some consider those to be going in the wrong direction, increasing cardiovascular risk. The study authors, however, considered these increases “slight,” implying lack of real-world significance.

I’ll not fisk the entire research paper. Have a go at it yourself by clicking the link to full-text below.

The researchers included 12 randomized controlled trials in their analysis. They defined low-carb diets as having less than 40% of calories derived from carbohydrates. If you’re eating 2200 calories a day, 39% of calories from carb would be 215 g of carbs/day. That’s a lot of carb, and wouldn’t be much lower than average. I scanned the report pretty quickly and didn’t run across an overall average for carb grams or calories in the low-carb diets. The “control diets” had 45–55% of calories from carbohydrate.

Here’s the abstract:

Background

Low-carbohydrate diets are associated with cardiovascular risk factors; however, the results of different studies are inconsistent.

Purpose

The aim of this meta-analysis was to assess the relationship between low-carbohydrate diets and cardiovascular risk factors.

Method

Four electronic databases (PubMed, Embase, Medline, and the Cochrane Library) were searched from their inception to November 2018. We collected data from 12 randomized trials on low-carbohydrate diets including total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides, and blood pressure levels, as well as weight as the endpoints. The average difference (MD) was used as the index to measure the effect of a low-carbohydrate diet on cardiovascular risk factors with a fixed-effects model or random-effects model. The analysis was further stratified by factors that might affect the results of the intervention.

Results

From 1292 studies identified in the initial search results, 12 randomized studies were included in the final analysis, which showed that a low-carbohydrate diet was associated with a decrease in triglyceride levels of -0.15mmol/l (95% confidence interval -0.23 to -0.07). Low-carbohydrate diet interventions lasting less than 6 months were associated with a decrease of -0.23mmol/l (95% confidence interval -0.32 to -0.15), while those lasting 12–23 months were associated with a decrease of -0.17mmol/l (95% confidence interval -0.32 to -0.01). The change in the body weight in the observation groups was -1.58kg (95% confidence interval -1.58 to -0.75); with for less than 6 months of intervention, this change was -1.14 kg (95% confidence interval -1.65 to -0.63),and with for 6–11 months of intervention, this change was -1.73kg (95% confidence interval -2.7 to -0.76). The change in the systolic blood pressure of the observation group was -1.41mmHg (95% confidence interval—2.26 to -0.56); the change in diastolic blood pressure was -1.71mmHg (95% confidence interval—2.36 to -1.06); the change in plasma HDL-C levels was 0.1mmHg (95% confidence interval 0.08 to 0.12); and the change in serum total cholesterol was 0.13mmol/l (95% confidence interval 0.08 to 0.19). The plasma LDL-C level increased by 0.11mmol/l (95% confidence interval 0.02 to 0.19), and the fasting blood glucose level changed 0.03mmol/l (95% confidence interval -0.05 to 0.12),which was not significant.

Conclusions

This meta-analysis confirms that low-carbohydrate diets have a beneficial effect on cardiovascular risk factors but that the long-term effects on cardiovascular risk factors require further research.

Source: The effects of low-carbohydrate diets on cardiovascular risk factors: A meta-analysis

Steve Parker, M.D.

PS: The Paleobetic Diet provides roughly 60 grams/day of digestible carbohydrate.

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Is the Ornish diet really the most heart-healthy?

Pulmonary artery arrow is wrong

From Cardiovascular Business:

The Mediterranean diet has been eclipsed as the U.S. News & World Report’s best-ranked heart-healthy diet for the first time in a decade, nudged out of the top spot by the popular Ornish diet.

The Ornish diet—also ranked as the ninth-best overall diet in the 2020 report—was pioneered by physician Dean Ornish more than 40 years ago and restricts the consumption of fats, refined carbohydrates and animal proteins. It also emphasizes the importance of exercise and stress management in living healthfully.

Source: Ornish beats Mediterranean as best heart-healthy diet of 2020

I’ve always associated the Ornish diet with group therapy, meditation, and vegetarianism. But no mention of those in the linked article. I can’t remember the last time I met anybody doing the Ornish diet, it’s been that long. It was popular in the 1990s.

We don’t know how well he paleo diet ranks as a heart-healthy diet because it’s never been adequately tested as such.

Steve Parker, M.D.

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No: Should Your DNA or  Gut Microbiome Determine What You Eat or Your Nutritional Supplements?

I take this to help control blood pressure

From Scott Gavura at Science Based Medicine:

Our ability to collect DNA data is progressing quickly, and in time we may have more evidence to inform decisions about nutrition and possibly even supplements. At this time, however, there is a big gap between what we know, and what, if anything, to do with that information. You don’t need a DNA test or a stool sample to know that eating a varied, healthy diet, minimizing highly processed foods, eliminating trans fats, and keeping alcohol consumption moderate are reasonable approaches to designing your diet. It’s worth noting again, as we have blogged about many times before, that the evidence for taking supplementary vitamins, in general, is neutral to negative. In the absence of a specific medical need (e.g., pregnancy) there a few circumstances where routine supplementation is necessary or warranted. There is no robust evidence to date to show that personalized, “DNA-based” or “microbiome-based” nutritional recommendations give useful, actionable nutrition advice that actually improve health outcomes.

Source: “DNA-based” personalized nutrition advice: Not ready for prime time – Science-Based Medicine

Hucksters use sciency terms to convince you they know the best weight-loss diet or supplements for you. Don’t believe it.

Steve Parker, M.D.

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Ketogenic Diet May Help Knee Osteoarthritis

Photo credit: Steven Paul Parker II

Dr Ken Berry published at YouTube a 4-minute video on a diet he believes will lessen the effects and incidence of knee osteoarthritis. For men, the lifetime risk of developing knee osteoarthritis is 40%. For women, 47%. The effects of arthritis are pain and impaired functional status. The title of the video even mentions reversing arthritis. I suppose improved pain and functional ability would be at least a partial reversal.

In short, Dr Berry suggests a diet free of all sugar (no mention of fruits), all grains, and all vegetable oils.

 

Dr Berry refers to a study done at University of Alabama at Birmingham.  The research was published in Pain Medicine.

Dr Berry also referred to a study of cadavers that found a doubling of knee osteoarthritis from around 1850 to 2000. The researchers don’t think aging and obesity are related to the increase. Maybe diet has some thing to do with it.

How was the UAB study done?

The twenty-one study participants were folks with knee osteoarthritis between 65 and 75-years-old. Nine men, 12 women. Average baseline weight was 194 lb (88 kg). The 21 participants were randomly assigned to one of three diets they would follow for 12 weeks:

  1. L0w-carb diet group (8 participants). Restricted daily total carbohydrates (not net carbs) to 20 grams or less for the first three weeks. Then could go up to 40 grams “if required” (not explained). No fat or protein or calorie restriction. Limited amount of vegetables were OK (e.g., 2 cups/day of leafy greens, 1 cup of non-starchy vegetables). Carb-free sweeteners (stevia, sucralose) were allowed but maltodextrin-containing sweeteners were limited (stevia, sucralose, aspartame, saccharin). This group had no drop-outs.
  2. Low-fat diet group (6 participants). 800–1,200 calories/day. It looks like the men were put on reduced calorie diets—500 cals under estimated baseline or maintenance calories. Women’s calories were reduced by 250-300/day from baseline. Calories were reduced mainly through reduction of fats. They ate veggies, fruit, low-fat foods, whole grains, low-fat dairy, and limited cholesterol and saturated fats. Macronutrient distribution: 60% of calories from carb, 20% from protein, 20% from fat. (Yet Table 1 indicates 50–67 g of fat/day. Twenty percent of 1,200 of calories is only 27 g of fat. So misprint in table 1?) This group had one drop-out.
  3. Control group (N=7), eating as per their usual routine although given documents on portion control. Two drop-outs.

The authors indicate that groups 1 and 2 ate about 100 g of protein/day.

All participants filled out surveys documenting knee pain levels and were put through periodic supervised tests like a timed walk and repeatedly arising from a chair with their hands placed on opposite shoulders.

Results

The low-carb diet group is the only one that demonstrated decreased pain intensity and unpleasantness in some functional pain tasks. In other words, improved quality of life.

The low-carb group lost an average of 20 lb (9 kg) compared to the low-fat weight loss of 14 lb (6.5 kg), not a statistically significant difference. Even the control group lost 4 lb (1.8 kg).

A blood test—thiobarbituric acid reactive substances or TBARS—indicated reduced oxidative stress in the low-carb dieters.

The authors hypothesize that the improvement in arthritis pain in the low-carb group was related to the reduction in oxidative stress, which reduces pain and inflammation.

Will these old knees make it up Humprheys Peak one more time?

Implications

With so few participants, you know this was a pilot study that ultimately may not be entirely valid or replicable. But it’s promising. Next, we need a study with 150 participants.

Dr Berry is getting a bit ahead the the science here. He gives a powerful personal testimony in his video. And perhaps he’s seen many of his patients improve their arthritis with a very low-carb diet.

The carb consumption of the low-carb dieters would be ketogenic in most folks. Yet I didn’t even see “ketogenic” in their report. Perhaps because they didn’t measure ketone levels?

The authors of the report mention other studies finding improvement of osteoarthritis  pain and inflammation by the Mediterranean diet. The Mediterranean diet even helps rheumatoid arthritis.

How about combining a very low-carb and Mediterranean diet? As in my Ketogenic Mediterranean Diet. If you have the funds to run the study, I can probably get you a nice discount on books. Have your people contact my people.

Given the safety of very low-carb diets, I can’t argue against a 12-week trial if you have bothersome knee osteoarthritis. Get your doctor’s clearance first.

Steve Parker, M.D.

References:

Strath LJ, et al. The effect of low-carbohydrate and low-fat diets in individuals with knee osteoarthritis. Pain Medicine, 21(1), 2020, pp 150-160.

Oliviero, F, et al. How the Mediterranean diet and some of its components modulate inflammatory pathways in arthritis. Swiss Med Wkly, 2015; 145; w14190.

Veronese, N, et al. Adherence to the Mediterranean diet is associated with better quality of life: Data from the Osteoarthritis Initiative. American Journal of Clinical Nutrition 2016: 104(5): 1403-9.

McKellar, G. et al. A pilot study of a Mediterranean-like diet intervention in female patients with rheumatoid arthritis living in areas of social deprivation in Glasgow. Ann Rheum Dis 2007;66(9):1239-43.

Slöldstam, LB, et al. Weight reduction is not a major reason for improvement in rheumatoid arthritis from lacto-vegetarian, vegan or Mediterranean diets. Nutr J 2005;4(15).

 

Paleo Ketogenic Diet Put Crohn’s Disease Into Remission

Have you ever tried to catch a wild rabbit by hand?

The study at hand is an isolated case report, so we can’t get too excited about it. But it does suggest that a “paleolithic ketogenic diet” may be helpful in Crohn’s disease. “Carnivore diet” may be a better description of the treatment.

The problem with case reports is that an individual’s response to intervention may simply reflect placebo effect or spontaneous improvement of the underlying condition, rather than a true response to the treatment applied.

Crohn’s disease is one of two “inflammatory bowel diseases,” the other being ulcerative colitis. Both of these are felt to be autoimmune, meaning the body is attacking its own tissues as if they were foreign invaders, like germs. Crohn’s disease causes abdominal pain, diarrhea (sometimes bloody), bloating, nausea, malnutrition, and other effects. Ulcerative colitis is similar in presentation. I wrote many years ago about a paleo diet improving at least one case of ulcerative colitis.

Moving along….

Hungarian physicians (?) reported a case of a 16-year-old who was diagnosed with Crohn’s disease at age 14 and wasn’t doing well at all despite standard medical therapy. At one point, intestinal surgery was recommended but he (or his parents) declined.

On the paleolithic ketogenic diet, the patient went into remission within months, off medications, and has been in remission for 15 months. The patient’s BMI rose from 17.7 to 19.5.

So, what was this diet?

  • “animal fat, meat, offal and eggs with an approximate 2:1 fat:protein ratio” [is that ratio grams or calories? Not stated]
  • no grains, milk, dairy, refined sugars, vegetable oils, oilseeds (sic), nightshades, and artificial sweeteners
  • honey OK in small amounts
  • poultry OK but discouraged
  • at one point the patient added small amounts of vegetables and fruits but the authors favor “no plants at all”
  • no supplements

The authors mention good ol’ Walter Voegtlin, author of 1975’s The Stone Age Diet. Voegtlin, by the way, was or is a gastroenterologist. Here’s an iconoclastic quote from Voegtlin.

Why did this carnivore diet seem to work? The authors propose it improves the pathological intestinal permeability seen in Crohn’s disease.

This is a radical diet compared to the Standard American Diet featuring dairy, grains, industrial seed oils, and ultra-processed foods. As usual, check with your personal physician before making any radical diet change. Odds are, however, your doctor doesn’t know much about this diet and won’t approve.

Steve Parker, M.D.

h/t P.D. Mangan

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QOTD: Blogging is Dead

I’m wondering if the age of blogging is at an end. 12 years ago blogs were the way to express ideas to a wider audience. Twitter and most of the social media we take for granted today was around, but it was certainly less endemic as it is now. Hell, even YouTube was still privately owned back then. If you wanted to build an online media brand you had to really believe in what you were doing to make the effort worthwhile. Blogging has always been a labor of love. That’s especially true today because everyone on social media today is their own Brand of Me. If all you do it curate an Instagram account with no other function than to show off how great a life you live, congratulations, you are your brand. It’s second nature to us now, but it used to take a lot more effort to relate your digital consciousness to an audience. That was what you used to blog for.

-Rollo Tomassi in 2020

Source: Exit Dalrock

Medical Errors May Be the Third Most Common Cause of Death in the U.S.

Hospitals are notorious for iatrogenic deaths

“May be.” But they’re not. The 3rd leading cause of death is accidents (unintentional injuries).

From Dr Gorski at Science Based Medicine (and he’s right):

I say this at the beginning of nearly every post that I write on this topic, but it bears repeating. It is an unquestioned belief among believers in alternative medicine and even just among many people who do not trust conventional medicine that conventional medicine kills. Not only does exaggerating the number of people who die due to medical complications or errors fit in with the world view of people like Gary Null and Joe Mercola, but it’s good for business. After all, if conventional medicine is as dangerous as claimed, then the quackery peddled by the likes of Adams and Mercola starts looking better in comparison. Unfortunately, there are a number of academics more than willing to provide quacks with inflated estimates of deaths due to medical error. The most famous of these is Dr. Martin Makary of Johns Hopkins University, who published a review (not an original study, as those citing his estimates like to claim) estimating that the number of preventable deaths due to medical error is between 250,000 and 400,000 a year, thus cementing the common (and false) trope that “medical error is the third leading cause of death in the US” into the public consciousness and thereby doing untold damage to public confidence in medicine. As I pointed out at the time, if this estimate were correct, it would mean that between 35% and 56% of all in-hospital deaths are due to medical error and that medical error causes between 10% and 15% of all deaths in the US. The innumeracy that is required to believe such estimates beggars the imagination.

Source: Are medical errors really the third most common cause of death in the U.S.? (2020 edition) – Science-Based Medicine

Steve Parker, M.D.

PS: Minimize your risk of iatrogenic death by getting and staying as healthy as possible. Let me help.

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What’s the Optimal Diet to Reverse Non-Alcoholic Fatty Liver Disease (NAFLD)?

Stages of liver damage. Healthy, fatty, liver fibrosis, and finally cirrhosis

A recent article in Gastroenterology Clinics suggests this one:

•Prioritize intact starches such as brown rice, quinoa, and steel-cut oats, and limit or avoid refined starches such as white bread and white rice

•Replace some of the CHO [carbohydrate], especially refined CHO, in the diet with additional protein from a mixture of animal or vegetable sources, including chicken, fish, cheese, tofu, and pulses

•Include a variety of bioactive compounds in the diet by consuming fruits, vegetables, coffee, tea, nuts, seeds, and extra virgin olive oil

•Get most fat from unsaturated sources, such as olive oil (ideally extra virgin), rapeseed oil, sunflower oil, safflower oil, canola oil, or nuts and seeds

•Limit or avoid added sugars, whether sucrose, fructose, maltose, maltodextrin, or any syrups. If any of these words appear in the first 3–5 ingredients of any food item, it is best to avoid that item and choose a no-sugar version instead. Examples are yogurts and commercial cereals•In particular, avoid liquid sugar such as carbonated sugary drinks/sodas, lemonade, any juices, smoothies, and added sugar to tea and coffee

Source: Nutrition and Nonalcoholic Fatty Liver Disease – Gastroenterology Clinics

See the article for a typical daily menu. Looks like a Mediterranean diet to me. I’m not aware of the paleo diet being used to combat NAFLD.

Excessive fructose and saturated fatty acid consumption appear to be particularly harmful to the liver.

The authors also seem to endorse exercise: 150 t0 300 minutes per week of moderate- to vigorous intensity aerobics exercise, performed at least thrice weekly.

And all experts recommend loss of excess fat weight.

If you really want to get into the weeds, read about how fat deposits in liver and muscle lead to metabolic inflexibility, resulting in insulin resistance and mitochondrial dysfunction, which alters lipid metabolism, releasing free fatty acids (some of which are lipotoxic), leading to lipotoxic molecules (like ceramides), causing inflammation and fibrosis.

Steve Parker, M.D.

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Has Your New Weight Loss Plan Failed Already? I Can Help

That excess weight can shorten your life

If you’re down at least 4–5 pounds (2.5 kg) since making that weight loss resolution Jan. 1, that’s great. Keep it up. But most folks did well for a couple weeks and started gaining the weight back. Don’t be too hard on yourself. Weight management is not a walk in the park. You probably weren’t adequately prepared for the challenge.

Longterm success requires careful forethought. That’s why I’ve written this eight-part series.

Questions beg for answers.  For example . . .

Which of the myriad weight-loss programs will I follow?  Can I design my own program?  Should I use a diet book?  Sign up for Nutri-System, Weight Watchers, or Jenny Craig?  Should I stop wasting my time dieting and go directly to bariatric surgery?  Can I simply cut back on sodas and chips?  What should I eat?  What should I not eat?  Do I need to start exercising?  What kind?  How much?  Do I need to join a gym?  What methods are proven to increase my odds of success?  How much weight should I lose?  Should I use weight-loss pills or supplements?  Which ones?  What’s the easiest, most effective way to lose weight?  Is there a program that doesn’t require willpower?  Now, what were those “top 10 super-power foods” that melt away the fat?  Am I ready to get serious and stick with it this time?

This series will answer many of these questions and get you teed up for success.  Teed up like a golfer ready to hit his first shot on hole #1 of an 18-hole course.  Take 10 minutes to read the following articles.  The time invested will pay dividends for years.

C’mon now. Let’s be realistic.

Part 1:  Motivation

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

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

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

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

Part 2:  The Energy Balance Equation

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

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

Where does the fat go when you lose weight dieting?  Metabolic reactions convert it to energy, water, and carbon dioxide, which weigh less than fat.  Most of your energy supply is used to fuel basic life-maintaining physiologic processes at rest, referred to as resting or basal metabolism.  Basal metabolic rate (BMR) is expressed as calories per kilogram of body weight per hour.  Even at rest, a kilogram of muscle is much more metabolically active than a kilogram of fat tissue.  So muscular lean people sitting quietly in a room are burning more calories than are fat people of the same weight sitting in the same room.

The major determinants of BMR are age, sex, and the body’s relative proportions of muscle and fat.  Heredity plays a lesser role.

Energy not used for basal metabolism is either stored as fat or converted by the muscles to physical activity.  Most of us use about 70 percent of our energy supply for basal metabolism and 30 percent for physical activity.  Those who exercise regularly and vigorously may expend 40–60 percent of their calorie intake doing physical activity.  Excess energy not used in resting metabolism or physical activity is stored as fat.

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

The energy you eat,

          minus the energy you burn in metabolism and activity,

               determines your change in body fat.  [read more]

Cute mouse, but a slave to instincts.

Part 3:  Free Will

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

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

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

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

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

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

If we don’t have free will, you’re wasting time trying to lose weight through dieting; nothing will get your weight problem under control.  Even liposuction and weight-reduction stomach surgery will fail in time if you are fated to be fat.  The existence of free will is . . . [read more]

Part 4:  Starting New Habits

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

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

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

Exercise isn’t very important for weight loss, but critical for preventing weight regain.

Part 5:  Supportive Social System

Success at any major endeavor is easier when you have a supportive social system.  And make no mistake: losing a significant amount of weight and keeping it off long-term is a major endeavor.

As an example of a supportive social system, consider childhood education.  A network of actors play supportive roles.  Parents provide transportation, school supplies, a home study area, help with homework, etc.  Siblings leave the child alone so he can do his homework, and older ones set an example.  Neighbors may participate in carpooling.  Taxpayers provide money for public schools.  Teachers do their part.  The school board oversees the curriculum, supervises teachers, and does long-range planning.

Success is more likely when all the actors work together for their common goal: education of the child.  Similarly, your starring role in a weight-loss program may win an Academy Award if you have a strong cast of supporting actors.  Your mate, friends, co-workers, and relatives may be helpers or hindrances.  It will help if they . . . [read more]

Part 6:  Weight Goals

Despite all the chatter about how to lose weight, few talk about how much should be lost.

"This can't be right!"

Down 4 pounds in 6 months. I’ll take it!

If you are overweight, deciding how much weight you should lose is not as simple as it seems at first blush.  I rarely have to tell a patient she’s overweight. She knows it and has an intuitive sense of whether it’s mild, moderate, or severe in degree.  She’s much less clear about how much weight she should lose.  If it’s any consolation, clinicians in the field aren’t always sure either.

Five weight standards have been in common usage over the last quarter-century . . . [read more]

Part 7:  Creative Visualization

How will your life be different after you make a commitment and have the willpower to lose weight permanently?

Odds are, you will be more physically active than you are now.  Exercise will be a habit, four to seven days per week.  Not necessarily vigorous exercise, perhaps just walking for 30 or 45 minutes.  It won’t be a chore.  It will be pleasant, if not fun.  The exercise will make you more energetic, help you sleep better, and improve your self-esteem.

After you achieve your goal weight, you’ll be able to cut back on exercise to three or four days per week, if you want.  If you enjoy eating as much as I do, you may want to keep very active physically so that you can eat more.  I must tell you that I rarely see anyone lose a major amount of weight and keep it off without . . . [read more]

Part 8:  Choosing A Program

I listed most of your weight-loss program options in the introductory comments to this series.  Now it’s time to make a choice.  And it’s not easy sorting through all the options.

Straight away, I must tell you that women over 300 pounds (136 kg) and men over 350 pounds (159 kg) rarely have permanent success with self-help methods such as diet books, meal replacement programs, diet pills or supplements, and meal-delivery systems.  People at those high weights who have tried and failed multiple different weight-loss methods should seriously consider bariatric surgery.

I respect your intelligence and desire to do your “due diligence” and weigh all your options: diet books, diet pills and supplements, bariatric surgery, meal replacement products (e.g., SlimFast), portion-control meal providers (e.g., NutriSystem), Weight Watchers, fad diets, no-diet diets, “just cutting back,” etc.  You have to make the choice; I can’t make it for you.  Here are some well-respected sources of advice to review before you choose . . . [read more]

Last modification date:  November 1, 2017

Paleo Diet No Better Than Several Other in Terms of Glucose and Insulin

He can’t choose his diet

But I thought the paleo diet was better than many others. Not according to this meta-analysis published and Journal of Clinical Nutrition.

Recently, the Paleolithic diet became popular due to its possible health benefits. Several, albeit not all, studies suggested that the consumption of the Paleolithic diet might improve glucose tolerance, decrease insulin secretion, and increase insulin sensitivity. Therefore, the aim of this meta-analysis was to compare the effect of the Paleolithic diet with other types of diets on glucose and insulin homeostasis in subjects with altered glucose metabolism. Four databases (PubMed, Web of Sciences, Scopus, and the Cochrane Library) were searched to select studies in which the effects of the Paleolithic diet on fasting glucose and insulin levels, glycated hemoglobin (HbA1c), homeostasis model assessment of insulin resistance (HOMA-IR), and area under the curve (AUC 0-120) for glucose and insulin during the oral glucose tolerance test were assessed. In total, four studies with 98 subjects which compared the effect of the Paleolithic diet with other types of diets (the Mediterranean diet, diabetes diet, and a diet recommended by the Dutch Health Council) were included in this meta-analysis. The Paleolithic diet did not differ from other types of diets with regard to its effect on fasting glucose (standardized mean difference (SMD): -0.343, 95% confidence interval (CI): -0.867, 0.181, p = 0.200) and insulin (SMD: -0.141; 95% CI: -0.599, 0.318; p = 0.548) levels. In addition, there were no differences between the Paleolithic diet and other types of diets in HOMA-IR (SMD: -0.151; 95% CI: -0.610, 0.309; p = 0.521), HbA1c (SMD: -0.380; 95% CI: -0.870, 0.110; p = 0.129), AUC 0-120 glucose (SMD: -0.558; 95% CI: -1.380, 0.264; p = 0.183), and AUC 0-120 insulin (SMD: -0.068; 95% CI: -0.526, 0.390; p = 0.772). In conclusion, the Paleolithic diet did not differ from other types of diets commonly perceived as healthy with regard to effects on glucose and insulin homeostasis in subjects with altered glucose metabolism.

Source: The Effect of the Paleolithic Diet vs. Healthy Diets on Glucose and Insulin Homeostasis: A Systematic Review and Meta-Analysis of Randomized Contro… – PubMed – NCBI

Steve Parker, M.D.

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