Category Archives: Book Reviews

Book Review: “Fit With Diabetes” by Christel Oerum

Front cover

Ginger Vieira introduced me recently to Christel Oerum via email. I was pleased to hear about Christel’s brand new e-book, “Fit With Diabetes.”

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Physical fitness is a major determinant of longevity. It’s truly our only fountain of youth, and it’s available to most everybody. The only way to get and stay physically fit is through regular exercise. Some studies document shorter life spans for PWDs (persons with diabetes). So it’s particularly important for them to maintain a good level of fitness.

I like this e-book and highly recommend it to adults taking insulin for diabetes who need a great physical activity program but don’t know how to go about it. Use of insulin, whether in type 1 or 2 diabetes, significantly complicates exercise due to sometimes mysterious effects on blood sugar. Christel de-mystifies the issue in a clear and science-based manner.

The most dangerous interaction between insulin and exercise is hypoglycemia, although the opposite can be a problem, too. Much of the book is about avoiding dramatic swings in blood sugar, particularly hypoglycemia. Christel teaches the reader how to balance insulin, food, and exercise to keep sugars on an even keel. Aerobic exercise tends to cause hypoglycemia, whereas anaerobic exercise tends to cause high sugar spikes. But your own reaction may be a little different, if not a lot. As you might imagine, monitoring and record-keeping are critical, and Christel shares her own downloadable log.

Trust me, most primary care physicians and many endocrinologists are not going to be much help in the exercise advice department. I only remember one thing my first-ever accountant told me 30 years ago: “No one cares about your money as much as you do.” Likewise, no one cares about your health as much as you do. You’ll have to become your own expert.

The author is like a trusted old friend who’s “been there, done that,” and is sharing freely with you.

Christel has had type 1 diabetes for 21 years and is a diabetes coach. She’s been an avid exerciser since 2010. At that time there were very few resources that addressed vigorous exercise in the setting of T1 diabetes. Learn from her clients’ experience and her own N=1 experimentation so you don’t have to make the same trial-and-error mistakes.

The author works out five days a week. That doesn’t mean you have to. I suspect you can achieve 80–90% of the maximal longevity and other health benefits with just three days a week, maybe two. (Note: I am contradicting several authoritative medical panels!) If you’re sedentary now, two or three days a week should definitely improve your fitness. But you have to exercise right.

Early on, the author talks about how to get motivated for exercise. I like her SMART goal setting-checklist: Goals must be Specific, Measurable, Achievable, Relevant, and Time-bound.

She recommends a combination of aerobic exercise (“cardio”) and weight training. (I wouldn’t be surprised if we find out one day that the right weight-training program alone is good enough.) Christel tells exactly how to get started and maintain both types of exercise. She outlines both home-based and gym-based training programs.

Dietary calories for adults in the U.S. come 16% from protein, 48% from carbohydrates, and 34% from fats. Alternatively, the author recommends dietary calories come 40% from protein, 30% from carbohydrates, and 30% from fats. So 150 carb grams/day if eating 2000 calories, limiting meal carbs to 30 grams. I wonder if most folks will end up closer to 30% protein and 40% fat, especially for those not doing as much exercise as Christel. (Protein is important for muscle building and maintenance.) Many of my patients do well with additional carbohydrate restriction, but most don’t exercise as much as Christel despite my encouragement.

You can easily track your macronutrients and calories at MyFitnessPal.com.

The author shares some recipes and tells you how to get started on the all-important meal-planning and coming up with your own recipes. There’s even a helpful and realistic chapter on loss of excess weight.

As a reviewer, I always feel like I have to pick a few nits, so here it is. Christel says cardio exercise is great for losing weight. That probably true if you’re competing for $250,000 on TV’s Biggest Loser show. But usually exercise contributes at most 10% to a successful weight-loss program. Diet’s is critical. Exercise does help with prevention of weight regain and has many other benefits.

Again, I like this e-book and highly recommend it to adults taking insulin for diabetes who need a great physical activity program but don’t know how to go about it. Get the e-book here.

Of course, get the blessings of your personal healthcare provider before making any changes to your diet, exercise program, or medications.

Steve Parker, M.D.

PS: Disclosure: Christel kindly gave me a copy of the e-book. Otherwise there was not, and will not be, any remuneration for this review.

 

Book Review: P.D. Mangan’s “Best Supplements for Men”

Death in a bottle?

Best Supplements for Men: for more muscle, higher testosterone, longer life, and better looks was published in 2017 so should still be up to date. I have the paperback but it’s also available as a Kindle e-book. Per Amazon.com’s rating system, I give it five stars (I love it).

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My favorite sentence in this book is, “If you don’t eat, exercise, and sleep right, the health effects of adding any supplement may be minimal to non-existent.” That sets an honest tone. Also in favor of integrity is that the author doesn’t offer Mangan-branded supplements for sale.

I like this book and learned a lot from it. I’ve benefited by reading the author’s tweets and blog (Rogue Health and Fitness) for several years. He’s smart and, I believe, honest.

The author supports his assertions with numerous scientific references, organized by chapter at the back of the book. If he cites a study done in mice, he tells you. Human studies admittedly carry more weight.

Have you wondered if protein supplements and creatine are good for muscle strength and energy? Does magnesium increase testosterone levels? Does berberine have beneficial health effects? The answers are here.

The author gives good advice regarding calcium supplements that even most physicians don’t know about.

Great recommendations on food.

No book is perfect, and this one is no different. It has no index. So if you’re curious about turmeric or supplements that control diabetes, you have to scan the whole book. My copy didn’t include references for chapter 11. Page numbers for chapters in the index didn’t match the actual chapter starts. My least favorite sentence in the book was something about Dr. Joseph Mercola being a trustworthy source of health information; he is not (search “mercola” at ScienceBasedMedicine.org).

Again, I like this book, learned much from it, and recommend it to men. If you’re taking lots of supplements now, read this book to find out if they help, harm, or are only good for making expensive urine.

Steve Parker, M.D.

PS: Some personal notes from my reading. Many of the cited studies are “association”-type evidence  rather causation. Berberine may help reduce blood sugars in diabetics just as well as metformin. Creatine: Yes, for muscle growth and strength. Magnesium 700 mg/day increases testosterone. Mag oxide may be worthless due to poor absorption. Mangan likes mag citrate but Lexicomp says it’s no better than oxide; absorption “up to 30%.” Citrulline: Yes, for ED, and may help with HTN. DHEA 50 mg/day increases testosterone in men by 50%, but only in men over 70. During fat weight loss, whey protein helps prevent muscle loss. MCT oil may also help (e.g., cook with coconut oil). ASA 81 mg/day seems to prevent some cancers in folks over 55, especially colorectal cancer.

Book Review: “Gorilla Mindset” by Mike Cernovich

 

Gorilla-Mindset-book

Dieting is a bad idea because it treats weight as a function of what you do. The idea is that if you do less of the bad stuff – eating cake, for example – and more of the good stuff – let’s say eating salad – you will lose weight and be healthy. While that is technically true, it is a terrible system because it ignores the biggest challenge of weight management: Your mind. If you get your mind right, everything else happens easily.

Scott Adams

Lawyer, blogger, and Tweetmaster Mike Cernovich has  new book, Gorilla Mindset: How to dominate and unleash the animal inside you to live a life of health, wealth, and freedom. Per Amazon.com’s rating system, I give it four stars (I like it).

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I’m an internal medicine specialist. For years, I’ve been struggling with how to convince my patients to exercise regularly and lose excess weight permanently. Why? So they’ll be healthier and live longer. Everyone wants to do that, right? But so few do. Because it’s hard to change lifelong habits to achieve a goal that may be years away. To make the change, you need the right mindset. Yes, it starts in your head.

The old mindset is: “I’ve been fat and lazy for years. I’ll always be fat and lazy. I’ve tried and failed a dozen times to change my lifestyle, and will fail every time.”

What’s the necessary new mindset? “I can do this. I’m not a brainless automaton without free will. I can see that discipline and sacrifice today will pay priceless dividends down the road. I don’t have to be fat just because everyone in my family is. I can overcome temptation. I’m not going to spend time with losers that bring me down. I’ll make new friends, people who live like me and support me. I will not be brainwashed by advertisers and food manufacturers who are only concerned about their profit, not my life. I have a plan for my life, and being fat and lazy aren’t in it.”

I wish I could download and install that into my patients’ brains!

Who created this?

Who created this?

I read this book hoping to pick up some new tips that would help me with my patients that need that mindset shift. And the author did not disappoint. I also ran across several techniques that I already use in my diet books, such as visualization.

Mike Cernovich’s methods include self-talk, posture improvement, mindfulness, focus, visualization, framing, and others. They will help with mindset re-set. The book is a fill-in-the-blank workbook, so buy your own copy and get to work.

The book is explicitly aimed at men. I would say the target demographic age is 16 to 40. The mind-bending methods should work for those over 40. It’s for men wanting more out of life, to rise above the hoi polloi, and willing to do the work.

It’s not a “weight loss book” per se; see the subtitle for details. However, Mr. Cernovich lost weight from 260 to 180 lb (118 to 81 kg). So he knows the struggle. He says, “…it’s almost impossible to maintain high levels of health while eating a diet high in processed foods.” I agree.

I particularly liked the chapter on money and livelihood. Young men need this information. The book is chock full of avuncular advice, so needed these days when too many boys grow up without a masculine role model. (Women, think long and hard about your children before you frivorce your husband.)

A little of the advice herein is California hippy-dippy woo, but it shouldn’t hurt you and may help, even if it doesn’t appeal to me. I’m convinced the author firmly believes in his recommendations and follows his own advice. I’m skeptical about some of the nutritional supplement advice, too; I’d check with P.D. Mangan for his thoughts.

The author hopes Gorilla Mindset becomes a perennial classic. He’s not quite there yet with this edition. He needs a chapter addressing sex/girls/women. Also, many young men need help on how to find a life purpose that motivates them. This isn’t enough: “If you feel unfilled [sic], stop doing whatever it is you’re doing. Try something else. Walk the streets until you’re exhausted. Repeat this every day. When you finally see what you want, your life will change.” My teenage daughter recently took an online occupational aptitude test that really helped give her some direction. My son is next; his interests are superficial and all over the map. Of course, aptitude is nothing without deep interest or passion. Another issue for the next edition: What about God and centuries-old religions?

A watershed moment in the Mike’s adolescence was when his father asked him, “When are you going to get serious?”

I ask you the same.

Steve Parker, M.D.

PS: If you think this review has too many words with vowels, you should see my books. They’re full of ’em.

 

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.

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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 have diabetes or prediabetes and want to reduce your carbohydrate consumption, consider my Low-Carb Mediterranean Diet or Paleobetic Diet.

Book Review: Zest For Life

A couple years ago I read and reviewed Zest For Life: The Mediterranean Anti-Cancer Diet, by Conner Middelmann-Whitney, published in 2011. Per Amazon.com’s rating system, I give it five stars (I love it).

This post has nothing to do with the paleo diet, yet I see Stella Metsovas has a new program called the PaleoMediterranean™ diet. I’m not familiar with it.

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The lifetime risk of developing invasive cancer in the U.S. is four in ten: a little higher for men, a little lower for women.  Those are scary odds.  Cancer is second only to heart disease as a cause of death in western societies.  The Mediterranean diet has a well established track record of protecting against cancers of the prostate, colon/rectum, uterus, and breast.  Preliminary data suggest protection against melanoma and stomach cancer, too.  I’m not aware of any other way of eating that can make similar claims.

So it makes great sense to spread the word on how to eat Mediterranean-style, to lower your risk of developing cancer.  Such is the goal of Zest For Life’s author.  The Mediterranean diet is mostly, although by no means exclusively, plant-based.  It encourages consumption of natural, minimally processed, locally grown foods.  Generally, it’s rich in vegetables, fruits, legumes, olive oil, whole grains, red wine, and nuts. It’s low to moderate in meat, chicken, fish, eggs, and dairy products (mostly cheese and yogurt).

Note that one of the four longevity hot spots featured in Dan Buettner’s Blue Zones was Mediterranean: Sardinia.  All four Blue Zones were characterized by plant-based diets of minimally processed, locally grown foods. (I argue that Okinawa and the Nicoya Peninsula dwellers ate little meat simply due to economic factors.)

Proper diet won’t prevent all cancer, but perhaps 10-20% of common cancer cases, such as prostate, breast, colorectal, and uterine cancer.  A natural, nutrient-rich, mostly plant-based diet seems to bolster our defenses against cancer.

Ms. Middelmann-Whitney is no wacko claiming you can cure your cancer with the right diet modifications.  She writes, “…I do not advocate food as a cancer treatment once the disease has declared itself….”

She never brings it up herself, but I detect a streak of paleo diet advocacy in her.  Several of her references are from Loren Cordain, one of the gurus of the modern paleo diet movement.

She also mentions the ideas of Michael Pollan very favorably.

She’s not as high on whole grains as most of the other current nutrition writers.  She points out that, calorie for calorie, whole grains are not as nutrient-rich as vegetables and fruits.  Speaking of which, she notes that veggies generally have more nutrients than fruits. Furthermore, she says, grain-based flours probably contribute to overweight and obesity. She suggests that many people eat too many grains and would benefit by substituting more nutrient-rich foods, such as veggies and fruits.

Some interesting things I learned were 1) the 10 most dangerous foods to eat while driving, 2) the significance of organized religion in limiting meat consumption in some Mediterranean regions, 3) we probably eat too many omega-6 fatty acids, moving the omega-6/omega-3 ratio away from the ideal of 2:1 or 3:1 (another paleo diet principle), 4) one reason nitrites are added to processed meats is to create a pleasing red color (they impair bacterial growth, too), 5) fresh herbs are better added towards the end of cooking, whereas dried herbs can be added earlier, 6) 57% of calories in western societies are largely “empty calories:” refined sugar, flour, and industrially processed vegetable oils, and 7) refined sugar consumption in the U.S. was 11 lb (5 kg) in the 1830s, rising to 155 lb (70 kg) by 2000.

Any problems with the book?  The font size is a bit small for me; if that worries you, get the Kindle edition and choose your size.  She mentions that omega-6 and omega-3 fatty acids are “essential” fats. I bet she meant to say specifically that linolenic and linoleic fatty acids are essential (our bodies can’t make them); linolenic happens to be an omega-3, linoleic is an omega-6.  Reference #8 in chapter three is missing.  She states that red and processed meats cause cancer (the studies are inconclusive).  I’m not sure that cooking in or with polyunsaturated plant oils causes formation of free radicals that we need to worry about.

As would be expected, the author and I don’t see eye to eye on everything.  For example, she worries about bisphenol-A, pesticide residue, saturated fat, excessive red meat consumption, and strongly prefers pastured beef and free-range chickens and eggs.  I don’t worry much.  She also subscribes to the “precautionary principle.”

The author shares over 150 recipes to get you started on your road to cancer prevention.  I easily found 15 I want to try.  She covers all the bases on shopping for food, cooking, outfitting a basic kitchen, dining out, shopping on a strict budget, etc.  Highly practical for beginning cooks.  Numerous scientific references are listed for you skeptics.

I recommend this book to all adults, particularly for those with a strong family history of cancer.  But following the author’s recommendations would do more than lower your risk of cancer.  You’d likely have a longer lifespan, lose some excess fat weight,  and lower your risk of type 2 diabetes, dementia, heart disease, stroke, and vision loss from macular degeneration.  Particularly compared to the standard American diet.

Steve Parker, M.D.

Disclosure: The author arranged a free copy of the book for me, otherwise I recieved nothing of value for writing this review.

Book Review: Sean Preuss’ “The Heart Healthy Lifestyle – The Prevention and Treatment of Type 2 Diabetes”

I just finished an ebook, The Heart Healthy Lifestyle: The Prevention and Treatment of Type 2 Diabetes by Sean Preuss, published in 2013. Per Amazon.com’s rating system, I give it five stars (I love it).

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This is an invaluable resource for 1) anyone recently diagnosed with type 2 diabetes or prediabetes, 2) those who aren’t responding well to their current therapeutic regimen, and 3) type 2 diabetics who want to reduce their drug use.

Strength Training Helps Get Excess Blood Sugar Out of Circulation

Strength Training Helps Get Excess Blood Sugar Out of Circulation

Mr. Preuss is a fitness trainer in my neck of the woods who has worked with many type 2 diabetics. He demonstrates great familiarity with the issues diabetics face daily. His science-based recommendations are familiar to mine since I reviewed many of his references at on of my other blogs (Diabetic Mediterranean Diet).

Like me, Mr. Preuss recognizes the primacy of lifestyle modification over drug therapy for type 2 diabetes, as long as drugs can safely be avoided or postponed. The main lifestyle factors are diet and exercise. Too many physicians don’t spend enough time on these, preferring instead to whip out the prescription pad and say, “Here ya go. I’ll see you in three months.”

I have gradually come to realize that most of my sedentary type 2 diabetes patients need to start a work-out program in a gym where they can get some personal attention. That’s Mr. Preuss’s opinion, too. The clearly explained strength training program he recommends utilizes machines most commonly found in a commercial gym, although some home gyms will have them also. His regimen is easily done in 15–20 minute sessions two or three times a week.

He also recommends aerobic activity, such as walking at least several days a week. He recommends a minimum of 113 minutes a week of low intensity aerobic work, citing evidence that it’s more effective than higher intensity effort for improving insulin sensitivity.

I don’t recall specific mention of High Intensity Interval Training. HIIT holds great promise for delivering the benefits of aerobic exercise in only a quarter of the time devoted to lower intensity aerobics.

I was glad to see all of Mr. Preuss’s scientific references involved humans, particularly those with type 2 diabetes. No mouse studies here!

Another strength of the book is that Sean tells you how to use legitimate psychological tricks to make the necessary lifestyle changes.

The author notes that vinegar can help control blood sugars. He suggests, if you can tolerate it, drinking straight (undiluted) red wine vinegar or apple cider vinegar – 2 tbsp at bedtime or before carbohydrate consumption. I’ve heard rumors that this could be harmful to teeth, so I’d do some research or ask my dentist before drinking straight vinegar regularly. For all I know, it could be perfectly harmless. If you have a definitive answer, please share in the comments section below.

I read a pertinent vinegar study out of the University of Arizona from 2010 and reviewed it at one of my blogs. The most effective dose of vinegar was 10 g (about two teaspoons or 10 ml) of 5% acetic acid vinegar (either Heinz apple cider vinegar or Star Fine Foods raspberry vinegar).  This equates to two tablespoons of vinaigrette dressing (two parts oil/1 part vinegar) as might be used on a salad.  The study authors also say that “…two teaspoons of vinegar could be consumed palatably in hot tea with lemon at mealtime.”

The diet advice herein focuses on replacement of a portion of carbohydrates with proteins, healthy oils, and vegetables.

I highly recommend this book. And sign up for Mr. Preuss’s related tweets at @HeartHealthyTw.

Steve Parker, M.D.

Disclosure: Mr. Preuss gave me a free copy of the book, otherwise I have received no monetary compensation for this review.

What Do Mainstream Dietitians Think of the Paleo Diet?

Australian Aborigine in Swamp Darwin

I’m curious to know what mainstream dietitians think about the Paleolithic diet, so I read an article entitled “Are diets from Paleolithic times relevant today?”  This one-page article is in the August, 2012, issue of the Journal of the American Academy of Nutrition and Dietetics. The author is Eleese Cunningham, RD, of the Academy of Nutrition and Dietetics Knowledge Center Team.

The Academy of Nutrition and Dietetics is the new name of the American Dietetics Association, “the world’s largest organization of food and nutrition professionals.”

Ms. Cunningham notes that “diet books for modern humans are extremely popular, and the Paleolithic diet, sometimes called the “Caveman Diet” or the “Stone Age Diet,” is one of the latest trends.”  You’d think the author would mention one of the popular paleo diet books, such as Loren Cordain’s, Robb Wolf’s, or Mark Sisson’s.  Think again.  She brings up only another dietitian’s review of Richard Nikoley’s paleo diet book, pointing out his lack of professional health credentials and his advocacy of raw milk consumption.  But milk isn’t even considered a component of most paleo diets.  Ms. Cunningham justifiably points out the infectious risks, however small, linked to raw milk consumption.  (I’ve not read Nikoley’s book, Free the Animal.)

(If you click the link to see the review of Nikoley’s book, scroll to page 30.  Sample: “Based more on science fiction than science fact, Nikoley’s recommendations are misguided and reckless…”)

Ms. Cunningham likes the fact that the paleo diet reduces consumption of salt and added sugars, while promoting fruit and vegetables.  However, she immediately notes thereafter that, “a striking counter to the meat-based Paleolithic diet is the evidence that supports the healthfulness of a vegetarian diet and the benefits it may have in the prevention and treatment of certain diseases.  Another review of this approach . . . questions the exclusion of nutrient-rich grains, beans, and low-fat dairy and the potential nutrient shortfalls associated with the Paleolithic diet restrictions.”

This article appears to be in a regular feature of the journal called, “From the Academy: Question of the Month.”  Are diets from Paleolithic times relevant today?  She never answers directly.  I suspect the average dietitian reading this article will conclude that Ms. Cunningham and the Academy are not in favor of the paleo diet.

Steve Parker, M.D.

Reference: Cunningham, Eleese.  Are diets from Paleolithic times relevant today?  Journal of the Academy of Nutrition and Dietetics, 2012 (vol. 112, issue 8): p. 1296.  doi: 10.1016/j.jand.2012.06.019

Position of the American Dietetic Association: Vegetarian diets.  Journal of the American Dietetic Association, 2009 (109): 1266-1282.

Book Review: Low-Carbing Among Friends, Volume 1

About six months ago I read Low-Carbing Among Friends, Volume 1 by Jennifer Eloff, Maria Emmerich, Carolyn Ketchum, Lisa Marshall, and Kent Altena.

The paleo diet is often thought of as low-carbohydrate, even though Eaton and Konner have convinced me that’s not necessarily the case.  Eaton and Konner suggest that an ancestral diet, on average, provides 35 to 40% of total calories as carbohydrate.  Compare that to the 50-55% of carb-derived calories in the Standard American Diet.  Many hard-core low-carbers restrict digestible carbs to 10 or 20% of total calories.

Old Stone Age diet followers nearly always exclude grains.  Cookbooks that exclude gluten, derived from certain grains, could appeal to paleo dieters.  In that spirit, here’s my review of Low-Carbing Among Friends, Volume 1.  Many of these recipes use dairy products and artificial sweeteners, so if you’re eating strict pale, look for a different cookbook.

If you have a favorite pure paleo cookbook, do me a favor and tell me in the comment section.

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If you’re serious about low-carb eating, you’ll want this book.  Five well-known low-carb cooks and chefs present many of their best recipes in a straightforward format.  All 300+ recipes are gluten-free, wheat-free, and sugar-free.  I read through over half of the recipes and understood all the instructions; I’m confident I could make anything in this book.

Some of of the recipe ingredients will be a little hard to find. You may have to order a few of them online, and the authors tell you where to order. Unless you’re just dabbling in low-carb eating, you’ll want to stock up on some of these anyway.

I have an incurable sweet tooth.  I like to share my cooking with my wife, but she has, um, (ahem)… “gastrointestinal problems” with my usual non-caloric sweetener, Splenda.  That’s not very common, but is a well-known phenomenon.  I was glad to learn herein that erythritol is a trouble-free alternative, GI-wise.

One thing I miss about standard high-carb eating is baked sugary items like cakes and muffins.  Sure, I’ve read that if you stay away from those for four to six months, you’ll lose your desire.  Not me.  And I tried.  In my next stretch of days off, I’m making a batch of Jennifer Eloff’s Splendid Gluten-Free Bake Mix and spending some time in the kitchen!

Not being previously familiar with him, I was particularly impressed with Kent Altena’s background.  Starting at over 400 pounds (182+ kg), he lost over 200 pounds (91+ kg) and reenlisted in the U.S. National Guard and started running marathons (26.2 miles)!  Thank you for your service to our country, Mr. Altena.

The book is laced with commentary from low-carb proponents, including Dana Carpender, Jimmy Moore, Dr. John Briffa, Dr. Andreas Eenfeldt, Dr. Robert Su, and me.  I am honored to have been invited.

By the way, recipe measurements are given in both U.S. customary and metric units, which non-U.S. residents will appreciate.  Serving size nutrient analysis includes digestible carb grams (aka net carbs).  All recipe carb counts are under 10 g; most are under 5 g.

If you’re tired of eating the same old things, I’m sure you’ll find many new dishes here that will become time-honored classics in your household.

Steve Parker, M.D.

Disclosure: As a supporter of low-carb eating, I contributed two pages to the book.  I did not and will not recieve any remuneration, and I purchased my own copy of the book.

PS: Recipes I want to try: Cinnamon Swirl Cookies, Green Bean and Bacon Salasd, Gingerbread Biscotti, Tuan Burgers, Blueberry Muffins, Pecan Sun-Dried Tomato and Bacon Cauli-Rice, Spicy Shrimp with Avocado Dressing, 24-Hour Chili, Harvest Pancakes, Breakfast Casserole, Bacon Wrapped Jalapeno Poppers, Stuffed Mushrooms, Broccoli Bacon Salad, Seven Layer Salad, Sausage Quiche, Low-Carb Pancakes, Stuffed Hamburgers, Eggplant Parmeson, Flax Bread, Splendid Gluten-Free Bake Mix, and Mock Danish.

Book Review: The Blood Sugar Solution

A few months ago, I read The Blood Sugar Solution: The UltraHealthy Progam for Losing Weight, Preventing Disease, and Feeling Great Now!  Published in 2012, the author is Dr. Mark Hyman. I give it three stars per Amazon’s rating system (“It’s OK”).  Actually, I came close to giving it two stars, but was afraid the review would have been censored at the Amazon site.

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The book’s promotional blurbs by the likes of Dr. Oz, Dr. Dean Ornish, and Deepak Chopra predisposed me to dislike this book.  But it’s not as bad as I thought it’d be.

The good parts first.  Dr. Hyman favors the Mediterranean diet, strength training, and high-intensity interval training.  His recommended way of eating is an improvement over the standard American diet, improving prospects for health and longevity.  His dietary approach to insulin-resistant overweight/obesity and type 2 diabetes includes 1) avoidance of sugar, flour, processed foods, 2) preparation of your own meals from natural, whole food, and 3) keeping glycemic loads low.  All well and good for weight loss and blood sugar control.  It’s not a vegetarian diet.

The author proposes a new trade-marked medical condition: diabesity. It refers to insulin resistance in association with (usually) overweight, obesity, and/or type 2 diabetes mellitus.  Dr. Hyman says half of Americans have this brand-new disorder, and he has the cure.  If you don’t have overt diabetes or prediabetes, you’ll have to get your insulin levels measured to see if you have diabesity.

He reiterates many current politically correct fads, such as grass-fed/pastured beef, organic food, detoxification, and strict avoidance of all man-made chemicals, notwithstanding the relative lack of scientific evidence supporting many of these positions.

Dr. Hyman bills himself as a scientist, but his biography in the book doesn’t support that label.  Shoot, I’ve got a degree in zoology, but I’m a practicing physician, not a scientist.

The author thinks there are only six causes of all disease: single-gene genetic disorders, poor diet, chonic stress, microbes, toxins, and allergens.  Hmmm… None of those explain hypothyroidism, rheumatoid arthritis, systemic lupus erythematosis, tinnitus, migraines, irritable bowel syndrome, Parkinsons disease, chronic fatigue syndrome, or multiple sclerosis, to name a few that don’t fit his paradigm.

Dr. Hyman makes a number of claims that are just plain wrong.  Here are some:
– Over 80% of Americans are deficient in vitamin D
– Lack of fiber contributes to cancer
– High C-reactive protein (in blood) is linked to a 1,700% increased probability of developing diabetes
– Processed, factory-made foods have no nutrients
– We must take nutritional supplements

Furthermore, he recommends a minimum of 11 and perhaps as many as 16 different supplements even though the supportive science is weak or nonexistent.  Is he selling supplements?  You betcha!

After easily finding these bloopers, I started questioning many other of the author’s statements.

I was very troubled by the apparent lack of warning about hypoglycemia (low blood sugar).  Many folks with diabetes will be reading this book.  They could experience hypoglycemia on this diet if they’re taking certain diabetes drugs: insulin, sulfonylureas, meglitinides, pramlintide plus insulin, exenatide plus sulfonylurea, and possibly thiazolidinediones, to name a few instances.

If you don’t have diabetes but do need to lose weight, this book may help.  If you have diabetes, strongly consider an alternative such as Dr. Bernstein’s Diabetes Solution or my Conquer Diabetes and Prediabetes.

In the interest of brevity, I’ll not comment on Dr. Hyman’s substitution of time-tested science-based medicine with his own “Functional Medicine.”

Steve Parker, M.D.

Book Review: The Smarter Science of Slim

I  recently read The Smarter Science of Slim, by Jonathan Bailor, published in 2012.   I post this here because the author considers his eating plan to be a Paleolithic-style (Stone Age) diet.  Per Amazon.com’s rating system, I give it four stars (“I like it”).

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Mr. Bailor’s weight-management diet avoids grains, most dairy, oils, refined starches, added sugars, starchy veggies, corn, white potatoes.  You eat meat, chicken, eggs, some fruit, nuts, seeds, and copious low-starch vegetables.  No limit on food if you eat the right items.   

It’s high-fiber, high-protein, moderate-fat, moderate-carb (1/3 of calories from carbohydrate,  1/3 from protein, 1/3 from fat).  He considers it paleo eating (aka Stone Age) even though he allows moderate legumes and dairy (fat-free or low-fat cottage cheese and plain Greek yogurt).  Paleo purists outlaw legumes and  milk products.

Will it lead to weight lose? Quite probably in a majority of followers, especially those eating the standard, low-quality American diet.  When it works, it’s because you’ve cut out the fattening carbohydrates so ubiquitous in Western societies.  The protein and fiber will help with satiety.  Is it a safe eating plan?  Yes.

For those with diabetes needing to lose weight, I prefer a lower carbohydrate content in the diet, something like Dr. Bernstein’s Diabetes Solution or  Conquer Diabetes and Prediabetes: The Low-Carb Mediterranean Diet.

I don’t recall any recipes or specific meal plans.  You put your own meals together following his guidelines.

Our major points of agreement:

  • Exercise isn’t terribly helpful as a weight-loss technique for most folks.
  • We’re overweight because we eat too many starches and sweets.
  • Natural, minimally processed foods are healthier than man-made highly refined items.
  • No need to emphasize “organic” /grass-fed beef/free-range chicken.
  • We don’t do enough high-quality exercise.

I have a few problems with the book:

  • It says we’re eating less.  U.S. caloric consumption over the last several decades has increased by about 150 cals (630 kJ) a day for men and 300 cals (1260 kJ) for women.  The author seems to contradict himself at one point by favorably quoting Hilda Bruch’s writing that “…overeating is observed with great regularity” in the obese. 
  • Scary graphs showing increasing instances of heart disease and diabetes over time aren’t helpful because they ignore population growth.  The population-adjusted diabetes rate is indeed increasing whereas heart disease rates are decreasing.
  • It says the Calories In/Calories Out theory of overweight has been proven wrong.  This is by no means true.  It just hasn’t helped us much to reverse the overweight epidemic.  Sure, it’s often said that if you just cut a daily tablespoon of butter out of your diet, you’d lose 11 lb (5 kg) in a year, all other things being equal.  Problem is, all other things are never equal.  In reality, we replace the butter with something else, or we’re slightly less active.  So weight doesn’t change or we gain a little.
  • It says the “eat less, exercise more” mantra has been proven wrong as a weight loss method.  Not really.  See above.  And watch an episode of TV’s The Biggest Loser.  Exercise can burn off fat tissue.  The problem is that we tend to overeat within the next 12 hours, replacing the fat we just burned. I agree with the author that “eat less, exercise more” is extremely hard to do, which is the reason it so often fails over the long run.  As Mr. Bailor writes elsewhere: “Hard to do” plus “do not want to do” generally equals “it’s not happening.”  Mr. Bailor would say the reason it ultimately fails is because of a metabolic clog or dysregulation. 
  • He says there’s no relationship between energy (calorie) consumption and overweight.  Not true.  Need references?  Google these: PMID 15516193, PMID 17878287, PMID 14762332.  The author puts too much faith in self-reports of food intake, which are notoriously inaccurate.  And obese folks under-report consumption more than others (this is not to say they’re lying). 
  • Mr. Bailor’s assessments too often rely on rat and mice studies.
  • By page 59, I had found five text sentences that didn’t match up well with the numeric bibiographic references (e.g., pages 48, 50, 59).
  • S. Boyd Eaton is thrice referred to as S. Boyd.
  • How did he miss the research on high intensity interval training by Tabata and colleagues in 1996.  Gibala is mentioned often but he wasn’t the pioneer.
  • Several diagrams throughout the book didn’t print well (not the author’s fault, of course).
  • In several spots, the author implies that HIS specific eating and exercise program has been tested in research settings.  It hasn’t.

Mr. Bailor’s exercise prescription is the most exciting part of the book for me.  His review of the literature indicates you can gain the weight-management and health benefits of exercise with just 10 or 20 minutes a week.  NOT the hour a day recommended by so many public heath authorities.  And he tells you how to do the exercises without a gym membership or expensive equipment.  That 20 minutes is exhausting and not fun.  You have fun in all the hours you saved.  If this pans out, we’re on the cusp of a fitness revolution.  Gym owners won’t be happy.  Sounds too good to be true, doesn’t it?

One component of the exercise program is high intensity interval training (HIIT), which I’m convinced is better than hours per week of low-intensity “cardio” like jogging. Better in terms of both fitness and weight management.

The resistance training part of the program focuses on low repetitions with high resistance, especially eccentric slow muscle contraction.  This is probably similar to programs recommended by Doug McGuff. John Little, Chris Highcock, and Skyler Tanner.  I’m no authority on this but I’m trying to learn.  By this point in the book, I was tired of looking up his cited references (76 pages!).  I just don’t know if this resistance training style is the way to go or not.  I’ll probably have to just try it on myself.  What do you think?

I admire Mr. Bailor’s effort to digest and condense decades of nutrition and exercise research.  He succeeds to a large degree.

Steve Parker, M.D.