Q&A Session at HealthTap.com

Can low vitamin D levels effect your period?

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What is an example of a high protein, high carb, low fat meal?

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Need guide to what to eat to get healthy?

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Will drinking a table spoon of extra virgin olive oil be beneficial or harmful? Or no effect? (drinking it daily)

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Wut is the best foods to eat ?

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What are the side effects of magrim diet , please ??

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Please tell me what should I not eat, in order to keep my cholesterol low?

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I'm an 18 y/o college student eating 2-3 larger meals/day. I am 115 lbs with little muscle weight. How can I gain weight?

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Mediterranean Diet vs Depression

Everywhere you look, someone's trying to sell you this diet or that diet, most w/preposterous claims of miraculous weight loss and dramatic cures of a multitude of conditions.  In truth, very few of these diets have any peer-reviewed published evidence supporting their claims.  Of these, I would daresay that the Mediterranean diet has the most data behind it, having been linked to lower risk for dementia, diabetes & heart disease.

So perhaps it shouldn't surprise you that a multicenter, randomized, primary prevention trial of community dwelling participants published 2 weeks ago in BioMedCentral found that the Mediterranean diet supplemented w/nuts was linked to a lower risk of depression in diabetics. No, we can't explain the physiology behind this finding but given that there's been no harm found as a result of this manner of eating, it's certainly reasonable to consider the reverse, that perhaps eating this way may be useful in treating depression.  

Yes, I realize this is a major leap of faith since we haven't established cause & effect in the forward direction.  But for the multitude suffering from depression who aren't responding to medications, suffering from side effects, or who want a more natural means of treating their depression, we should consider adding the Mediterranean diet to counseling, exercise & sleep.

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Mediterranean Diet, Glycemic Load & Diabetes

We know from several recent posts that the Mediterranean Diet is good for your heart & your brain.  It turns out that the more you adhere to the Mediterranean Diet, the lower your risk for developing diabetes, as demonstrated by an observation study published early online this month in Diabetologia.  You remember the Mediterranean Diet, right?  Plenty of fruits & vegetables.  Nuts & legumes.  Olive oil.  Nuts & legumes.  Whole grains & cereals.  Some fish & chicken but minimal beef & dairy.  And let's not forget the wine in moderation (averaging not allowed).  What's so special about this particular "diet"?  Especially because "Mediterranean" refers to a geographic region that is encompassed by multiple & varied ethnicities, religions & cultures such that each has its own variation on a theme.

So even as we attempt to figure out what makes this way of eating so healthy, others have looked at the glycemic index as a means to replicate benefit on a more global scale.  Recall that glycemic index refers to a foods innate ability to raise blood sugar.  This value doesn't change.  Glycemic load, which is calculated as glycemic index multiplied by serving size, takes into account how much food one is consuming.  Thus, this value can change.  And as the 22,295 Greek participants followed for 11+yrs showed, glycemic load is associated risk for diabetes.  So pay attention not only to what you eat but how much of it you consume.  It's not just quality but quantity, too.

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My weight is too much ie 229 lbs height 5'7 age 20..I need a heavy weight loss.give me tips to lose weight quickly.waiting for precious reply..thanks.

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Mediterranean Diet vs (Loss of) Memory Part 2

Pop quiz: what's better than a population-based cohort study?  A randomized controlled trial!  So think back to just 3 weeks ago when a population-based cohort study was published in Neurology concluding that the Mediterranean diet was linked to lower risk of cognitive impairment.  But if you'll recall, such studies fall under the rubric of observational trials.  As such, the conclusions are only useful in developing hypotheses, as they can't & don't prove cause & effect.  For this, you need randomized controlled trials, ideally double-blind.  Be that as it may, reach deep into your memory banks from 3 months ago when a randomized control trial (PREDIMED) was published in the New England Journal of Medicine in which the authors demonstrated that the Mediterranean diet plus either extra virgin olive oil or nuts was able to prevent 1st heart attack in high risk patients.

Well, in another analysis of that very same PREDIMED trial published early online this month in the Journal of Neurology, Neurosurgery & Psychiatry, 522 men & women avg 75yo at high risk for vascular disease were randomized to low fat control diet vs Mediterranean diet plus either extra virgin olive oil or mixed nuts and then followed for 6+yrs.  Cognitive function was assessed by Folstein's Mini-Mental State Examination (MMSE) and the Clock Drawing Test.  The authors concluded that the Mediterranean diet plus either extra virgin olive oil or mixed nuts lead to improved cognitive function compared to typical low fat diet.  

Bottom line, I haven't found anything bad associated with the Mediterranean diet, aside from the fact that I can't trademark it and make a profit.  Therefore, there's no true commercial or capitalistic motive in promoting it, unlike all the other fad or better known diets out there.  So I have nothing to gain by telling you to eat this way but you have everything to gain!

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Mediterranean Diet vs (Loss of) Memory

It never ceases to amaze me but I keep getting asked which is the best diet.  Both patients & physicians want a definitive answer, even those who attended the recent American Academy of Family Physicians' Geriatric Medicine conference held in Santa Ana Pueblo, NM last week.  Whether for fat loss, muscle gain, heart disease, diabetes, etc, we're all searching for that elusive best diet.  Perhaps it's even scarier that so many different authors have stepped in to fill this void as we're inundated each day with the diet du jour.  that claims to be the newest, greatest way to lose fat, gain muscle, prevent heart disease & treat diabetes.  And of course, each of the authors claims to have discovered the key to unlocking the secrets of our poor health.

But if you think about it, typically when there are many clamoring for the attention of the same demographic, there usually isn't one best.  Take cars, medications, music & movies, for example.  Sure, we attempt to name a Car of the Year, and offer both a Grammy award & Oscar, but when it comes to medications, the best one is the one you can afford that will do what you want when administered in a manner & frequency which you can accept with tolerable side effects.  Not so easy, right?

Likewise, when it comes to eating habits, we need to take into account cultural, ethnic & religious factors.  But what separates diet & medications from cars, music & movies is the evidence available to support one's claim to best.  And when it comes to diets, only the Mediterranean diet has continuous, consistent & compelling evidence to support its adoption.  Most recently, a randomized controlled trial of the Mediterranean diet was shown to be better than placebo at preventing an initial cardiac event.  Of course, we've always had plenty of observational data suggesting benefit from eating in a manner similar to the Mediterranean diet.

The best news is that earlier this week, a prospective, population-based, cohort study was published in Neurology in which the authors concluded that greater adherence to the Mediterranean diet was linked to lower risk of cognitive impairment.  They followed 17,478 participants for an avg of 4yrs during which time cognitive status was assessed annually while food frequency was just assessed once at study onset.

And what of those other diets?  While they can make any number of miraculous claims, none have peer-reviewed published outcome data to support their capitalistic attempts.  So check out the Mediterranean diet and adopt your variation on a theme.  No one stands to receive any (financial) gain, just you.  

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Q&A Session at HealthTap.com

I have degenative disc disease badly and my chiropractor wants to put me on nutrihcg diet. Is this a safe diet to be on?

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Hello doctor i am un 20 years old girl and i like eating meat very much. is there any risk in the future by consuming it a lot?

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I can't adjust to new situations, persons quickly. I think a lot before doing anything. This gives me lit if stress. What should i do to improve it?

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Mediterranean Diet Prevents Heart Disease in Those at High Risk

Before getting to the good stuff today, let's remind ourselves about the difference between observational studies (in all their various guises) and randomized controlled trials.  The former can only assist in developing hypotheses; they can only make associations & demonstrate links.  They're the medical version of hearsay evidence (in my non-legal mind).  Contrast that w/RCTs which actually demonstrate cause & effect, which is what any good prosecutor or district attorney wants to do, prove that the defendant committed the crime beyond a shadow of a doubt.  At the conclusion of the trial, there should be no doubt in the jury's minds that perhaps the defendant was just in the wrong place at the wrong time.

Along those lines, all prior evidence regarding the benefit of the Mediterranean diet has been observational in nature.  We monitor a bunch of folks as to what they claim to eat and see what happens to them after some given period of time.  We may ask them at the start how they eat (prospective observational study) or at the end (retrospective observational study).  We can look specifically for a cohort of those cases who eat a Mediterranean diet and then compare them to controls, those who are similar in every way except nutrition to the cases.  

But no matter how fancy the statistics, in the end, these studies only demonstrate support of the idea that eating a Mediterranean diet is good for your heart.  It doesn't matter how many of these studies are published, how many participants are involved, how long the studies last, none of these observational studies prove that Mediterranean diet prevents heart disease (the Lyon Diet Heart Study did demonstrate benefit in those w/known heart disease but that's secondary prevention).

Until yesterday, when a randomized controlled study was published in the New England Journal of Medicine in which the authors demonstrated that a Mediterranean diet supplement with either extra-virgin olive oil or with mixed nuts lowered risk for cardiovascular events compared to those who consumed a control diet (basically advised to reduce fat intake).

The authors found 7,447 participants (55-80yo of whom 57% were female) who were at high risk for but had no evidence of cardiovascular disease at study onset and randomized them to either a control diet (advised to reduce fat intake) or to Mediterranean diet supplemented by either extra-virgin olive oil or mixed nuts.  Due to the dramatic reduction in heart attacks, strokes & death from cardiovascular causes, the trial was stopped early after just under 5yrs.

So here's a reasonable RCT demonstrating cause & effect, that eating a Mediterranean diet supplemented with either extra-virgin olive oil or mixed nuts can prevent heart disease in those at high risk but w/o actual known disease.  Let's all start eating this way!  But wait, what is this Mediterranean diet?  Besides the high intake of olive oil, it's also high in fruit, nuts, vegetables & cereals; moderate in fish & poultry; and low in dairy products, red meat, processed meats & sweets.  The oenophiles will love this part: wine is consumed in moderation with all meals!

Is this the end of the story?  No, because it's the first of its kind.  Furthermore, it was performed on a group at high risk for heart disease.  Would it work for those at lower risk?  And as the study was of Spanish nationals, would the results be generalizable to non-Spanish men & women.  And what of the age group?  Would this diet work in a younger cohort?  After all, why wait until middle age to start eating in a health fashion?  So while we now have proof of cause & effect that the Mediterranean diet can prevent heart disease in middle-age Spanish men & women, we've only touched the tip of the iceberg.  We now have to explore all that exists under the water.

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My weight is 110kg and height is 6 feet.Ijust want to reduce my weight to 90 kg .can u sugest a diet plan to do it?

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Weight Loss from Starbucks Diet?

You get to read  a lot of old magazines while waiting in professional offices.  I figured I'd try to stay a bit more current by surfing the Internet on my phone this past week or so.  In doing so, I stumbled upon what appeared to be a good fishing tale.  Apparently, a 66yo law librarian lost 75 pounds, no 80 pounds, almost 85 pounds while eating daily at Starbucks for 2 years.

What I found interesting was the interpretation of this means of controlling one's caloric intake by Shape and Men's Health, which took almost opposing views.  While neither recommended the Starbucks diet as the best & most balanced means of losing weight, Shape focused on the downsides, such as restricting oneself to a very narrow menu that would border on boring after the 1st week.  Men's Health focused on the bigger picture of calories and making healthy choices when faced with temptation.  

Personally, I like the Mediterranean diet for its balance of vegetables, lean protein & healthy oils.  It also helps that this way of eating has been studied and linked to better health outcomes than any other diet.  In case, you're wondering, there are also less expensive ways of eating than stopping by Starbucks three times a day.  Let's hope she purchased stock in the company before starting her diet . . .

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Q&A Session at Avvo.com

What supplements should i take for a poor diet

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