The Nutrition Physician's Weblog

STATINS AND DIABETES

nutdoc — Sun, 12 Aug 2012 03:29:12 +0000

Statin cholesterol-lowering drugs reduce risk for heart attack and premature death from cardiovascular disease but have significant risks. In 1975 our research showed how dramatically diet could reduce serum cholesterol (down 35%) and LDL (bad-guy cholesterol by 40%)(1). In 2003, editors of the Journal of the American Medical Association asked me to write an editorial about the side effects of statin drugs (2). Since then I have closely followed the mounting evidence related to the side effects of statin drugs. Now we should add diabetes to this list of risks or side effects.

In mid-August 2012 another study confirms that taking statins increases risk for diabetes (3) as well as risk for dementia and neurological diseases. These are common side effects of statins: stomach irritation; one in ten get muscle aching and some get severe muscle damage (4) or damage to tendons (5); and neuropathy (tingling or pain in legs) or damage to the nerves (6). Serious concerns related to statin use are these: more rapid loss of cognition with aging (7;8); occasional cases of serious neurological conditions such as Lou Gehrig’s disease (9;10).

Most people can lower their LDL (bad-guy) cholesterol by 33% through diet (including soluble fiber like oats and soy protein) and using supplements such as psyllium and plant sterols. For most adults, an LDL less than 130 mg/dl is desirable and less than 100 mg/dl is ideal. If someone has high risk for heart attack, their value should be 70-100 mg/dl. If you have heart disease of history of stroke—and you are less than 70 years old– your LDL should be in the 50-70 mg/dl range. Since statins accelerate loss of cognition for persons over 70 years, you should have your LDL in the 70-100 mg/dl range, no matter what your heart attack risk is. Details of my research on statins and LDL-cholesterol and that of others are provided on other Nutdoc posts. Best, Nutdoc

1. Kiehm TG, Anderson JW, Ward K. Beneficial effects of a high carbohydrate, high fiber diet on hyperglycemic diabetic men. Am J Clin Nutr 1976;29:895-9.

2. Anderson JW. Diet first, then medication for hypercholesterolemia. JAMA 2003;290:531-3.

3. Ridker PM, Pradhan A, MacFayden JG, Libby P, Glynn RJ. Cardiovascular benefits and diabetes risks of statin therapy in primary prevention: an analysis of the JUPITER trial. Lancet 2012;380:565-71.

4. Joy TR, Hegele RA. Narrative review: statin-related myopathy. Ann Intern Med 2009;150:858-68.

5. Marie I, Delafenetre H, Massy N, Thuillez C, Noblet C. Tendinous disorders attributed to statins: a study on ninety-six spontaneous reports in the period 1990-2005 and review of the literature. Arthritis Rheum 2008;59:367-72.

6. de Langen JJ, van Puijenbroek EP. HMG-CoA-reductase inhibitors and neuropathy: reports to the Netherlands Pharmacovigilance Centre. Neth J Med 2006;64:334-8.

7. Xiong GL, Benson A, Doraiswamy PM. Statins and cognition: what can we learn from existing randomized trials? CNS Spectr 2005;10:867-74.

8. Elias PK, Elias MF, D’Agostino RB, Sullivan LM, Wolf PA. Serum cholesterol and cognitive performance in the Framingham Heart Study. Psychosom Med 2005;67:24-30.

9. Cramer C, Haan MN, Galea S, Langa KM, Kalbfleisch JD. Use of statins and incidence of dementia and cognitive impairment without dementia in a cohort study. Neurology 2008;71:344-50.

10. Edwards IR, Star K, Kiuru A. Statins, neuromuscular degenerative disease and an amyotrophic lateral sclerosis-like syndrome: an analysis of individual case safety reports from vigibase. Drug Saf 2007;30:515-25.

FISH FOR HEALTH

nutdoc — Thu, 09 Aug 2012 01:56:33 +0000

Fish is one of our healthiest choices for protein. Consumption of fish or fish oil has major health protective effects including these: decreased risk for cardiovascular disease (heart attack and stroke); preservation of cognitive thinking; and, probably, reduced risk for diabetes. Fish or fish oil intake also lowers blood triglyceride levels. Fish oils are omega-3 fatty acids that include DHA (decosahexaenoic acid) and EPA (eicosapentaenoic acid) and ALA (alpha-linolenic acid). Flax seeds provide ALA but the health benefits of taking flax seeds alone are not well established. Early observations suggested that fish oil intake might increase risk for diabetes but later, more persuasive studies, indicates that fish oil intake decreases risk for diabetes. Having pre-diabetes myself for 14 years has led me to take fish oil capsules twice daily. Ideally, everyone should eat two servings of fish weekly. I recommend that all adults consume one capsule daily and seniors should consume one capsule twice daily. I use two capsules of high-potency Fisol (VitaminShoppe.com) daily. We also enjoy salmon broiled on a cedar board. Delicious, enjoy. Nutdoc

1. Balk EM, Lichtenstein AH, Chung M, Kupelnick B, Chew P, Lau J. Effects of omega-3 fatty acids on serum markers of cardiovascular disease risk: A systematic review. Atherosclerosis 2006;189:19-30.

2. Wang C, Harris WS, Chung M et al. n-3 Fatty acids from fish or fish-oil supplements, but not alpha-linolenic acid, benefit cardiovascular disease outcomes in primary- and secondary-prevention studies: a systematic review. Am J Clin Nutr 2006;84:5-17.

3. Djousse L, Gaziano JM, Buring JE, Lee IM. Dietary omega-3 fatty acids and fish consumption and risk of type 2 diabetes. Am J Clin Nutr 2011;93:143-50.

4. Nurk E, Drevon CA, Refsum H et al. Cognitive performance among the elderly and dietary fish intake: the Hordaland Health Study. Am J Clin Nutr 2007;86:1470-8.

SHAKE UP YOUR DIET

nutdoc — Sun, 05 Aug 2012 21:22:11 +0000

Try my favorite shake. Add one packet of vanilla shake to 12 oz. chilled diet rootbeer to blender. Add 4 to 5 large strawberries (fresh or frozen) and blend. Add 5 ice cubes and bend well to you have your smoothie.

For chocolate lovers: blend in 1 tsp. of Special Dark Cocoa (100% cacao).

For ready-made shakes, add 4-6 oz. of diet soda and the other ingredients.

More recipes to follow. Enjoy, Nutdoc

SLEEP WEIGHT AWAY

nutdoc — Sun, 05 Aug 2012 20:32:17 +0000

Many of us do not get adequate sleep. The routine of not getting enough sleep contributes to weight gain and make weight loss more difficult. Most people require seven (7!) hours of sleep each night for optimal health and weight management. Sometimes people on weight loss plans use more caffeine to reduce food intake. This may be counterproductive because increased caffeine intake may aggravate the weight problem. Often inadequate sleep is related to poor stress management. Good sleep “hygiene” or practices include: planning your bedtime so you will get seven hours of sleep each night; doing relaxing things like reading or listening to soothing music for 30 minutes before “to sleep time”; quiet meditation at bedtime; and not watching TV during this last 30 minutes before “to sleep time.” Good luck, Jim

References

1. Leproult R, Copinschi G, Buxton O, Van CE. Sleep loss results in an elevation of cortisol levels the next evening. Sleep 1997;20:865-70.

2. Vgontzas AN, Bixler EO, Chrousos GP, Pejovic S. Obesity and sleep disturbances: meaningful sub-typing of obesity. Arch Physiol Biochem 2008;114:224-36.

3. St-Onge MP, Roberts AL, Chen J et al. Short sleep duration increases energy intakes but does not change energy expenditure in normal-weight individuals. Am J Clin Nutr 2011;94:410-6.

4. Patel SR, Hu FB. Short sleep duration and weight gain: a systematic review. Obesity (Silver Spring) 2008;16:643-53.

5. Chen X, Beydoun MA, Wang Y. Is sleep duration associated with childhood obesity? A systematic review and meta-analysis. Obesity (Silver Spring) 2008;16:265-74.

6. Patel SR, Malhotra A, White DP, Gottlieb DJ, Hu FB. Association between reduced sleep and weight gain in women. Am J Epidemiol 2006;164:947-54.

I GET HUNGRY

nutdoc — Fri, 27 Jul 2012 03:44:03 +0000

Some Simple Diet-ers report that the 3 shakes, 2 entrees, and 5 fruits/vegetable are too much to eat but many report getting hungry. We developed plans to combat hunger and I will briefly give an overview.

VOLUME is first. Be sure to get in your eight 8 oz. glasses of noncaloric fluids (don’t count shakes). The stomach rumbles when it is empty. The stomach can’t discern whether it is water that is filling it up or a strawberry smoothie, it just wants something in there!

BIG SHAKES are next. Some 200 calorie shakes come in 8 oz. containers. That’s 25 calories/oz. My favorite GNC Total Lean Shake has 170 calories in 14 oz. or 12 calories/oz. You can expand your single shakes to 20 or 25 ounces. Add the recommended water PLUS 8 oz. of diet soda to your powdered shake. Blend with 5 ice cubes. I added 8 oz. of diet 7 UP and four strawberries to my GNC shake today— delicious (8 calories/oz.). But you can do better recipes than me. SHARE YOUR RECIPES.

EAT MORE is third. That’s right, eat more low calorie choices (not bars!) First, add low calorie vegetables (see list on p. 271). Second, add low calorie fruits (p. 270). Third, add another high volume shake. Fourth, add lower calorie entrees (~200 calories/entrée).

That’s it, as easy as one, two, three. Best, Nutdoc

Simple Diet Transitions.

nutdoc — Mon, 16 Jul 2012 03:25:35 +0000

Congratulations. You have reached a weight milestone and plan to transition to the Second Phase or on to the Simple Lifetime Diet. Any dietary modification calls for a review of your goals and potential modifications or reinforcements of these goals. Remember why you are losing weight and why health maintenance is so important to you. In this transition period you should renew your passion for your health and weight management goals. Daily repeat your health-promoting self-talk like “I can achieve and maintain my health-promoting weight by following the Simple Diet guidelines including shakes, entrees, fruits, vegetables and physical activity.”

Second Phase of Simple Diet. If you have lost about 75% of the weight you have planned in order to reach your health and weight maintenance goal, you may wish to transition to the Second Phase. Here you can use two meal replacements daily (shakes and/or entrees), continue five servings of fruits and vegetables and include low-fat dairy, poultry or fish, and whole grains. See our Green Light Calorie Guide (p. 201). We recommend you continue the Second Phase for six months before transitioning to the Simple Lifetime Diet.

Simple Lifetime Diet. At a health-promoting weight, you want to review the four dimensions of health maintenance. Maintaining your health and wellness requires these dimensions: emotional—having a heart or passion for your health; soul—having a deep-seated personal priorities for your wellness; mental—having an active mind that plans your diet and physical activity and proactively uses your brain to verbalize health promoting self-talk; and physical—using your body as a machine to perform the nutrition and physical activity required to continue to improve your health and wellness. “Every day I awaken with a thankful, positive attitude and make plans and follow them.”

More specifics are given in The Simple Diet, Facebook, and other nutdoc blog. You can access these through andersonsimplediet.com. Best, Jim

Faster Weight Loss for Simple Diet-ers

nutdoc — Wed, 11 Jul 2012 03:23:53 +0000

All of us want rapid weight loss. The Simple Diet is helping uncounted numbers of people do this. Eighty Simple-Diet-ers report average weight losses of 23 pounds in 8 weeks and about 35 pounds in 16 weeks. That’s about 3 pounds per week for 8 weeks and more than 2 pounds per week over 16 weeks. These weight losses are higher than we had when I saw patients weekly in my clinic. [Of course, the 80 people reporting may be bragging a little and probably the more successful people are those who report results.]

Being the researcher I am, I have done more calculations. Our clinic records give me data on weight losses for persons weighing approximately 140#, 180# and 220#. Someone weighing 140# should lose about 12 pounds in 8 weeks and 17 pounds in 16 weeks. If you weigh about 180 pounds you should lose 17 pounds in 8 weeks and 25 pounds in 16 weeks on the Simple Diet. The person weighing about 220# should lose about 21# in 8 weeks and 33# in 16 weeks.

My calculations suggest that the average person on the Simple Diet is consuming about 1400 calories per day. On the Simple Diet you can use 3 shakes, 2 entrees, 3 vegetables and 2 fruits and consume as little as 1000 calories. On the other hand, you could consume 1500 calories or more and still be following the diet carefully. If you consume 1000 calories per day you lose 1# (one pound!) more per week than if you consume 1500 calories per day.

FOR FASTER WEIGHT LOSS, try this. Choose 3 shakes that have 150 calories or less per shake. Choose two entrees that have 240 calories or less per entrée. Select 3 vegetables from the low calorie list (26 choices, page 271, The Simple Diet) and choose 2 fruits from the low calorie column (10 choices, page 270). If you do not have bars or extra servings of these items you can get a healthy protein intake (70 grams/day) and consume less than 1100 calories. Chances are, making these diet choices and burning 2000 calories in physical activity will increase your weight loss by almost a pound per week. Try it, you’ll like it.

Many of our recommended shakes and entrees meet these criteria. Two shakes that I use are: HMR70 Plus shakes (110 calories—HMR 859-422-4671) and Vanilla Pleasure soy shakes (120 calories—1-800-REVIVAL). I use HMR shelf-stable entrees and they have good choices around 240 calories or lower. You can find many choices at groceries, pharmacies and nutrition stores. Kick start you weight loss by making these choices. Best, Jim

Maintaining Simple Diet

nutdoc — Thu, 14 Jun 2012 02:12:50 +0000

Many of you have been on the Simple Diet for several months now. You are reporting, as our research shows, about 2.5 pounds per week over 8 weeks. However, between 2 months and 4 months, average weight loss drops to about 1.5 pounds per week. That is not fair, but it’s what happens. After 8 weeks, there is very little water loss and metabolism slows down. Also, there what we call “diet fatigue.” It’s extremely hard to sustain a diet for months and months. If this is what is happening to you, here are some suggestions.

First, review your goals and purpose. Your heart or passion for achieving and maintaining a healthy weight is the most important ingredient in your program. Second, review your records to assess how well you are meeting program goals. (Are you eating off the diet?) Consuming 3 shakes, 2 entrees, 5 fruits or vegetables is critical. Meet your physical activity goals. Maintain careful records. And, review your progress regularly with your buddy.

Third, EAT MORE! Eat more fruits, vegetables, shakes, entrees to avoid snacking. Add more volume from non-caloric beverages or higher volume shakes. And, add more variety to your diet to reduce some monotony.

If this is not working, transition to the Second Phase that brings in a variety of new food options.

You can do this!!! Best, Nutdoc (last post for 10 days– traveling!)

BALANCE EXERCISES

nutdoc — Sun, 10 Jun 2012 02:34:26 +0000

		Use chair, counter or bannister to grab for unsteadiness; do all exercises for 15 seconds or for distance indicated.
	Foot
One foot R	R	Stand on 1 foot, lift other slightly in front; do small kicks with lifted foot; do small circles with lifted foot; put raised foot on other calf or thigh.
One foot L	L
Dynamic walking	Both	Walk slowly for 10 feet, turning head slowly and looking fully to each side. Repeat this 10 times.

Eye track R	R	Stand on 1 foot, rotate opposite hand, at eye level, from L to R and follow raised thumb with both eyes
Eye track L	L
High knee march	R	Stand on 1 foot and move the other leg in a march fashion; lift knees as high as you can. Do this 15 times on each side.
High knee march	L
Tight rope stand	R	Stand with 1 foot directly in front of other foot, heel to toe. Repeat on other side.
Tight rope stand	L
Tight rope walk	Both	Walk 10 feet, heel to toe (sobriety test). Do this 10 times..
At the gym or with your own half ball (like a Bosu ball), do each of these for 15 seconds.
Balance ball both	Both	Balance with both feet on the ball;shift from side to side; do the hula.
Balance ball R	R	Stand on 1 foot, lift other slightly in front; do small kicks with lifted foot; do small circles with lifted foot; put raised foot on other calf or thigh.
Balance ball L	L

Improve Your Balance

nutdoc — Sun, 10 Jun 2012 01:28:29 +0000

Keeping your balance is very important in your life, especially your postural balance and equilibrium. Everyone should do balance exercises almost daily to avoid falls. Falls are a leading cause of disability, injury and death for seniors. Also, obese individuals have more trouble maintaining their postural balance. Some say our bodies are like an inverted pendulum with the top of the pendulum being the ankles and the bottom being the trunk. In the Simple Diet, unfortunately, I did not recommend balance exercises. Since I started going to the YMCA 4-6 times a week, I see that less than 5% of people there regularly do balance training.

My wife and I are seniors and we have balance challenges. I don’t want to mention her age but we celebrated our 55^th Anniversary this week. I have developed a worksheet and we plan to do balance exercises almost daily. Over the past 9 months I have become strongly convinced that regular balance exercises are very important health-promoting activities for everyone. These can be done without equipment and while in the kitchen, while waiting in line, etc.

Dr. Anderson’s New Guide to Total Fitness includes these recommendations: do home balance exercises for about 10 minutes for 6 days per week. I recently gave specific directions (BALANCE YOU FITNESS PROGRAM) on nutdoc.wordpress.com. Add this row of information to the Table on page 49 of The Simple Diet:

Balance

Do standing and walking exercises

10 Balance Exercises, 6 days per week

60 minutes (300 calories)

Remember, maintaining your balance is very important—especially for seniors. Best, Nutdoc