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Jun10

Is It Fewer Carbs, More Fat or Both That’s So Good For You?

Posted in: Cancer, High Cholesterol, Refuel
Atkins was all the rage in the late 1970s; Ornish in the late 1980s; Atkins again in the late 1990s; and now there is free-for-all, with Paleo, Raw, Vegan and Gluten Free all vying for media time, most-favored-diet-status and celebrity spokespersons.

Diets come and go in waves.

I love analyzing research studies and finding the answer to hard questions. One of the most important nutrition and lifestyle research studies was just published in JAMA (it’s about prostate cancer prevention and treatment with fewer carbs and more foods with plant fat): the take-away is this:
- *instead of rice or pasta with a meal, have a handful of toasted almonds or walnuts
- *instead of bread and butter as an appetizer, have a handful of olives and nuts
- *instead of cheese and croutons on a salad, have a full fat extra virgin olive oil drizzle and a few slices of avocado.
- *instead of sour cream in a chicken or tuna salad, use guacamole or hummus.
But the above, practical take-aways, if you don’t have prostate cancer or aren’t at risk for it (and you are especially if you are a man, you’re African-American, and you smoke), isn’t the most important part.

What’s most important is that a new swell is the horizon. That new swell: fat isn’t bad, it’s good, in moderate amounts.

Carbs especially processed, starchy and sugary ones, cause inflammation and insulin surges, and maybe present a ready, easy energy source for cancer and growth factors to boot. And although cancer is very specific–and the foods that help or hurt are cancer-specific, as I began to illustrate in Culinary Medicine–it’s an important beacon because what seems to improve cancer risk also seems to improve heart disease risk. And treatment.

Because the same was shown, not long ago, for heart disease: saturated fat (which is largely from animals, but also present in coconut and palm kernels) isn’t directly associated with heart disease (though it does raise cholesterol in many people: that’s a related issue, which Drs Sinatra and Bowden have recently covered in their wildly popular The Great Cholesterol Myth.

And more men and women die of heart disease than prostate cancer or breast cancer every day of the week.

The point is this: for both men and women, that swell is getting a lot closer, and it’s about time. Because soon we’ll be able to see if it’s the subtraction of carbs (easily the best weight loss diet, and the most palatable, even if you do nothing else) or the addition of good fats (also the most pleasurable flavors for people to eat) that makes the real difference in chronic disease.

In the meanwhile, I would do both, and find someone who can guide you: you’ll eat more happily and pleasurably, and live longer, more naturally and better. Such a life starts with guacamole!
Apr17

How to Prevent Heart Attacks

Posted in: Arthritis, Diabetes, High Cholesterol, Hypertension, Obesity and Weight Loss, Refuel, Stroke, Wellness and Health

Two views of why heart disease prevention does not work well: one, personal responsibility is not given the attention it deserves.

And two, physicians are not trained or incentivized to advise patients to stop smoking, improve their diet and become fit…maybe because people don’t think they can make a real difference in their own health. Which is wrong: it is *never* too late to start.

Both of these commentaries are tragic.

People need skills they don’t have, and don’t have easy access to: preparing, choosing and shopping for food well, improving mindset, productivity and sleep, and optimizing the home, work and mobile environments for the best lifestyle choices.

Health care begins at home…not in the doctor’s office. Too often, it ends in the hospital, where we manage disease intensively. At which hospitals excel.

What I want to do professionally over the next 5 years is help people like those in these videos—people at risk for or with chronic disease (heart, stroke, Alzheimer’s, diabetes, arthritis, hypertension, many cancers)–avoid the hospital. And avoid the Heart Attack Grill.

The key is to make caring for yourself–and lifestyle–as fun as a vacation. My first step: helping men, and the women who love them Refuel.
Mar7

Lose Weight, Lower Your Blood Pressure

Posted in: Uncategorized

Fatty tissue in arteries

Weight and hypertension go hand in hand. The more you weigh, the more likely you are to have high blood pressure, and the more vascular resistance your heart will have to work against.

An estimated 43 million Americans have hypertension, and more than double that figure are dangerously close to developing it. Hypertension is the leading cause of cardiovascular disease, which is the leading cause of death in America.

Males over the age of 45 and females over 55 are at a greater risk of developing hypertension. Too much alcohol or salt, and too little activity or ability to handle stress worsen the risk. By changing any of these factors you can give your heart a hand and lose weight while you are at it: just 5% weight loss can lower your blood pressure enough to lower your dependence on medication.

A great way to lower sodium and lose weight is to avoid eating highly processed food. Instead, just once a week, try cooking fresh clean food at home, in quantity (the link is to Pinterest, where there is more).

Eating fresh clean food is the best way to control your weight and make yourself healthier. Check out my healthy recipes for delicious meals that are healthy, easy and filling.

Along with eating healthier, start a simple exercise regime. By devoting just a few minutes out of each day to a simple workout, anyone can be on their way to lower blood pressure and a healthier weight. Here is a great workout tool that I recommend to help you lower your weight and avoid hypertension–it is my favorite elliptical trainer, on Amazon.

If you are not at your ideal weight, losing between 2-4 pounds a week is a great goal for your body, and most importantly your heart.

Starvation diets, fasting diets and extreme diets, put unnecessary stress on your organs and ultimately do not keep the weight off. That is why it is so important to create a healthy eating plan for every day of your life and supplement that with a simple exercise, sleep and stress control program. For men, that’s Refuel.
Jan21

Osteoporosis – The Silent Disease

Posted in: Aging and Costs of Aging, Obesity and Weight Loss, Wellness and Health

Osteoporosis is thought of as a women’s disease, but osteoporosis in men can be even more dangerous.

Men are at greater risk of complication and death when they fracture their hip than are women: men are twice as likely to die as women after a fracture.

Up to 25% of men over the age of 50 will break a bone due to osteoporosis or because of low bone mass, and about 80,000 men break their hips each year. Bone is constantly changing and old bone is replaced by new bone. But that’s not the way you want to remodel your bones.

Osteoporosis, courtesy of Health News Updates

As we age though, the rate of change of bone remodeling declines.

Men in their 50s experience less bone loss than women of the same age. Somewhere between the ages of 65 and 70, the playing field is leveled and men lose just as much of their bone density as women, which makes them more prone to debilitating fractures.

This is where healthy weight loss and muscle gain come into play.

Being obese or overweight will put extra stress on your bones, but losing weight rapidly puts you in a position of greater risk for osteoporosis.

When you drop weight rapidly, you lose important minerals and hormones such as testosterone. A low testosterone level is one culprit behind osteoporosis in men. Too much alcohol, long term steroid use, smoking, and a low vitamin D level are four others.

One way men can increase testosterone levels is by working out. Lifting weights twice a week will help your upper body, and a brisk walk for 30 minutes daily will begin to fortify your hip bones. Not only will exercising build your muscle mass and strength, but it will also help to increase your bone density, which will put you one step closer to preventing osteoporosis.

Changing your diet will also help you lose weight and prevent osteoporosis. I suggest at least 600 IU of Vitamin D3, and up to 1000 (measure your level!) and no supplement of calcium: you don’t need it if you get enough greens and dairy.

Start with a gradual change in exercise and diet to give you a head start on preventing osteoporosis. See your doctor if you have any questions or want a bone density evaluation: if you have osteoporosis, and you’re over 40 and you’re a man, you need a testosterone level check.
Dec2

New Weight Loss Coverage–A Better Version of Yourself (video)

Posted in: Obesity and Weight Loss, Wellness and Health

There are 3 weight loss months in the U.S.: January, or New Year’s Resolution Month; May, aka pre-SwimSuit Season; and September, or the leaves are changing and so must I. (video inspiration below)

Booksellers, commercial weight loss programs and pharmaceutical manufacturers (to say nothing of fitness shops, resort managers and food and drink vendors) mark these seasons with special offerings, and why shouldn’t they? More than ever, people need the help. For example, here are my 3 favorite elliptical trainers: the Octane Fitness, the Smooth Fitness, and the Sole Fitness (which is the previous year’s model and half price)

There are 4 inescapable truths (derived from the National Weight Control Registry research databases) about weight loss maintenance: self-monitoring, accountability, individualization of diet and adequate exercise. Many people confuse the first two, but they are different.

In other words, because you track your weight, your steps, your belt holes doesn’t mean you change them.

If, however, you are accountable to someone for identifying why the tracking did or didn’t make enough of a difference in your food choices, exercise regime or wine consumption to move the needle on the scale (or the blood pressure cuff or the cholesterol test or your blood sugar), then you are half way to control.

Some of my patients have told me that having me on their shoulder is the accountability they need for the steady, slow, deliberate, steady results that our program provides. People love to have a coach, and have an expert in their corner.

And next year, some clinicians will begin to try out a new step-by-step approach to helping patients lose weight, for two reasons:

First, because Medicare is paying for up to 26 visits in a year, with proper documentation.

And second, because Aetna will now cover the new obesity drugs, Qsymia and Belviq if the insured’s plan covers obesity drugs (many do not); if (1) their BMI is> 30 kg/m^2,; or if it’s > 27 kg/m² with one of five risk factors (coronary heart disease, high cholesterol, hypertension, sleep apnea, and type 2 diabetes) and (2) if they have tried for 6 months but have not lost an average of a pound per week.

From a health policy and payment standpoint, it’s important that obesity is recognized as a chronic disease with significant health consequences, not as a cosmetic or willpower problem. From a patient care view, however, I don’t have a single patient who thinks he is chronically ill, irrespective of his medications or conditions. And to me, he or she is not: my patients are on their way to being better men, better women, better and healthier versions of themselves.

Here’s a recent Foodbank video I participate in that illustrates men and women doing just that—not just by getting healthier, but by helping others who do not have enough nutrition or enough food.

The Table of Life (Stir-Fry), from the Foodbank of Santa Barbara County from John La Puma MD on Vimeo.