Thursday, July 17, 2008

Study: Low-carb diet best for weight, cholesterol

By MIKE STOBBE, AP Medical WriterThu Jul 17, 7:23 AM ET

The Atkins diet may have proved itself after all: A low-carb diet and a Mediterranean-style regimen helped people lose more weight than a traditional low-fat diet in one of the longest and largest studies to compare the dueling weight-loss techniques.
A bigger surprise: The low-carb diet improved cholesterol more than the other two. Some critics had predicted the opposite.
"It is a vindication," said Abby Bloch of the Dr. Robert C. and Veronica Atkins Foundation, a philanthropy group that honors the Atkins' diet's creator and was the study's main funder.
However, all three approaches — the low-carb diet, a low-fat diet and a so-called Mediterranean diet — achieved weight loss and improved cholesterol.
The study is remarkable not only because it lasted two years, much longer than most, but also because of the huge proportion of people who stuck with the diets — 85 percent.
Researchers approached the Atkins Foundation with the idea for the study. But the foundation played no role in the study's design or reporting of the results, said the lead author, Iris Shai of Ben-Gurion University of the Negev.
Other experts said the study — being published Thursday in the New England Journal of Medicine — was highly credible.
"This is a very good group of researchers," said Kelly Brownell, director of Yale University's Rudd Center for Food Policy and Obesity.
The research was done in a controlled environment — an isolated nuclear research facility in Israel. The 322 participants got their main meal of the day, lunch, at a central cafeteria.
"The workers can't easily just go out to lunch at a nearby Subway or McDonald's," said Dr. Meir Stampfer, the study's senior author and a professor of epidemiology and nutrition at the Harvard School of Public Health.
In the cafeteria, the appropriate foods for each diet were identified with colored dots, using red for low-fat, green for Mediterranean and blue for low-carb.
As for breakfast and dinner, the dieters were counseled on how to stick to their eating plans and were asked to fill out questionnaires on what they ate, Stampfer said.
The low-fat diet — no more than 30 percent of calories from fat — restricted calories and cholesterol and focused on low-fat grains, vegetables and fruits as options. The Mediterranean diet had similar calorie, fat and cholesterol restrictions, emphasizing poultry, fish, olive oil and nuts.
The low-carb diet set limits for carbohydrates, but none for calories or fat. It urged dieters to choose vegetarian sources of fat and protein.
"So not a lot of butter and eggs and cream," said Madelyn Fernstrom, a University of Pittsburgh Medical Center weight management expert who reviewed the study but was not involved in it.
Most of the participants were men; all men and women in the study got roughly equal amounts of exercise, the study's authors said.
Average weight loss for those in the low-carb group was 10.3 pounds after two years. Those in the Mediterranean diet lost 10 pounds, and those on the low-fat regimen dropped 6.5.
More surprising were the measures of cholesterol. Critics have long acknowledged that an Atkins-style diet could help people lose weight but feared that over the long term, it may drive up cholesterol because it allows more fat.
But the low-carb approach seemed to trigger the most improvement in several cholesterol measures, including the ratio of total cholesterol to HDL, the "good" cholesterol. For example, someone with total cholesterol of 200 and an HDL of 50 would have a ratio of 4 to 1. The optimum ratio is 3.5 to 1, according to the American Heart Association.
Doctors see that ratio as a sign of a patient's risk for hardening of the arteries. "You want that low," Stampfer said.
The ratio declined by 20 percent in people on the low-carb diet, compared to 16 percent in those on the Mediterranean and 12 percent in low-fat dieters.
The study is not the first to offer a favorable comparison of an Atkins-like diet. Research published in the Journal of the American Medical Association last year found overweight women on the Atkins plan had slightly better blood pressure and cholesterol readings than those on the low-carb Zone diet, the low-fat Ornish diet and a low-fat diet that followed U.S. government guidelines.
The heart association has long recommended low-fat diets to reduce heart risks, but some of its leaders have noted the Mediterranean diet has also proven safe and effective.
The heart association recommends a low-fat diet even more restrictive than the one in the study, said Dr. Robert Eckel, the association's past president who is a professor of medicine at the University of Colorado-Denver.
It does not recommend the Atkins diet. However, a low-carb approach is consistent with heart association guidelines so long as there are limitations on the kinds of saturated fats often consumed by people on the Atkins diet, Eckel said.
The new study's results favored the Atkins-like approach less when subgroups such as diabetics and women were examined.
Among the 36 diabetics, only those on the Mediterranean diet lowered blood sugar levels. Among the 45 women, those on the Mediterranean diet lost the most weight.
"I think these data suggest that men may be much more responsive to a diet in which there are clear limits on what foods can be consumed," such as an Atkins-like diet, said Dr. William Dietz, of the Centers for Disease Control and Prevention.
"It suggests that because women have had more experience dieting or losing weight, they're more capable of implementing a more complicated diet," said Dietz, who heads CDC's nutrition unit.
On the Net:
New England Journal:

Finally, some validation that a low carbohydrate diet is not only effective but safe longterm.

As many of you know, I have long been a proponent of low processed carbohydrate diets. I have seen many beneficial effects including weight loss- especially around the waistline, increased energy level, decrease in appetite, better sugar levels for diabetics, and much improved cholesterol levels. Almost all of these benefits have been linked to a lower risk of cardiovascular disease.

When I think of diet, I try to think of what makes sense by how our bodies react to what we put into them. Our ancestors ate more of a low processed carbohydrate diet, as it was before industrialization and food processing began. They seemed to have had lower rates of what I called DRD, or diet related disorders. Some DRD’s include obesity, heart disease, diabetes and arthritis.

We need to eat more like our ancestors and stop believing that our modern food processing systems know more about how we can stay healthy than our individual bodies! If you have any further questions on how your diet can affect your health, then I encourage you to come in for an evaluation. As Benjamin Franklin once said, "An ounce of prevention is worth a pound of cure."

Steven Horvitz, D.O.
Board Certified Family Medicine
Founder of The Institute for Medical Wellness
For past issues of the newsletter please click here.

Wednesday, July 09, 2008

Cholesterol drugs recommended for some 8-year-olds

By LINDSEY TANNER, AP Medical WriterMon Jul 7, 7:26 AM ET

For the first time, an influential doctors group is recommending that some children as young as 8 be given cholesterol-fighting drugs to ward off future heart problems.

It is the strongest guidance ever given on the issue by the American Academy of Pediatrics, which released its new guidelines Monday. The academy also recommends low-fat milk for 1-year-olds and wider cholesterol testing.

Dr. Stephen Daniels, of the academy's nutrition committee, says the new advice is based on mounting evidence showing that damage leading to heart disease, the nation's leading killer, begins early in life.

It also stems from recent research showing that cholesterol-fighting drugs are generally safe for children, Daniels said.

Several of these drugs are approved for use in children and data show that increasing numbers are using them.

"If we are more aggressive about this in childhood, I think we can have an impact on what happens later in life ... and avoid some of these heart attacks and strokes in adulthood," Daniels said. He has worked as a consultant to Abbott Laboratories and Merck & Co., but not on matters involving their cholesterol drugs.

Drug treatment would generally be targeted for kids at least 8 years old who have too much LDL, the "bad" cholesterol, along with other risky conditions, including obesity and high blood pressure.

For overweight children with too little HDL, the "good" cholesterol, the first course of action should be weight loss, more physical activity and nutritional counseling, the academy says.

Pediatricians should routinely check the cholesterol of children with a family history of inherited cholesterol disease or with parents or grandparents who developed heart disease at an early age, the recommendations say. Screening also is advised for kids whose family history isn't known and those who are overweight, obese or have other heart disease risk factors.

Screening is recommended sometime after age 2 but no later than age 10, at routine checkups.

The academy's earlier advice said cholesterol drugs should only be considered in children older than 10 after they fail to lose weight. Its previous cholesterol screening recommendations also were less specific and did not include targeted ages for beginning testing.

Because obesity is a risk factor for heart disease and often is accompanied by cholesterol problems, the academy recommendations say low-fat milk is appropriate for 1-year-olds "for whom overweight or obesity is a concern."

Daniels, a pediatrician in the Denver area, agreed that could include virtually all children. But he said doctors may choose to offer the new milk advice only to 1-year-olds who are already overweight or have a family history of heart problems.

The academy has long recommended against reduced-fat milk for children up to age 2 because saturated fats are needed for brain development.

"But now we have the obesity epidemic and people are thinking maybe this isn't such a good idea," said Dr. Frank Greer of the University of Wisconsin, co-author of the guidelines report, which appears in the July edition of Pediatrics, the group's medical journal.

Very young children are increasingly getting fats from sources other than milk and Greer said the updated advice is based on recent research showing no harm from reduced-fat milk in these youngsters.

With one-third of U.S. children overweight and about 17 percent obese, the new recommendations are important, said Dr. Jennifer Li, a Duke University children's heart specialist.

"We need to do something to stem the tide of childhood obesity," Li said.

Li said that 15 years ago most of her patients with cholesterol problems had an inherited form of cholesterol disease not connected to obesity.

"But now they're really outnumbered" by overweight kids with cholesterol problems and high blood pressure, she said.

Dr. Elena Fuentes-Afflick, a pediatrics professor at the University of California at San Francisco, also praised the new advice but said some parents think their kids will outgrow obesity and cholesterol problems, and might not take it seriously.

"It's hard for people to really understand" that those problems in childhood can lead to serious health consequences in adulthood, Fuentes-Afflick said.


On the Net:

American Academy of Pediatrics:

When I first heard of this recommendation I was stunned, then outraged. Then I came to my senses and realized this is just another step in the direction of medicalizing our society, however this time with our children.
The theory is that adults already have some coronary artery blockages, and cholesterol lowering will slow this down. I do not buy into that theory as I have not seen it to work.
For an excellent website that refutes the cholesterol hypothesis please visit .
Lets look at some numbers. You need to treat 50 adults with a statin cholesterol lowering drug to prevent 1 heart attack or death over 5 years. To simplify that means that there is a 1 in 50, or 2% chance that taking the drug will help, and a 49 in 50, or 98% chance that it will not help.
Now lets extrapolate that out to children who rarely have any coronary blockages and that even if they did would take a minimum of 30-40 years to exert any effect. So how many children would need to be treated with statin medications to prevent heart disease or death over 5, 10 or even 20 years? How bout the potential side effects that these drugs cause?
This recommendation is extremely misguided and I hope the American Academy of Pediatrics will change these recommendations.
Steven Horvitz, D.O.
Board Certified Family Medicine
Founder of The Institute for Medical Wellness
For past issues of the newsletter please click here.

Friday, July 04, 2008

Treating Summertime Insect Bites:

First , I would like to wish everyone a Happy 4th of July!
As we are now fully into the summer season, the bugs are out and a biting! Most bug bites will resolve on their own within a few days , but if they get worse or show signs of infection, they should be more closely evaluated. There are some hometown recipes I have heard over the years to ease the sting of bug bites.
Some are included below:
  • Lime Juice: Mix lime juice with some water and rub onto the insect bites as long as the skin is still intact.
  • Raw Potato: Mash and mix some raw potato with baking soda and water. Apply to the bite to help reduce the redness and itch.
  • Aspirin: As long as you are not allergic to aspirin, you can crush a few aspirin pills and mix with water into a paste. You can then put the paste onto a sting to help with the inflammation.
  • Rubbing Alcohol: First make sure the skin is intact and not broken. Coat the itchy area with rubbing alcohol to help soothe it.
For anyone who has a bad allergy to bee stings, if you do not have an epi-pen, please use this newsletter as your reminder to renew your prescription.
If anyone has any other home remedies that have worked please send them back to me via email. I am always interested in safe methods of treatment.
Steven Horvitz, D.O.
Board Certified Family Medicine
Founder of The Institute for Medical Wellness
For past issues of the newsletter please click here.