Who would have imagined that my patient, Evo, would have lost 14 pounds on the “beer and sausage” diet (now called the Evo diet).

From the medical side there are two other benefits — his triglyceride level dropped by half, his cholesterol dropped by a third, and his “good” cholesterol increased.  There was never an increase or a blip in any of the liver enzymes.  His fat mass dropped, the only non-fat mass of his that decreased was that tissue associated with and supporting the fat mass (I know, sounds complicated).  His muscle mass maintained itself.

One important lesson learned: we do not know enough about science and medicine and diets to be able to say anything to anyone about which diet is healthy and which is not. But let me give you an example – we had more data points for this one month of the Evo diet than Ornish had for his diet program.

The famous Ornish line is that his data showed a decrease in “Plaques” of patients who had heart disease. This was based on less than 20 patients, including the control group.  He has since gone on to show poor data with prostate cancer, as well as aging. The data that Ornish has isn’t good, and when you look at the data we generated in one month from the Evo diet, one could assume that we would find people would do better not doing the Ornish diet and following the Evo diet.  This is said with a smile, because never has a “lifestyle” and diet – such as Ornish, been propagated with less data and more press.  Ok- there is also the China Project (a single misuse of data to say the same thing).

The second important part of Evo’s diet was this: there was a simple and yet profound control of the portion sizes that he had. It was measured, it was regulated to around 1500 calories per day.  Based on that,  Evo lost more than we would expect him to have lost. Why? No clue.

What can you take away from this: First, if you want to have a diet begin by strictly regulating portions. Portion control is a key for any weight loss, including weight loss surgery.  Limit your portions, and thus your calories, and you should lose weight.  The advantage of beer and sausages is that they come in nice units that you can measure.

Processed meats appear to increase risk of colo-rectal cancer

What you should NOT take away from this: beer and sausage are not “diet foods.” Beer and sausage were, in this case, a tool for great portion control. And Evo ate more than just sausage. He ate what came with it.  When I cooked for him he had the peppers and onions that went with my famous recipe (recipe will be on terrysimpson.com later). He had bread (yes, I know some of you think bread is the devil’s tool) – if it came with the sausage.

The final message is most important- We don’t understand food as well as Ornish, Atkins, or pick some diet guru would have you believe.

The internet is full of claims of individuals living longer because of some diet, lifestyle, or supplement living longer.  So let us start with this disclaimer:

Anyone who gives absolute statements about one person living longer because they only drink Yak milk, or eat raw foods, or are a vegan, or a pescetarian, or eat raw lion meat – etc. – are making an opinion, not based on data.

The classic example is studies done on Seventh Day Adventists in the 1960’s and 1970’s.  Seventh Day Adventists are vegetarians by choice. They also do not drink alcohol, and they do not smoke tobacco.  Their lifespan was longer when compared to non-vegetarians. However, the study did not adjust for variables such as smoking, alcohol, lower body mass index, and what is called the “healthy volunteer effect.”

In 1999 a metastudy combined data from five western countries and reported mortality ratios.  This broad study showed fish eaters (pescetarians) had a the lowest ratio of 0.82, followed by vegetarians at 0.84.  Occasional meat eaters were at 0.84 and vegans as well as regular meat eaters had a ratio of 1.0.  (The lower the number the longer the lifespan.) – American Journal of Clinical Nutrition Vol 70 (3): 516S-524S – September 1999.

Fish eaters seem to live the longest

One of the most commonly cited studies is the “China Project” where blood samples were pooled from 65 rural counties in China.  Their conclusion was that meat eaters lived less long than those who ate animal proteins.  However, analysis of the raw data from that study leads to the opposite conclusion.  Ultimately the China Study became a best selling book. The books conclusions are the opinions of the author T Collin Campbell, many of those opinions have been refuted by peer-reviewed papers based on the raw data in the study.  One study example came from examination of the stomach cancer data showing that there was an inverse correlation between meat and stomach cancer.  Cancer Epidemiol Biomarkers Prev 1992, 1: 113-118.

Recently reported was the risk of meat consumption and colorectal cancers. Previous studies have been inconsistent so a metastudy was performed and there was an increase in risk of colo-rectal cancers with increased consumption of meat—however, this was “processed” meat- defined as cured or nitrate, or sausages.  The study did not adjust for other dietary habits, lifestyle, or genetic factors.  It should be noted that nitrate cured meats have higher associations with stomach and colo-rectal cancers.

Processed meats appear to increase risk of colo-rectal cancer

Population studies are flawed, and sometimes, the author’s conclusions may not agree with the raw data. There is not clear evidence that one dietary lifestyle is going to significantly increase lifespan if one does not include obesity, smoking, or consumption of fish.

While there are thousands of internet sites concluding that vegans live much longer- there is no study that agrees with that conclusion. What conclusion can you come to? Probably that eating fish is a good thing- eating too much processed food may not be a good thing. Best to pick great parents, don’t overeat, and a bit of red wine and chocolate are not bad things.

Heart disease happens when the arteries feeding the heart become infiltrated with plaques – and these plaques happen to contain fat, cholesterol, white blood cells. If the plaque builds up slowly the flow of blood to the heart diminishes and people develop chest pain or angina. If that plaque ruptures and causes the artery to close- that is a heart attack or myocardial infarction.

Plaque formation was thought to be because of a person’s diet – since the plaques had high levels of fat and cholesterol, it was thought that a diet that was low in fat and cholesterol would minimize a person’s risk of heart disease. Sometimes that is true- but not always- as the French have shown us- with a diet high in fat and cholesterol and one of the lowest levels of heart disease in the western world.

It turns out the instigator of plaque formation are the lipo-proteins that carry cholesterol and triglycerides. Think of LDL, HDL, VLDL, and IDL (low density lipoprotein, high density lipoprotein, very low density lipoprotein, and intermediate density lipoproteins) as boxcars that carry cholesterol and triglycerides. Those lipoproteins set off an inflammatory reaction in the blood vessel (they become oxidized) and that leads to plaque formation. The more of those proteins a person has, the higher the likelihood that they will develop heart disease.

Think of LDL as “lousy.” The HDL levels are associated with fewer tendencies for heart disease – but they still can cause inflammation of the artery, and a problem. Hence, artificially raising HDL levels causes more issues with heart disease (as was recently discovered in the niacin trials). HDL levels are seen in people who have more omega-3 fatty acids in their diets, but increasing their levels is still harmful.

The more lipoproteins your body makes the higher incidence of heart disease you will have.

It has only been recently that science has recognized that one must measure the lipoproteins directly. Not indirectly by measuring cholesterol – as the laboratories do today. In the recent article from the Journal of the American Medical Association, they measured LDL-cholesterol in people placed on diets rich in soy proteins, fiber, and walnuts – showing a decrease in the LDL-cholesterol – a classic mistake. LDL-cholesterol does not measure the total number of lipoproteins. The amount of lipoproteins one has depends on how much cholesterol and triglycerides the lipoproteins have to carry. If a person has a lot of cholesterol and/or triglycerides in the blood the body will make more lipoproteins. If you have too many, those lipoproteins will get into the wall of the artery and lay down their cholesterol and triglycerides (which are fats).

If you have a lot of triglycerides it will bump off the cholesterol and you will make more proteins to carry the triglycerides. Your cholesterol level will be low, but your number of lipoproteins will be high- and thus, even with low cholesterol you will have a high incidence of heart disease. This explains some of the seemingly contradictory data of people who had low LDL-cholesterol levels but a higher incidence of heart disease – when that blood was looked at later they were found to have a high level of the LDL proteins.

We still don’t understand everything about the biology of the formation of plaque but we do know this: genetics determines most of the level of cholesterol, and if your level is high reducing it with medication will reduce the incidence of heart attacks and strokes. If you have genetically high triglyceride levels, the same applies.

In terms of diet- dietary cholesterol has minimal impact on blood cholesterol. Triglyceride level can be greatly impacted by diet – however.

To reduce triglycerides in your diet, here are some suggestions:

* Eat fewer calories if you are overweight. Excess calories are converted into triglycerides and stored as fat.
* Avoid trans fats, found in some fried foods and commercial baked products.
* Replace saturated fat (found in animal fat and some tropical oils) for mono-unsaturated fat (found in olive/canola/peanut oils, etc.).
* Consume at least 2 servings of cold water fish each week, such as salmon, mackerel, tuna, lake trout, herring, and sardines (all of which are high in omega-3-fatty acid). *Include into your diet other foods high in omega-3 fatty acid, such as ground/milled flaxseed, walnuts, almonds, canola or soybean oil, etc.
* Avoid refined foods and foods that contain sugar (such as white flour, desserts, candy, juices, fruit drinks).
* Choose carbohydrates that have 2 grams fiber or more per serving, such as brown rice, whole wheat bread, and whole grain cereals.
* Consume at least 2-3 cups of vegetables and 1 cup of fruit each day.
* Follow your doctor’s advice regarding alcohol. Alcohol increases triglyceride levels for some individuals. If you have high triglycerides and do consume alcohol (such as red wine), it is recommended to limit intake to 5 ounces per day or limit it entirely.
* Exercise to burn excess calories, aiming for at least 30 minutes of physical activity on most days of the week.

Medications
People who have high triglycerides and low HDL or high LDL levels may require medications as well as diet modifications. Patients with triglycerides in the very high range (over 500 mg/dL) generally will require medications, because triglyceride levels this high may cause an acute inflammation of the pancreas.

There are about 150 species of asparagus,  but the most common in the US is Asparagus Officinalis.  Many of my favorite restaurants celebrate the return of asparagus with the white asparagus (which is grown by keeping the plants from getting all but UV light).  I remember well, picking wild asparagus from the roadsides in Illinois; there was nothing fresher.

Asparagus has a long medical history- even in the second century it was described as a cleansing (probably because it is a mild diuretic) and healing properties. It has been touted as a cure for cancer (it isn’t) to its anti-oxidant properties (see my previous post about anti-oxidants).

Some of the good things in asparagus are: 1) about half a dozen contain 50% of the daily recommended dose of folate; 2) it contains rutin, which may be an anti-inflammatory useful in fighting plaque in blood vessels (not proven, but interesting theory);  3) it contains some amino acids – which form the basis for proteins; 4) it contains glutathione, cysteine, glutamic acid, and glycine.

I must confess that until this last year I didn’t even think about eating asparagus, and then I tried it, and loved it once again.

So — asparagus is in season- and here are some easy things you can do with it that are so basic, even this busy surgeon can eat them.

First,  know that there is a woody end to the asparagus and you have to get rid of it. No matter how much you try to cook them, this part of the asparagus is more useful for making clothing or shelter, than it is for eating.

Second, the key to asparagus is that it is tender and delicate, so don’t over cook it. There are six simple methods for cooking it– and they are all pretty easy.

Boiling:
Boil the water in a medium sauce pan – add a pinch of salt and one T of olive oil  (whenever I see boiling water I think of the old western movies where someone was giving birth and the doctor or midwife would tell the husband – “we need hot water, and lots of it.”)  It takes four minutes to boil asparagus.   However, I prefer less time.

Blanche
In a medium sauce pan with water, salt, and olive oil- bring to a boil.  Add the asparagus until it is tender, or about two minutes.

Steaming
I like cookware. And, there are a lot of great steamers made just for asparagus. Asparagus needs to be steamed in the rack about one inch above the boiling water until just crisp – which is about four minutes.

Roasting
Put the asparagus in a large ziploc bag. Add some olive oil and a pinch of sea salt, and mix together until coated. Place on a baking sheet at 500 degrees for about 2 minutes. Turn once – and bake another two minutes. The asparagus should be tender.

Grilling
You can grill like I do on a big outdoor grill — which always raises my testosterone. You can also grill them over a gas grill on your stove. Brush the asparagus with olive oil, on medium high heat, turning once. This method takes about five to seven minutes.

Sous Vide
My favorite way to prepare the asparagus, or most food really, is Sous Vide. Coat the asparagus with olive oil and salt and pepper. Place in the sealed bag. Keep in a water bath at 183-185 degrees for 40 minutes to one hour.

I’m always looking for new ingredients to cook with that make an impact on flavor and calories. Spaghetti Squash is a great substitute for pasta. It has more flavor, fewer calories, more nutrients – and is just as easy to cook as pasta.

Making this is pretty easy. The hardest part is cutting the squash. There are two ways to do it: brute force, or heat. If you’re feeling really strong, you can use a serrated knife- cut off both ends and cut from the inside out. Or with a very sharp knife, pierce the skin with the tip- and pull toward you. All of which require being careful or you will need my surgical services to sew you up.

Not liking brute force when it comes to knives (we surgeons like a delicate touch) – I prefer this method: With a fork, pierce the skin of the squash. Pretend the squash is a rectangle and pierce it twice per side with the fork. Place in a microwave on high for two minutes. This will allow the squash skin to soften then you can cut it with minimal force.

Once it is cut in half- scoop out the seeds with a spoon. You can roast the seeds if you like. I like to drizzle olive oil over the squash as well as some Sea salt and pepper. Bake at 350 degrees for 30-45 minutes (its done when you can easily pierce the skin with a fork). Take it out of the oven- let it sit for ten minutes- then pull the pulp away from the skin and it will naturally form into noodles.

I like to use tongs to separate the squash from the skin. You can season the squash after you separate it from the skin. This can be used as the basis for its own dish- a much healthier and less fattening dish than any pasta.

My Favorite, And the Easiest Method

You can do it all in the microwave. Pierce the skin of the squash with the fork and place it into the microwave for 10 to 12 minutes. Once it is cooked let it rest for about five minutes. Cut the squash and scoop out the seeds (you can roast the seeds for a healthy snack). Drizzle on olive oil (with some a touch of truffle) and salt and pepper to taste (I like sea salt).

YourDoctorsOrders.com – the Juice and what it’s full of! from TweetMeTV on Vimeo.

Today in the supermarket there is a wide variety of juices available. Great combination of just about any juice you could imagine.  And, if you wanted even fresher juices, there are machines that will do it for you. One of my favorite devices is a juice press that I use for making fresh squeezed orange juice from the trees in my back yard.

But what about using juices for weight loss? For weight loss you want to have a lot of volume in your stomach of bulky high fiber items that are low in calories. For that, vegetables and fruits work well. But if you juice those fruits and vegetables, then the stomach doesn’t register the bulk with the brain.

Every time you eat something, especially something with bulk – the brain registers that sensation through a complex nerve network that begins in the top of the stomach. As bulky food goes through this area, your brain gets the sensation and when it reaches a certain amount it will hold off on sending out those hormones cause you to be hungry.

For example, if you eat a cup of broccoli you will have a lot of bulky foods, but only 12 calories! Your brain will sense that you have eaten a lot and as a result you will not feel hungry for hours. But if you juice all that broccoli you will drink about a cup of juice, and in two hours you will start to feel hungry again.

So while juicing allows you to concentrate a lot of good vitamins, minerals, and other nutrients, the juice doesn’t provide the bulk that the stomach needs to keep you from being hungry.

The other caution with juicing is this: don’t store the juice too long, and be sure to keep your juicer clean. There are a lot of bacteria that grow in juices – like salmonella and E. Coli, that can cause severe food poisoning. So, keep your juicer clean — and if you store the juice, be sure to drink it within a day or two — and keep it refrigerated.

So if you want weight loss– eat the vegetables and the fruits– they have plenty of bulk to keep you from being hungry – and provide a lot of nutrients for your body.

Thinking of skipping meals? Think Again! from McMedia ProducerGirl on Vimeo.