Diete squilibrate e risultati difficili da mantenere....

Sentiamo spesso parlare di diete a basso contenuto di carboidrati, a basso contenuto di grassi o le cosidette basse calorie/pochi carboidrati.

Queste diete sono seguite soprattutto per ridurre il peso corporeo.

Ricordiamo che sono per definizione diete squilibrate che possono essere mantenute per un breve periodo e preferibilmente sotto controllo medico.
Sappiamo infatti che una dieta a bassissimo contenuto di carboidrati e tante proteine provoca un'acidosi pronunciata ed un'alterazione consistente dei microbiota intestinale.

Queste diete hanno conquistato una certa notorietà grazie al fatto che sono spesso in grado di portare ad una rapida riduzione del peso corporeo in tempi ragionevolmente brevi.
Ma le domande che vengono spontanee sono:

1) Questa riduzione del peso viene poi mantenuta?
2) Questo temporaneo squilibro metabolico può provocare danni alla salute generale?

Una recente ricerca, presentata al congresso WCIR (World Congress on Insulin Resistance, Diabetes, and Cardiovascular Disease) sembra affermare che la riduzione di peso ottenuta da questo tipo di diete si perde con grande facilità.
La meta-analisi presentata mostrava infatti che sia le diete a basso contenuto di grassi che quelle a basso contenuto di carboidrati portavano a perdite ponderali non mantenute.

Non è certo una muona notizia per gli oltre 1,5 miliardi di persone sovrappeso o obese che cercano ogni giorno nuove soluzioni miracolose.
Probabilmente le ricerche future confermeranno come una dieta equilibrata, ricca di cereali integrali, grassi buoni, tanta frutta e verdura possa rappresentare la soluzione più efficace per il raggiungimento del peso ideale e di un buono stato di salute.
La dieta non è solo una questione di calorie o di bilanciare in vario modo i macronutrienti (carboidrati, proteine e grassi).
E' fondamentale fornire al nostro corpo nutrienti di qualità che forniscano informazioni corrette al nostro genoma.


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SugarStacks

Would you eat 10 tea spoons of sugar one after the other?
I don't think so..
But this is what we do everytime we drink a can of soft drinks like Coke.
Here we can know more about sugar content of many foods, drinks and snaks that we usually eat.
It is true that carbohydrates (and sugar is one of them) are an essential components of any balanced diet (that should have a percentage of carboidrates of about 30%), but it is also true that:
- A regular refined carbohydrates and sugars abuse causes overweight, obesity and many chronical diseases like tipe II diabetes;
- Regular use of sugar-added soft drinks, fruit juices and flavoured milks should be avoided particularly during meals when we usually eat enough carbohydrates.
- We should not encourage children to start using sugar-added drinks because they induce addiction;

Added sugars in soft drinks, fruit juices and flavoured milks contains empty calories.These calories are called empty because they carry energy but not nutrients (like minerals and vitamins) and they have an high Glicemic Index.

GLICEMIC INDEX
The glycemic index is found by measuring the increase in glycemia that is produced when a subject is given 50 grams of sugar extracted from a food. Therefore, the glycemic index tells us how quickly the sugar concentration in the blood rises and is expressed in relation to the increase produced by 50 grams of pure glucose.
This means that the index doesn't depend upon the sugar content of each single food. Let's look at an example: melon has a very high glycemic index but this doesn't take into consideration the fact that in order to reach 50 grams of sugar a person would have to eat 6-7 melons at one time. This explains why we can't only consider this parameter when we evaluate the body's response and especially the insulin response.
GLICEMIC LOAD
The glycemic load, on the other hand, is determined by multiplying the glycemic index by the quantity of sugar contained in the foods that are consumed. By introducing the variable of the amount of carbohydrates ingested in every single food that is eaten, we can reach a more precise evaluation of its affect upon the body

Whole grains provide calories with a lower Glicemic Index and they respect our metabolic paths not charging too much on our metabolic response.

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Almonds and diabetes

Walnuts and almonds consumption can help you fighting and preventing diabetes.
Adding these nuts to your diet can result in ameliorations in obesity, hyperlipidemia, hypertension, and hyperglycemia.
MedDiets and nuts-enriched MedDiets seem to be effective in the prevention of diabetes in subjects at high cardiovascular risk, and a preventive effect is demonstrated also in healthy subjects.
Women in a Harvard School of Public Health study who reported eating 5 or more 1 ounce servings of nuts/peanuts per week reduced their risk of Type 2 diabetes by almost 30 percent compared to those who rarely or never ate nuts.


HCP are usually cautious in recommending walnuts and almonds regular consumption due to their high caloric power and high fat content.
That's true. Infact:
100g of Wallnuts provides Kcalories 582- 650
100g of Almonds provides Kcalories 578- 600

But it is not needed to eat 1Kg, nor it is recommended!!!!

PORTION: 1 oz or 28g is equal to 20-22 almonds or 14 half wallnuts or 28 penuts
It's 160-180 KCalories.

CAUTION: Nuts in general are among the 5 most frequent food allergens.
Be sure not to be allergic to nuts befor adding them to your diet.

J Am Coll Nutr. 2010 Jun;29(3):189-97.
Almond consumption and cardiovascular risk factors in adults with prediabetes
Tested: Insulin sensitivity and CV risks
Comparedwith: nut free diet
Conclusions:An ADA diet consisting of 20% of calories as almonds over a 16-week period is effective in improving markers of insulin sensitivity and yields clinically significant improvements in LDL-C in adults with prediabetes

Nutr Metab (Lond). 2011 Jan 28;8(1):6.
Acute and second-meal effects of almond form in impaired glucose tolerant adults: a randomized crossover trial
Tested: Postprandial concentrations of blood glucose, insulin, non-esterified free fatty acids (NEFA), glucagon-like peptide-1 (GLP-1) and appetitive sensations
Conclusions: Inclusion of almonds in the breakfast meal decreased blood glucose concentrations and increased satiety both acutely and after a second-meal in adults with IGT. The lipid component of almonds is likely responsible for the immediate post-ingestive response, although it cannot explain the differential second-meal response to AB versus WA and AO

Metabolism. 2011 Apr;60(4):474-9. Epub 2010 May 23.
Almond consumption improved glycemic control and lipid profiles in patients with type 2 diabetes mellitus
Tested: fasting insulin, fasting glucose, and homeostasis model assessment of insulin resistance index
Conclusions: incorporation of almonds into a healthy diet has beneficial effects on adiposity, glycemic control, and the lipid profile, thereby potentially decreasing the risk for cardiovascular disease in patients with type 2 diabetes mellitus

J Nutr. 2006 Dec;136(12):2987-92.
Almonds decrease postprandial glycemia, insulinemia, and oxidative damage in healthy individuals
Tested:effect of decreasing postprandial glucose excursions on measures of oxidative damage
Conclusions: Almonds are likely to lower this risk by decreasing the glycemic excursion and by providing antioxidants

European Journal of Clinical Nutrition(2009)
Long-term effects of increased dietary polyunsaturated fat from walnuts on metabolic parameters in type II diabetes
Conclusions:Dietary fat can be manipulated with whole foods such as walnuts, producing reductions in fasting insulin levels.

In 2003, the U.S. Food and Drug Administration (FDA) approved this package label "qualified" health claim for nuts:
“Scientific evidence suggests but does not prove that eating 1.5 ounces per day of most nuts, as part of a diet low in saturated fat and cholesterol, may reduce the risk of heart disease.”

Apple's apps for HCP: my opinion

A new section of Apple store dedicated to Health Care Professionals started in September.
We can find six cathegories of apps:
reference apps
educational apps
EMR & patient monitoring apps
imaging apps
point of care apps

The sixth cathegory, called personal care apps, is for consumers.
In this sections we can find many "must have" for anybody involved in health care, like PubMed On tap, and Micromedex Drug and iTriage.
I like iTriage even if it is focused on USA and many services are not working in Europe yet.
I already congratulated with the people who developed the app and I think that they are doing well in this "early stage" sector without having the investments of Google Health!
I like the Merk manual but it costs 27,99 euro.
I tested Muscle trigger points and I think that it can be useful for students and FKTR's.
Patients can benefit of iHealth BPM and Diabetes Buddy to keep on track fighting their chronic disease. Don't forget that diabetes and hypertension are the most terrible cardiovascular killers.
In the near future mobile apps for health care will be commonly used and I think that governative authorities should immediately play a central role helping developers in standardizing protocols, languages and data formats.
This will allows HCP to access patient's data everywhere and whenever is needed.
Governative authorities could also plan to use the "open data" generated by the people to promote research and population studies.

Stevia is eventually going to be approved in Italy

Used for centuries in South America and some Asian countries,
Stevia is a plant that attracts considerable attention from the food industry for its use as sweetener especially after that Coca cola co. and Pepsi co. started to use one of its extract as ingredient of their soft drinks.

The genus Stevia is composed of 240 shrubs and herbs of the Asteraceae family.
The most famous specie is Stevia rebaudiana, well known for its sweet leaves with a licorice-lke after taste.
Extracts of the Stevia rebaudiana with a 95% purity of rebaudioside A (Reb A) were given the FDA thumbs up in the US in late 2008.
In Europe the EU declined approval for dried stevia in 2000, however, saying more research was needed.
In January 2011, EFSA revised their consumer exposure estimates.

For high consumers, the estimates are up to four times the EFSA established Acceptable Daily Intake (ADI) of 4 mg per kg body weight per day (mg/kg bw/day).

The revised exposure estimates for high consumers are: children from 1.7 to 16.3 mg/kg bw/day; adults from 5.6 to 6.8 mg/kg bw/day.
Wim Debeuckelaere of the Directorate General for Health and Consumers (DG Sanco) stated in June 2011 that stevia is on schedule for approval by the EC before the end of 2011 at the latest.
Meanwhile, France approved 97% rebaudioside sweeteners, under a clause that allows pre-emption of EU approval for a two year period.
Industrial suppliers of stevia sweeteners are moving in to take advantage of these opportunities starting from Jan 2012.

But in Italy, the extracts and dried portions of the plant cannot currently be used as food ingredient yet and they are sold in strange ways, like "bath salts".

Stevia leaves and exstracts counts no calories and consequently they have a low glycaemic index (which means it does not cause the same spike in blood sugar levels as sucrose and other refined carbohydrates).
So Stevia and its extracts can be considered elective sweeteners for diabetic patients.
30 years of free use in Japan seems to confirm the safety profile.

Some positive effects on blood pressure and glicemic control are currently scientifically investigated.

I personally tested both the dried leaves and the rebaudioside extracts and I was astonished by the sweetener power. Beeing hundreds of time more sweet than sugar you need only very low quantities to change the taste of drinks and foods.

I personally don't like the persistence af sweet taste after (sometimes) minutes of use but the problem can be solved using lower quantities.

Licorice-like after tast can be avoided using different extracts but some people like it.