April 12, 2024 · 3:25 AM

If You’re Planning on Ketogenic Diet to Control Blood Pressure: Fuggetaboutit

Not bad

From an April, 2024, Nutrition, Metabolism & Cardiovascular Diseases issue:

Abstract

Aims

Cardiovascular diseases (CVDs) are major causes of mortality around the world. High blood pressure (BP) or hypertension is one of the most significant predisposing factors to CVDs. Ketogenic diets (KDs) have been the center of attention for their possible health benefits. The aim of this analysis is to study the impact of KDs on BP through the existing literature.

Data synthesis

We investigated the impact of KDs on systolic and diastolic blood pressures (SBP and DBP) conducted in the format of randomized controlled trials (RCTs). Four online databases (PubMed/Medline, SCOPUS, Cochrane Library, and Google Scholar) were searched from inception up to November 2022. Subgroup analyses were carried out to find the sources of heterogeneities.

Twenty-three RCTs with 1664 participants were identified. KDs did not exert any significant impacts on SBP (WMD: −0.87 mmHg, 95% CI: −2.05, 0.31) nor DBP (WMD: −0.11 mmHg, 95% CI -1.14, 0.93). Subgroup analyses did not reveal any further information. Also, non-linear dose-response analysis could not detect any associations between the percentage of calorie intake from fat in the KD format and BP levels.

Conclusion

KDs do not seem to be effective in improving BP. Nonetheless, further investigations are recommended to examine the proportion of fat intake needed to induce favorable clinical impacts.

Steve Parker, M.D.

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April 2, 2024 · 6:23 PM

Does Collagen Supplementation Help With Knee Arthritis?

A few months ago I heard fitness guru Mark Sisson mention during an interview that he was taking a collagen supplement for a painful hip condition that might need surgery, which he is trying to avoid. At the time, I had never heard of collagen supplementation. I used the google machine to find out it was indeed “a thing.” The popular trend may have been started after endorsement by a female celebrity (Jennifer Anniston?).

I have osteoarthritis (aka degenerative joint disease or DJD) in my knees, mainly manifested by very transient aching and stiffness if I sit for too long, and impaired range of motion. I cannot do a deep squat. I got my first inkling of arthritis awareness thirty years ago when I thought I’d start skipping rope because it’s such a great aerobic workout. After just a few jumps, my knees convinced me that was a bad idea.

Six months ago I developed a strange awareness of my left knee; it just didn’t feel like it was quite mine, like how I imagine it feels like to have a prosthetic knee joint. Plus some minimal aching while in bed, relieved by simply changing position. I walk around without any discomfort.

Does genetics play a role? My mother had knee replacement surgery for DJD at age 83. By that time her gait had become quite impaired.

I did a little Internet research and determined I had little to lose if I tried collagen, except for $. A family member was going to Costco so I asked them to get me some. I didn’t research various brands. Pictured is what they brought home. ~$40 for a month’s worth. I planned a two-month trial although WebMD suggested that 3-5 months may be needed for arthritis. (This is not a formal endorsement of the brand, nor am I being paid to feature it here.)

My two month trial of 20 grams daily ended yesterday. Did it work? I think maybe it did. The knee feels like it’s mine again, and sleep-time aching is less frequent. Could these be placebo effect? Yes. Was this a fair trial? Not entirely. In a totally legit experiment, you should only change one variable. Meaning: take this supplement but keep everything else exactly the same. In my experiment, I inadvertently added probiotics in addition to collagen (my shopper picked the product). I also significantly upped my exercise with more walking and weight training. Maybe my subjective improvement was due to those non-collagen factors. Heck, even the season of the year may have been an issue. A legitimate trial would involve hundreds of study subjects, a placebo group, before and after range of motion testing, a validated knee function questionaire, etc.

I was going to stop supplementation at this point but my wife already got me another cannister that lasts a month.

Click for my other posts on knee arthritis.

Steve Parker, M.D.

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March 31, 2024 · 5:01 PM

COVID-19: FDA Gets Bitch-Slapped By Appeals Court for Statements on Ivermectin

artist rendition of coronavirus
Artist conception of the dreaded virus

From The Tennessee Star:

Dr. Mary Talley Bowden, Dr. Paul E. Marik and Dr. Robert L. Apter sued the FDA in June of 2022, asking the court to: “Hold unlawful and set aside any FDA actions directing or opining on whether ivermectin should be used for certain off-label purposes, including treatment of COVID-19.”

“After nearly two years and a resounding rebuke by the Fifth Circuit Court of Appeals, the FDA has agreed to remove its misleading social media posts and consumer directives regarding ivermectin and Covid-19,” said Bowden.

The Appeals Court had written in its decision: “The FDA is not a physician. It has authority to inform, announce, and apprise—but not to endorse, denounce, or advise.”

That last line is beautifully written.

Steve Parker, M.D.

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March 28, 2024 · 12:41 AM

New Drug Resmetirom for Non-Alcholic SteatoHepatitis

Stages of liver damage. Healthy, fatty, liver fibrosis and cirrhosis. Vector illustration

DiabetesDaily informed me of a new drug available for treatment of a liver disease that affects “up to 20% of people with diabetes. The disease is MASH: metabolic dysfunction-associated steatohepatitis, something else I’d never heard of. (Shouldn’t the acronym be MDASH?) The drug is resmetirom, sold in the U.S. as Rezdiffra. Click for the FDA announcement. MASH can lead to liver scarring (fibrosis), which then qualifies the patient for resmetirom. The DiabetesDaily article is well-written and includes alternatives to this new drug.

I’ve long been aware of NASH: non-alcoholic steatohepatitis). THIS is the liver disease target according to the FDA announcement, which states “Rezdiffra is a partial activator of a thyroid hormone receptor; activation of this receptor by Rezdiffra in the liver reduces liver fat accumulation.” Furthermore:

The most common side effects of Rezdiffra included diarrhea and nausea. Rezdiffra comes with certain warnings and precautions, such as drug-induced liver toxicity and gallbladder-related side effects. 

There may be potential significant interaction of this new drug with others, particularly statin cholesterol-lowering drugs.

Color me skeptical. If only because the drug was on the “accelerated approval pathway.” But I’ll keep and open mind.

I’m not sure, but it appears that candidates for the drug will need a liver biopsy showing fibrosis (scarring).

Steve Parker, M.D.

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March 19, 2024 · 5:44 AM

Does a Ketogenic Diet Prevent Cardiovascular Disease?

In July, 2023, the journal Nutrients published a review of literature on the effect of ketogenic diets on cardiovascular disease. The abstract mentions potentially beneficial changes blood lipids, inflammation, blood pressure, etc., without going where the rubber meets the road: the effect on mortality and incidence of cardiovascular events in live humans. Click the link to see the entire article.

The Abstract:

“The most common and increasing causes of death worldwide are cardiovascular diseases (CVD). Taking into account the fact that diet is a key factor, it is worth exploring this aspect of CVD prevention and therapy. The aim of this article is to assess the potential of the ketogenic diet in the prevention and treatment of CVD. The article is a comprehensive, meticulous analysis of the literature in this area, taking into account the most recent studies currently available. The ketogenic diet has been shown to have a multifaceted effect on the prevention and treatment of CVD. Among other aspects, it has a beneficial effect on the blood lipid profile, even compared to other diets. It shows strong anti-inflammatory and cardioprotective potential, which is due, among other factors, to the anti-inflammatory properties of the state of ketosis, the elimination of simple sugars, the restriction of total carbohydrates and the supply of omega-3 fatty acids. In addition, ketone bodies provide “rescue fuel” for the diseased heart by affecting its metabolism. They also have a beneficial effect on the function of the vascular endothelium, including improving its function and inhibiting premature ageing. The ketogenic diet has a beneficial effect on blood pressure and other CVD risk factors through, among other aspects, weight loss. The evidence cited is often superior to that for standard diets, making it likely that the ketogenic diet shows advantages over other dietary models in the prevention and treatment of cardiovascular diseases. There is a legitimate need for further research in this area.”

Steve Parker, M.D.

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March 6, 2024 · 11:48 PM

I Was Right! Mediterranean Diet Prevents Cardiovascular Disease

Branzino, aka European Bass, live in Mediterranean waters

Yet another epidemiologic study supports the contention that the Mediterranean diet reduces cardiovascular disease. The higher the adherence to the Medi diet, the less cardiovascular disease over the next 20 years. I scanned the report down to the Discussion section and, surprisingly, didn’t catch their definition of cardiovascular disease. It usually refers to heart attacks, strokes, angina, congestive heart failure, and hypertension. Some would include aneurysms. The study at hand was done in Greece. You can read the whole thing.

Abstract

Background and aims

Only few studies have assessed longitudinal dietary trends in relation to cardiovascular disease (CVD) risk. We aimed to evaluate the association between adherence to the Mediterranean diet, both baseline and longitudinal, and 20-year CVD incidence.

Methods and results

This was a prospective study among 1988 Greek adults (50% men, age: 45 ± 14years). Adherence to the Mediterranean diet was evaluated at baseline and 10 years through the MedDietScore, based on which longitudinal Mediterranean diet trajectories were identified. CVD incidence was recorded at 20 years. Each one-unit increase in baseline MedDietScore was associated with an 8% reduction in 20-year CVD incidence. Compared to subjects in the lowest tertile of baseline MedDietScore, those in the highest exhibited a 44% lower 20-year CVD risk (relative risk: 0.56, 95% confidence interval: 0.32, 0.97) adjusted for age, sex, baseline body mass index, smoking, physical activity, presence of hypercholesterolemia, hypertension and diabetes mellitus, and family history of CVD; further adjustment for high-sensitivity C-reactive protein, uric acid and estimated glomerular filtration rate attenuated this association. Results were similar in models adjusted for longitudinal changes in body weight, physical activity and smoking, and 10-year medical status. Mediterranean diet trajectory analysis revealed that 24.7%, 8.6%, 45.8% and 20.9% of participants longitudinally sustained a low adherence, moved closer, moved away or sustained a high adherence, respectively; among those, the corresponding CVD incidence was 63.3%, 65.5%, 28.1% and 9.4% (p-value<0.001).

Conclusion

The Mediterranean diet offers long-term protection against CVD, part of which is mediated by inflammation, uricemia and renal function.

Steve Parker, M.D.

PS: The study is in Nutrition, Metabolism & Cardiovascular Disease: “Mediterranean diet trajectories and 20-year incidence of cardiovascular disease: The ATTICA cohort study (2002–2022),” published in January 2024.

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March 6, 2024 · 10:29 PM

What About Ketogenic Diet for Kids?

Diabetes Daily has in interesting article that addresses that question. A snippet:

In October 2023, the American Academy of Pediatrics (AAP) published a report examining low-carbohydrate diets like keto in children and adolescents. You probably won’t be surprised that the authors are concerned. Despite the increasing popularity of carbohydrate restriction, evidence to support the benefits of low-carb diets in young people under 18 with obesity or diabetes is very limited. And though diabetes authorities have acknowledged that carb restriction has “the most evidence” for improving blood sugar levels, the American Diabetes Association has only endorsed low-carb eating as one of multiple possible eating patterns.

And yet, there are many people in the diabetes community who believe in the effectiveness of low, even very-low, carbohydrate diets for their children. There’s at least one study that supports their advocacy

I’m not a pediatrician and never treat children in my hospital practice, not even 17-year-olds. Nor have I reviewed the pertinent pediatric scientific literature. So I’ve never been comfortable writing about keto diets for children. The linked DD article was reviewed by Anna Goldman, M.D.

Steve Parker, M.D.

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February 28, 2024 · 11:20 PM

Leap Year Customs and Superstitions

Jan over at The Low Carb Diabetic has a fun post regarding Feb 29.

Read about marriage proposals, gloves, leap day babies, bad luck, and St. Oswald’s Day, all from an occidental perspective.

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February 18, 2024 · 2:49 AM

Does Vitamin D Prevent Dementia?

Dr. John Campbell is “totally convinced” that high-dose vitamin D supplementation would prevent many cases of dementia, particularly Alzheimer dementia, which is 75% of all dementia cases. He takes 4,000 IU of vitamin D/day plus 100 mcg of vitamin K2. Unclear to me if that’s year-round or only in fall and winter, when there’s less sunshine in the northern hemisphere. I assume it’s oral vitamin D3 (there are several types of vitamin D). Dr. Campbell didn’t say why he takes the K2. Click for a brief review of K2. In contrast to his vitamin D dose of 4,000 IU/day, U.K. health authorities recommend a tenth of that — 400 IU — in autumn and winter.

Several observational studies link higher risk of dementia with blood levels of vitamin D that are deficient or insufficient. Blood levels of 25-hydroxy-vitamin D under 25 mg/ml are particularly linked to dementia. Dr. Campbell admits that it’s difficult to prove that adequate vitamin D supplementation would prevent Alzheimer dementia.

  Steve Parker, M.D.

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February 8, 2024 · 11:26 AM

Male Versus Female Longevity

Working on powerlines is dangerous and it’s mostly men who do it.
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Jim Goad is one of my favorite living cultural commentators. On par with a young P. J. O’Rourke, who died in 2022 at age 74. Last year Goad wrote a thoughtful and thought-provoking article on why women outlive men. A sample:

This disparity is not exclusive to the United States. In fact, it’s worse elsewhere. Worldwide, women outlive men by an average of seven years. According to a 2001 report, the only five countries on Earth where men outlived women were the flea-bitten open-air latrines we call Afghanistan, Nepal, Papua New Guinea, Namibia, and Zimbabwe. But a report from 2017 says there’s no longer any country on the planet where men outlive women.

It wasn’t always this way.

According to data from developed countries, men lived longer than women throughout most of the 1800s, only for the longevity stats to tip in favor of females during the 1890s — an advantage that women have held ever since. Women are supposedly more vulnerable than men to infectious diseases, but once male scientists got a grip on the microbes and brought those pesky critters to heel, women started living longer than men.

As far as I know, women have never thanked men for it.

+ + +

For another example of Goad’s work, check out his valentine, Why I Never Gave Up On Women.

  Steve Parker, M.D.

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