Some Fad Diets Are Better Than Others

Paleobetic Diet, Steve Parker MD, paleo diet, Paleolithic diet, diabetes, diabetic diet
Original bare-bones e-book cover

Frontiers In Nutrition in July, 2022, published “Fad Diets: Facts and Fiction.” Thank you, FIN, for making it available at no cost. The authors are based in Pakistan and Romania. They attempted to summarize the literature on popular fad diets. I am shocked that they included the Mediterranean diet. Read the article and 134 references then form your own opinion. Some snippets:

Regarding the Atkins Diet: “AD provides several benefits including weight reduction and cardio-metabolic health improvement, but limited evidence exists as compliance is the major barrier to this dietary regimen. Strict supervision by health professionals is advised as adverse metabolic sequelae can result from this type of diet.”

The Paleolithic Diet: “More randomized trials need to be done to highlight the consequences of such diets that eliminate one or more food groups. PD is powerful at advancing weight reduction for the time being but its efficacy in cardiovascular events is not well established as limited long-term data is available.”

Mediterranean Diet: “No evidence of adverse effects associated with MD is available in the literature. Rather, MD has preventive and therapeutic potential for many chronic diseases. It is highly suitable for the general public for the prevention of micronutrient deficiencies and specifically for those patients who are more health-conscious than just weight loss oriented.”

Vegetarian Diet: “No evidence of adverse effects associated with MD is available in the literature. Rather, MD has preventive and therapeutic potential for many chronic diseases. It is highly suitable for the general public for the prevention of micronutrient deficiencies and specifically for those patients who are more health-conscious than just weight loss oriented.”

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Intermittent Fasting: “Despite the effectiveness of IF in weight loss as indicated by several studies, the current evidence is non-conclusive. The prime focus of available literature is weight loss but little is known about its sustainability and long-term health effects. More long-term trials should be conducted to draw a clear conclusion.”

Detox Diets: “Energy-restricted DDs are capable of short-term weight loss. But still, there is a high likelihood of health risks from detox products because of their nutritional inadequacy. As no convincing evidence exists in this domain so such diets and products need to be discouraged by health professionals and must be subjected to regulatory review and monitoring.”

Ketogenic Diet: difficult to summarize.

Steve Parker, M.D.

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Ultra-Processed Foods May Impair Cognition in Elderly

Processed or ultra-processed?

An article earlier this year in the European Journal of Nutrition reported that high consumption of ultra-processed foods is linked to worse-than-average performance on one particular test of cognitive function in older U.S. adults (60+ years-old) who did not have chronic diseases such as diabetes or cardiovascular disease. The particular test was “Animal Fluency.” Never heard of it? Me either. Keep reading.

The study included 2,700 participants, average age 69. Participants were asked to recall what they ate in the prior 24 hours. Foods were “classified according to NOVA, a food classification based on the extent and purpose of industrial food processing, into four mutually exclusive groups: (1) unprocessed or minimally processed foods, (2) processed culinary ingredients, (3) processed foods, and (4) UPFs [ultra-processed foods].”

Ultra-processed foods? “…most foods described as “Frozen meals” or “Lunchables”, as well as some items described as consumed in “Restaurant fast food/pizza” or acquired at a “Vending machine” were classified as UPFs.” Furthermore, the authors write in the introduction that “UPFs, according to NOVA classification system, are industrial formulations of processed food substances (oils, fats, sugars, starch, and protein isolates) that contain little or no whole food and typically include flavourings, colourings, emulsifiers, and other cosmetic additives. UPFs are becoming dominant in diets globally and are replacing traditional diets based on unprocessed and minimally processed foods.

Of the entire study population at hand, UPFs were about half of all calories consumed but ranged from 30 to 70%.

“Cognitive performance was assessed using the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD), Word Learning test, Animal Fluency test, and the Digit Symbol Substitution test (DSST).”

The Animal Fluency test “evaluates categorical verbal fluency (executive function).” “For the Animal Fluency test, the participant is requested to name as many animals as possible within a 60-s [60 seconds, I assume] time period. Each animal corresponds to 1 point and the result is presented as the total sum of points.”

Mr Ed, the fluent horse (You won’t get this if under 63)

The test subjects were given two other tests of cognitive function but the investigators found no differences in performance based on ultra-processed food consumption. Here are these other two tests:

The two parts of the CERAD Word Learning test consist of (1) three consecutive learning trials, where the participant is requested to recall a list of ten unrelated words immediately after their presentation. Each word corresponds to one point, and the result is presented as a total score across the three trials (range 0–30); and (2) a delayed word recall test, performed after the two other cognitive tests. The result ranges from 0 to 10. … For the DSST, the participant is presented a single sheet of paper where they are asked to match a list of nine symbols to numbers according to a key located on the top of the page. The task had 133 numbers and the participant had 2 min to complete it. The result is shown as the total number of correct matches. For all the tests, higher scores represent better cognitive function. 

The authors conclude: “Consumption of UPF was associated with worse performance in Animal Fluency, a cognitive test that assesses language and executive function in older adults without pre-existing diseases such as CVD [cardiovascular disease] and diabetes, while no associations were observed for those with these conditions. While longitudinal studies are required to provide stronger evidence, these results suggest that decreasing UPF consumption may be a way to mitigate age-associated cognitive decline and reduce the risk of dementia.”

I agree these results aren’t very strong.

Steve Parker, M.D.

h/t Jan at The Low Carb Diabetic blog

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Overweight U.S. Adolescents Eat More Ultra-Processed Foods

“One little piece won’t hurt . . .”

An article in the Journal of the Academy of Nutrition and Dietetics found an association between overweight/obesity and consumption of ultraprocessed foods in U.S. adolescents.

The study looked at 3,600 adolescents who reported their food intake over a 24-hour period. The results are pretty strong: the more ultra-processed food consumed, the greater the odds of overweight and obesity.

Jan at The Low Carb Diabetic blog reported that:

Ultra-processed foods make up ‘two-thirds of calories consumed by children and teens’
Experts from Tufts University in Massachusetts studied two decades of dietary data to 2018 and found that the amount of calories young people consumed from ultra-processed foods jumped from 61 per cent to 67 per cent.

I’m not paying for the JAND scientific report so I don’t know how they defined ultra-processed foods. The definition varies quite a bit over time, by researcher, and by research goals. From the U.S. National Library of Medicine:

The definitions [of ultra-processed foods] used in 2009, 2010, 2012, 2014, and 2016a represent the definitions used from publications devoted solely to that purpose and are heavily referenced in the literature on ultra-processed foods. The definitions used in years 2015, 2016b, and 2017 are from articles that focused on the relation between ultra-processed food intake and public health nutrition, in which definitions of ultra-processed foods are presented in detail in the article. The first definition alludes mainly to the use of both food additives and salt in food products (6). The second introduces the putative impact of ultra-processed foods on accessibility, convenience, and palatability of ultra-processed foods (8). Subsequently, the definitions become longer and include more elements. Thus, the third definition builds on previous definitions but introduces 2 new angles (9). One is the nonavailability of ingredients used in ultra-processed foods from retail outlets such as supermarkets, and the second introduces food additives as the most widely used ingredients, in numerical terms, in the manufacture of ultra-processed foods. The next definition now introduces the role of food fortification as a defining element of ultra-processed foods (4). Further definitions introduce new elements such as the importance of foods synthesized in a laboratory, based on organic materials such as oil- and coal-based additives and flavoring compounds (10), a specification for the minimal number of ingredients to be found in these foods (5), and then an emphasis on the inclusion of salt, sugars, oils, and fats as a starting point for defining ultra-processed foods. This definition gives details of specific categories of food additives and highlights how the intended use of these additives is to imitate sensory qualities of fresh or minimally processed foods (group 1) or to specifically disguise undesirable qualities of ultra-processed foods (11). The final definition from 2017 (12) is quite similar to that used in the 2016b publication (11).

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If you want to dive deep, you can download a list of ultra-processed food examples from that NLM article. I didn’t. But I figure the way to avoid over-processed foods is to eat food closer to the way God made it rather than man-made.

Steve Parker, M.D.

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Two Hospitals Fined for Violation of Medicare’s Price Transparency Law

hospital emergency room
Not the offending hospital

I’ve long been an advocate for price transparency in healthcare. The Centers for Medicare and Medicaid Services (aka CMS) has recently taken action that requires hospitals to post their prices online, which should boost competition and help you shop around to save money. If memory serves, the price posting only applies to a limited number of services. I presume the rare hospitals that don’t accept Medicare and Medicaid payments are exempt.

From MedPage Today:

This week [June 2022], CMS handed down their first penalties to two hospitals in Georgia for failing to comply with the price transparency law that went into effect Jan. 1, 2021.

Northside Hospital Atlanta in Sandy Springs and Northside Hospital Cherokee in Canton were both fined for a lack of readily available standard charges for hospital services online, despite warnings.

The fines were on the order of $200,000 and $900,000.

If you find a hospital breaking the law, report ’em to CMS!

Steve Parker, M.D.

PS: Let me help you avoid hospitals.

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Chronic Stress, Even in Childhood, Linked to Arthritis Onset

Knees are the most common joint affected by osteoarthritis.
Photo credit: Steven Paul Parker II

Have you heard of the “diabetic triad”? Diabetes (type 2) + hypertension + arthritis. Very common.

A MedPage Today article indicates that chronic stress may precipitate or aggravate arthritis. Even childhood stress. The link is not as strong for rheumatoid arthritis as it is for more common types of arthritis. Most for the reviewed studies “categorized stress as stemming from adverse life events … or adverse childhood experiences …. Most studies … suggested a relationship between exposure to chronic stressors and arthritis development.”

Would stress reduction improve the quality of life of arthritis patients? The study at hand doesn’t address that but I’d wager that it does.

Steve Parker, M.D.

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QOTD: Do Not Fret Because of Evil Men…

Do not fret because of evil men or be envious of the wicked, for the evil man has no future hope, and the lamp of the wicked shall be snuffed out.

Proverbs 24: 19-20

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Two Dietitians Wonder What’s the Healthiest Way of Eating

A couple of dietitians did an massive literature review looking for evidence that diet has an effect on major health conditions such as obesity, diabetes, and cardiovascular disease. Sounds interesting, and similar to my own obsessive review done between 1995 and 2005. It bothers me that “hypertension” is misspelled in the abstract. For the researchers’ conclusions, you have to pay $27.95 USD.

Abstract from the Journal of the Academy of Nutrition and Dietetics:

Appropriate diet can prevent, manage, or reverse noncommunicable health conditions such as obesity, cardiovascular disease, and diabetes. Consequently, the public’s interest in diet and nutrition has fueled the multi-billion-dollar weight loss industry and elevated its standing on social media and the internet. Although many dietary approaches are popular, their universal effectiveness and risks across overall populations are not clear. The objective of this scoping review was to identify and characterize systematic reviews (SRs) examining diet or fasting (intermittent energy restriction [IER]) interventions among adults who are healthy or may have chronic disease. An in-depth literature search of six databases was conducted for SRs published between January 2010 and February 2020. A total of 22,385 SRs were retrieved, and 1,017 full-text articles were screened for eligibility. Of these, 92 SRs met inclusion criteria. Covered diets were organized into 12 categories: high/restricted carbohydrate (n = 30), Mediterranean, Nordic, and Tibetan (n = 19), restricted or modified fat (n = 17), various vegetarian diets (n = 16), glycemic index (n = 13), high protein (n = 12), IER (n = 11), meal replacements (n = 11), paleolithic (n = 8), Dietary Approaches to Stop Hypretension (DASH; n = 6), Atkins, South Beach, and Zone (n = 5), and eight other brand diets (n = 4). Intermediate outcomes, such as body weight or composition and cardiometabolic, were commonly reported. Abundant evidence was found exploring dietary approaches in the general population. However, heterogeneity of diet definitions, focus on single macronutrients, and infrequent macronutrient subanalyses were observed. Based on this scoping review, the Evidence Analysis Center prioritized the need to collate evidence related to macronutrient modification, specifically restricted carbohydrate diets.


Steve Parker, M.D.

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Vitamin Combo Prevents Age-Related Vision Loss

These are the ones I take. In the U.S., your best price may be at Costco or Sam’s Club.

I have a particular interest in preventing age-related macular degeneration (ARMD) since it runs in my family. It’s the leading cause of vision loss in adults over 50.

Photo of the retina at the back of the eyeball

From JAMA Ophthalmology:

Question  What were the long-term findings of Age-Related Eye Disease Study 2 (AREDS2) supplements regarding development of lung cancer or progression to late age-related macular degeneration (AMD)?

Findings  In this epidemiologic follow-up study of the AREDS2 cohort of 3882 participants and 6351 eyes, 10-year follow-up results showed that development of lung cancer nearly doubled in participants assigned to beta carotene among former smokers but not those assigned to lutein/zeaxanthin. Lutein/zeaxanthin was associated with a reduction in the risk of progression to late AMD when compared with beta carotene.

Meaning  These findings suggest that the AREDS2 supplement with lutein/zeaxanthin instead of beta carotene was safe, with no association with developing lung cancer and a potential beneficial association with further reduction in progression to late AMD.

Steve Parker, M.D.

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U.S. Women Getting Fatter

You men are gaining weight, too!

From the Journal of Obesity:

…. 10-year weight gain is substantially greater in US women compared to men. On average (±SE), women gained 5.4 ± 0.3 kg and 9.2 ± 0.4 percent of their initial weight over the previous 10 years, whereas men gained 2.6 ± 0.2 kg and 3.8 ± 0.3 percent of their initial weight. In general, compared to US men, women gained about twice as much weight (kg) and 2.4 times more weight expressed as a percent of initial weight, over the previous 10 years. Fourth, 10-year weight gain is significantly higher in Non-Hispanic Blacks than in other racial groups, especially NH [non-Hispanic] Black women. Moreover, 10-year weight gain is significantly lower in Non-Hispanic Asians compared to other racial categories.

If you think in pounds instead of kilograms, like me, note that 1 kg = 2.2 lb.

Since 2000, U.S. obesity in adults has increased from 30% to 42% of the population. This doesn’t even include suspected pandemic-related weight gain.

Mean [~average] 10-year weight gain was 4.2 ± 0.2 kg or 6.6 ± 0.2% of initial body weight within the United States. 

The incidence of severe obesity had increased from 5% in 2000 to almost 10% now. (The article likely defines “severe obesity” but I didn’t catch it in my quick scan.)

Not enough Americans are reading and implementing my books!

Steve Parker, M.D.

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Vitamin D Supplement Did Not Prevent Fractures in Healthy Adults.

You do NOT want this hip bone to break!

Vitamin D supplementation of 2000 IU/day does not prevent fractures in the general population of healthy midlife and older adults.

The study at NEJM.

Steve Parker, M.D.

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