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
QOTD: Do Not Fret Because of Evil Men…
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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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Filed under Longevity
Vitamin Combo Prevents Age-Related Vision Loss
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.
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.
Filed under Uncategorized
U.S. Women Getting Fatter
…. 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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Filed under Weight Regain
Vitamin D Supplement Did Not Prevent Fractures in Healthy Adults.
Vitamin D supplementation of 2000 IU/day does not prevent fractures in the general population of healthy midlife and older adults.
Steve Parker, M.D.
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Dietitian Questions Healthfulness of the Mediterranean Diet
Shana Spence, RD, wrote at Self.com:
The Mediterranean diet is constantly lauded in the nutrition world—in fact, U.S. News has named it the “best diet overall” for five years straight—but as a registered dietitian, I think it’s time to think about it a little differently: It’s time to dethrone the Mediterranean diet as being the very best way to eat.
Now, the Mediterranean diet—which emphasizes whole grains and plant foods such as fruits, vegetables, legumes, tree nuts, seeds, and olives, and limits red meat, sugar, and saturated fat—is not the only culturally based way of eating that’s been celebrated. The Japanese diet, rich in foods such as seafood, steamed rice, tofu, natto, seaweed, and pickled fruits and vegetables, has been promoted for its longevity-promoting aspects as well. But as scrolling through social media or even many news and health websites will show, it still doesn’t come close to the Mediterranean diet in terms of widespread recognition.
As an RD, I’ve noticed an overwhelming belief in our society that eating Mediterranean-style is just the way to go. So if your cultural foods don’t hail from one of the countries that make up that area, how does this make you feel?
Spoiler: Probably not so good—and that’s why I believe we need to rethink how we talk about cultural foods and ways of eating.
You know I’m a Mediterranean diet advocate. There are other healthy ways of eating. I’m an advocate of free speech and open debate. No censorship here! Read it and see what you think. I’m not sure what the “Japanese diet” is. I’ve written good things about the Okinawan diet as discussed in Dan Buettner’s Blue Zones books. Click for my review of Blue Zones.
Steve Parker, M.D.
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Filed under Health Benefits, Longevity, Mediterranean Diet
Does Tirzepatide Work for Weight Loss?
Here’s the evidence at New England Journal of Medicine for tirzepatide for weight loss. It is a once-weekly injection. Cost? Unknown to me.
At baseline, the mean body weight was 104.8 kg, the mean BMI was 38.0, and 94.5% of participants had a BMI of 30 or higher. The mean percentage change in weight at week 72 was −15.0% (95% confidence interval [CI], −15.9 to −14.2) with 5-mg weekly doses of tirzepatide, −19.5% (95% CI, −20.4 to −18.5) with 10-mg doses, and −20.9% (95% CI, −21.8 to −19.9) with 15-mg doses and −3.1% (95% CI, −4.3 to −1.9) with placebo (P<0.001 for all comparisons with placebo). The percentage of participants who had weight reduction of 5% or more was 85% (95% CI, 82 to 89), 89% (95% CI, 86 to 92), and 91% (95% CI, 88 to 94) with 5 mg, 10 mg, and 15 mg of tirzepatide, respectively, and 35% (95% CI, 30 to 39) with placebo; 50% (95% CI, 46 to 54) and 57% (95% CI, 53 to 61) of participants in the 10-mg and 15-mg groups had a reduction in body weight of 20% or more, as compared with 3% (95% CI, 1 to 5) in the placebo group (P<0.001 for all comparisons with placebo).
Three to 7% of users stopped the drug due to side effects.
Click for a Diabetes Daily article about the drug.
Steve Parker, M.D.
PS: I can help you with weight loss at less cost than tirzepatide. Buy my book!
Filed under Weight Loss
“Cellular Exercise” May Promote Longevity
London researchers introduce the concept of “cellular exercise.”
Nutritional discipline and dietary restriction result in resistance exercise for our cells. Triggered by calorie restriction or physical exercise, our cells end up producing transcription factors that lead to protection against oxidation, inflammation, atherosclerosis, and carcinogenic proliferation. In the long-term, this results in longevity and a decrease in cancer, T2DM [type 2 diabetes], myocardial infarction, and stroke. Since centuries past, studies on humans, rhesus monkeys, and multilevel organisms have demonstrated the benefits of calorie restriction without malnutrition. Periodic fasting and calorie restriction show increases in regeneration markers and decreases in biomarkers for diabetes, CVD [cardiovascular disease], cancer, and aging.
The present review concluded that longevity can be increased through moderation of diet and exercise. Research shows that a concoction of the diverse diets modernly popularized— MED [Mediterranean], DASH, high-protein diets±—tempered by overall calorie restriction through periodic fasting or chronic calorie restriction, will provide protection against CVD, cancer, and aging. Exercise has also been shown to increase longevity in the general population, lower incidence of diabetes and cancer, and produce psychological benefits.
This review of research indicates that incorporating a moderate caloric restriction or fasting regimen could provide substantial benefits at low risk. Cellular exercise through calorie restriction and physical exercise can increase longevity and prevent the greatest killers of human society today—stroke and heart disease.
Caloric restriction is a form of hormesis. If interested, read more about it in free article from Journal of Physiological Anthropology.
Steve Parker, M.D.
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Recipe: Green Cabbage Salad
I have posted one or more cabbage recipes on this blog. Use the search box if interested.
When I was a wee lad, my mother never served cabbage. Don’t know why.
Adam Piggott is a good writer. He claims he has the best cabbage recipe ever. Here ’tis:
Ingredients:
- 1 fresh green cabbage
- Salt
- Cumin
- Apple [cider] vinegar
- Extra virgin olive oil.
Remove the rough outside leaves of the cabbage and then cut it into quarters. Using a mandoline slicer or a grater, carefully shave the cabbage as thinly as possible.
Now add the other ingredients in the order in which I listed them. Then mix well together and leave to sit for a few hours. Yes, a few hours and the longer the better. A minimum of one hour but if you can leave it all afternoon then you will thank me. This is why I was worried about them running out at the lunch. The cabbage will release some fluids over this time. Check for seasoning and olive oil before serving as you may have to add a little more.
His original post didn’t include specific amounts of most ingredients. Adam elaborated in the comments section:
Yes, the amounts are the issue here and it is what makes this a unique dish. Salt is the key. I use a large salt grinder which you can see in the last photo. I had half a cabbage for lunch and I would say that I used a good half tablespoon of salt. I added a little more at the end. Remember though with salt – you can always add more but you can’t take any away.
I used a quarter teaspoon of cumin. You’re just after a hint of the taste there. A small splash of the vinegar. Too much vinegar becomes overpowering; you can always add more later if you think you need it. Olive oil you can give it a good splash. Looking at the bowl of cabbage you should not see any liquid oozing out of the bottom. If you do then you have used too much oil or vinegar.
You can definitely refrigerate it but you don’t have to. If you do then you should cover it with cling film.
Read Adam’s entire post. It’s not long. You won’t regret it.
Steve Parker, M.D.
Filed under Recipes
Chronic Use of Proton Pump Inhibitors Is Dangerous
Proton Pump Inhibitor drugs (PPIs) greatly reduce the production of acid in the stomach. They revolutionized and improved the treatment of ulcers in the stomach and duodenum. When I started medical practice in 1981, I saw many patients who had required stomach surgery to treat their ulcers. Remember the good ol’ Billroth procedures? Of course you don’t. The first PPI approved for use in the US. was cimetidine (Tagamet) in 1979.
But wait, you say. “Isn’t there a reason we have stomach acid in the first place?” Good question! Because if we reduce stomach acid, it may cause problems. Regardless of what acid contributes to food digestion, it also kills germs in food and water. Germs that may kill us if ignored. Most of us in the developed world would be horrified to drink untreated water out of a lake, stream, river, or spring. But what do you think Homo sapiens did for most our 200,000 years of our existence?
Omeprazole was made over the counter in 2003 but I don’t think these drugs should ever have been made available without prescription. PPIs are powerful drugs that treat heartburn by reducing gastric acid production. This is accomplished by PPI binding to the hydrogen/potassium ATPase enzyme on gastric parietal cells lining the stomach. PPIs do more than block acid. They are associated with an increased risk of congestive heart failure, kidney disease, long bone fractures, and dementia, vitamin B12 deficiency, reviewed here. Regular use of proton pump inhibitors is associated with increased incidence of type two diabetes, about 24% higher compared to non-users of the drug. Proton pump inhibitors are also linked an with increased risk of small intestinal bacterial overgrowth (which is a clue as to why these drugs can be harmful). They also increase the risk of infection by Clostridiales difficile by about 2x.
Most of these individual observational studies are unable to establish causation, but the preponderance of evidence points to PPIs causing harm.
Dr Alcock also found evidence that PPI users who catch COVID-19 have 1.6x increased risk for severe disease and death.
If you’re prescribed a PPI for chronic use, check with your physician to see if you still need it. Occasional use for heartburn shouldn’t be a problem. For chronic heartburn, consider a low-carb diet and stop nocturnal alcohol consumption.
Steve Parker, M.D.
Filed under Causes of Diabetes, Coronavirus
Diabetic Mediterranean Diet 