August 5, 2010 · 2:00 AM

Are Most Statin Prescriptions a Waste of Money?

A recent medical journal article suggests that three of every four statin prescriptions do nothing to prevent death, since they’re taken by people without an established diagnosis of cardiovascular disease.  The researchers don’t address whether statin drugs prevent heart attacks or strokes or otherwise improve quality of life. 

Most of the “healthy” people taking statins are trying to prevent heart attacks associated with high cholesterol levels.  You’d think if statins prevented heart attacks, they’d prolong life.  That’s not what these researchers found.

Details are at my recent Self/NutritionData Heart Health Blog post.

Steve Parker, M.D.

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August 3, 2010 · 2:00 AM

Quote of the Day

Thomas Jefferson, author of the Declaration of Independence

“The Declaration of Independence—the “father of all moral principle” in our politics, as Lincoln called it—defines the purpose of government in distinctly limited terms: “To secure these rights, governments are instituted among men, deriving their just powers from the consent of the governed.”  The rights in question are the natural ones to life, liberty, and the pursuit of happiness.  That the Declaration speaks of the pursuit of happiness rather than happiness itself as a right is an important indication of the Founders’ commitment to limited government.  A government that is responsible for sustaining the conditions in which we can pursue happiness is a limited one.  But is is difficult to say what the limits are on a government that is responsible for our happiness iteslf.”

                                                 —Matthew J. Franck, professor and chairman of political science at Radford University, writing in National Review, May 17, 2010

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August 2, 2010 · 10:25 AM

Is Your Diet Deficient in Micronutrients?

Laura Dolson at her Low Carb Diets Blog today reports on a recent study that compared micronutrient levels in three diets: Atkins, Zone, and LEARN.  Visit her post for the surprising and worrisome results of this study in the American Journal of Clinical Nutrition.

[In a nutshell, “micronutrients” are important vitamins and minerals present in small amounts in our food.]

Monica Reinagel has also reviewed the study.  I respect both of their opinions.

Steve Parker, M.D., author of The Advanced Mediterranean Diet

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July 29, 2010 · 7:45 PM

Drew Carey Succeeds With Very Low-Carb Diet

Jimmy Moore today at Livin’ La Vida Low Carb reports on Drew Carey’s fantastic success in losing 80 pounds (36.4 kg) of fat and controlling (curing?) his type 2 diabetes.  Jimmy says many Hollywood celebrities control their weight with carbohydrate-restricted eating.

Steve Parker, M.D.

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July 28, 2010 · 9:32 AM

Paleo Diet and Diabetes: Improved Cardiovascular Risk Factors

Compared to a standard diabetic diet, a Paleolithic diet improves cardiovascular risk factors in type 2 diabetics, according to investigators at Lund University in Sweden.

Researchers compared the effects of a Paleo and a modern diabetic diet in 13 type 2 diabetic adults (10 men) with average hemoglobin A1c’s of 6.6% (under good control, then).  Most were on diabetic pills; none were on insulin.  So this was a small, exploratory, pilot study.  Each of the diabetics followed both diets for three months.

How Did the Diets Differ?

ResearchBlogging.orgCompared to the diabetic diet, the Paleo diet was mainly lower in cereals and dairy products, higher in fruits and vegetables, meat, and eggs.  The Paleo diet was lower in carbohydrates, glycemic load, and glycemic index.  Paleo vegetables were primarily leafy and cruciferous.  Root vegetables were allowed; up to 1 medium potato daily.  The Paleo diet also featured lean meats [why lean?], fish, eggs, and nuts, while forbidding refined fats, sugars, and beans.  Up to one glass of wine daily was allowed.

See the actual report for details of the diabetic diet, which seems to me to be similar to the diabetic diet recommended by most U.S. dietitians.

What Did the Researchers Find?

Compared to the diabetic diet, the Paleo diet yielded lower hemoglobin A1c’s (0.4% lower—absolute difference), lower trigylcerides, lower diastolic blood pressure, lower weight, lower body mass index, lower waist circumference, lower total energy (caloric) intake, and higher HDL cholesterol.  Glucose tolerance was the same for both diets.  Fasting blood sugars tended to decrease more on the Paleo diet, but did not reach statistical significance (p=0.08).

So What?

The greater improvement in multiple cardiovascular risk factors seen here suggests that the Paleo diet has potential to reduce the higher cardiovascular disease rates we see in diabetics.  Larger studies—more participants—are needed for confirmation.  Ultimately, we need data on hard clinical endpoints such as heart attacks, strokes, and death.

These diabetics had their blood sugars under fairly good control at baseline.  I wouldn’t be surprised if diabetics under poor control—hemoglobin A1c of 9%, for example—would see even greater improvements in risk factors as well as glucose levels while eating Paleo.

I see a fair amount of overlap between this version of the Paleo diet and Dr. Bernstein’s Diabetes Solution diet and the Low-Carb Mediterranean Diet. 

Steve Parker, M.D.

Reference:  Jönsson, T., Granfeldt, Y., Ahrén, B., Branell, U., Pålsson, G., Hansson, A., Söderström, M., & Lindeberg, S. (2009). Beneficial effects of a Paleolithic diet on cardiovascular risk factors in type 2 diabetes: a randomized cross-over pilot study Cardiovascular Diabetology, 8 (1) DOI: 10.1186/1475-2840-8-35

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July 27, 2010 · 2:00 AM

Diabetes Consumes 7% of the UK’s Drug Budget

The BBC reports that drugs for diabetes account for 7% of the United Kingdom’s National Health Service’s prescription drug budget. 

They would spend less on diabetic drugs if more diabetics adhered to low-carb eating or the Mediterranean diet.  Better yet, combine both eating styles as in the Low-Carb Mediterranean Diet.

Steve Parker, M.D.

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July 26, 2010 · 2:00 AM

2nd Printing of “Advanced Mediterranean Diet” Now Available

The first printing of The Advanced Mediterranean Diet: Lose Weight, Feel Better, Live Longer is sold out. Yay! And many thanks to my readers!

The book is available now from a new printer that also handles distribution, CreateSpace.  As always, you can also get the book from Amazon.com.

Steve Parker, M.D.

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July 15, 2010 · 10:01 AM

Maybe Diet Prevents Alzheimer Dementia After All

I blogged about a study by Gu et al on April 30, 2010, that found significantly lower incidence of Alzheimer dementia in people in Manhattan who followed this dietary pattern:

  • relatively high consumption of salad dressing, nuts, fish, tomatoes, fruits, dark green leafy vegetables, and cruciferous  vegetables
  • relatively low consumption of poultry, red meat, butter, and high-fat dairy

About the same time, a National Institutes of Health expert panel pooh-poohed the possibility that diet had any effect one way or the other on Alzheimer’s. 

Why does this matter?  Five million U.S. adults have Alzheimer dementia already, and it’s going to get much worse over the coming decades.

A June, 2010, issue of Journal of the American Medical Association has a commentary by two doctors (Martha Morris, Sc.D., and Christine Tangney, Ph.D.), experts in the field of nutrition.  Here’s their explanation of the NIH panel’s negative findings:

Many of the inconsistencies among studies of dietary factors can be attributed to the complexity of nutrition science and the omission of nutrition expertise in the design and analysis of both epidemiological and randomized controlled trials.

Morris and Tangney think the findings of Gu et al are valid, confirming prior studies showing benefit to diets high in vitamin E (from food) and low in saturated fat from animals.  They point out that the animal foods may simply be displacing beneficial nutrients in other foods, rather than directly causing harm.

Until we have further data, anyone at risk for Alzhiemer’s may be better off following the dietary pattern above, or the Mediterranean diet.  The two are similar.

Steve Parker, M.D.

Disclaimer:  All matters regarding your health require supervision by a personal physician or other appropriate health professional familiar with your current health status.  Always consult your personal physican before making any dietary or exercise changes. 

Reference: Morris, M., & Tangney, C.  Diet and Prevention of Alzheimer Disease.  The Journal of the American Medical Association, 303 (2010): 2,519-2,520.    doi: 10.1001/jama.2010.844

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July 6, 2010 · 6:32 AM

Diabetes Drug Rosiglitazone About to Be Pulled Off the Market?

ResearchBlogging.orgIt’s over for rosiglitazone.

Sold in the U.S. as Avandia, rosiglitazone is a drug used to control type 2 diabetes either alone or in combination with insulin, metformin, or a sulfonylurea.  It has only one competitor in its class: pioglitazone (sold as Actos).

Both drugs in the thiazolidinedione class (aka TZDs or glitazones) increase the risk of heart failure.  Prior studies had suggested that rosiglitazone increases the risk of heart attack, heart failure, and death.  Research suggested that pioglitazone actually reduces the risk of heart attack, stroke, and death.

A study just published in the Journal of the American Medical Association directly compared clinical use of rosiglitazone and pioglitazone.  Investigators looked at Medicare data involving over 227,000 patients, average age 74, average follow-up of 105 days.

Rosiglitazone comes out the loser: users had significantly higher risk of stroke, heart failure, and death.  Risk of heart attack trended a bit higher in the rosi users but did not reach statistical significance. 

The researchers also calculated the composite risk of suffering either a heart attack, stroke, heart failure, or death:  rosiglitazone risk was about 18% higher compared to pioglitazone. 

What do these numbers mean from a practical viewpoint?  The researchers calculated a “number needed to harm.” Treat 60 patients with rosi and 60 with pio for one year; the rosi group will have one extra event—heart attack, stroke, heart failure, or death—compared with the pio users.

Why put up with that risk?  There’s no good reason.  Especially when pioglitazone is available.

Implications

If you take rosiglitazone, ask your doctor to find an alternative or switch you to pioglitazone.  Soon.

Clearly, we don’t know all of the adverse effects of many of the drugs doctors prescribe, whether for diabetes or other illnesses.  We balance the good with the bad, and that equation changes over time. 

Rosiglitazone’s manufacturer may pull the drug off the market voluntarily.  If not, the FDA will do it.  Cardiovascular disease—e.g., heart attacks, strokes, heart failure—kills 68% of diabetics.  The last thing we need is a drug that increases that risk.

Within a month, you’ll see ads on U.S. television from trial lawyers asking if you or a loved one has been hurt by rosiglitazone.  “If so, call this toll-free number now…”

Steve Parker, M.D.

Reference: Graham, D., Ouellet-Hellstrom, R., MaCurdy, T., Ali, F., Sholley, C., Worrall, C., & Kelman, J. (2010). Risk of Acute Myocardial Infarction, Stroke, Heart Failure, and Death in Elderly Medicare Patients Treated With Rosiglitazone or Pioglitazone JAMA: The Journal of the American Medical Association DOI: 10.1001/jama.2010.920

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July 2, 2010 · 2:00 AM

Basic Science: Mediterranean Diet Boosts Antioxidant Power

Compared to the low-fat American Heart Association diet, the traditional Mediterranean diet rich in olive oil has more capacity to counteract potentially harmful “free radicals” and “reactive oxygen species” in our bodies, according to researchers at the University of Navarra in Spain.

Our tissues normally contain free radicals and reactive oxygen species, which are intrinsic to cell metabolism.  They serve useful purposes.  In excessive amounts, however, many believe they cause “oxidative damage” and thereby contribute to chronic degenerative conditions such as atherosclerosis, aging, dementia, and cancer.

Antioxidants are thought to neutralize free radicals and reactive oxygen species, which may lead to better health.

The PREDIMED study is an ongoing Spanish project testing the heart-protective effects of the Mediterranean diet in high-risk people over the course of four years.  The three intervention groups are 1) Medi diet plus supplemental virgin olive oil, 2) Medi diet plus extra tree nuts, and 3) low-fat American Heart Association diet.

After three years of follow-up, the researchers measured “total antioxidant capacity” in the bloodstream of a subset of the PREDIMED participants.

They found that the two Mediterranean diet groups had significantly greater total antioxidant capacity, about 50% more than the low-fat control group.  Within the Medi + olive oil group, the participants with the highest levels of antioxidant capacity actually tended to lose weight, an association not seen in the other groups.

The Researchers’ Conclusions

Mediterranean diet, especially rich in virgin olive oil, is associatied with higher levels of plasma antioxidant capactiy.  Plasma total antioxidant capacity is related to a reduction in body weight after three years of intervention in a high cardiovascular risk population with a Mediterranean-style diet rich in virgin olive oil.

In other words, the Mediterranean diet with virgin olive oil may help you keep your weight under control, and the antioxidant capacity may contribute to the well-documented health benefits of the diet.

Steve Parker, M.D.

PS:  It’s impossible to tell from this report just how much weight loss was seen in the high-TAC Medi+olive oil subjects.  I doubt it was much.  Baseline body mass index for all participants was around 29, so they were overweight and just a shade under obese.

PPS:  Both the Ketogenic Mediterranean and Diabetic Mediterranean Diets mandate minimal amounts of olive oil consumption, with no upper limit.

Reference: Razquin, C., et al. A 3 year follow-up of a Mediterranean diet rich in virgin olive oil is associated with high plasma antioxidant capacity and reduced body weight gain.  European Journal of Clinical Nutrition, 63 (2009): 1,387-1,393.  doi 10.1038/ejcn.2009.106

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