Fatty Liver: Green-Mediterranean Diet Worked Better Than Mediterranean Diet

stages of liver damage
Stages of liver damage. Healthy, fatty, liver fibrosis and cirrhosis

About one quarter of the world’s adults have excess fat accumulation in the the liver called non-alcoholic fatty liver disease (NAFLD). This can lead to liver inflammation, scarring (cirrhosis), and liver cancer. The adverse effects of liver fat can be prevented by loss of that fat. The most common medical recommendation to accomplish that is to loss excess body weight via any reasonable method.

A study published in Gut last year found greater reduction in liver fat in those eating a “green-Mediterranean” diet compared to a regular Mediterranean diet over 18 months. Both diets were supplemented with walnuts 28 grams/day. Details of the green-Med diet:

In addition to [physical activity] and the provision of 28 g/day walnuts, the green-MED diet was restricted in processed and red meat and was richer in plants and polyphenols. The participants were guided to further consume the following provided items: 3–4 cups/day of green tea and 100 g/day of frozen Wolffia globosa (Mankai strain) plant frozen cubes, as a green shake replacing dinner. Both green tea and Mankai together provided additional daily intake of 800 mg polyphenols ((GAE), according to Phenol-Explorer and Eurofins lab analysis, including catechins (flavanols)) beyond the polyphenol content in the prescribed MED diet. Both the MED and green-MED diets were equally calorie-restricted (1500–1800 kcal/day for men and 1200–1400 kcal/day for women).

The researchers don’t tell us where to get frozen Wolffia globosa (Mankai strain) plant frozen cubes.

Study participants were almost all men, so results may not apply to women.

Click for some of the details in Endocrinology Advisor.

Steve Parker, M.D.

PS: Need to lose weight? Let me help.

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Viagra May Prevent or Treat Dementia

Photo by Anna Shvets on Pexels.com

Viagra (one brand name for generic sildenafil) is used to treat erectile dysfunction and pulmonary hypertension. I bet that usage for ED is far more common than for pulmonary hypertension.

From an article published in Dec 2021 by National Institutes of Health:

…the team analyzed insurance claims data from more than 7 million Americans. They found that the people (mostly men) who took sildenafil were 69% less likely to develop AD [Alzheimer’s Disease] over 6 years than those who did not take the drug. This association between sildenafil and AD held after adjusting for sex, age, and other diseases and conditions.

To understand how sildenafil might affect AD, the researchers grew neurons from stem cells derived from AD patients. Exposing the cells to sildenafil led to increased growth of neurites, which connect neurons to each other, and decreased tau phosphorylation, an early biomarker of AD.

Taken together, these results show an association between sildenafil use and reduced AD risk. But the researchers emphasize that they haven’t shown that sildenafil prevents or reverses AD.

These things usually don’t pan out, but one can hope. How often were these guys taking viagra? Once a month? Twice a week? To treat erectile dysfunction, sildenafil is typically taken as needed one hour before sexual activity. A typical dose for pulmonary hypertension is 20 mg by mouth three times a day, every day. Would this drug affect dementia in women? As they say, further studies are needed.

Steve Parker, M.D.


Filed under Dementia

Mediterranean Diet Is Ranked Best for Diabetes

according to U.S. News & World Report. Click through if interested in the two runners-up. I think a low-carb version of Mediterranean is better for most folks.

Steve Parker MD, low-carb diet, diabetic diet
Olives, olive oil, and vinegar: classic Mediterranean foods

I’m surprised they ranked Atkins as the “Best Fast Weight-Loss Diet.” Looks like we’re getting over our collective phobia about saturated fat. “Keto Diet” ranked #4 in that category.

Steve Parker, M.D.


Filed under Mediterranean Diet, Weight Loss

COVID-19 Prevention Strategies

Artist’s renditions of coronavirus

Oral preventatives during disease surges:

  • Vitamin D (cholecalciferol) 1,000-2,000 IU/day. (Gruff Davies and Linda Benskin recommend, in general, 4,000 IU daily, perhaps year-round, or whatever combination of food, supplementation, and sunlight gets your blood level of 25-hydroxy vitamin D to to 50 ng/mL.)
  • Aspirin 81-325 mg/day
  • Vitamin C 500 mg/day
  • Elemental zinc 10-50 mg/day
  • Melatonin 1.5-6 mg/day at night or bedtime

The doses vary, depending on body weight, age, tolerance to the drug. Generally, the higher doses are for younger and heavier folks. If one gets plentiful sunlight exposure, the oral vitamin D may not be needed.

Other strategies during disease surges (or always?):

  • Regular exercise
  • Lose excess weight, especially if obese (BMI over 30)
  • Maintain normal blood sugars (if diabetic, keep HgbA1c under 6.5%)
  • Avoid close, prolonged contact with coughing and sneezing people, especially in enclosed spaces
  • Frequent hand-washing if exposed to public doorknobs, elevator buttons, or other potentially contaminated surfaces, or if around sick (coughing and/or sneezing) people
  • Avoid sick people who are coughing and sneezing
  • Eat healthful food

Did you notice I haven’t mentioned masks? I’m not a big believer. Do I wear an N-95 mask when I’m seeing a COVID-19 patient at the hospital? You bet. And the mask was fit-tested. Is that testing available to the general public? Not that I’m aware.

Do I have great data to support all these strategies? No, but some. Are they recommended by the CDC or NIH (Nat’l Institutes of Health)? I don’t know or care. I’ve lost faith in them. I’m afraid they’ve been bought and paid for by Big Pharma (and others?).

I don’t know about your personal health and medical history. I’m not your doctor. If you’re considering any of these recommendations, consult your personal physician before implementation.

The patient is wise to look away. If you watch the needle go in, it’ll hurt more.

I was motivated to write this post by the failures and risks of the rushed vaccines. Vaccination might be helpful if you are sickly, over 65, or have underlying conditions such as diabetes, active cancer, a poor immune system, obesity (especially BMI over 35), or some other co-morbidities. I see both very healthy, vigorous 65-year-olds, and sickly 65-year-olds. Which one are you? If you’re over 80, you may have nothing to lose by vaccinating. Average U.S. life expectancy is 79 years, less for men, longer for women.

Steve Parker, M.D.

Update on Jan 9, 2022:

From Dr Robert Malone on Dec 31, 2021:

“So, yes back to my thoughts on Omicron – please keep taking that vitamin D3 and get your levels tested, if you haven’t already.  Use a formulation that combines the D3 with Vitamins A and K. Please keep up with the zinc, vitamin C and magnesium.  Work on weight control, glycemic control and please exercise!  All are important.”

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Reduce Your Coronary Artery Disease Risk By Limiting Ultra-Processed Foods

Heart attacks and chest pains are linked to blocked arteries in the heart (coronary artery disease)

What are ultra-processed foods? I’m not paying $35 for the scientific article to find out. If you can grab the definition from your copy, please share in the Comments section. The 2020 profit from my publishing company was only $937.08, so I’m watching my expenses.

Here’s the free abstract:



Higher ultra-processed food intake has been linked with several cardiometabolic and cardiovascular diseases. However, prospective evidence from US populations remains scarce.


To test the hypothesis that higher intake of ultra-processed foods is associated with higher risk of coronary artery disease.

Ultra-processed versus processed?


A total of 13,548 adults aged 45–65 y from the Atherosclerosis Risk in Communities study were included in the analytic sample. Dietary intake data were collected through a 66-item FFQ. Ultra-processed foods were defined using the NOVA classification, and the level of intake (servings/d) was calculated for each participant and divided into quartiles. We used Cox proportional hazards models and restricted cubic splines to assess the association between quartiles of ultra-processed food intake and incident coronary artery disease.


There were 2006 incident coronary artery disease cases documented over a median follow-up of 27 y. Incidence rates were higher in the highest quartile of ultra-processed food intake (70.8 per 10,000 person-y; 95% CI: 65.1, 77.1) compared with the lowest quartile (59.3 per 10,000 person-y; 95% CI: 54.1, 65.0). Participants in the highest compared with lowest quartile of ultra-processed food intake had a 19% higher risk of coronary artery disease (HR: 1.19; 95% CI: 1.05, 1.35) after adjusting for sociodemographic factors and health behaviors. An approximately linear relation was observed between ultra-processed food intake and risk of coronary artery disease.Conclusions

Higher ultra-processed food intake was associated with a higher risk of coronary artery disease among middle-aged US adults. Further prospective studies are needed to confirm these findings and to investigate the mechanisms by which ultra-processed foods may affect health.


I admit I must eat some ultra-processed foods, but try to limit them.

Heart disease is the #1 killer in the developed world, even more lethal the COVID19! If you haven’t chosen your New Years’ weight-loss diet yet, consider one low in ultra-processed foods, like the Mediterranean diet.

Conquer Diabetes and Prediabetes, Steve Parker MD
Not ultra-processed. Salmon is a rich source of heart-healthy omega-3 fatty acids

Steve Parker, M.D.

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Filed under coronary heart disease, Heart Disease

Alcohol: Consider a “Dry January”

Goodbye to you. Maybe see you in February.

I’ve run across a number of people who slowly increased their alcohol consumption over months or years, not realizing it was causing or would cause problems for them. Alcohol is dangerous, lethal at times.

From a health standpoint, the generally accepted safe levels of consumption are:

  • no more than one standard drink per day for women
  • no more than two standard drinks per day for men

One drink is 5 ounces of wine, 12 ounces of beer, or 1.5 ounces of 80 proof distilled spirits (e.g., vodka, whiskey, gin).

Dry January was conceived in the UK in 2012 or 2014. The idea is simply to abstain from all alcohol for the month of January. The Alcohol Change UK website can help you git ‘er done. Many folks notice that they sleep better, have more energy, lose weight, and save money. There are other potential benefits.

If you think you may have an unhealthy relationship with alcohol, check your CAGE score. It’s quick and easy.

Alternatively, if you make a commitment to a Dry January but can’t do it, you may well have a problem.

Steve Parker, M.D.

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Merry Christmas!

Credit: Zvonimir Atletic / Shutterstock.com

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Mediterranean Diet Reduces Cardiovascular and All-Cause Mortality

Caprese salad: mozzarella cheese, tomatoes, basil, extra virgin olive oil

Folks with diabetes have higher-than-average risk of dying from cardiovascular disease, such as heart attacks and strokes. So it’s good to know about dietary habits that enhance longevity.




Examining a variety of diet quality methodologies will inform best practice use of diet quality indices for assessing all-cause and CVD [cardiovascular disease] mortality.


To examine the association between three diet quality indices (Australian Dietary Guideline Index, DGI; Dietary Inflammatory Index, DII; Mediterranean-DASH Intervention for Neurodegenerative Delay, MIND) and risk of all-cause mortality, CVD mortality and non-fatal CVD events up to 19 years later.Design

Data on 10,009 adults (51.8 years; 52% female) from the Australian Diabetes, Obesity and Lifestyle study were used. A food frequency questionnaire was used to calculate DGI, DII and MIND at baseline. Cox proportional hazard models were used to estimate hazard ratios (HR) and 95% CI of all-cause mortality, CVD mortality and non-fatal CVD events (stroke; myocardial infarction) according to 1 SD increase in diet quality, adjusted for age, sex, education, smoking, physical activity, energy intake, history of stroke or heart attack, and diabetes and hypertension status.Results

Deaths due to all-cause (n = 1,955) and CVD (n = 520), and non-fatal CVD events (n = 264) were identified during mean follow-ups of 17.7, 17.4 and 9.6 years, respectively. For all-cause mortality, HRs associated with higher DGI, DII and MIND were 0.94 (95% CI: 0.89, 0.99), 1.08 (95% CI: 1.02, 1.15) and 0.93 (95% CI: 0.89, 0.98), respectively. For CVD mortality, HRs associated with higher DGI, DII and MIND were 0.93 (95% CI: 0.85, 0.99), 1.10 (95% CI: 1.00, 1.24) and 0.90 (95% CI: 0.82, 0.98), respectively. There was limited evidence of associations between diet quality and non-fatal CVD events.Conclusions

Better quality diet predicted lower risk of all-cause and CVD mortality in Australian adults, while a more inflammatory diet predicted higher mortality risk. These findings highlight the applicability of following Australian dietary guidelines, a Mediterranean style diet and a low-inflammatory diet for the reduction of all-cause and CVD mortality risk.

Steve Parker, M.D.

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Filed under coronary heart disease, Health Benefits, Heart Disease, Longevity, Mediterranean Diet, Stroke

Parade: Low-Carb Mediterranean Diet Is the Best for Heart Health

Steve Parker MD, low-carb diet, diabetic diet
Olives, olive oil, and vinegar: classic Mediterranean foods

Parade.com has an article touting the health benefits of a low-carb high-fat Mediterranean diet. Can you believe they didn’t even mention my books?!

In fairness to my readers, I must mention that I scanned the referenced AJCN article and didn’t see the word “Mediterranean” in it.

From Parade:

“If you’re looking to improve your heart health, you may want to try eating a low-carb, high-fat Mediterranean diet. Why? Because a new study published in The American Journal of Clinical Nutrition found that eating a low-carb (no more than 20% of daily calories from carbs), the high fat-style Mediterranean diet may reduce the risk of cardiovascular disease (CVD).For the study, obese study participants reported both improved insulin resistance and cholesterol levels compared to those who ate a moderate carb (40%) or high carb (60%) diet over a five-month period.”

Steve Parker, M.D.

PS: I also have a low-carb option in my Advanced Mediterranean Diet (2nd Edition). And KMD: Ketogenic Mediterranean Diet is very low-carb.

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Filed under Health Benefits, Heart Disease, Mediterranean Diet

Low-Carb Diet OK for Heart

Roasted Radishes and Brussels Sprouts

A recent scientific article supported low-carb eating for heart health.

Link to article



Carbohydrate restriction shows promise for diabetes, but concerns regarding high saturated fat content of low-carbohydrate diets limit widespread adoption.Objectives

This preplanned ancillary study aimed to determine how diets varying widely in carbohydrate and saturated fat affect cardiovascular disease (CVD) risk factors during weight-loss maintenance.


After 10–14% weight loss on a run-in diet, 164 participants (70% female; BMI = 32.4 ± 4.8 kg/m2) were randomly assigned to 3 weight-loss maintenance diets for 20 wk. The prepared diets contained 20% protein and differed 3-fold in carbohydrate (Carb) and saturated fat as a proportion of energy (Low-Carb: 20% carbohydrate, 21% saturated fat; Moderate-Carb: 40%, 14%; High-Carb: 60%, 7%). Fasting plasma samples were collected prerandomization and at 20 wk. Lipoprotein insulin resistance (LPIR) score was calculated from triglyceride-rich, high-density, and low-density lipoprotein particle (TRL-P, HDL-P, LDL-P) sizes and subfraction concentrations (large/very large TRL-P, large HDL-P, small LDL-P). Other outcomes included lipoprotein(a), triglycerides, HDL cholesterol, LDL cholesterol, adiponectin, and inflammatory markers. Repeated measures ANOVA was used for intention-to-treat analysis.


Retention was 90%. Mean change in LPIR (scale 0–100) differed by diet in a dose-dependent fashion: Low-Carb (–5.3; 95% CI: –9.2, –1.5), Moderate-Carb (–0.02; 95% CI: –4.1, 4.1), High-Carb (3.6; 95% CI: –0.6, 7.7), P = 0.009. Low-Carb also favorably affected lipoprotein(a) [–14.7% (95% CI: –19.5, –9.5), –2.1 (95% CI: –8.2, 4.3), and 0.2 (95% CI: –6.0, 6.8), respectively; P = 0.0005], triglycerides, HDL cholesterol, large/very large TRL-P, large HDL-P, and adiponectin. LDL cholesterol, LDL-P, and inflammatory markers did not differ by diet.


A low-carbohydrate diet, high in saturated fat, improved insulin-resistant dyslipoproteinemia and lipoprotein(a), without adverse effect on LDL cholesterol. Carbohydrate restriction might lower CVD risk independently of body weight, a possibility that warrants study in major multicentered trials powered on hard outcomes.

Parker here. No surprise to me.

Steve Parker, M.D.

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Filed under Carbohydrate, Heart Disease