July 23, 2019 · 2:52 PM

Lowering Blood Pressure to 120 Systolic May Reduce Age-Related Memory Loss, Even Dementia

Exercise also seems to protect against memory loss and dementia

Keep your eyes on this development, folks. Potential game-changer. And a boon to Big Pharma. From NBCnews.com…

Lowering blood pressure to recommended levels can prevent dementia and the memory and thinking problems that often show up first [mild cognitive impairment], researchers reported Wednesday.

People whose top blood pressure reading was taken down to 120 were 19 percent less likely to develop mild cognitive impairment, the loss of memory and brain processing power that usually precedes Alzheimer’s, the study found. And they were 15 percent less likely to eventually develop cognitive decline and dementia.

***

It may take a few more years before the study conclusively shows whether the risk of Alzheimer’s was actually reduced because of the lower blood pressure,the researchers said.

It’s the first intervention that has been clearly demonstrated to lower rates of mental decline.

***

The findings come from a large trial of blood pressure called the Systolic Blood Pressure Intervention Trial, or SPRINT.

It has already found that lowering systolic blood pressure — the top number in a blood pressure reading — to 120 or less can prevent stroke, heart attacks, kidney disease and other problems.

Source: Tight blood pressure control can cut memory loss, study finds

Steve Parker, M.D.

PS: The Mediterranean diet also protects against dementia.

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July 22, 2019 · 3:22 PM

High Diabetes Rate in South Asians in the U.S. Is Not Related to Body Composition (e.g., High BMI)

Indian woman cooking chapati

“We did not identify strong evidence that accounting for body composition explains differences in the risk for type 2 diabetes. Future prospective studies of the MESA and MASALA cohorts are needed to understand how adipose tissue impacts the risk for type 2 diabetes and how to best assess this risk.”

So the high incidence of diabetes and prediabetes in South Asians in the U.S. is related to genetics or diet or activity levels?

Source: Body Composition and Diabetes Risk in South Asians: Findings From the MASALA and MESA Studies | Diabetes Care

Steve Parker, M.D.

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July 20, 2019 · 6:18 PM

Have I Been Wrong About the Mediterranean Diet for the Last 12 years?

Bastian is also skeptical about the health benefits of judicious alcohol consumption. Fair enough.

Hilda Bastian at PLOS Blogs wrote about the recent retraction of a PREDIMED sub-study published in the New England Journal of Medicine in 2013. The suspect conclusion of that study was: “Among persons at high cardiovascular risk, a Mediterranean diet supplemented with extra-virgin olive oil or nuts reduced the incidence of major cardiovascular events.”

From Ms Bastian:

A very influential nutrition trial just tanked. It was retracted from the New England Journal of Medicine (NEJM) on 13 June, and re-published with new analyses and toned-down conclusions. Both Gina Kolata, writing in the New York Times, and Alison McCook, writing at NPR, imply, at least to some extent, that it might make no difference to the evidence. But I disagree.

Here’s what’s happened to the trial, and where I think it leaves the overall evidence. Called PREDIMED, it was a multi-center trial from Spain, with the NEJM final report published in 2013. Altogether, 7,447 people at risk of cardiovascular disease (CVD) – heart attack and stroke – were reported as randomized to one of 3 groups:

  • Mediterranean diet with free olive oil provided, along with individual and group training sessions at the start, and then quarterly;
  • Mediterranean diet with free nuts provided, along with individual and group training sessions at the start, and then quarterly;
  • Advice to reduce fat intake, with a leaflet – but after the first 3 years, people in this control group were also offered individual and group training sessions.

The primary endpoint for the trial was a composite one of major cardiovascular events: myocardial infarction, stroke, or CVD-related death. And the trial was stopped early. More people dropped out of the control group than the Mediterranean diet groups.There are several alarm bells here already, and we’ll come back to those.

Source: What Does the PREDIMED Trial Retraction & Reboot Mean for the Mediterranean Diet? | Absolutely Maybe

I encourage you to read Ms Bastian’s article if you enjoy such debates. I consider the 2013 PREDIMED sub-study to be one of numerous pieces of the nutritional puzzle.

I published the 2nd edition of my Advanced Mediterranean Diet in 2012, so the 2013 PREDIMED sub-study was not available to me. At the end of my book you’ll find not one, but 43 scientific references supporting the healthfulness of the Mediterranean diet.

Steve Parker MD, Advanced Mediterranean Diet

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My Conquer Diabetes and Prediabetes book was also based predominantly on those 43 studies.

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Steve Parker, M.D.

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July 18, 2019 · 10:07 PM

Healthful Mediterranean Diet Still Standing After All These Years

Dead whole fish aren’t very appealing to many folks

From Paul Greenberg’s opinion piece in the New York Times (July 19, 2018):

In 1953, not long before President Dwight Eisenhower suffered a heart attack in office, the social scientist Leland Allbaugh published “Crete: A Case Study of an Underdeveloped Area.” The landmark analysis of the eating patterns of an isolated Greek population strongly suggested that a calorie-limited diet high in fresh fruits and vegetables, whole grains, and olive oil and low in animal protein, particularly red meat, could lower the risk of heart attacks and strokes, decrease chronic disease and extend life.

Medical research over the last half-century has largely borne out this initial finding. Weight-loss fads and eating trends come and go, but the so-called Mediterranean diet has stood fast. “Among all diets,” Dr. Walter Willett of Harvard’s T.H. Chan School of Public Health concluded in an email, “the traditional Mediterranean diet is most strongly supported for delivering long term health and wellbeing.”

Click for a more complete definition of the traditional Mediterranean Diet, which includes alcohol. More from Greenberg:

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As the clinician Artemis Simopoulos pointed out to me, two meatless days a week are the norm in Greek Orthodox communities. This religious provision encouraged traditional communities to eat fish not only on Fridays but on Wednesdays as well. Recent epidemiological evidence links two portions of seafood a week with lower blood pressure, lower LDL cholesterol and lower triglycerides. In spite of this, American seafood consumption has stayed consistently low compared with other developed countries.

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And for decades now, even Greeks have been abandoning their traditional foods and eating much more than they previously did. “In my view, the reason the diet worked to prevent heart disease on Crete was because they weren’t overeating,” said Marion Nestle, a professor of nutrition, food studies and public health at New York University. “By the time I got to Crete in the early 1990s, they were, and the hospitals were full of heart attacks and people with type 2 diabetes.”

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Today, 65 years after Allbaugh returned from Crete, with modern America plagued by one of the highest obesity rates in the world and failing to meet life expectancy averages of almost every other developed nation, it’s worth circling back to the eating patterns of the ancients. For if the United States were to put itself on a Mediterranean diet, we would likely see huge improvements not only in human and environmental health, but also in rural economic stability.

RTWT for Greenberg’s roadmap to an American Mediterranean diet.

Steve Parker, M.D.

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July 17, 2019 · 4:43 AM

Are Drugs the Answer to Unhealthy Lifestyles?

paleobetic diet, low-carb diet, diabetic diet

“This is much easier than exercising and losing 30 pounds!”

Fiona Godlee, editor-in-chief of the British Medical Journal, has a heretical short article at BMJ. I recommend you read the whole thing. It starts thusly:

More than half of adults aged over 45 will be labelled as hypertensive if new US guidelines are adopted, concludes a study in The BMJ this week (doi:10.1136/bmj.k2357). This equates to 70 million people in the US and 267 million people in China being eligible for antihypertensive drugs, a marked increase on already high rates of drug treatment for high blood pressure. Furthermore, the study calculates that 7.5 million people in the US and 55 million in China would be advised to start drug treatment, while 14 million in the US and 30 million in China would be advised to receive more intensive treatment. The evidence from trials indicates some benefit from drugs in terms of reduced risk of stroke and heart disease, but is mass medication really what we want?

Hypertension is just one of the many heads of the lifestyle disease hydra. Another is type 2 diabetes. Once thought to be irreversible and progressive, it is now known to be potentially reversible through weight loss. This is the cautious conclusion of the review by Nita Forouhi and colleagues (doi:10.1136/bmj.k2234), part of our series on the science and politics of nutrition (bmj.com/food-for-thought). Whether by calorie or carbohydrate restriction, weight loss has been shown to improve glycaemic control, blood pressure, and lipid profile and is the key to treatment and prevention of type 2 diabetes, they say.

She goes on to talk about fatty liver disease (NASH) and offers an alternative, of sorts, to pills. Good luck with that.

Source: Pills are not the answer to unhealthy lifestyles | The BMJ

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July 10, 2019 · 10:51 AM

ACFT to Replace Army Physical Fitness Test

Look into “body weight training” if weight machines and free weights like dumbbells don’t appeal to you

I have long advocated measuring your fitness level periodically and seeing how you stack up against a benchmark. My favorite benchmark is the U.S. Army Physical Fitness Test (APFT).

The new Army standard testing will be too complicated for most non-military folks.

UPI has the story:

The U.S. Army is introducing an extensive overhaul of its physical fitness test that, with minor changes, has mostly been the same since 1980.The new test, announced this week, changes the name from the Army Physical Fitness Test to the Army Combat Fitness Test and is planned to become gender and age neutral. It will include a series of physical events, while the APFT was a series of pushups, situps and a 2-mile run.

The new standards call for deadlift tests, throwing ten-pound balls for distance backwards, and hand-release pushups that require hands to be taken off the ground for greater muscle tension. It also includes sled drags to simulate casualties, sprints with 40-pound kettle bells, hanging from a pull-up bar with legs up and the standard 2-mile run.

Source: U.S. Army to introduce new physical fitness test – UPI.com

You will also find the comment section interesting.

Steve Parker, M.D.

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July 8, 2019 · 1:39 PM

Which Supplements REALLY work for Osteoarthritis?

Steve Parker MD

Does running promote osteoarthritis? Probably not.

If you live long enough, you’ll probably develop osteoarthritis, aka degenerative joint disease. Getting old ain’t for sissies!

Science Based Medicine has a new article on supplements for osteoarthritis pain. A snippet:

“Based on their review, the authors do not recommend omega-3 fatty acids, vitamins D and E, willow bark extract, collagen hydrolysate, glucosamine, chondroitin, combinations of glucosamine and chondroitin, and rose hip. Based on the review, Boswellia serrata extract and pycnogenol appear to demonstrate the most clinically important effects. They also note that while curcumin and MSM demonstrated clinically important effects, the quality of that evidence was low.”

Furthermore…

“The authors conclude that in those with osteoarthritis who are enthusiastic about using supplements, short-term trials of the pycnogenol, curcumin, Boswellia serrata extract, or MSM could be attempted, and should be discontinued after 4-6 weeks if no obvious benefits are noted. Importantly, drug-supplement interactions are not always well understood or well documented, and any supplement should be used with caution (and preferably, consultation with their pharmacist) if being combined with prescription or non-prescription drugs. There is also the very real concerns about supplement quality and batch-to-bath consistency, which complicates evaluations of risk, and determining whether or not they work.”

The SBM writer (Scott Gavura, a pharmacist) also points out the benefits of ongoing exercise, appropriate weight loss, and topical nonsteroidal anti-inflammatory drugs.

Source: Supplements for Osteoarthritis – Evaluating the Evidence – Science-Based Medicine

Steve Parker, M.D.

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