March 23, 2020 · 5:43 AM

Low-Carb Diets Improve Cardiovascular Risk Factors

This Avocado Chicken soup is very low-carb. Use the search box to find the recipe.

A meta-analysis by Chinese investigators found that low-carb diets improve cardiovascular risk factors. Specifically: body weight (lowered), triglycerides (lowered), HDL-cholesterol (raised), blood pressure (lowered systolic and diastolic, but less than 2 points each).

Additionally, they found increases in total cholesterol  and HDL-cholesterol. Some consider those to be going in the wrong direction, increasing cardiovascular risk. The study authors, however, considered these increases “slight,” implying lack of real-world significance.

I’ll not fisk the entire research paper. Have a go at it yourself by clicking the link to full-text below.

The researchers included 12 randomized controlled trials in their analysis. They defined low-carb diets as having less than 40% of calories derived from carbohydrates. If you’re eating 2200 calories a day, 39% of calories from carb would be 215 g of carbs/day. That’s a lot of carb, and wouldn’t be much lower than average. I scanned the report pretty quickly and didn’t run across an overall average for carb grams or calories in the low-carb diets. The “control diets” had 45–55% of calories from carbohydrate.

Here’s the abstract:

Background

Low-carbohydrate diets are associated with cardiovascular risk factors; however, the results of different studies are inconsistent.

Purpose

The aim of this meta-analysis was to assess the relationship between low-carbohydrate diets and cardiovascular risk factors.

Method

Four electronic databases (PubMed, Embase, Medline, and the Cochrane Library) were searched from their inception to November 2018. We collected data from 12 randomized trials on low-carbohydrate diets including total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides, and blood pressure levels, as well as weight as the endpoints. The average difference (MD) was used as the index to measure the effect of a low-carbohydrate diet on cardiovascular risk factors with a fixed-effects model or random-effects model. The analysis was further stratified by factors that might affect the results of the intervention.

Results

From 1292 studies identified in the initial search results, 12 randomized studies were included in the final analysis, which showed that a low-carbohydrate diet was associated with a decrease in triglyceride levels of -0.15mmol/l (95% confidence interval -0.23 to -0.07). Low-carbohydrate diet interventions lasting less than 6 months were associated with a decrease of -0.23mmol/l (95% confidence interval -0.32 to -0.15), while those lasting 12–23 months were associated with a decrease of -0.17mmol/l (95% confidence interval -0.32 to -0.01). The change in the body weight in the observation groups was -1.58kg (95% confidence interval -1.58 to -0.75); with for less than 6 months of intervention, this change was -1.14 kg (95% confidence interval -1.65 to -0.63),and with for 6–11 months of intervention, this change was -1.73kg (95% confidence interval -2.7 to -0.76). The change in the systolic blood pressure of the observation group was -1.41mmHg (95% confidence interval—2.26 to -0.56); the change in diastolic blood pressure was -1.71mmHg (95% confidence interval—2.36 to -1.06); the change in plasma HDL-C levels was 0.1mmHg (95% confidence interval 0.08 to 0.12); and the change in serum total cholesterol was 0.13mmol/l (95% confidence interval 0.08 to 0.19). The plasma LDL-C level increased by 0.11mmol/l (95% confidence interval 0.02 to 0.19), and the fasting blood glucose level changed 0.03mmol/l (95% confidence interval -0.05 to 0.12),which was not significant.

Conclusions

This meta-analysis confirms that low-carbohydrate diets have a beneficial effect on cardiovascular risk factors but that the long-term effects on cardiovascular risk factors require further research.

Source: The effects of low-carbohydrate diets on cardiovascular risk factors: A meta-analysis

Steve Parker, M.D.

PS: You know what else reduces cardiovascular disease risk? The Mediterranean diet. The Diabetic Mediterranean Diet provides between 20 and 100 grams of digestible carb daily, depending on your individual carbohydrate tolerance level.

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March 22, 2020 · 7:00 AM

Future Posting on #Coronavirus #COVID19

Artist’s rendition of Coronavirus

I’ve been cross-posting about coronavirus and COVID-19 among my three blogs. In view of time limitations and efficiency, I’m going to be posting nearly all my coronavirus thoughts at Advanced Mediterranean Diet. Check it out if interested.

Thus far I haven’t treated a confirmed case of COVID-19 although I’m a full-time hospitalist in Scottsdale, AZ. I’ve been off-duty for four days but return to work soon. If the mainstream media is correct, I’m about to be overwhelmed by cases. So far, I’m overwhelmed by the damage this thing is doing to our economy, not to mention my 401k, which I just did.

Spicy times, indeed.

Steve Parker, M.D.

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March 21, 2020 · 6:31 AM

Despite $11,000 per person per year, U.S. still not getting its money’s worth in healthcare

Adult life is a battle against gravity. Eventually we all lose.

From UPI Jan. 31, 2020:

Despite spending far more on health care than other wealthy nations, the United States has the lowest life expectancy and the highest suicide rate, new research shows.

For the study, researchers at The Commonwealth Fund compared the United States with 10 other high-income nations in the Organization for Economic Cooperation and Development (OECD)—Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland and the United Kingdom—and with the average for all 36 OECD nations.

In 2018, the United States spent almost 17 percent of its gross domestic product (GDP) on healthcare. That’s more than any other high-income country and twice the overall OECD average. For example, New Zealand and Australia spent 9 percent of GDP on healthcare.

U.S. healthcare spending now tops $10,000 per person, and much of it is driven by private insurance costs such as premiums, according to The Commonwealth Fund report published online Jan. 30.

Source: U.S. health stats remain low despite trillions in healthcare spending – UPI.com

The numbers above are outdated. U.S. health care spending grew 4.6 percent in 2018, reaching $3.6 trillion or $11,172 per person.  As a share of the nation’s Gross Domestic Product, health spending accounted for 17.7 percent.

Click to learn what that money is spent on.

Click to learn why U.S. healthcare is so expensive.

Steve Parker, M.D.

PS: Why not try to avoid healthcare spending by getting and staying as healthy as possible? Let me help now. And for less than $20.

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March 20, 2020 · 8:00 AM

Do Low-Carb Diets Cause Psychological Disorders? #LCHF

Not in Iranians at least (that’s where the study was done). From Nutrition Journal:

Adherence to the low carbohydrate diet, which contains high amount of fat and proteins but low amounts of carbohydrates, was not associated with increased odds of psychological disorders including depression, anxiety and psychological distress. Given the cross-sectional nature of the study which cannot reflect causal relationships, longitudinal studies, focusing on types of macronutrients, are required to clarify this association.

Source: Adherence to low carbohydrate diet and prevalence of psychological disorders in adults | Nutrition Journal | Full Text

At Longhorn Steakhouse in Amarillo, TX

I’d have been surprised if the researchers did find a linkage. But you don’t know for sure until y0u do the science.

Steve Parker, M.D.

low-carb mediterranean diet

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March 19, 2020 · 9:00 AM

Tea in China Prolongs Life and Prevents Heart Disease

One of my favorite green teas

For years we’ve been hearing about the potential longevity and cardiovascular benefits of green tea. If memory serves, most of the data comes from Japanese studies. Now a Chinese observational study finds 15–20% reductions in atherosclerotic cardiovascular disease (ASCVD) and death, compared to non-tea drinkers. Most of the participants drank green tea, and they did so at least thrice weekly.

From the European Journal of Preventive Cardiology:

Using large prospective cohorts among general Chinese adults, we have provided novel evidence on the protective role of tea consumption on ASCVD events and all-cause mortality, especially among those who kept the habit all along. The current study indicates that tea might be a healthy beverage for primary prevention against ASCVD and premature death.

Source: Tea consumption and the risk of atherosclerotic cardiovascular disease and all-cause mortality: The China-PAR project – Xinyan Wang, Fangchao Liu, Jianxin Li, Xueli Yang, Jichun Chen, Jie Cao, Xigui Wu, Xiangfeng Lu, Jianfeng Huang, Ying Li, Liancheng Zhao, Chong Shen, Dongsheng Hu, Ling Yu, Xiaoqing Liu, Xianping Wu, Shouling Wu, Dongfeng Gu,

The researchers point out that results may not apply to non-Chinese populations.

Steve Parker, M.D.

h/t to Jan at The Low Carb Diabetic (click link for more details about the study)

low-carb mediterranean diet

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March 18, 2020 · 9:00 AM

How To Avoid #CoronaVirus If You Have Risk Factors for Serious Illness (and Even If You Don’t) #COVID-19

Artist’s renditions of coronavirus

On March 12, 2020, I published a list of conditions that increase the risk of a bad outcome from pandemic Coronavirus infection. I told you to be extra careful around Coronavirus if you had risk factors for serious illness. What I failed to do is tell you how to take precautions if you have risk factors. I rectify that today, although this may be well-known to you already.

By the way, physicians are calling the disease caused by Coronavirus, “COVID-19.”

Like the U.S. Centers for Disease Control, I mentioned that age 60–65 or higher is a risk factor.

Is Age Really Important?

Yes. Here’s a chart from the report of UK’s Imperial College COVID-19 Response Team dated March 16, 2020:

Age-specific hospitalization and ICU admission rates from the Imperial College COVID-19 Response Team

TL;DR version: The need for hospitalization and ICU (intensive care unit) admission starts to rise dramatically for patients aged 50-59 and shoots up from there. If you make it into the ICU with COVID-19, you’ll quite likely have a tube down your throat and be on a ventilator (a mechanical “breathing machine”), or getting ECMO.

BTW, the Response Team figures you have only a 50:50 chance of surviving if you end up on a ventilator.

If You Have One or More of the Listed Conditions, What Does “Being Extra Careful Around Coronavirus” Mean?

Avoid the virus if at all possible. The U.S. Centers for Disease Control and state governments have been issuing guidelines. One major issue is that the virus incubates in the body without symptoms for 5–7 days, and the affected individual may be infectious—shedding the virus that could get into you if you’re nearby—for 24 hours or so before the virus carrier even knows they’re sick. For folks that get sick with the virus, symptoms last for 1–2 weeks, and their oral or respiratory secretions (and feces? tears?) could infect you if the they enter your body via the mouth, nose, or eyes (or gastrointestinal tract?). Even after recovery, infected individuals can shed infectious virus for about a week. Further complicating the situation is that infected individuals may just have mild symptoms like a cough (or runny nose or sneezing?), and won’t be quarantining themselves or avoiding other people. They won’t know they have the virus. Other people can harbor the virus in their bodies and never feel sick—we don’t know how infectious these folks are. So what specifically can you do if you have risk factors for serious disease?

  • Monitor your local news reports to know how common is the virus in your community. If there’s an outbreak there or where you’re going…
  • Avoid crowds (0f 10 people? 50?)
  • Stay home as much as possible.
  • Don’t be around people with symptoms of possible COVID-19: c0ugh, shortness of breath, fever, ?sneezing, ?runny nose. Sure, they could just have common illnesses like bronchitis, pneumonia, hay fever, allergies, the common cold, or a sinus infection. You just don’t know. The virus won’t get into your residence unless you allow an infected person in.
  • Avoid touching high-touch surfaces in public places, like hand rails, elevator buttons, door handles, handshakes, etc. If you must touch, cover the surface with a tissue or disinfect it first.
  • Wash your hands frequently with soap and water. Particularly after touching high-touch surfaces in public places.
  • Avoid cruises, mass transit, air travel. Again: crowds.
  • If you can’t avoid someone who’s coughing or sneezing, offer them a surgical mask.
  • Don’t touch your mouth, nose, or eyes. That’s how germs on your hands can enter you.

Steve Parker, M.D.

PS: It’s still very early in this pandemic and there’s much we don’t know. Some of the above information is probably wrong. Stay tuned.

Steve Parker, M.D.

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March 13, 2020 · 11:23 AM

Good News? Nuts Have Fewer Calories Than We Thought!

natural cashews, cashew apple

Cashews fresh off the tree. They’re actually fruits, not nuts. And while I’m being pedantic, peanuts aren’t nuts – they’re legumes.

…but you’ll still gain weight if you eat too many.

I’m glad to hear the USDA at least occasionally updates their nutritional analysis database.

From RD Franziska Spritzler at DietDoctor:

There’s no denying that nuts are both nutritious and delicious. Yet for years, people have been cautioned to avoid eating too many because they’re also high in calories.

But last week, the USDA reported that nuts are actually lower in calories than originally thought. According to researchers who conducted a serious of studies over the past seven years, many nuts are 16 to 25% lower in calories than currently listed in the USDA nutrient database. The reason? Apparently, we don’t digest and absorb all of the calories from nuts.

Although the USDA’s database hasn’t yet been updated with the new values….

Source: Researchers Reveal That Nuts Have Fewer Calories Than Previously Thought — Diet Doctor

Steve Parker, M.D.

low-carb mediterranean diet

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