June 11, 2020 · 7:00 AM

One More Reason to Avoid Proton Pump Inhibitors: Dementia

I have nothing against Prilosec in particular. It can be very helpful.

There are reasons our stomachs produce acid. One is that the acid helps kill pathogens in our food before they make us sick. Another is to start the digestion of proteins we eat. You can imagine that drastically reducing stomach acid production has some potential adverse effects.

We have two major classes of drugs that reduce acid production by the stomach. The first was H2 blockers, the granddaddy being Tagamet (cimetidine). Tagamet was the first H2 blocker on the market in the U.S., probably 25–30 years ago. Several H2 blockers are are available without a prescription. The second and later class of acid-reducing drugs are the PPIs: proton pump inhibitors. These are more potent than H2 blockers. Because of H2 blockers and PPIs, and the discovery that H. pylori causes many ulcers, we have many fewer patients requiring surgery for upper GI ulcers. Surgery like Billroth’s and vagotomy & pyloroplasty. Once the ulcer heals, most folks don’t need to take a PPI for the rest of their lives.

Bix at Fanatic Cook turned me on to the possibility that chronic use of  PPIs might cause cognitive decline, up to and including dementia. In the U.S., PPIs are available over-the-counter and many physicians prescribe and recommend them to patients in order to reduce stomach acid. The most common reason for chronic usage must be gastroesophageal reflux disease (aka GERD), which is severe or frequently recurrent heartburn. Common PPI names are Protonix, Nexium, Prilosec, omeprazole, and pantoprazole.

A German population study a few years ago linked PPI usage with higher risk of dementia.

A total of 73,679 participants 75 years of age or older and free of dementia at baseline were analyzed. The patients receiving regular PPI medication (n = 2950; mean [SD] age, 83.8 [5.4] years; 77.9% female) had a significantly increased risk of incident dementia compared with the patients not receiving PPI medication (n = 70,729; mean [SD] age, 83.0 [5.6] years; 73.6% female) (hazard ratio, 1.44 [95% CI, 1.36-1.52]; P < .001).

The avoidance of PPI medication may prevent the development of dementia. This finding is supported by recent pharmacoepidemiological analyses on primary data and is in line with mouse models in which the use of PPIs increased the levels of β-amyloid in the brains of mice. Randomized, prospective clinical trials are needed to examine this connection in more detail.

Source: Association of Proton Pump Inhibitors With Risk of Dementia: A Pharmacoepidemiological Claims Data Analysis – PubMed

I don’t know about Germany, but there’s evidence that the incidence of dementia has been decreasing lately in the U.S. I’m guessing that the use of PPIs has been increasing over the last couple decades. So this doesn’t fit with the PPI-dementia theory.

Check out Bix’s article to read that:

  • PPIs interfere with production of acetylcholine, a major chemical than nerve cells use to communicate with each other
  • Healthy young folks who took a PPI for 10 days performed worse on tests of memory

If you have GERD, a low-carb diet may well control it, allowing you to avoid the side effects of PPIs, not to mention the cost.

Oh, darn. I may not be getting my check from Big Pharma this month.

Steve Parker, M.D.

PS: Buy one of my books so I don’t have to depend on Big Pharma.

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June 2, 2020 · 7:00 AM

From Harvard: How to Ease Into the Mediterranean Diet

Steve Parker MD, low-carb diet, diabetic diet

Olives, olive oil, and vinegar: classic Mediterranean foods

From Harvard Health Publishing:

The Mediterranean diet is already something of a star in the health world. Numerous studies have linked this dietary pattern with health benefits ranging from a lower risk of heart disease to a reduction in certain cancers. Now there may be another benefit to add to the list: improvements to the gut microbiome, the name for the 100 trillion or so bacteria and other microorganisms that live in a person’s digestive tract.

Source: Adopting a Mediterranean-style diet, one meal at a time – Harvard Health

Steve Parker, M.D.

PS: If you want to jump into the Mediterranean diet with both feet, try this:

low-carb mediterranean diet

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May 29, 2020 · 7:00 AM

Gastric Bypass Surgery Improves Heart and Kidney Outcomes in Type 2 Diabetes

Steve Parker MD, bariatric surgery, gastric bypass

Band Gastric Bypass Surgery

From a recent Diabetes Care article:

Our data suggest robust benefits for renal outcomes, heart failure, and CV mortality after GBP in individuals with obesity and T2DM. These results suggest that marked weight loss yields important benefits, particularly on the cardiorenal axis (including slowing progression to end-stage renal disease), whatever the baseline renal function status.

Source: Renal and Cardiovascular Outcomes After Weight Loss From Gastric Bypass Surgery in Type 2 Diabetes: Cardiorenal Risk Reductions Exceed Atherosclerotic Benefits | Diabetes Care

Because of the risk of surgery, I’d make sure first that diet modification was seriously tried and failed.

Steve Parker, M.D.

low-carb mediterranean diet

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May 27, 2020 · 11:04 AM

Mediterranean Diet Benefits Elderly Hospitalized Patients

…at least in Greece, where the study was done.

Not sure where this is. Leave a comment if you recognize it.

The Mediterranean diet in an observational study of folks over 65 admitted to a hospital was linked to:

  • Shorter duration of hospitalization
  • Reduced healthcare cost
  • Improved longevity

The study at hand lasted two years.

Abstract

Objective:

Mediterranean diet (MD) has been related to reduced overall mortality and improved diseases’ outcome. Purpose of our study was to estimate the impact of MD on duration of admission, financial cost and mortality (from hospitalization up to 24 months afterwards) in elderly, hospitalized patients.

Research Methods & Procedures:

One hundred eighty three elderly patients (aged >65 years), urgently admitted for any cause in the Internal Medicine department of our hospital, participated in this observational study. Duration of admission and its financial cost, mortality (during hospitalization, 6 and 24 months after discharge), physical activity, medical and anthropometric data were recorded and they were correlated with the level of adherence to MD (MedDiet score).

Results:

In multivariate analyses, duration of admission decreased 0.3 days for each unit increase of MedDiet score (p<0.0001), 2.1 days for each 1g/dL increase of albumin (p=0.001) and increased 0.1 days for each day of previous admissions (p<0.0001). Extended hospitalization (p<0.0001) and its interaction with MedDiet score (p=0.01) remained the significant associated variables for financial cost. Mortality risk increased 3% per each year increase of age (HR=1.03, p=0.02), 6% for each previous admission (HR=1.06, p=0.04) whereas it decreased 13% per each unit increase of MedDiet score (HR=0.87, p<0.0001).

Conclusion:

Adoption of MD decreases duration of admission and long-term mortality in elderly hospitalized patients with parallel reduction of relevant financial cost.

Source: The impact of Mediterranean Diet on duration of admission, medical expenses and mortality in elderly, hospitalized patients: A 2-year observational study – ScienceDirect

I haven’t read the entire article. Didn’t see any need, based on my prior knowledge of the Mediterranean diet. The findings are not unexpected.

Steve Parker, M.D.

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May 19, 2020 · 7:21 AM

Olive Oil Linked to Reduced Cardiovascular Disease Risk

Steve Parker MD, low-carb diet, diabetic diet

Olives, olive oil, and vinegar: classic Mediterranean foods

A new analysis of the Nurses Health Study confirms the headline above. Olive oil, of course, is a primary component of the healthy Mediterranean diet. From the American College of Cardiology:

Higher olive oil intake was associated with a lower risk of CHD [coronary heart disease] and total CVD [cardiovascular disease] in two large prospective cohorts of US men and women. The substitution of margarine, butter, mayonnaise, and dairy fat with olive oil could lead to lower risk of CHD.

***

This study of well-educated health professionals is the first in the United States to show the relative value of higher intake of olive oil for preventing CHD and CVD. It was conducted in the era that margarine was primarily trans fatty acids and would not apply to the present soft and liquid margarines. The benefit attributed to olive oil is not simply the substitution for saturated fatty acid. The modest benefit of olive oil in the United States occurred at relatively low olive oil intake (average 12 g/day). In contrast, the Mediterranean diet generally has over 25 g/day. In European studies, a healthy cohort had a 7% reduction in CHD risk for each 10 g/d increase in olive oil; extra virgin olive oil reduced cerebrovascular events by 31% in a high-risk group, and regular olive oil was associated with a 44% lower risk of CHD after about 7.8 years in Italian women survivors of an MI. Amongst the benefits of olive oil include positive effects on inflammation, endothelial function, hypertension, insulin sensitivity, and diabetes.

Source: Olive Oil Consumption and Cardiovascular Risk – American College of Cardiology

Steve Parker, M.D.

low-carb mediterranean diet

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April 28, 2020 · 10:00 AM

Mediterranean Diet Linked to Improved Verbal Memory in Type 2 Diabetes

 

Steve Parker MD, low-carb diet, diabetic diet

Olives, olive oil, and vinegar: classic Mediterranean foods

Click for my description of the traditional Mediterranean diet.

From a recent study done in Germany:

These data suggest that closer adherence to MedD (the Mediterranean diet) was associated with better performance in verbal memory in patients with type 2 diabetes with known diabetes duration ≥5 years, but not in patients with recently diagnosed type 2 diabetes or in patients with type 1 diabetes or metabolically healthy individuals.

The MedD has been already reported to exert beneficial effects on cardiovascular disease and additionally on cognitive performance mainly in healthy elderly individuals or individuals with increased cardiovascular risk. The present results show an association between MedD and verbal memory in individuals with diabetes. Although the underlying mechanisms are currently unknown, one may speculate that the high content of antioxidants in MedD may contribute to better cognitive performance by reducing the production of reactive oxygen species and attenuating inflammatory processes, both of which have been linked to cognitive decline. Furthermore, positive effects might be mediated by n-3 fatty acids (FA). Higher dietary n-3 FA intake or circulating blood n-3 FA levels have been associated with better global or single cognitive function which was mainly explained by their anti-inflammatory, antioxidative and antithrombotic properties. However, the influence of n-3 FA is controversial according to the literature, as not all studies observed beneficial effects, possibly due to different study designs, methods and varying quality of studies.

Source: Associations between cognitive performance and Mediterranean dietary pattern in patients with type 1 or type 2 diabetes mellitus | Nutrition & Diabetes

Steve Parker, M.D.

low-carb mediterranean diet

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April 25, 2020 · 8:00 AM

Don’t Be “That Guy”: Re-Rack Your Weights…

Arizona Governor Ducey, stop your unconstitutional business closures and let my gym re-open! Now. You’re doing more harm than good.

Steve Parker, M.D.

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April 19, 2020 · 8:00 AM

Low-Carb Diet Could Improve Brain Health

MRI of brain

From Stony Brook University News:

A diet low in carbohydrates could stave off, or even reverse, the effects of aging on the brain, Stony Brook-led research finds.

A study using neuroimaging led by Stony Brook University professor and lead author Lilianne R. Mujica-Parodi, PhD, and published in PNAS, reveals that neurobiological changes associated with aging can be seen at a much younger age than would be expected, in the late 40s. But the study also suggests that this process may be prevented or reversed based on dietary changes that involve minimizing the consumption of simple carbohydrates.

Even in younger adults, under age 50, dietary ketosis (whether achieved after one week of dietary change or 30 minutes after drinking ketones) increased overall brain activity and stabilized functional networks.

Source: Low-Carb Diet Could Boost Brain Health, Study Finds | | SBU News

Steve Parker, M.D.

PS: You know what else helps preserve brain health? The Mediterranean diet.

low-carb mediterranean diet

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April 11, 2020 · 10:00 AM

Psoriasis Improved With Ketogenic Followed by Mediterranean Diet

The headline says it all. Read below if you want details. What stands out to me is that they started these guinea pigs on a diet of under 500 calories/day for four weeks. I bet their drop-out rate was high because that’s not many calories. I wouldn’t ask you to go that low. But it probably helped these overweight/obese folks lose an average of 23 pounds in 10 weeks.

My book gives you a ketogenic diet without calorie restriction, followed by a Mediterranean diet. I don’t guarantee it’ll improve your psoriasis. But it might!

Objectives

Very low-calorie ketogenic diet (VLCKD) has been associated with a significant reduction in visceral adipose tissue and ketone bodies likely possessing anti-inflammatory properties. We evaluated the efficacy of an aggressive WL [weight loss?] program with a ketogenic induction phase as first-line treatment for chronic plaque psoriasis.

Research methods & procedures

Adult overweight/obese drug-naïve (never treated excluding use of topical emollients) patients (N=37; 30% males; age, 43.1±13.8 years) with stable chronic plaque psoriasis underwent a 10-week two-phase WL program consisting in a 4-week protein-sparing, VLCKD (<500 kcal/day; 1.2 grams of protein/kg of ideal body weight/day) and a 6-week balanced, hypocaloric (25-30 kcal/kg of ideal body weight/day), Mediterranean-like diet. The primary endpoint was the reduction in the Psoriasis Area and Severity Index (PASI) at week 10. Major secondary endpoints included: PASI50 and PASI75 response, reduction in body surface area (BSA) involved, improvement in itch severity (visual-analogue scale) and Dermatology Life Quality Index (DLQI) at week 10.

Results

With a mean body weight reduction of 12.0% (-10.6 kg), dietary intervention resulted in a significant reduction in PASI (baseline score, 13.8±6.9 [range, 7-32]): mean change, -10.6 [95%CI, -12.8 to -8.4] (P<0.001). A PASI50 and PASI75 response was recorded in 36 (97.3%) and 24 (64.9%) patients, respectively. Treatment resulted also in a significant reduction (P<0.001) in BSA involved (-17.4%) and an improvement in itch severity (-33.2 points) and DLQI (-13.4 points).

Conclusions

In drug-naïve adult overweight [what about obese?] patients with stable chronic plaque psoriasis an aggressive dietary WL program consisting in a very low-calorie ketogenic regimen followed by a balanced, hypocaloric Mediterranean-like diet appeared to be an efficacious first-line strategy for improving disease severity.

Source: Aggressive weight loss program with a ketogenic induction phase for the treatment of chronic plaque psoriasis: a proof-of-concept, single-arm, open label clinical trial – ScienceDirect

Steve Parker, M.D.

low-carb mediterranean diet

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April 10, 2020 · 9:00 AM

Obamacare 10 Years Later: Disappointing

Big Pharma has been doing OK, at least until COVID-19 shut down 20% of the economy

From an article published March 5, 2020, at The Hill:

March 2020 marks the 10th anniversary of the passage of the Affordable Care Act, also known as ObamaCare. In its first decade, ObamaCare has failed to solve many of the health care problems it was supposed to address. Even worse, it has compounded many of the issues it was meant to fix — the law of unintended consequences in action.

First, then-candidate Barack Obama said his namesake act would “cut the cost of a typical family’s premiums by up to $2,500 a year.”

In reality, the opposite has occurred. According to the Department of Health and Human Services (HHS), “premiums have doubled for individual health insurance plans since 2013, the year before many of Obamacare’s regulations and mandates took effect.”

***

Third, President Obama repeatedly assured voters, “If you like your health care plan, you’ll be able to keep your health care plan, period.” After ObamaCare was enacted, millions of Americans were unable to keep their pre-ObamaCare health insurance plan.

Individual market premiums were $2789/year in 2013, compared to $5712/year in 2017.

Obamacare proponents promised that the plan would drastically reduce the number of uninsured folks. Wasn’t it 30 million uninsured? But there are still 28 million uninsured. And it’s probably going to get worse since citizens are no longer forced to buy something they don’t want or can’t afford.

The author of the article is affiliated with The Heartland Institute.

Source: ObamaCare: 10 years of distress and disappointment | TheHill

Steve Parker, M.D.

PS: Avoid the medical-industrial complex by getting and staying as healthy as possible. Let me help.

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