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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April 9, 2020 · 9:00 AM

SGLT2 Inhibitors Yield Cardiac and Kidney Benefits

Cardiovascular and renal systems simplified in one pic

The cited article below is by Milton Packer, who may have conflicts of interest since he has done work on behalf of drug companies. His article is a review of existing published literature showing beneficial effects of SGLT2 inhibitors on congestive heart failure, cardiovascular death, and kidney disease.

There is compelling evidence that sodium–glucose cotransporter 2 (SGLT2) inhibitors exert cardioprotective and renoprotective effects that are far greater than expected based on their effects on glycemia or glycosuria. In large-scale randomized controlled trials, SGLT2 inhibitors reduce the risk of hospitalizations for heart failure by ∼30% and often decrease the risk of cardiovascular death. This benefit is particularly striking in patients who have the most marked impairment of systolic function prior to treatment. In parallel, SGLT2 inhibitors also reduce the risk of end-stage renal events, including the occurrence of renal death and the need for dialysis or renal transplantation by ∼30%. This benefit is seen even when glomerular filtration rates are sufficiently low to abolish the glycosuric effect of these drugs.

Source: SGLT2 Inhibitors Produce Cardiorenal Benefits by Promoting Adaptive Cellular Reprogramming to Induce a State of Fasting Mimicry: A Paradigm Shift in Understanding Their Mechanism of Action | Diabetes Care

Steve Parker, M.D.

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April 8, 2020 · 9:00 AM

Derek Lowe on ACEI and ARB Hypertension Drugs and #COVID19 #Coronavirus

Artist’s rendition of coronavirus

Recall that the coronavirus itself uses the ACE2 protein as an entry point into cells. One worry has been that the use of antihypertensive drugs [specifically angiotensin converting enzyme inhibitors or angiotensin receptor blockers] might well cause ACE2 expression to increase, which seems as if it could be a bad idea, providing more targets for the virus to latch on to. But this survey of the literature found little evidence that these expression changes even happen. The animal data that show these effects, they report, tend to be via acute injury models or doses that are much higher than human patients encounter, and there seems to be no good evidence that it happens in humans. So that’s one thing to think about: a big part of the worry about antihypertension drugs may not be even be founded on a real problem.

We also have some clinical data: this preprint from a multicenter team in Wuhan retrospectively evaluates 43 patients with hypertension who were taking drugs in these two classes versus 83 hypertension patients who were not taking ACE inhibitors or ARBs, versus. 125 age- and gender-matched controls without hypertension at all. They also compared hospital admission statistics in general to patients’ medical histories. They first confirmed what others have found, that hypertension itself is a risk factor: the patients admitted for treatment had higher levels of hypertension than the general population, and once admitted those patients had higher death rates and longer hospital stays. But when they looked at the hypertension patients who were taking either ACE inhibitors or ARBs, their numbers were better. They had comparable blood pressure numbers to those taking other drugs, but they were a lower percent of critical patients (9.3% versus 22.9%, near miss on statistical significance) and had a lower death rate (4.7% versus 13.3%). The ACE/ARB cohort also had lower inflammation markers (c-reactive protein and calcitonin). So while the data are noisy, there may be a trend towards protection in those taking angiotensin-targeting drugs. All the more reason to heed the advice not to change therapies for people with hypertension.

Source: Angiotensin and Coronavirus Infection: The Latest as of April 7 | In the Pipeline

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April 8, 2020 · 7:00 AM

Carbohydrate-Restricted Eating Increased Risk of Type 2 Diabetes!?

Eating this reduces risk of type 2 diabetes?

This is a real head-scratcher for me, just based on the abstract. I can’t explain or write-off the researchers findings at this point. I hope they administered the food frequency questionnaire more than once. If not, I can’t take this seriously.

Highlights

•Of 9689 middle-aged Australian women, 10% developed type 2 diabetes over 15 years.

•Carbohydrate restriction was associated with a 27% higher risk of type 2 diabetes.

•This association was attenuated after adjustment for BMI.

•The association was comparable for women with and without prior gestational diabetes.

•Women should be advised to avoid carbohydrate restricted diets low in fruit and grains.

Abstract

Background and aims

Low-carbohydrate diets (LCDs) are increasingly popular but may be nutritionally inadequate. We aimed to examine if carbohydrate restriction in midlife is associated with risk of developing type 2 diabetes (T2DM), and if this association differs by previous gestational diabetes (GDM) diagnosis.

Methods and results

Dietary intake was assessed for 9689 women from the Australian Longitudinal Study on Women’s Health in 2001 (aged 50–55) and 2013 (aged 62–67) via validated food frequency questionnaires. Average long-term carbohydrate restriction was assessed using a low-carbohydrate diet score (highest quartile (Q4) indicating lowest proportion of energy from carbohydrates). Incidence of T2DM between 2001 and 2016 was self-reported at 3-yearly surveys. Log-binomial regression was used to estimate relative risks (RR) and 95% CIs. During 15 years of follow-up, 959 women (9.9%) developed T2DM. Carbohydrate restriction was associated with T2DM after adjustment for sociodemographic factors, history of GDM diagnosis and physical activity (Q4 vs Q1: RR 1.27 [95% CI 1.10, 1.48]), and this was attenuated when additionally adjusted for BMI (1.10 [0.95, 1.27]). Carbohydrate restriction was associated with lower consumption of fruit, cereals and high-fibre bread, and lower intakes of these food groups were associated with higher T2DM risk. Associations did not differ by history of GDM (P for interaction >0.15).

Conclusion

Carbohydrate restriction was associated with higher T2DM incidence in middle-aged women, regardless of GDM history. Health professionals should advise women to avoid LCDs that are low in fruit and grains, and to consume a diet in line with current dietary recommendations.

Source: Carbohydrate restriction in midlife is associated with higher risk of type 2 diabetes among Australian women: A cohort study – Nutrition, Metabolism and Cardiovascular Diseases

Steve Parker, M.D.

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