Diabetic Mediterranean Diet

November 11, 2019 · 2:34 AM

Are Oral Bacteria the Cause of Alzheimer’s Dementia?

Several respected researchers think that Alzheimer’s dementia may primarily be an infectious disease, particularly related to gum bacteria.

From MedScape:

LOS ANGELES — As more disappointing results emerge from anti-amyloid drug trials in Alzheimer’s disease (AD), there is growing interest in novel treatment approaches for this condition.

One such approach is based on the hypothesis that Porphyromonas gingivalis (Pg), the bacteria involved in periodontal disease, may cause AD. The biopharmaceutical company Cortexyme Inc is testing this theory with an investigational agent COR388, which targets gingipains, the toxic proteases released by Pg. Early results show the drug is well tolerated and promising in terms of biomarker findings. Organizers hope that a phase 2/3 trial of the treatment now under way will provide definitive efficacy results.

Source: Gum Disease Bacteria a Novel Treatment Target for Alzheimer’s?

Steve Parker, M.D.

PS: The Mediterranean diet had been shown to reduce the risk of dementia.

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November 10, 2019 · 1:42 AM

Fitness Training at Midlife and Beyond

You won’t see her at your home gym

From American Partisan:

If you have chronic pain or have been out of the gym a long time, build up volume (number of sets x number of reps x weight) slowly. Pick weights you can lift without pain and increase weight and volume in pain-free steps. The great thing about weight training is it allows you to easily control training variables in a safe, measurable, and repeatable manner while building work capacity and strength. If one exercise hurts, substitute for another. For example, if it hurts to back squat, substitute for a front squat….Right now, for example, I’ve built up a bit of pain in my biceps so I’ve substitute pull-ups for chin-ups which seem to take the stress off my biceps due to the weird angle between my upper and lower arms.

Cardio is built-up in a similar manner. If one thing hurts, do something else or do it only within a pain-free time-interval and intensity to prevent pain flare-ups. Develop a large variety of ways of doing cardio rather than do the same thing every day since training benefits heavily from novelty. For example, you can use the assault bike one day, the agility ladder the next, barbell complexes a third day, and agility ladders a fourth day. If you’re very overweight, start with walking.

Source: Fitness through midlife | American Partisan

I would add: Advance work load slowly. It took you years to get out of shape. What’s the rush? Progressing too quickly leads to injuries.

The article recommends a book by Bill Hartman called All Gain No Pain. The numerous five-star reviews (and very few with lesser stars) at Amazon.com seem a bit fishy to me due to over-the-top praise and few details. Do you have an opinion on the book?

Steve Parker, M.D.

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November 8, 2019 · 9:45 AM

Higher Plasma Levels of Omega-3 Fatty Acids Linked to Lower Rate of Heart Failure

Salmon is a rich source of omega-3 fatty acids

Cold-water fatty fish are a great source of healthy omega-3 fatty acids, one of which is EPA (eicosapentaenoic acid).

Here’s the abstract from JACC: Heart Failure:

Objectives

The aim of this study was to determine if plasma eicosapentaenoic acid (EPA) abundance (%EPA) is associated with reduced hazard for primary heart failure (HF) events in the MESA (Multi-Ethnic Study of Atherosclerosis) trial.

Background

Clinical trials suggest that omega-3 polyunsaturated fatty acids (ω3 PUFAs) prevent sudden death in coronary heart disease and HF, but this is controversial. In mice, the authors demonstrated that the ω3 PUFA EPA prevents contractile dysfunction and fibrosis in an HF model, but whether this extends to humans is unclear.

Methods

In the MESA cohort, the authors tested if plasma phospholipid EPA predicts primary HF incidence, including HF with reduced ejection fraction (EF) (EF <45%) and HF with preserved EF (EF ≥45%) using Cox proportional hazards modeling.

Results

A total of 6,562 participants 45 to 84 years of age had EPA measured at baseline (1,794 black, 794 Chinese, 1,442 Hispanic, and 2,532 white; 52% women). Over a median follow-up period of 13.0 years, 292 HF events occurred: 128 HF with reduced EF, 110 HF with preserved EF, and 54 with unknown EF status. %EPA in HF-free participants was 0.76% (0.75% to 0.77%) but was lower in participants with HF at 0.69% (0.64% to 0.74%) (p = 0.005). Log %EPA was associated with lower HF incidence (hazard ratio: 0.73 [95% confidence interval: 0.60 to 0.91] per log-unit difference in %EPA; p = 0.001). Adjusting for age, sex, race, body mass index, smoking, diabetes mellitus, blood pressure, lipids and lipid-lowering drugs, albuminuria, and the lead fatty acid for each cluster did not change this relationship. Sensitivity analyses showed no dependence on HF type.

Conclusions

Higher plasma EPA was significantly associated with reduced risk for HF, with both reduced and preserved EF. (Multi-Ethnic Study of Atherosclerosis [MESA]; NCT00005487)

Source: Predicting Risk for Incident Heart Failure With Omega-3 Fatty Acids | JACC: Heart Failure

Steve Parker, M.D.

PS: All my diets recommend cold-water fatty fish.

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Filed under Fish, Heart Disease

November 1, 2019 · 3:23 AM

Is Cinnamon a Legitimate Treatment for Diabetes?

What type of cinnamon is this?

Be aware that there are several types of cinnamon.

Pharmacist Scott Gavura writes at Science Based Medicine:

Given the consequences of diabetes, self-management is something I want to encourage, not discourage. Without a commitment from the patient to take an active role in managing their diabetes, any treatment plan is doomed to fail. So is self-treatment with dietary supplements a wise idea? There’s an array available, and patients regularly ask about the latest treatment “Big Pharma doesn’t want you to know about”. That treatment used to be chromium. Ginseng was popular for a time, too. Fenugreek and bitter melon are used as well. One of the most persistently popular treatments is cinnamon. Like any other herbal remedy, most sources will tell you that it’s been used for “thousands of years” as a medicinal herb. As a treatment for diabetes, I have my doubts. While reports of diabetes go back to 1552 BCE, the ability to measure the effectiveness of any diabetes treatment only goes back a few decades. Interest in cinnamon as a treatment seems to have started with in vitro tests but gained some plausibility in 2003, when a study from Alam Khan suggested several grams of cassia cinnamon per day could lower fasting blood glucose. Khan randomized Type 2 diabetes to 1g, 3g, or 6g of cinnamon for 40 days. All three groups improved their fasting blood glucose, and blood lipid levels, but there was no effect on A1C.Like trials with any other supplement or herbal product, the primary question we must answer is “What exactly was studied?” The cinnamon you have in your kitchen may be a single species of plant or a mix of different cultivars. Ceylon cinnamon (Cinnamommum verum) is more commonly found in the West. Cassia cinnamon (Cinnamomum aromaticum) is the version of cinnamon that’s been studied in trials. The chemical hydroxychalcone has been identified as a potential active ingredient, which is believed to modify the sensitivity of cells to insulin, enhancing their uptake. If that’s the true mechanism of action, then it would work in a manner similar to that of the drugs Avandia, Actos, and metformin (Glucophage). Given the active ingredient (or ingredients) have not yet been definitively isolated, the issue of studying cinnamon is problematic. There’s no way to assess the potency of any batch, which complicates any evaluation. And that may be a reason why the research with cinnamon is inconsistent, and on balance, not impressive.

While the Khan study looked promising, supplementary studies have failed to consistently show beneficial effects.

Source: How effectively does cinnamon treat diabetes? – Science-Based Medicine

Steve Parker, M.D.

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Filed under Drugs for Diabetes, Supplements

October 30, 2019 · 4:12 PM

Is 10,000 Steps a Day Really Necessary for the Longevity Benefit?

Dog owners live longer. Is it because of dog-walking?

It depends.

Among older women [average age 72], as few as approximately 4400 steps/d was significantly related to lower mortality rates compared with approximately 2700 steps/d. With more steps per day, mortality rates progressively decreased before leveling at approximately 7500 steps/d. Stepping intensity was not clearly related to lower mortality rates after accounting for total steps per day.

Source: Association of Step Volume and Intensity With All-Cause Mortality in Older Women | Geriatrics | JAMA Internal Medicine | JAMA Network

10,000 steps is about five miles, depending on stride length. 6,000 steps would be about three miles. Walking at two miles per hour, a leisurely stroll, it would take 90 minutes to walk three miles.

Steve Parker, M.D.

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October 29, 2019 · 12:25 PM

Vegetarians Are Less Healthy Than Omnivores

Bussells sprouts and radishes ready for roasting

From Independent:

Vegetarians are less healthy than meat-eaters, a controversial study has concluded, despite drinking less, smoking less and being more physically active than their carnivorous counterparts.

A study conducted by the Medical University of Graz in Austria found that the vegetarian diet, as characterised by a low consumption of saturated fat and cholesterol, due to a higher intake of fruits, vegetables and whole-grain products, appeared to carry elevated risks of cancer, allergies and mental health problems such as depression and anxiety.

While not mentioned in the Independent article, the full PLOS One report defined “vegetarian”:

While 0.2% of the interviewees were pure vegetarians (57.7% female), 0.8% reported to be vegetarians consuming milk and eggs (77.3% female), and 1.2% to be vegetarians consuming fish and/ or eggs and milk (76.7% female).

I haven’t read the whole thing, but if you’re a vegetarian, you should digest it. Note the study was done in Austria. And if vegetarians are so unhealthy, why do Seventh Day Adventists in Loma Linda, CA, seem to have a longevity benefit. Do ya think maybe there’s more involved than diet, like culture or genetics?

Steve Parker, M.D.

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Filed under Longevity, Vegetarian Diet

October 28, 2019 · 11:02 AM

Are Ketogenic Diets Nutritionally Adequate?

Sardines and a good source of calcium on a ketogenic diet

I was concerned about inadequate calcium consumption during the design of my ketogenic diet. Many experts believe that inadequate calcium intake causes thin, easily broken bones (osteoporosis). But his may not be true. And high calcium consumption seems to have increased risk of premature death in Swedish women. Furthermore, calcium supplementation almost doubled the risk of having a heart attack, at least in Germans. Yeah, it’s complicated.

From the journal Nutrition:

Objective

A 12-week ketogenic diet was shown to have many beneficial effects in healthy obese adults, but it is not clear if the supply of micronutrients is adequate.

Methods

In 35 adult individuals with BMI above 30, the intakes of minerals and their serum levels were analyzed at baseline and at weeks 4 and 12 of the ketogenic diet intervention. The intake of vitamins and serum antioxidative potential were also investigated.

Results

Throughout the diet the intakes of magnesium, calcium, iron, phosphorus and potassium were below recommended values, but their serum levels always remained within the reference range. Nevertheless, the level of calcium decreased significantly (from 2.52 ± 0.10 mmol/L at baseline to 2.36 ± 0.07 mmol/L at week 12, P < 0.001) which could be due to the omission of legumes and reduced dairy intake or due to the high fat intake alone. The levels of phosphate increased concomitantly. Calcium serum levels were negatively associated with ω-6 but not with ω-3 unsaturated fatty acid intake. The intakes of water-soluble vitamins were also too low. However, the antioxidative potential of serum did not change during intervention.

Conclusion

Careful choice of foods which would provide the necessary micronutrients is of utmost importance when consuming ketogenic diet. In the 12 weeks the decreased intakes did not reflect in serum values, but special attention to calcium should be advised if such diet is recommended through longer periods.

Source: Assessment of micronutrients in a 12-week ketogenic diet in obese adults – ScienceDirect

Steve Parker, M.D.

PS: If you have my Conquer Diabetes and Prediabetes book, you already have my ketogenic diet, plus much more.

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October 26, 2019 · 12:36 PM

LCHF Diet Improves Metabolic Syndrome Even Without Weight Loss

Use the search box to find the recipe for this LCHF avocado chicken soup

“Metabolic syndrome” may be a new term for you. It’s a collection of clinical features that are associated with increased future risk of type 2 diabetes and atherosclerotic complications such as heart attack and stroke. One in six Americans has metabolic syndrome. Diagnosis requires at least three of the following five conditions:

high blood pressure (130/85 or higher, or using a high blood pressure medication)
low HDL cholesterol: under 40 mg/dl (1.03 mmol/l) in a man, under 50 mg/dl (1.28 mmol/l) in a women (or either sex taking a cholesterol-lowering drug)
triglycerides over 150 mg/dl (1.70 mmol/l) (or taking a cholesterol-lowering drug)
abdominal fat: waist circumference 40 inches (102 cm) or greater in a man, 35 inches (89 cm) or greater in a woman
fasting blood glucose over 100 mg/dl (5.55 mmol/l)

One approach to improving the numbers is a low-carb, high-fat (LCHF) diet. Here’s a journal article abstract from JCI Insight:

BACKGROUND. Metabolic syndrome (MetS) is highly correlated with obesity and cardiovascular risk, but the importance of dietary carbohydrate independent of weight loss in MetS treatment remains controversial. Here, we test the theory that dietary carbohydrate intolerance (i.e., the inability to process carbohydrate in a healthy manner) rather than obesity per se is a fundamental feature of MetS.

METHODS. Individuals who were obese with a diagnosis of MetS were fed three 4-week weight-maintenance diets that were low, moderate, and high in carbohydrate. Protein was constant and fat was exchanged isocalorically for carbohydrate across all diets.

RESULTS. Despite maintaining body mass, low-carbohydrate (LC) intake enhanced fat oxidation and was more effective in reversing MetS, especially high triglycerides, low HDL-C, and the small LDL subclass phenotype. Carbohydrate restriction also improved abnormal fatty acid composition, an emerging MetS feature. Despite containing 2.5 times more saturated fat than the high-carbohydrate diet, an LC diet decreased plasma total saturated fat and palmitoleate and increased arachidonate.

CONCLUSION. Consistent with the perspective that MetS is a pathologic state that manifests as dietary carbohydrate intolerance, these results show that compared with eucaloric high-carbohydrate intake, LC/high-fat diets benefit MetS independent of whole-body or fat mass.

TRIAL REGISTRATION. ClinicalTrials.gov Identifier: NCT02918422.

FUNDING. Dairy Management Inc. and the Dutch Dairy Association.

Source: JCI Insight – Dietary carbohydrate restriction improves metabolic syndrome independent of weight loss

Steve Parker, M.D.

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Filed under Causes of Diabetes, coronary heart disease, Fat in Diet, Stroke, Uncategorized

October 23, 2019 · 6:40 AM

Worrisome Liver Fat? Low-Carb Mediterranean Diet Works Better Than Low-Fat Diet

From the article at International Business Times:

Reducing hepatic [liver] fat or fat around the liver by 30%, along with moderate weight loss is an important part in reducing obesity-related health risks from a long-term perspective, the researchers of the study said. In addition to moderate weight loss, visceral fat or fat stored within the abdominal cavity was reduced by 25% and fat around the heart decreased by 11%. Fat in and around the muscle and pancreas was also reduced by 1 to 2%.

“Reduction in liver fat is a better predictor of long-term health than reduction of visceral fat, which was previously believed to be the main predictor,” Professor Shai explained in a press release. “The findings are a significant contributor to the emerging understanding that for many obese individuals, excess liver fat is not merely a sign of health risks associated with obesity, including cardiovascular disease and diabetes, but is likely also a cause.”

Source: Scientists Reveal Most Effective Diet For Weight Loss, And It’s Not Keto

Click for details of the study.

Steve Parker, M.D.

PS: There’s a low-carb Mediterranean diet in this book.

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Filed under liver disease

October 18, 2019 · 3:49 AM

Do You Really Need That PPI?

“I don’t mind dying. I just don’t want to be there when it happens.” –Woody Allen

Proton pump inhibitors (PPIs) are widely used in the U.S. to treat or prevent heartburn and ulcers. For example, omeprazole is the 6th most prescribed drug in the U.S. according to one source. PPIs reduce acid production by the stomach. Doesn’t it make sense that God or Nature gave us that stomach acid for a reason? Like to kill germs or aid the digestive process?

From the British Medical Journal:

Taking PPIs is associated with a small excess of cause specific mortality including death due to cardiovascular disease, chronic kidney disease, and upper gastrointestinal cancer. The burden was also observed in patients without an indication for PPI use. Heightened vigilance in the use of PPI may be warranted.

Source: Estimates of all cause mortality and cause specific mortality associated with proton pump inhibitors among US veterans: cohort study | The BMJ

Click for UPI’s coverage.

If you suffer from frequent heatburn, try cutting down on carbohydrates.

Steve Parker, M.D.