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 It was retracted from the New England Journal of Medicine (NEJM) on 13 June, and re-published with new analyses and toned-down conclusions.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.

low-carb mediterranean diet

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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:

***

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.

***

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.”

***

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.

Need help with weight loss?

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July 6, 2019 · 10:13 PM

1/2 of American Adults Trying to Lose Weight

No wonder they’re not having much success:

“Exercise, eating less, consuming more fruits and vegetables and drinking more water were the most common strategies. The least common were skipping meals and cutting down on fatty foods.”

Source: Nearly Half of Americans Battling to Lose Weight: CDC Data – Bloomberg Quint

Drinking more water? Come on, America, get serious.

Steve Parker, M.D.

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July 4, 2019 · 6:37 AM

Very Low Carbohydrate Diets for Diabetes (ADA 2018)

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

Over at Diabete Daily, Dr Maria Muccioli wrote about recent low-carb diet research as applied to diabetes. A couple excerpts to whet your appetite:

Dr. Tay stated that a very low carbohydrate diet offers a considerable advantage over a high carbohydrate approach for patients with type 2 diabetes.She noted that reducing medication use is not only cost-effective but can also safeguard from the considerable side effects of some second-line medications. She also explained that achieving less glycemic variability, which may be an independent risk factor for the development of diabetes-associated complications, is “of great clinical importance.”“It is a good diet to have if you have diabetes, and the data support that,” she concluded.

  *   *   *

What about VLC diet for children with type 1 diabetes?

Dr. de Bock does not deny that a VLCD for children with type 1 diabetes can help to achieve exceptional glycemic control, as recently demonstrated in a study showing normal average A1c levels in a large cohort of patients. The speaker remarked that the patients in that study had very low glycemic variability.

He believes that more research needs to be conducted to evaluate the relevance of the potential concerns that he outlined. Until then, he advises parents of children who follow a VLCD to work closely with their medical care providers to monitor growth, cardiac, nutritional, and mental/emotional parameters.

Source: Very Low Carbohydrate Diets for Diabetes (ADA 2018)

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June 21, 2019 · 3:10 AM

Will Doctors and Nurses Show Up for Work When Ebola Hits the U.S. Again?

Hazmat-suited healthcare worker in a decontamination shower. What happens to the run-off water or bleach or whatever?

Don’t count on nurse Aesop. I’m sure he’s not alone. Few healthcare providers got into the business to put their lives on the line every day. The Ebola virus is highly contagious and often lethal. Prevention of the spread of Ebola to healthcare providers and the general population requires high-level isolation units. Aesop says there are only 15 such beds in the U.S. (He calls them BL-IV beds). There are zero at most hospitals and zero in most cities.

What follows are Aesop’s words:

We aren’t set up for this [virus], and we’re doing nothing to stop it getting here (rather the opposite in fact).

And when it does, after those first 15 beds are occupied, we’ve done nothing anywhere close to adequate to handle things properly and nip it in the bud.

But everyone in charge pretends we’ve done exactly that, when nothing could be further from the truth.

Maybe you can bullshit the Low Information Viewers in flyover country, but you can’t bullshit me or countless other doctors, nurses, and ancillary staff who’ll be on the frontlines (for about 20 seconds, in my case) before we drop our clipboards where we’re standing, and head for the parking lot.

I may make a bullshit excuse about not feeling well, I may pass off report on my patients to someone else who stays, but go I will, and I mean within minutes.

I can’t collect paychecks at Forest Lawn [cemetery], and I won’t be helping anyone shitting my intestines into my scrub pants, and both of those are slam-dunk outcomes with the present (and perpetual) half-assed level of preparedness for Ebola or any one of 27 other pandemic-worthy infections at every hospital (but for a small part of a bare few) from Anchorage to Miami, and Maine to Hawaii.

Anyone wants to go to medical or nursing school, and go work on the frontlines of Ebola with WHO or the CDC, rolling the dice you’ll live to retirement every time you scrub in or out, operators are standing by. (When every hospital has an actual 24/7 BL-IV capability, and staffs and supplies and trains for its use regularly – by which I mean more than once a year or three to salve their own charred consciences and pen-whip JCAHO’s lackadaisical clipboard commandos – we can talk. Otherwise: F**K that noise. Sideways, with a rusty chainsaw.)

In such an epidemic, there is no such thing as a valiant death.There’s just death.

I’ll do my damnedest to save your life if you come into my ER.

But I won’t kill myself to do it, and I won’t die for you because TPTB [the powers that be] at every level are too half-assed and cheapskate to prepare for this as if it was Really A Thing, too stupid to know that, and too evil to care. That ain’t in my contract, and unlike joining the Marines, I took no such oath, and it isn’t part of the deal.

I don’t know how many out of 4,000,000 medical practitioners will be that honest and tell you that up front.

I just did.

Source: Raconteur Report: Where The Problem Is

Have a great day! 🙂

Steve Parker, M.D.

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June 20, 2019 · 12:49 AM

Often Imitated But Never Duplicated: My Ketogenic Mediterranean Diet

I don’t know Dodie’s Doodles but she reviewed a competitor to my KMD: Ketogenic Mediterranean Diet at Amazon.com on May 30, 2018. She gave it two stars out of five. Here’s her review in toto:

This book, by Robert Santos-Prowse, a dietician, is not what you want. It’s a little over 180 pages, and the first 50 PAGES are how your digestive system works. Seriously, from the fact that your teeth chew your food all the way down your intestine, as if that’s why you bought the book. Yawn. No offense, but stick with the original by Dr. Steve Parker, who also has an acclaimed cookbook, and I recommend that. He’s the one you want and he has an author’s page here on Amazon.

The book Dodie reviewed is The Ketogenic Mediterranean Diet: A Low-Carb Approach to the Fresh-and-Delicious, Heart-Smart Healthy Lifestyle.

For a free taste of my Ketogenic Mediterranean Diet, click here. If you have my Conquer Diabetes and Prediabetes book, you already have the KMD and much much more.

Steve Parker, M.D.

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Probably under $13 at Amazon.com in the U.S.

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June 19, 2019 · 1:54 AM

Prevent Macular Degeneration With Mediterranean Diet

Photo of the retina at the back of the eyeball

I thought we knew this already. Yet another reason to love the Mediterranean diet. Macular degeneration is a leading cause of blindness in the developed world. Prevention is much better than treatment.

High adherence to a Mediterranean diet and regular physical activity seem to be protective factors for AMD in a Portuguese population. The effect of the diet is likely driven by the increased consumption of vegetables, fruits, and nuts.

Source: Adherence to a Mediterranean diet and its association with age-related macular degeneration. The Coimbra Eye Study–Report 4 – Nutrition

Hmmm…No mention of heart-healthy whole grains.

Steve Parker, M.D.

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