Does Vitamin D Prevent Dementia?

Dr. John Campbell is “totally convinced” that high-dose vitamin D supplementation would prevent many cases of dementia, particularly Alzheimer dementia, which is 75% of all dementia cases. He takes 4,000 IU of vitamin D/day plus 100 mcg of vitamin K2. Unclear to me if that’s year-round or only in fall and winter, when there’s less sunshine in the northern hemisphere. I assume it’s oral vitamin D3 (there are several types of vitamin D). Dr. Campbell didn’t say why he takes the K2. Click for a brief review of K2. In contrast to his vitamin D dose of 4,000 IU/day, U.K. health authorities recommend a tenth of that — 400 IU — in autumn and winter.

Several observational studies link higher risk of dementia with blood levels of vitamin D that are deficient or insufficient. Blood levels of 25-hydroxy-vitamin D under 25 mg/ml are particularly linked to dementia. Dr. Campbell admits that it’s difficult to prove that adequate vitamin D supplementation would prevent Alzheimer dementia.


  Steve Parker, M.D.

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Male Versus Female Longevity

Working on powerlines is dangerous and it’s mostly men who do it.
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Jim Goad is one of my favorite living cultural commentators. On par with a young P. J. O’Rourke, who died in 2022 at age 74. Last year Goad wrote a thoughtful and thought-provoking article on why women outlive men. A sample:

This disparity is not exclusive to the United States. In fact, it’s worse elsewhere. Worldwide, women outlive men by an average of seven years. According to a 2001 report, the only five countries on Earth where men outlived women were the flea-bitten open-air latrines we call Afghanistan, Nepal, Papua New Guinea, Namibia, and Zimbabwe. But a report from 2017 says there’s no longer any country on the planet where men outlive women.

It wasn’t always this way.

According to data from developed countries, men lived longer than women throughout most of the 1800s, only for the longevity stats to tip in favor of females during the 1890s — an advantage that women have held ever since. Women are supposedly more vulnerable than men to infectious diseases, but once male scientists got a grip on the microbes and brought those pesky critters to heel, women started living longer than men.

As far as I know, women have never thanked men for it.

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For another example of Goad’s work, check out his valentine, Why I Never Gave Up On Women.


  Steve Parker, M.D.

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Red Meat and Diabetes Risk

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Red meat consumption — whether processed or not — was linked to onset of type 2 diabetes in the U.S. according to a 2023 article in American Journal of Clinical Nutrition. The research was a long-term observational study by mostly Harvard-based scientists. Among the authors that might be familiar to you are Walter Willett, Frank Hu, and Frank Sacks. Click the link for the deets.

This doesn’t prove that red meat consumption causes diabetes. But if you enjoy a fair or high amount of red meat, you might benefit by cutting back, especially if diabetes runs in your family. I’d also suggest regular exercise and avoiding overweight and obesity to reduce your risks of type 2 diabetes. The author suggest red meat alternatives: nuts, legumes, dairy foods.

In the same journal issue is a commentary by Daan Kremer. Some snippets:

The current observational study is unlikely to end the discussion on whether red meat intake increases risk of type 2 diabetes and even less likely to end the epistemological debates on how to grade quality of observational evidence when many efforts are made to reduce bias and confounding.

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All in all, the study by Gu et al. may arguably be the best evidence to date on the relation between red meat intake and type 2 diabetes. Yet somehow, I feel that the books have not been closed.

  Steve Parker, M.D.

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Faster Walking Speed is Linked to Lower Risk of Type 2 Diabetes

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You probably want to shoot for a speed of 3 miles per hour or higher. Or 4.8 kilometers/hr or faster.

The British Journal of Sports Medicine published an article by researchers based in Iran. They analyzed 10 cohort studies that looked at average habitual walking speed and the incidence of type 2 diabetes. Study subjects were not in Iran, but in the U.S., U.K., and Japan.

An easy, casual walking speed is 2 miles per hour (mph) or less. Brisk walking speed is 3-4 mph. The researchers found that a habitual walking speed of even 2.5 mph was linked to a slightly lower risk of type 2 diabetes compared to the casual walkers. A more definitive reduction of diabetes incidence (25%) was seen in those who walk at 3 to 4 mph.

For those of you who think in terms of km/hr: An easy, casual walking speed is 3.2 km/hr or less. Brisk walking speed is 4.8-6.4 km/hr. The researchers found that a habitual walking speed of even 4 km/hr was linked to a slightly lower risk of type 2 diabetes compared to the casual walkers. A more definitive reduction of diabetes incidence (25%) was seen in those who walk at 4.8-6.4 km/hr.

This doesn’t necessarily mean that you’ll cut your risk of developing type 2 diabetes if you increase your habitual walking speed from an easy stroll to 3 mph or higher. But it is suggestive and there is physiological science to support that suggestion. The problem is that this study was observational. Which means it’s possible that faster walkers are simply overall healthier than slower ones. They walk faster because they’re healthier and are just constitutionally (genetically?) less prone to illness. To prove that faster walking speeds prevent some cases of type 2 diabetes, you’d have to take 2,000 slow walkers and somehow motivate 1,000 of them to walk faster habitually, while making sure the slow-pokes stay slow for 5-10 years. Keep everything else the same for all 2,000. After 5-10 years, you compare the incidence of diabetes. That study will not, probably cannot, be done.

  Steve Parker, M.D.

h/t to Diabetes Daily for a well-written article on this.

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10,000 Steps a Day: C’mon, Man! Is That Really Necessary?

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For perhaps 15-20 years, many health experts have recommended you walk 10,000 steps/day as important for maximizing your health and longevity. Depending on your stride length, that’s roughly 5 miles (8 km). When I walk my dogs 4 miles, it takes about 90 minutes, which is a big time commitment. Frankly, it’s often boring. But not for the dogs. So many fascinating odors!

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The good news is, you don’t need to walk the 10,000 steps in one fell swoop. Your walking around your residence and workplace throughout the day counts, too.

More good news. If you’re an older woman, maybe 4,400 steps/day is enough for a longevity benefit. In other populations studied, 6,000 to 8,000 steps/day was optimal.

I admitted a patient to the hospital a few days ago who told me her health insurer sends her a small check monthly if she meets their step goal. She’s saving them money via lower healthcare expenditures, and they’re sharing with her. I love it!

  Steve Parker, M.D.

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What Really Matters?

Only one thing really matters. That’s your relationship with Jesus Christ/God. Who was Jesus? Did he exist? Was he crucified for your eternal salvation?

Jesus is my Lord and Savior. He died for my sins. After my death, I’ll be with him in heaven forever.

  Steve Parker, M.D.

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19 Expert Weight-Loss Tips and Tricks

1.  Record-keeping is often the key to success.

2.  Accountability is another key to success. Consider documenting your program and progress on a free website such as FitDay, SparkPeople, 3FatChicks, or others. Consider blogging about your adventure on a free platform such as WordPress or Blogger, or try the newer social media sites. Such a public commitment may be just what you need to keep you motivated.

3.  Do you have a friend or spouse who wants to lose weight? Start the same program at the same time and support each other. That’s built-in accountability.

4.  If you tend to over-eat, floss and brush your teeth after you’re full. You’ll be less likely to go back for more anytime soon.

5.  Eat at least two or three meals daily. Skipping meals may lead to uncontrollable overeating later on. On the other hand, ignore the diet gurus who say you must eat every two or three hours. That’s codswallop.

6.  Eat meals at a leisurely pace, chewing and enjoying each bite thoroughly before swallowing.

7.  Plan to give yourself a specific reward for every 10 pounds (4.5 kg) of weight lost. You know what you like. Consider a weekend get-away, a trip to the beauty salon, jewelry, an evening at the theater, a professional massage, home entertainment equipment, new clothes, etc.

8.  Carefully consider when would be a good time to start your new lifestyle. It should be a period of low or usual stress. Bad times would be Thanksgiving day, Christmas/New Years’ holiday, the first day of a Caribbean cruise, and during a divorce.

9.  If you know you’ve eaten enough at a meal to satisfy your nutritional requirements yet you still feel hungry, drink a large glass of water and wait a while.

10  Limit television to a maximum of a few hours a day.

11.  Maintain a consistent eating pattern throughout the week and year.

12.  Eat breakfast routinely.

13.  Control emotional eating.

14.  Weigh frequently: daily during active weight-loss efforts and during the first two months of your maintenance-of-weight-loss phase. After that, cut back to weekly weights if you want. Daily weights will remind you how hard you worked to achieve your goal.

15.  Be aware that you might regain five or 10 pounds (2-4 kg) of fat now and then. You probably will. Don’t freak out. It’s human nature. You’re not a failure; you’re human. But draw the line and get back on the old weight-loss program for one or two months. Analyze and learn from the episode. Why did it happen? Slipping back into your old ways? Slacking off on exercise? Too many special occasion feasts or cheat days? Allowing junk food or non-essential carbs back into the house?

16.  Learn which food item is your nemesis—the food that consistently torpedoes your resolve to eat right. For example, mine is anything sweet. Remember an old ad campaign for a potato chip: “Betcha can’t eat just one!”? Well, I can’t eat just one cookie. So I don’t get started. I might eat one if it’s the last one available. Or I satisfy my sweet craving with a diet soda, small piece of dark chocolate, or sugar-free gelatin. Just as a recovering alcoholic can’t drink any alcohol, perhaps you should totally abstain from…? You know your own personal gastronomic Achilles heel. Or heels. Experiment with various strategies for vanquishing your nemesis.

17.  If you’re not losing excess weight as expected (about a pound or half a kilogram per week), you may benefit from eating just two meals a day. This will often turn on your cellular weight-loss machinery even when total calorie consumption doesn’t seem much less than usual. The two meals to eat would be breakfast and a mid-afternoon meal (call it what you wish). The key is to not eat within six hours of bedtime. Of course, this trick could cause dangerous hypoglycemia if you’re taking drugs with potential to cause low blood sugars, like insulin and sulfonylureas. If you take drugs for diabetes, talk to your dietitian or physician before instituting a semi-radical diet change like this.

18.  One of the fitness bloggers I used to follow was James Fell. He said, “If you want to lose weight you need to cook. Period.”

19.  Regular exercise is much more important for prevention of weight regain rather than for actually losing weight.

Steve Parker, M.D.

 

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Lyrica or Neurontin for Chronic Pain?

“You can take this pill, but there’s not much evidence it does any good.”

Physicians in the U.S. who prescribe opioids need a license from the Drug Enforcement Administration and it has to be renewed periodically. By the time of my next renewal, I must be able to prove to the DEA that I’ve had six (eight?) hours of approved continuing medical education on drug abuse and addiction. Because of the prescription opioid “epidemic” that reared it’s head several years ago, regulators are putting pressure on prescribers to reduce prescriptions. I’m not saying that’s a bad thing, but it can be taken too far, like expecting a patient with very recent knee or hip replacement surgery to be just fine with acetaminophen (aka paracetamol) alone. Big Pharma has convinced some prescribers to substitute opioids with Neurontin (aka gabapentin) or Lyrica (pregabalin). If not substitution, then augmentation of opioid effect at lower doses. I definitely see that in my part of the world.

Regarding that, here’s a thought-provoking article from Paul Ingraham:

One of the most notorious examples of Big Pharma living up to its reputation for evil-doing is the illegal promotion of anticonvulsant drugs like Neurontin and Lyrica for painful problems like back pain. Pfizer coughed up billions for lawsuit settlements and record-breaking fines. I think it’s safe to say that they didn’t actually pay enough to undo the damage, though…

Thanks to that horror show, and to research by Peet et al, we now know that there was a mighty 5× surge in gabapentin prescriptions in the 2000s and 2010s. That was — and continues to be — a chilling demonstration of the power of under-handed and well-funded marketing. Even as opioid prescriptions fell somewhat, gabapentin scrips rose dramatically, despite the dubious value for most of what it was being prescribed for (most kinds of pain).

  Steve Parker, M.D.

PS: Pregabalin and gabapentin are commonly used and often effective drugs for painful diabetic neuropathy in the U.S. This blog post isn’t about that neuropathic.

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Merry Christmas, Ya’ll!

Nativity Scene

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December 24, 2023 · 7:00 AM

Have You Heard of Dry January?

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I’ve run across a number of patients who slowly increased their alcohol consumption over months or years, not realizing it was causing or would cause problems for them. Alcohol is dangerous, lethal at times.

From a health standpoint, the generally accepted safe levels of consumption are:

  • no more than one standard drink per day for women
  • no more than two standard drinks per day for men

One drink is 5 ounces of wine, 12 ounces of beer, or 1.5 ounces of 80 proof distilled spirits (e.g., vodka, whiskey, rum, gin).

Dry January was conceived in the UK in 2012 or 2014. (A related concept is Sober October.) The idea is simply to abstain from all alcohol for the month of January. The Alcohol Change UK website can help you git ‘er done. Many folks notice that they sleep better, have more energy, lose weight, and save money. There are other potential benefits.

If you think you may have an unhealthy relationship with alcohol, check your CAGE score. It’s quick and easy.

Alternatively, if you make a commitment to a Dry January but can’t do it, you may well have a problem.

Steve Parker, M.D.

PS: Check out this video about the benefits of sobriety.

PPS: This guy quit alcohol for 30 days:

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