How to Prevent Macular Degeneration

Remember...peanuts aren't nuts, they're legumes

Remember…peanuts aren’t nuts, they’re legumes

I saw an optometrist recently for a new eyeglass prescription and mentioned that age-related macular degeneration (ARMD or AMD) runs in my family. ARMD is the leading cause of adult blindness in the West. Thank God, I don’t have it….yet.

The optometrist suggested I start taking eye vitamins to help prevent ARMD. Popular eye vitamin preparations around here are Ocuvite and I-Caps. He said a multivitamin like Centrum might be just as effective.

UpToDate.com, a source I trust, says that supplements for prevention probably don’t work and are not recommended. Which means Centrum would be just as effective: i.e., none of them work.

Instead, UpToDate recommends regular exercise, not smoking, and relatively high consumption of leafy green vegetables, fruits, fish and nuts. Although they didn’t mention it by name, the traditional Mediterranean diet provides all of those.

On the other hand, if you already have macular degeneration (wet or dry), UpToDate recommends these supplements (probably based on the AREDS-2 study):

  • vitamin C 500 mg/day
  • vitamin E 400 mg/day
  • lutein 10 mg/day
  • zeaxanthin 1 mg/day
  • zinc 80 mg/day (as zinc oxide)
  • copper 2 mg/day (as cupric oxide)

An reasonable alternative for non-smokers and never-smokers is the standard AREDS formula. It’s the same as above except it substitutes beta carotene for lutein or zeaxanthin. You can buy both formulations over-the-counter in the U.S. pre-mixed so you don’t have to swallow a handful of pills, just one.

I was in a supermarket yesterday checking out eye vitamins and noted that Bausch and Lomb’s AREDS-2 formula costs about $10/month.

I haven’t decided yet whether I’ll take the optometrist’s supplement advice. Probably not. But I’ll go the diet, exercise, and non-smoking route.

Steve Parker, M.D.

Fruit Smoothie #1: Grapes, Mandarin Orange, Banana, Pear, Chia Seeds, Kale

 

A 12 fl oz serving

A 12 fl oz serving

My wife has started to experiment with smoothies. Most Americans should eat more fruits; smoothies are one way to do that. Here’s one she made today. Note the trendy chia seeds and kale. You can easily include today’s recipe in your Advanced Mediterranean Diet. Smoothies are a great substitute for junk food desserts.

We’re using a Vitamix mixer. Other devices may be able to get the job done. The mixing speeds our device range from one to 10. (Tip for a competitor: make one that goes to 11.) We love our Vitamix and have no regrets about the purchase. It is hard to hear anything else when it’s running at top speed.

One potential advantage of blending these fruits is that one fruit may provide nutrients that the others lack

One potential advantage of blending these fruits is that one fruit may provide nutrients that the others lack

Ingredients

1 cup (240 ml) grapes, green seedless

1 mandarin orange, peeled, halved

1 banana (7 inches or 18 cm), peeled, cut into 3–4 pieces

1 pear, medium-size, cored, quartered (ok to leave peel on)

1/2 tbsp (7 g) chia seeds

1 cup (50 g) raw kale

1/2 cup (120 ml) water

2 cups (480 ml) ice cubes

Instructions

First put the water in the Vitamix, then grapes, pear, orange, banana, chia seeds, kale, and finally ice. Ice is always last. Then blend on variable speed 1 and gradually go up to high level (10). Total spin time is about 45 seconds.

Full speed ahead!

Full speed ahead!

Number of Servings: 2.5 consisting of 12 fl oz (350 ml) each.

Advanced Mediterranean Diet boxes: 2 fruits

Nutritional Analysis per Serving:

7% fat

88% carbohydrate

5% protein

160 calories

38 g carbohydrate

6 g fiber

32 g digestible carbohydrate

15 mg sodium

520 mg potassium

Prominent features: Good source of vitamin C, fair amount of fiber, miniscule sodium.

Steve Parker, M.D.

 

 

Ashes to Ashes, Dust to Dust…

Here’s a beautiful rendition of an Anglican hymn I’d never heard before, “Abide With Me.”

Visit YouTube and you can see the printed lyrics. Written in 1847, the author reportedly died of tuberculosis three weeks later.

h/t John Derbyshire

Do Low-Carb Diets Cause Death?

Adult life is a battle against gravity. Eventually we all lose.

Adult life is a battle against gravity. Eventually we all lose.

Japanese researchers say low-carb diets are causing premature death. I’m skeptical.

The potentially healthful side effects linked to low-carb eating include reduced weight, higher HDL cholesterol, and lower triglycerides and blood pressure. The Japanese investigators wondered if the improved cardiovascular risk factors seen with low-carb diets actually translate into less heart disease and death.

How Was the Study At Hand Done?

The best way to test long-term health effects of a low-carb diet (or any diet) is to do a randomized controlled trial. You take 20,000 healthy and very similar people—not rodents—and randomize half of them to follow a specific low-carb diet while the other half all eat a standard or control diet. Teach them how to eat, make damn sure they do it, and monitor their health for five, 10, or 20 years. This has never been, and never will be, done in humans. The Nazis may have done it, but it’s not published. In the old days, we could do this study on inmates of insane asylums or prisons.

What we have instead are observational studies in which people voluntarily choose what they’re eating, and we assume they keep eating that way for five or 10+ years. You also assume that folks who choose low-carb diets are very similar to other people at the outset. You depend on regular people to accurately report what and how much they’re eating. You can then estimate how much of their diet is derived from carbohydrate and other macronutrients (protein and fat), then compare health outcomes of those who were in the top 10% of carb eaters with those in the bottom 10%. (We’ve made a lot of assumptions, perhaps too many.)

Of the observational studies the authors reviewed, the majority of the study participants were from the U.S. or Sweden. So any true conclusions may not apply to you if you’re not in those countries. In looking for articles, they found no randomized controlled trials.

The observational studies estimated carb consumption at the outset, but few ever re-checked to see if participants changed their diets. That alone is a problem. I don’t know about you, but I’ve had significant changes in my diet depending on when I was in college and med school, when I was a bachelor versus married, when my income was higher or lower, and when I had young children versus teenagers. But maybe that’s just me.

The researchers looked at all-cause mortality, deaths from cardiovascular disease, and incidence of cardiovascular disease. They don’t bother to define cardiovascular disease. I assume heart attack, strokes, and peripheral vascular disease. (But aren’t aneurysms, deep vein thrombosis, and pulmonary embolism vascular diseases, too?) Wouldn’t you think they’d carefully define their end-points? I would. Since they were going to all this trouble, why not look at cancer deaths, too?

What Did the Investigators Conclude?

Very low-carbohydrate dieters had a 30% higher risk of death from any cause (aka all-cause mortality) compared to very high-carb eaters. The risk of cardiovascular disease incidence or death were not linked with low-carb diets. Nor did they find protection against cardiovascular disease.

Finally, “Given the facts that low-carbohydrate diets are likely unsafe and that calorie restriction has been demonstrated to be effective in weight loss regardless of nutritional composition, it would be prudent not to recommend low-carbohydrate diets for the time being.”

If Low-Carb Dieters Die Prematurely, What Are They Dying From?

The top four causes of death in the U.S. in 2011, in order, were:

  1. heart attacks
  2. cancer
  3. chronic lower respiratory tract disease
  4. stroke

You’ll note that two of those are cardiovascular disease: heart attacks and stroke. So if low-carb diets promote premature death, it’s from cancer, chronic lung disease, or myriad other possibilities. Seventy-five percent of Americans die from one of the top 10 causes. Causes five through 10 are:

  • accidents
  • Alzheimer disease
  • diabetes
  • flu and pneumonia
  • kidney disease
  • suicide

Problem is, no one has ever linked low-carb diets to higher risk of death from any specific disease, whether or not in the top ten. Our researchers don’t mention that. That’s one reason I’m very skeptical about their conclusion. If you’re telling me low-carb diets cause premature death, tell me the cause of death.

Another frustration of mine with this report is that they never specify how many carbohydrates are in this lethal low-carb diet. Is it 20 grams, 100, 150? The typical American eats 250-300 grams of carb a day. If you’re going to sound the alarm against low-carb diets, you need to specify the lowest safe daily carb intake.

For most of my career—like most physicians—I’ve been wary of low-carb diets causing cardiovascular disease. That’s because they can be relatively high in total fat and saturated fat. In 2009, however, I did my own review of the scientific literature and found little evidence of fats causing cardiovascular disease.

If you’re looking for a reason to avoid low-carb diets, you can cite this study and its finding of premature death. I’m not convinced. I’ll turn it around on you and note this study found no evidence that low-carb diets cause cardiovascular disease. The risk of cardiovascular disease had been the traditional reason for physicians to recommend against low-carb diets.

Steve Parker, M.D.

Reference: Noto, Hiroshi et al. Low-Carbohydrate diets and all-cause mortality: A systematic review and meta-analysis of observational studies. PLoS One, 2013; 8(1): e55050

Ibuprofen and Acetaminophen Enhance Exercise-Induced Muscle Strength and Size in Older Adults

The study involved 12 weeks of resistance training in 36 adults who were in their 60s. Subjects were randomly assigned to take acetaminophen, ibuprofen, or placebo for the duration of the study. The acetaminophen dose (e.g., Tylenol) was 4000 mg/day and the ibuprofen dose (e.g., Advil) was 1200 mg/day. The total daily amount was divided into three doses.

Compared to placebo, the drug-takers saw a 25-50% increase in muscle mass and strength. The authors attribute the benefit to inhibition of cyclooxygenase (COX).

In case you’re tempted to try this hack on yourself, you might want to run it by your doctor first. For instance, I wouldn’t take the acetaminophen if I had chronic liver disease. I’d eschew the ibuprofen if I had kidney impairment, were prone to bleeding, had stomach ulcers or gastritis, or were taking a strong blood thinner.

Update December 20, 2014: Ibuprofen seems to increase lifespan in several species. Humans, too?

Steve Parker, M.D.

h/t P.D. Mangan

Do Salt Substitutes Help Lower Blood Pressure?

Yes, according to a meta-analysis in a recent AJCN. They drop systolic pressure about 5 units and diastolic only about 1.5 units (mmHg). Although modest, that may be enough to help reduce the need for blood pressure medications.

Steve Parker, M.D.

Could Smart Healthcare Reform Solve the U.S. Budget Deficit?

Karl Denninger makes the case that the U.S. federal budget deficit is the fault of medical monopolies that are exempt from the Sherman and Clayton anti-trust laws. In his 20-minute video, Karl mentions that a vial of scorpion antivenin costs $10,000 in the U.S., but only $100 across the border in Mexico.

In a free market, a buyer of a product or service can easily determine how much it costs, whether it’s a haircut or a house. If you think U.S. healthcare is anything near a free market, just call up your local hospitals and ask how much they charge for an uncomplicated hospitalization to have a baby or groin hernia repair. Go ahead, I’ll wait.

They won’t or can’t give you the numbers. Nor do they advertise the prices so you can be a smart shopper.

Have you noticed how advances in science and technology tend to lower the cost of most goods and services, such as computers, cell phones, food, and clothing? Why don’t we see that in healthcare? Because of monopolistic practices and other excessive governmental regulation and bureaucracy affecting not only healthcare providers but also Big Pharma and health insurers.

Unfortunately, I don’t see the situation changing anytime soon.

Steve Parker, M.D.