Longevity in the U.S. Is Decreasing

The U.S. empire’s future?

Sir John Glubb studied various empires that existed over the last 4,000 years. He deduced that empires have predictable lifecycles, from origin to ascendence, to great power then decline and collapse. The cycle takes 250 years, give or take 50. I’m not the only one to notice that the U.S.—244 years old—may be on the decline. Decreasing life expectancies are a potential marker of decline.

Glubb died in 1986 at the age of 88.

From JAMA Network:

U.S. life expectancy increased for most of the past 60 years, but the rate of increase slowed over time and life expectancy decreased after 2014. A major contributor has been an increase in mortality from specific causes (eg, drug overdoses, suicides, organ system diseases) among young and middle-aged adults of all racial groups, with an onset as early as the 1990s and with the largest relative increases occurring in the Ohio Valley and New England. The implications for public health and the economy are substantial, making it vital to understand the underlying causes.

Source: Life Expectancy and Mortality Rates in the United States, 1959-2017 | Population Health | JAMA | JAMA Network

Steve Parker, M.D.

PS: Not many diets are proven to improve longevity. The Mediterranean diet is one.

Steve Parker MD, Advanced Mediterranean Diet

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Ketogenic Diet: Evidence for Optimism From Dr David Ludwig

Sous vide chicken and sautéed sugar snap peas. This meal is allowed on a ketogenic diet.

From The Journal of Nutrition:

Recently, ketogenic diets have received substantial attention from the general public and nutrition research community. These very-low-carbohydrate diets, with fat comprising >70% of calories, have been dismissed as fads. However, they have a long history in clinical medicine and human evolution. Ketogenic diets appear to be more effective than low-fat diets for treatment of obesity and diabetes. In addition to the reductions in blood glucose and insulin achievable through carbohydrate restriction, chronic ketosis might confer unique metabolic benefits of relevance to cancer, neurodegenerative conditions, and other diseases associated with insulin resistance. Based on available evidence, a well-formulated ketogenic diet does not appear to have major safety concerns for the general public and can be considered a first-line approach for obesity and diabetes. High-quality clinical trials of ketogenic diets will be needed to assess important questions about their long-term effects and full potential in clinical medicine.

Source: Ketogenic Diet: Evidence for Optimism but High-Quality Research Needed | The Journal of Nutrition | Oxford Academic

Steve Parker, M.D.

PS: If you have the 2nd edition of The Advanced Mediterranean Diet, you already have the Ketogenic Mediterranean Diet.

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Now That You’ve Blown Your New Years’ Weight Loss Resolution, What’s Next?

That excess weight can shorten your life

If you’re down at least 4–5 pounds (2.5 kg) since Jan. 1, that’s great. Keep it up. But most folks did well for a couple weeks and started gaining the weight back. Don’t be too hard on yourself. Weight management is not a walk in the park. You probably weren’t adequately prepared for the challenge.

Longterm success requires careful forethought. That’s why I’ve written this eight-part series.

Questions beg for answers.  For example . . .

Which of the myriad weight-loss programs will I follow?  Can I design my own program?  Should I use a diet book?  Sign up for Nutri-System, Weight Watchers, or Jenny Craig?  Should I stop wasting my time dieting and go directly to bariatric surgery?  Can I simply cut back on sodas and chips?  What should I eat?  What should I not eat?  Do I need to start exercising?  What kind?  How much?  Do I need to join a gym?  What methods are proven to increase my odds of success?  How much weight should I lose?  Should I use weight-loss pills or supplements?  Which ones?  What’s the easiest, most effective way to lose weight?  Is there a program that doesn’t require willpower?  Now, what were those “top 10 super-power foods” that melt away the fat?  Am I ready to get serious and stick with it this time?

This series will answer many of these questions and get you teed up for success.  Teed up like a golfer ready to hit his first shot on hole #1 of an 18-hole course.  Take 10 minutes to read the following articles.  The time invested will pay dividends for years.

C’mon now. Let’s be realistic.

Part 1:  Motivation

Immediate, short-term motivation to lose weight may stem from an upcoming high school reunion, swimsuit season, or a wedding. You want to look your best. Maybe you want to attract a mate or keep one interested. Perhaps a boyfriend, co-worker, or relative said something mean about your weight. These motivators may work, but only temporarily. Basing a lifestyle change on them is like building on shifting sands. You need a firmer foundation for a lasting structure. Without a lifestyle change, you are unlikely to vanquish a chronic overweight problem.  Proper long-term motivation may grow from:

  • the discovery that you feel great and have more energy when you are lighter and eating sensibly
  • the sense of accomplishment from steady progress
  • the acknowledgment that you have free will and are responsible for your weight and many aspects    of your health
  • the inspiration from seeing others take charge of their lives successfully
  • the admission that you have some guilt and shame about being fat, and that you like yourself more when you’re not fat  [I’m not laying shame or guilt on you; many of us do it to ourselves.]
  • the awareness of overweight-related adverse health effects and their improvement with even modest weight loss.

Appropriate motivation will support the commitment and willpower that will be needed soon.

PS: I’m thinking of how Dave Ramsay, when he’s counseling people who have gotten way overhead in debt, tells them they have to get mad at the debt.  Then they can attack it.  Maybe you have to get mad at your fat.  It’s your enemy, dragging you down, trying to kill you.  Now attack it!

Part 2:  The Energy Balance Equation

An old joke from my medical school days asks, “How many psychiatrists does it take to change a light bulb?”  Only one, but the light bulb must want to change.

How many weight-loss programs does it take before you lose that weight for good?  Only one, but…

Where does the fat go when you lose weight dieting?  Metabolic reactions convert it to energy, water, and carbon dioxide, which weigh less than fat.  Most of your energy supply is used to fuel basic life-maintaining physiologic processes at rest, referred to as resting or basal metabolism.  Basal metabolic rate (BMR) is expressed as calories per kilogram of body weight per hour.  Even at rest, a kilogram of muscle is much more metabolically active than a kilogram of fat tissue.  So muscular lean people sitting quietly in a room are burning more calories than are fat people of the same weight sitting in the same room.

The major determinants of BMR are age, sex, and the body’s relative proportions of muscle and fat.  Heredity plays a lesser role.

Energy not used for basal metabolism is either stored as fat or converted by the muscles to physical activity.  Most of us use about 70 percent of our energy supply for basal metabolism and 30 percent for physical activity.  Those who exercise regularly and vigorously may expend 40–60 percent of their calorie intake doing physical activity.  Excess energy not used in resting metabolism or physical activity is stored as fat.

If you want to lose excess weight and keep it off, you must learn the following equation:

The energy you eat,

          minus the energy you burn in metabolism and activity,

               determines your change in body fat.  [read more]

Cute mouse, but a slave to instincts.

Part 3:  Free Will

The only way to lose excess fat weight is to cut down on the calories you take in, increase your physical activity, or do both.

Oh, sure.  You could get a leg amputated, develop hyperthyroidism or out-of-control diabetes, or have liposuction or bariatric surgery.  But you get my drift.

Although the exercise portion of the energy balance equation is somewhat optional, you must reduce food intake to lose a significant amount of weight.  Once you reach your goal weight you will be able to return to nearly your current calorie consumption, and even higher consumption if you have increased your muscle mass and continue to be active.

Are you be able to reduce calorie intake and increase your physical activity temporarily? It comes down to whether we have free will.  Free will is the power, attributed especially to humans, of making free choices that are unconstrained by external circumstances or by an agency such as divine will.

Will is the mental faculty by which one chooses or decides upon a course of action; volition.

Willpower is the strength of will to carry out one’s decisions, wishes, or plans.

If we don’t have free will, you’re wasting time trying to lose weight through dieting; nothing will get your weight problem under control.  Even liposuction and weight-reduction stomach surgery will fail in time if you are fated to be fat.  The existence of free will is . . . [read more]

Part 4:  Starting New Habits

You already have a number of good habits that support your health and make your life more enjoyable, productive, and efficient.  For example, you brush your teeth and bathe regularly, put away clean clothes in particular spots, pay bills on time, get up and go to work every day, wear your seat belt, put your keys or purse in one place when you get home, balance your checkbook periodically.

At one point, these habits took much more effort than they do now.  But you decided they were the right thing to do, made them a priority, practiced them at first, made a conscious effort to perform them on schedule, and repeated them over time.  All this required discipline.  That’s how good habits become part of your lifestyle, part of you.  Over time, your habits require much less effort and hardly any thought.  You just do it.

Your decision to lose fat permanently means that you must establish some new habits, such as regular exercise and reasonable food restriction.  You’ve already demonstrated that you have self-discipline.  The application of that discipline to new behaviors will support your commitment and willpower.

Exercise isn’t very important for weight loss, but critical for preventing weight regain.

Part 5:  Supportive Social System

Success at any major endeavor is easier when you have a supportive social system.  And make no mistake: losing a significant amount of weight and keeping it off long-term is a major endeavor.

As an example of a supportive social system, consider childhood education.  A network of actors play supportive roles.  Parents provide transportation, school supplies, a home study area, help with homework, etc.  Siblings leave the child alone so he can do his homework, and older ones set an example.  Neighbors may participate in carpooling.  Taxpayers provide money for public schools.  Teachers do their part.  The school board oversees the curriculum, supervises teachers, and does long-range planning.

Success is more likely when all the actors work together for their common goal: education of the child.  Similarly, your starring role in a weight-loss program may win an Academy Award if you have a strong cast of supporting actors.  Your mate, friends, co-workers, and relatives may be helpers or hindrances.  It will help if they . . . [read more]

Part 6:  Weight Goals

Despite all the chatter about how to lose weight, few talk about how much should be lost.

"This can't be right!"

Down 4 pounds in 6 months. I’ll take it!

If you are overweight, deciding how much weight you should lose is not as simple as it seems at first blush.  I rarely have to tell a patient she’s overweight. She knows it and has an intuitive sense of whether it’s mild, moderate, or severe in degree.  She’s much less clear about how much weight she should lose.  If it’s any consolation, clinicians in the field aren’t always sure either.

Five weight standards have been in common usage over the last quarter-century . . . [read more]

Part 7:  Creative Visualization

How will your life be different after you make a commitment and have the willpower to lose weight permanently?

Odds are, you will be more physically active than you are now.  Exercise will be a habit, four to seven days per week.  Not necessarily vigorous exercise, perhaps just walking for 30 or 45 minutes.  It won’t be a chore.  It will be pleasant, if not fun.  The exercise will make you more energetic, help you sleep better, and improve your self-esteem.

After you achieve your goal weight, you’ll be able to cut back on exercise to three or four days per week, if you want.  If you enjoy eating as much as I do, you may want to keep very active physically so that you can eat more.  I must tell you that I rarely see anyone lose a major amount of weight and keep it off without . . . [read more]

Part 8:  Choosing A Program

I listed most of your weight-loss program options in the introductory comments to this series.  Now it’s time to make a choice.  And it’s not easy sorting through all the options.

Straight away, I must tell you that women over 300 pounds (136 kg) and men over 350 pounds (159 kg) rarely have permanent success with self-help methods such as diet books, meal replacement programs, diet pills or supplements, and meal-delivery systems.  People at those high weights who have tried and failed multiple different weight-loss methods should seriously consider bariatric surgery.

I respect your intelligence and desire to do your “due diligence” and weigh all your options: diet books, diet pills and supplements, bariatric surgery, meal replacement products (e.g., SlimFast), portion-control meal providers (e.g., NutriSystem), Weight Watchers, fad diets, no-diet diets, “just cutting back,” etc.  You have to make the choice; I can’t make it for you.  Here are some well-respected sources of advice to review before you choose . . . [read more]

Last modification date:  November 1, 2017

Alcohol and Cancer Risk: Clinical and Research Implications | Oncology | JAMA | JAMA Network

Stillhouse Moonshine Whiskey (NOT specifically linked to increased cancer risk)

Do you drink alcohol in part because you think it’s good for heart health? For longevity? To prevent dementia? If so, you may be increasing your risk of cancer.

From JAMA Network:

Ample evidence has been available for some time indicating that alcohol use is a preventable risk factor for cancer, and the World Health Organization deemed alcohol a carcinogen more than 30 years ago. In the United States, it is estimated that 5.6% of incident cancer cases (approximately 87 000 each year) are associated with alcohol, including cancers of the oral cavity, pharynx, larynx, liver, esophagus (squamous cell carcinoma), female breast, and colorectum. Type of alcohol does not appear to matter; all alcoholic beverages include ethanol, which increases levels of acetaldehyde and in turn promotes DNA damage. Moreover, even moderate levels of consumption (often defined as approximately 14–28 g/d, the equivalent of about 1–2 drinks) appear to be associated with higher risk of some cancers, including cancers of the female breast. A protective association has emerged for some cancers, with the most evidence for kidney, Hodgkin lymphoma, and non-Hodgkin lymphoma. Nonetheless, the overall cancer burden associated with alcohol use is substantial and comparable with that of other preventable risk factors such as UV exposure and excess body weight.

Source: Alcohol and Cancer Risk: Clinical and Research Implications | Oncology | JAMA | JAMA Network

Steve Parker, M.D.

Steve Parker MD, Advanced Mediterranean Diet

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords. com.

Is Type 2 Diabetes Caused by Ultra-Processed Foods?

 

One example of UPF

A recent observational study done in France found an association between incidence of type 2 diabetes and consumption of ultra-processed foods.

What are ultra-processed foods? From the study at hand, “Ultraprocessed foods (UPF) (ie, foods undergoing multiple physical, biological, and/or chemical processes, among which mostly of exclusive industrial use, and generally containing food additives) are widespread worldwide and especially in Western diets, representing between 25% and 60% of total daily energy [calories].”

These results suggest an association between UPF consumption and type 2 diabetes risk. They need to be confirmed in large prospective cohorts in other settings, and underlying mechanisms need to be explored in ad hoc epidemiological and experimental studies. Beyond nutritional factors, nonnutritional dimensions of the diet may play a role in these associations, such as some additives, neoformed contaminants, and contact materials. Even if a causal link between UPF and chronic diseases cannot be established so far, the accumulation of consistent data leads public health authorities in several countries such as France or Brazil to recommend privileging the consumption of unprocessed/minimally processed foods, and limiting the consumption of UPF in the name of the precautionary principle.

Source: Ultraprocessed Food Consumption and Risk of Type 2 Diabetes Among Participants of the NutriNet-Santé Prospective Cohort | Lifestyle Behaviors | JAMA Internal Medicine | JAMA Network

Steve Parker, M.D.

Steve Parker MD, Advanced Mediterranean Diet

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords. com.

Paul Ingraham Versus Dr John Sarno on Low Back Pain

I read Sarno’s Healing Back Pain many years ago. I’ve mentioned Sarno on this blog at least once. Sarno claims to alleviate many medical problems with his psychological approach. Whenever my wife or I get a migraine or flare of low back pain, we jokingly refer to is as “repressed anger.” Dr Sarno helped Dr Stephan Guyenet (PhD) with his low back pain.

From Paul Ingraham:

Sarno is articulate and has some important ideas, yes — but he’s also gotten into the business of selling miracle cures. The more recent the book, the less he sounds like a doctor and the more he reads like a mind-body medicine guru trying to convince you that you can heal anything if you can just master the right mental attitude.

Yuck. I don’t care for that. I don’t like it any better than I like the opposite extreme: denying the importance of the mind in medicine is just as foolish as exaggerating it.

History has shown us that it is all too easy to sell books by promising that the “power of the mind” can do whatever you want to believe it can do. Sarno has jumped on that old bandwagon. And so, unfortunately, it is not possible for a serious thinker to take Sarno at his word straight through his books. It is necessary to take the good, and filter out the exaggerated, the grandiose, the empty promises.

Source: Critical Analysis Review of Dr. John Sarno’s Books & Ideas

Steve Parker, M.D.

Steve Parker MD, Advanced Mediterranean Diet

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords. com.

Dr Gorski on Dr Joseph Mercola: Not a Fan

 

“Would I lie to you if my income depended on it?”

I’m probably on the opposite end of the political spectrum from Dr Gorski, but from a science-based medical perspective I almost always agree with him.

From Dr G at Science-Based Medicine:

One of the most frequent ad hominem attacks leveled against those of us who try to educate the public about medical quackery, antivaccine pseudoscience, and the infiltration of pseudoscience and quackery into medicine in the form of “complementary and alternative medicine” (CAM) or “integrative medicine” is that we’re shills for big pharma. It’s such a common attack that I even coined a phrase to describe it. (Well, I think I coined the phrase; I could be wrong.) It’s known as the “pharma shill gambit.” The idea is as obvious as it is trite: to cast doubt on what defenders of science say about medical quackery by portraying them as in the pocket of big pharma. My frequent retort goes along the lines of, “Dammit, where is all filthy lucre I’m supposed to be getting doing this? Where is my mansion? Where is my Maserati?” Of course, I have none of these things. Don’t get me wrong. As an academic surgeon I make considerably more than the average person, but I’m just well off, not wealthy, and I don’t even make that much compared to the average surgeon in private practice with my level of experience. (Hell, I don’t even make as much as the radiologists at my hospital.) The point is, no one gets wealthy opposing pseudoscience. They do, however, become wealthy selling pseudoscience, as a recent Washington Post story about Dr. Joseph Mercola demonstrates.

Source: “Natural health” and the antivaccine movement: The case of Dr. Joseph Mercola – Science-Based Medicine

Steve Parker, M.D.

Steve Parker MD, Advanced Mediterranean Diet

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords. com.