Soft Drinks Kill

Green tea is not linked to premature death

The study at hand involved Europeans. It’s the first time I’ve seen artificially-sweetened soft drinks linked to premature death.

From JAMA Network:

This study found that consumption of total, sugar-sweetened, and artificially sweetened soft drinks was positively associated with all-cause deaths in this large European cohort; the results are supportive of public health campaigns aimed at limiting the consumption of soft drinks.

Source: Association Between Soft Drink Consumption and Mortality in 10 European Countries | Cardiology | JAMA Internal Medicine | JAMA Network

Steve Parker, M.D.

Steve Parker MD, Advanced Mediterranean Diet

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Does Calcium  Intake Affect Postmenopausal Osteoporosis or Osteopenia?

Waste of money and effort?

Many physicians worry that inadequate calcium consumption causes or contributes to thin, brittle, easily breakable bones in postmenopausal women. A recent study suggests that calcium intake doesn’t matter.

Abstract

CONTEXT:

Calcium intakes are commonly lower than the recommended levels, and increasing calcium intake is often recommended for bone health.

OBJECTIVE:To determine the relationship between dietary calcium intake and rate of bone loss in older postmenopausal women.

PARTICIPANTS:

Analysis of observational data collected from a randomized controlled trial. Participants were osteopenic (hip T-scores between -1.0 and -2.5) women, aged >65 years, not receiving therapy for osteoporosis nor taking calcium supplements. Women from the total cohort (n = 1994) contributed data to the analysis of calcium intake and bone mineral density (BMD) at baseline, and women from the placebo group (n = 698) contributed data to the analysis of calcium intake and change in BMD. BMD and bone mineral content (BMC) of the spine, total hip, femoral neck, and total body were measured three times over 6 years.

RESULTS:

Mean calcium intake was 886 mg/day. Baseline BMDs were not related to quintile of calcium intake at any site, before or after adjustment for baseline age, height, weight, physical activity, alcohol intake, smoking status, and past hormone replacement use. There was no relationship between bone loss and quintile of calcium intake at any site, with or without adjustment for covariables. Total body bone balance (i.e., change in BMC) was unrelated to an individuals’ calcium intake (P = 0.99).

CONCLUSIONS:

Postmenopausal bone loss is unrelated to dietary calcium intake. This suggests that strategies to increase calcium intake are unlikely to impact the prevalence of and morbidity from postmenopausal osteoporosis.

Source: Dietary Calcium Intake and Bone Loss Over 6 Years in Osteopenic Postmenopausal Women. – PubMed – NCBI

Steve Parker, M.D.

PS: Elderly men get osteoporosis, too. But when the Emergency Department calls me to admit an older patient with a hip fracture, it’s a woman 9 out of 10 times.

Steve Parker MD, Advanced Mediterranean Diet

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QOTD: H.L. Mencken on Practical Politics

The whole aim of practical politics is to keep the populace alarmed (and hence clamorous to be led to safety) by menacing it with an endless series of hobgoblins, all of them imaginary.

—H.L. Mencken (born in 1880)

Substitution of Tea or Coffee for Sugar-Sweetened Beverages Linked to Lower Type 2 Diabetes Incidence in Europe

Green tea

Sugar-sweetened beverages (SSBs) increase the risk of developing type 2 diabetes. If you want to avoid T2 diabetes, what should you substitute? The study at hand looked at milk, juice, coffee, and tea. Why not water?

From The Journal of Nutrition:

These findings indicate a potential benefit of substituting coffee or tea for SSBs for the primary prevention of T2D and may help formulate public health recommendations on beverage consumption in different populations.

Source: Estimated Substitution of Tea or Coffee for Sugar-Sweetened Beverages Was Associated with Lower Type 2 Diabetes Incidence in Case–Cohort Analysis across 8 European Countries in the EPIC-InterAct Study | The Journal of Nutrition | Oxford Academic

Steve Parker, M.D.

Steve Parker MD, Advanced Mediterranean Diet

Two diets in one book, including the Ketogenic Mediterranean Diet

If Gut Bacteria Cause Alzheimer’s Dementia, What If You Alter Those Bacteria?

The short answer? We don’t know the answer to either of those questions.

Low-carb salad

The gut bacteria (aka microbiome) seem to be able to decrease or increase inflammation that could cause or exacerbate Alzheimer’s dementia. The  microbiome’s effect on inflammation depends on the species of bacteria present, and the amount of those bacteria. At least one study found that Alzheimer’s patients have a greater abundance of the pro-inflammatory species and less of the anti-inflammatory species, compared to other folks.

Researchers with Wake Forest School of Medicine tried to find answers to the questions in the title of this post. (Click for full text.) They studied 17 experimental subjects, average age 64, who had mild cognitive impairment (11) or “cogni/subjective memory complaints” (6). God bless them for submitting to three spinal taps apiece. The experimental diets were 1) Mediterranean-Ketogenic (under 20 g carb/day), or 2) Low-fat American Heart Association diet (under 40 g fat/day). Participants were on each diet for six weeks.

The investigators didn’t find anything useful for those of us trying today to avoid Alzheimer’s or prevent the progression of mild cognitive impairment to dementia. Their bottom line is, “The data suggest that specific gut microbial signatures may depict [characterize] the mild cognitive impairment and that the modified Mediterranean-ketogenic diet can modulate the gut microbiome and metabolites in association with improved Alzheimer’s disease biomarkers in cerebrospinal fluid.”

So we won’t know for several more years, if ever, whether intentional modification of diet will “improve” our gut microbiomes, leading to lower risk of dementia.

What we have known for many year, however, is that the traditional Mediterranean diet is linked to lower risk of Alzhiemer’s dementia.

For more details, see Science Daily:

In a small pilot study, the researchers identified several distinct gut microbiome signatures — the chemicals produced by bacteria — in study participants with mild cognitive impairment (MCI) but not in their counterparts with normal cognition, and found that these bacterial signatures correlated with higher levels of markers of Alzheimer’s disease in the cerebrospinal fluid of the participants with MCI.

Through cross-group dietary intervention, the study also showed that a modified Mediterranean-ketogenic diet produced changes in the gut microbiome and its metabolites that correlated with reduced levels of Alzheimer’s markers in the members of both study groups.

Source: Diet’s effect on gut bacteria could play role in reducing Alzheimer’s risk — ScienceDaily

Steve Parker, M.D.

Steve Parker MD, Advanced Mediterranean Diet

Two diets in one book, including the Ketogenic Mediterranean Diet

Click the pic to purchase the world’s first practical ketogenic Mediterranean diet at Amazon.com

 

Mediterranean Diet May Prevent Multiple Sclerosis

MRI scan of brain, commonly done to evaluate for MS and demyelination

Multiple sclerosis is a disease of unknown cause characterized by demyelination (loss of the protective coating around nerves) in the brain.

From The Journal of Nutrition:

A Mediterranean diet, including unprocessed red meat, was associated with reduced risk of [first clinical diagnosis of brain demyelination] in this Australian adult population. The addition of unprocessed red meat to a Mediterranean diet may be beneficial for those at high risk of [multiple sclerosis].

Source: Higher Mediterranean Diet Score, Including Unprocessed Red Meat, Is Associated with Reduced Risk of Central Nervous System Demyelination in a Case-Control Study of Australian Adults | The Journal of Nutrition | Oxford Academic

Steve Parker MD, Advanced Mediterranean Diet

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Association of Intensive vs Standard Blood Pressure Control With Brain Small Vessel Ischemic Disease

Not good enough

Aiming for systolic blood pressure of 120 or less (instead of 140) may reduce the risk of age-related brain impairment. A recent study suggests the mechanism is better brain blood flow.

The 2017 guidelines from the American College of Cardiology recommend a BP treatment goal of under 130/80.

Ischemia means poor or no blood flow.

Small vessel ischemic disease (SVID in the brain) is something I see so often on CT scans of 70-year-olds that I usually ignore it. Mind you, I’m a hospitalist and usually looking for acute major strokes, brain tumors, and bleeding on CT scans. SVID is a chronic disease and it’s often difficult to say how long a specific lesion has been present and whether it’s causing symptoms. Ischemia in the brain is linked to impaired cognitive functioning and dementia. On the other hand, some brain ischemic lesions don’t seem to cause any detectable impairment.

From JAMA Network:

Question:  Is intensive blood pressure treatment associated with less progression of small vessel ischemic disease, as reflected by cerebral white matter lesion volume?

Findings:  In this substudy of a randomized clinical trial of 449 hypertensive patients with longitudinal brain magnetic resonance imaging, intensive blood pressure management to a target of less than 120 mm Hg, vs less than 140 mm Hg, was associated with a smaller increase in white matter lesion volume (0.92 cm3 vs 1.45 cm3).

Meaning:  More intensive blood pressure management was associated with less progression of cerebral small vessel ischemic disease, although the difference was small.

Source: Association of Intensive vs Standard Blood Pressure Control With Cerebral White Matter Lesions | Dementia and Cognitive Impairment | JAMA | JAMA Network

Steve Parker, M.D.

PS: The Mediterranean diet also reduces dementia and cognitive impairment.

Steve Parker MD, Advanced Mediterranean Diet

Click the pic to purchase at Amazon.com