Category Archives: Uncategorized

Effect of Aspirin on Disability-free Survival in the Healthy Elderly

“Aspirin use in healthy elderly persons did not prolong disability-free survival over a period of 5 years but led to a higher rate of major hemorrhage than placebo.”

Source: Effect of Aspirin on Disability-free Survival in the Healthy Elderly | NEJM

Jenna Jameson Loses 80 Pounds on Ketogenic Diet 

I hesitated to link to this story about a porn star, but decided to do it anyway. You judge her lifestyle for yourself.

Looks to me like she could use some weight training.

From Fox News:

“For dinner, Jameson, 44, says she prepares salmon in the oven with lemon, butter and dill around 5 p.m. and serves it with broccoli or asparagus.

Jameson also noted that she doesn’t mix meat and dairy because she eats Kosher, but says her followers should feel welcome to do so.The blonde bombshell, who welcomed daughter Batel Lu in April 2017, says that when she’s hungry, she eats, particularly because she’s breastfeeding — but that she makes it a point to avoid keto breads and snacks and focus solely on whole, organic foods.

The “How to Make Love Like a Porn Star” author has shared her weight loss progress for months.”

Source: Jenna Jameson shares keto diet tips after 80-pound weight loss | Fox News

Is this the diet she used?

Drug Therapy For Alzheimer’s Dementia Is Worse Than No Drug

dementia, memory loss, Mediterranean diet, low-carb diet, glycemic index, dementia memory loss

“Honey, let’s talk to doc about stopping those drugs.”

I commonly admit patients to the hospital who happen to be taking either Aricept or memantine (or both) in an effort to slow the cognitive decline of dementia. Aricept is a cholinesterase inhibitor, abbreviated ChEI below.

A meta-analysis published in November 2018 in JAMA Network suggests that folks taking those drugs have a more rapid cognitive decline compared to those who don’t. Moreover, the rate of decline for those taking memantine, with or without ChEIs, was faster than those receiving ChEIs only or receiving neither medication.

A typical dose of Aricept (donepezil) is 10 mg/day. The average wholesale price for that pill is $20.23 (USD). One brand of memantine is called Namenda, and the usual dose is 10 mg twice daily. Average wholesale dose for that is $17.80/day.  Take both those drugs daily for one month and it’s $1,140.90. Or $13,690.80 for a year. And that’s the wholesale price.

I can think of a few better uses of that money.

Admittedly, there must be individual patients that respond better than average to these drug, and some respond worse than average. You can’t tell in advance who those are.

Click the link below for the full study. From the Abstract:

Results

Across 10 studies, of 2714 participants, the mean (SD) age was 75.0 (8.2) years, 58% were female, and 9% were racial/ethnic minorities. There were 906 participants (33.4%) receiving ChEIs, 143 (5.3%) receiving memantine, 923 (34.0%) receiving both, and 742 (27.3%) receiving neither. Meta-analysis showed those receiving ChEIs or memantine were associated with significantly greater annual rate of decline on the ADAS-cog [a test of cognition] than those receiving neither medication (1.4 points/y; 95% CI, 0.1-2.7).

Conclusions and Relevance

Similar to observational studies, many participants in AD clinical trials receiving ChEIs or memantine experience greater cognitive decline. This difference is nearly as large as the hypothesized effect sizes of the treatments investigated in the trials. Concomitant use of ChEIs or memantine may be confounded with outcomes on the ADAS-cog and should be considered in design of clinical trials of potential therapeutic agents for AD. Post hoc analyses stratifying by ChEIs or memantine must be interpreted cautiously given the potential for confounding.

Source: Association of Concomitant Use of Cholinesterase Inhibitors or Memantine With Cognitive Decline in Alzheimer Clinical Trials: A Meta-analysis | Dementia and Cognitive Impairment | JAMA Network Open | JAMA Network

The Truth About Low-Protein, High-Carb Diets and Brain Aging

From Dr Georgia Edes:

“A new study conducted at the University of Sydney and published in the journal Cell Reports is inspiring headlines around the world, like this one: “Low-protein, high-carb diet may help ward off dementia”

In the study, scientists compared diets containing different amounts of protein and carbohydrate to a low-calorie diet. Their results suggested that diets lower in protein and higher in carbohydrate may, in some cases, provide subtle brain benefits similar to the benefits seen with calorie restriction. The researchers concluded, “A very low-protein, high-carbohydrate diet may be a feasible nutritional intervention to delay brain aging.”

Source: The Truth About Low-Protein, High-Carb Diets and Brain Aging | Psychology Today

This is ground-breaking research if you’re a mouse.

Keeping Alzheimer’s Disease at Bay 

No surprise here:

“A review of studies that looked at the effect of the Mediterranean diet on long-term cognitive function established that people who adhered to this way of eating had less cognitive decline, had improvements in cognitive function, or were less likely to develop Alzheimer’s disease compared to people who did not stick to this diet. The Mediterranean diet emphasizes fruits, vegetables, whole grains, beans, nuts, fish and olive oil, with lesser amounts of poultry and cheese and limited amounts of red meat and sweets.”

Source: Keeping Alzheimer’s Disease at Bay – Diabetes Self-Management

Very Low Calorie Meal-Replacement Diets Seem to Be Making a Comeback

“Abstract

Objective

To test the effectiveness and safety of a total diet replacement (TDR) programme for routine treatment of obesity in a primary care setting.Design Pragmatic, two arm, parallel group, open label, individually randomised controlled trial.Setting 10 primary care practices in Oxfordshire, UK.

Participants 278 adults who were obese and seeking support to lose weight: 138 were assigned to the TDR programme and 140 to usual care. 73% of participants were re-measured at 12 months.Interventions The TDR programme comprised weekly behavioural support for 12 weeks and monthly support for three months, with formula food products providing 810 kcal/day (3389 kJ/day) as the sole food during the first eight weeks followed by reintroduction of food. Usual care comprised behavioural support for weight loss from a practice nurse and a diet programme with modest energy restriction.

Main outcome measures

The primary outcome was weight change at 12 months analysed as intention to treat with mixed effects models. Secondary outcomes included biomarkers of cardiovascular and metabolic risk. Adverse events were recorded.Results Participants in the TDR group lost more weight (−10.7 kg) than those in the usual care group (−3.1 kg): adjusted mean difference −7.2 kg (95% confidence interval −9.4 to −4.9 kg). 45% of participants in the TDR group and 15% in the usual care group experienced weight losses of 10% or more. The TDR group showed greater improvements in biomarkers of cardiovascular and metabolic risk than the usual care group. 11% of participants in the TDR group and 12% in the usual care group experienced adverse events of moderate or greater severity.

Conclusions

Compared with regular weight loss support from a practice nurse, a programme of weekly behavioural support and total diet replacement providing 810 kcal/day seems to be tolerable, and leads to substantially greater weight loss and greater improvements in the risk of cardiometabolic disease.”

Source: Doctor Referral of Overweight People to Low Energy total diet replacement Treatment (DROPLET): pragmatic randomised controlled trial | The BMJ

Another Reason to Drink Green Tea: Lower Incidence of Kidney Stones

In a Chinese population, green tea consumption was linked to 15-20% lower risk of kidney stones:

“During 319 211 and 696 950 person-years of follow up, respectively, 1202 men and 1451 women reported incident stones. Approximately two-thirds of men and one-quarter of women were tea drinkers at baseline, of whom green tea was the primary type consumed (95% in men, 88% in women). Tea drinkers (men: hazard ratio 0.78, 95% confidence interval 0.69-0.88; women: hazard ratio 0.8, 95% confidence interval 0.77-0.98) and specifically green tea drinkers (men: hazard ratio 0.78, 95% confidence interval 0.69-0.88; women: hazard ratio 0.84, 95% confidence interval 0.74-0.95) had lower incident risk than never/former drinkers. Compared with never/former drinkers, a stronger dose-response trend was observed for the amount of dried tea leaf consumed/month by men (hazard ratiohighest category 0.67, 95% confidence interval 0.56-0.80, Ptrend  < 0.001) than by women (hazard ratiohighest category 0.87, 95% confidence interval 0.70-1.08, Ptrend  = 0.041).

CONCLUSIONS:Green tea intake is associated with a lower risk of incident kidney stones, and the benefit is observed more strongly among men.”

Source: Green tea intake and risk of incident kidney stones: Prospective cohort studies in middle-aged and elderly Chinese individuals. – PubMed – NCBI