Category Archives: Uncategorized

Wealth Inequality In the U.S.: It’s a Problem

From The Big Picture (emphasis added):

Yes, America is wealthier than ever, especially if you are in the top 10% of households. The Fed [Federal Reserve] found that the top 1% of American households held wealth of $32.5 trillion. That works out to be an average household asset value of about $25 million each. The rest of the top 10% (90th to 99th wealth percentiles) held total wealth of $42.8 trillion. Add the top 1% to this group and we get a total of $75.3 trillion, with an average household wealth of $5.8 million. To be sure, this is an average and is skewed by the enormous wealth of those at the very top; the median, or midpoint, would be lower.

The next 40% (50th to 90th percentiles) has total assets of $35.3 trillion. The 63.8 million households in the top half of America have average household total wealth of $1.72 million apiece. Note this does not include liabilities such as mortgages, student loans, consumer credit, which offsets some of this.

Where things get interesting is when we look at the bottom 50% of households in America by wealth. They own total assets of $6.86 trillion. That reflects wealth (before liabilities) of a mere $107,523 per household.Let’s dig a bit deeper: The top decile of America holds almost about 70% of the national wealth — 31% is held by the top 1%, while the rest of the top 10% holds about 39%.

Source: Wealth Distribution Analysis – The Big Picture

Is Subclinical Hypothyroidism Real and Should It Be Treated?

From JAMA Network:

Subclinical hypothyroidism is common [up to 10% of adults] and most individuals can be observed without treatment. Treatment might be indicated for patients with subclinical hypothyroidism and serum thyrotropin [TSH]  levels of 10 mU/L or higher or for young and middle-aged individuals with subclinical hypothyroidism and symptoms consistent with mild hypothyroidism.

Source: Subclinical Hypothyroidism: A Review | Cardiology | JAMA | JAMA Network

Steve Parker MD, Advanced Mediterranean Diet

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Low-Carb, High-Fat Diet Improves Metabolic Syndrome Even Without Weight Loss

My monitor works well

“Metabolic syndrome” may be a new term for you. It’s a collection of clinical features that are associated with increased future risk of type 2 diabetes and atherosclerotic complications such as heart attack and stroke. One in six Americans has metabolic syndrome. Diagnosis requires at least three of the following five conditions:

  • high blood pressure (130/85 or higher, or using a high blood pressure medication)
  • low HDL cholesterol:  under 40 mg/dl (1.03 mmol/l) in a man, under 50 mg/dl (1.28 mmol/l) in a women (or either sex taking a cholesterol-lowering drug)
  • triglycerides over 150 mg/dl (1.70 mmol/l) (or taking a cholesterol-lowering drug)
  • abdominal fat:  waist circumference 40 inches (102 cm) or greater in a man, 35 inches (89 cm) or greater in a woman
  • fasting blood glucose over 100 mg/dl (5.55 mmol/l)

One approach to improving the numbers is a LCHF diet. Here’s a journal article abstract from JCI Insight:

BACKGROUND. Metabolic syndrome (MetS) is highly correlated with obesity and cardiovascular risk, but the importance of dietary carbohydrate independent of weight loss in MetS treatment remains controversial. Here, we test the theory that dietary carbohydrate intolerance (i.e., the inability to process carbohydrate in a healthy manner) rather than obesity per se is a fundamental feature of MetS.

METHODS. Individuals who were obese with a diagnosis of MetS were fed three 4-week weight-maintenance diets that were low, moderate, and high in carbohydrate. Protein was constant and fat was exchanged isocalorically for carbohydrate across all diets.

RESULTS. Despite maintaining body mass, low-carbohydrate (LC) intake enhanced fat oxidation and was more effective in reversing MetS, especially high triglycerides, low HDL-C, and the small LDL subclass phenotype. Carbohydrate restriction also improved abnormal fatty acid composition, an emerging MetS feature. Despite containing 2.5 times more saturated fat than the high-carbohydrate diet, an LC diet decreased plasma total saturated fat and palmitoleate and increased arachidonate.

CONCLUSION. Consistent with the perspective that MetS is a pathologic state that manifests as dietary carbohydrate intolerance, these results show that compared with eucaloric high-carbohydrate intake, LC/high-fat diets benefit MetS independent of whole-body or fat mass.

TRIAL REGISTRATION. ClinicalTrials.gov Identifier: NCT02918422.

FUNDING. Dairy Management Inc. and the Dutch Dairy Association.

Source: JCI Insight – Dietary carbohydrate restriction improves metabolic syndrome independent of weight loss

Steve Parker, M.D.

Steve Parker MD, Advanced Mediterranean Diet

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Will Healthcare Providers Be There for You When Ebola Breaks Out in the U.S.?

Hazmat-suited healthcare worker in a decontamination shower

Don’t count on nurse Aesop. I’m sure he’s not alone. Few healthcare providers got into the business to put their lives on the line every day. The Ebola virus is highly contagious and often lethal. Prevention of the spread of Ebola to healthcare providers and the general population requires high-level isolation units. Aesop says there are only 15 such beds in the U.S. (He calls them BL-IV beds). There are zero at most hospitals and zero in most cities.

We aren’t set up for this [virus], and we’re doing nothing to stop it getting here (rather the opposite in fact).

And when it does, after those first 15 beds are occupied, we’ve done nothing anywhere close to adequate to handle things properly and nip it in the bud.

But everyone in charge pretends we’ve done exactly that, when nothing could be further from the truth.

Maybe you can bullshit the Low Information Viewers in flyover country, but you can’t bullshit me or countless other doctors, nurses, and ancillary staff who’ll be on the frontlines (for about 20 seconds, in my case) before we drop our clipboards where we’re standing, and head for the parking lot.

I may make a bullshit excuse about not feeling well, I may pass off report on my patients to someone else who stays, but go I will, and I mean within minutes.

I can’t collect paychecks at Forest Lawn [cemetery], and I won’t be helping anyone shitting my intestines into my scrub pants, and both of those are slam-dunk outcomes with the present (and perpetual) half-assed level of preparedness for Ebola or any one of 27 other pandemic-worthy infections at every hospital (but for a small part of a bare few) from Anchorage to Miami, and Maine to Hawaii.

Anyone wants to go to medical or nursing school, and go work on the frontlines of Ebola with WHO or the CDC, rolling the dice you’ll live to retirement every time you scrub in or out, operators are standing by. (When every hospital has an actual 24/7 BL-IV capability, and staffs and supplies and trains for its use regularly – by which I mean more than once a year or three to salve their own charred consciences and pen-whip JCAHO’s lackadaisical clipboard commandos – we can talk. Otherwise: F**K that noise. Sideways, with a rusty chainsaw.)

In such an epidemic, there is no such thing as a valiant death.There’s just death.

I’ll do my damnedest to save your life if you come into my ER.

But I won’t kill myself to do it, and I won’t die for you because TPTB [the powers that be] at every level are too half-assed and cheapskate to prepare for this as if it was Really A Thing, too stupid to know that, and too evil to care. That ain’t in my contract, and unlike joining the Marines, I took no such oath, and it isn’t part of the deal.

I don’t know how many out of 4,000,000 medical practitioners will be that honest and tell you that up front.

I just did.

Source: Raconteur Report: Where The Problem Is

Have a great day! 🙂

Steve Parker, M.D.

Steve Parker MD, Advanced Mediterranean Diet

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The Uncertainty Of Nutrient Absorption

 

IMG_2935From Bix, the Fanatic Cook…

It is just about impossible to anticipate how much, say, calcium we will absorb from a meal or a pill. It depends upon a number of variables which themselves can be difficult to measure, including but not limited to: our calcium status, how much calcium is in the meal or pill, what the calcium is bound to, how acidic the internal environment is, what our vitamin D status is, how much of the calcium binding protein is in place, how much of and what type of fiber is present, the presence of other divalent cations like zinc or magnesium, the condition of the intestinal brush border.

The amount of calcium (or any nutrient, I’m using calcium as an example) consumed and the amount absorbed is not a linear relationship. That is, eating 100 mg of calcium does not mean 100 mg gets absorbed. One thing that is known – the more calcium we eat, the less we absorb; and the less we eat, the more we absorb.

***

Compounding the uncertainty, nutrient content varies within food – the same type of food. In this study:

Calcium and Magnesium Concentration of Inbred and Hybrid Broccoli Heads, Journal of the American Society for Horticultural Science, 2000

Farnham et al. found significant variability among broccoli varieties for calcium and magnesium. Broccoli purchased at random across the US varied by as much as 2-fold for these elements.

Here’s a study that shows almost a three-fold difference in calcium content among several varieties of kale and collards. It also shows significant year-to-year variability for the same variety:

Variability In Elemental Accumulations Among Leafy Brassica Oleracea Cultivars And Selections, Journal of Plant Nutrition, 2005

And yet, data bases and nutrient tables give calcium content in a cup of cooked kale to 2 decimal places!

Source: The Uncertainty Of Nutrient Absorption | Fanatic Cook

A practical guide to the Mediterranean diet – Harvard Health Blog – Harvard Health Publishing

From the Harvard Health blog:

“The Mediterranean diet has received much attention as a healthy way to eat, and with good reason. The Mediterranean diet has been shown to reduce risk of heart disease, metabolic syndrome, diabetes, certain cancers, depression, and in older adults, a decreased risk of frailty, along with better mental and physical function. In January, US News and World Report named it the “best diet overall” for the second year running.”

Source: A practical guide to the Mediterranean diet – Harvard Health Blog – Harvard Health Publishing

Steve Parker MD, Advanced Mediterranean Diet

Two diet books in one

The Secret of Weight Loss, and the Source of Coke Syrup 

From Wilder, Wealthy, and Wise…

“Humanity’s most complicated machines can’t even come close to the versatility that is a human:  if your car were able to fuel itself like a person, you’d be able to feed it gasoline or junk mail or plastic bags and it would turn that into a trip to Cleveland leaving only carbon dioxide and water vapor exhaust gas, and some form of car-poop that you presumably would compost so you could grow more car food.  Oh, and the car would self-repair for decades – your tires would grow back in the middle of the night.  Unfortunately your car would try to pick up on other cars, and might identify as a truck, but that’s a longer story.

The human body is excellently designed, and very, very consistent in its response to inputs.  But the owner’s manual sucks, and many times we don’t operate it properly or fuel it very well.  Case in point – achieving excellent health requires measurement.  Of what?  Unless you’re an adolescent reading this, you’re not getting taller.  What parameter might be changing that you could measure, say, every day?  Besides armpit hair length.  That’s too obvious, and everyone does that, anyway.  Think harder.

Oh, yes!  Weight!”

Source: Maps, the Secret of Weight Loss, and the Source of Coke Syrup – Wilder, Wealthy, and Wise