Posted onMarch 12, 2020|Comments Off on #OrnishDiet Beats Mediterranean as Best Heart-Healthy Diet of 2020?
Pulmonary artery arrow is wrong
From Cardiovascular Business:
The Mediterranean diet has been eclipsed as the U.S. News & World Report’s best-ranked heart-healthy diet for the first time in a decade, nudged out of the top spot by the popular Ornish diet.
The Ornish diet—also ranked as the ninth-best overall diet in the 2020 report—was pioneered by physician Dean Ornish more than 40 years ago and restricts the consumption of fats, refined carbohydrates and animal proteins. It also emphasizes the importance of exercise and stress management in living healthfully.
I’ve always associated the Ornish diet with group therapy, meditation, and vegetarianism. But no mention of those in the linked article. I can’t remember the last time I met anybody doing the Ornish diet, it’s been that long. It was popular in the 1990s.
Steve Parker, M.D.
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Posted onMarch 11, 2020|Comments Off on Low-Carb Diet May Help Your Knee Arthritis, Regardless of Weight Loss
Photo credit: Steven Paul Parker II
Dr Ken Berry published at YouTube a 4-minute video on a diet he believes will lessen the effects and incidence of knee osteoarthritis. For men, the lifetime risk of developing knee osteoarthritis is 40%. For women, 47%. The effects of arthritis are pain and impaired functional status. The title of the video even mentions reversing arthritis. I suppose improved pain and functional ability would be at least a partial reversal.
In short, Dr Berry suggests a diet free of all sugar (no mention of fruits), all grains, and all vegetable oils.
The twenty-one study participants were folks with knee osteoarthritis between 65 and 75-years-old. Nine men, 12 women. Average baseline weight was 194 lb (88 kg). The 21 participants were randomly assigned to one of three diets they would follow for 12 weeks:
L0w-carb diet group (8 participants). Restricted daily total carbohydrates (not net carbs) to 20 grams or less for the first three weeks. Then could go up to 40 grams “if required” (not explained). No fat or protein or calorie restriction. Limited amount of vegetables were OK (e.g., 2 cups/day of leafy greens, 1 cup of non-starchy vegetables). Carb-free sweeteners (stevia, sucralose) were allowed but maltodextrin-containing sweeteners were limited (stevia, sucralose, aspartame, saccharin). This group had no drop-outs.
Low-fat diet group (6 participants). 800–1,200 calories/day. It looks like the men were put on reduced calorie diets—500 cals under estimated baseline or maintenance calories. Women’s calories were reduced by 250-300/day from baseline. Calories were reduced mainly through reduction of fats. They ate veggies, fruit, low-fat foods, whole grains, low-fat dairy, and limited cholesterol and saturated fats. Macronutrient distribution: 60% of calories from carb, 20% from protein, 20% from fat. (Yet Table 1 indicates 50–67 g of fat/day. Twenty percent of 1,200 of calories is only 27 g of fat. So misprint in table 1?) This group had one drop-out.
Control group (N=7), eating as per their usual routine although given documents on portion control. Two drop-outs.
The authors indicate that groups 1 and 2 ate about 100 g of protein/day.
All participants filled out surveys documenting knee pain levels and were put through periodic supervised tests like a timed walk and repeatedly arising from a chair with their hands placed on opposite shoulders.
Results
The low-carb diet group is the only one that demonstrated decreased pain intensity and unpleasantness in some functional pain tasks. In other words, improved quality of life.
The low-carb group lost an average of 20 lb (9 kg) compared to the low-fat weight loss of 14 lb (6.5 kg), not a statistically significant difference. Even the control group lost 4 lb (1.8 kg).
A blood test—thiobarbituric acid reactive substances or TBARS—indicated reduced oxidative stress in the low-carb dieters.
The authors hypothesize that the improvement in arthritis pain in the low-carb group was related to the reduction in oxidative stress, which reduces pain and inflammation.
Will these old knees make it up Humprheys Peak one more time?
Implications
With so few participants, you know this was a pilot study that ultimately may not be entirely valid or replicable. But it’s promising. Next, we need a study with 150 participants.
Dr Berry is getting a bit ahead the the science here. He gives a powerful personal testimony in his video. And perhaps he’s seen many of his patients improve their arthritis with a very low-carb diet.
The carb consumption of the low-carb dieters would be ketogenic in most folks. Yet I didn’t even see “ketogenic” in their report. Perhaps because they didn’t measure ketone levels?
The authors of the report mention other studies finding improvement of osteoarthritis pain and inflammation by the Mediterranean diet. The Mediterranean diet even helps rheumatoid arthritis.
How about combining a very low-carb and Mediterranean diet? As in my Ketogenic Mediterranean Diet. If you have the funds to run the study, I can probably get you a nice discount on books. Have your people contact my people.
Given the safety of very low-carb diets, I can’t argue against a 12-week trial if you have bothersome knee osteoarthritis. Get your doctor’s clearance first.
Steve Parker, M.D.
References:
Strath LJ, et al. The effect of low-carbohydrate and low-fat diets in individuals with knee osteoarthritis. Pain Medicine, 21(1), 2020, pp 150-160.
Oliviero, F, et al. How the Mediterranean diet and some of its components modulate inflammatory pathways in arthritis. Swiss Med Wkly, 2015; 145; w14190.
Veronese, N, et al. Adherence to the Mediterranean diet is associated with better quality of life: Data from the Osteoarthritis Initiative. American Journal of Clinical Nutrition 2016: 104(5): 1403-9.
McKellar, G. et al. A pilot study of a Mediterranean-like diet intervention in female patients with rheumatoid arthritis living in areas of social deprivation in Glasgow. Ann Rheum Dis 2007;66(9):1239-43.
Slöldstam, LB, et al. Weight reduction is not a major reason for improvement in rheumatoid arthritis from lacto-vegetarian, vegan or Mediterranean diets. Nutr J 2005;4(15).
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Posted onMarch 11, 2020|Comments Off on Stop Taking Lorcaserin: Drug Linked to Cancer
Don’t blame her
From the U.S. Food and Drug Administration:
ISSUE: FDA has requested that the manufacturer of Belviq, Belviq XR (lorcaserin) voluntarily withdraw the weight-loss drug from the U.S. market because a safety clinical trial shows an increased occurrence of cancer. The drug manufacturer, Eisai Inc,. has submitted a request to voluntarily withdraw the drug. When FDA approved lorcaserin in 2012, we required the drug manufacturer to conduct a clinical trial to evaluate the risk of cardiovascular problems. A range of cancer types was reported, with several different types of cancers occurring more frequently in the lorcaserin group, including pancreatic, colorectal, and lung.
BACKGROUND: In January 2020, FDA announced we were reviewing clinical trial data and alerted the public about a possible risk of cancer associated with lorcaserin based on preliminary analysis of the data.
RECOMMENDATION: PatientsPatients should stop taking lorcaserin and talk to your health professionals about alternative weight-loss medicines and weight management programs.
Posted onMarch 10, 2020|Comments Off on Three Ways to Reduce Your Risk of Fatty Liver
Where does bile come from? The liver.
I found this study a while back. TL;DR: Physical activity, the Mediterranean diet, and legume consumption are linked to lower incidence of liver fat. At least in a Spanish population with metabolic syndrome.
Abstract
Objective
Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver morbidity. This condition often is accompanied by obesity, diabetes, and metabolic syndrome (MetS). The aim of this study was to evaluate the connection between lifestyle factors and NAFLD in individuals with MetS.
Methods
A cross-sectional study with 328 participants (55–75 y of age) diagnosed with MetS participating in the PREDIMED-Plus trial was conducted. NAFLD status was evaluated using the non-invasive hepatic steatosis index (HSI). Sociodemographic, clinical, and dietary data were collected. Adherence to the Mediterranean diet (mainly assessed by the consumption of olive oil, nuts, legumes, whole grain foods, fish, vegetables, fruits, and red wine) and physical activity were assessed using validated questionnaires.
Results
Linear regression analyses revealed that HSI values tended to be lower with increasing physical activity tertiles (T2, β = –1.47; 95% confidence interval [CI], –2.73 to –0.20; T3, β = –1.93; 95% CI, –3.22 to –0.65 versus T1, Ptrend = 0.001) and adherence to the Mediterranean diet was inversely associated with HSI values: (moderate adherence β = –0.70; 95% CI, –1.92 to 0.53; high adherence β = –1.57; 95% CI, –3.01 to –0.13 versus lower, Ptrend = 0.041). Higher tertiles of legume consumption were inversely associated with the highest tertile of HSI (T2, relative risk ratio [RRR], 0.45; 95% CI, 0.22–0.92; P = 0.028; T3, RRR, 0.48; 95% CI, 0.24–0.97; P = 0.041 versus T1).
Conclusion
Physical activity, adherence to the Mediterranean diet, and consumption of legumes were inversely associated with a non-invasive marker of NAFLD in individuals with MetS. This data can be useful in implementing precision strategies aimed at the prevention, monitoring, and management of NAFLD.
Posted onMarch 4, 2020|Comments Off on Ketogenic Mediterranean Diet Improves Psoriasis
What an odd study I found…
Abstract
Objectives
Very low-calorie ketogenic diet (VLCKD) has been associated with a significant reduction in visceral adipose tissue and ketone bodies likely possessing anti-inflammatory properties. We evaluated the efficacy of an aggressive WL [weight loss] program with a ketogenic induction phase as first-line treatment for chronic plaque psoriasis.
Research methods & procedures
Adult overweight/obese drug-naïve (never treated excluding use of topical emollients) patients (N=37; 30% males; age, 43.1±13.8 years) with stable chronic plaque psoriasis underwent a 10-week two-phase WL program consisting in a 4-week protein-sparing, VLCKD (<500 kcal/day; 1.2 grams of protein/kg of ideal body weight/day) and a 6-week balanced, hypocaloric (25-30 kcal/kg of ideal body weight/day), Mediterranean-like diet. The primary endpoint was the reduction in the Psoriasis Area and Severity Index (PASI) at week 10. Major secondary endpoints included: PASI50 and PASI75 response, reduction in body surface area (BSA) involved, improvement in itch severity (visual-analogue scale) and Dermatology Life Quality Index (DLQI) at week 10.
Results
With a mean body weight reduction of 12.0% (-10.6 kg), dietary intervention resulted in a significant reduction in PASI (baseline score, 13.8±6.9 [range, 7-32]): mean change, -10.6 [95%CI, -12.8 to -8.4] (P<0.001). A PASI50 and PASI75 response was recorded in 36 (97.3%) and 24 (64.9%) patients, respectively. Treatment resulted also in a significant reduction (P<0.001) in BSA [body surface area?] involved (-17.4%) and an improvement in itch severity (-33.2 points) and DLQI (-13.4 points).
Conclusions
In drug-naïve adult overweight patients with stable chronic plaque psoriasis an aggressive dietary WL program consisting in a very low-calorie ketogenic regimen followed by a balanced, hypocaloric Mediterranean-like diet appeared to be an efficacious first-line strategy for improving disease severity.
Posted onMarch 3, 2020|Comments Off on QOTD: James Thompson on Coronavirus Counter-Measures
If life is an IQ test, then dealing with pandemics is a high-priority item. Getting the right answer may save your life, so test-taking motivation ought to be high.
At first glance, the answer is obvious: avoid ill people, and if in doubt, avoid people. That ought to do it. Stay quietly in a room until the whole thing blows over. If you have the means, that room should be guarded on either side by fires. Such was the advice the Pope received during the Great Pestilence, and following it saved his life. Not everyone can afford such luxurious protection, but the principles are clear: since there must be a means of transmission, a blazing fire is likely to consume the noxious agent, whatever it is. As for visitors, they are to be kept away, preferably in a guarded place, like the ship they came in, moored at a safe distance for forty days, the Venetian quaranta giorni which worked well to protect them. Those inland principalities which harshly confined plague victims to die with their families in their bricked-up houses were able to save their other citizens. Tough governance. Forty days in the wilderness and the whole thing is over.
Posted onMarch 2, 2020|Comments Off on NO: Are medical errors really the third most common cause of death in the U.S.?
Hospitals are notorious for iatrogenic deaths
From Dr Gorski at Science Based Medicine (and he’s right):
I say this at the beginning of nearly every post that I write on this topic, but it bears repeating. It is an unquestioned belief among believers in alternative medicine and even just among many people who do not trust conventional medicine that conventional medicine kills. Not only does exaggerating the number of people who die due to medical complications or errors fit in with the world view of people like Gary Null and Joe Mercola, but it’s good for business. After all, if conventional medicine is as dangerous as claimed, then the quackery peddled by the likes of Adams and Mercola starts looking better in comparison. Unfortunately, there are a number of academics more than willing to provide quacks with inflated estimates of deaths due to medical error. The most famous of these is Dr. Martin Makary of Johns Hopkins University, who published a review (not an original study, as those citing his estimates like to claim) estimating that the number of preventable deaths due to medical error is between 250,000 and 400,000 a year, thus cementing the common (and false) trope that “medical error is the third leading cause of death in the US” into the public consciousness and thereby doing untold damage to public confidence in medicine. As I pointed out at the time, if this estimate were correct, it would mean that between 35% and 56% of all in-hospital deaths are due to medical error and that medical error causes between 10% and 15% of all deaths in the US. The innumeracy that is required to believe such estimates beggars the imagination.
Hazmat-suited healthcare worker in a decontamination shower
I hadn’t been too concerned about coronavirus (COVID-19), but then I read about quarantined towns in northern Italy. I’m still not terribly worried for my own health, even if I end up treating cases at the hospital. I’m 65—a risk factor for viral death—but otherwise healthy, thank God! There’s still a good chance this will blow over and not affect the U.S. in a major way.
BUT…
If coronavirus becomes an epidemic in the U.S., you will want to be prepared. You’ll want to avoid unnecessary contact with others, especially if you’re over 65 or have significant chronic medical conditions like heart disease, COPD, asthma, active cancer, impaired liver or kidney function, or a poor immune system (e.g, cancer chemotherapy).
If your city or neighborhood is quarantined, will supply trucks be allowed through the checkpoints? Will drivers be willing to enter the quarantine zone? I’ve started to call Wal-Mart, “China-Mart.” Because is it seems like at least half the goods there are made in China. China’s industrial output has already been reduced by the coronavirus epidemic there. A significant number of prescription drugs in the U.S. depend on a healthy China.
Post-viral apocalypse? Raccoon City?
A severe coronavirus outbreak in the U.S. might mean you need to hunker down at home, or close to it, for one or two months. So consider stocking up on the following items to last for 4–6 weeks. The good new is, you’ll eventually use most of this anyway.
various foods with a long shelf-life
face masks (you’re too late; this ship has already sailed)
toilet paper
paper towels
over-the-counter cold and flu remedies
acetaminophen
ibuprofen
throat lozenges
antiseptic wipes
toothpaste
a multivitamin
hand sanitizer
facial tissues
important prescription medicines (you may need to call your doctor for a three-month supply)
body soap
dishwashing and clothing detergents
feminine hygeine products
household cleaning products
Have I missed anything?
Steve Parker, M.D.
Update on March 3, 2020: hand sanitizer (60+% alcohol)
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Posted onFebruary 26, 2020|Comments Off on What’s the Best Diet to Combat Non-Alcoholic Fatty Liver Disease (NAFLD)?
Stages of liver damage. Healthy, fatty, liver fibrosis, and finally cirrhosis
A recent article in Gastroenterology Clinics suggests this one:
•Prioritize intact starches such as brown rice, quinoa, and steel-cut oats, and limit or avoid refined starches such as white bread and white rice
•Replace some of the CHO [carbohydrate], especially refined CHO, in the diet with additional protein from a mixture of animal or vegetable sources, including chicken, fish, cheese, tofu, and pulses
•Include a variety of bioactive compounds in the diet by consuming fruits, vegetables, coffee, tea, nuts, seeds, and extra virgin olive oil
•Get most fat from unsaturated sources, such as olive oil (ideally extra virgin), rapeseed oil, sunflower oil, safflower oil, canola oil, or nuts and seeds
•Limit or avoid added sugars, whether sucrose, fructose, maltose, maltodextrin, or any syrups. If any of these words appear in the first 3–5 ingredients of any food item, it is best to avoid that item and choose a no-sugar version instead. Examples are yogurts and commercial cereals•In particular, avoid liquid sugar such as carbonated sugary drinks/sodas, lemonade, any juices, smoothies, and added sugar to tea and coffee
See the article for a typical daily menu. Looks like a Mediterranean diet to me.
Excessive fructose and saturated fatty acid consumption appear to be particularly harmful to the liver.
The authors also seem to endorse exercise: 150 t0 300 minutes per week of moderate- to vigorous intensity aerobics exercise, performed at least thrice weekly.
And all experts recommend loss of excess fat weight.
If you really want to get into the weeds, click the link above to read about how fat deposits in liver and muscle lead to metabolic inflexibility, resulting in insulin resistance and mitochondrial dysfunction, which alters lipid metabolism, releasing free fatty acids (some of which are lipotoxic), leading to lipotoxic molecules (like ceramides), causing inflammation and fibrosis.
Steve Parker, M.D.
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Posted onFebruary 22, 2020|Comments Off on Despite $10,000 per person per year, U.S. still not getting its money’s worth in healthcare
From UPI Jan. 31, 2020:
Despite spending far more on health care than other wealthy nations, the United States has the lowest life expectancy and the highest suicide rate, new research shows.
For the study, researchers at The Commonwealth Fund compared the United States with 10 other high-income nations in the Organization for Economic Cooperation and Development (OECD)—Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland and the United Kingdom—and with the average for all 36 OECD nations.
In 2018, the United States spent almost 17 percent of its gross domestic product (GDP) on healthcare. That’s more than any other high-income country and twice the overall OECD average. For example, New Zealand and Australia spent 9 percent of GDP on healthcare.
U.S. healthcare spending now tops $10,000 per person, and much of it is driven by private insurance costs such as premiums, according to The Commonwealth Fund report published online Jan. 30.
Advanced Mediterranean Diet 