12 Years Later: Does Gastric Bypass Still Work?

Posted on October 2, 2017 | Comments Off on 12 Years Later: Does Gastric Bypass Still Work?

Type 2 diabetes remission persisted in half the surgical patients. Rates of high blood pressure and bad lipid numbers were also better in the surgical patients.

“The follow-up rate exceeded 90% at 12 years. The adjusted mean change from baseline in body weight in the surgery group was −45.0 kg (95% confidence interval [CI], −47.2 to −42.9; mean percent change, −35.0) at 2 years, −36.3 kg (95% CI, −39.0 to −33.5; mean percent change, −28.0) at 6 years, and −35.0 kg (95% CI, −38.4 to −31.7; mean percent change, −26.9) at 12 years; the mean change at 12 years in nonsurgery group 1 was −2.9 kg (95% CI, −6.9 to 1.0; mean percent change, −2.0), and the mean change at 12 years in nonsurgery group 2 was 0 kg (95% CI, −3.5 to 3.5; mean percent change, −0.9). Among the patients in the surgery group who had type 2 diabetes at baseline, type 2 diabetes remitted in 66 of 88 patients (75%) at 2 years, in 54 of 87 patients (62%) at 6 years, and in 43 of 84 patients (51%) at 12 years. The odds ratio for the incidence of type 2 diabetes at 12 years was 0.08 (95% CI, 0.03 to 0.24) for the surgery group versus nonsurgery group 1 and 0.09 (95% CI, 0.03 to 0.29) for the surgery group versus nonsurgery group 2 (P<0.001 for both comparisons). The surgery group had higher remission rates and lower incidence rates of hypertension and dyslipidemia than did nonsurgery group 1 (P<0.05 for all comparisons).

CONCLUSIONSThis study showed long-term durability of weight loss and effective remission and prevention of type 2 diabetes, hypertension, and dyslipidemia after Roux-en-Y gastric bypass. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others.)”

Source: Weight and Metabolic Outcomes 12 Years after Gastric Bypass — NEJM

Before resorting to surgery, try the Advanced Mediterranean Diet (2nd Ed.).

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Mediterranean diet linked to lower risk for gallbladder removal surgery

Posted on October 2, 2017 | Comments Off on Mediterranean diet linked to lower risk for gallbladder removal surgery

“A high score of the Mediterranean diet was associated with 11% reduced risk of cholecystectomy,” the researchers wrote.“Women at risk of gallbladder disease should follow simple preventive measures to reduce the high costs and morbidity associated with complications of gallbladder disease,” Barré said.

Source: Mediterranean diet linked to lower risk for gallbladder removal surgery

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Higher Blood Magnesium Levels Linked to Lower Incidence of Hypertension, Cardiovascular Disease, and Type 2 Diabetes

Posted on October 2, 2017 | Comments Off on Higher Blood Magnesium Levels Linked to Lower Incidence of Hypertension, Cardiovascular Disease, and Type 2 Diabetes

From the abstract of a recent meta-analysis:

“Magnesium (Mg) is the second most predominant intracellular electrolyte, following after potassium. Mg serves as an important cofactor in many essential enzymatic reactions involved in glucose metabolism and several essential physiological processes, including modulating vascular smooth muscle tone and endothelial cell function. The role of Mg in the development and progress of T2DM and cardiovascular diseases (CVD) has drawn researchers’ attention in the recent decades. Several large prospective cohort studies have shown that low Mg intake is associated with incidence of T2DM and CVD. Notably, because Mg intake was usually assessed based on self-administered food frequency questionnaires, misclassification is inevitable. In addition, dietary Mg could not represent the accurate amount of Mg intake without considering the substantial loss during food processing and cooking. Moreover, the health impact of Mg is difficult to be distinguished from intake of other nutrients such as calcium, potassium, phosphorus, and fiber.”

Source: Circulating magnesium levels and incidence of coronary heart diseases, hypertension, and type 2 diabetes mellitus: a meta-analysis of prospective cohort studies | Nutrition Journal | Full Text

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Trek Report: Humphreys Peak 2017

Posted on September 17, 2017 | Comments Off on Trek Report: Humphreys Peak 2017

Humphreys Peak on the left

The latter half of life is a battle with aging and gravity. We all eventually lose the war, but I’m not ready to give up the fight. Physical fitness is a powerful tactic in that war. For me, hiking is one way to get and stay fit. Mountain climbing, and the preparation therefor, pushes me to greater levels of fitness.

Scruffy little guy

I walked this route to Arizona’s highest point two years ago. Read that report for typical details. The post today is more personal and helps me plan my next climb, if any. A goal of mine for decades has been to climb one of the 14,000 foot peaks in Colorado, like Longs Peak. At my age, 62, that’s probably too ambitious. However, per Infogalactic: “The oldest person to summit Longs Peak was Rev. William “Col. Billy” Butler, who climbed it on September 2, 1926, his 85th birthday.”

Tundra plants above the tree line

I usually label posts like this a “hike report.” But I found one definition of trek as “a trip or movement especially when involving difficulties or complex organization : an arduous journey.” That’s more accurate here than a simple “hike.”

A view from about 10,000 ft

Miscellaneous Details

Two years ago I wrote that if I ever did this hike again, I’d want to acclimate to the altitude first, by spending 4–5 days in the Flagstaff area at 7,000 feet. Family obligations precluded that this year. We came up a day early and took the ski lift up to 11,000 feet, spending about an hour there. We then spent the night in Flagstaff at Sonesta ES Suites (very nice, and less expensive than many other hotels in the area). I slept fitfully, probably because of the altitude. I wonder if Diamox would have helped me sleep better.

A fire near Kendrick Peak

I started on the trail on June 20 at 7 AM and finished at 4:30 PM, so nine and a half hours. If you read trip reports from younger or more avid hikers, six to eight hours is more typical.

I am Groot

Trailhead temperature at the start was 65°F. I was in shorts and a tee shirt the whole day. Even in the afternoon, it can be much colder on the Peak, so you have to be prepared for that. I was too warm for much of this trip, so if I do it again it may be in mid-May instead of June.

Same fire

I drank four quarts (one gallon) on the trail. I ate six orange-colored peanut butter cracker sandwiches, four ounces of leftover Sizzler steak, and dried banana and apple slices.

A view from the Saddle

The hip belt on my backpack did a great job of taking some of the weight off my shoulders. I should have used this more during my training hikes.

On the way from the Saddle to the peak

From the trailhead to the Saddle took four hours. The reverse took 2.5 hrs.

I was surprised that my walk between the Peak and the Saddle took the same amount of time whether I was ascending or descending. About an hour and 15 minutes to cover the mile.

The Peak was covered with thousands of flying gnats. They didn’t bite much so I just ignored them and got off the Peak immediately after taking pictures.

I did it!

It’s easy to lose the trail as you’re heading up at a particular switchback at approximately 11,000 feet. See the photos below for details. This is dangerous, and whoever is in charge of trail maintenance needs to fix it before catastrophe strikes. I lost the trail and searched for it for 10 minutes before finding where I lost it. I was ready to give up and head down the hill when a couple from Prescott, AZ, showed up and pointed me in the right direction. Smooth sailing from then on. Nearly everywhere the trail is easy to see.

Turn left immediately after you pass the log jutting out. From this view going up the hill, the log hides the true trail. We need a sign here. 

Yes, walk up the right side of this log!

This is the view of this log as you’re descending. Very easy to see trail.

I did this on a weekday, so there were not nearly as many folks on the trail as when I did a weekend trek two years ago. If you hike this on a summer weekend, get there early or you may not have a place to park.

There were patches of snow on the ground as low as 10,000 feet. Very unusual for this time of year.

I’m at the Saddle

At the start of the hike and even half-way into it, I put my odds of success—reaching the summit—at 50:50. It’s up to me whether I sprain an ankle or break a bone, but it’s up to God whether I get altitude sickness or have a heart attack or stroke. My biggest doubts were inadequate preparation and my patellofemoral pain (PFP) syndrome. My last training hike was on June 3, and the day after that I was resigned to calling off the trip entirely. Part of me was willing to try it, but my smarter side said it wasn’t worth possible permanent knee injury or 6–12 months of disability and rehabilitation. But by June 14 the knee was feeling much better so I decided to forge ahead. After this trek, I was  done hiking for the summer and expected the knee to be back to normal within the subsequent 3–4 weeks even without rehab or NSAIDs. But it took three months.

Tundra flowers

That last mile to the Peak was not as arduous as it was two years ago. I’m not sure if that’s psychological, or attributable to better hydration, better nutrition or pacing. I consciously kept my pace slow on the way up, averaging one to one and a half miles per hour (don’t be critical; this includes breaks for hydration, food, rest, and photos). I’ll keep this slow pace next time.

Don’t be so focused on the peak that you forget to look around

Overall, I think I was in the same state of physical conditioning as I was two years ago. I had no muscular soreness the day after the hike.

I had no trouble with altitude sickness.

Flagstaff

This is the home of Northern Arizona University, a typical small college town. The main drag is Milton Road. I love visiting here. I almost took a job here until I learned that the average daily low temperature is 32°F or below for seven months out of the year. We are “horse people” and didn’t think the low temps were a good fit.

Free Hiking Tips

Obvious dangers to consider on a trek like this: dehydration, rain, sleet, hail, lightning, heat exhaustion, sun over-exposure. Bears and mountain lions don’t seem to be problems on Mt. Humphreys, although bears are certainly in the area.

A less obvious but more common danger is missteps. You always have to be on the lookout for rocks and tree roots that can trip you or sprain your ankle. Particularly treacherous are flat rock surfaces coated with gravel or dust; these can be nearly as slick as ice. In the wilderness, a bad ankle sprain, lower limb fracture, or torn knee ligament or meniscus can put your life at risk, particularly if you’re by yourself. Missteps are more likely to occur when you’re tired.

In the wilderness, keep track of your location constantly, either with a map or GPS unit or both. Yes, GPS units can malfunction and batteries die. If you’re on an established trail but suddenly find yourself off it, stop going forward immediately and try to find the trail. Don’t panic. If you get hopelessly lost, a personal transmitter could save your life. Before your trip, let someone know where you’re going, on which trails, and when you’re expected to be back in civilization. Tell them to expect your call when done. Hike with a pal when able.

Steve Parker, M.D.

 

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PURE Study: Higher Carb Consumption Linked to More Deaths

Posted on September 12, 2017 | Comments Off on PURE Study: Higher Carb Consumption Linked to More Deaths

Here’s the abstract of a new epidemiological study that investigated the relationships between diet, cardiovascular disease, and death rates. I don’t have the entire article. My sense is that the 18 countries studied are mostly non-Western:

Background

The relationship between macronutrients and cardiovascular disease and mortality is controversial. Most available data are from European and North American populations where nutrition excess is more likely, so their applicability to other populations is unclear.

Methods

The Prospective Urban Rural Epidemiology (PURE) study is a large, epidemiological cohort study of individuals aged 35–70 years (enrolled between Jan 1, 2003, and March 31, 2013) in 18 countries with a median follow-up of 7·4 years (IQR 5·3–9·3). Dietary intake of 135 335 individuals was recorded using validated food frequency questionnaires. The primary outcomes were total mortality and major cardiovascular events (fatal cardiovascular disease, non-fatal myocardial infarction, stroke, and heart failure). Secondary outcomes were all myocardial infarctions, stroke, cardiovascular disease mortality, and non-cardiovascular disease mortality. Participants were categorised into quintiles of nutrient intake (carbohydrate, fats, and protein) based on percentage of energy provided by nutrients. We assessed the associations between consumption of carbohydrate, total fat, and each type of fat with cardiovascular disease and total mortality. We calculated hazard ratios (HRs) using a multivariable Cox frailty model with random intercepts to account for centre clustering.

Findings

During follow-up, we documented 5796 deaths and 4784 major cardiovascular disease events. Higher carbohydrate intake was associated with an increased risk of total mortality (highest [quintile 5] vs lowest quintile [quintile 1] category, HR 1·28 [95% CI 1·12–1·46], ptrend=0·0001) but not with the risk of cardiovascular disease or cardiovascular disease mortality. Intake of total fat and each type of fat was associated with lower risk of total mortality (quintile 5 vs quintile 1, total fat: HR 0·77 [95% CI 0·67–0·87], ptrend<0·0001; saturated fat, HR 0·86 [0·76–0·99], ptrend=0·0088; monounsaturated fat: HR 0·81 [0·71–0·92], ptrend<0·0001; and polyunsaturated fat: HR 0·80 [0·71–0·89], ptrend<0·0001). Higher saturated fat intake was associated with lower risk of stroke (quintile 5 vs quintile 1, HR 0·79 [95% CI 0·64–0·98], ptrend=0·0498). Total fat and saturated and unsaturated fats were not significantly associated with risk of myocardial infarction or cardiovascular disease mortality.

Interpretation

High carbohydrate intake was associated with higher risk of total mortality, whereas total fat and individual types of fat were related to lower total mortality. Total fat and types of fat were not associated with cardiovascular disease, myocardial infarction, or cardiovascular disease mortality, whereas saturated fat had an inverse association with stroke. Global dietary guidelines should be reconsidered in light of these findings.

Source: Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study – The Lancet

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Dementia Rates Are Falling In The U.S.

Posted on September 12, 2017 | Comments Off on Dementia Rates Are Falling In The U.S.

“An important new national study finds that, after adjusting for age, Americans 65 and older are less likely to get dementia than in the past. The report, published in the Journal of the American Medical Assn (JAMA) confirms previous regional studies in the US as well as recent research in Europe. The reasons for this decline in prevalence of the many dementia-related diseases are complicated, but may be related to higher educational levels. Whatever the cause, the news is positive.”

Source: Dementia Rates Are Falling In The U.S.

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Lithium as a Preventative or Treatment of Alzheimer’s Disease

Posted on September 12, 2017 | Comments Off on Lithium as a Preventative or Treatment of Alzheimer’s Disease

The following excerpt is boring, so move along now. It’s from a recent review article on all the potential causes and therapeutic options for Alzheimer’s Disease (AD). I post it here so I can find it later. Click the link at bottom to RTWT.

“Lithium is not yet generally recognized as a trace element but several lines of evidence make it a strong candidate. For instance, long-term low-dose exposure to lithium exerts anti-aging capabilities and unambiguously decreases mortality in animal models. In humans, epidemiological studies indicate an inverse correlation between lithium concentration in drinking water and mood, depression and suicide rates, amongst other psychiatric conditions. In a study that compared elderly bipolar patients (who exhibit a higher risk for dementia) who had received chronic lithium treatment, with bipolar patients who had not received lithium, it was shown that the prevalence of the treated group was equivalent to the general, age-comparable population, whereas the non-lithium-treated patients had an incidence of dementia that was six times greater, i.e. 5 % vs. 33 %, respectively. In another study it was shown that lithium treatment resulted in an increase in volumes of the hippocampi in both hemispheres compared to an unmedicated group, an effect that was apparent even after a brief treatment period of about 4 weeks on average. Importantly, intake of lithium not only in standard therapeutic but also in trace doses reduces the risk for dementia, suicide, and other behavioural outcomes, suggesting an pharmacological interference with key regulators of these pathological processes. So, lithium naturally regulates critical cell signalling pathways and a lack of lithium in the diet can therefore cause increased disease risk.It has been shown that lithium modulates negatively the activity of the two kinases GSK-3α and GSK-3β, which might explain both the relative specificity and sensitivity of the effects of low-dose lithium treatment (see below). Since GSK-3β-activation by oligomeric Aβ promotes neuroinflammation, phosphorylation of tau and disturbance of AHN [adult hippocampal neurogenesis], all key mechanisms in the AD process, in inhibition of GSK-3 by lithium results in reduced tauopathy and neurodegeneration in vivo. Likewise, lithium treatment was shown to improve AHN, neuropathology and cognitive functions in a mouse model of AD. Furthermore, such “AD-mice” treated from two months of age had decreased numbers of senile plaques, no neuronal loss in cortex and hippocampus and increased BDNF levels when compared to non-treated transgenic mice. In order to achieve this effect, it was sufficient to give lithium at about one per mill of the high standard-dose therapy in bipolar disorder, a dose which can cause some significant side effects. Hence the authors of the study believe that their data support the use of (virtually side-effect free) microdose lithium in the prevention and treatment of Alzheimer’s disease.Indeed, long-term lithium treatment already provided preliminary evidence of its disease-modifying properties for amnestic MCI [mild cognitive impairment] in a randomised controlled trial, where the lithium-treated group had fewer conversions from MCI to AD. Lithium treatment was associated with a significant decrease in cerebrospinal fluid concentrations of hyperphosphorylated tau and better performance on the cognitive subscale of the Alzheimer’s Disease Assessment Scale and in attention tasks. At a more advanced stage of AD, microdose treatment with only 300 μg lithium administered once daily stabilized the AD patients during the complete evaluation phase of 15 months. For instance, whereas the treated group showed no decreased performance in the mini-mental state examination (MMSE), lower scores were observed for the control group during the same period, with significant differences occurring after three months, and increasing progressively.Importantly, lithium, besides being required for efficient AHN and blocking AD-specific pathological processes, also impacts on cell-rejuvenating autophagy. Lithium was found to inhibit the activity of inositol monophosphatase (IMPase), which leads to a decrease of myo-1, 4, 5-triphosphate (IP3). This reduction of IP3-activity induces autophagy, independent of mTOR. In this context it is important to note that lithium chloride extends the lifespan of the nematode Caenorhabditis elegans, possibly by means of mitochondrial rejuvenation, which suggests that lithium exerts its effects on evolutionary highly conserved mechanisms. Intake of drinking water with comparable low lithium concentrations were found to be inversely correlated with all-cause mortality in a large epidemiological study in Japan. Hence a lack of lithium is linking aging and frailty (all increasing mortality) to disturbed autophagy, and AD to impaired AHN, and, thus, might represent another important and modifiable risk factor in this neurodegenerative disease. Traces of lithium can be ingested in some geographic areas by drinking local tap water or otherwise by consuming commercially available, mineral-rich spring waters, containing suitable concentrations of around 1 mg lithium per litre. Hence microdose lithium intake by means of one or two glasses of such water a day is not only of potential therapeutic value (see below) but also a safe preventive measure, by means of simply reducing an intake-deficit of an important novel trace element.”

Source: Unified theory of Alzheimer’s disease (UTAD): implications for prevention and curative therapy

Bonus excerpt:

“Taken together, besides the importance of IMF and physical exercise, also dietary MCTGs [medium-chain trigylcerides] can be an attractive (indirect) source of ketone bodies during the non-fasting state. The intake of coconut oil as a healthy source of MCTGs has additional positive effects on neuronal insulin resistance, neuroinflammation as well as Aβ-toxicity, improves the LDL/HDL-cholesterol quotient by increasing HDL, and ameliorates several others key progression factors of AD. Hence the use of virgin coconut oil is highly recommended as a safe and healthy alternative for polyunsaturated oils for frying and baking and butter and an important part of a comprehensive strategy for the prevention and treatment of AD.”

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QOTD: Abraham Lincoln, White Supremacist

Posted on August 21, 2017 | Comments Off on QOTD: Abraham Lincoln, White Supremacist

“I will say then that I am not, nor ever have been in favor of bringing about in any way the social and political equality of the white and black races, that I am not nor ever have been in favor of making voters or jurors of Negroes, nor of qualifying them to hold office, nor to intermarry with white people . . . . I as much as any man am in favor of the superior position assigned to the white race.”

— Abraham Lincoln, First Lincoln-Douglas Debate, Ottawa, Illinois, Sept. 18, 1858, in The Collected Works of Abraham Lincoln vol.3, pp. 145-146.

Donald Sensing argues that the Civil War, for Lincoln, was about preserving the Union of these United States, not about abolishing slavery.

Donald also wrote: “The Confederate States of America was founded to do one thing only: to preserve the power of one class of people to literally own as chattel property another class of people. There is no other reason the CSA existed.“

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Cold Exposure May Help You Lose Weight

Posted on August 19, 2017 | Comments Off on Cold Exposure May Help You Lose Weight
Well below room temp here

Should be well below room temp here

David Mendosa found a 2016 research report suggesting that cool temperatures may help with weight management by activating our brown fat, which burns more calories. Heat generated by brown fat is derived from glucose and triglycerides. Keep in mind as you read further that a comfortable environment temperature for a clothed human is about 23°C or 73°F. Those temps don’t stress our bodies by requiring us to either generate or dissipate extra body heat.

David writes:

Researchers have discovered that when we get mildly cold, which they define as being cool without shivering, our bodies burn more calories. As a result, managing our weight can be easier.
This is the conclusion of a recent review that two researchers at Maastricht University Medical Center in the Netherlands published in the November 2016 issue of the professional journal Diabetologia. The title of their article, “Combatting type 2 diabetes by turning up the heat,” puzzled me at first.

The title confused me because the study is about turning down the heat in the room we’re in. But then our bodies compensate by turning up their internal heat production.

When our body does this, its energy expenditure increases, ratcheting up our metabolism. Being mildly cold revs up our bodies’ brown fat, which unlike white fat, burns calories instead of storing them.

It’s not quite clear how much cold exposure it takes to turn on your brown fat. From the link above:

Cold acclimation by intermittent exposure to a cool (14–17°C) [57–63°F], or cold (10°C) [50°F] environment resulted in significant increases in NST [non-shivering thermogenesis or heat production] capacity. A 10 day cold acclimation study with 6 hour exposure to 14–15°C [57–59°F] per day was enough to significantly increase NST by 65% on average. A 6 week mild cold acclimation study (daily 2 hour cold exposure at 17°C [63°F]) also resulted in an increase in NST together with a concomitant decrease in body fat mass. The latter two studies also revealed significant increases in BAT [brown adipose tissue] presence and activation. All in all, cold-induced BAT activity is significant in adults and parallels NST. The actual quantitative contributions of BAT and of other tissues (e.g. skeletal muscle) to whole-body NST are, however, not elucidated and await further studies. Furthermore, more information is needed on the duration, timing and temperatures to find out which treatments are most effective with respect to increasing NST.

Furthermore, cold exposure over the course of 10 days increased insulin sensitivity in T2 diabetics by 43%. Eight study subjects, probably in the Netherlands, were exposed to temps of 14–15°C [57–59°F] but I don’t know for how many hours a day. Increased insulin sensitivity should help keep a lid on blood sugar levels and reduce the need for diabetes drugs.

In case you’re elderly, obese, or have type 2 diabetes, be aware that the activation of brown fat by cold exposure is not as robust as in others.

On the other hand, I found evidence that higher ambient temperatures (above 23°C) [73°F] may also help with weight management, regardless of what brown fat is doing.

Science is hard.

Steve Parker, M.D.

PS: Check out my books for more ideas on weight management.

 

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Yes: You Can You Regain Muscle Mass After Age 60

Posted on July 23, 2017 | Comments Off on Yes: You Can You Regain Muscle Mass After Age 60
She'll lose muscle fibers if she gets too sedentary as she ages

She’ll lose muscle fibers if she gets too sedentary as she ages

“Our lab and others have shown repeatedly that older muscles will grow and strengthen,” says Marcas Bamman, a professor of integrative biology at the University of Alabama at Birmingham. In his studies, men and women in their 60s and 70s who began supervised weight training developed muscles that were as large and strong as those of your average 40-year-old.”

Source: Can You Regain Muscle Mass After Age 60? – The New York Times

Dr. Bamman says older folks (over 60?) don’t add new muscle fibers like young’uns do. But an effective exercise program will cause hypertrophy (growth) of the existing muscle fibers. “Effectiveness” probably depends on exhausting muscle groups during weigh training.

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