How to Prevent Age-Related Muscle Loss

paleo diet, low-carb, Steve Parker MD
This hunter-gatherer snagged himself a brown trout

Axel Sigurdsson, MD, PhD, published a great article on prevention of age-related sarcopenia (loss of muscle mass). Click through for details. To stay vigorous as you age, you should preserve muscle mass and the strength it provides. If you’ve lost muscle mass, you can re-build it. Summary from the good doctor:

Age-related loss of muscle mass (sarcopenia)may start as early as in our thirties and appears to continue for the rest of our lives.

There is also a loss of muscle strength and muscle function. The consequences may often be severe, particularly in the elderly.

Increased physical activity and adequate nutrition are the most powerful tools at our disposal to delay age-related loss of muscle mass.

Well-rounded exercise programs consisting of aerobic and resistance exercises are believed to be most effective

Modification of dietary habits may be an important tool to prevent the decline in muscle mass and function that occurs with aging.

Adequate protein intake is of key importance. Animal-derived protein may provide a higher and broader biological value than vegetable protein.

Fish consumption is recommended and fruits and vegetables should be consumed regularly.

Nutritional supplements containing essential amino acids may be helpful. This is particularly true for whey protein.

Fish-derived protein hydrolysates also appear promising.

Adequate intake of vitamin D is essential.

“Fish-derived protein hydrolysates” doesn’t sound very appetizing. I’ll stick with real fish for now, especially cold-water fatty fish.

Steve Parker, M.D.

Liver Fat and Fibrosis Are Common in Type 2 Diabetes

A 2021 issue of Diabetes Care reveals the shocking prevalence of advanced liver fibrosis (scarring) in folks with type 2 diabetes: one of every six. Fibrosis may eventually lead to cirrhosis and require a liver transplant. The study at hand used vibration-controlled transient elastography to measure liver stiffness. The more fibrosis, the stiffer the liver. The measuring device “uses a pulse-echo ultrasound technique to quantify the speed of mechanically induced shear wave within liver tissue,” which correlates with the severity of fibrosis. Liver fat, i.e., steatosis, can also be quantified at the same time by measuring the ultrasonic attenuation of the echo wave. 

Here’s the study abstract:

OBJECTIVE

Assess the prevalence of nonalcoholic fatty liver disease (NAFLD) and of liver fibrosis associated with nonalcoholic steatohepatitis in unselected patients with type 2 diabetes mellitus (T2DM).

RESEARCH DESIGN AND METHODS

A total of 561 patients with T2DM (age: 60 ± 11 years; BMI: 33.4 ± 6.2 kg/m2; and HbA1c: 7.5 ± 1.8%) attending primary care or endocrinology outpatient clinics and unaware of having NAFLD were recruited. At the visit, volunteers were invited to be screened by elastography for steatosis and fibrosis by controlled attenuation parameter (≥274 dB/m) and liver stiffness measurement (LSM; ≥7.0 kPa), respectively. Secondary causes of liver disease were ruled out. Diagnostic panels for prediction of advanced fibrosis, such as AST-to-platelet ratio index (APRI) and Fibrosis-4 (FIB-4) index, were also measured. A liver biopsy was performed if results were suggestive of fibrosis.

RESULTS

The prevalence of steatosis was 70% and of fibrosis 21% (LSM ≥7.0 kPa). Moderate fibrosis (F2: LSM ≥8.2 kPa) was present in 6% and severe fibrosis or cirrhosis (F3–4: LSM ≥9.7 kPa) in 9%, similar to that estimated by FIB-4 and APRI panels. Noninvasive testing was consistent with liver biopsy results. Elevated AST or ALT ≥40 units/L was present in a minority of patients with steatosis (8% and 13%, respectively) or with liver fibrosis (18% and 28%, respectively). This suggests that AST/ALT alone are insufficient as initial screening. However, performance may be enhanced by imaging (e.g., transient elastography) and plasma diagnostic panels (e.g., FIB-4 and APRI).

CONCLUSIONS

Moderate-to-advanced fibrosis (F2 or higher), an established risk factor for cirrhosis and overall mortality, affects at least one out of six (15%) patients with T2DM. These results support the American Diabetes Association guidelines to screen for clinically significant fibrosis in patients with T2DM with steatosis or elevated ALT.

Source: Advanced Liver Fibrosis Is Common in Patients With Type 2 Diabetes Followed in the Outpatient Setting: The Need for Systematic Screening | Diabetes Care

The good news is that excessive liver fat (aka hepatic steatosis), a precursor to fibrosis, can be reversed to a great degree.

Steve Parker, M.D.

Meta-Analysis: Paleolithic diet effects on glucose metabolism and lipid profile among patients with metabolic disorders

See modern man walking off that cliff?

From mostly Iran-based researchers, published in Critical Reviews in Food Science and Nutrition:

Abstract

Objective:

Several randomized clinical trials (RCTs) have investigated the effects of the Paleolithic diet (PD) in adult patients suffering from metabolic disorders. However, the results of these RCTs are conflicting. Therefore, we conducted a systematic review and meta-analysis to assess the effects of the PD in patients with metabolic disorders.

Methods:

We searched the PubMed/Medline, Scopus, Cochrane Databases, Google Scholar, Web of Science, and Embase databases up to June, 2020. The data were pooled using a random-effects model. From the eligible publications, 10 articles were selected for inclusion in this systematic review and meta-analysis. The meta-analysis was performed using a random-effects model. The heterogeneity was determined using the I2 statistics and the Cochrane Q test.

Results:

The pooled results from the random-effects model showed a significant reduction of the homeostatic model assessment of insulin resistance (HOMA-IR) (weighted mean difference, WMD: -0.39, 95% CI: -0.70, -0.08), fasting insulin (WMD: -12.17 μU/mL, 95% CI: -24.26, -0.08), total cholesterol (WMD: -0.32 mmol/l, 95% CI: -0.49, -0.15), triglycerides (WMD: -0.29 mmol/L, 95% CI: -0.42, -0.16), low-density lipoprotein cholesterol (WMD: -0.35 mmol/L, 95% CI: -0.67, -0.03), blood pressure (BP)(WMD – 5.89 mmHg; 95% CI – 9.973 to – 1.86 for the systolic BP and WMD – 4.01 mmHg; 95% CI – 6.21 to – 1.80 for the diastolic BP values) and C-reactive protein (CRP) levels (WMD: -0.84, mg/L, 95% CI: -1.62, -0.06) in the PD group versus control group.

Conclusions:

Our findings provide better insights into the effect of the PD on the modulation of the glucose and lipid metabolism factors in patients with metabolic disorders, providing comprehensive information for the development of future RCTs with a high quality design.

Source: The effect of paleolithic diet on glucose metabolism and lipid profile among patients with metabolic disorders: a systematic review and meta-analysis of randomized controlled trials – PubMed

Could a paleolithic lifestyle intervention help breast cancer patients undergoing radiotherapy?

A modern paleo meal

We don’t know from the study at hand.

This pilot and feasibility study involved only 11 patients that completed the study. The main finding was a loss of about a pound of fat weight weekly. Hey abstract writer, how about telling us how long the study lasted? Anyway, breast cancer patients primarily want to know what a particular management approach will do for their cure rate and quality of life.

Abstract

Evolutionary principles are rarely considered in clinical oncology. We here aimed to test the feasibility and effects of a dietary and physical activity intervention based on evolutionary considerations in an oncological setting. A total of 13 breast cancer patients referred to our clinic for curative radiotherapy were recruited for this pilot study. The women were supposed to undertake a “Paleolithic lifestyle” (PL) intervention consisting of a Paleolithic diet and daily outdoor activity of at least 30 min duration while undergoing radiotherapy. Body composition was measured weekly by bioimpedance analysis. Blood parameters were assessed before, during, and at the end of radiotherapy. A control group on an unspecified standard diet (SD) was assigned by propensity score matching. A total of eleven patients completed the study. The majority of patients (64%) reported feeling good or very good during the intervention. The intervention group experienced an average decrease of 0.4 kg body weight (p < 0.001) and 0.34 kg (p < 0.001) fat mass per week, but fat-free and skeletal muscle mass were not significantly affected. Vitamin D levels increased slightly from 23.8 (11-37.3) ng/ml to 25.1 (22.6-41.6) ng/ml (p = 0.053). β-hydroxybutyrate levels were significantly increased and triglycerides and free T3 hormone levels significantly reduced by the PL intervention. This pilot study shows that adoption of a PL intervention during curative radiotherapy of breast cancer patients is feasible and able to reduce fat mass. Daily outdoor activity could eliminate vitamin D deficiency (vitamin D < 20 ng/ml). Future studies are needed to confirm these findings.

Source: Short-term effects of a Paleolithic lifestyle intervention in breast cancer patients undergoing radiotherapy: a pilot and feasibility study – PubMed

We don’t know if the paleo diet prevents breast cancer. But I know one diet that does: the traditional Mediterranean diet.

Steve Parker, M.D.

Do You Have Any Recourse If Injured By the COVID-19 Vaccine?

needle, syringe, vaccine, vaccination, covid-19
The vaccination needle probably won’t be this large

I know it’s a little early to be asking that question. Within a year, an unknown number of you will be asking. Where do you go for satisfaction? The CICP: Countermeasures Injury Compensation Program. Forget about suing the vaccine manufacturer, distributor, or medical practitioner who jabbed you. They got the federal government to absolve them of liability in most cases. If injured, you need to file your claim within a year of vaccination.

As far as I know, this program only applies to U.S. residents. Perhaps only U.S. citizens.

Here’s an excerpt from a related fedgov program, the NVICP web page:

Vaccines save lives by preventing disease.

Most people who get vaccines have no serious problems. Vaccines, like any medicines, can cause side effects, but most are very rare and very mild. Some health problems that follow vaccinations are not caused by vaccines.

In very rare cases, a vaccine can cause a serious problem, such as a severe allergic reaction.  

In these instances, the National Vaccine Injury Compensation Program (VICP) may provide financial compensation to individuals who file a petition and are found to have been injured by a VICP-covered vaccine. Even in cases in which such a finding is not made, petitioners may receive compensation through a settlement. 

Many physicians in my community are excited and lined up to take the COVID-19 vaccine. But not me. I even have risk factors for more serious COVID-19 disease: age 66 and hypertension. After reviewing what little data are available from the Warp Speed vaccine trials, I’m not convinced the vaccines are safe enough for me. I’ll take my chances with the virus rather than the vaccine. I’m not afraid of dying from COVID-19; if that happens I’ll be in heaven with Jesus. I’ve lived a full and lucky life, blessed by a wonderful wife, fantastic children, good health, missed Viet Nam by a few years, no major economic upheaval. My biggest concern about catching the virus is the burden it would lay on my co-workers if I’m off-duty for 1 to 3 weeks.

At her age, great odds of surviving COVID-19

That said, if I were older and had other co-morbidities, I might take the vaccine now. When we have more long-term data on vaccine safety, I might take the vaccine. It could take up to a couple years before we have that data.

I am not anti-vaccine, in general. As a child I got the vaccines for polio, measles, mumps, rubella, tetanus, and probably diphtheria, maybe others. I took the hepatitis B vaccine as an adult because I’m exposed to blood from my patients. I’m due for another tetanus booster and will take it without reservation.

Steve Parker, M.D.

PS: I’m doing everything I can to optimize my health and immune system, including weight management and regular exercise.

PPS: Pharmacist Scott Gavura at Science Based Medicine provides a table comparing vaccination vs catching the virus vs hydroxychloroquine treatment. He implies my odds of death from COVID-19 infection are two out of a hundred (2%). I don’t think it’s nearly that high.

PPPS: Click for an interesting article on CICP at the Centre for Research on Globalization. I have no idea of its accuracy.

Drinking Too Much Alcohol Lately? I Challenge You to a Dry January

Goodbye to you. Maybe see you in February.

I’ve run across a number of people who slowly increased their alcohol consumption over months or years, not realizing it was causing or would cause problems for them. Alcohol is dangerous, lethal at times.

From a health standpoint, the generally accepted safe levels of consumption are:

  • no more than one standard drink per day for women
  • no more than two standard drinks per day for men

One drink is 5 ounces of wine, 12 ounces of beer, or 1.5 ounces of 80 proof distilled spirits (e.g., vodka, whiskey, gin).

Dry January was conceived in the UK in 2012 or 2014. The idea is simply to abstain from all alcohol for the month of January. The Alcohol Change UK website can help you git ‘er done. Many folks notice that they sleep better, have more energy, lose weight, and save money. There are other potential benefits.

If you think you may have an unhealthy relationship with alcohol, check your CAGE score. It’s quick and easy.

Alternatively, if you make a commitment to a Dry January but can’t do it, you may well have a problem.

I did the Dry January in January 2020. The only definite change I saw was that I was more productive. E.g., I blogged more regularly, worked out a bit more. The lesson for me is that alcohol makes me a little lazy. At three weeks in, I started thinking maybe I was able to fall asleep sooner but still woke up often, as usual. I also lost three pounds of body weight fat, but had consciously cut back on food intake.

Steve Parker, M.D.

Covid-19 Vaccine?: Maybe, Maybe Not

professor, equations
The governments “top men” are working on it

Peter Doshi, an associate editor at British Medical Journal, is not favorably impressed with the recent vaccine trial announcements. “90% effective.” “95% effective!”

Coronavirus guru Anthony Fauci assures us that a coronavirus vaccine will only be FDA-approved if it’s “safe and effective.”

From Doshi:

But what will it mean exactly when a vaccine is declared “effective”? To the public this seems fairly obvious. “The primary goal of a covid-19 vaccine is to keep people from getting very sick and dying,” a National Public Radio broadcast said bluntly.

Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston, said, “Ideally, you want an antiviral vaccine to do two things . . . first, reduce the likelihood you will get severely ill and go to the hospital, and two, prevent infection and therefore interrupt disease transmission.”

Yet the current phase III trials are not actually set up to prove either. None of the trials currently under way are designed to detect a reduction in any serious outcome such as hospital admissions, use of intensive care, or deaths. Nor are the vaccines being studied to determine whether they can interrupt transmission of the virus.

Will COVID-19 vaccines save lives? Current trials aren’t designed to tell us.
elderly man, face mask
Do you ever wonder why we didn’t see widespread use face masks during a typical flu season in the past?

Switching gears to the flu vaccine for a minute. The flu vaccine’s been a godsend in preventing influenza death among the frail elderly, right? Not so fast there, pardner. Doshi again:

But the truth is that the science remains far from clear cut, even for influenza vaccines that have been used for decades. Although randomised trials have shown an effect in reducing the risk of symptomatic influenza, such trials have never been conducted in elderly people living in the community to see whether they save lives.

Only two placebo controlled trials in this population have ever been conducted, and neither was designed to detect any difference in hospital admissions or deaths.

Moreover, dramatic increases in use of influenza vaccines has not been associated with a decline in mortality.

The Moderna and Pfizer trials enrolled 30,000 and 44,000 participants, respectively. That sounds like a lot of people to be vaccinated. But they only vaccinate half the folks. The other have serve as a control group. Next, the investigators track the occurrence of coronavirus events over time, then compare the two groups. An “event” may be anything from a cough plus positive COVID-19 PCR test, to hospitalization or death. Of course, they also look at potential adverse effect of vaccination, comparing the two groups.

The trials aren’t going to give us good information on COVID-19 hospitalizations and death rates because those outcomes are so infrequent. Most people with symptomatic COVID-19 experience only mild symptoms; there are relatively few cases of serious disease in a general population of 30,000.

Who needs a safe and effective vaccine the most?

  • Those over 60-65
  • Anybody seriously immunocompromised (i.e., a poor immune system too weak to fight infection).

Immunocompromised people are excluded from the seven ongoing trials. So these trials focus on those over 60, right? Wrong. The Moderna trial eligibility started at age 18. Pfizer’s accepted 12-year-olds.

Surely the vaccine trials will have some participants over 60-years-old. There just may not be enough to generate clinically meaningful data on serious disease outcomes and adverse effects in the elderly.

Steven Novella says Moderna developed their vaccine with a grant from the U.S. government. Pfizer funded themselves. Each vaccine has cost over two billion dollars to develop. They will be the first ever mRNA vaccines approved by the FDA. Our other vaccines are based on different technology. Both vaccines require two shots, 28 days apart.

Steve Parker, M.D.

PS: I am not generally anti-vaccination.

Some Prehistoric Women Were Big-Game Hunters

caveman, saber-toothed tiger, cavewoman, hunter, hunting, prehistoric, paleo diet
OK, but does she also cook and clean?

From Science Advances:

Sexual division of labor with females as gatherers and males as hunters is a major empirical regularity of hunter-gatherer ethnography, suggesting an ancestral behavioral pattern. We present an archeological discovery and meta-analysis that challenge the man-the-hunter hypothesis. Excavations at the Andean highland site of Wilamaya Patjxa reveal a 9000-year-old human burial (WMP6) associated with a hunting toolkit of stone projectile points and animal processing tools. Osteological, proteomic, and isotopic analyses indicate that this early hunter was a young adult female who subsisted on terrestrial plants and animals. Analysis of Late Pleistocene and Early Holocene burial practices throughout the Americas situate WMP6 as the earliest and most secure hunter burial in a sample that includes 10 other females in statistical parity with early male hunter burials. The findings are consistent with nongendered labor practices in which early hunter-gatherer females were big-game hunters.

Source: Female hunters of the early Americas | Science Advances

Steve Parker, M.D.

What’s the Best Fitness Tracker?

I don’t know. It partially depends on your needs.

ConsumersAdvocate.org has an article comparing and contrasting some of the available fitness trackers:

young woman, exercise, weight training, gym
You go, girl!
HOW WE FOUND THE BEST FITNESS TRACKERFEATURES

We checked for fitness trackers with diverse features that users could choose to best match their lifestyle and goals. This includes multiple health and activity monitoring options.

CONNECTIVITY

Many fitness trackers sync with smartphones or Bluetooth to receive calls, get message notifications, and send data to their corresponding fitness apps. We looked at trackers that were easy to connect.

COST

Regular fitness trackers can range from $50 to $200, while hybrid smartwatches can cost over $400. We compared prices to special features to make sure consumers get the most out of their investment.

CUSTOMER EXPERIENCE

Fitness trackers should be durable, lightweight, and comfortable. We interviewed customers and read dozens of reviews and testimonies for thorough feedback on each product.

Source: The Best Fitness Trackers For 2020

Click through for details. I use none of these trackers, so have no dog in this fight.

Steve Parker, M.D.

Reduce Insulin Resistance with Resistance Training

Didn’t we already know this? The study at hand involved 10 overweight young men.

Insulin is a blood-borne hormone that the pancreas gland secretes in order to keep blood sugar levels from getting too high. (Insulin does many other things, but table that for now.) Insulin triggers certain body cells to absorb glucose from the bloodstream. “Insulin resistance” means that these cells don’t respond to insulin as well as they should, so either the pancreas secretes even more insulin (hyperinsulinemia) or blood sugar levels rise. Insulin resistance is a harbinger of type 2 diabetes mellitus. Most overweight or obese type 2 diabetics have insulin resistance. Many experts think hyperinsulinemia causes disease by itself, regardless of blood sugar levels. So it may be best to avoid insulin resistance and hyperinsulinemia.

The aim of the study was to investigate the effects of 6 weeks of resistance exercise training, composed of one set of each exercise to voluntary failure, on insulin sensitivity and the time course of adaptations in muscle strength/mass. Ten overweight men (age 36 ± 8 years; height 175 ± 9 cm; weight 89 ± 14 kg; body mass index 29 ± 3 kg m−2) were recruited to the study. Resistance exercise training involved three sessions per week for 6 weeks. Each session involved one set of nine exercises, performed at 80% of one‐repetition maximum to volitional failure. Sessions lasted 15–20 min. Oral glucose tolerance tests were performed at baseline and post‐intervention. Vastus lateralis muscle thickness, knee‐extensor maximal isometric torque and rate of torque development (measured between 0 and 50, 0 and 100, 0 and 200, and 0 and 300 ms) were measured at baseline, each week of the intervention, and after the intervention. Resistance training resulted in a 16.3 ± 18.7% (P < 0.05) increase in insulin sensitivity (Cederholm index). Muscle thickness, maximal isometric torque and one‐repetition maximum increased with training, and at the end of the intervention were 10.3 ± 2.5, 26.9 ± 8.3, 18.3 ± 4.5% higher (P < 0.05 for both) than baseline, respectively. The rate of torque development at 50 and 100 ms, but not at 200 and 300 ms, increased (P < 0.05) over the intervention period. Six weeks of single‐set resistance exercise to failure results in improvements in insulin sensitivity and increases in muscle size and strength in young overweight men.

Source: The effect of short‐duration resistance training on insulin sensitivity and muscle adaptations in overweight men – Ismail – 2019 – Experimental Physiology – Wiley Online Library

Steve Parker, M.D.