What Exactly Is the Healthy Lifestyle That Prevents Dementia?

Yes, some cases of dementia are preventable. If you have a genetic predisposition to develop dementia, the deck is stacked against you. But it’s not hopeless. A healthy lifestyle will help you, too.

The research at hand was done in the UK and involved over 500,000 older adults of European ancestry, free of dementia and cognitive impairment at baseline.

So what are the healthy lifestyle characteristics linked to lower risk of dementia, whether you have genetic risk or not?

  • Physical activity
  • Not smoking
  • Healthy diet
  • Judicious alcohol consumption

Lifestyle details from the research report:

A healthy lifestyle score was constructed based on 4 well-established dementia risk factors (smoking status, physical activity, diet, and alcohol consumption) assessed at baseline using a touchscreen questionnaire. Participants scored 1 point for each of 4 healthy behaviors defined on the basis of national recommendations (full details in eTable 1 in Supplement 1). Smoking status was categorized as current or no current smoking. Regular physical activity was defined as meeting the American Heart Association recommendations of at least 150 minutes of moderate activity per week or 75 minutes of vigorous activity per week (or an equivalent combination) or engaging in moderate physical activity at least 5 days a week or vigorous activity once a week. Healthy diet was based on consumption of at least 4 of 7 commonly eaten food groups following recommendations on dietary priorities for cardiometabolic health, which are linked to better late-life cognition and reduced dementia risk. Previous studies of alcohol consumption and dementia risk support a U-shaped relationship, with moderate consumption associated with lower risk. Therefore, moderate consumption was defined as 0 to 14 g/d for women and 0 to 28 g/d for men, with the maximum limit reflecting US dietary guidelines.

Source: Association of Lifestyle and Genetic Risk With Incidence of Dementia | Dementia and Cognitive Impairment | JAMA | JAMA Network

What do they consider a healthy dementia-preventing diet? At least four of the following food groups and consumption levels:

  • Fruits: 3 or more servings a day
  • Veggies: 3 or more servings a day
  • Fish: 2 or more servings a week
  • Processed meats: no more than 1 serving a week
  • Unprocessed red meats: no more than 1.5 servings a week
  • Whole grains: 3 or more servings a day
  • Refined grains: no more than 1.5 servings a day

Regarding alcohol, the guideline is no more than one drink a day for women, and no more than two a day for men. “One drink” is 14 grams of pure alcohol. In human terms, 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).

We don’t know if the paleo diet would help prevent dementia or not.

Steve Parker, M.D.

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How Much of U.S. Healthcare Cost is Waste?

Are ALL the clerks and administrators in hospitals necessary?

25% according to an article at JAMA Network.

Let’s face it, there’s always going to be some waste. The authors of the study at hand figure that, whatever the dollar amount of waste is, we can reduce it by 1/4. Which could be $250 billion.

A prior study indicated that 30% of healthcare spending may be considered waste. Is that still valid?

Researchers reviewed the pertinent literature from January 2012 to May 2019 focused on the 6 previously identified “waste domains”:

  1. failure of care delivery
  2. failure of care coordination
  3. overt-reatment or low-value care
  4. pricing failure
  5. fraud and abuse
  6. administrative complexity

Waste-related costs were converted to 2019 dollars.

From the abstract:

Findings

The review yielded 71 estimates from 54 unique peer-reviewed publications, government-based reports, and reports from the gray literature. Computations yielded the following estimated ranges of total annual cost of waste: failure of care delivery, $102.4 billion to $165.7 billion; failure of care coordination, $27.2 billion to $78.2 billion; overtreatment or low-value care, $75.7 billion to $101.2 billion; pricing failure, $230.7 billion to $240.5 billion; fraud and abuse, $58.5 billion to $83.9 billion; and administrative complexity, $265.6 billion. The estimated annual savings from measures to eliminate waste were as follows: failure of care delivery, $44.4 billion to $93.3 billion; failure of care coordination, $29.6 billion to $38.2 billion; overtreatment or low-value care, $12.8 billion to $28.6 billion; pricing failure, $81.4 billion to $91.2 billion; and fraud and abuse, $22.8 billion to $30.8 billion. No studies were identified that focused on interventions targeting administrative complexity. The estimated total annual costs of waste were $760 billion to $935 billion and savings from interventions that address waste were $191 billion to $282 billion.

Conclusions and Relevance 

In this review based on 6 previously identified domains of health care waste, the estimated cost of waste in the US health care system ranged from $760 billion to $935 billion, accounting for approximately 25% of total health care spending, and the projected potential savings from interventions that reduce waste, excluding savings from administrative complexity, ranged from $191 billion to $282 billion, representing a potential 25% reduction in the total cost of waste. Implementation of effective measures to eliminate waste represents an opportunity reduce the continued increases in US health care expenditures.

Source: Waste in the US Health Care System: Estimated Costs and Potential for Savings | Health Care Policy | JAMA | JAMA Network

Here’a radical idea. Why not stay out of the healthcare system as much as possible by getting and staying as healthy as possible? I have few ideas how…

Steve Parker, M.D.

PS: Getting and staying healthy will help you avoid wasteful healthcare spending. Let me help.

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Suicide Rate Among Young Americans Is Skyrocketing

This too shall pass

From The New York Times:

After declining for nearly two decades, the suicide rate among Americans ages 10 to 24 jumped 56 percent between 2007 and 2017, according to data from the Centers for Disease Control and Prevention. And for the first time the gender gap in suicide has narrowed: Though the numbers of suicides are greater in males, the rates of suicide for female youths increased by 12.7 percent each year, compared with 7.1 percent for male youths.

If you or someone you know needs help dealing with suicidal thought, please please please contact the National Suicide Prevention Lifeline at 1-800-273-8255

Steve Parker, M.D.

Soybean Oil Not Healthy for Humans?

Soybean oil seems to be a real problem for male mice. We need more research in humans before outlawing it as dangerous toxin. If you’re eating the Standard American Diet, you’ll find it hard if not impossible to avoid. Of course, paleo diets should be naturally low in soybean oil.

From EurekAlert:

New UC Riverside research shows soybean oil not only leads to obesity and diabetes, but could also affect neurological conditions like autism, Alzheimer’s disease, anxiety, and depression.

Used for fast food frying, added to packaged foods, and fed to livestock, soybean oil is by far the most widely produced and consumed edible oil in the U.S., according to the U.S. Department of Agriculture. In all likelihood, it is not healthy for humans.

Source: America’s most widely consumed oil causes genetic changes in the brain | EurekAlert! Science News

Steve Parker, M.D.

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Reduce Your Risk of Cancer By Up to 25%

hypoglycemia, woman, rock-climbing

This activity could increase your odds of accidental death by up to 100%

What I dislike about a phrase like “…up to 25%” is that it includes only 1%.

From UPI:

In findings published Thursday in the Journal of Clinical Oncology, researchers at the National Cancer Institute, the American Cancer Society, and the Harvard T.H. Chan School of Public Health report that people who engaged in physical activity as recommended by the National Institutes of Health were able to reduce their risk for seven different types of cancer by as much as 25 percent.

This included common—and deadly—forms of the disease like colon and breast cancers, as well as endometrial cancer, kidney cancer, myeloma, liver cancer, and non-Hodgkin lymphoma.

*  *  *

Updated federal guidelines for physical activity recommend that people should aim for two and a half to five hours per week of moderate-intensity activity or 75 to 150 minutes per week of “vigorous activity.”

Source: Exercise may reduce risk for cancer by as much as 25 percent – UPI.com

Steve Parker, M.D.

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Is Fasting Healthful? Dr Sigurdsson Reviews the Evidence

This dude probably went days without food

Dr Axel Sigurdsson published an epic post on intermittent fasting early in 2020. I don’t doubt anything in it although I haven’t yet taken a deep dive into the subject like he has. I touched in it here, here, here, and here. I’ve done some 24-hour fasting myself (here and here).

From the good doctor:

Animal studies suggest that intermittent fasting may have several health benefits. Some of these benefits, in particular, the effects on obesity, type 2 diabetes, and cardiovascular risk factors, have been confirmed in studies on humans.

However, the popularity of intermittent fasting within the general public is in stark contrast with the gaps in evidence on the clinical benefits of this approach.

Source: Intermittent Fasting and Health – The Scientific Evidence

Steve Parker, M.D.

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High Protein Diet May Prevent Regain of Lost Weight

Filet mignon and sautéed asparagus

Weight loss can change your metabolism in such a way that promotes regain of lost weight. For successful weight-losers with prediabetes, a higher protein diet could help with prevention of regain. How much higher protein? 25% versus the usual 15% of calories from fat.

This is important research since most people who lose fat weight gain it back, typically within the subsequent 6–12 months.

For the boring details, keep reading.

ABSTRACT

Background

Weight loss has been associated with adaptations in energy expenditure. Identifying factors that counteract these adaptations are important for long-term weight loss and weight maintenance.

Objective

The aim of this study was to investigate whether increased protein/carbohydrate ratio would reduce adaptive thermogenesis (AT) and the expected positive energy balance (EB) during weight maintenance after weight loss in participants with prediabetes in the postobese state.

Methods

In 38 participants, the effects of 2 diets differing in protein/carbohydrate ratio on energy expenditure and respiratory quotient (RQ) were assessed during 48-h respiration chamber measurements ∼34 mo after weight loss. Participants consumed a high-protein (HP) diet (n = 20; 13 women/7 men; age: 64.0 ± 6.2 y; BMI: 28.9 ± 4.0 kg/m 2) with 25:45:30% or a moderate-protein (MP) diet (n = 18; 9 women/9 men; age: 65.1 ± 5.8 y; BMI: 29.0 ± 3.8 kg/m 2) with 15:55:30% of energy from protein:carbohydrate:fat. Predicted resting energy expenditure (REEp) was calculated based on fat-free mass and fat mass. AT was assessed by subtracting measured resting energy expenditure (REE) from REEp. The main outcomes included differences in components of energy expenditure, substrate oxidation, and AT between groups.

Results

EB (MP = 0.2 ± 0.9 MJ/d; HP = −0.5 ± 0.9 MJ/d) and RQ (MP = 0.84 ± 0.02; HP = 0.82 ± 0.02) were reduced and REE (MP: 7.3 ± 0.2 MJ/d compared with HP: 7.8 ± 0.2 MJ/d) was increased in the HP group compared with the MP group (P < 0.05). REE was not different from REEp in the HP group, whereas REE was lower than REEp in the MP group (P < 0.05). Furthermore, EB was positively related to AT (rs = 0.74; P < 0.001) and RQ (rs = 0.47; P < 0.01) in the whole group of participants.

Conclusions

In conclusion, an HP diet compared with an MP diet led to a negative EB and counteracted AT ∼34 mo after weight loss, in participants with prediabetes in the postobese state. These results indicate the relevance of compliance to an increased protein/carbohydrate ratio for long-term weight maintenance after weight loss. The trial was registered at clinicaltrials.gov as NCT01777893.

Source: High Compared with Moderate Protein Intake Reduces Adaptive Thermogenesis and Induces a Negative Energy Balance during Long-term Weight-Loss Maintenance in Participants with Prediabetes in the Postobese State: A PREVIEW Study | The Journal of Nutrition | Oxford Academic

Steve Parker, M.D.

PS: I didn’t read the whole study. I leave that to you.

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How to Prevent Full-Blown Diabetes After Gestational Diabetes

Paleobetic diet

“Mommy, I don’t want you to get diabetes.”

Gestational diabetes occurs in one out of twenty pregnancies in the U.S., affecting more than 240,000 births annually. Compared to caucasians, gestational diabetes mellitus (GDM) occurs more often in blacks, native Americans, Asians, and Latinos.

So What’s the Big Deal?

Numerous problems are associated with GDM, for both the mother and the baby:

  • dangerously high blood pressure (preeclampsia)
  • excessive amount of amniotic fluid (the baby in the uterus floats in this fluid)
  • delivery requiring an operation
  • early or premature delivery
  • death of the baby
  • birth trauma, such as broken bones or nerve injury
  • metabolic problems in the baby (low blood sugar, for example)
  • abnormally large baby (macrosomia, a major problem)

Having had gestational diabetes once, a woman is at increased risk of developing type 2 diabetes later in life, when she’s not pregnant. Can this be prevented?

From the Journal of the Academy of Nutrition and Dietetics:

Based on the current evidence, a specific dietary intervention for diabetes prevention in women with prior GDM [gestational diabetes mellitus] can therefore not be recommended. Previous systematic reviews have also consistently concluded that evidence for an effect of combined diet and physical activity interventions is inconclusive, with the exception of strong evidence from the Diabetes Prevention Program. Findings from that intensive intervention that focused on diet and physical activity to achieve and maintain weight loss of at least 7% of initial body weight showed >50% reduction in the risk of developing T2DM in women at high risk of T2DM including women with previous GDM; however, this personalised lifestyle intervention is unlikely to be feasible for implementation in routine care. As a limited number of studies have examined diet-alone and physical activity-alone interventions, it remains unclear which diabetes prevention approach would be most effective for women with a GDM history.

Source: The Role of Diet in the Prevention of Diabetes among Women with Prior Gestational Diabetes: A Systematic Review of Intervention and Observational Studies – Journal of the Academy of Nutrition and Dietetics

If it were me at risk for T2 diabetes? I’d lose the excess weight with a reasonable diet and exercise regularly.

Steve Parker, M.D.

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Sedentary Behavior Makes Sense

Sedentary lifestyle NOT an option here

I had lots of evolution indoctrination during study for my zoology degree. It helps me understand the following.

From BioEssays:

Most people are aware of the health benefits of being physically active. The question arises then why people so easily fall into sedentary habits. The idea developed here is that sedentary behavior is part of a suite of behaviors to reduce levels of physical activity that were strongly selected in the evolutionary past, likely because high levels of physical activity had direct negative consequences for survival. However, hunter-gatherer populations could not reduce activity indefinitely because of the need to be active to hunt for, and gather food. Hence they never experienced low levels of activity that are damaging to health, and no corresponding mechanism avoiding low activity evolved. Consequently, gene variants promoting efficiency of activity and increased sedentariness were never selected against. Modern society facilitates reduced activity by providing many options to become less active and divorcing food intake from the need to be active. Choosing the less active option is hard wired in the genes; this explains why being sedentary is so common, and why reversing it is so difficult.

Source: An Evolutionary Perspective on Sedentary Behavior. – PubMed – NCBI

Steve Parker, M.D.

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Real-World Comparison of Paleo, Mediterranean, and Intermittent Fasting Diets for Weight Loss

New Zealand researchers didn’t find much difference in outcomes between the three diets: intermittent fasting, Mediterranean, or paleo.

I don’t have the full article so know few details about the diets. For instance, there are many different intermitting fasting diets: which one did they use?

250 overweight adults chose which diet they wanted to follow for 12 months. Participants got a 30-minute educational session on their chosen diet and then were set loose. They may also have chosen “standard exercise” or high-intensity interval training.

From the report abstract:

RESULTS:

Although 54.4% chose IF [intermittent fasting], 27.2% Mediterranean, and 18.4% Paleo diets originally, only 54% (IF), 57% (Mediterranean), and 35% (Paleo) participants were still following their chosen diet at 12 mo (self-reported). At 12 mo, weight loss was -4.0 kg (95% CI: -5.1, -2.8 kg) in IF, -2.8 kg (-4.4, -1.2 kg) in Mediterranean, and -1.8 kg (-4.0, 0.5 kg) in Paleo participants. Sensitivity analyses showed that, due to substantial dropout, these may be overestimated by ≤1.2 kg, whereas diet adherence increased mean weight loss by 1.1, 1.8, and 0.3 kg, respectively. Reduced systolic blood pressure was observed with IF (-4.9 mm Hg;  -7.2, -2.6 mm Hg) and Mediterranean (-5.9 mm Hg; -9.0, -2.7 mm Hg) diets, and reduced glycated hemoglobin with the Mediterranean diet (-0.8 mmol/mol; -1.2, -0.4 mmol/mol). However, the between-group differences in most outcomes were not significant and these comparisons may be confounded due to the nonrandomized design.

CONCLUSIONS:

Small differences in metabolic outcomes were apparent in participants following self-selected diets without intensive ongoing dietary support, even though dietary adherence declined rapidly. However, results should be interpreted with caution given the exploratory nature of analyses.

Source: Intermittent fasting, Paleolithic, or Mediterranean diets in the real world: exploratory secondary analyses of a weight-loss trial that included ch… – PubMed – NCBI

I probably won’t bother to read the full report. You’re welcome to it for $35 USD. The abstract doesn’t convince me it’s worth my time and money.

Steve Parker, M.D.

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