Proton Pump Inhibitor Drugs Linked to Dementia

I have nothing against Prilosec in particular. It can be very helpful.

We have two major classes of drugs that reduce acid production by the stomach. The first was H2 blockers, the granddaddy being Tagamet (cimetidine). Tagamet was the first PPI on the market in the U.S., probably 25-30 years ago. Several H2 blockers are are available without a prescription. The second and later class of acid-reducing drugs is the PPI. These are more potent than H2 blockers. Because of H2 blockers and PPIs, and the discovery that H. pylori causes many ulcers, we have many fewer patients requiring surgery for upper GI ulcers. Surgery like vagotomy and pyloroplasty. Once the ulcer heals, most folks don’t need to take a PPI for the rest of their lives.

There are reasons our stomachs produce acid. One is that the acid helps kill pathogens in our food before they make us sick. Another is to start the digestion of proteins we eat. You can imagine that drastically reducing stomach acid production has some potential adverse effects.

Bix at Fanatic Cook turned me on to the possibility that chronic use of  PPIs might cause cognitive decline, up to and including dementia. In the U.S., PPIs are available over-the-counter and many physicians prescribe and recommend them to patients in order to reduce stomach acid. The most common reason for chronic usage must be gastroesophageal reflux disease (aka GERD), which is severe or frequently recurrent heartburn. Common PPI names are Protonix, Nexium, Prilosec, omeprazole, and pantoprazole.

A German population study a few years ago linked PPI usage with higher risk of dementia.

A total of 73,679 participants 75 years of age or older and free of dementia at baseline were analyzed. The patients receiving regular PPI medication (n = 2950; mean [SD] age, 83.8 [5.4] years; 77.9% female) had a significantly increased risk of incident dementia compared with the patients not receiving PPI medication (n = 70,729; mean [SD] age, 83.0 [5.6] years; 73.6% female) (hazard ratio, 1.44 [95% CI, 1.36-1.52]; P < .001).

The avoidance of PPI medication may prevent the development of dementia. This finding is supported by recent pharmacoepidemiological analyses on primary data and is in line with mouse models in which the use of PPIs increased the levels of β-amyloid in the brains of mice. Randomized, prospective clinical trials are needed to examine this connection in more detail.

Source: Association of Proton Pump Inhibitors With Risk of Dementia: A Pharmacoepidemiological Claims Data Analysis – PubMed

Check out Bix’s article to read that:

  • PPIs interfere with production of acetylcholine, a major chemical than nerve cells use to communicate with each other
  • Healthy young folks who took a PPI for 10 days performed worse on tests of memory

I don’t know about Germany, but there’s evidence that the incidence of dementia has been decreasing lately in the U.S. I’m guessing that the use of PPIs has been increasing over the last couple decades. So this doesn’t fit with the PPI-dementia theory.

If you have GERD, a low-carb diet may well control it, allowing you to avoid the side effects of PPIs, not to mention the cost.

Oh, darn. I may not be getting my check from Big Pharma this month.

Steve Parker, M.D.

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Lower Cardiovascular Disease Risk With Olive Oil

low-carb diet, diabetic diet, Paleobetic diet, balsamic vinaigrette,

I like this and use it. The lower left corner says “with EXTRA VIRGIN OLIVE OIL.” In order, the listed ingredients are water, balsamic vinegar, soybean oil and extra virgin olive oil, sugar…. 2 tbsp has 3 grams of carb. Which oil would you guess predominates? BTW, balsamic has the most carbs of all the vinegars. Ideally, make your own vinaigrette with EVOO and NO soybean oil. 

A new analysis of the Nurses Health Study confirms the headline above. Olive oil, of course, is a primary component of the healthy Mediterranean diet. From the American College of Cardiology:

Higher olive oil intake was associated with a lower risk of CHD [coronary heart disease] and total CVD [cardiovascular disease] in two large prospective cohorts of US men and women. The substitution of margarine, butter, mayonnaise, and dairy fat with olive oil could lead to lower risk of CHD.

***

This study of well-educated health professionals is the first in the United States to show the relative value of higher intake of olive oil for preventing CHD and CVD. It was conducted in the era that margarine was primarily trans fatty acids and would not apply to the present soft and liquid margarines. The benefit attributed to olive oil is not simply the substitution for saturated fatty acid. The modest benefit of olive oil in the United States occurred at relatively low olive oil intake (average 12 g/day). In contrast, the Mediterranean diet generally has over 25 g/day. In European studies, a healthy cohort had a 7% reduction in CHD risk for each 10 g/d increase in olive oil; extra virgin olive oil reduced cerebrovascular events by 31% in a high-risk group, and regular olive oil was associated with a 44% lower risk of CHD after about 7.8 years in Italian women survivors of an MI. Amongst the benefits of olive oil include positive effects on inflammation, endothelial function, hypertension, insulin sensitivity, and diabetes.

Source: Olive Oil Consumption and Cardiovascular Risk – American College of Cardiology

Steve Parker, M.D.

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Evidence for cooked starchy rhizomes in Africa 170,000 years ago

“Grok luv rhizome!”

From a recent article in Science:

Plant carbohydrates were undoubtedly consumed in antiquity, yet starchy geophytes were seldom preserved archaeologically. We report evidence for geophyte exploitation by early humans from at least 170,000 years ago. Charred rhizomes from Border Cave, South Africa, were identified to the genus Hypoxis L. by comparing the morphology and anatomy of ancient and modern rhizomes. Hypoxis angustifolia Lam., the likely taxon, proliferates in relatively well-watered areas of sub-Saharan Africa and in Yemen, Arabia. In those areas and possibly farther north during moist periods, Hypoxis rhizomes would have provided reliable and familiar carbohydrate sources for mobile groups.

Source: Cooked starchy rhizomes in Africa 170 thousand years ago. – PubMed – NCBI

Steve Parker, M.D.

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Why Does Body Size Vary Geographically?

Paleo diet proponents may be interested in the article below. I new that Norwegians tended to be very tall, but didn’t know that folks from the Netherlands and Balkan countries were taller.

I don’t know much about deer and elk hunting, but my impression is that colder climates tend to produce to larger animals.

Much larger than Coue’s deer we have in hot Arizona

Abstract:

Humans show marked variation in body size around the world, both within and among populations. At present, the tallest people in the world are from the Netherlands and the Balkan countries, while the shortest populations are central African Pygmies. There are genetic, genetic plasticity, developmental, and environmental bases for size variation in Homo sapiens from the recent past and the present. Early populations of Homo species also have shown considerable size variation. Populations from the present and the past are also marked by sexual dimorphism, which, itself, shows group variation. There is abundant evidence for the effects of limited food and disease on human growth and resultant adult body size. This environmental influence has been reflected in “secular trends” (over a span of years) in growth and adult size from socioeconomic prosperity or poverty (availability of resources). Selective and evolutionary advantages of small or large body size also have been documented. Heritability for human height is relatively great with current genome-wide association studies (GWAS) identifying hundreds of genes leading to causes of growth and adult size variation. There are also endocrinological pathways limiting growth. An example is the reduced tissue sensitivity to human growth hormone (HGH) and insulin-like growth factor (IGF-1) in Philippine and African hunter-gatherer populations. In several short-statured hunter-gatherer populations (Asian, African, and South American), it has been hypothesized that short life expectancy has selected for early maturity and truncated growth to enhance fertility. Some island populations of humans and other mammals are thought to have been selected for small size because of limited resources, especially protein. The high-protein content of milk as a staple food may contribute to tall stature in East African pastoral peoples. These and other evolutionary questions linked to life history, male competition, reproduction, and mobility are explored in this paper.

Source: Evolutionary Strategies for Body Size. – PubMed – NCBI

Steve Parker, M.D.

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A Modest Proposal to Revive the U.S. Economy #COVID19 #Coronavirus

 

Will we allow coronavirus to destroy the fabric of American life?

I propose a four-point plan to prevent a prolonged economic recession or depression in the U.S. caused by unjustified fear and panic about coronavirus:

  1. Young and middle-aged healthy adults go back to work now.
  2. Young and middle-aged healthy adults and children return to usual social interactions and school, using 6-foot distancing and face masks if desired.
  3. Extreme social distancing for those at risk for serious illness from COVID-19 for the next 2–3 months, then re-evaluate the situation. The goal is NO EXPOSURE  to those who may transmit the virus to them. Protect the medically frail who are over 60, particularly if over 70 or 80.
  4. Continued isolation of COVID-19 cases until they’re no longer infectious.

My presuppositions:

  • A large majority of the COVID-19 deaths and serious illness will be in the elderly (over 60-65) and/or those with risk factors for serious illness, as we’ve seen in Italy, China, and South Korea.
  • Those under 60-65 will have less severe illness and be much less likely to require hospitalization.
  • The pandemic in the U.S. is not going to be as bad as predictions you may have heard or read (e.g., 500,000 to 2.2 million deaths), in part due to actions already taken: isolation of cases, self-quarantine or mandated quarantine, social distancing, education on infection prevention, etc).
  • The recent $2 trillion relief package passed by Congress is unlikely to be very effective, particularly after the bureaucrats, politicians, major banks, and Big Business take their usual lions share. There won’t be much left for little guys like you and me.
  • “Relief packages” passed by politicians are not the answer. Government is more of a problem than a solution.
  • GM and Ford, et al, can’t make 50,000 ventilators in 3–4 weeks. By the time they’re ready, they won’t be needed.
  • The situation is quite fluid and helpful medical information arrives daily. So we need to stay light on our feet and ready to incorporate it.
  • The role of quarantine isn’t clear even now. We need more information. If a nurse treats a COVID-19 patient at the hospital, should she be on quarantine for two weeks or can she keep working? At what point do folks without symptoms start shedding virus that can infect others?
  • We’re seeing a power grab by federal and state governments that is unjustified and unprecedented in our lifetimes. For instance, a Florida pastor was arrested for holding a church service in violation of social distancing. Doesn’t the first amendment to the U.S. Constitution give us the right to peaceably assemble and freely exercise our religion? Once grabbed, government does not readily relinquish power. For more on this issue, read Peter Grant’s April 1 blog post.
  • Behavior of those living in COVID-19 hot spots like New Orleans or New York city may need to be different from those living elsewhere.
  • Extreme social distancing of those at risk or serious illness from COVID-19 may well require them to withdraw from the workforce for several months (or longer), but that’s much less harmful than what is essentially “house arrest” of 80–90% of the population.
  • Our list of conditions that increase serious risk from COVID-19 may well change over time as we learn more.
  • Increased testing to identify those infected with coronavirus will help us devise better containment measures. Containment will also be easier when we can identify—via antibody testing—those who have already been infected and are cured and (hopefully) immune to the current strain of the virus.

The problem with state-mandated or encouraged social distancing is that it’s strangling our economy.

Physicians, virologists, and epidemiologists who are advising our politicians are typically focused on medical aspects of the coronavirus epidemic. Economics is on the back burner, naturally, since that’s not their area of expertise. But the economy matters!

Post-viral apocalypse? Raccoon City?

In the U.S. in February 2020, 165 million people were in the labor force. For the week ended March 21, 2020, the U.S. set a record for unemployment benefits applications: 3.3 million. The very next week, a new record was set: 6.6 million. Economists are predicting a drop in 2nd quarter Gross Domestic Product of at least 20%.

In good times, most folk don’t apprehend the web of connections among various parts of the economy. They will soon find out.

From LexisNexis:

Unemployment has been linked with a number of psychological disorders, particularly anxiety, depression, and substance abuse; dangerous behaviors including suicide and violence toward family members or others also correlate with unemployment. These associations hold true not only in surveys of those already unemployed but also in studies that follow one or several individuals with no psychological difficulties into a period of unemployment. Such findings have been reported from many industrialized nations and, with some minor variations, apply to workers of both sexes and all ages.

Research regarding the consequences of unemployment may be confounded by a commensurate loss of income in subjects being studied. However, some studies try to account for this phenomenon of drop in socioeconomic status. Although an alert health care system may provide some needed assistance, resolution of the problem lies outside the field of medicine.

For example regarding suicide, among the unemployed aged 26 to 64 suicide was two-and-a-half times more likely than those who had jobs. Worldwide, one in five suicides is linked to unemployment. In 2017, suicide was the 10th leading cause of death in the U.S., with over 47,000 victims. At the time of this posting, the U.S. has reported 5,137 deaths from COVID-19.

Bankruptcies and unemployment will lead to an epidemic of despair.

dementia, memory loss, Mediterranean diet, low-carb diet, glycemic index, dementia memory loss

“Honey, we’ll be able to see the grandkids in few months. It’s just too dangerous right now.”

Additionally, the stock markets in the U.S—S&P 500 and Dow Jones Industrial Average—are already down by 20–30%, depending on the day you check. I wouldn’t be surprised if it drops another 20% or more from here. Imagine how that affects folks approaching retirement, or in it already, who are depending on their 401k’s to live.

Laid-off workers without a paycheck can’t pay their mortgages or car payments or other loans. In most jurisdictions, unemployment benefits are woefully inadequate: in Arizona it’s $240/week. This is a set-up for massive loan defaults. One silver lining: If you have cash, it may soon be buyer’s market for homes and new or used cars.

Panicking is rarely good. Let’s stop.

Expect more from me on Extreme Social Distancing in a future post.

Steve Parker, M.D.

PS: A few other sources that question the mainstream media’s and government narratives…

PPS: The history of the Coronavirus Pandemic will be written in the the next few years. I have no doubt it will look different than what we’re seeing now.

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Image

If You’re Too Weak to Re-Rack Your Weights…

New Study Suggests Low-Carb Diet Improves Brain Health

MRI of brain

From Stony Brook University News:

A diet low in carbohydrates could stave off, or even reverse, the effects of aging on the brain, Stony Brook-led research finds.

A study using neuroimaging led by Stony Brook University professor and lead author Lilianne R. Mujica-Parodi, PhD, and published in PNAS, reveals that neurobiological changes associated with aging can be seen at a much younger age than would be expected, in the late 40s. But the study also suggests that this process may be prevented or reversed based on dietary changes that involve minimizing the consumption of simple carbohydrates.

Even in younger adults, under age 50, dietary ketosis (whether achieved after one week of dietary change or 30 minutes after drinking ketones) increased overall brain activity and stabilized functional networks.

Source: Low-Carb Diet Could Boost Brain Health, Study Finds | | SBU News

Steve Parker, M.D.

PS: Hey! I know of a low-carb diet. Start boosting your brain health today!

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Dr Georgia Ede: Six Reasons to Go Paleo for Mental Health

paleobetic diet

Prehistoric man would be awestruck seeing this John Deere combine harvesting wheat

From Dr Ede at Psychology Today:

If you are living with a mental health problem of any kind, there are many dietary strategies you can use to try to address the root causes of your symptoms, and the so-called paleo diet is an excellent place to start for just about everyone.

Dr Ede, what’s the evidence for your proposal?

I am not aware of any clinical studies testing the effects of a paleo-style diet on mental health, but in my nutrition consultation service, I have witnessed significant improvements, particularly in certain individuals with depression, anxiety, and ADHD; and I am not alone. Cutting-edge nutritional psychiatrists who recommend paleo style diets include Ann Childers MD in Oregon, Ignacio Cuaranta MD in Argentina, Emily Deans MD in Massachusetts and Kelly Brogan MD in New York.

Read the full article for her nutrition-based justifications.

Source: Six Reasons to Go Paleo for Mental Health | Psychology Today

Steve Parker, M, D.

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Low-Carb Eating Isn’t for Every PWD

diabetic diet, Paleobetic diet, diabetes,

Sunny’s Super Salad. Use search box for recipe and nutritional analysis. 

(PWD is person with diabetes.)

Healthline has an article by Christina Crowder Anderson, a certified diabetes educator and pediatric registered dietitian nutritionist:

While I was in my dietetic internship at Duke University, I met a person with diabetes who had morbid obesity and who had participated in Dr. Eric Westman’s “low carb clinic.” They did well on that regimen until they ended up gaining back all the weight plus some, along with a resurgence in their type 2 diabetes.

At that moment, my iron-clad nutrition paradigm started to shift, as the sadness and shame from “diet failure” was palpable. Most individuals would say they “didn’t try hard enough.” But when you meet an actual person and hear their story, you’ll learn there are many factors that play into their success with a specific dietary approach.

Even though I was moved by this experience, my practice philosophies still didn’t change in terms of my recommended dietary approach for type 1 or type 2 diabetes — low carbohydrate. Over the next few years as I worked in a pediatric and adult endocrinology clinic, I steered most patients toward the more severe end of the “low carbohydrate spectrum” and was enthralled by the ability of the low carb approach to produce a flat line continuous glucose monitor (CGM) tracing.

That was, until I worked with 10 young adults in a clinical trial (for my graduate thesis), who chose to participate for a total of 8 months: 3 months on the low carbohydrate diet (60 to 80g day), 2 months of a “washout” period back on their own preferred diet, and another 3 months on the “standard diabetes diet” of >150 g carbs per day.

Source: When Low Carb Eating Backfires for Diabetes

Steve Parker, M.D.

PS: The Paleobetic Diet is low-carb.

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Housekeeping: Future Posts About #Coronavirus #COVID19

Artist’s conception of coronavirus

I’ve been cross-posting about coronavirus and COVID-19 among my three blogs. In view of time limitations and efficiency, I’m going to be posting nearly all my coronavirus thoughts at Advanced Mediterranean Diet. Check it out if interested.

Thus far I haven’t treated a confirmed case of COVID-19 although I’m a full-time hospitalist in Scottsdale, AZ. I’ve been off-duty for four days but return to work soon. If the mainstream media is correct, I’m about to be overwhelmed by cases. So far, I’m overwhelmed by the damage this thing is doing to our economy.

Steve Parker, M.D.

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