New (?) Scientific Review of the Paleolithic Diet

Sedentary lifestyle NOT an option

A couple of Dr Singhs in Kansas authored a review article on the paleo diet in January 2023. You can read it for free in the journal Cureus (cute name, huh). I didn’t learn anything new since the most recent references were from 2012. But you may find interesting. The abstract:

“The promotion of healthy diets is likely one of the most cost-effective strategies for preventing a wide range of disorders, including cardiovascular disease, obesity, hypertension, and type 2 diabetes. The majority of present non-communicable chronic diseases are attributed to civilization, an abundance of food, and a lack of physical activity. According to the purported lifestyles of early humans, the paleolithic diet (PD) encourages the intake of wild animal and plant foods. In recent decades, the paleolithic diet has grown in popularity, particularly among younger populations and those with cardiometabolic syndrome and other chronic diseases. Due to the nutrition profile of the paleolithic diet, historical studies have postulated that hunter-gatherers (HGs) have slender physiques and were physically fit and devoid of chronic ailments such as cardiovascular diseases (CVDs). This review highlights the composition/constituent of the paleolithic diet along with an emphasis on current studies and evidence on the effectiveness of the paleolithic diet in mitigating chronic diseases.”

Steve Parker, M.D.

Knee Osteoarthritis: A Surgeon Helps You Avoid Knee Replacement

Photo credit: Steven Paul Parker II

Dr. Howard J. Luks is an orthopedist who published a reasonable and fairly comprehensive article on knee osteoarthritis management. Thankfully, knee replacement surgery is a last resort for this surgeon. He discusses exercise, tai chi, diet, yoga, knee injections, NSAIDs, ice, heat, etc.

Osteoarthritis of the knee is a prevalent health issue.  Despite a diagnosis of arthritis of the knee, the majority of you can live an active, happy life.  But you’ve heard awful phrases used to describe your Xrays– phrases like Bone on Bone, bone spurs, degeneration, wearing away, etc. Those phrases scare you.  I get that! 

Life does not stop after a diagnosis of arthritis. Exercise is perhaps the best medicine for your arthritis.  Exercising a joint that you’ve been told is wearing out may seem counterintuitive.  Exercise is essential if your goal is to avoid surgery for as long as possible.  Being active will not cause your arthritis to worsen.  Not all pain implies harm

Click for Dr. Luks’ exercise recommendations for stronger legs.

Steve Parker, M.D.

Paleo Diet Seems to Lower Breast Cancer Risk

Photo by Valeria Boltneva on

The study was done in women in France. From the abstract:

Methods: 65,574 women from the Etude Epidémiologique auprès de femmes de la Mutuelle Générale de l’Education Nationale (E3N) cohort were followed from 1993 to 2014. Incident BC cases were identified and validated. The PD [paleolithic diet] score was calculated using dietary intake self-reported at baseline (1993) and follow-up (2005) or baseline only if censored before follow-up. Multivariable Cox proportional hazards regression models were used to estimate BC hazard ratios (HR) and 95% confidence intervals (CI).Results: Over a mean follow-up of 20 years, 3968 incident BC cases occurred. An increase of 1 standard deviation in the PD score was associated with an 8% lower BC risk, fully-adjusted model: HR1-SD 0.92, 95% CI; 0.89, 0.95. Compared to women with low adherence to the PD, women with high adherence had a 17% lower BC risk, HRQ5 vs Q1 0.83, 95% CI; 0.75, 0.92, Ptrend < 0.01. When considering BC [breast cancer] subtypes, we observed the same pattern of association (Pheterogeneity > 0.10 for all).Conclusions: High adherence to a PD characterised by fruit, vegetables, nuts, fish, and lean meat and limited in dairy, grains, legumes, refined sugar, and alcohol was associated with a lower BC [breast cancer] risk. The lack of heterogeneity according to BC subtypes could indicate the involvement of non-hormonal mechanisms. 

Steve Parker, M.D.

Metformin Knocked Off Its Pedestal as First-Line Rx Choice for Type 2 Diabetes

From Diabetes Daily:

Metformin is the world’s most-prescribed diabetes drug. For a generation, most Americans with newly diagnosed type 2 diabetes have been prescribed metformin as their first medication.

But now metformin’s reign as the universally acknowledged “first-line” treatment for type 2 diabetes has come to an end. Updated guidance from the American Diabetes Association (ADA), released on December 12, 2022, has substantially minimized the importance of the popular drug. The ADA’s committee of experts removed metformin from key recommendations and now ranks the drug as inferior to other options for blood sugar control, weight loss, and long-term heart and kidney protection


The new ADA recommendation can be seen as a major endorsement for the stars of the newest generation of diabetes drugs: SGLT-2 inhibitors and GLP-1 and GIP/GLP-1 receptor agonists. These options combat hyperglycemia effectively but add other important benefits that metformin cannot claim: enhanced weight loss and more robust protection against cardiovascular and kidney disease.

IIRC, when I started my medical career in 1981 we had only three types of drugs for diabetes: metformin, sulfonylureas, and insulin. I’ve lost count, but we must have at least 8-10 classes now. We also have better science-based dietary approaches.

Steve Parker, M.D.

Another “Disease of Modern Civilization” Linked to Diet

Colorado researchers theorize that fructose metabolism may be the driving force behind Alzheimer Disease pathology. Diets high in sugar and high glycemic index carbohydrates would exacerbate the problem. Salt may also play a role. Fructose is a simple sugar (a monosaccharide) typically found in fruit, honey, and some vegetables. Table sugar is sucrose, a combination of fructose with a glucose molecule. High-fructose corn syrup (HFCS) is added to many processed foods as a sweetener. From the article linked above:

An ancient human foraging instinct, fueled by fructose production in the brain, may hold clues to the development and possible treatment of Alzheimer’s disease (AD), according to researchers at the University of Colorado Anschutz Medical Campus.

The study, published recently in The American Journal of Clinical Nutrition, offers a new way of looking at a fatal disease characterized by abnormal accumulations of proteins in the brain that slowly erode memory and cognition.

“We make the case that Alzheimer’s disease is driven by diet,” said the study’s lead author Richard Johnson, MD, professor at the University of Colorado School of Medicine specializing in renal disease and hypertension. The study co-authors include Maria Nagel, MD, research professor of neurology at the CU School of Medicine.

Steve Parker, M.D.

Canadian Euthanasia

From DailyMail:

Last year, more than 10,000 people in Canada – astonishingly that’s over three percent of all deaths there – ended their lives via euthanasia, an increase of a third on the previous year. And it’s likely to keep rising: next year, Canada is set to allow people to die exclusively for mental health reasons.

Only last week, a jaw-dropping story emerged of how, five years into an infuriating battle to obtain a stairlift for her home, Canadian army veteran and Paralympian Christine Gauthier was offered an extraordinary alternative.

A Canadian official told her in 2019 that if her life was so difficult and she so ‘desperate’, the government would help her to kill herself. ‘I have a letter saying that if you’re so desperate, madam, we can offer you MAiD, medical assistance in dying,’ the paraplegic ex-army corporal testified to Canadian MP

God gave me life. It’s up to God, not me, when it’s over. Over 40 years of practicing medicine, I’ve never had a patient ask me to “put them down,” like we would a cherished pet that was suffering during impending death.

Steve Parker, M.D.

New Drug Tzield Delays Onset of Type 1 Diabetes

In November, 2022, the FDA approved the first drug that can delay onset of type 1 diabetes. Type 1 is the kind that requires insulin therapy to sustain life. The FDA press release won’t make much sense unless you know that type 1 diabetes has several stages. From Diabetes Care:

Stage 2, like stage 1, includes individuals with two or more islet autoantibodies but whose disease has now progressed to the development of glucose intolerance, or dysglycemia, from loss of functional β-cell mass. The 5-year risk of symptomatic disease at this stage is approximately 75%, and the lifetime risk approaches 100%.

Stage 3 represents manifestations of the typical clinical symptoms and signs of diabetes, which may include polyuria, polydipsia, weight loss, fatigue, diabetic ketoacidosis (DKA), and others.

What follows is the verbatim FDA press release:

Today, the U.S. Food and Drug Administration approved Tzield (teplizumab-mzwv) injection to delay the onset of stage 3 type 1 diabetes in adults and pediatric patients 8 years and older who currently have stage 2 type 1 diabetes. 

“Today’s approval of a first-in-class therapy adds an important new treatment option for certain at-risk patients,” said John Sharretts, M.D., director of the Division of Diabetes, Lipid Disorders, and Obesity in the FDA’s Center for Drug Evaluation and Research. “The drug’s potential to delay clinical diagnosis of type 1 diabetes may provide patients with months to years without the burdens of disease.” 

Type 1 diabetes is a disease that occurs when the immune system attacks and destroys the cells that make insulin. People with a type 1 diabetes diagnosis have increased glucose that requires insulin shots (or wearing an insulin pump) to survive and must check their blood sugar levels regularly throughout the day. Although it can appear at any age, type 1 diabetes is usually diagnosed in children and young adults. A person is at higher risk for type 1 diabetes if they have a parent, brother or sister with type 1 diabetes, although most patients with type 1 diabetes do not have a family history.

Tzield binds to certain immune system cells and delays progression to stage 3 type 1 diabetes. Tzield may deactivate the immune cells that attack insulin-producing cells, while increasing the proportion of cells that help moderate the immune response. Tzield is administered by intravenous infusion once daily for 14 consecutive days. 

Tzield’s safety and efficacy were evaluated in a randomized, double-blind, event-driven, placebo-controlled trial with 76 patients with stage 2 type 1 diabetes. In the trial, patients randomly received Tzield or a placebo once daily via intravenous infusion for 14 days. The primary measure of efficacy was the time from randomization to development of stage 3 type 1 diabetes diagnosis. The trial results showed that over a median follow-up of 51 months, 45% of the 44 patients who received Tzield were later diagnosed with stage 3 type 1 diabetes, compared to 72% of the 32 patients who received a placebo. The mid-range time from randomization to stage 3 type 1 diabetes diagnosis was 50 months for the patients who received Tzield and 25 months for those who received a placebo. This represents a statistically significant delay in the development of stage 3 type 1 diabetes. 

The most common side effects of Tzield include decreased levels of certain white blood cells, rash and headache. The use of Tzield comes with warnings and precautions, including premedicating and monitoring for symptoms of Cytokine Release Syndrome; risk of serious infections; decreased levels of a type of white blood cell called lymphocytes; risk of hypersensitivity reactions; the need to administer all age-appropriate vaccinations prior to starting Tzield; as well as avoiding concurrent use of live, inactivated and mRNA vaccines with Tzield. 

Steve Parker, M.D.

Have You Heard of Ozempic Face?

Semaglutide is an injectable drug for diabetes in the class called GLP-1 analogues. Click for my overview of the class. Semaglutide is sold in the U.S. as brand name Ozempic.

Folks with diabetes taking Ozempic found that it promoted fat weight loss. Facial fat tends to fill in wrinkles, hence, younger-looking skin. Loss of fat on the face can make your skin sag and older-looking, more wrinkled, gaunt. That’s so-called Ozempic face.

Semaglutide and others in it’s class are increasingly being used by non-diabetics for weight loss, either as an injection or a pill.

From the esteemed medical journal, People:

To restore volume in a patient’s face, doctors will often perform noninvasive, but expensive, procedures such as injecting Radiesse and hyaluronic acid-based fillers or Sculptra injections, which stimulates collagen production. Doctors can also restore volume with a face lift or by transferring fat from other body parts to the face.

Steve Parker, M.D.

h/t DiabetesDaily

Paleo Diet Might Improve Hashimoto’s Thyroiditis and Grave’s Disease

But the evidence is weak. From the Journal of the American Nutrition Association:


The aim of this systematic review was to examine the characteristics of Paleolithic diet (PD) interventions designed for adult patients with autoimmune thyroid disease (AITD) in order to determine if diet elements have the potential to successfully reduce thyroid antibodies (Ab) such as thyroglobulin (Tg), thyroid peroxidase (TPO), and thyroid stimulating hormone receptor (TSHR), and improve thyroid hormones (thyroxine (T4), triiodothyronine (T3) and thyroid stimulating hormone (TSH)) or resolve AITD pathogenesis. Randomized controlled trials (RCTs) with an adult population of 18 years and older, diagnosed with Hashimoto’s thyroiditis (HT) or Graves’ disease (GD) (Basedow’s), who were placed on a diet of Paleolithic or ancestral nature, and achieved reduction of AITD Abs, improvement of thyroid hormones, and, or resolution of AITD were searched. Various electronic databases were used. Bias was assessed using critical appraisal tools from the Scottish Intercollegiate Guidelines Network (SIGN) and Joanna Briggs Institute (JBI). Studies were excluded according to exclusion criteria and results analyzed. One randomized controlled trial (RCT), a pilot study, and six case studies were found. In total, eight AITD studies focusing on Paleolithic or ancestral interventions were located. In highlight, females were the predominant gender. Case studies solely focused on AITD with protocols ranging from 8-60 weeks. All studies showed clinical improvements, one had significant improvement, two showed AITD resolution. After structured evaluation of nutritional interventions utilizing the PD on the effects of AITD, it was concluded foods of ancestral nature along with the addition of specific supplements, food components, exercise and mindfulness meditation, and exclusion of modern day foods have a considerable impact on thyroid Ab and hormones. The relevant studies suggest while this dietary protocol can be useful in clinical practice, larger-scale studies need to be conducted. Key teaching points: There are currently no dietary interventions recommended for the treatment of autoimmune thyroid disease. The Paleo diet has been documented to improve AITD antibodies and thyroid hormones in both Hashimoto’s thyroiditis and Graves’ disease.The Paleo diet can provide a natural source of nutrients similar to supplemental nutrients that have shown positive results on AITD.The paleo diet provides specific macronutrient percentages that may be beneficial in reducing AITD antibodies, while improving thyroid hormones.Methylation supplementation may be useful in AITD cases.

Steve Parker, M.D.

U.S. Longevity Falling, Not Keeping Up With the Jones’s

From NPR:

The average life expectancy for Americans shortened by over seven months [in 2021], according to new data from the Centers for Disease Control and Prevention.

That decrease follows an already big decline of 1.8 years in 2020. As a result, the expected life span of someone born in the U.S. is now 76.4 years — the shortest it has been in nearly two decades.

But we still have the best healthcare system in the world, right? Not if you judge it by life expectancy. From Health System Tracker:

Life expectancy in the U.S. and peer countries generally increased from 1980-2019, but decreased in most countries in 2020 due to COVID-19. From 2020 to 2021, life expectancy at birth began to rebound in most comparable countries while it continued to decline in the U.S. The CDC estimates life expectancy at birth in the U.S. decreased to 76.1 years in 2021, down 2.7 years from 78.8 years in 2019 and down 0.9 years from 2020. The average life expectancy at birth among comparable countries was 82.4 years in 2021, down 0.2 years from 2019 and up 0.4 years from 2020. 

Click the article links for potential explanations.

Steve Parker, M.D.

PS: Healthy diet, exercise, and weight management improve longevity. Let me help.