Category Archives: Longevity

Is “evolutionary-concordance lifestyle” the new “paleo diet”?

From the March 6, 2021, European Journal of Nutrition:

Sedentary lifestyle NOT an option back then

Purpose:

Evolutionary discordance may contribute to the high burden of chronic disease-related mortality in modern industrialized nations. We aimed to investigate the associations of a 7-component, equal-weight, evolutionary-concordance lifestyle (ECL) score with all-cause and cause-specific mortality.

Methods:

Baseline data were collected in 2003-2007 from 17,465 United States participants in the prospective Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. The ECL score’s components were: a previously reported evolutionary-concordance diet score, alcohol intake, physical activity, sedentary behavior, waist circumference, smoking history, and social network size. Diet was assessed using a Block 98 food frequency questionnaire and anthropometrics by trained personnel; other information was self-reported. Higher scores indicated higher evolutionary concordance. We used multivariable Cox proportional hazards regression models to estimate ECL score-mortality associations.

Results:

Over a median follow-up of 10.3 years, 3771 deaths occurred (1177 from cardiovascular disease [CVD], 1002 from cancer). The multivariable-adjusted hazard ratios (HR) (95% confidence intervals [CI]) for those in the highest relative to the lowest ECL score quintiles for all-cause, all-CVD, and all-cancer mortality were, respectively, 0.45 (0.40, 0.50), 0.47 (0.39, 0.58), and 0.42 (0.34, 0.52) (all P trend < 0.01). Removing smoking and diet from the ECL score attenuated the estimated ECL score-all-cause mortality association the most, yielding fifth quintile HRs (95% CIs) of 0.56 (0.50, 0.62) and 0.50 (0.46, 0.55), respectively.

Conclusions:

Our findings suggest that a more evolutionary-concordant lifestyle may be inversely associated with all-cause, all-CVD, and all-cancer mortality. Smoking and diet appeared to have the greatest impact on the ECL-mortality associations.

Source: A novel evolutionary-concordance lifestyle score is inversely associated with all-cause, all-cancer, and all-cardiovascular disease mortality risk – PubMed

Steve Parker, M.D.

High Glycemic Index Diet Linked to Cardiovascular Disease and Premature Death

Low glycemic index meal

Haven’t we know this for years? From a recent New England Journal of Medicine:

Most data regarding the association between the glycemic index and cardiovascular disease come from high-income Western populations, with little information from non-Western countries with low or middle incomes. To fill this gap, data are needed from a large, geographically diverse population.

METHODS

This analysis includes 137,851 participants between the ages of 35 and 70 years living on five continents, with a median follow-up of 9.5 years. We used country-specific food-frequency questionnaires to determine dietary intake and estimated the glycemic index and glycemic load on the basis of the consumption of seven categories of carbohydrate foods. We calculated hazard ratios using multivariable Cox frailty models. The primary outcome was a composite of a major cardiovascular event (cardiovascular death, nonfatal myocardial infarction, stroke, and heart failure) or death from any cause.

RESULTS

In the study population, 8780 deaths and 8252 major cardiovascular events occurred during the follow-up period. After performing extensive adjustments comparing the lowest and highest glycemic-index quintiles, we found that a diet with a high glycemic index was associated with an increased risk of a major cardiovascular event or death, both among participants with preexisting cardiovascular disease (hazard ratio, 1.51; 95% confidence interval [CI], 1.25 to 1.82) and among those without such disease (hazard ratio, 1.21; 95% CI, 1.11 to 1.34). Among the components of the primary outcome, a high glycemic index was also associated with an increased risk of death from cardiovascular causes. The results with respect to glycemic load were similar to the findings regarding the glycemic index among the participants with cardiovascular disease at baseline, but the association was not significant among those without preexisting cardiovascular disease.

CONCLUSIONS

In this study, a diet with a high glycemic index was associated with an increased risk of cardiovascular disease and death.

Source: Glycemic Index, Glycemic Load, and Cardiovascular Disease and Mortality | NEJM

The paleo diet is low glycemic index.

Steve Parker, M.D.

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.

For Type 2 Diabetes, Gastric Bypass May Improve Cardiac and Renal Outcomes

Steve Parker MD, bariatric surgery, gastric bypass

Band Gastric Bypass Surgery

From a recent Diabetes Care article:

Our data suggest robust benefits for renal outcomes, heart failure, and CV [cardiovascular] mortality after GBP [gastric bypass] in individuals with obesity and T2DM. These results suggest that marked weight loss yields important benefits, particularly on the cardiorenal axis (including slowing progression to end-stage renal disease), whatever the baseline renal function status.

Source: Renal and Cardiovascular Outcomes After Weight Loss From Gastric Bypass Surgery in Type 2 Diabetes: Cardiorenal Risk Reductions Exceed Atherosclerotic Benefits | Diabetes Care

Because of the risk of surgery, I’d make sure first that diet modification was seriously tried and failed.

Steve Parker, M.D.

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Medical Errors May Be the Third Most Common Cause of Death in the U.S.

Hospitals are notorious for iatrogenic deaths

“May be.” But they’re not. The 3rd leading cause of death is accidents (unintentional injuries).

From Dr Gorski at Science Based Medicine (and he’s right):

I say this at the beginning of nearly every post that I write on this topic, but it bears repeating. It is an unquestioned belief among believers in alternative medicine and even just among many people who do not trust conventional medicine that conventional medicine kills. Not only does exaggerating the number of people who die due to medical complications or errors fit in with the world view of people like Gary Null and Joe Mercola, but it’s good for business. After all, if conventional medicine is as dangerous as claimed, then the quackery peddled by the likes of Adams and Mercola starts looking better in comparison. Unfortunately, there are a number of academics more than willing to provide quacks with inflated estimates of deaths due to medical error. The most famous of these is Dr. Martin Makary of Johns Hopkins University, who published a review (not an original study, as those citing his estimates like to claim) estimating that the number of preventable deaths due to medical error is between 250,000 and 400,000 a year, thus cementing the common (and false) trope that “medical error is the third leading cause of death in the US” into the public consciousness and thereby doing untold damage to public confidence in medicine. As I pointed out at the time, if this estimate were correct, it would mean that between 35% and 56% of all in-hospital deaths are due to medical error and that medical error causes between 10% and 15% of all deaths in the US. The innumeracy that is required to believe such estimates beggars the imagination.

Source: Are medical errors really the third most common cause of death in the U.S.? (2020 edition) – Science-Based Medicine

Steve Parker, M.D.

PS: Minimize your risk of iatrogenic death by getting and staying as healthy as possible. Let me help.

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Tea May Postpone Death and Prevent Heart Disease

One of my favorite green teas

For years we’ve been hearing about the potential longevity and cardiovascular benefits of green tea. If memory serves, most of the data comes from Japanese studies. Now a Chinese observational study finds 15–20% reductions in atherosclerotic cardiovascular disease (ASCVD) and death, compared to non-tea drinkers. Most of the participants drank green tea, and they did so at least thrice weekly.

From the European Journal of Preventive Cardiology:

Using large prospective cohorts among general Chinese adults, we have provided novel evidence on the protective role of tea consumption on ASCVD events and all-cause mortality, especially among those who kept the habit all along. The current study indicates that tea might be a healthy beverage for primary prevention against ASCVD and premature death.

Source: Tea consumption and the risk of atherosclerotic cardiovascular disease and all-cause mortality: The China-PAR project – Xinyan Wang, Fangchao Liu, Jianxin Li, Xueli Yang, Jichun Chen, Jie Cao, Xigui Wu, Xiangfeng Lu, Jianfeng Huang, Ying Li, Liancheng Zhao, Chong Shen, Dongsheng Hu, Ling Yu, Xiaoqing Liu, Xianping Wu, Shouling Wu, Dongfeng Gu,

The researchers point out that results may not apply to non-Chinese populations.

Steve Parker, M.D.

h/t to Jan at The Low Carb Diabetic (click link for more details about the study)

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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.

Should You Eat Salads?

A masterpiece by Sunny Parker

I’m not generally a fan of U.S. federal government committee recommendations on what we should eat. They’ve led us astray before. For what it’s worth, the USDA and National Cancer Institute have put together a Healthy Eating Index. Salad-eaters score higher on the Index, which they say is better for you. I do believe the best salads are better than the crap most Americans eat.

From the Journal of the Academy of Nutrition and Dietetics:

Abstract

Background

Consuming salad is one strategy with the potential to harmonize diets more closely with national dietary guidance. However, it is not known whether nutrient intake and diet quality differ between people who consume vegetable-based salad and those who do not.

Objective

The objective of this study was to compare nutrient intake and diet quality between salad reporters and nonreporters.

Design

This study is a cross-sectional analysis of 1 day of dietary intake data collected via 24-hour recall.

Participants/setting

Adults 20 years and older (n=9,678) in What We Eat in America, National Health and Nutrition Examination Survey 2011-2014 were included. Respondents who ate salad on the intake day were considered salad reporters.

Main outcome measures

This study estimated nutrient intake from all foods and beverages (excluding supplements) and evaluated diet quality using the Healthy Eating Index (HEI) 2015.

Statistical analyses

Nutrient intake and HEI scores were compared between salad reporters and nonreporters using paired t tests with regression adjustment for confounding variables. Results were considered significant at P<0.001.

Results

On the intake day, 23% of adults consumed salad. Energy, protein, and carbohydrate intakes did not differ between salad reporters and nonreporters. Salad reporters had higher intakes than nonreporters of dietary fiber, total fat, unsaturated fatty acids, vitamins A, B-6, C, E, K, folate, choline, magnesium, potassium, and sodium (P<0.001). Total HEI 2015 scores were significantly higher for reporters (56 of a possible 100 points) than nonreporters (50 points) P<0.001. Reporters also had significantly higher scores for eight of 13 HEI components: total vegetables, greens and beans, whole fruits, total protein foods, seafood and plant proteins, fatty acids, refined grains, and added sugars (P<0.001).

Conclusions

Incorporating vegetable-based salad into one’s diet may be one effective way to increase nutrient intake and improve overall diet quality. Regardless of salad reporting status, HEI scores show that diets of US adults need improvement.

Source: Consuming Vegetable-Based Salad Is Associated with Higher Nutrient Intakes and Diet Quality among US Adults, What We Eat in America, National Health and Nutrition Examination Survey 2011-2014 – Journal of the Academy of Nutrition and Dietetics

Steve Parker, M.D.

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Low-Carb Diets Linked to Premature Death

…and high-carb diets might be just as harmful. In the research at hand, low-carb was defined as under 40% of calories from carbohydrate, and high-carb was over 70% of calories.

Grain-based high-carb Neolithic food

The longevity sweet spot was 50-55% of calories from carbs.

If you want to eat low-carb, read more below to identify the possibly healthier substitutions for carbs. Tl;dr version: Eat plant-derived protein and fats.

From a 2018 study in The Lancet Public Health:

Background

Low carbohydrate diets, which restrict carbohydrate in favour of increased protein or fat intake, or both, are a popular weight-loss strategy. However, the long-term effect of carbohydrate restriction on mortality is controversial and could depend on whether dietary carbohydrate is replaced by plant-based or animal-based fat and protein. We aimed to investigate the association between carbohydrate intake and mortality.

Methods

We studied 15 428 adults aged 45–64 years, in four US communities, who completed a dietary questionnaire at enrolment in the Atherosclerosis Risk in Communities (ARIC) study (between 1987 and 1989), and who did not report extreme caloric intake (4200 kcal per day for men and 3600 kcal per day for women). The primary outcome was all-cause mortality. We investigated the association between the percentage of energy from carbohydrate intake and all-cause mortality, accounting for possible non-linear relationships in this cohort. We further examined this association, combining ARIC data with data for carbohydrate intake reported from seven multinational prospective studies in a meta-analysis. Finally, we assessed whether the substitution of animal or plant sources of fat and protein for carbohydrate affected mortality.

Findings

During a median follow-up of 25 years there were 6283 deaths in the ARIC cohort, and there were 40 181 deaths across all cohort studies. In the ARIC cohort, after multivariable adjustment, there was a U-shaped association between the percentage of energy consumed from carbohydrate (mean 48·9%, SD 9·4) and mortality: a percentage of 50–55% energy from carbohydrate was associated with the lowest risk of mortality. In the meta-analysis of all cohorts (432 179 participants), both low carbohydrate consumption (70%) conferred greater mortality risk than did moderate intake, which was consistent with a U-shaped association (pooled hazard ratio 1·20, 95% CI 1·09–1·32 for low carbohydrate consumption; 1·23, 1·11–1·36 for high carbohydrate consumption). However, results varied by the source of macronutrients: mortality increased when carbohydrates were exchanged for animal-derived fat or protein (1·18, 1·08–1·29) and mortality decreased when the substitutions were plant-based (0·82, 0·78–0·87).

Interpretation

Both high and low percentages of carbohydrate diets were associated with increased mortality, with minimal risk observed at 50–55% carbohydrate intake. Low carbohydrate dietary patterns favouring animal-derived protein and fat sources, from sources such as lamb, beef, pork, and chicken, were associated with higher mortality, whereas those that favoured plant-derived protein and fat intake, from sources such as vegetables, nuts, peanut butter, and whole-grain breads, were associated with lower mortality, suggesting that the source of food notably modifies the association between carbohydrate intake and mortality.

Source: Dietary carbohydrate intake and mortality: a prospective cohort study and meta-analysis – The Lancet Public Health

Steve Parker, M.D.

PS: This type of research is often unreliable. If you have a better study design or more reliable data, please share with the world.

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David Sinclair’s Anti-Aging Regimen

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

“Darling, think about upping your NMN dose.”

David Sinclair is a PhD professor and researcher at Harvard. Harriet Hall, M.D., reviewed his 2019 anti-aging book at Science-Based Medicine. Here’s his current anti-aging regimen as outlined by Dr Hall:

He makes no recommendations for others except “Eat fewer calories”, “Don’t sweat the small stuff”, and “Exercise”.

But he argues that if he does nothing, he will age and die, so he has nothing to lose by trying unproven treatments, and he has personally chosen to do these things:

    • He takes a gram each of NMN [nicotinamide mononucleotide] resveratrol, and metformin daily.
    • He takes vitamin D, vitamin K2, and 83 mg. aspirin.
    • He limits sugar, bread, and pasta intake, doesn’t eat desserts, and avoids eating meat from animals.
    • He skips one meal a day.
    • He gets frequent blood tests to monitor biomarkers; if not optimal, he tries to moderate them with food and exercise.
    • He stays active, goes to the gym, jogs, lifts weights, uses the sauna and then dunks in an ice-cold pool.
    • He doesn’t smoke.
    • He avoids microwaved plastic, excessive UV exposure, X-rays, and CT scans.
    • He tries to keep environmental temperatures on the cool side.
    • He maintains a BMI of 23-25 [click to calculate your BMI].

He plans to fine-tune his regimen as research evolves. He acknowledges “It’s impossible to say if my regimen is working…but it doesn’t seem to be hurting.” He says he feels the same at 50 as he did at 30.

Source: Aging: Is It a Preventable Disease? – Science-Based Medicine

Steve Parker, M.D.

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