Category Archives: Longevity

Sitting is the new smoking? No, it’s worse than that.

exercise for weight loss and management, dumbbells

At least he’s trying…

I’ve long advocated that life-and health-insurance companies base their premiums on results of individual treadmill exercise tests or similar. Here’s why.

From CNN:

We’ve all heard exercise helps you live longer. But a new study goes one step further, finding that a sedentary lifestyle is worse for your health than smoking, diabetes and heart disease.

Dr. Wael Jaber, a cardiologist at the Cleveland Clinic and senior author of the study, called the results “extremely surprising.”

“Being unfit on a treadmill or in an exercise stress test has a worse prognosis, as far as death, than being hypertensive, being diabetic or being a current smoker,” Jaber told CNN. “We’ve never seen something as pronounced as this and as objective as this.”

Source: Not exercising worse for your health than smoking, diabetes and heart disease – CNN

Most folks can improve their fitness by exercising regularly. But what about nonresponders?

Steve Parker, M.D.

PS: All of my weight-loss books recommend and teach you how to improve your level of fitness.

Omega-3 Fatty Acids Have No Effect on Cardiovascular Disease After All

Salmon, a cold-water fatty fish, is a rich source of omega-3 fatty acids

That headline is the conclusion of a Cochrane systematic review of the evidence. As you read the summary below, be aware that the main omega-3 fatty acids are alpha-lenolinic acid (ALA), docosahexaenoic acid (DHA), and eicosapentaenoic acid (EPA).

From Cochrane Library:

Increasing EPA and DHA has little or no effect on all‐cause deaths and cardiovascular events (high‐quality evidence) and probably makes little or no difference to cardiovascular death, coronary deaths or events, stroke, or heart irregularities (moderate‐quality evidence, coronary events are illnesses of the arteries which supply the heart). EPA and DHA slightly reduce serum triglycerides and raise HDL (high‐quality evidence).

Eating more ALA (for example, by increasing walnuts or enriched margarine) probably makes little or no difference to all‐cause or cardiovascular deaths or coronary events but probably slightly reduce cardiovascular events, coronary mortality and heart irregularities (moderate/low‐quality evidence). Effects of ALA on stroke are unclear as the evidence was of very low quality.

There is evidence that taking omega‐3 capsules does not reduce heart disease, stroke or death. There is little evidence of effects of eating fish. Although EPA and DHA reduce triglycerides, supplementary omega‐3 fats are probably not useful for preventing or treating heart and circulatory diseases. However, increasing plant‐based ALA may be slightly protective for some heart and circulatory diseases.

Source: Omega‐3 fatty acids for the primary and secondary prevention of cardiovascular disease – Abdelhamid, AS – 2018 | Cochrane Library

Even short bursts of exercise can reduce risk of disease and death

Steve Parker MD

Bouts of 5 minutes may be enough

From ABC News:

The old benchmark of 150 minutes per week of moderate activity (or 75 minutes of vigorous activity) originated in 1995. The “rules”: Each time you exercise, it should be for at least 10 minutes.

“For about 30 years, guidelines have suggested that moderate-to-vigorous activity could provide health benefits, but only if you sustained the activity for 10 minutes or more,” an author of the research, William E. Kraus, M.D., of the Duke University School of Medicine, said in a press release. “That flies in the face of public health recommendations, like taking the stairs instead of the elevator, and parking farther from your destination. Those don’t take 10 minutes, so why were they recommended?

“The new study finds that the length of each bout or episode of exercise is unrelated to the benefit seen in living longer. Five minutes of jogging, researchers said, “counts” toward better health.

Source: Even short bursts of exercise can reduce Americans’ risk of disease and death, study says – ABC News

For Overweight Type 2 Diabetics on a Paleo Diet, What’s the Effect of Adding an Exercise Program?

You better have good cardiovascular fitness if battling this big guy

Swedish researchers wondered if adding an exercise program to the Paleo diet in overweight type 2 diabetics would improve blood sugars or insulin sensitivity. Surprisingly, it did not. Exercise did, however, improve cardiovascular fitness.

How Was the Research Done?

Study participants in northern Sweden had been diagnosed with diabetes within the last 8 years and were either taking metformin (about 2/3 of them) or were using lifestyle modification (primarily diet, I presume) to treat diabetes. Folks on additional diabetes drugs were excluded. Baseline BMI was between 25 and 40, with and average of 31.5. (For example, a 5-ft, 9-inch person weighing 206 lb has a BMI of 30.4.) Men were 30–70 years old; women were post-menopausal or up to age 70 (no explanation given for excluding younger women). A third of participants were women. All were sedentary at the time of enrollment. Baseline hemoglobin A1c’s were between 6.5 and 10.8% (average of 7.2%).

Participants were divided into two groups (14 or 15 in each):

  1. Paleolithic diet (PD)
  2. Paleolithic diet plus thrice weekly supervised exercise (PD-EX)

The exercise regimen was included both aerobic and resistance training. Click the reference link below for details. It looks like a vigorous and reasonable program to me.

The study lasted for 12 weeks.

Here’s their Paleo diet: “…lean meat, fish, seafood, eggs, vegetables, fruits, berries, and nuts. Cereals, dairy products, legumes, refined fats, refined sugars, and salt were excluded with the exception of canned fish and cold cuts like ham. The diet was consumed ad libitum [i.e., they could eat as much as they wanted], with restrictions of the following: eggs (1–2/day but a maximum of 5/week, potatoes (1 medium sized/day), dried fruit (130 g/day), and nuts (60 g/day). Rapeseed or olive oil (maximum 15 g/day) and small amounts of honey and vinegar were allowed as flavoring in cooking. Participants were instructed to drink mainly still water. Coffee and tea were restricted to a maximum of 300 g/day, and red wine to a maximum of one glass/week.

Who could stand to eat this junk for 12 weeks?

What Did They Find?

  • Both groups had and average individual weight loss of 7.1 kg (15.4 lb).
  • Both groups lost fat mass (measured by DEXA). The males in the PD-EX group retained more lean mass (e.g., muscle) than the other males.
  • Insulin sensitivity and blood sugar control improved in both groups to a comparable degree.
  • Hemoglobin A1c dropped about 1% in both groups.
  • VO2max (a measure of cardiovascular fitness) increased only in the PD-EX group, from 22.5 to 25.8 mL/kg/min.
  • Both groups dropped both systolic and diastolic blood pressures by 10%.
  • Both groups cut their leptin levels by about half. Leptin causes inflammation and is linked to cardiovascular events (heart attacks, strokes).

So What?

This study adds to the relatively few previous ones proving that the Paleo diet is effective in diabetes (overweight and obese type 2 diabetes in this case).

Fifteen-pound weight loss over 12 weeks while eating as much as you want is amazing.

The 1% absolute drop in Hemoglobin A1c is also quite welcome, comparable to or better than the reductions we see with many of our diabetes drugs. The authors remind us that “The UK prospective diabetes study (UKPDS) stated that a 1% unit improvement of HbA1c reduces microvascular complications by 37% and reduces diabetes-related death by 21%.”

The exercise program didn’t add to the weight loss. No surprise there. Unless you’re a contestant on The Biggest Loser show, 90% of weight loss depends on diet.

Unlike other studies, the exercisers didn’t see extra improvement in insulin resistance or blood sugar control. I can’t explain it.

The 10% blood pressure reduction by this Paleo diet could be quite beneficial for an individual with high blood pressure, allowing drug avoidance or dose reduction. Systolic pressure of 150 mmHg is often treated with drugs; a 10% reduction gets you down to 135, which doesn’t require drug therapy.

Note the 3.3 mL/kg/min increase in VO2max from this exercise program, which could be an 18% in all-cause mortality if sustained over time. The investigators cite a cohort study that found a VO2max increase of 1.44 mL/kg/min reduced overall mortality by 7.9%.

Steve Parker, M.D.

Reference: Otten, et al. (including Ryberg and Olsson). Effects of a Paleolithic diet with and without supervised exercise on fat mass, insulin sensitivity, and glycemic control: a randomized controlled trial in individuals with type 2 diabetes. Diabetes/Metabolism Research and Reviews, 2017; 33(1): doi: 10.1002/dmrr.2828   Published online in 2016.

Paleo and Mediterranean Diets Linked to Lower Risk of Death

The Journal of Nutrition in 2017 published a study that looked at baseline diet characteristics of over 21,000 folks, then over the next six years noted who died, and why. Guess how many died?

Here’s a clue. These U.S. study participants were at least 45 years old at the start of the study.

2,513 died. Seems high to me, so I bet the average age was close to 65.

Hank’s not worried about death

I can’t tell for sure from the report’s abstract, but it looks like the researchers were interested in the Mediterranean and caveman diets from the get-go. Study subjects who ate Paleo- or Mediterranean-style were significantly less likely to die over six years. They were less likely to die from any cause or from cancer or from cardiovascular disease.

Composition of the paleo diet is debatable (click for my 2012 definition).

Consider adopting some Mediterranean diet features, too.

Steve Parker, M.D.

Reference:

Paleolithic and Mediterranean Diet Pattern Scores Are Inversely Associated with All-Cause and Cause-Specific Mortality in Adults. First published February 8, 2017, doi: 10.3945/​jn.116.241919.

Abstract

Background: Poor diet quality is associated with a higher risk of many chronic diseases that are among the leading causes of death in the United States. It has been hypothesized that evolutionary discordance may account for some of the higher incidence and mortality from these diseases.

Objective: We investigated associations of 2 diet pattern scores, the Paleolithic and the Mediterranean, with all-cause and cause-specific mortality in the REGARDS (REasons for Geographic and Racial Differences in Stroke) study, a longitudinal cohort of black and white men and women ≥45 y of age.

Methods: Participants completed questionnaires, including a Block food-frequency questionnaire (FFQ), at baseline and were contacted every 6 mo to determine their health status. Of the analytic cohort (n = 21,423), a total of 2513 participants died during a median follow-up of 6.25 y. We created diet scores from FFQ responses and assessed their associations with mortality using multivariable Cox proportional hazards regression models adjusting for major risk factors.

Results: For those in the highest relative to the lowest quintiles of the Paleolithic and Mediterranean diet scores, the multivariable adjusted HRs for all-cause mortality were, respectively, 0.77 (95% CI: 0.67, 0.89; P-trend < 0.01) and 0.63 (95% CI: 0.54, 0.73; P-trend < 0.01). The corresponding HRs for all-cancer mortality were 0.72 (95% CI: 0.55, 0.95; P-trend = 0.03) and 0.64 (95% CI: 0.48, 0.84; P-trend = 0.01), and for all-cardiovascular disease mortality they were 0.78 (95% CI: 0.61, 1.00; P-trend = 0.06) and HR: 0.68 (95% CI: 0.53, 0.88; P-trend = 0.01).

Conclusions: Findings from this biracial prospective study suggest that diets closer to Paleolithic or Mediterranean diet patterns may be inversely associated with all-cause and cause-specific mortality.

 

PURE Study: High Carb Consumption Increases Risk of Death

How many innocent lives will be cut short by this tasty but silent killer?

Here’s the abstract of a new epidemiological study that investigated the relationships between diet, cardiovascular disease, and death rates. I don’t have the entire article. My sense is that the 18 countries studied are mostly non-Western:

Background

The relationship between macronutrients and cardiovascular disease and mortality is controversial. Most available data are from European and North American populations where nutrition excess is more likely, so their applicability to other populations is unclear.

Methods

The Prospective Urban Rural Epidemiology (PURE) study is a large, epidemiological cohort study of individuals aged 35–70 years (enrolled between Jan 1, 2003, and March 31, 2013) in 18 countries with a median follow-up of 7·4 years (IQR 5·3–9·3). Dietary intake of 135 335 individuals was recorded using validated food frequency questionnaires. The primary outcomes were total mortality and major cardiovascular events (fatal cardiovascular disease, non-fatal myocardial infarction, stroke, and heart failure). Secondary outcomes were all myocardial infarctions, stroke, cardiovascular disease mortality, and non-cardiovascular disease mortality. Participants were categorised into quintiles of nutrient intake (carbohydrate, fats, and protein) based on percentage of energy provided by nutrients. We assessed the associations between consumption of carbohydrate, total fat, and each type of fat with cardiovascular disease and total mortality. We calculated hazard ratios (HRs) using a multivariable Cox frailty model with random intercepts to account for centre clustering.

paleo diet, paleolithic diet, caveman diet

“Do you understand the words that are coming out of my mouth?”

Findings

During follow-up, we documented 5796 deaths and 4784 major cardiovascular disease events. Higher carbohydrate intake was associated with an increased risk of total mortality (highest [quintile 5] vs lowest quintile [quintile 1] category, HR 1·28 [95% CI 1·12–1·46], ptrend=0·0001) but not with the risk of cardiovascular disease or cardiovascular disease mortality. Intake of total fat and each type of fat was associated with lower risk of total mortality (quintile 5 vs quintile 1, total fat: HR 0·77 [95% CI 0·67–0·87], ptrend<0·0001; saturated fat, HR 0·86 [0·76–0·99], ptrend=0·0088; monounsaturated fat: HR 0·81 [0·71–0·92], ptrend<0·0001; and polyunsaturated fat: HR 0·80 [0·71–0·89], ptrend<0·0001). Higher saturated fat intake was associated with lower risk of stroke (quintile 5 vs quintile 1, HR 0·79 [95% CI 0·64–0·98], ptrend=0·0498). Total fat and saturated and unsaturated fats were not significantly associated with risk of myocardial infarction or cardiovascular disease mortality.

Interpretation

High carbohydrate intake was associated with higher risk of total mortality, whereas total fat and individual types of fat were related to lower total mortality. Total fat and types of fat were not associated with cardiovascular disease, myocardial infarction, or cardiovascular disease mortality, whereas saturated fat had an inverse association with stroke. Global dietary guidelines should be reconsidered in light of these findings.

Source: Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study – The Lancet

What’s More Important For Longevity: Level of Fitness Or Minutes of Exercise Per Week?

She can increase intensity by increasing the weight of those dumbbells

She can increase intensity by increasing the weight of those dumbbells

You’ve heard that “sitting is the new smoking,” right?

Regular physical activity prevents disease and prolongs life. But if you nevertheless still spend to much time sitting around either at work or home, the sitting tends to counteract the benefits of your exercise.

A new study says that your fitness level is more important for long-term health than the number of hours you exercise. Fitness level in this context was cardiorespiratory fitness, probably measured by a maximal-effort treadmill or bicycle test.

Some of your fitness level is inherited, but you can also improve your fitness with the proper intensity or duration of exercise. Rather than exercise longer, I prefer more intensity. Just strolling around the mall at 2 mph for two hours isn’t going to improve fitness in most folks.

From MNT:

“The team conducted a cross-sectional study of 495 women and 379 men from Norway aged between 70-77 years. Sedentary time and physical activity were assessed by accelerometers, while cardiorespiratory fitness was determined by peak oxygen uptake (VO2 peak) – the measurement of the volume of oxygen that the body can utilize during physical exertion.

Researchers compared different levels of activity with fitness levels and cardiovascular risk factor clusters. A cardiovascular risk factor cluster was defined as the presence of three to five risk factors for heart disease.

These risk factors included: elevated waist circumference, elevated blood triglycerides or reduced “good” cholesterol levels, high blood pressure or treatment for hypertension, and elevated fasting blood sugar levels – combined symptoms commonly referred to as metabolic syndrome.

High cardiorespiratory fitness reduced risk of heart diseaseFindings – published in Mayo Clinic Proceedings – showed that when compared with women and men who were the least sedentary, women and men from the most sedentary group were 83 percent and 63 percent more likely to have cardiovascular risk factors from extended time sitting, respectively.

However, when the team took participants’ level of fitness into consideration – measured by having high age-specific cardiorespiratory fitness – they found that the fittest 40 percent had a decreased likelihood of cardiovascular risk factors from prolonged sitting.This finding held true even though the fittest participants spent between 12-13 hours per day sedentary and did not meet current moderate to vigorous physical activity guidelines.”

Source: Fitness, not physical activity, mitigates negative effects of prolonged sitting – Medical News Today

PS: If you’re new to exercise, I teach you how to get started in my books.

Living at Higher Altitude May Prolong Life

Adult life is a battle against gravity. Eventually we all lose.

Adult life is a battle against gravity. Eventually we all lose.

From P.D. Mangan:

“Death rates from both of these cancers [breast in women, colon in men] were about half as high at an altitude of greater than 1000 meters (3300 feet).  The study also found about a 30% reduction in deaths from coronary artery disease at >1000 meters.

This accords well with a number of other studies. For example, “Lower Mortality From Coronary Heart Disease and Stroke at Higher Altitudes in Switzerland“. This study found 22% less heart disease death for every +1000 meters in altitude, and 12% less stroke death.

Association Between Alzheimer Dementia Mortality Rate and Altitude in California Counties“: This study found about half the death rate from Alzheimer’s at an altitude of 1600 meters vs that at sea level.

There’s less diabetes at high altitude.”

Source: Higher Altitude Means Much Lower Death Rates – Rogue Health and Fitness

RTWT.

Intensive Program Extended Life By Eight Years in T2 Diabetes

MedPageToday has some details:

“Type-2 diabetics lived nearly 8 years longer when treated with an intensive, multifactorial approach that employed behavioral and pharmacological interventions.

The 160 patients with type-2 diabetes mellitus and microalbuminuria, now followed for 21 years, received either conventional or intensified therapy.

Thirty-eight intensive-therapy patients died during the follow-up period compared with 55 conventional-therapy patient deaths during the same time. This translated to a median survival period 7.9 years longer for the intensive-therapy cohort, as well as a median delay of 8.1 years to a first cardiovascular event, the investigators reported in the journal Diabetologia.

“The outcome of our study is very encouraging and emphasizes the need for early and intensified treatment of multiple modifiable risk factors for a poor prognosis of patients with type 2 diabetes,” said lead study author Peter Gaede, MD, of the University of Southern Denmark in Odense, in a statement.”

Source: Intensive Program Extends Lifespan in T2D Patients | Medpage Today

Parker here.

Study participants were northern Europeans (Danes) who had small amounts of protein (albumin) in their urine and were mostly in their 50s when the long-term study started.

Medical intervention included diet changes, drugs for diabetes/blood pressure/lipids, and exercise. Therapy for the intensive therapy group was “target-driven, with stepwise implementation of both behavioral and pharmacological treatment following a structured approach.”

If you’re a researcher and want to test how my diabetes diets would perform in a study like this, contact me for a discount on books.

Steve Parker, M.D.

DietDoctor Shares More Practical Tips for Fasting 

This guy had long spans of time between meals, perhaps days

This guy had long spans of time between meals, perhaps days

Yet another good post from DietDoctor! Why fast? Among many reasons is that fasting turns on autophagy, which helps clear the debris of daily living out of your cells, probably leading to longer life.

Click here for P.D. Mangan’s post on fasting and autophagy.

Dr. Fung at DietDoctor also warns about the danger of hypoglycemia for certain folks with diabetes. Read that part carefully.

Anyway, here are Dr. Fung’s top eight tips:

“Drink water: Start each morning with a full eight-ounce glass of water.

Stay busy: It’ll keep your mind off food. It often helps to choose a busy day at work for a fast day.

Drink coffee: Coffee is a mild appetite suppressant. Green tea, black tea, and bone broth may also help.Ride the waves: Hunger comes in waves; it is not continuous. When it hits, slowly drink a glass of water or a hot cup of coffee. Often by the time you’ve finished, your hunger will have passed.

Don’t tell anybody you are fasting: Most people will try to discourage you, as they do not understand the benefits. A close-knit support group is often beneficial, but telling everybody you know is not a good idea.

Give yourself one month: It takes time for your body to get used to fasting. The first few times you fast may be difficult, so be prepared. Don’t be discouraged. It will get easier.

Follow a nutritious diet on non-fast days: Intermittent fasting is not an excuse to eat whatever you like. During non-fasting days, stick to a nutritious diet low in sugars and refined carbohydrates.

Don’t’ binge: After fasting, pretend it never happened. Eat normally, as if you had never fasted.”

Source: More Practical Tips for Fasting – Diet Doctor

Steve Parker, M.D.

PS: I don’t feature fasting in any of my books, but I’ve gradually come around to seeing the potential benefits.