Category Archives: Uncategorized

Ultra-Processed Foods May Impair Cognition in Elderly

Mr Ed, the fluent horse (You won’t get this reference if you’re under 63)

An article earlier this year in the European Journal of Nutrition reported that high consumption of ultra-processed foods is linked to worse-than-average performance on one particular test of cognitive function in older U.S. adults (60+ years-old) who did not have chronic diseases such as diabetes or cardiovascular disease. The particular test was “Animal Fluency.” Never heard of it? Me either. Keep reading.

The study included 2,700 participants, average age 69. Participants were asked to recall what they ate in the prior 24 hours. Foods were “classified according to NOVA, a food classification based on the extent and purpose of industrial food processing, into four mutually exclusive groups: (1) unprocessed or minimally processed foods, (2) processed culinary ingredients, (3) processed foods, and (4) UPFs [ultra-processed foods].”

Ultra-processed foods? “…most foods described as “Frozen meals” or “Lunchables”, as well as some items described as consumed in “Restaurant fast food/pizza” or acquired at a “Vending machine” were classified as UPFs.” Furthermore, the authors write in the introduction that “UPFs, according to NOVA classification system, are industrial formulations of processed food substances (oils, fats, sugars, starch, and protein isolates) that contain little or no whole food and typically include flavourings, colourings, emulsifiers, and other cosmetic additives. UPFs are becoming dominant in diets globally and are replacing traditional diets based on unprocessed and minimally processed foods.

Of the entire study population at hand, UPFs were about half of all calories consumed but ranged from 30 to 70%.

Processed or ultra-processed?

“Cognitive performance was assessed using the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD), Word Learning test, Animal Fluency test, and the Digit Symbol Substitution test (DSST).”

The Animal Fluency test “evaluates categorical verbal fluency (executive function).” “For the Animal Fluency test, the participant is requested to name as many animals as possible within a 60-s [60 seconds, I assume] time period. Each animal corresponds to 1 point and the result is presented as the total sum of points.”

The test subjects were given two other tests of cognitive function but the investigators found no differences in performance based on ultra-processed food consumption. Here are these other two tests:

The two parts of the CERAD Word Learning test consist of (1) three consecutive learning trials, where the participant is requested to recall a list of ten unrelated words immediately after their presentation. Each word corresponds to one point, and the result is presented as a total score across the three trials (range 0–30); and (2) a delayed word recall test, performed after the two other cognitive tests. The result ranges from 0 to 10. … For the DSST, the participant is presented a single sheet of paper where they are asked to match a list of nine symbols to numbers according to a key located on the top of the page. The task had 133 numbers and the participant had 2 min to complete it. The result is shown as the total number of correct matches. For all the tests, higher scores represent better cognitive function. 

The authors conclude: “Consumption of UPF was associated with worse performance in Animal Fluency, a cognitive test that assesses language and executive function in older adults without pre-existing diseases such as CVD [cardiovascular disease] and diabetes, while no associations were observed for those with these conditions. While longitudinal studies are required to provide stronger evidence, these results suggest that decreasing UPF consumption may be a way to mitigate age-associated cognitive decline and reduce the risk of dementia.”

I agree these results aren’t very strong.

Steve Parker, M.D.

h/t Jan at The Low Carb Diabetic blog

Should You Take “Eye Vitamins”?

Steve Parker MD, paleobetic diet,
Couldn’t find my retina picture

I have a particular interest in preventing age-related macular degeneration (ARMD) since it runs in my family. It’s the leading cause of vision loss in adults over 50.

From JAMA Ophthalmology:

Question  What were the long-term findings of Age-Related Eye Disease Study 2 (AREDS2) supplements regarding development of lung cancer or progression to late age-related macular degeneration (AMD)?

Findings  In this epidemiologic follow-up study of the AREDS2 cohort of 3882 participants and 6351 eyes, 10-year follow-up results showed that development of lung cancer nearly doubled in participants assigned to beta carotene among former smokers but not those assigned to lutein/zeaxanthin. Lutein/zeaxanthin was associated with a reduction in the risk of progression to late AMD when compared with beta carotene.

Meaning  These findings suggest that the AREDS2 supplement with lutein/zeaxanthin instead of beta carotene was safe, with no association with developing lung cancer and a potential beneficial association with further reduction in progression to late AMD.


Once you lose vision, you may never get it back.

These are the ones I take. In the U.S., your best price may be at Costco or Sam’s Club.

Steve Parker, M.D.

Permanent Adipose Breasts in Women Is a Uniquely Human Trait

Photo by MART PRODUCTION on Pexels.com

Discover Magazine has an article on the evolutionary role of non-pregnant human female breasts.

From Biological Reviews of the Cambridge Philosophical Society:

ABSTRACT

The possession of permanent, adipose breasts in women is a uniquely human trait that develops during puberty, well in advance of the first pregnancy. The adaptive role and developmental pattern of this breast morphology, unusual among primates, remains an unresolved conundrum. The evolutionary origins of this trait have been the focus of many hypotheses, which variously suggest that breasts are a product of sexual selection or of natural selection due to their putative role in assisting in nursing or as a thermoregulatory organ. Alternative hypotheses assume that permanent breasts are a by-product of other evolutionary changes. We review and evaluate these hypotheses in the light of recent literature on breast morphology, physiology, phylogeny, ontogeny, sex differences, and genetics in order to highlight their strengths and flaws and to propose a coherent perspective and a new hypothesis on the evolutionary origins of perennially enlarged breasts in women. We propose that breasts appeared as early as Homo ergaster, originally as a by-product of other coincident evolutionary processes of adaptive significance. These included an increase in subcutaneous fat tissue (SFT) in response to the demands of thermoregulatory and energy storage, and of the ontogenetic development of the evolving brain. An increase in SFT triggered an increase in oestradiol levels (E2). An increase in meat in the diet of early Homo allowed for further hormonal changes, such as greater dehydroepiandrosterone (DHEA/S) synthesis, which were crucial for brain evolution. DHEA/S is also easily converted to E2 in E2-sensitive body parts, such as breasts and gluteofemoral regions, causing fat accumulation in these regions, enabling the evolution of perennially enlarged breasts. Furthermore, it is also plausible that after enlarged breasts appeared, they were co-opted for other functions, such as attracting mates and indicating biological condition. Finally, we argue that the multifold adaptive benefits of SFT increase and hormonal changes outweighed the possible costs of perennially enlarged breasts, enabling their further development.


Steve Parker, M.D.

Recipe: Adam Piggotts’ Insalata di Cavolo Capuccio (green cabbage salad)

Photo by freestocks.org on Pexels.com

I have posted one or more cabbage recipes on this blog. Use the search box if interested.

When I was a wee lad, my mother never served cabbage. Don’t know why.

Adam Piggott is a good writer. He claims he has the best cabbage recipe ever. Here ’tis:

Ingredients:

  • 1 fresh green cabbage
  • Salt
  • Cumin
  • Apple [cider] vinegar
  • Extra virgin olive oil.

Remove the rough outside leaves of the cabbage and then cut it into quarters. Using a mandoline slicer or a grater, carefully shave the cabbage as thinly as possible. 

Now add the other ingredients in the order in which I listed them. Then mix well together and leave to sit for a few hours. Yes, a few hours and the longer the better. A minimum of one hour but if you can leave it all afternoon then you will thank me. This is why I was worried about them running out at the lunch. The cabbage will release some fluids over this time. Check for seasoning and olive oil before serving as you may have to add a little more.

His original post didn’t include specific amounts of most ingredients. Adam elaborated in the comments section:

Yes, the amounts are the issue here and it is what makes this a unique dish. Salt is the key. I use a large salt grinder which you can see in the last photo. I had half a cabbage for lunch and I would say that I used a good half tablespoon of salt. I added a little more at the end. Remember though with salt – you can always add more but you can’t take any away.

I used a quarter teaspoon of cumin. You’re just after a hint of the taste there. A small splash of the vinegar. Too much vinegar becomes overpowering; you can always add more later if you think you need it. Olive oil you can give it a good splash. Looking at the bowl of cabbage you should not see any liquid oozing out of the bottom. If you do then you have used too much oil or vinegar.

You can definitely refrigerate it but you don’t have to. If you do then you should cover it with cling film.

Read Adam’s entire post. It’s not long. You won’t regret it.

Steve Parker, M.D.

Paleobetic diet, low-carb,paleo diet, Steve Parker MD, cabbage soup, diabetic diet
This cabbage soup only has 9 grams of digestible carbohydrate per 2-cup serving. Use the search box for the recipe.

Books on Type 1 Diabetes

Diabetes Daily has an article by Julia Flaherty that reviews books regarding type 1 diabetes. Just thought you might be interested. It didn’t discuss Cheating Destiny: Living with Diabetes, which I am mentioned in.

Steve Parker, M.D.

Who’da thunk it? Paleo Diabetic made it onto a Top 80 List!

Not your average cave-woman

My little corner of teh innerwebs here made it onto Feedspot’s Top 80 Paleo Diet Blogs and Websites list. I need to peruse some of the other sites listed when time allows. You might wanna check it out, too.

Steve Parker, M.D.

Cataract Extraction Linked to Lower Risk of Dementia

Steve Parker MD, eye chart, eye exam

From JAMA Network, December 2021:


Association Between Cataract Extraction and Development of Dementia

Question  Is cataract extraction associated with reduced risk of developing dementia?

Findings  In this cohort study assessing 3038 adults 65 years of age or older with cataract enrolled in the Adult Changes in Thought study, participants who underwent cataract extraction had lower risk of developing dementia than those who did not have cataract surgery after controlling for numerous additional risks. In comparison, risk of dementia did not differ between participants who did or did not undergo glaucoma surgery, which does not restore vision.

Meaning  This study suggests that cataract extraction is associated with lower risk [~30% less] of developing dementia among older adults.

Importance  Visual function is important for older adults. Interventions to preserve vision, such as cataract extraction, may modify dementia risk.


Details in the abstract:

Objective  To determine whether cataract extraction is associated with reduced risk of dementia among older adults.

Design, Setting, and Participants  This prospective, longitudinal cohort study analyzed data from the Adult Changes in Thought study, an ongoing, population-based cohort of randomly selected, cognitively normal members of Kaiser Permanente Washington. Study participants were 65 years of age or older and dementia free at enrollment and were followed up biennially until incident dementia (all-cause, Alzheimer disease, or Alzheimer disease and related dementia). Only participants who had a diagnosis of cataract or glaucoma before enrollment or during follow-up were included in the analyses (ie, a total of 3038 participants). Data used in the analyses were collected from 1994 through September 30, 2018, and all data were analyzed from April 6, 2019, to September 15, 2021.

Exposures  The primary exposure of interest was cataract extraction. Data on diagnosis of cataract or glaucoma and exposure to surgery were extracted from electronic medical records. Extensive lists of dementia-related risk factors and health-related variables were obtained from study visit data and electronic medical records.

Main Outcomes and Measures  The primary outcome was dementia as defined by Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria. Multivariate Cox proportional hazards regression analyses were conducted with the primary outcome. To address potential healthy patient bias, weighted marginal structural models incorporating the probability of surgery were used and the association of dementia with glaucoma surgery, which does not restore vision, was evaluated.

Results  In total, 3038 participants were included (mean [SD] age at first cataract diagnosis, 74.4 (6.2) years; 1800 women (59%) and 1238 men (41%); and 2752 (91%) self-reported White race). Based on 23 554 person-years of follow-up, cataract extraction was associated with significantly reduced risk (hazard ratio, 0.71; 95% CI, 0.62-0.83; P < .001) of dementia compared with participants without surgery after controlling for years of education, self-reported White race, and smoking history and stratifying by apolipoprotein E genotype, sex, and age group at cataract diagnosis. Similar results were obtained in marginal structural models after adjusting for an extensive list of potential confounders. Glaucoma surgery did not have a significant association with dementia risk (hazard ratio, 1.08; 95% CI, 0.75-1.56; P = .68). Similar results were found with the development of Alzheimer disease dementia.

Conclusions and Relevance  This cohort study found that cataract extraction was significantly associated with lower risk of dementia development. If validated in future studies, cataract surgery may have clinical relevance in older adults at risk of developing dementia.


Steve Parker, M.D.

Another Estimate of Paleolithic Man’s Diet

Not many edible leafy greens around this time of year

I see no reason to disagree with this abstract.

Abstract

We review the evolutionary origins of the human diet and the effects of ecology economy on the dietary proportion of plants and animals. Humans eat more meat than other apes, a consequence of hunting and gathering, which arose ∼2.5 Mya with the genus Homo. Paleolithic diets likely included a balance of plant and animal foods and would have been remarkably variable across time and space. A plant/animal food balance of 40-60% prevails among contemporary warm-climate hunter-gatherers, but these proportions vary widely. Societies in cold climates, and those that depend more on fishing or pastoralism, tend to eat more meat. Warm-climate foragers, and groups that engage in some farming, tend to eat more plants. We present a case study of the wild food diet of the Hadza, a community of hunter-gatherers in northern Tanzania, whose diet is high in fiber, adequate in protein, and remarkably variable over monthly timescales. Expected final online publication date for the Annual Review of Nutrition, Volume 41 is September 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

I Appreciate Your Support!

I published my first book in 2007 to extend my healing reach beyond the confines of the clinic and hospital room. I’m certain my writing has improved the health of many folks I’ll never know about, and that means more to me than any financial success I’ve had with the books. 

In 2020, my net profit from writing was $937.08, which is admittedly pitiful. The prior year’s net profit was $5,802.48. Pandemic effect, maybe? To lower my expenses in 2021, I’ll look into a private PO box instead of US Postal Service ($168/year), drop Amazon Prime ($129/year), and negotiate lower fees with Network Solutions.

I am blessed to have a hospitalist job that pays well. COVID-19 has caused major economic hardship for many of you, including unemployment.

My primary means of advertising has been blogging. Cross-posting on Facebook, Twitter, and LinkedIn has done almost nothing for book sales. A few years ago I could give my hospital patients a business card with links to my books, but my employer insisted I stop. 

If you care to support my writing, buy a book. If not for yourself, then for someone you care about. 

Steve Parker, M.D.

PS: All my books are here and at Smashwords.com.

PPS: Guesstimating my combined federal and state taxes being 40%, I have $562.25 left after paying taxes. And don’t forget sales tax on many things I might buy. 

For How Long Did Neanderthals Breast-Feed?

For 5-6 months.

Now aren’t you glad you read this blog? Where else you gonna get this vital info?

The discovery is based on dental analysis of a whopping three Neanderthals found in Italy.

The early onset of weaning in modern humans has been linked to the high nutritional demand of brain development that is intimately connected with infant physiology and growth rate. In Neanderthals, ontogenetic patterns in early life are still debated, with some studies suggesting an accelerated development and others indicating only subtle differences vs. modern humans. Here we report the onset of weaning and rates of enamel growth using an unprecedented sample set of three late (∼70 to 50 ka) Neanderthals and one Upper Paleolithic modern human from northeastern Italy via spatially resolved chemical/isotopic analyses and histomorphometry of deciduous teeth. Our results reveal that the modern human nursing strategy, with onset of weaning at 5 to 6 mo, was present among these Neanderthals. This evidence, combined with dental development akin to modern humans, highlights their similar metabolic constraints during early life and excludes late weaning as a factor contributing to Neanderthals’ demise.

Source: Early life of Neanderthals – PubMed

Steve Parker, M.D.