Category Archives: Uncategorized

The Bees Have Recovered!

We had one of these swarms in our front yard a few years ago for several weeks. Yes, that’s hundreds of bees. And most in Arizona are Africanized.

Remember 8–10 years ago when scientists told us that bee colonies were mysteriously disappearing. My recollection is that they called it “colony decline syndrome.” Maybe caused by pesticides or other pollution. If the trend continued, crops wouldn’t be pollinated and we’d starve to death. Apocalypse within a few years.

Looks harmless enough, right?

Turns out it was Fake News. Thank God.

Another reason for science skepticism.

Steve Parker, M.D.

PS: See details at Issues & Insights, the source of the graphs above.

PPS: My recollection was wrong; they called it Colony Collapse Disorder.

Steve Parker MD, Advanced Mediterranean Diet

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Science Skepticism

 

“You can’t tell whether I’m lying, delusional, ignorant, or simply incompetent. Sometimes even I don’t know!”

I ran across a 2016 article by Callie Joubert that summarizes skeptical ideas I’ve read about for years, but most people and physicians don’t know about. Bottom line: scientific research and medical studies aren’t nearly as reliable as you think.

Read the whole thing, but here are some excerpts:

We tend to think of science as a dispassionate (impartial, neutral) search for truth and certainty. But is it possible that we are facing a situation in which there is a massive production of wrong information or distortion of information? Is it possible that certain scientific disciplines are facing a crisis of credibility? Mounting evidence suggests this is indeed the case, which raises two questions: How serious is the problem? And what could explain this?

***

The title of an editorial in the prestigious medical journal The Lancet, dated April 6, 2002, asks the question, “Just How Tainted Has Medicine Become?”4 The article states, “Heavily, and damagingly so, is the answer.” Among other things, in 2001, researchers completed experiments with biotechnology products in which they had a direct financial interest and doctors did not tell their patients that others had died using these products when safer alternatives were available. In the same journal, dated April 11, 2015, Dr. Richard Horton stated the gravity of the problem as follows: “The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue . . . science has taken a turn towards darkness.”

In 2004, under the heading of “Depressing Research,” the editor of The Lancet had this to say about antidepressants for children: “The story of research into selective serotonin reuptake inhibitor (SSRI) use in childhood depression is one of confusion, manipulation, and institutional failure. . . . In a global medical culture where evidence-based practice is seen as the gold standard for care, these failings [i.e., of the USA Food and Drug Administration to act on information provided to them about the harmful effects of these drugs on children] are a disaster.”6 After being editor of the New England Journal of Medicine for 20 years, Dr. Marcia Angell stated that “physicians can no longer rely on the medical literature for valid and reliable information.”7 She referred to a study of 74 clinical trials of antidepressants that indicates that 37 of 38 positive studies were published. In contrast, 33 of the 36 negative studies were either not published or published in a form that conveyed a positive outcome. She also mentions the fact that drug companies are financing “most clinical research on the prescription drugs, and there is mounting evidence that they often skew the research they sponsor to make their drugs look better and safer.”

In 2011, researchers at Bayer decided to test 67 recent drug discoveries on preclinical cancer biology research. In more than 75 percent of cases, the published data did not match their attempts to replicate them.8 In 2012, a study published in Nature announced that only 11 percent of the sampled preclinical cancer studies coming out of the academic pipeline were replicable.9

In the prestigious Science journal, in 2015, the Open Science Collaboration10 presented a study of 100 psychological research studies that 270 contributing authors tried to replicate. An astonishing 65 percent failed to show any statistical significance on replication, and many of the remainder showed greatly reduced effect sizes. In plain terms, evidence for original findings is weak.

***

A discovery in physics, the hardest of all hard sciences, is usually thought of as the most reliable in the world of science. However, two of the most vaunted physics results of the past few years—“cosmic inflation and gravitational waves at the BICEP2 experiment in Antarctica, and the supposed discovery of superluminal neutrinos at the Swiss-Italian border—have now been retracted, with far less fanfare than when they were first published.”

***

Parker here again….

The science skeptic best known to physicians is John P.A. Ioannidis:

Empirical evidence from diverse fields suggests that when efforts are made to repeat or reproduce published research, the repeatability and reproducibility is dismal.

Another quote form Ioannidis:

There is increasing concern that most current published research findings are false. The probability that a research claim is true may depend on study power and bias, the number of other studies on the same question, and, importantly, the ratio of true to no relationships among the relationships probed in each scientific field. In this framework, a research finding is less likely to be true when the studies conducted in a field are smaller; when effect sizes are smaller; when there is a greater number and lesser preselection of tested relationships; where there is greater flexibility in designs, definitions, outcomes, and analytical modes; when there is greater financial and other interest and prejudice; and when more teams are involved in a scientific field in chase of statistical significance. Simulations show that for most study designs and settings, it is more likely for a research claim to be false than true. Moreover, for many current scientific fields, claimed research findings may often be simply accurate measures of the prevailing bias.

Ioannidis again:

Most physicians and other healthcare professionals are unaware of the pervasiveness of poor quality clinical evidence that contributes considerably to overuse, underuse, avoidable adverse events, missed opportunities for right care and wasted healthcare resources. The Medical Misinformation Mess comprises four key problems. First, much published medical research is not reliable or is of uncertain reliability, offers no benefit to patients, or is not useful to decision makers. Second, most healthcare professionals are not aware of this problem. Third, they also lack the skills necessary to evaluate the reliability and usefulness of medical evidence. Finally, patients and families frequently lack relevant, accurate medical evidence and skilled guidance at the time of medical decision‐making.

If you like videos, here’s Ioannidis on YouTube.

Staying skeptical,

Steve Parker, M.D.

h/t Vox Day

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Antioxidants: Is the Bloom Off the Rose?

If you’re the TL;DR type: Antioxidants in supplements or food may not be all they’re cracked up to be.

A science journal article abstract:

The powerful action of antioxidants in preventing premature lipid oxidation in food suggests that the same compounds, when consumed with the daily diet, could unfold antioxidative/anti-aging effects in the human body. Therefore, it has been hypothesized that antioxidants are helpful in preventing various diseases. More detailed chemical and physiological examination of antioxidants shows, however, that the extrapolation of in vitro data to in vivo behavior may be misleading. Indeed, such a procedure fails to take into account the mismatch between most in vitro models (e.g., cell cultures) and in vivo systems. For example, the physiological relevance of pro-oxidative and other physiological activities of antioxidants have been largely underestimated. Actually, contrary to the antioxidant hypothesis, clinical trials testing the health benefits of dietary antioxidants have reported rather mixed or negative results. Many clinical studies have not taken into account the nutrikinetic and nutridynamic nature of antioxidants. Further, oxidative stress is not only an inevitable event in a healthy human cell, but responsible for the functioning of vital metabolic processes, such as insulin signaling and erythropoietin production. In the light of recent physiological studies it appears more advisable to maintain the delicate redox balance of the cell than to interfere with the antioxidant homeostasis by a non-physiological, excessive exogenous supply of antioxidants in healthy humans.

Source: Antioxidants in food: mere myth or magic medicine? – PubMed – NCBI

Steve  Parker, M.D.

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Incidence of Diabetes in U.S. Is Decreasing

According to researchers at the CDC:

“After an almost 20-year increase in the national prevalence and incidence of diagnosed diabetes, an 8-year period of stable prevalence and a decrease in incidence has occurred. Causes of the plateauing and decrease are unclear but the overall burden of diabetes remains high and deserves continued monitoring and intervention.”

Source: New directions in incidence and prevalence of diagnosed diabetes in the USA | BMJ Open Diabetes Research & Care

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Is There a Single Best Diet for Diabetes?

173 Years of U.S. Sugar Consumption

According to an article at Diabetes Care:

The Consensus Report highlights the role of weight management, dietary patterns, and technology-enabled tools in diabetes prevention and management. There is a clear consensus on reducing intake of added sugars, sodium, and unhealthy fats, especially trans fat, in the diet, although the panel does not recommend a “one-size-fits-all” eating plan. Instead, multiple eating patterns including the Mediterrranean diet, DASH (Dietary Approaches to Stop Hypertension) diet, and vegetarian and low-carbohydrate diets can be used for weight and diabetes management. However, the quality and food sources of the macronutrients are among the most critical factors determining the efficacy and long-term outcomes of these diets.

Source: Nutritional Strategies for Prevention and Management of Diabetes: Consensus and Uncertainties | Diabetes Care

Looks Like “Diabetes Care” is Recommending a  Paleo Diet for Diabetes

From Diabetes Care:

Consensus recommendations:

A variety of eating patterns (combinations of different foods or food groups) are acceptable for the management of diabetes.

Until the evidence surrounding comparative benefits of different eating patterns in specific individuals strengthens, health care providers should focus on the key factors that are common among the patterns:

○ Emphasize nonstarchy vegetables.

○ Minimize added sugars and refined grains.

○ Choose whole foods over highly processed foods to the extent possible.

Reducing overall carbohydrate intake for individuals with diabetes has demonstrated the most evidence for improving glycemia and may be applied in a variety of eating patterns that meet individual needs and preferences.

For select adults with type 2 diabetes not meeting glycemic targets or where reducing antiglycemic medications is a priority, reducing overall carbohydrate intake with low- or very low-carbohydrate eating plans is a viable approach.

Source: Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report | Diabetes Care

Urinary Sodium and Potassium Excretion Predict Adverse Cardiovascular Events

Heart attack is one of several cardiovascular diseases.

There’s a reason I take a magnesium supplement daily…

“In an observational study, lowest CV (cardiovascular) risk occurred with moderate sodium intake and high potassium intake.

The WHO recommends restricting sodium intake (to 3.5 g daily). However, prior research has shown a J-shaped association between sodium intake and cardiovascular (CV) disease. In this international cohort study, researchers evaluated the combined association of sodium and potassium excretion (as surrogate measures of intake) on major adverse CV events (i.e., myocardial infarction, stroke, and heart failure) and death.

More than 100,000 people in 18 countries provided morning fasting urine samples for estimation of 24-hour excretion of sodium and potassium. Median sodium and potassium excretions were 4.9 g and 2.1 g daily. After a mean 8.2 years, 6% of participants had experienced major adverse CV events or died. A J-shaped association between sodium excretion and adverse CV events and death was observed (risk nadir was at sodium excretion of 3–5 g daily). Lowest risk occurred in participants with moderate sodium excretion (3–5 g daily) and high potassium excretion (≥2.1 g daily). Compared with this combination, all other combinations were associated with higher risk, including lower sodium and higher potassium excretion. Higher potassium excretion significantly attenuated risk associated with higher sodium excretion.”

Source: Urinary Sodium and Potassium Excretion Predict Adverse Cardiovascular Events

The Effectiveness of MyPlate and Paleolithic-based Diet Recommendations, both with and without Exercise In Young Women

This isn’t an important study, but you might find it interesting anyway…

The purpose of this study was to evaluate the effectiveness of recommending a MyPlate or a Paleolithic-based diet, both with and without exercise, on aerobic fitness, strength, and anaerobic power over eight weeks. Participants (n=20) were randomized to one of four groups, (1) a MyPlate diet (MP), (2) Paleolithic-based diet (PD), (3) MyPlate and exercise (MP + Ex), and (4) Paleolithic-based diet and exercise (PD + Ex). The exercise included two days of unsupervised aerobic and resistance exercise. At baseline and final, absolute and relative peak oxygen consumption (absVO2peak and relVO2peak), anaerobic power, and upper and lower body strength were determined. Data were analyzed using repeated measures two-way analysis of variance (ANOVA). The ANOVA indicated that there was no significant interaction between time point (TP)*diet (D)*exercise (Ex) for all variables except relVO2peak (p = 0.016). The MP + Ex group (Δ+4.4 ml·kg-1·min-1) had a greater change from baseline compared to the MP group (Δ-2.7 ml·kg-1·min-1, p = 0.002), and PD + Ex group (Δ-0.3 ml·kg-1·min-1, p = 0.03). The results suggest recommending a MyPlate diet with both aerobic and resistance training are effective at improving aerobic fitness when compared to PD recommendations with exercise, although these conclusions may be confounded by low compliance to exercise recommendations.

Source: The Effectiveness of MyPlate and Paleolithic-based Diet Recommendations, both with and without Exercise, on Aerobic Fitness, Muscular Strength and … – PubMed – NCBI

Does a Modified Paleo Diet Improve Multiple Sclerosis Patients?

Dr. Terry Wahls saw a dramatic and major improvement in her multiple sclerosis after adopting a particular diet. I think she’s calling it a modified paleo diet and it was used in the study linked below. I haven’t read the whole thing yet, but you can see the entire journal article at the link below.

From YouTube:


Note this is a small pilot study with no control group. At first blush, it appears her dramatic diet-related improvement may be difficult to reproduce in others.

Effects of a multimodal intervention on gait and balance of subjects with progressive multiple sclerosis: a prospective longitudinal pilot study

Authors: Babita Bisht, Warren G Darling, Emily C White, Kaitlin A White, E Torage Shivapour, M Bridget Zimmerman, and Terry L Wahls

Purpose

To investigate the effects of a multimodal intervention including a modified Paleolithic diet, nutritional supplements, stretching, strengthening exercises with electrical stimulation of trunk and lower limb muscles, meditation and massage on walking performance and balance of subjects with progressive multiple sclerosis (MS).

Materials and methods

Twenty subjects with mean (standard deviation) age of 51.7 (6.4) years and Expanded Disability Status Scale score of 6.2 (1) participated in a 12-month study. Assessments were completed at baseline, 3, 6, 9, and 12 months.

Results

The entire cohort did not show significant changes in any of the assessments over 12 months except higher speed of walking toward the 10 feet mark during timed up and go (TUG) test at 6 months compared with baseline (mean change 7.9 cm/s [95% confidence interval {CI}]: 0.3, 15.2; p=0.041). Sub-group analysis revealed that 50% subjects (n=10) showed decrease in TUG time from baseline to at least 3 of 4 time-points post-intervention and were considered as responders (TUG-Res), the remaining 10 subjects were considered as nonresponders (TUG-NRes). Over 12 months, TUG-Res showed decreased mean TUG time by 31% (95% CI: −52%, −2%), increased median Berg Balance Scale scores (42 to 47), 30% increase in mean timed 25-foot walk speed (>20% considered clinically significant) and increased speed of walk toward 10 feet mark during TUG by 11.6 cm/s (95% CI: −3.0, 25.9) associated with increases in step lengths and decrease in step duration. TUG-NRes showed deterioration in walking ability over 12 months. Comparison of TUG-Res and TUG-NRes showed no significant differences in adherence to intervention but better stride duration and longer step length at baseline for TUG-Res than for TUG-NRes (p<0.05).

Conclusion

A multimodal lifestyle intervention may improve walking performance and balance in subjects with progressive MS who have mild-to-moderate gait impairment, whereas subjects with severe gait impairments may not respond to this intervention. Future trials should assess effects of this intervention in subjects with MS during early stages of the disease.

Source: Effects of a multimodal intervention on gait and balance of subjects with progressive multiple sclerosis: a prospective longitudinal pilot study

The dawn of bread, 14,000 years ago

Archaeologists working at Shubayqa 1, a site in northeastern Jordan, found tiny fragments of an ancient unleavened bread as they were excavating a hearth. The site was made by people of the Natufian culture, 14,400 years ago. The paper describing the discovery, by Amaia Arranz-Otaegui and coworkers, documents the use of a mixed unleavened dough to make bread more than 4000 years before the introduction of agriculture in this region of the world.

Source: The dawn of bread · john hawks weblog