Category Archives: Uncategorized

No: Should Your DNA or  Gut Microbiome Determine What You Eat or Your Nutritional Supplements?

I take this to help control blood pressure

From Scott Gavura at Science Based Medicine:

Our ability to collect DNA data is progressing quickly, and in time we may have more evidence to inform decisions about nutrition and possibly even supplements. At this time, however, there is a big gap between what we know, and what, if anything, to do with that information. You don’t need a DNA test or a stool sample to know that eating a varied, healthy diet, minimizing highly processed foods, eliminating trans fats, and keeping alcohol consumption moderate are reasonable approaches to designing your diet. It’s worth noting again, as we have blogged about many times before, that the evidence for taking supplementary vitamins, in general, is neutral to negative. In the absence of a specific medical need (e.g., pregnancy) there a few circumstances where routine supplementation is necessary or warranted. There is no robust evidence to date to show that personalized, “DNA-based” or “microbiome-based” nutritional recommendations give useful, actionable nutrition advice that actually improve health outcomes.

Source: “DNA-based” personalized nutrition advice: Not ready for prime time – Science-Based Medicine

Hucksters use sciency terms to convince you they know the best weight-loss diet or supplements for you. Don’t believe it.

Steve Parker, M.D.

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Paleo Ketogenic Diet Put Crohn’s Disease Into Remission

Have you ever tried to catch a wild rabbit by hand?

The study at hand is an isolated case report, so we can’t get too excited about it. But it does suggest that a “paleolithic ketogenic diet” may be helpful in Crohn’s disease. “Carnivore diet” may be a better description of the treatment.

The problem with case reports is that an individual’s response to intervention may simply reflect placebo effect or spontaneous improvement of the underlying condition, rather than a true response to the treatment applied.

Crohn’s disease is one of two “inflammatory bowel diseases,” the other being ulcerative colitis. Both of these are felt to be autoimmune, meaning the body is attacking its own tissues as if they were foreign invaders, like germs. Crohn’s disease causes abdominal pain, diarrhea (sometimes bloody), bloating, nausea, malnutrition, and other effects. Ulcerative colitis is similar in presentation. I wrote many years ago about a paleo diet improving at least one case of ulcerative colitis.

Moving along….

Hungarian physicians (?) reported a case of a 16-year-old who was diagnosed with Crohn’s disease at age 14 and wasn’t doing well at all despite standard medical therapy. At one point, intestinal surgery was recommended but he (or his parents) declined.

On the paleolithic ketogenic diet, the patient went into remission within months, off medications, and has been in remission for 15 months. The patient’s BMI rose from 17.7 to 19.5.

So, what was this diet?

  • “animal fat, meat, offal and eggs with an approximate 2:1 fat:protein ratio” [is that ratio grams or calories? Not stated]
  • no grains, milk, dairy, refined sugars, vegetable oils, oilseeds (sic), nightshades, and artificial sweeteners
  • honey OK in small amounts
  • poultry OK but discouraged
  • at one point the patient added small amounts of vegetables and fruits but the authors favor “no plants at all”
  • no supplements

The authors mention good ol’ Walter Voegtlin, author of 1975’s The Stone Age Diet. Voegtlin, by the way, was or is a gastroenterologist. Here’s an iconoclastic quote from Voegtlin.

Why did this carnivore diet seem to work? The authors propose it improves the pathological intestinal permeability seen in Crohn’s disease.

This is a radical diet compared to the Standard American Diet featuring dairy, grains, industrial seed oils, and ultra-processed foods. As usual, check with your personal physician before making any radical diet change. Odds are, however, your doctor doesn’t know much about this diet and won’t approve.

Steve Parker, M.D.

h/t P.D. Mangan

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Is Either Politically Correct?: PWT1D or PWT2D

paleobetic diet, low-carb diet

Totally unrelated: Waldorfian salad. Hit the search box for recipe and nutritional analysis.

A decade ago, some folks began to object being called diabetics. Instead, they proposed “person with diabetes” or “people with diabetes.” Or simply PWD.

Given the major differences between type 1 and type 2 diabetes, I now propose PWT1D (person or people with type 1 diabetes) and PWT2D.

And so no one’s left out: PWLADA. Person with Latent Autoimmune Diabetes in Adulthood.

Whadda u think?

Steve Parker, M.D.

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U.S. Life Expectancy Decreasing

Sir John Glubb studied various empires that existed over the last 4,000 years. He deduced that empires have predictable lifecycles, from origin to ascendence, to great power then decline and collapse. I’m not the only one to notice that the U.S. may be on the decline. Decreasing life expectancies are a potential marker of decline. Glubb died in 1986 at the age of 88.

From JAMA Network:

U.S. life expectancy increased for most of the past 60 years, but the rate of increase slowed over time and life expectancy decreased after 2014. A major contributor has been an increase in mortality from specific causes (eg, drug overdoses, suicides, organ system diseases) among young and middle-aged adults of all racial groups, with an onset as early as the 1990s and with the largest relative increases occurring in the Ohio Valley and New England. The implications for public health and the economy are substantial, making it vital to understand the underlying causes.

Source: Life Expectancy and Mortality Rates in the United States, 1959-2017 | Population Health | JAMA | JAMA Network

Steve Parker, M.D.

PS: Maybe we’d live longer if we ate food congruent with our evolution instead ultra-processed man-made foods.

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Merry Christmas, Everyone!

Credit: Zvonimir Atletic / Shutterstock.com

1 in 4 Young Adults in U.S. Has Prediabetes

I’m worried about the kid’s future health

Stats from JAMA Pediatics:

In the United States, about 1 of 5 adolescents [12-18 y.o.] and 1 of 4 young adults [19-34 y.o.] have prediabetes. The adjusted prevalence of prediabetes is higher in male individuals and in people with obesity. Adolescents and young adults with prediabetes also present an unfavorable cardiometabolic risk profile, putting them both at increased risk of type 2 diabetes and cardiovascular diseases.

Source: Prevalence of Prediabetes Among Adolescents and Young Adults in the United States, 2005-2016. – PubMed – NCBI

I’m doing my part to prevent conversion of prediabetes to type 2 diabetes.

Steve Parker, M.D.

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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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