Book Review: P.D. Mangan’s “Best Supplements for Men”

Death in a bottle?

Best Supplements for Men: for more muscle, higher testosterone, longer life, and better looks was published in 2017 so should still be up to date. I have the paperback but it’s also available as a Kindle e-book. Per Amazon.com’s rating system, I give it five stars (I love it).

*  *  *

My favorite sentence in this book is, “If you don’t eat, exercise, and sleep right, the health effects of adding any supplement may be minimal to non-existent.” That sets an honest tone. Also in favor of integrity is that the author doesn’t offer Mangan-branded supplements for sale.

I like this book and learned a lot from it. I’ve benefited by reading the author’s tweets and blog (Rogue Health and Fitness) for several years. He’s smart and, I believe, honest.

The author supports his assertions with numerous scientific references, organized by chapter at the back of the book. If he cites a study done in mice, he tells you. Human studies admittedly carry more weight.

Have you wondered if protein supplements and creatine are good for muscle strength and energy? Does magnesium increase testosterone levels? Does berberine have beneficial health effects? The answers are here.

The author gives good advice regarding calcium supplements that even most physicians don’t know about.

Great recommendations on food.

No book is perfect, and this one is no different. It has no index. So if you’re curious about turmeric or supplements that control diabetes, you have to scan the whole book. My copy didn’t include references for chapter 11. Page numbers for chapters in the index didn’t match the actual chapter starts. My least favorite sentence in the book was something about Dr. Joseph Mercola being a trustworthy source of health information; he is not (search “mercola” at ScienceBasedMedicine.org).

Again, I like this book, learned much from it, and recommend it to men. If you’re taking lots of supplements now, read this book to find out if they help, harm, or are only good for making expensive urine.

Steve Parker, M.D.

PS: Some personal notes from my reading. Many of the cited studies are “association”-type evidence  rather causation. Berberine may help reduce blood sugars in diabetics just as well as metformin. Creatine: Yes, for muscle growth and strength. Magnesium 700 mg/day increases testosterone. Mag oxide may be worthless due to poor absorption. Mangan likes mag citrate but Lexicomp says it’s no better than oxide; absorption “up to 30%.” Citrulline: Yes, for ED, and may help with HTN. DHEA 50 mg/day increases testosterone in men by 50%, but only in men over 70. During fat weight loss, whey protein helps prevent muscle loss. MCT oil may also help (e.g., cook with coconut oil). ASA 81 mg/day seems to prevent some cancers in folks over 55, especially colorectal cancer.

Paleo Theory: The sedentary (r)evolution: Have we lost our metabolic flexibility?

Gotcha!

If you can’t easily go over four hours without eating something, you’ve lost your metabolic flexibility. Or something.

European authors in F1000Research (?!) suggest we consider our hunter-gatherer roots for clues to prevention of diseases of modern civilization. Here’s the abstract to whet your appetite:

During the course of evolution, up until the agricultural revolution, environmental fluctuations forced the human species to develop a flexible metabolism in order to adapt its energy needs to various climate, seasonal and vegetation conditions. Metabolic flexibility safeguarded human survival independent of food availability. In modern times, humans switched their primal lifestyle towards a constant availability of energy-dense, yet often nutrient-deficient, foods, persistent psycho-emotional stressors and a lack of exercise. As a result, humans progressively gain metabolic disorders, such as the metabolic syndrome, type 2 diabetes, non-alcoholic fatty liver disease, certain types of cancer, cardiovascular disease and Alzheimer´s disease, wherever the sedentary lifestyle spreads in the world. For more than 2.5 million years, our capability to store fat for times of food shortage was an outstanding survival advantage. Nowadays, the same survival strategy in a completely altered surrounding is responsible for a constant accumulation of body fat. In this article, we argue that the metabolic disease epidemic is largely based on a deficit in metabolic flexibility. We hypothesize that the modern energetic inflexibility, typically displayed by symptoms of neuroglycopenia, can be reversed by re-cultivating suppressed metabolic programs, which became obsolete in an affluent environment, particularly the ability to easily switch to ketone body and fat oxidation. In a simplified model, the basic metabolic programs of humans’ primal hunter-gatherer lifestyle are opposed to the current sedentary lifestyle. Those metabolic programs, which are chronically neglected in modern surroundings, are identified and conclusions for the prevention of chronic metabolic diseases are drawn.

Source: The sedentary (r)evolution: Have we lost our metabolic flexibility?

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 Diet Improves Lipid Profile Better Than AHA’s Grain-Based Hearth-Healthy Diet in Adults With High Cholesterol

He’s not worried about his lipids

Abstract from the journal Nutrition Research:

Recent research suggests that traditional grain-based heart-healthy diet recommendations, which replace dietary saturated fat with carbohydrate and reduce total fat intake, may result in unfavorable plasma lipid ratios, with reduced high-density lipoprotein (HDL) and an elevation of low-density lipoprotein (LDL) and triacylglycerols (TG). The current study tested the hypothesis that a grain-free Paleolithic diet would induce weight loss and improve plasma total cholesterol, HDL, LDL, and TG concentrations in nondiabetic adults with hyperlipidemia to a greater extent than a grain-based heart-healthy diet, based on the recommendations of the American Heart Association. Twenty volunteers (10 male and 10 female) aged 40 to 62 years were selected based on diagnosis of hypercholesterolemia. Volunteers were not taking any cholesterol-lowering medications and adhered to a traditional heart-healthy diet for 4 months, followed by a Paleolithic diet for 4 months. Regression analysis was used to determine whether change in body weight contributed to observed changes in plasma lipid concentrations. Differences in dietary intakes and plasma lipid measures were assessed using repeated-measures analysis of variance. Four months of Paleolithic nutrition significantly lowered (P < .001) mean total cholesterol, LDL, and TG and increased (P < .001) HDL, independent of changes in body weight, relative to both baseline and the traditional heart-healthy diet. Paleolithic nutrition offers promising potential for nutritional management of hyperlipidemia in adults whose lipid profiles have not improved after following more traditional heart-healthy dietary recommendations.

PMID: 26003334 DOI: 10.1016/j.nutres.2015.05.002

Source: Paleolithic nutrition improves plasma lipid concentrations of hypercholesterolemic adults to a greater extent than traditional heart-healthy dietar… – PubMed – NCBI

Authors are Pastore RL, Brooks JT, and Carbone JW

Certain Blood Pressure Meds Interfere With Exercise

If you have to choose between aerobic and resistance training, I favor the latter. The combination is better.

Seriously athletic folks, particularly those in sports with high aerobic demand, should avoid these BP drug classes:

  • Diuretics (they predispose to dehydration)
  • Beta blockers (they may decrease exercise tolerance via slowing of heart rate)

Better choices for athletes are:

  • Angiotensin converting enzyme inhibitors (ACEIs)
  • Angiotensin II receptor blockers (ARBs)
  • long-acting dihydropyridine calcium channel blockers

These latter drugs are not likely to affect athletic performance or cause other complications. If you can’t figure out which class of drug you take, ask your physician or pharmacist.

Steve Parker, M.D.

Is There a Cure for Type 2 Diabetes?

Seems to be, at least for some folks who are overweight. Nine of 10 T2 diabetes are overweight or obese

Science Alert has the story.

The “cure” at hand involves reduction of daily calories to 800 for four weeks. Average weight loss of those in the experimental group was 10 kg (22 lb). The full text of the scientific report may have been published already. I bet the drop-out rate was high.

 Steve Parker, M.D.

 

NASEM: Don’t Trust U.S. Dietary Guidelines

Back to the drawing board

NASEM is the National Academies of Sciences, Engineering, and Medicine. Dr. Andy Harris writes that:

The nation’s senior scientific body recently released a new report raising serious questions about the “scientific rigor” of the Dietary Guidelines for Americans. This report confirms what many in government have suspected for years and is the reason why Congress mandated this report in the first place: our nation’s top nutrition policy is not based on sound science.

Dr. Harris notes that since 1980, when the guidelines were first published, rates of obesity have doubled and diabetes has quadrupled.

Current recommendations to reduce saturated fat consumption and to eat health whole grains do not, after all, reduce rates of cardiovascular disease. That was my conclusion about saturated fat in 2009.

For a mere $68 you can read the NASEM report yourself. Better yet, read Tom Naughton’s thoughts for free.

Steve Parker, M.D.

PS: The diets I’ve designed are contrary to U.S. Dietary Guidelines.

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.

 

Paleo Diet Reduces Gingivitis and Periodontitis

..at least in a tiny short-term study done in Germany. Only 10 experimental subjects. And the researchers didn’t call it a paleo, Paleolithic, Stone Age, or caveman diet.

Here’s their description of the food: “..low in carbohydrates, rich in Omega-3 fatty acids, and rich in vitamins C and D, antioxidants and fiber for four weeks.” How low in carbs? To a level “as far as possible to a level < 130 grams/day.” Click the link above for full diet details. By my reading, it qualifies as a paleo diet.

Certified paleo-compliant, plus high omega-3 fatty acids and low-carb

The researchers note in the body of their report that they can’t tell for sure which components of the experimental diet were most helpful, but they suspect it’s 1) the carbohydrate restriction, 2) increased omega-3 fatty acids, and 3) reduced omega-6 consumption.

Those three factors are at play in the both the Paleobetic Diet and Low-Carb Mediterranean Diet.

Here’s the study’s abstract for you science nerds:

Background

The aim of this pilot study was to investigate the effects of four weeks of an oral health optimized diet on periodontal clinical parameters in a randomized controlled trial.

Methods

The experimental group (n = 10) had to change to a diet low in carbohydrates, rich in Omega-3 fatty acids, and rich in vitamins C and D, antioxidants and fiber for four weeks. Participants of the control group (n = 5) did not change their dietary behavior. Plaque index, gingival bleeding, probing depths, and bleeding upon probing were assessed by a dentist with a pressure-sensitive periodontal probe. Measurements were performed after one and two weeks without a dietary change (baseline), followed by a two week transitional period, and finally performed weekly for four weeks.

Results

Despite constant plaque values in both groups, all inflammatory parameters decreased in the experimental group to approximately half that of the baseline values (GI: 1.10 ± 0.51 to 0.54 ± 0.30; BOP: 53.57 to 24.17 %; PISA: 638 mm2 to 284 mm2). This reduction was significantly different compared to that of the control group.

Conclusion

A diet low in carbohydrates, rich in Omega-3 fatty acids, rich in vitamins C and D, and rich in fibers can significantly reduce gingival and periodontal inflammation.

Thanks to BioMed Central for making the entire report available for free.

Reference:

An oral health optimized diet can reduce gingival and periodontal inflammation in humans – a randomized controlled pilot study. BMC Oral Health 2016, 17:28. Published: 26 July, 2016.

Short-Term Benefits of Low-Carb Compared to High-Carb Diet in Type 1 Diabetes

Shrimp Salad

A scientific study published 2017 compared a high-carb (at least 250 grams/day) to low-carb diet (50 grams or less) in 10 patients with type 1 diabetics. The low-carb diet yielded more time in the normal blood sugar range, less hypoglycemia, and less variability of glucose levels.

I assume the low-carb diet required less insulin, but I don’t know since I haven’t seen the full article. Let me know if you can confirm.

In case you’re wondering, the Paleobetic diet provides about 60 grams of carb daily.

Here’s the abstract:

The aim of the present study was to assess the effects of a high carbohydrate diet (HCD) vs a low carbohydrate diet (LCD) on glycaemic variables and cardiovascular risk markers in patients with type 1 diabetes. Ten patients (4 women, insulin pump-treated, median ± standard deviation [s.d.] age 48 ± 10 years, glycated haemoglobin [HbA1c] 53 ± 6 mmol/mol [7.0% ± 0.6%]) followed an isocaloric HCD (≥250 g/d) for 1 week and an isocaloric LCD (≤50 g/d) for 1 week in random order. After each week, we downloaded pump and sensor data and collected fasting blood and urine samples. Diet adherence was high (225 ± 30 vs 47 ± 10 g carbohydrates/d; P < .0001). Mean sensor glucose levels were similar in the two diets (7.3 ± 1.1 vs 7.4 ± 0.6 mmol/L; P = .99). The LCD resulted in more time with glucose values in the range of 3.9 to 10.0 mmol/L (83% ± 9% vs 72% ± 11%; P = .02), less time with values ≤3.9 mmol/L (3.3% ± 2.8% vs 8.0% ± 6.3%; P = .03), and less glucose variability (s.d. 1.9 ± 0.4 vs 2.6 ± 0.4 mmol/L; P = .02) than the HCD. Cardiovascular markers were unaffected, while fasting glucagon, ketone and free fatty acid levels were higher at end of the LCD week than the HCD week. In conclusion, the LCD resulted in more time in euglycaemia, less time in hypoglycaemia and less glucose variability than the HCD, without altering mean glucose levels.

Steve Parker, M.D.