In October 2023, the American Academy of Pediatrics (AAP) published a report examining low-carbohydrate diets like keto in children and adolescents. You probably won’t be surprised that the authors are concerned. Despite the increasing popularity of carbohydrate restriction, evidence to support the benefits of low-carb diets in young people under 18 with obesity or diabetes is very limited. And though diabetes authorities have acknowledged that carb restriction has “the most evidence” for improving blood sugar levels, the American Diabetes Association has only endorsed low-carb eating as one of multiple possible eating patterns.
And yet, there are many people in the diabetes community who believe in the effectiveness of low, even very-low, carbohydrate diets for their children. There’s at least one study that supports their advocacy
I’m not a pediatrician and never treat children in my hospital practice, not even 17-year-olds. Nor have I reviewed the pertinent pediatric scientific literature. So I’ve never been comfortable writing about keto diets for children. The linked DD article was reviewed by Anna Goldman, M.D.
Red meat consumption — whether processed or not — was linked to onset of type 2 diabetes in the U.S. according to a 2023 article in American Journal of Clinical Nutrition. The research was a long-term observational study by mostly Harvard-based scientists. Among the authors that might be familiar to you are Walter Willett, Frank Hu, and Frank Sacks. Click the link for the deets.
This doesn’t prove that red meat consumption causes diabetes. But if you enjoy a fair or high amount of red meat, you might benefit by cutting back, especially if diabetes runs in your family. I’d also suggest regular exercise and avoiding overweight and obesity to reduce your risks of type 2 diabetes. The author suggest red meat alternatives: nuts, legumes, dairy foods.
The current observational study is unlikely to end the discussion on whether red meat intake increases risk of type 2 diabetes and even less likely to end the epistemological debates on how to grade quality of observational evidence when many efforts are made to reduce bias and confounding.
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All in all, the study by Gu et al. may arguably be the best evidence to date on the relation between red meat intake and type 2 diabetes. Yet somehow, I feel that the books have not been closed.
Posted onMarch 2, 2024|Comments Off on Paleolithic Diet Linked to Lower Risk of Death, Tumor, Cardiovascular, Respiratory, Neurological, and Digestive Disease
The study at hand was done on a Swedish population, published in 2024 in European Journal of Nutrition. It’s not perfect but suggestive of benefit. You can read the entire report yourself (I haven’t). Reports like this usually give their strongest findings in the first paragraph of the Discussion section:
PDF [paleo diet fraction] was inversely associated with the risk of death from all causes, tumor, cardiovascular, respiratory, neurological, and digestive disease. PDF was also inversely but non-significantly associated with death from other diseases combined. For incident event outcomes, PDF was inversely associated with the risk of coronary events and also inversely, but non-significantly associated, with ischemic stroke and type 2 diabetes. Besides longer follow-up, the present study extends previous research by examining associations for a measure of how Paleolithic a diet is based on absolute food intakes with mortality and incidence of cardiometabolic disease. This enables comparison between studies not possible for Paleolithic diet pattern scores based on relative food intakes.
Abstract
Purpose
Paleolithic Diet Fraction (PDF) estimates how large a portion of the absolute dietary intake stems from food groups included in the Paleolithic diet. In randomized controlled trials higher PDFs have been associated with healthier levels of cardiometabolic risk markers. Our aim was to build upon these findings by examining associations between PDF and mortality and incidence of cardiometabolic disease in the prospective Malmö Diet and Cancer Study.
Methods
PDF was calculated from an interview-based, modified diet history method, and associations were estimated by using multivariable Cox proportional hazards regression. The examined cohort consisted of 24,104 individuals (44–74 years, 63% women) without previous coronary events, diabetes, or stroke at baseline (1992–1996). A total of 10,092 individuals died during a median follow-up of 18 years.
Results
Median PDF was 40% (0–90%). The adjusted hazard ratios (HR) for PDF as a continuous variable (from 0 to 100%) were for risk of death from all causes 0.55 [95% CI 0.45, 0.66], tumor 0.68 [95% CI 0.49, 0.93], cardiovascular 0.55 [95% CI 0.39, 0.78], respiratory 0.44 [95% CI 0.21, 0.90], neurological 0.26 [95% CI 0.11, 0.60], digestive, 0.10 [95% CI 0.03, 0.30], and other diseases 0.64 [95% CI 0.41, 1.00]. The corresponding HR for risk of coronary event was 0.61 [95% 0.43, 0.86], for ischemic stroke it was 0.73 [95% 0.48, 1.09] and for type 2 diabetes it was 0.82 [95% 0.61, 1.10].
Conclusion
Observational data suggest an inverse association between PDF and all-cause as well as cause-specific mortality and incidence of cardiometabolic disease.
Posted onFebruary 28, 2024|Comments Off on Why Do Women Outlive Men?
Logging is dangerous work and it’s mostly men who do it. Photo by AX H on Pexels.com
Jim Goad is one of my favorite living cultural commentators. On par with a young P. J. O’Rourke, who died in 2022 at age 74. Last year Goad wrote a thoughtful and thought-provoking article on why women outlive men. A sample:
This disparity is not exclusive to the United States. In fact, it’s worse elsewhere. Worldwide, women outlive men by an average of seven years. According to a 2001 report, the only five countries on Earth where men outlived women were the flea-bitten open-air latrines we call Afghanistan, Nepal, Papua New Guinea, Namibia, and Zimbabwe. But a report from 2017 says there’s no longer any country on the planet where men outlive women.
It wasn’t always this way.
According to data from developed countries, men lived longer than women throughout most of the 1800s, only for the longevity stats to tip in favor of females during the 1890s — an advantage that women have held ever since. Women are supposedly more vulnerable than men to infectious diseases, but once male scientists got a grip on the microbes and brought those pesky critters to heel, women started living longer than men.
As far as I know, women have never thanked men for it.
Posted onFebruary 18, 2024|Comments Off on Walk Faster to Prevent Type 2 Diabetes?
You probably want to shoot for a speed of 3 miles per hour or higher. (I’ll convert to kilometers per hour below.)
About one in 500 dogs will acquire diabetes. Some breeds are more prone than others.
The British Journal of Sports Medicine published an article by researchers based in Iran. They analyzed 10 cohort studies that looked at average habitual walking speed and the incidence of type 2 diabetes. Study subjects were not in Iran, but in the U.S., U.K., and Japan.
An easy, casual walking speed is 2 miles per hour (mph) or less. Brisk walking speed is 3-4 mph. I tried walking my dog today at 4 mph and couldn’t keep it up for long. Dog was fine with it.
The researchers found that a habitual walking speed of even 2.5 mph was linked to a slightly lower risk of type 2 diabetes compared to the casual walkers. A more definitive reduction of diabetes incidence (25%) was seen in those who walk at 3 to 4 mph.
For those of you who think in terms of km/hr: An easy, casual walking speed is 3.2 km/hr or less. Brisk walking speed is 4.8-6.4 km/hr. The researchers found that a habitual walking speed of even 4 km/hr was linked to a slightly lower risk of type 2 diabetes compared to the casual walkers. A more definitive reduction of diabetes incidence (25%) was seen in those who walk at 4.8-6.4 km/hr.
This doesn’t necessarily mean that you’ll cut your risk of developing type 2 diabetes if you increase your habitual walking speed from an easy stroll to 3 mph or higher. But it is suggestive and there is physiological science to support that suggestion. The problem is that this study was observational. Which means it’s possible that faster walkers are simply overall healthier than slower ones. They walk faster because they’re healthier and are just constitutionally (genetically?) less prone to illness. To prove that faster walking speeds prevent some cases of type 2 diabetes, you’d have to take 2,000 slow walkers and somehow motivate 1,000 of them to walk faster habitually, while making sure the slow-pokes stay slow for 5-10 years. Keep everything else the same for all 2,000. After 5-10 years, you compare the incidence of diabetes. That study will not, probably cannot, be done.
Posted onFebruary 8, 2024|Comments Off on Eaton and Konner Update Their View of the Paleo Diet
Melvin Konner and S. Boyd Eaton are highly respected pioneers in the paleo diet movement. Their new article in Evolutionary Anthropology is titled “Hunter-gatherer diets and activity as a model for health promotion: Challenges, responses, and confirmations.” For the low, low price of $15 USD you can read it here.
Abstract
Beginning in 1985, we and others presented estimates of hunter-gatherer (and ultimately ancestral) diet and physical activity, hoping to provide a model for health promotion. The Hunter-Gatherer Model was designed to offset the apparent mismatch between our genes and the current Western-type lifestyle, a mismatch that arguably affects prevalence of many chronic degenerative diseases. The effort has always been controversial and subject to both scientific and popular critiques. The present article (1) addresses eight such challenges, presenting for each how the model has been modified in response, or how the criticism can be rebutted; (2) reviews new epidemiological and experimental evidence (including especially randomized controlled clinical trials); and (3) shows how official recommendations put forth by governments and health authorities have converged toward the model. Such convergence suggests that evolutionary anthropology can make significant contributions to human health.
The Paleo diet (PD) involves a restriction of carbohydrates and increased fat content (35% energy from carbohydrates, 35% energy from fats and 30% energy from protein). The aim of this study was to examine the effect of the PD on body composition, concentration of carbohydrates and lipids, as well as insulin, irisin, adiponectin and leptin in the blood. A total of 25 handball players were assigned to two groups: 14 in the experimental group (PD) and 11 in the control group (CD), using a PD and a rational diet, respectively. Analysis of body mass and body composition (body mass index, fat mass, lean body mass, fat-free mass, muscle mass, bone mineral content and bone mineral density), as well as blood concentration of metabolism markers (glucose, insulin, total cholesterol, HDL-cholesterol, non-HDL-cholesterol, LDL-cholesterol, triglycerides, free fatty acids, β-hydroxybutyrate, irisin, adiponectin and leptin), were determined at the beginning and after 4 and 8 weeks of nutritional intervention. Body mass was lower (p < 0.01), and adiponectin blood concentration was higher (p = 0.03) in the PD group at the end of the intervention. There were no changes (p ≥ 0.05) in body composition and blood levels of other biochemical markers in either group.
For perhaps 15-20 years, many health experts have recommended you walk 10,000 steps/day as important for maximizing your health and longevity. Depending on your stride length, that’s roughly 5 miles (8 km). When I walk my dogs 4 miles, it takes about 90 minutes, which is a big time commitment. Frankly, it’s often boring. But not for the dogs. So many fascinating odors!
The good news is, you don’t need to walk the 10,000 steps in one fell swoop. Your walking around your residence and workplace throughout the day counts, too.
I admitted a patient to the hospital a few days ago who told me her health insurer sends her a small check monthly if she meets their step goal. She’s saving them money via lower healthcare expenditures, and they’re sharing with her. I love it!
This research from Poland doesn’t look very interesting to me, so I’ve not read the free full text of the article. Let us know what you think.
Abstract
The aim of the study was to assess the impact of an eight-week Paleo diet on the health status (body composition, haematology and biochemistry of blood and urine) and the level of physical capacity (aerobic and anaerobic) of professional handball players. Fifteen athletes were assigned to two groups: 9 in the experimental group (PD) and 6 in the control group (CD). Significant decreases in body mass (BM), body mass index (BMI), and fat mass (FM) as well as an increase in the fat-free mass (FFM) (%) in both groups were observed. There were no significant differences between groups in particular series during the experiment in all haematological and biochemical indicators of blood and urine. Only HDL-C was significantly higher in the last series in the PD compared to the CD (1.63 mmol/l vs. 1.23 mmol/l). In the Wingate test, there were only single intragroup changes, consisting of a significant decrease in the Wt, MAP and Pmean in the experimental group. There were no significant differences between the groups in individual series or intragroup differences during the experiment, determined by the VO2max, VEmax, VE ∙ VCO2-1, RER, and the time of the test with a gradually increasing load on a treadmill, except for a significant decrease of maximum tidal volume (TVmax) in the PD. No adverse effect of the Paleo diet on the health status was found. The use of the Paleo diet slightly adversely affects anaerobic capacity and does not affect the level of aerobic capacity.
Posted onJanuary 18, 2024|Comments Off on Neurontin and Lyrica for Pain Suppression: Do They Work?
“You can take this pill, but there’s not much evidence it does any good.”
Physicians in the U.S. who prescribe opioids need a license from the Drug Enforcement Administration and it has to be renewed periodically. By the time of my next renewal, I must be able to prove to the DEA that I’ve had six (eight?) hours of approved continuing medical education on drug abuse and addiction. Because of the prescription opioid “epidemic” that reared its head several years ago, regulators are putting pressure on prescribers to reduce prescriptions. I’m not saying that’s a bad thing, but it can be taken too far, like expecting a patient with very recent knee or hip replacement surgery to be just fine with acetaminophen (aka paracetamol) alone. Big Pharma has convinced some prescribers to substitute opioids with Neurontin (aka gabapentin) or Lyrica (pregabalin). If not substitution, then augmentation of opioid effect at lower doses. I definitely see that in my part of the world.
One of the most notorious examples of Big Pharma living up to its reputation for evil-doing is the illegal promotion of anticonvulsant drugs like Neurontin and Lyrica for painful problems like back pain. Pfizer coughed up billions for lawsuit settlements and record-breaking fines. I think it’s safe to say that they didn’t actually pay enough to undo the damage, though…
Thanks to that horror show, and to research by Peet et al, we now know that there was a mighty 5× surge in gabapentin prescriptions in the 2000s and 2010s. That was — and continues to be — a chilling demonstration of the power of under-handed and well-funded marketing. Even as opioid prescriptions fell somewhat, gabapentin scrips rose dramatically, despite the dubious value for most of what it was being prescribed for (most kinds of pain).
Steve Parker, M.D.
PS: Pregabalin and gabapentin are commonly used and often effective drugs for painful diabetic neuropathy in the U.S. This blog post isn’t about that neuropathic pain.
Paleo Diabetic 