The App That Helps Me Be a More Patient Centered Physician — A Country Doctor Writes:

One of the most rewarding things I do in my clinic happens on my iPhone. When I sit down with a middle aged patient to talk about their cardiovascular risk, I open the risk calculator created by the American Heart Association and the American College of Cardiology. I talk my way through as I enter […]

The App That Helps Me Be a More Patient Centered Physician — A Country Doctor Writes:

The risk calculator is quite useful but I re-blogged this post for its link to the Hale study, which was news to me. This study published in 2004 showed older people between the ages of 70 and 90 who followed a Mediterranean diet have 50% lower rate of all-cause and cause-specific mortality than people who dine on the SAD Western diet. The four primary risk factors were diet, moderate alcohol intake, physical activity, and non-smoking.

Lifestyle matters.

Scary Charts (the scariest chart of 2021)

https://wolfstreet.com/2021/12/23/oops-americans-big-pay-increases-got-run-over-by-even-bigger-price-increases/

This week I made a donation to the Regional Food Bank of Oklahoma https://www.regionalfoodbank.org/. If you live in Oklahoma please consider a year end gift. There is a $500,000 dollar for dollar match until year end. If you live elsewhere there will be a similar charity you can give to.

End of post.

Diet Quality and Covid-19 Risk/Severity

Poor metabolic health and unhealthy lifestyle behaviors have been associated with higher risk and severity of COVID-19.

A dietary pattern characterized by healthy plant-based foods was associated with lower risk and severity of COVID-19.

We found evidence of a synergistic association of poor diet and increased socioeconomic deprivation with COVID-19 risk that was higher than the sum of the risk associated with each factor alone.

Merino J, Joshi AD, Nguyen LH, et al
Diet quality and risk and severity of COVID-19: a prospective cohort study
Gut 2021;70:2096-2104. — https://gut.bmj.com/content/70/11/2096

In six countries, plant-based diets or pescatarian diets were associated with lower odds of moderate-to-severe COVID-19. These dietary patterns may be considered for protection against severe COVID-19 In 2884 front-line healthcare workers from six countries (France, Germany, Italy, Spain, UK, USA), individuals who reported following plant-based diets and plant-based diets or pescatarian diets that were higher in vegetables, legumes and nuts, and lower in poultry and red and processed meats, had 73% and 59% lower odds of moderate-to-severe COVID-19, respectively.

Kim H, Rebholz CM, Hegde S, et al. Plant-based diets, pescatarian diets and COVID-19 severity: a population-based case–control study in six countries
BMJ Nutrition, Prevention & Health 2021;4:doi: 10.1136/bmjnph-2021-000272 — https://nutrition.bmj.com/content/4/1/257

Eat your vegetables!

MIND Your Diet

MIND diet is associated with better cognitive functioning independently of brain pathology, suggesting that the MIND diet may contribute to cognitive resilience in older adults.

Dhana, Klodian et al. ‘MIND Diet, Common Brain Pathologies, and Cognition in Community-Dwelling Older Adults’. 1 Jan. 2021 : 683 – 692. — https://content.iospress.com/articles/journal-of-alzheimers-disease/jad210107

So, what is the MIND diet?

The traditional Mediterranean dietary pattern includes mainly whole, minimally processed plant foods including cereal grains, legumes, vegetables, fruit, nuts, and fish with small amounts of meat, milk, and dairy products and a regular modest amount of alcohol.4 The DASH diet emphasizes fruit, vegetables, and low-fat dairy products and includes whole grains, poultry, fish, and nuts, and is reduced in fats, red meat, sweets, and sugar-containing beverages.4 Combining the two diets, the MIND diet emphasizes natural, plant-based foods, specifically promoting an increase in the consumption of berries and green leafy vegetables, with limited intakes of animal-based and high saturated fat foods.

What Are the Components to the MIND Diet? — https://jandonline.org/article/S2212-2672(15)01251-4/fulltext

I became aware of the MIND diet earlier this year. It’s nice to know my dietary pattern has a name.

Trends in Consumption of Ultraprocessed Foods (not good news)

The calories that children and adolescents consumed from ultraprocessed foods jumped from 61% to 67% of total caloric intake from 1999 to 2018, according to a new study from researchers at the Friedman School of Nutrition Science & Policy at Tufts University. Published August 10, 2021, in JAMA, the study analyzed dietary intake from 33,795 children and adolescents nationwide.

Tufts University. “Ultraprocessed foods now comprise 2/3 of calories in children and teen diets.” ScienceDaily. http://www.sciencedaily.com/releases/2021/08/210810110955.htm (accessed August 10, 2021).

The largest spike in calories came from such ready-to-eat or ready-to-heat dishes as takeout and frozen pizza and burgers: from 2.2% to 11.2% of calories. The second largest spike in calories came from packaged sweet snacks and desserts, the consumption of which grew from 10.6% to 12.9%.

Frozen pizza and burgers? Is this a problem?

Findings  In this serial cross-sectional study of nationally representative data from 33 795 US youths aged 2-19 years, the estimated percentage of total energy consumed from ultraprocessed foods increased from 61.4% to 67.0%, whereas the percentage of total energy consumed from unprocessed or minimally processed foods decreased from 28.8% to 23.5%.

https://jamanetwork.com/journals/jama/article-abstract/2782866

We are doomed.

Just Another Sweet Saturday Morning

These findings show that the prevalence of food insecurity in the U.S. is highest among Americans for whom a healthy diet is especially critical—Medicaid enrollees with insulin-dependent diabetes and diabetes-related eye or kidney complications (over 40% were food insecure). The problem of co-occurring food insecurity and diabetes among the nation’s disadvantaged has likely worsened during the coronavirus disease 2019 pandemic.

The Prevalence of Food Insecurity Is Highest Among Americans for Whom Diet Is Most Critical to Health — Diabetes Care 2021 Jun; 44(6): e131-e132. https://doi.org/10.2337/dc20-3116

In patients with newly diagnosed T2DM, alcohol abstinence was associated with a low risk of AF development. Lifestyle modifications, such as alcohol abstinence, in patients newly diagnosed with T2DM should be recommended to reduce the risk of AF.

Diabetes Care 2021 Jun; 44(6): 1393-1401. https://doi.org/10.2337/dc20-2607

New research published in Diabetologia has shown that if people achieve and maintain substantial weight loss to manage their type 2 diabetes, many can also effectively control their high blood pressure and stop or cut down on their anti-hypertensive medication.

Diabetologia. “Diabetes remission diet also lowers blood pressure and reduces need for medication.” ScienceDaily. ScienceDaily, 31 May 2021 — https://www.sciencedaily.com/releases/2021/05/210531180422.htm

Sat 6/19

Spice Blend

1 teaspoon ground cumin
1 teaspoon ground coriander
1 teaspoon smoked paprika
½ teaspoon ground turmeric
½ teaspoon dried oregano
½ teaspoon dried chili flakes
¼ teaspoon ground cinnamon

Copied from The First Mess Seven Spice Chickpea Stew recipe https://thefirstmess.com/2016/01/20/vegan-seven-spice-chickpea-stew-recipe/ so I don’t have to look it up online again if I decide to make this dish tonight.

During Pandemic Year One I lost 25 pounds. My PCP was impressed but when I told her how my diet changed she put her “doctor face” on, looked me straight in the eyes and said,

“I can’t wait to see your blood test results.”

Due to my family history my risk of developing DM2 is approximately 25% higher than the average underwriter. When I asked a prominent Endocrinologist for some advice many years ago he too put on his “doctor face” looked me straight in the eyes and said,

“Stay as thin as you can as long as you can.”

Yesterday I went to see Kevin and got a fresh flattop. The first question he asked was,

“Did you lose more weight?”

No, I haven’t. But my face definitely looks thinner without a mask.

BTW my blood work was about the same as last year even with my change in diet.

Preferred Plus NN.

Mortality in biopsy-confirmed nonalcoholic fatty liver disease: results from a nationwide cohort

Conclusion All NAFLD histological stages were associated with significantly increased overall mortality, and this risk increased progressively with worsening NAFLD histology. Most of this excess mortality was from extrahepatic cancer and cirrhosis, while in contrast, the contributions of cardiovascular disease and HCC were modest.

Mortality in biopsy-confirmed nonalcoholic fatty liver disease: results from a nationwide cohort — https://gut.bmj.com/content/70/7/1375?rss=1

Also see previous posts:

NAFLD – Why are Life Insurers Taking This Risk at Standard Rates?

NAFLD

NAFLD and Obesity: What Is the Mortality Risk? | Medpage Today

NAFLD = Higher Mortality Rate

Eating Leafy Green Vegetables (just a wee bit) Lowers Heart Disease Risk

Researchers examined data from over 50,000 people residing in Denmark taking part in the Danish Diet, Cancer, and Health Study over a 23-year period. They found that people who consumed the most nitrate-rich vegetables had about a 2.5 mmHg lower systolic blood pressure and between 12 to 26 percent lower risk of heart disease.

Lead researcher Dr Catherine Bondonno from ECU’s Institute for Nutrition Research said identifying diets to prevent heart disease was a priority.

“Our results have shown that by simply eating one cup of raw (or half a cup of cooked) nitrate-rich vegetables each day, people may be able to significantly reduce their risk of cardiovascular disease,” Dr Bondonno said.

Edith Cowan University. “One cup of leafy green vegetables a day lowers risk of heart disease.” ScienceDaily. http://www.sciencedaily.com/releases/2021/05/210504112604.htm (accessed May 9, 2021).

One cup raw or a half cup cooked daily. I’ll be the first to admit I don’t leafy greens on a daily basis. But now since my awareness level is higher I simply need to try harder.

I love spinach.

I don’t understand kale at all.

I have a package of organic baby bok choy leaves in the fridge which I actually bought before I read this article.

I wonder if parsley counts?

Showing Cajones in the Obesity Wars

In Mexico obesity reached epidemic proportions after it joined NAFTA with the United States and Canada in the early 1990s, making processed food more easily available. Diets quickly changed as many people, particularly those on lower incomes, replaced largely healthy traditional staples (corn tortilla, frijoles, Jamaica Water) with highly processed alternatives (hotdogs, nuggets, sodas). Sugar consumption soared and waistlines exploded. In the past 20 years the number of obese and overweight people has tripled, with 75% of the population now overweight.

Mexico also has the sixth highest mortality rate from Covid-19, which has spurred the government to escalate its war against obesity.

Mexico’s War on Obesity Sends Global Junk-Food & Sugary-Drink Giants Scrambling — https://wolfstreet.com/2021/04/13/mexicos-war-on-obesity-sends-global-junk-food-sugary-drink-giants-scrambling/#comments

NAFLD: not a benign disease

Non-alcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease worldwide, affecting at least a quarter of the global adult population. It is rapidly becoming one of the most common indications for liver transplantation in Western countries. NAFLD is widely considered as the hepatic manifestation of the metabolic syndrome. It is particularly common among patients with type 2 diabetes and obesity. Nonetheless, emerging data suggest that NAFLD is present in a significant proportion of lean individuals. In a systematic review and meta-analysis of 93 studies (involving over 10 million individuals), Ye et al found that 19.2% and 40.8% of patients with NAFLD were lean and non-obese, respectively, according to ethnic-specific body mass index (BMI) cut-offs.1 However, over 80% of the studies included in this systematic review were from Asia, raising the suspicion that NAFLD in lean individuals is a unique phenomenon among Asians, especially as Asians are known to have more central fat deposition and develop NAFLD and metabolic complications at a lower BMI.2

NAFLD in lean individuals: not a benign disease — https://gut.bmj.com/content/early/2021/03/11/gutjnl-2021-324162?rss=1

80% of the studies reviewed were from Asia which helps to explain why NAFLD was found in lean and non-obese people. I wonder how their diets have changed from traditional cuisines to cause this incidence level? Western style fast food?

Also see previous posts:

NAFLD – Why are Life Insurers Taking This Risk at Standard Rates?

NAFLD

NAFLD and Obesity: What Is the Mortality Risk? | Medpage Today

NAFLD = Higher Mortality Rate

Alkaline phosphatase 59 U/L, AST 28. ALT 10 as of September 2020. GGTP 36 as of December 2015. Sharing these numbers for all of my friends from the past who thought I would never live long enough to boast about these numbers.