Doctors Only?

This section is for Doctors, Scientists and Nerds.

The information in the front of the website is written in Plain English. Here I list articles with their summary. They use scientific language and acronyms freely.

I have tried to explain things as clearly as I can and I will explain why I think some scientific “fact” is wrong. Sometimes it is the result of poor research and sometimes it is because when the original opinion was formulated we did not have all the knowledge and understanding that we have been able to discover since that time. Sometimes we do accept that our original understanding was incorrect and we hope that we are now closer to a better understanding of how things really happen.

You will disagree with some of what I say. If you can shed light on work that I have not considered please bring this to my attention.

References

Designing KOOS

Ewa M Roos, L Stefan Lohmander. The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis  Health Qual Life Outcomes. 2003; 1: 64.

Summary:

The Knee injury and Osteoarthritis Outcome Score (KOOS) was developed as an extension of the WOMAC Osteoarthritis Index with the purpose of evaluating short-term and long-term symptoms and function in subjects with knee injury and osteoarthritis. The KOOS holds five separately scored subscales: Pain, other Symptoms, Function in daily living (ADL), Function in Sport and Recreation (Sport/Rec), and knee-related Quality of Life (QOL). The KOOS has been validated for several orthopaedic interventions such as anterior cruciate ligament reconstruction, meniscectomy and total knee replacement. In addition the instrument has been used to evaluate physical therapy, nutritional supplementation and glucosamine supplementation. The effect size is generally largest for the subscale QOL followed by the subscale Pain. The KOOS is a valid, reliable and responsive self-administered instrument that can be used for short-term and long-term follow-up of several types of knee injury including osteoarthritis. The measure is relatively new and further use of the instrument will add knowledge and suggest areas that need to be further explored and improved.

Protein

Baum et al.Protein Consumption and the Elderly: What Is the Optimal Level of Intake?Nutrients. 2016 Jun; 8(6): 359.

Summary:

Maintaining independence, quality of life, and health is crucial for elderly adults. One of the major threats to living independently is the loss of muscle mass, strength, and function that progressively occurs with aging, known as sarcopenia. Several studies have identified protein (especially the essential amino acids) as a key nutrient for muscle health in elderly adults. Elderly adults are less responsive to the anabolic stimulus of low doses of amino acid intake compared to younger individuals. However, this lack of responsiveness in elderly adults can be overcome with higher levels of protein (or essential amino acid) consumption. The requirement for a larger dose of protein to generate responses in elderly adults similar to the responses in younger adults provides the support for a beneficial effect of increased protein in older populations. The purpose of this review is to present the current evidence related to dietary protein intake and muscle health in elderly adults.

Protein and Weight-Loss

Leidy et al. The role of protein in weight loss and maintenance. The American Journal of Clinical Nutrition, Volume 101, Issue 6, June 2015, Pages 1320S–1329S

Summary

Over the past 20 y, higher-protein diets have been touted as a successful strategy to prevent or treat obesity through improvements in body weight management. These improvements are thought to be due, in part, to modulations in energy metabolism, appetite, and energy intake. Recent evidence also supports higher-protein diets for improvements in cardiometabolic risk factors. This article provides an overview of the literature that explores the mechanisms of action after acute protein consumption and the clinical health outcomes after consumption of long-term, higher-protein diets. Several meta-analyses of shorter-term, tightly controlled feeding studies showed greater weight loss, fat mass loss, and preservation of lean mass after higher-protein energy-restriction diets than after lower-protein energy-restriction diets. Reductions in triglycerides, blood pressure, and waist circumference were also reported. In addition, a review of the acute feeding trials confirms a modest satiety effect, including greater perceived fullness and elevated satiety hormones after higher-protein meals but does not support an effect on energy intake at the next eating occasion. Although shorter-term, tightly controlled feeding studies consistently identified benefits with increased protein consumption, longer-term studies produced limited and conflicting findings; nevertheless, a recent meta-analysis showed persistent benefits of a higher-protein weight-loss diet on body weight and fat mass. Dietary compliance appears to be the primary contributor to the discrepant findings because improvements in weight management were detected in those who adhered to the prescribed higher-protein regimen, whereas those who did not adhere to the diet had no marked improvements. Collectively, these data suggest that higher-protein diets that contain between 1.2 and 1.6 g protein · kg−1 · d−1 and potentially include meal-specific protein quantities of at least ∼25–30 g protein/meal provide improvements in appetite, body weight management, cardiometabolic risk factors, or all of these health outcomes; however, further strategies to increase dietary compliance with long-term dietary interventions are warranted.

testosterone-levels-by-age

Testosterone decline in Brazil

Archimedes Nardozza Júnior. Age-related testosterone decline in a Brazilian cohort of healthy military men. Int. braz j urol. 37 (5) • Oct 2011

Summary

INTRODUCTION: Androgen decline in the aging man has become a topic of increasing clinical relevance worldwide, as the reduction in testosterone levels has been reported to be accompanied by loss of muscle mass, accumulation of central adiposity, impaired mobility and increase risk of bone fractures. Although well-established in studies conducted in developed countries, progressive decline in serum testosterone levels with age has been poorly investigated in Brazil. AIM: To determine the pattern of blood testosterone concentrations decline with age in a cohort of Brazilian healthy military men. MATERIALS AND METHODS: We retrospectively reviewed data on serum testosterone measurements of healthy individuals that had undergone a routine check-up at the Military Biology Institute. Blood samples were obtained early in the morning, and total testosterone concentration was determined using a commercial chemoluminescent immunoassay. Mean values were analyzed in five age groups: < 40, 41 to 50, 51 to 60, 61 to 70, and > 70 years. MAIN OUTCOME MEASURE: Mean total testosterone levels. RESULTS: 1,623 subjects were included in the analysis; mean age was 57 years (24 to 87), and mean testosterone level was 575.5 ng/dL (25.0 to 1308.0 ng/dL). The evaluation of age-related changes in total testosterone levels revealed a progressive reduction in serum levels of this hormone with increasing age. Testosterone levels below 300 ng/dL were reported in 321 participants, a prevalence of nearly 20% in the study population. CONCLUSION: In agreement with other findings, a reduction of total testosterone levels with age was reported for healthy Brazilian men.

Whole Grain vs Processed Grain.

Milesi et al. Whole Grain Consumption and Inflammatory Markers: A Systematic Review of Randomized Controlled Trials. Nutrient.2022 Jan: 14(2): 374

Summary

Whole grain foods are rich in nutrients, dietary fibre, a range of antioxidants, and phytochemicals, and may have potential to act in an anti-inflammatory manner, which could help impact chronic disease risk. This systematic literature review aimed to examine the specific effects of whole grains on selected inflammatory markers from human clinical trials in adults. As per the Preferred Reporting Items for Systematic Reviews (PRISMA) protocol, the online databases MEDLINE, Embase, Cochrane, CINAHL, and Scopus were searched from inception through to 31 August 2021. Randomized control trials (RCTs) ≥ 4 weeks in duration, reporting ≥1 of the following: C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor (TNF), were included. A total of 31 RCTs were included, of which 16 studies recruited overweight/obese individuals, 12 had pre-existing conditions, two were in a healthy population, and one study included participants with prostate cancer. Of these 31 RCTs, three included studies with two intervention arms. A total of 32 individual studies measured CRP (10/32 were significant), 18 individual studies measured IL-6 (2/18 were significant), and 13 individual studies measured TNF (5/13 were significant). Most often, the overweight/obese population and those with pre-existing conditions showed significant reductions in inflammatory markers, mainly CRP (34% of studies). Overall, consumption of whole grain foods had a significant effect in reducing at least one inflammatory marker as demonstrated in 12/31 RCTs.

Red Meat

Sabine Rohrmann, Jakob Linseisen. Processed meat: the real villain? Proc Nutr Soc. 2016 Aug;75(3):233-41.

Summary

Meat is a food rich in protein, minerals such as iron and zinc as well as a variety of vitamins, in particular B vitamins. However, the content of cholesterol and saturated fat is higher than in some other food groups. Processed meat is defined as products usually made of red meat that are cured, salted or smoked (e.g. ham or bacon) in order to improve the durability of the food and/or to improve colour and taste, and often contain a high amount of minced fatty tissue (e.g. sausages). Hence, high consumption of processed foods may lead to an increased intake of saturated fats, cholesterol, salt, nitrite, haem iron, polycyclic aromatic hydrocarbons, and, depending upon the chosen food preparation method, also heterocyclic amines. Several large cohort studies have shown that a high consumption of processed (red) meat is related to increased overall and cause-specific mortality. A meta-analysis of nine cohort studies observed a higher mortality among high consumers of processed red meat (relative risk (RR) = 1·23; 95 % CI 1·17, 1·28, top v. bottom consumption category), but not unprocessed red meat (RR = 1·10; 95 % CI 0·98, 1·22). Similar associations were reported in a second meta-analysis. All studies argue that plausible mechanisms are available linking processed meat consumption and risk of chronic diseases such as CVD, diabetes mellitus or some types of cancer. However, the results of meta-analyses do show some degree of heterogeneity between studies, and it has to be taken into account that individuals with low red or processed meat consumption tend to have a healthier lifestyle in general. Hence, substantial residual confounding cannot be excluded. Information from other types of studies in man is needed to support a causal role of processed meat in the aetiology of chronic diseases, e.g. studies using the Mendelian randomisation approach

Weight loss from whole grain

Karl et al.Substituting whole grains for refined grains in a 6-wk randomized trial favorably affects energy-balance metrics in healthy men and postmenopausal women. The American J of Clinical Medicine. Vol 105, issue 3, March 2017, Pages 589-599

Summary

Background: The effect of whole grains on the regulation of energy balance remains controversial.

Objective: We aimed to determine the effects of substituting whole grains for refined grains, independent of body weight changes, on energy-metabolism metrics and glycemic control.

Design: The study was a randomized, controlled, parallel-arm controlled-feeding trial that was conducted in 81 men and postmenopausal women [49 men and 32 women; age range: 40–65 y; body mass index (in kg/m2): <35.0]. After a 2-wk run-in period, participants were randomly assigned to consume 1 of 2 weight-maintenance diets for 6 wk. Diets differed in whole-grain and fiber contents [mean ± SDs: whole grain–rich diet: 207 ± 39 g whole grains plus 40 ± 5 g dietary fiber/d; refined grain–based diet: 0 g whole grains plus 21 ± 3 g dietary fiber/d] but were otherwise similar. Energy metabolism and body-composition metrics, appetite, markers of glycemic control, and gut microbiota were measured at 2 and 8 wk.

Results: By design, body weight was maintained in both groups. Plasma alkylresorcinols, which are biomarkers of whole-grain intake, increased in the whole grain–rich diet group (WG) but not in the refined grain–based diet group (RG) (P-diet-by-time interaction < 0.0001). Beta ± SE changes (ΔWG compared with ΔRG) in the resting metabolic rate (RMR) (43 ± 25 kcal/d; P = 0.04), stool weight (76 ± 12 g/d; P < 0.0001), and stool energy content (57 ± 17 kcal/d; P = 0.003), but not in stool energy density, were higher in the WG. When combined, the favorable energetic effects in the WG translated into a 92-kcal/d (95% CI: 28, 156-kcal/d) higher net daily energy loss compared with that of the RG (P = 0.005). Prospective consumption (P = 0.07) and glycemia after an oral-glucose-tolerance test (P = 0.10) trended toward being lower in the WG than in the RG. When nonadherent participants were excluded, between-group differences in stool energy content and glucose tolerance increased, and between-group differences in the RMR and prospective consumption were not statistically significant.

Conclusion: These findings suggest positive effects of whole grains on the RMR and stool energy excretion that favourably influence energy balance and may help explain epidemiologic associations between whole-grain consumption and reduced body weight and adiposity.

Weight loss and reduced Inflammation

Munch Roager H. et al. Whole grain-rich diet reduces body weight and systemic low-grade inflammation without inducing major changes of the gut microbiome: A randomised cross-over trial. Gut. 2019;68:83–93.

Summary

50 participants completed both periods with a whole grain intake of 179±50 g/day and 13±10 g/day in the whole grain and refined grain period, respectively. Compliance was confirmed by a difference in plasma alkylresorcinols (p<0.0001). Compared with refined grain, whole grain did not significantly alter glucose homeostasis and did not induce major changes in the faecal microbiome. Also, breath hydrogen levels, plasma short-chain fatty acids, intestinal integrity and intestinal transit time were not affected. The whole grain diet did, however, compared with the refined grain diet, decrease body weight (p<0.0001), serum inflammatory markers, interleukin (IL)-6 (p=0.009) and C-reactive protein (p=0.003). The reduction in body weight was consistent with a reduction in energy intake, and IL-6 reduction was associated with the amount of whole grain consumed, in particular with intake of rye.

Compared with refined grain diet, whole grain diet did not alter insulin sensitivity and gut microbiome but reduced body weight and systemic low-grade inflammation.

T.H.Chan.

www.hsph.harvard.edu/nutritionsource/what-should-you-eat/whole-grains/

The above link takes you to a very detailed description by T.H.Chan of the components of whole grains.

Wheat Bran anti-inflammatory

Shengin Sang, Emmanual Idehen , Yantao Zhao, YiFang Chu Emerging science on whole grain intake and inflammation Nutrition Reviews, Volume 78, Issue Supplement_1, August 2020, Pages 21–28,

Summary

Although the biological mechanisms surrounding the widely reported association between whole grain (WG) consumption and reduced risk of several diseases are not fully understood, there is growing evidence suggesting that inflammation may be an essential mediator in this multifaceted process. It also appears that several mechanisms influence the modulatory actions of WGs on inflammation, including the effect of fiber, phytochemicals, and their microbial-derived metabolites. While some of these effects are direct, others involve gut microbiota, which transform important bioactive substances into more useful metabolites that moderate inflammatory signaling pathways. This review evaluates emerging evidence of the relationship between WGs and their effects on markers of subclinical inflammation, and highlights the role of fiber, unique WG phytochemicals, and gut microbiota on the anti-inflammatory effects of WG intake.

Adipose SVF for OA

Michalek et al. Autologous adipose tissue-derived stromal vascular fraction cells application in patients with osteoarthritis.

Summary

Stromal vascular fraction (SVF), containing large amount of stem cells and other regenerative cells, can be easily obtained from loose connective tissue that is associated with adipose tissue. Here we
evaluated safety and clinical efficacy of freshly isolated autologous SVF cells in a case control study in patients with grade 2-4 degenerative osteoarthritis (OA). A total of 1128 patients underwent standard liposuction under local anesthesia and SVF cells were isolated and prepared for application into 1-4 large joints. A total of 1856 joints, mainly knee and hip joints, were treated with a single dose of SVF cells. 1114 patients were followed for 12.1-54.3 months (median 17.2 months) for safety and efficacy. Modified KOOS/HOOS Clinical Score was used to evaluate clinical effect and was based on pain, non-steroid analgesic usage, limping, extent of joint movement, and stiffness evaluation before and at 3, 6, and 12 months after the treatment. No serious side
effects, systemic infection or cancer was associated with SVF cell therapy. Most patients gradually improved 3-12 months after the treatment. At least 75% Score improvement was noticed in 63%
of patients and at least 50% Score improvement was documented in 91% of patients 12 months after SVF cell therapy. Obesity and higher grade of OA were associated with slower healing. In conclusion, here we report a novel and promising treatment approach for patients with
degenerative OA that is safe, cost-effective, and relying only on autologous cells.