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Diet

Diet and exercise are the first line of defense for those living with diabetes. Stock photo

Taking your blood pressure medications at night has beneficial effects

By David Dunaief, M.D.

Dr. David Dunaief

Not surprisingly, soda – with 39 grams of sugar per 12-ounce can – is associated with increased risk of diabetes. However, the drink with the lowest amount of sugar is wine, red or white. Even more surprising, it may have benefits in reducing complications associated with diabetes. Wine has about 1.2 grams of sugar in 5 ounces. Per ounce, soda has the most sugar, and wine has the least.

Why is this important? The prevalence of diabetes currently sits at 9.4 percent of the U.S. population, while another 84 million have prediabetes (HbA1C of 5.7-6.4 percent) (1).

For those with diabetes, cardiovascular risk and severity may not be equal between the sexes. In two trials, women had greater risk than men. In one study, women with diabetes were hospitalized due to heart attacks at a more significant rate than men, though both had substantial increases in risk, 162 percent and 96 percent, respectively (2). This was a retrospective (backward-looking) study.

What may reduce risks of disease and/or complications? Fortunately, we are not without options. Several factors may help. These include the timing of blood pressure medications, lifestyle modifications (diet and exercise) and, yes, wine.

Diet trumps drugs for prevention

All too often in the medical community, we are guilty of reaching for drugs and either overlooking lifestyle modifications or expecting that patients will fail with them. This is not only disappointing, but it is a disservice; lifestyle changes may be more effective in preventing this disease. In a head-to-head comparison study (Diabetes Prevention Program), diet plus exercise bests metformin for diabetes prevention (3). This study was performed over 15 years of duration in 2,776 participants who were at high risk for diabetes because they were overweight or obese and had elevated sugars.

There were three groups in the study: those receiving a low-fat, low-calorie diet with 15 minutes of moderate cardiovascular exercise; those taking metformin, 875 mg twice a day; and a placebo group. Diet and exercise reduced the risk of diabetes by 27 percent, while metformin reduced it by 18 percent over the placebo, both reaching statistical significance. While these are impressive results that speak to the use of lifestyle modification and to metformin, this is not the optimal diabetes diet.

Is wine really beneficial?

Alcohol in general has mixed results. Wine is no exception. However, the CASCADE trial, a randomized controlled trial, considered the gold standard of studies, shows wine may have heart benefits in well-controlled patients with type 2 diabetes by altering the lipid (cholesterol) profile (4).

Patients were randomized into three groups, each receiving a drink with dinner nightly; one group received 5 ounces of red wine, another 5 ounces of white wine, and the control group drank 5 ounces of water. Those who drank the red wine saw a significant increase in their “good cholesterol” HDL levels, an increase in apolipoprotein A1 (the primary component in HDL) and a decrease in the ratio of total cholesterol-to-HDL levels compared to the water-drinking control arm. In other words, there were significant beneficial cardiometabolic changes.

White wine also had beneficial cardiometabolic effects, but not as great as red wine. However, white wine did improve glycemic (sugar) control significantly compared to water, whereas red wine did not. Also, slow metabolizers of alcohol in a combined red and white wine group analysis had better glycemic control than those who drank water. This study had a two-year duration and involved 224 patients. All participants were instructed on how to follow a Mediterranean-type diet.

Does this mean diabetes patients should start drinking wine? Not necessarily, because this is a small, though well-designed, study. Wine does have calories, and these were also well-controlled type 2 diabetes patients who generally were nondrinkers.

Drugs (not diabetes drugs) show good results

Interestingly, taking blood pressure medications at night has an odd benefit, lowering the risk of diabetes (5). In a study, there was a 57 percent reduction in the risk of developing diabetes in those who took blood pressure medications at night rather than in the morning.

It seems that controlling sleep-time blood pressure is more predictive of risk for diabetes than morning or 48-hour ambulatory blood pressure monitoring. This study had a long duration of almost six years with about 2,000 participants.

The blood pressure medications used in the trial were ACE inhibitors, angiotensin receptor blockers and beta blockers. The first two medications have their effect on the renin-angiotensin-aldosterone system (RAAS) of the kidneys. According to the researchers, the drugs that blocked RAAS in the kidneys had the most powerful effect on preventing diabetes. 

Furthermore, when sleep systolic (top number) blood pressure was elevated one standard deviation above the mean, there was a 30 percent increased risk of type 2 diabetes. Interestingly, the RAAS blocking drugs are the same drugs that protect kidney function when patients have diabetes.

We need to reverse the trend toward higher diabetes prevalence. Diet and exercise are the first line for prevention. Even a nonideal diet, in comparison to medication, had better results, though medication such as metformin could be used in high-risk patients that were having trouble following the diet. A modest amount of wine, especially red, may have effects that reduce cardiovascular risk. Blood pressure medications taken at night, especially those that block RAAS in the kidneys, may help significantly to prevent diabetes.

References:

(1) cdc.gov. (4) Journal of Diabetes and Its Complications 2015;29(5):713-717. (3) Lancet Diabetes Endocrinol. Online Sept. 11, 2015. (4) Ann Intern Med. 2015;163(8):569-579. (5) Diabetologia. Online Sept. 23, 2015.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.

Chronic heart failure increases the risk of heart attack and death. Stock photo
Reducing oxidative stress may reduce risk

By David Dunaief, M.D.

Dr. David Dunaief

Heart attacks and heart disease get a lot of attention, but chronic heart failure is often overlooked by the press. The reason may be that heart failure is not acute like a heart attack.

To clarify by using an analogy, a heart attack is like a tidal wave whereas heart failure is like a tsunami. You don’t know it’s coming until it may be too late. Heart failure is an insidious (slowly developing) disease and thus may take years before it becomes symptomatic. It also increases the risk of heart attack and death.

There are about 5.7 million Americans with heart failure, and experts project that will increase to 8 million by 2030 (1). Not surprisingly, incidence of heart failure increases with age (2).

Heart failure (HF) occurs when the heart’s pumping is not able to keep up with the body’s demands and may decompensate. It is a complicated topic, for there are two types — systolic heart failure and diastolic heart failure. The basic difference is that the ejection fraction, the output of blood with each contraction of the left ventricle of the heart, is more or less preserved in diastolic HF, while it can be significantly reduced in systolic HF.

We have more evidence-based medicine, or medical research, on systolic heart failure. Fortunately, both types can be diagnosed with the help of an echocardiogram, an ultrasound of the heart. The signs and symptoms may be similar, as well, and include shortness of breath on exertion or when lying down, edema or swelling, reduced exercise tolerance, weakness and fatigue. The risk factors for heart failure include diabetes, coronary artery disease, high blood pressure, obesity, smoking, heart attacks and valvular disease.

Typically, heart failure is treated with blood pressure medications, such as beta blockers, ACE inhibitors and angiotensin receptor blockers. We are going to look at how diet, iron and the supplement CoQ10 impact heart failure.

Effect of diet

If we look beyond the usual risk factors mentioned above, oxidative stress may play an important role as a contributor to HF. Oxidative stress is thought to potentially result in damage to the inner lining of the blood vessels, or endothelium, oxidation of cholesterol molecules and a decrease in nitric oxide, which helps vasodilate blood vessels.

In a population-based, prospective (forward-looking) study, called the Swedish Mammography Cohort, results show that a diet rich in antioxidants reduces the risk of developing HF (3). In the group that consumed the most nutrient-dense foods, there was a significant 42 percent reduction in the development of HF, compared to the group that consumed the least. According to the authors, the antioxidants were derived mainly from fruits, vegetables, whole grains, coffee and chocolate. Fruits and vegetables were responsible for the majority of the effect.

This nutrient-dense approach to diet increased oxygen radical absorption capacity. Oxygen radicals have been implicated in cellular damage and DNA damage, potentially as a result of increasing chronic inflammation. What makes this study so impressive is that it is the first of its kind to investigate antioxidants from the diet and their impacts on heart failure prevention.

This was a large study, involving 33,713 women, with good duration — follow-up was 11.3 years. There are limitations to this study, since it is an observational study, and the population involved only women. Still, the results are very exciting, and it is unlikely there is a downside to applying this approach to the population at large.

CoQ10 supplementation

Coenzyme Q10 is a substance produced by the body that helps the mitochondria (the powerhouse of the cell) produce energy. It is thought of as an antioxidant. 

Results of the Q-SYMBIO study, a randomized controlled trial, showed an almost 50 percent reduction in the risk of all-cause mortality and 50 percent fewer cardiac events with CoQ10 supplementation (4). This one randomized controlled trial followed 420 patients for two years who had severe heart failure. This involved using 100 mg of CoQ10 three times a day compared to placebo.

The lead author goes as far as to suggest that CoQ10 should be part of the paradigm of treatment. This the first new “drug” in over a decade to show survival benefits in heart failure. Thus, if you have heart failure, you may want to discuss CoQ10 with your doctor.

Iron deficiency

Anemia and iron deficiency are not synonymous, since iron deficiency can occur without anemia. A recent observational study that followed 753 heart failure patients for almost two years showed that iron deficiency without anemia increased the risk of mortality in heart failure patients by 42 percent (5).

In this study, iron deficiency was defined as a ferritin level less than 100 μg/L (the storage of iron) or, alternately, transferrin saturation less than 20 percent (the transport of iron) with a ferritin level in the range 100–299 μg/L.

The authors conclude that iron deficiency is potentially more predictive of clinical outcomes than anemia, contributes to the severity of HF and is common in these patients. Thus, it behooves us to try to prevent heart failure through dietary changes, including high levels of antioxidants, because it is not easy to reverse the disease. Those with HF should have their ferritin and iron levels checked, for these are correctable. 

I am not typically a supplement advocate; however, based on the latest results, CoQ10 seems like a compelling therapy to reduce risk of further complications and potentially death. Consult with your doctor before taking CoQ10 or any other supplements, especially if you have heart failure.

References:

(1) Card Fail Rev. 2017 Apr; 3(1):7–11. (2) J Am Coll Cardiol. 2003;41(2):21. (3) Am J Med. 2013 Jun:126(6):494-500. (4) JACC Heart Fail. 2014 Dec;2(6):641-649. (5) Am Heart J. 2013;165(4):575-582.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.     

A recent study suggests that drinking diet soda may increase the risk of heart disease. Stock photo
Simple dietary changes can improve outcomes

By David Dunaief, M.D.

Dr. David Dunaief

Cardiovascular disease is anything but boring; what we know about it is constantly evolving. New information comes along all the time, which on the whole is a good thing. Even though cardiovascular disease has been on the decline, it is still the number one killer of Americans, responsible for almost 30 percent of deaths per year (1). However, not all studies nor all analyses on the topic are created equal. Therefore, I thought it apropos to present a quiz on cardiovascular disease myths and truths.

Without further ado, here is a challenge to your cardiovascular disease IQ. The questions below are either true or false. The answers and evidence are provided after.

1) Saturated fat is good for us, but processed foods and trans fats are unhealthy.

2) Fish oil supplements help reduce the risk of cardiovascular disease and mortality.

3) Fiber has significant beneficial effects on heart disease prevention.

4) Unlike sugary sodas and drinks, diet soda is most likely not a contributor to this disease.

5) Vitamin D deficiency may contribute to cardiovascular disease.

Now that was not so difficult. Or was it? The answers are as follows: 1-F, 2-F, 3-T, 4-F and 5-T. So, how did you do? Regardless of whether you know the answers, the reasons are even more important to know. Let’s look at the evidence.

Saturated fat

Most of the medical community has been under the impression that saturated fat is not good for us. We need to limit the amount we ingest to no more than 10 percent of our diet. But is this true? The results of a published meta-analysis (a group of 72 randomized clinical trials and observational studies) would upend this paradigm (2).

While saturated fat did not decrease the risk of cardiovascular disease, it did not significantly increase the risk either. Also, results showed that trans fats increase risk. Of course, trans fats are a processed fat, so this is something that most of us would agree upon. And in the clinical trials portion of the meta-analysis, omega-3 and omega-6 polyunsaturated fats did not significantly reduce the risk of cardiovascular disease.

Does this mean that we can go back to eating saturated fats with impunity? Well, there were weaknesses and flaws with this study. The authors only looked at the one dimension of fat. Their comparison was based on the upper-third of intake of one type of fat versus the lower-third of intake of the same type of fat (whether it was saturated fat or a type of unsaturated fat). It did not consider whether saturated fat was substituted with refined grains or unsaturated fatty acids. Also, what was the source of saturated fats, animal or plant, and did these sources also contain unsaturated fats as well, like olive oil or nuts which contain good fats?

Therefore, there are many unanswered questions and potentially several significant flaws with this study.

The meta-analysis also does not differentiate among plant or animal saturated fat sources. But in one that does, the researchers found saturated fats from animal sources increased cholesterol and the risk of cardiovascular disease (3). Also in another study, specifically using unsaturated fats in place of saturated fat reduced the risk of this disease (4, 5).

Fish oil

There is a whole industry built around fish oil and reducing the risk of cardiovascular disease. Yet the data don’t seem to confirm this theory. In the age-related eye disease study 2 (AREDS2), unfortunately, 1 gram of fish oil (long-chain omega-3 fatty acids) daily did not demonstrate any benefit in the prevention of cardiovascular disease nor its resultant mortality (6). This study was done over a five-year period in the elderly with macular degeneration. The cardiovascular primary end point was a tangential portion of the ophthalmic AREDS2. This does not mean that fish, itself, falls into that same category, but for now there does not seem to be a need to take fish oil supplements for heart disease, except potentially for those with very high triglycerides. Fish oil, at best, is controversial; at worst, it has no benefit with cardiovascular disease.

Fiber

We know that fiber tends to be important for a number of diseases, and cardiovascular disease does not appear to be an exception. In a meta-analysis involving 22 observational studies, the results showed a linear relationship between fiber intake and decreased risk for developing cardiovascular disease (7). In other words, for every 7 grams of fiber consumed, there was a 9 percent reduced risk in developing the disease. It did not matter the source of the fiber from plant foods; vegetables, grains and fruit all decreased the risk of cardiovascular disease. This did not involve supplemental fiber, like that found in Fiber One or Metamucil. To give you an idea about how easy it is to get a significant amount of fiber, one cup of lentils has 15.6 grams of fiber, one cup of raspberries or green peas has almost 9 grams, and one medium-size apple has 4.4 grams. Americans are sorely deficient in fiber (8).

Diet soda

A presentation at the American College of Cardiology examined the Women’s Health Initiative: The study suggests that diet soda may increase the risk of heart disease (9). In those drinking two or more cans per day, defined as 12 ounces per can, there was a 30 percent increased risk of a cardiovascular event, such as a stroke or heart attack, but an even greater risk of cardiovascular mortality, 50 percent, over 10 years. These results took into account confounding factors like smoking, diabetes, high blood pressure and obesity. This study involved over 56,000 postmenopausal women for almost a nine-year duration.

Vitamin D

The results of an observational study in the elderly suggest that vitamin D deficiency may be associated with cardiovascular disease risk. The study showed that those whose vitamin D levels were low had increased inflammation, demonstrated by elevated biomarkers including C-reactive protein (CRP) (10). This biomarker is related to inflammation of the heart, though it is not as specific as one would hope.

Beware in regards to saturated fat. If a study looks like an outlier or too good to be true, then probably it is. I would not run out and get a cheeseburger just yet. However, study after study has shown benefit with fiber. So if you want to reduce the risk of cardiovascular disease, consume as much whole food fiber as possible. Also, since we live in the Northeast, consider taking at least 1000 IUs of vitamin D daily. This is a simple way to help thwart the risk of the number one killer.

References:

(1) hhs.gov. (2) Ann Intern Med. 2014;160(6):398-406. (3) JAMA 1986;256(20):2623. (4) Am J Clin Nutr. 2009;99(5):1425-1432. (5) Cochrane Database Syst Rev. 2012:5;CD002137. (6) JAMA Intern Med. Online March 17, 2014. (7) BMJ 2013; 347:f6879. (8) Am J Med. 2013 Dec;126(12):1059-67.e1-4. (9) ACC Scientific Sessions 2014; Abstract 917-905. (10) J Clin Endocrinol Metab online February 24, 2014.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.

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Cheese, milk, butter, ice cream, yogurt. You were all such good friends. I was lucky to have known you at all.

Long ago, I developed an intolerance for you. It’s not as if you’d kill me but, let’s just say, you’d incapacitate me for a prolonged and agonizing period of time if I ever decided to ignore all the earlier experiences and indulge again.

That doesn’t mean, however, that I can’t appreciate the quality time we shared together, the memories you forever embedded in my taste buds and in my satisfied stomach.

I’ll start with the unexpected. Yes, you, in the corner, looking all innocuous. Stand up custardy yogurt and let me recall the smooth, cool feel and consistent taste. My favorite was banana, even though I lost the second-grade spelling bee when I thought there had to be an extra “n” in there somewhere. Someone with as many vowels as there are in the name Dunaief should have recognized the superfluous nature of consonants, but alas I was too young.

Then there’s macaroni and cheese. The soft noodles and almost too-sweet cheese was like a warm, sweet bath for my mouth. After throwing snowballs at my brothers or coming in from the walk along Mud Road from Gelinas on a rainy day, the hot mac and cheese revived me enough to break out my homework and try to figure how to find a second derivative or identify feldspar (a rock-forming mineral).

Then there’s that tall carton of milk. How awesome were you with Oreos and chocolate chip cookies? I’d dip the cookies deep into the milk, hoping they’d break apart. At the end of that refreshing glass, I’d have a blend of cookie crumbs supersaturated in milk at the bottom. I tipped the cool glass toward my mouth and let those mushy morsels land gently on my unfolded tongue.

And then there’s ice cream. After a movie at Stony Brook Loews, I’d sit with my buddies at Friendly’s on Route 347 and wait as patiently as I could for everyone else to figure out what they wanted. I pretended to read the menu, particularly when I was on a date and was considering what to say next, but the choice was always the same: the mint chocolate chip sundae.

During cold winter days, particularly after a day of skiing with my family — who were patient enough for me to stop getting frustrated when I fell, learn from my mistakes and enjoy the ride — I looked forward to onion soup. Oh, the melted cheese on the top of that soup. As my wife would say, what’s better than that?

Busboys risked serious injuries to their fingers if they tried to take the Crock-Pot before I’d finished picking every piece of cheese off the sides. When I finally looked up from my cheese removal operation, I saw my mom flashing that same annoying grin I show our children when I see how satisfied they are in a moment.

Since we’re discussing cheese, how about a grilled cheese? Buttered bread with soft American cheese was an irresistible delight. I’d order several of these sandwiches at the old Jack in the Box at the corner of 25A and Main Street in Setauket.

When I was young, one of my late father’s favorite sandwiches was Swiss cheese on rye with lettuce, tomato and mustard. The first time I tried it, I smiled politely and gave it back to him. Before the end of the dairy road for me, I ordered it again and thoroughly enjoyed it. Maybe it was an acquired taste or maybe it brought me closer to my father, who I could imagine enjoying the life and the food as much as I did. Oh, those dairy delights.

Stock photo.

By Chris Zenyuh

Throughout our evolution, fruit stood as the primary source of sugars in our diet. That we evolved to desire sweetness, I contend, was not for energy but for the vitamins, minerals, fiber and antioxidants that come with the fruit. The fiber helps slow sugar absorption and reduce its negative metabolic potential, and the vitamins compensate.

The limitations of seasonal fruit accessibility made getting too much of these sugars infrequent, at most. Access to purified cane sugar was limited as well, due its tropical origins. The cost of growing and shipping cane sugar slowed its consumption, certainly for those of lesser means. Still, the demand for sugar steadily increased, a fact that the English monarchy used to fund its war chest.

William Duffy (in his book “Sugar Blues”) has suggested that the sugar machine was largely behind English colonization and enslavement through the 1800s. Duffy suggests that denying sugar’s responsibility for metabolic dysfunction dates back to Dr. Thomas Willis, private physician to King Charles II. Willis both discovered and named diabetes mellitus. Smart enough to recognize the illness and its sugar-related cause, Willis was also smart enough to name it after “honey” instead of sugar, perhaps to keep his job and his head!

Enjoying rations of sugar and rum, tens of thousands of the British sailors who guarded the sugar routes fell ill and died from scurvy. School children are taught that scurvy is a vitamin C deficiency, as it was discovered that the symptoms could be reversed with the addition of citrus to the rations. Sadly, this well-known story promotes the denial of the cause: too much sugar (and rum). Our food, medical and supplement industries continue to promote the use of fortification and vitamin supplements to “protect” against illnesses like scurvy, rather than incur financial loses that would result from curtailed consumption of sugars.

The spiraling decline of our general health gained momentum in 1973, when then Secretary of Agriculture Earl Butz instituted a 180 degree change in the farm subsidy program. Prior to 1973, farmers were directed by the government to curtail production to keep the supply and demand for corn in check. Sometimes, the farmers were instructed not to grow corn but were compensated for lost income. The restricted supplies kept corn prices high, making it too expensive to use high fructose corn syrup as a sweetener. Sugar cane, expensive due to its tropical origins, found itself in a limited range of food products.

The new program launched in 1973 rewarded corn farmers for producing as much corn as possible. Soon, the science to produce more corn, then the science to engineer additional uses for the extra corn became big businesses. High fructose corn syrup and cattle feed businesses were early beneficiaries of the new system. The ranchers and corn refiners lobbied to pay below cost for corn. Corn farmers would lose money, but, the new farm bills enabled the farmers to make up their losses (and more) by receiving the subsidies, funded by tax dollars. That made it cheaper to feed cattle corn than to feed them grass and cheaper to sweeten food with high fructose corn syrup (HFCS) than with sugar.

Americans were now able to purchase foods sweetened with HFCS and corn-fed meat at much cheaper prices than ever before. The cost, of course, does not include the medical expenses that may be incurred from chronic exposure to glucose and fructose, though.

The Sugar Association, still burdened with the expense of sugar cane’s tropical origins, has expanded its use of sugar beets to become price competitive in the caloric sweetener market. Farmed and processed in the continental United States, sugar beets are used to sweeten processed foods almost as cheaply as HFCS. If the ingredient label doesn’t specify cane sugar, it may very well be beet sugar. Of course, it is still sucrose.

Now you know why caloric sweeteners are omnipresent in our food system and how “food” can be available so cheap. You might want to reconsider the amount that you consume of what nature so frugally offers. Regardless of its source or history, it is metabolically the same!

Chris Zenyuh is a science teacher at Harborfields High School and has been teaching for
30 years.

Residents participate in a CDC survey to accumulate data on health and diets of Americans. Photo by Alex Petroski

By Alex Petroski

Suffolk County residents will play an important role in improving the health of their fellow Americans in 2017. The Centers for Disease Control and Prevention selected Suffolk as one of 15 counties nationwide to participate in its annual National Health and Nutrition Examination Survey, a data collection study that is used to draw conclusions about the health and diets of people in the United States.

The CDC is the nation’s health protection agency, conducting research in the hopes of preventing the spread of diseases and tracking their prevalence. The NHANES is a 55-year-old program that tracks health and diet trends in the U.S. by selecting counties based on demographics with the goal of accumulating a set of data representative of the entire population of the country.

Three CDC trailers will spend about six weeks parked in Stony Brook’s Research and Development Park to study Suffolk County residents. Photo from CDC

This is the second time Suffolk was observed as part of the survey since the turn of the century, according to study manager Jacque DeMatteis. The CDC arrived April 29 at Stony Brook University’s Research and Development Park in three mobile trailers outfitted with dozens of pieces of medical equipment, researchers and physicians to begin assessments on the approximately 600 Suffolk residents selected.

“It’s important because right now we’ve got all of these miracles happening with cancer research and things like that, without information that people help us to provide — a lot of it comes from here — [researchers] don’t have anything to draw on,” DeMatteis said of the purpose of the yearly survey during a tour of the CDC mobile facility May 19.

Charles Rothwell, director of the National Center for Health Statistics, reiterated the importance of accumulating the data in a statement.

“The survey is a unique resource for health information, and without it we would lack important knowledge about major health conditions,” he said. “The comprehensive data collected by NHANES has a far-reaching and significant impact on everything from the quality of the air we breathe, to the vaccinations you get from your doctor, to the emergence of low-fat and ‘light’ foods on the shelves of your grocery store.”

A young participant in the study is measured. Photo from CDC

The process for selecting participants within a county begins with about 1,500 addresses, and interviewers scour the area in the hopes of securing about 600 willing participants who also provide a representative sample of age ranges, genders, races and ethnicities and degrees of health. The selected participants who are willing to be examined then visit the mobile facility to be subjected to a variety of tests of blood pressure, diet, dental/oral health, vision and hearing, bone density, liver function and much more using high-tech scans not often available through traditional physicians.

DeMatteis made the case for selected participants making the trip to be studied despite some minor possible inconveniences.

“For the people who participate, they get their results back,” she said. “If anything abnormal comes up they’re contacted immediately. Our national health officer will contact them and we’ve had a couple of situations where it was kind of life-threatening situations and they were totally unaware of it.”

Participating adults also receive $125, reimbursement for travel expenses and the opportunity to receive credit for five hours of community service. Newborns and up are required for data collection, though specific scans and tests are not done uniformly across age groups.

“A lot of people do it for the exams, and in the past even more people had no means to get access to health care, so they came here because they’re going to get a whole lot of data about their health that they otherwise can’t afford to get,” DeMatteis said.

No medical procedures are offered at the site, though on occasion physicians are forced to recommend immediate treatment if anything concerning appears as a result of a test. Patients are also allowed to pick and choose which tests they’d like to participate in of the ones they qualify for. The CDC urges anyone selected to participate in the survey.

Studies show that even moderate exercise can significantly lower mortality risk when compared with no physical activity at all.

Reducing inflammation is part of this process.

By David Dunaief, M.D.

Dr. David Dunaief

When asked what was more important, longevity or healthy aging (quality of life), more people choose the latter. Why would you want to live a long life but be miserable? Well, it turns out the two components are not mutually exclusive. I would like you to ponder the possibility of a third choice, “all of the above.” Would you change your answer and, instead of making a difficult choice between the first two, choose the third?

I frequently use the example of Jack LaLanne, a man best known for popularizing fitness. He followed and preached a healthy lifestyle, which included diet and exercise. He was quite a motivator for many and ahead of his time. He died at the ripe old age of 96.

This brings me to my next point, which is that the number of 90-year-olds is growing by leaps and bounds. According to the National Institutes of Health, those who were more than 90 years old increased by 2.5 times over a 30-year period from 1980 to 2010 (1). This group is among what researchers refer to as the “oldest-old,” which includes those aged 85 and older.

What do these people have in common? According to one study, they tend to have fewer chronic morbidities or diseases. Thus, they tend to have a better quality of life with a greater physical functioning and mental acuity (2).

In a study of centenarians, genetics played a significant role. Characteristics of this group were that they tended to be healthy and then die rapidly, without prolonged suffering (3). Another benchmark is the amount of health care dollars spent in their last few years. Statistics show that the amount spent for those who were in their 60s and 70s was significantly higher, three times as much, as for centenarians in their last two years (4).

Factors that predict one’s ability to reach this exclusive club may involve both genetics and lifestyle choices. One group of people in the U.S. that lives longer lives on average than most is Seventh-day Adventists. We will explore why this might be the case and what lifestyle factors could increase our potential to maximize our healthy longevity. Exercise and diet may be key components of this answer. Now that we have set the tone, let’s look at the research.

Exercise

For all those who don’t have time to exercise or don’t want to spend the time, this next study is for you. We are told time and time again to exercise. But how much do we need, and how can we get the best quality? In a 2014 study, the results showed that 5 to 10 minutes of daily running, regardless of the pace, can have a significant impact on life span by decreasing cardiovascular mortality and all-cause mortality (5).

Amazingly, even if participants ran fewer than six miles per week at a pace slower than 10-minute miles, and even if they ran only one to two days a week, there was still a decrease in mortality compared to nonrunners. Here is the kicker: Those who ran for this very short amount of time potentially added three years to their life span. There were 55,137 participants ranging in age from 18 to 100 years old.

An accompanying editorial to this study noted that more than 50 percent of people in the United States do not meet the current recommendation of at least 30 minutes of moderate exercise per day (6). Thus, this recent study suggests an easier target that may still provide significant benefits.

Diet

A long-standing paradigm is that we need to eat sufficient animal protein. However, there have been cracks developing in this façade of late, especially as it relates to longevity. In an observational study using NHANES III data, results show that those who ate a high-protein diet (greater than 20 percent from protein) had a twofold increased risk of all-cause mortality, a four times increased risk of cancer mortality and a four times increased risk of dying from diabetes (7). This was over a considerable duration of 18 years and involved almost 7,000 participants ranging in age at the start of the study from 50 to 65.

However, this did not hold true if the protein source was from plants. In fact, a high-protein plant diet may reduce the risks, not increase them. The reason for this effect, according to the authors, is that animal protein may increase insulin growth factor-1 and growth hormones that have detrimental effects on the body.

Interestingly, those who are over the age of 65 may benefit from more animal protein in reducing the risk of cancer. However, there was a significantly increased risk of diabetes mortality across all age groups eating a high animal protein diet. The researchers therefore concluded that lower animal protein may be wise at least during middle age.

The Adventists Health Study 2 trial reinforced this data. It looked at Seventh-day Adventists, a group whose emphasis is on a plant-based diet, and found that those who ate animal protein up to once a week had a significantly reduced risk of dying over the next six years compared to those who were more frequent meat eaters (8). This was an observational trial with over 73,000 participants and a median age of 57 years old.

Inflammation

You may have heard the phrase that inflammation is the basis for more than 80 percent of chronic disease. But how can we quantify this into something tangible?

In the Whitehall II study, a specific marker for inflammation was measured, interleukin-6. The study showed that higher levels did not bode well for participants’ longevity (9). In fact, if participants had elevated IL-6 (>2.0 ng/L) at both baseline and at the end of the 10-year follow-up period, their probability of healthy aging decreased by almost half.

The takeaway from this study is that IL-6 is a relatively common biomarker for inflammation that can be measured with a simple blood test offered by most major laboratories. This study involved 3,044 participants over the age of 35 who did not have a stroke, heart attack or cancer at the beginning of the study.

The bottom line is that, although genetics are important for longevity, so too are lifestyle choices. A small amount of exercise, specifically running, can lead to a substantial increase in healthy life span. While calories are not equal, protein from plants may trump protein from animal sources in reducing the risk of mortality from all causes, from diabetes and from heart disease. This does not necessarily mean that one needs to be a vegetarian to see the benefits. IL-6 may be a useful marker for inflammation, which could help predict healthy or unhealthy outcomes. Therefore, why not have a discussion with your doctor about testing to see if you have an elevated IL-6? Lifestyle modifications may be able to reduce these levels.

References: (1) nia.nih.gov. (2) J Am Geriatr Soc. 2009;57:432-440. (3) Future of Genomic Medicine (FoGM) VII. Presented March 7, 2014. (4) CDC.gov. (5) J Am Coll Cardiol. 2014;64:472-481. (6) J Am Coll Cardiol. 2014;64:482-484. (7) Cell Metab. 2014;19:407-417. (8) JAMA Intern Med. 2013;173:1230-1238. (9) CMAJ. 2013;185:E763-E770.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.

Exercise is important in reducing the risk of fractures. Stock photo

By David Dunaief, MD

Osteoporosis is a complex disease. For one thing, it progresses with no symptoms, until the more severe stage of fractures that cause potential disability and increase mortality. For another, the only symptoms are from the treatment with medications, better known as side effects. Third, lifestyle modifications and supplements, while important, require adherence to a regimen.

I am not a big advocate of medication, as I am sure you have gathered from my previous articles; however, medication does have its place. There are studies that show benefit from the two main classes for osteoporosis, bisphosphonates such as alendronate (Fosamax, though it is now generic) and the newer class that involves monoclonal antibodies such as denosumab (Prolia). And, of course, I am a big advocate of lifestyle modifications including diet, exercise, smoking cessation and even some supplements. The side effects of these modifications are better health outcomes for chronic diseases and disorders in general. What I can’t advocate for, as a physician sworn to help people, is the new emerging cohort that I refer to as the “do-nothing group.”

Recently, a New York Times article on June 1, 2016, entitled, “Fearing Drugs’ Rare Side Effects, Millions Take Their Chances With Osteoporosis,” reported that prescriptions for medications to treat the disease have fallen by more than 50 percent from 2008 to 2012 because of the fear of the side effect profile that include rare instances of atypical fractures and jawbone necrosis (1).

In the article, one doctor mentions that patients prefer diet and exercise, but that it does not work. Well, he may be partially correct. Diet and exercise may not work if they’re not implemented. However, if people actually make lifestyle modifications, there could be substantial benefit. Just to give up on the medications for osteoporosis or to refuse to take them is not going to improve your chances or reduce your risk of getting fractures in the spine, hip, wrist or other locations. In other words, the “do-nothing” approach won’t help and may significantly increase your risk of fracture and other complications, such as death.

At the top of the list of risk factors for osteoporosis is nontraumatic fractures — in other words, breaking of bone with low-impact events. In this case, once you have had a fracture, the probability of having a recurrent or subsequent fracture increases more than three times in the first year, according to a recent Icelandic study (2). Lest you think that you are in the clear after a year since your first fracture: After 10 years, the risk of subsequent fracture still remains high, with a twofold increased risk.

Osteoporosis involves bone loss. We typically measure this through the bone mineral density (BMD) biomarker using a DXA scan. However, another component is bone quality. Sarcopenia, or loss of lean muscle mass, may play a role in bone quality. There are vitamins, such as vitamin K2, that can have beneficial effects on bone based on bone quality as well. No, this is not the same as the more well-known vitamin K1 used in clotting, which may also have a smaller benefit in preserving bone.

Let’s look at the evidence.

Avoiding sacropenia

Sarcopenia is a fancy word for a depressing phenomenon that occurs as we age and become more and more sedentary; it is the loss of lean skeletal muscle mass at the rate of 3 to 8 percent each consecutive decade after 30 and also loss of strength (3). It may have significant effects on about one-third of those over age 60 and half of those over 80. Unless, of course, you are physically active on a regular basis. In the Study for Osteoporotic Fractures in Men, results show that sarcopenia plus osteoporosis, taken together, increases the risk of fracture more than three times in older men (4).

The researchers assessed muscle wasting by using the European Working Group on Sarcopenia in Older Patients (EWGSOP), which takes into account weakness (grip strength <20 kg for men), slowness (walking=0.8 m/s) and low lean muscle mass (< 20 percent). This involved over 5,000 men with a mean age of about 74. The group with sarcopenia had significantly lower grip strength and was less physically active. In another study, those who were healthy 65-year-old adults who had sarcopenia or low lean muscle mass were at a greater than two times risk of experiencing a low-trauma fracture within three years (5). This was according to the EWGSOP1 cutoff criteria for sarcopenia.

Preventing sarcopenia

Well, beyond the obvious of physical activity and formal exercise, there is a medication that has potentially shown positive results. This is the bisphosphonate alendronate (Fosamax). In a study, results showed that alendronate increased muscle mass significantly over a one-year period (6). In the appendicular (locomotive) skeletal muscle, there was a 2.5 times increase in muscle mass, while in lower limb muscle mass there was a greater than four times increase. This was a retrospective (backward-looking), case-control study involving about 400 participants. While these results are encouraging, we need a prospective (forward-looking), randomized controlled trial. For those who don’t want to or can’t for some reason exercise, then medication may help with muscle mass.

Exercise! Exercise! Exercise!

In a meta-analysis (a group of 10 trials), results showed there was a significant 51 percent reduction in the risk of overall fracture in postmenopausal women who exercised (7). This study involve over 1,400 participants. Does exercise intensity matter? Fortunately, the answer is no. If you like jogging or running, that’s great, but walking was also beneficial. This is important, since you want to do the type of activity that is more enjoyable to you, especially since the benefit of exercise dissipates when you stop doing it regularly (8).

The importance of K2

In a recent study, vitamin K2 was shown to reduce the risk of hip fracture by 60 percent, vertebral fracture by 77 percent and nonvertebral fractures by a whopping 81 percent (9). According to the authors, this benefit may be derived from bone strength (BMC, or bone mineral content) rather than from bone mineral density (BMD). There were 325 postmenopausal women in this study. It was a randomized controlled trial with one group receiving vitamin K2 (MK-4, menatetrenone) supplementation of 45 mg/day and the other a placebo group.

Don’t forget fruits and vegetables

In the Singapore Chinese Health Study, a prospective population-based study, results showed that there was a 34 percent reduction in the risk of hip fracture in the highest quintile of vegetable-fruit-soy (VFS) intake, compared to the lowest quintile (10). This study involved over 63,000 men, premenopausal and postmenopausal women with an age range from 45 to 74 years old. The results showed a dose-dependent curve, meaning the more VFS, the higher the reduction in hip fracture risk. Interestingly, there was no difference in risk of fracture when meat in the form of meat dim-sum was used instead of plant-based protein. The researchers concluded that an Asian plant-based diet may help reduce the risk of hip fracture. I’m not saying to take medications for osteoporosis, but you need to do something — either medications, lifestyle modifications, supplements or all three — especially if you have a history of low-trauma fractures, because your risks of disability, complications and death increase significantly with subsequent fractures. But, do not be part of the growing “do-nothing” group.

References:

(1) J Bone Miner Res. 2015;30(12):2179-2187. (2) World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases 2016. Abstract 0C35. (3) Curr Opin Clin Nutr Metab Care. 2009; 12(1):86–90. (4) American Society of Bone and Mineral Research 2013. Abstract 1026. (5) Age Ageing.2010;39:412-423. (6) Osteoporos Sarcopenia. 2015;1(1):53-58. (7) Osteoporos Int. 2013;24(7):1937. (8) Ann Intern Med. 1988;108(6):824. (9) Osteoporos Int. 2007;18(7):963-972. (10) J Nutr. 2014;144(4):511-518.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.

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Your guide to a healthy winter

By Lisa Steuer

It’s easy to become sedentary and gain a little extra weight during the winter. After all, the frigid temperatures tend to keep us indoors, there are holiday parties with goodies that tempt us and an extra weight gain can simply be hidden under a few more layers of clothing.

But if you take a few steps toward your health and fitness this winter, you can lose or maintain your weight and then be prepared to be in your best shape when the warmer months hit yet again. Here are some tips to keep you on track this winter.

Plan it out
Each Sunday, take the time to look at what you’re doing the week ahead. Plan out what days you’ll work out and what the workout will be. Scheduling them in like appointments may just become habit and make you less likely to miss them. Plus, prepare your healthy meals for the week on Sunday to save time and make it easier to stay on track during the week. For a simple guide to food prep, visit www.fitnessrxwomen.com and search for the article “10 Tips for a Quicker and Easier Food Prep.”

Work out — no excuses
Living a fit lifestyle doesn’t mean you have to miss out on sweet treats at holiday parties and other gatherings. If you know you’re going to be indulging in a few extra calories one day, be absolutely sure to get in a workout that morning so you don’t feel too guilty about it.

Eat beforehand
Before a party or gathering, have a satisfying but healthy snack like a protein shake or fruit like a banana so that you don’t attend the party starving and end up making poor food choices due to being so hungry.

Fill up on veggies
When you go to a party, go right to the veggie tray and fill up.

Stay away from eggnog and other high-calorie drinks
If having alcohol at a party, try a glass of dry red wine or vodka with cranberry. Liquid calories can add up extremely fast. If you do drink alcohol, make sure you’re also drinking plenty of water.

Experiment with healthy baking and cooking
A lot of times, with a few simple substitutions, it’s easy to cook and bake healthier without sacrificing taste. For example, you probably won’t be able to tell the difference if you use Greek yogurt in place of sour cream on lean chicken tacos. Visit www.fitnessrxwomen.com for tons of healthy, easy and delicious meals and desserts that won’t leave you feeling like you’re missing out on your favorite foods.

Fitness classes
Taking fitness classes can help keep you motivated, and you may even meet new friends who can help inspire you to get to class. The instructor running the class can help, too. Let him or her know your fitness goals for the winter, and they can probably help give you that extra push and also offer suggestions to help you meet those goals.

Work out at home
When it’s cold and snowy, you may be more likely to make excuses to stay home and avoid the gym. Instead, invest in a few simple items that don’t take up a lot of space but allow you to get a good workout in right in your living room — dumbbells, a medicine ball, exercise bands, etc. Try fitness DVDs and free on-demand fitness videos (if you have cable, go to the on-demand menu, select Free On Demand, then Sports then Exercise Sportskool).

Have an incentive
Check out www.dietbet.com and the app, which has games where players bet as little as $30 to meet a specific weight loss or fitness challenge within a specific time frame, and the winners split the pot. You can even start your own game and challenge your friends.

Sign up for a 5K
This will force you to get up and moving! Plus, meeting a challenge you never thought you could do is an indescribable feeling.

Don’t be so hard on yourself
If you overindulge a little bit over the holidays, don’t beat yourself up too much. The good news about getting fit and healthy is that you can always get back on track. Put it behind you, recommit yourself, have a goal and then get to work getting it done.

Lisa Steuer is the managing editor of FitnessRx for Women and FitnessRx for Men magazines. For more fitness tips, recipes, training videos and print-and-go workouts that you can take with you to the gym, visit www.fitnessrxformen.com and www.fitnessrxwomen.com.

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By Lisa Steuer

In the 1990s, low-fat food products lined the shelves. Consumers believed that choosing a product with a low-fat label was essential for optimal health and fat loss. But today, experts say that a low-fat diet can be detrimental — as food that has the fat removed can instead be high in sugar and calories to make up for the lack of fat.

“The whole low-fat phase was problematic because people substituted refined carbohydrates, and that is a huge problem,” said Dr. Josephine Connolly-Schoonen, Ph.D., RD, the executive director of Stony Brook Medicine Nutrition Division and author of “Losing Weight Permanently with the Bull’s Eye Food Guide: Your Best Mix of Carbs, Proteins, and Fats.”

So with so many diets out there today, which work best for weight loss and health? Here is Connolly-Schoonen’s input.

Going Gluten Free
Gluten is a name for proteins found in wheat, and some common foods that contain gluten include pasta, bread, flour tortillas, oats, dressings, cereals, sauces and more. Go to any grocery store these days and you will most likely find a “gluten-free” section. And while people with Celiac disease cannot eat gluten because they will get sick, many people who aren’t allergic to gluten are touting the weight loss and health benefits of going gluten free.

But if you don’t have a gluten allergy, is it necessary or nutritionally wise to go gluten free?

“I think that many people are gluten intolerant and can benefit from a gluten-free diet,” said Connolly-Schoonen. “But, [it should be] a high-quality gluten-free diet — foods that never had gluten. So your starches are going to be from potato and rice and quinoa, not from gluten-free bread and gluten-free pasta.”

So while foods that are naturally gluten free are generally healthy, those who are not gluten-intolerant should be wary of processed foods that have had the gluten removed, as there now exists a big market and opportunity for companies wanting to take advantage of the gluten-free trend — and products such as “gluten-free cookies” may not necessarily be nutritionally sound.

“In my practice, I’ve seen many people benefit from gluten-free styles of eating, but using whole foods, not processed gluten-free food … A slice of gluten-free bread is rather small and has the same or perhaps a little bit more calories than regular bread,” said Connolly-Schoonen. “Foods that are naturally gluten-free are quite healthy and I really do think people may benefit from a gluten-free style of eating, but it has to be natural.”

The Paleo Diet and Going Vegan
The idea behind the paleo diet is that we should eat as our ancestors or “cavemen” ate, including meat, fish, vegetables and fruit, and excluding processed food, grains and dairy. And while many people have reportedly lost weight on the diet, some argue that the paleo diet does not necessarily follow what our ancestors ate, and there is now a market for processed paleo bars and drinks.

But Connolly-Schoonen says the concept of consuming fewer processed foods is a good one to follow, especially when it comes to sugar-laden beverages.

“With the advent of the high fructose corn syrup, it became so cheap to make sweetened beverages … that have the equivalent of 17, 19, 20 packets of sugar in them, and we genetically cannot handle that.”

In addition, some people choose to go vegan or vegetarian for a variety of reasons — moral, health or a combination. Both vegans and vegetarians do not eat meat, fish or poultry, while vegans also do not use other animal products and byproducts, such as eggs, honey, cosmetics, and more.

“I don’t think you need to be a vegetarian to be at your optimal health, but there is a lot of research over an extended period of time showing that vegetarians, more than vegans, who eat a high-quality vegetarian diet — so no Snickers bars — do quite well in terms of decreasing the risk for chronic illnesses like diabetes and heart disease, and there really is a lot of research behind the vegetarian diet to support that,” said Connolly-Schoonen. “Vegan diets could be healthy, but it’s much more challenging to make sure that you get all of your micronutrients.”

Juicing Up
Juicing is still considered healthy in moderation and as a quick way to get antioxidants. But when you use a juicer, the juice is extracted from fruits and vegetables, leaving behind a pulp that is often thrown away. In addition, this strips the fruit of its fiber but leaves the sugar.

“Even if you’re juicing vegetables, you’re still getting the sugar … and making the sugar much more highly available,” said Connolly-Schoonen. “And most people are more satiated when they chew their food.”

In addition, many people subscribe to the idea of doing juicing “detoxes” or “cleanses” every so often — which have found to be not really necessary, as we already have a natural detoxification system that occurs in our livers. In addition, any sort of diet that deprives one of nutrients is never a great idea. Instead, work on supporting your body’s natural ability to detox.

“If you have an unhealthy gut environment, you’re taxing your liver’s detoxification system. So first you want to have a healthy gut environment, which means lots of fiber and a good source of probiotics,” said Connolly-Schoonen. “Then you need to support your liver’s detoxification system with a wide array of micronutrients, which is going to come from a wide array of whole foods like protein, fish, lean meats, beans and then your vegetables, fruits and nuts.”

The Bottom Line
Instead of following a super strict diet, you may want to simply remember Connolly-Schoonen’s “two key factors” for healthy nutrition: quality and quantity. In terms of quality, choose foods that are less processed — lean proteins like chicken and fish, a huge variety of vegetables, beans, nuts and olive oil for healthy fats.

Once one works on the quality of foods in his or her diet, “it’s been my experience that patients can then much more easily work on moderating the quantity,” she said. “Once you’re eating whole foods and you’re mixing your quality proteins and fats, it becomes much easier to manage your appetite.”

Does this mean you can never have dessert again? Not at all.

“I tell patients if you’re eating ice cream, it should be real ice cream made from whole milk fat and real sugar. You shouldn’t get artificially sweetened products,” she said. “When you want chocolate and you want ice cream, have the real stuff. And that you should be able to include in your diet, maybe not every day, maybe a few times a week — it all just depends on how active you are.”

Lisa Steuer is the managing editor of FitnessRx for Women and FitnessRx for Men magazines. For fitness tips, training videos and healthy recipes, visit www.fitnessrxformen.com and www.fitnessrxwomen.com.