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Health

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Is there a magic bullet to speed the healing process?

By David Dunaief, M.D.

Dr. David Dunaief

Now that many of us are interacting more fully in society, the common cold is becoming common again this fall.

All of us have suffered from the common cold at some point. Most frequently caused by the notorious human rhinovirus, its effects can range from an annoyance to more serious symptoms that put us out of commission for a week or more.

Amid folklore about remedies, there is evidence that it may be possible to reduce the symptoms — or even reduce the duration — of the common cold with supplements and lifestyle management.

I am frequently asked, “How do I treat this cold?” Below, I will review and discuss the medical literature, separating myth from fact about which supplements may be beneficial and which may not.

Zinc

You may have heard that zinc is an effective way to treat a cold. But what does the medical literature say? The answer is a resounding, YES! According to a meta-analysis that included 13 trials, zinc in any form taken within 24 hours of first symptoms may reduce the duration of a cold by at least one day (1) Even more importantly, zinc may significantly reduce the severity of symptoms throughout the infection, improving quality of life. The results may be due to an anti-inflammatory effect of zinc.

One of the studies, which was published in the Journal of Infectious Disease, found that zinc reduced the duration of the common cold by almost 50 percent from seven days to four days, cough symptoms were reduced by greater than 60 percent and nasal discharge by 33 percent (2). All of these results were statistically significant. Researchers used 13 grams of zinc acetate per lozenge taken three-to-four times daily for four days. This translates into 50-65 mg per day.

There are a few serious concerns with zinc. Note that the dose researchers used was well above the maximum intake recommended by the National Institutes of Health, 40 mg per day for adults. This maximum intake number goes down for those 18 and younger (3). Also, note that the FDA has warned against nasal administration through sprays, which has led to permanent loss of smell in some people.

As for the studies, note that not all studies showed a benefit. Also, all of the studies where there was a proven benefit may have used different formulations, delivery systems and dosages, and there is no current recommendation or consensus on what is optimal.

Vitamin C

According to a review of 29 trials with a combined population of over 11,000, vitamin C did not show any significant benefit in prevention, reduction of symptoms or duration in the general population (4). Thus, there may be no reason to take mega-doses of vitamin C for cold prevention and treatment. However, in a sub-group of serious marathon runners and other athletes, there was substantial risk reduction when taking vitamin C prophylactically; they caught 50 percent fewer colds.

Echinacea

After review of 24 controlled clinical trials, according to the Cochrane Database, the jury is still out on the effectiveness of echinacea for treatment of duration and symptoms, but the results are disappointing presently and, at best, are inconsistent (5). There are no valid randomized clinical trials for cold prevention using echinacea. In a randomized controlled trial with 719 patients, echinacea was no better than placebo for the treatment of the common cold (6).

Exercise

People with colds need rest – at least that was the theory. However, a study published in the British Journal of Sports Medicine may have changed this perception. Participants who did aerobic exercise at least five days per week, versus one or fewer days per week, had a 43 percent reduction in the number of days with colds over two 12-week periods during the fall and winter months (7). Even more interesting is that those who perceived themselves to be highly fit had a 46 percent reduction in number of days with colds compared to those who perceived themselves to have low fitness. The symptoms of colds were reduced significantly as well.

Symptom relief

What do I confidently recommend to my patients? If you have congestion or coughing symptoms with your cold, time-tested symptom relief may help. Sitting in a steamy bathroom, which simulates a medical mist tent, can help. Also, dry heat is your enemy. If your home is dry, use a cool mist humidifier to put some humidity back in the air.

Consuming salt-free soups loaded with vegetables can help increase your nutrient intake and loosen congestion. I start with a sodium-free base and add in spices, onions, spinach, broccoli and other greens until it’s more stew-like than soup-like.

Caffeine-free hot teas will also help loosen congestion and keep you hydrated.

Where does all of this information leave us?

Zinc is potentially of great usefulness the treatment and prevention of the common cold. Use caution with dosing, however, to reduce side effects. Echinacea and vitamin C may or may not provide benefits, but don’t stop taking them if you feel they work for you. And, if you need another reason to exercise, reducing your cold’s duration may a good one. Lastly, for symptom relief, simple home remedies may work better than any supplements.

References:

(1) Open Respir Med J. 2011; 5: 51–58. (2) J Infect Dis. 2008 Mar 15;197(6):795-802. (3) ods.od.nih.gov. (4) Cochrane Database of Systematic Reviews 2013, Issue 1. Art. No.: CD000980. (5) Cochrane Database of Systematic Reviews 2014, Issue 2. Art. No.: CD000530. (6) Ann Intern Med. 2010;153(12):769-777. (7) British Journal of Sports Medicine 2011;45:987-992.

Dr. David 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.

Start with small, but key dietary changes

By David Dunaief

Dr. David Dunaief

Heart disease is an umbrella term that includes a number of disorders. Most common is coronary artery disease, which can cause heart attacks. Others include valve issues and heart failure, which is a problem with the pumping mechanism. We will focus on coronary artery disease and the resulting heart attacks.

According to the Centers for Disease Control and Prevention, about 6.7 percent of U.S. adults over the age of 19 have coronary artery disease (CAD) (1). There are 805,000 heart attacks in the U.S. annually, and 200,000 of these occur in those who’ve already had a first heart attack.

Among the biggest contributors to heart disease risk are high blood pressure, high cholesterol, and smoking. In addition, if you have diabetes or are overweight or obese, your risk increases significantly. Lifestyle choices also contribute to your risk: poor diet, lack of physical activity and high alcohol consumption are among the most significant contributors.

We can significantly reduce the occurrence of CAD. The evidence continues to highlight lifestyle changes, including diet, as the most important factors in preventing heart disease. Changes that garner a big bang for your buck include the consumption of chocolate, legumes, nuts, fiber and omega-3 polyunsaturated fatty acids (PUFAs).

Can chocolate help?

Preliminary evidence shows that two pieces of chocolate a week may decrease the risk of a heart attack by 37 percent, compared to those who consume less (2). However, the authors warned against the idea that more is better. In fact, high fat and sugar content and calorically dense aspects may have detrimental effects when consumed at much higher levels. There is a fine line between potential benefit and harm. The benefits may be attributed to micronutrients referred to as flavonols.

I usually recommend that patients have one to two squares – about one-fifth to two-fifths of an ounce – of high-cocoa-content dark chocolate daily. Aim for chocolate labeled with 80 percent cocoa content. Alternatively, you can get the benefits without the fat and sugar by adding unsweetened, non-Dutched cocoa powder to a fruit and vegetable smoothie.

Who says prevention has to be painful?

Increase your dietary fiber

Fiber has a dose-response relationship to reducing risk. In other words, the more fiber you eat, the greater your risk reduction. In a meta-analysis of 10 studies, results showed for every 10-gram increase in fiber, there was a corresponding 14 percent reduction in the risk of a cardiovascular event and a 27 percent reduction in the risk of heart disease mortality (3). The authors analyzed data that included over 90,000 men and 200,000 women.

According to a 2021 analysis of National Health and Nutrition Examination Survey (NHANES) data from 2013 to 2018, only 5 percent of men and 9 percent of women get the recommended daily amount of fiber (4).

The average American consumes about 16 grams per day of fiber (5).

So, how much is “enough”? The Academy of Nutrition and Dietetics recommends 14 grams of fiber for each 1,000 calories consumed, or roughly 25 grams for women and 38 grams for men (6).

We can significantly reduce our risk of heart disease if we increase our consumption of fiber to reach the recommended levels. Good sources of fiber are fruits and vegetables with the edible skin or peel, beans and lentils, and whole grains.

Focus on legumes

 

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In a prospective (forward-looking) cohort study, the First National Health and Nutrition Examination Survey Epidemiologic Follow-up Study, legumes reduced the risk of coronary heart disease by a significant 22 percent (7). Those who consumed four or more servings per week, compared to those who consumed less than one serving, saw this effect. The legumes used in this study included beans, peas and peanuts. There were over 9,500 men and women involved, spanning 19 years of follow-up.

I recommend that patients consume at least one to two servings of legumes a day, or 7 to 14 a week. Imagine the impact that could have, compared to the modest four servings per week used to reach statistical significance in this study.

Add healthy nuts

In a study with over 45,000 men, there were significant reductions in CAD with omega-3 polyunsaturated fatty acids (PUFAs). Both plant-based and seafood-based omega-3s showed these effects (8). Good sources of omega-3s from plant-based sources include nuts, such as walnuts, and ground flaxseed.

Your ultimate goal should be to become “heart attack proof,” a term used by Dr. Sanjay Gupta and reinforced by Dr. Dean Ornish. Ideally, this requires a plant-based diet. But even modest changes in diet will result in significant risk reductions. The more significant the lifestyle changes you make, the closer you will come to achieving this goal.

References:

(1) cdc.gov. (2) BMJ 2011; 343:d4488. (3) Arch Intern Med. 2004 Feb 23;164(4):370-376. (4) nutrition.org (5) NHANES 2009-2010 Data Brief No. 12. Sep 2014. (6) eatright.org. (7) Arch Intern Med. 2001 Nov 26;161(21):2573-2578. (8) Circulation. 2005 Jan 18;111(2):157-164.

Dr. David 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. 

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Fracture risk is not linked to steroid use

By David Dunaief, M.D.

Dr. David Dunaief

Eczema is a common skin condition in both children and adults. It’s estimated that over seven percent of the U.S. adult population is afflicted (1), with twice as many females as males affected (2). Ranging in severity from mild to moderate to severe, adults tend to have moderate to severe eczema.

The causes of eczema are unknown, but it is thought that nature and nurture are both at play (3). Essentially, it is a chronic inflammatory process that involves symptoms of itching, pain, rashes and redness (4).

While there is no cure, treatments for eczema run the gamut from over-the-counter creams and lotions to prescription steroid creams to oral steroids and injectable biologics. Some use phototherapy for severe cases, but the research on its effectiveness is scant. Antihistamines are sometimes used to treat the itchiness. Interestingly, lifestyle modifications, specifically diet, may play an important role.

Two separate studies have shown an association between eczema and fracture risk, which we will investigate further. Let’s look at the evidence.

Not just skin deep

Eczema may be related to broken bones, according to several studies. For example, one observational study of 34,500 patients showed that those with eczema had a 44 percent increased risk of injury causing limitation and an even more disturbing 67 percent risk of bone fracture and bone or joint injury for those 30 years and older (5).

And if you have both fatigue or insomnia and eczema, you are at higher risk for bone or joint injury than having one or the other alone. The researchers postulated that the use of corticosteroids in treatment could be one reason for increased fracture risk, in addition to chronic inflammation, which may also contribute to the risk of bone loss.

Steroids may weaken bone, ligaments and tendons and may cause osteoporosis by decreasing bone mineral density.

A recently published study of over 500,000 patients tested this theory and found that the association between major osteoporotic fractures and atopic eczema remained, even after adjusting for a range of histories with oral corticosteroids (6). Also, fracture rates were higher in those with severe atopic eczema.

For those who have eczema, it may be wise to have a DEXA (bone) scan.

Do supplements help?

There are two well-known supplements for helping to reduce inflammation, evening primrose oil and borage oil. Are these supplements a good replacement for – or addition to – medications? The research is really mixed, leaning toward ineffective – and with some concerns.

In a meta-analysis of seven randomized controlled trials, evening primrose oil was no better than placebo in treating eczema (7).

The researchers also looked at eight studies of borage oil and found there was no difference from placebo in terms of symptom relief. While these supplements only had minor side effects in the study, they can interact with other medications. For example, evening primrose oil in combination with aspirin can cause clotting problems (8).

But don’t look to supplements for significant help.

Injectable solutions

Dupilumab is a biologic monoclonal antibody (9). In trials, this injectable drug showed good results, improving outcomes for moderate to severe eczema sufferers when topical steroids alone were not effective. Like any drug therapy, it does have side effects.

Topical probiotics

There are also potentially topical probiotics that could help with atopic dermatitis. In preliminary in-vitro (in a test tube) studies, the results look intriguing and show that topical probiotics from the human microbiome (gut) could potentially work as well as steroids (10). Currently, additional trials are underway in children with the atopic dermatitis form of eczema (11). This may be part of the road to treatments of the future. However, this is in very early stage of development.

Dietary possibilities

In a Japanese study involving over 700 pregnant women and their offspring, results showed that when the women ate either a diet high in green and yellow vegetables, beta carotene or citrus fruit there was a significant reduction in the risk of the child having eczema of 59 percent, 48 percent and 47 percent, respectively, when comparing highest to lowest consumption quartiles (12).

Elimination diets may also play a role. One study’s results showed when eggs were removed from the diet in those who were allergic, according to IgE testing, eczema improved significantly (13).

From an anecdotal perspective, I have seen very good results when treating patients who have eczema with dietary changes. My patient population includes about 15 to 20 percent of patients who suffer some level of eczema. For example, a young adult had eczema mostly on the extremities. When I first met the patient, these were angry, excoriated, erythematous and scratched lesions. However, after several months of a vegetable-rich diet, the patient’s skin had all but cleared.

Eczema exists on a spectrum from annoying to significantly affecting a patient’s quality of life (14). Supplements may not be the solution, at least not borage oil or evening primrose oil. However, there may be promising topical probiotics ahead and medications for the hard to treat. It might be best to avoid long-term systemic steroid use, because of the long-term side effects. Lifestyle modifications appear to be very effective, at least at the anecdotal level.

References:

(1) J Inv Dermatol. 2017;137(1):26-30. (2) BMC Dermatol. 2013;13(14). (3) Acta Derm Venereol (Stockh) 1985;117 (Suppl.):1-59. (4) uptodate.com. (5) JAMA Dermatol. 2015;151(1):33-41. (6) J Allergy Clin Immunol Pract. 2021 Sep 24;S2213-2198(21)01018-7. (7) Cochrane Database Syst Rev. 2013;4:CD004416. (8) mayoclinic.org (9) Medscape.com. (10) ACAAI 2014: Abstracts P328 and P329. (11) nih.gov. (12) Allergy. 2010 Jun 1;65(6):758-765. (13) J Am Acad Dermatol. 2004;50(3):391-404. (14) Contact Dermatitis 2008; 59:43-47.

Dr. David 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. 

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Nutrition is a popular topic of conversation, particularly among those embarking on a weight loss or maintenance plan. Individuals carefully study food macros and pore over various diets to get the most out of the foods they eat. When the end goal is simply looking good, it may be easy to forget about the other benefits of nutritious diets, including their link to overall health. 

A close relationship exists between nutritional status and health. Experts at Tufts Health Plan recognize that good nutrition can help reduce the risk of developing many diseases, including heart disease, stroke, diabetes, and some cancers. The notion of “you are what you eat” still rings true.

The World Health Organization indicates better nutrition means stronger immune systems, fewer illnesses and better overall health. However, according to the National Resource Center on Nutrition, Physical Activity, and Aging, one in four older Americans suffers from poor nutrition. And this situation is not exclusive to the elderly. A report examining the global burden of chronic disease published in The Lancet found poor diet contributed to 11 million deaths worldwide — roughly 22 percent of deaths among adults — and poor quality of life. 

Low intake of fruits and whole grains and high intake of sodium are the leading risk factors for illness in many countries. Common nutrition problems can arise when one favors convenience and routine over balanced meals that truly fuel the body. 

Improving nutrition

Guidelines regarding how many servings of each food group a person should have each day may vary slightly by country, but they share many similarities. The U.S. Department of Agriculture once followed a “food pyramid” guide, but has since switched to the MyPlate resource, which emphasizes how much of each food group should cover a standard 9-inch dinner plate. 

Food groups include fruits, vegetables, grains, proteins, and dairy. The USDA dietary guidelines were updated for its 2020-2025 guide. Recommendations vary based on age and activity levels, but a person eating 2,000 calories a day should eat 2 cups of whole fruits; 2 1⁄2 cups of colorful vegetables; 6 ounces of grains, with half of them being whole grains; 5 1⁄2 ounces of protein, with a focus on lean proteins; and 3 cups of low-fat dairy. 

People should limit their intake of sodium, added sugars and saturated fats. As a person ages he or she generally needs fewer calories because of less activity. Children may need more calories because they are still growing and tend to be very active.

Those who are interested in preventing illness and significantly reducing premature mortality from leading diseases should carefully evaluate the foods they eat, choosing well-balanced, low-fat, nutritionally dense options that keep saturated fat and sodium intake to a minimum.

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To take care of your heart, it’s important to know and track your blood pressure. Millions of Americans have high blood pressure, also called hypertension, but many don’t realize it or aren’t keeping it at a healthy level. 

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For most adults, healthy blood pressure is 120/80 millimeters of mercury or less. Blood pressure consistently above 130/80 millimeters of mercury increases your risk for heart disease, kidney disease, eye damage, dementia and stroke. Your doctor might recommend lowering your blood pressure if it’s between 120/80 and 130/80 and you have other risk factors for heart or blood vessel disease.

High blood pressure is often “silent,” meaning it doesn’t usually cause symptoms but can damage your body, especially your heart over time. Having poor heart health also increases the risk of severe illness from COVID-19. While you can’t control everything that increases your risk for high blood pressure – it runs in families, often increases with age and varies by race and ethnicity – there are things you can do. Consider these tips from experts with the National Heart, Lung, and Blood Institute’s (NHLBI) The Heart Truth program: 

#1: KNOW YOUR NUMBERS

Everyone ages 3 and older should get their blood pressure checked by a health care provider at least once a year. Expert advice: 30 minutes before your test, don’t exercise, drink caffeine or smoke cigarettes. Right before, go to the bathroom. During the test, rest your arm on a table at the level of your heart and put your feet flat on the floor. Relax and don’t talk.

#2: EAT HEALTHY

Follow a heart-healthy eating plan, such as NHLBI’s Dietary Approaches to Stop Hypertension (DASH). For example, use herbs for flavor instead of salt and add one fruit or vegetable to every meal.

#3: MOVE MORE

Get at least 2 1/2 hours of physical activity each week to help lower and control blood pressure. To ensure you’re reducing your sitting throughout the day and getting active, try breaking your activity up. Do 10 minutes of exercise, three times a day or one 30-minute session on five separate days each week. Any amount of physical activity is better than none and all activity counts.

#4: HAVE A HEALTHY PREGNANCY

High blood pressure during pregnancy can harm the mother and baby. It also increases a woman’s risk of having high blood pressure later in life. Talk to your health care provider about high blood pressure. Ask if your blood pressure is normal and track it during and after pregnancy. If you’re planning to become pregnant, start monitoring it now.

#5: MANAGE STRESS

Stress can increase your blood pressure and make your body store more fat. Reduce stress with meditation, relaxing activities or support from a counselor or online group. 

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#6: STOP SMOKING 

The chemicals in tobacco smoke can harm your heart and blood vessels. Seek out resources, such as smoke free hotlines and text message programs,  that offer free support and information.

#7: AIM FOR A HEALTHY WEIGHT

If you’re overweight, losing just 3-5% of your weight can improve blood pressure. If you weigh 200 pounds, that’s a loss of 6 to 10 pounds. To lose weight, ask a friend or family member for help or to join a weight loss program with you. Social support can help keep you motivated.

#8: WORK WITH YOUR DOCTOR

Get help setting your target blood pressure. Write down your numbers every time you get your blood pressure checked. Ask if you should monitor your blood pressure from home. Take all prescribed medications as directed and keep up your healthy lifestyle. If seeing a doctor worries you, ask to have your blood pressure taken more than once during a visit to get an accurate reading. 

To find more information about high blood pressure as well as resources for tracking your numbers, visit nhlbi.nih.gov/hypertension.

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Long-term proton pump inhibitor use may have serious side effects

By David Dunaief, M.D.

Dr. David Dunaief

Reflux (GERD) disease, sometimes referred to as heartburn, though this is more of a symptom, is one of the most commonly treated diseases. In line with this, proton pump inhibitors (PPIs) have become one of the top-10 drug classes prescribed or taken in the United States.

The class of drugs called PPIs includes Prevacid (lansoprazole), Prilosec (omeprazole), Nexium (esomeprazole), Protonix (pantoprazole) and Aciphex (rabeprazole). Several of these medications are now available over-the-counter, rather than by prescription. When they were first approved, they were touted as having one of the cleanest side-effect profiles. This may still be true, if we use them correctly. They are intended to be used only for the short term. This can range from 7 to 14 days for over-the-counter PPIs to 4 to 8 weeks for prescription PPIs.

Dangers of long-term use

While PPI pre-approval trials were short-term, not longer than a year, many physicians put patients on these medications for decades. And the longer people are on them, the more complications arise. Among potential associations with long-term use are chronic kidney disease, dementia, bone fractures and Clostridium difficile, a bacterial infection of the gastrointestinal tract.

Though PPIs may increase the risk of a number of complications, keep in mind that none of the data are from randomized controlled trials (RCTs), which are the gold standard of studies, but mostly observational studies that suggest an association, not a link.

Chronic kidney disease

In two separate studies, results showed that there was an increase in chronic kidney disease with prolonged PPI use (1). All of the patients started the study with normal kidney function based on glomerular filtration rate (GFR). In the Atherosclerosis Risk in Communities (ARIC) study, there was a 50 percent increased risk of chronic kidney disease, while the Geisinger Health System cohort study found there was a modest 17 percent increased risk. 

The first study had a 13-year duration, and the second had about a six-year duration. Both demonstrated modest, but statistically significant, increased risk of chronic kidney disease. But as you can see, the medications were used on a chronic basis for years. In an accompanying editorial to these published studies, the author suggests that there is overuse of the medications or that they are used beyond the resolution of symptoms and suggests starting with diet and lifestyle modifications as well as a milder drug class, H2 blockers (2).

Dementia

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A German study looked at health records from a large public insurer and found there was a 44 percent increased risk of dementia in the elderly who were using PPIs, compared to those who were not (3). These patients were at least age 75. The authors surmise that PPIs may cross the coveted blood-brain barrier and potentially increase beta-amyloid levels, markers for dementia. With occasional use, meaning once every 18 months for a few weeks to a few months, there was a much lower increased risk of 16 percent.

The researchers also suggested that PPIs may be significantly overprescribed in the elderly. Unfortunately, there were confounding factors that may have conflated the risk. Researchers also did not take into account family history of dementia, high blood pressure or excessive alcohol use, all of which have effects on dementia occurrence.

Bone fractures

In a meta-analysis of 18 observational studies, results showed that PPIs can increase the risk of hip fractures, spine fractures and any-site fractures (4). Interestingly, when it came to bone fractures, it did not make a difference whether patients were taking PPIs for more or less than a year.

They found increased fracture risks of 58, 26 and 33 percent for spine, hip and any site, respectively. It is not clear what may potentially increase the risk; however, it has been proposed that it may have to do with calcium absorption through the gut. PPIs reduce acid, which may be needed to absorb insoluble calcium salts. In another study, seven days of PPIs were shown to lower the absorption of calcium carbonate supplements when taken without food (5).

Need for magnesium

PPIs may have lower absorption effects on several electrolytes including magnesium, calcium and B12. In one observational study, PPIs combined with diuretics caused a 73 percent increased risk of hospitalization due to low magnesium (6). Diuretics are commonly prescribed for high blood pressure, heart failure and swelling.

Another study confirmed these results. In this second study, which was a meta-analysis of nine studies, PPIs increased the risk of low magnesium in patients by 43 percent, and when researchers looked only at higher quality studies, the risk increased to 63 percent (7). The authors note that a significant reduction in magnesium could lead to cardiovascular events.

The bottom line is that it’s best if you confer with your doctor before starting PPIs. You may not need PPIs, but rather a milder medication, such as H2 blockers (Zantac, Pepcid). Even better, start with lifestyle modifications including diet, not eating later at night, raising the head of the bed, losing weight and stopping smoking, if needed, and then consider medications (8).

If you do need medications, know that PPIs don’t give immediate relief and should only be taken for a short duration: 7 to 14 days, according to the FDA, without a doctor’s consult, and 4 to 8 weeks with one (9).

References:

(1) JAMA Intern Med. 2016;176(2). (2) JAMA Intern Med. 2016;176(2):172-174. (3) JAMA Neurol. online Feb 15, 2016. (4) Osteoporos Int. online Oct 13, 2015. (5) Am J Med. 118:778-781. (6) PLoS Med. 2014;11(9):e1001736. (7) Ren Fail. 2015;37(7):1237-1241. (8) Am J Gastroenterol 2015; 110:393–400. (9) fda.gov.

Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. Visit www.medicalcompassmd.com. 

Micronutrients are vitamins and minerals needed by the body in very small amounts. METRO photo
Micronutrient focus may reduce cravings

By David Dunaief, M.D.

Dr. David Dunaief

If we needed any more proof, this past year has been a good reminder that many things influence our eating behavior, including food addictions, boredom, lack of sleep and stress. This can make weight management or weight loss very difficult to achieve.

Unfortunately, awareness of a food’s caloric impact doesn’t always matter, either. Studies assessing the impact of nutrition labeling in restaurants gave us a clear view of this issue: knowing an item’s calories either doesn’t alter behavior or encourages higher calorie purchases (1, 2).

Does this mean we are doomed to acquiesce to temptation? Actually, no: It is not solely about willpower. Changing diet composition is more important.

How can we alter the dynamic? In my clinical experience, increasing the quality of food has a tremendous impact. Foods that are the most micronutrient dense, such as plant-based foods, rather than those that are solely focused on macronutrient density, such as protein, carbohydrates and fats, tend to be the most satisfying. In a week to a few months, one of the first things patients notice is a significant reduction in cravings. But don’t take my word for it. Let’s look at the evidence.

Examining refined carbohydrates

Many of us know that refined carbohydrates are not beneficial. Worse, however, a randomized control trial showed refined carbohydrates may cause food addiction (3). Certain sections of the brain involved in cravings and reward are affected by high-glycemic foods, as shown by MRI scans of trial subjects.

Study participants consumed a 500-calorie shake with either a high-glycemic index or a low-glycemic index. They were blinded (unaware) as to which they were drinking. The ones who drank the high-glycemic shake had higher levels of glucose in their blood initially, followed by a significant decline in glucose levels and increased hunger four hours later. The region of the brain that is related to addiction, the nucleus accumbens, showed a spike in activity with the high-glycemic intake.

According to the authors, this effect may occur regardless of the number of calories consumed. Granted, this was a very small study, but it was well designed. High-glycemic foods include carbohydrates, such as white flour, sugar and white potatoes. The conclusion: Everyone, but especially those trying to lose weight, should avoid refined carbohydrates. Calorie composition matters.

Comparing macronutrients

We tend to focus on macronutrients when looking at diets. These include protein, carbohydrates and fats, but are these the elements that have the greatest impact on weight loss? In an RCT, when comparing different macronutrient combinations, there was very little difference among groups, nor was there much success in helping obese patients reduce their weight (4, 5). Only 15 percent of patients achieved a 10 percent reduction in weight after two years.

The four different macronutrient diet combinations involved overall calorie restriction. In addition, each combination had either high protein, high fat; average protein, high fat; high protein, low fat; or low protein, low fat. Carbohydrates ranged from low to moderate (35 percent) in the first group to high (65 percent) in the last group. This was another well-designed study, involving 811 participants with an average BMI of 33 kg/m², which is classified as obese.

Again, focusing primarily on macronutrient levels and calorie counts did very little to improve results.

Adding micronutrients

In an epidemiological study looking at National Health and Nutrition Examination Survey data, results demonstrate that those who are overweight and obese tend to be lacking in micronutrients (6). These include carotenoids, such as lutein, zeaxanthin, beta-carotene, alpha-carotene and beta-cryptoxanthin, as well as vitamin B12, folate and vitamins C, E and D.

Unfortunately, taking supplements won’t solve the problem; supplements don’t compensate for missing micronutrients. Quite the contrary, micronutrients from supplements are not the same as those from foods. With a few exceptions, such as vitamin D and potentially B12, most micronutrient levels can be raised without supplementation, by adding variety to your diet. Please ask your doctor.

Lowering cortisol levels

The good news is that once people lose weight, they may be able to continue to keep the weight off. In a prospective (forward-looking) study, results show that once obese patients lose weight, the levels of cortisol metabolite excretion decrease significantly (7).

Why is this important? Cortisol is a glucocorticoid, which means it raises the level of glucose and is involved in mediating visceral or belly fat. This type of fat has been thought to coat internal organs, such as the liver, and result in nonalcoholic fatty liver disease. Decreasing the level of cortisol metabolite may also result in a lower propensity toward insulin resistance and may decrease the risk of cardiovascular mortality. This is an encouraging preliminary, yet small, study involving women.

Controlling or losing weight is not solely about willpower or calorie-counting. While calories have an impact, the nutrient density of the food may be more important. Thus, those foods high in a variety of micronutrients may also play a significant role in reducing cravings, ultimately helping to manage weight.

References:

(1) Am J Pub Health 2013 Sep 1;103(9):1604-1609. (2) Am J Prev Med.2011 Oct;41(4):434–438. (3) Am J Clin Nutr Online 2013;Jun 26. (4) N Engl J Med 2009 Feb 26;360:859. (5) N Engl J Med 2009 Feb 26;360:923. (6) Medscape General Medicine. 2006;8(4):59. (7) Clin Endocrinol.2013;78(5):700-705.

Dr. David 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. 

Yoga can improve balance and strength, which are risk factors for falls. METRO photo
Fear of falling can lead to greater risk

By David Dunaief, M.D.

Dr. David Dunaief

Earlier in life, falls usually do not result in significant consequences. However, once we reach middle age, falls become more substantial. Even without icy steps and walkways, falls can be a serious concern for older patients, where consequences can be devastating. They can include brain injuries, hip fractures, a decrease in functional ability and a decline in physical and social activities (1). Ultimately, a fall can lead to loss of independence (2).

Contributors to fall risk

Many factors contribute to fall risk. A personal history of falling in the recent past is the most prevalent. But there are many other significant factors, such as age and medication use. Some medications, like antihypertensive medications used to treat high blood pressure and psychotropic medications used to treat anxiety, depression and insomnia, are of particular concern. Chronic diseases can also contribute.

Circumstances that predispose us to falls also involve weakness in upper and lower body strength, decreased vision, hearing disorders and psychological issues, such as anxiety and depression (3).

Simple fall prevention tips

Of the utmost importance is exercise. But what do we mean by “exercise”? Exercises involving balance, strength, movement, flexibility and endurance all play significant roles in fall prevention (4).

Many of us in the Northeast are also low in vitamin D, which may strengthen muscle and bone. This is an easy fix with supplementation. Footwear also needs to be addressed. Nonslip shoes are crucial indoors, and outside in winter, footwear that prevents sliding on ice is a must. Inexpensive changes in the home, like securing area rugs, can also make a big difference.

Medication side-effects

There are a number of medications that may heighten fall risk. As I mentioned, psychotropic drugs top the list. But what other drugs might have an impact?

High blood pressure medications have been investigated. A propensity-matched sample study (a notch below a randomized control trial in terms of quality) showed an increase in fall risk in those who were taking high blood pressure medication (5). Those on moderate doses of blood pressure medication had the greatest risk of serious injuries from falls, a 40 percent increase.

While blood pressure medications may contribute to fall risk, they have significant benefits in reducing the risks of cardiovascular disease and events. Thus, we need to weigh the risk-benefit ratio in older patients before considering stopping a medication. When it comes to treating high blood pressure, lifestyle modifications may also play a significant role in treating this disease (6).

How exercise helps

All exercise has value. A meta-analysis of a group of 17 trials showed that exercise significantly reduced the risk of a fall (7). If the categories are broken down, exercise led to a 37 percent reduction in falls that resulted in injury and a 30 percent reduction in those falls requiring medical attention. Even more impressive was a 61 percent reduction in fracture risk.

Remember, the lower the fracture risk, the more likely you are to remain physically independent. Thus, the author summarized that exercise not only helps to prevent falls but also fall injuries.

Unfortunately, those who have fallen before, even without injury, often develop a fear that causes them to limit their activities. This leads to a dangerous cycle of reduced balance and increased gait disorders, ultimately resulting in an increased risk of falling (8).

What types of exercise?

Tai chi, yoga and aquatic exercise have been shown to have benefits in preventing falls and injuries from falls.

A randomized controlled trial showed that those who did an aquatic exercise program had a significant improvement in the risk of falls (9). The aim of the aquatic exercise was to improve balance, strength and mobility. Results showed a reduction in the number of falls from a mean of 2.00 to a fraction of this level — a mean of 0.29. There was also a 44 percent decline in the number of exercising patients who fell during the six-month trial, with no change in the control group.

If you don’t have a pool available, Tai Chi, which requires no equipment, was also shown to reduce both fall risk and fear of falling in older adults in a randomized control trial of 60 male and female participants (10).

Another pilot study used modified chair yoga classes with a small assisted living population (11). Participants were those over 65 who had experienced a recent fall and had a resulting fear of falling. While the intention was to assess exercise safety, researchers found that participants had less reliance on assistive devices and three of the 16 participants were able to eliminate their use of mobility assistance devices.

Thus, our best line of defense against fall risk is prevention. Does this mean stopping medications? Not necessarily. But for those 65 and older, or for those who have arthritis and are at least 45 years old, it may mean reviewing your medication list with your doctor. Before considering changing your blood pressure medications, review the risk-to-benefit ratio with your physician.

References:

(1) MMWR. 2014; 63(17):379-383. (2) J Gerontol A Biol Sci Med Sci. 1998;53(2):M112. (3) JAMA. 1995;273(17):1348. (4) Cochrane Database Syst Rev. 2012;9:CD007146. (5) JAMA Intern Med. 2014 Apr;174(4):588-595. (6) JAMA Intern Med. 2014;174(4):577-587. (7) BMJ. 2013;347:f6234. (8) Age Ageing. 1997 May;26(3):189-193. (9) Menopause. 2013;20(10):1012-1019. (10) Mater Sociomed. 2018 Mar; 30(1): 38–42. (11) Int J Yoga. 2012 Jul-Dec; 5(2): 146–150.

Dr. David 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. 

Sleep clears toxins from the brain. METRO photo
Exercise and sleep are crucial to clearing the clutter

By David Dunaief, M.D.

Dr. David Dunaief

Considering the importance of our brain to our functioning, it’s startling how little we know about it. 

We do know that certain drugs, head injuries and lifestyle choices negatively impact the brain. There are also numerous disorders and diseases that affect the brain, including neurological (dementia, Parkinson’s, stroke), infectious (meningitis), rheumatologic (lupus and rheumatoid arthritis), cancer (primary and secondary tumors), psychiatric mood disorders (depression, anxiety, schizophrenia), diabetes and heart disease.

Although these diseases vary widely, they generally have three signs and symptoms in common: they either cause altered mental status, physical weakness or change in mood — or a combination of these.

Probably our greatest fear regarding the brain is a loss of cognition. Fortunately, there are several studies that show we may be able to prevent cognitive decline by altering modifiable risk factors. They involve rather simple lifestyle changes: sleep, exercise and possibly omega-3s.

Let’s look at the evidence.

Clutter slows us down as we age

The lack of control over our mental capabilities as we age frightens many of us. Those who are in their 20s seem to be much sharper and quicker. But are they really?

In a study, German researchers found that educated older people tend to have a larger mental database of words and phrases to pull from since they have been around longer and have more experience (1). When this is factored into the equation, the difference in terms of age-related cognitive decline becomes negligible.

This study involved data mining and creating simulations. It showed that mental slowing may be at least partially related to the amount of clutter or data that we accumulate over the years. The more you know, the harder it becomes to come up with a simple answer to something. We may need a reboot just like a computer. This may be possible through sleep, exercise and omega-3s.

Get enough sleep

Why should we dedicate 33 percent of our lives to sleep? There are several good reasons. One involves clearing the mind, and another involves improving our economic outlook.

For the former, a study done in mice shows that sleep may help the brain remove waste, such as those all-too-dangerous beta-amyloid plaques (2). When we have excessive plaque buildup in the brain, it may be a sign of Alzheimer’s. When mice were sleeping, the interstitial space (the space between brain gyri, or structures) increased by as much as 60 percent.

This allowed the lymphatic system, with its cerebrospinal fluid, to clear out plaques, toxins and other waste that had developed during waking hours. With the enlargement of the interstitial space during sleep, waste removal was quicker and more thorough, because cerebrospinal fluid could reach much farther into the spaces. A similar effect was seen when the mice were anesthetized.

In another study, done in Australia, results showed that sleep deprivation may have been responsible for an almost one percent decline in gross domestic product for the country (3). The reason? People are not as productive at work when they don’t get enough sleep. They tend to be more irritable, and concentration may be affected. We may be able to turn on and off sleepiness on short-term basis, depending on the environment, but we can’t do this continually.

According to the Centers for Disease Control and Prevention, four percent of Americans reported having fallen asleep in the past 30 days behind the wheel of a car (4). And “drowsy driving” led to 83,000 crashes in a four-year period ending in 2009, according to The National Highway Traffic Safety Administration.

Prioritize exercise

How can I exercise, when I can’t even get enough sleep? Well there is a study that just may inspire you.

In the study, which involved rats, those that were not allowed to exercise were found to have rewired neurons in the area of their medulla, the part of the brain involved in breathing and other involuntary activities. There was more sympathetic (excitatory) stimulus that could lead to increased risk of heart disease (5). In rats allowed to exercise regularly, there was no unusual wiring, and sympathetic stimuli remained constant. This may imply that being sedentary has negative effects on both the brain and the heart.

This is intriguing since we used to think that our brain’s plasticity, or ability to grow and connect neurons, was finite and stopped after adolescence. This study’s implication is that a lack of exercise causes unwanted new connections. Human studies should be done to confirm this impact.

Consume omega-3 fatty acids

In the Women’s Health Initiative Memory Study of Magnetic Resonance Imaging Study, results showed that those postmenopausal women who were in the highest quartile of omega-3 fatty acids had significantly greater brain volume and hippocampal volume than those in the lowest quartile (6). The hippocampus is involved in memory and cognitive function.

Specifically, the researchers looked at the levels of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in red blood cell membranes. The source of the omega-3 fatty acids could either have been from fish or supplementation.

It’s never too late to improve brain function. Although we have a lot to learn about the functioning of the brain, we know that there are relatively simple ways we can positively influence it.

References:

(1) Top Cogn Sci. 2014 Jan.;6:5-42. (2) Science. 2013 Oct. 18;342:373-377. (3) Sleep. 2006 Mar.;29:299-305. (4) cdc.gov. (5) J Comp Neurol. 2014 Feb. 15;522:499-513. (6) Neurology. 2014;82:435-442.

Dr. David 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. 

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METRO photo

Resolutions that focus on health and fitness are made each year. Numerous people are eager to lose weight, improve their physical fitness levels or even stop habits that can hinder their mental or physical wellness.

People have many options when they seek to lose weight. Fad diets may promise quick results, but highly restrictive eating plans or marathon workout sessions can be dangerous. Taking shortcuts or risks in the hopes of losing weight can lead to various health issues and ultimately put people’s overall health in serious jeopardy. Thankfully, there are many safe ways people can lose weight. The first step in safe weight loss is to visit a doctor and let him or her know your plans. The doctor can help determine if a specific eating plan or exercise routine is safe based on your current health.

Certain medications can affect metabolism and even contribute to weight gain, so a discussion with the doctor can help ensure people aren’t putting their health in jeopardy when their goal is to get healthy. It’s also vital that people trying to lose weight do not believe everything they read online.

Research published in The American Journal of Public Health in October 2014 found that most people who search the internet for tips on how to lose weight come across false or misleading information on weight loss, particularly in regard to how quickly they can shed some pounds. The Centers for Disease Control and Prevention advises the safest amount of weight to lose per week is between one and two pounds. People who lose more per week, particularly on fad diets or programs, oftentimes are much more likely to regain weight later on than people who took more measured approaches to losing weight.

In addition, the Academy of Nutrition and Dietetics notes it is better to lose weight gradually because if a person sheds pounds too fast, he or she can lose muscle, bone and water instead of fat. The calories in, calories out concept is something to keep in mind when attempting to lose weight. But metabolism and other factors, including body composition and physical activity levels, also are factors. How well one’s body turns calories into fuel also needs to be considered. The best ways to experiment are to start slowly. • Calculate the average daily calories consumed in a day using a tracker. This can be a digital app on a phone or simply writing down calories on a piece of paper. Track over a few days and see, on average, how many calories you’ve been consuming.

• Notice extra calories. Many diets can be derailed by eating extra calories that you don’t realize you’re consuming. That cookie a coworker insists you eat or the leftover mac-and-cheese from your toddler’s plate can be sources of extra calories. Be mindful of what’s being consumed, including sweetened beverages.

• Explore the science. According to the Scotland-based health service NHS Inform, one pound of fat contains 3,500 calories on average. Cutting calorie intake by 500 calories per day should see you lose 1 pound per week. The same goes in the other direction. Eating 500 more calories per day for a year can result in gaining close to 50 pounds. Small changes really add up.

• Eat filling foods. Choose low-calorie, high quality foods, like vegetables, whole grains and lean proteins. Meals that provide satiety can help eliminate between-meals snacks that can derail your weight loss efforts.

• Seek support as a way to create accountability. Share weight loss plans with a friend or relative who can help monitor your progress and keep you on track.

• Incorporate strength training. Good Housekeeping says the more lean muscle you have, the faster you can slim down. Start slowly with strength training, using free weights or body weights. Aim for strength workouts three to four times per week and alternate with calorie-blasting cardio. Explore safer ways to lose weight, including taking a gradual approach that promotes long-term weight loss.