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Honor your friends and family with healthier Thanksgiving option

By David Dunaief, M.D.

Dr. David Dunaief

Research tells us that Americans are more likely to gain weight between Thanksgiving and New Year’s Day. This is when many accumulate the greatest weight gain of the year, and most do not lose the weight they gain during this time (1). In the study group, those who were already overweight or obese had the greatest weight gains. If you can avoid weight gain during the holidays, think of the possibilities for the rest of the year.

It’s difficult to maintain healthy eating habits during the Thanksgiving holidays, and the additional stress of the season doesn’t help. Even when we intend to resist, it’s too tempting to indulge in a sprawling buffet or seasonal treats.

Unfortunately, this can have significant health consequences. And if you tend to overeat, be aware that there are short-term consequences of stuffing ourselves. Overeating during a single meal can increase your heart attach risk in the near term, according to the American Heart Association (2).  

How can you turn Thanksgiving dinner into a healthier meal? The secret is often hidden in the side dishes on your table and the snacks you offer. 

Increase the carotenoids

Carotenoids help to prevent and potentially reverse diseases, such as breast cancer, amyotrophic lateral sclerosis (Lou Gehrig’s disease), age-related macular degeneration, and cardiovascular disease. Foods that contain these substances are dark green leafy vegetables, as well as orange, yellow and red vegetables and fruits. These phytochemicals (plant nutrients) have antioxidant and anti-inflammatory effects (3).

Prepare veggies in an appetizing way

Vegetables are often prepared in either an unappetizing way or smothered in cheese and butter, negating any benefits. Fruits are often buttered and sugared beyond recognition or used as a garnish for more decadent dishes. 

Other plant-based foods, like whole grains and leafy greens, are often afterthoughts. Here are some suggestions to get you thinking about ways to shift the heavy holiday meal paradigm:

Elevate plant-based dishes. Supplement tradition by adding mouthwatering vegetable-based dishes. One of my favorites is steamed “sweet” vegetables – cauliflower, broccoli, snap peas, onions and garlic. To make it sweet, I sauté it in a splash of citrus-infused balsamic vinegar and add sliced apples. Who doesn’t love poached apples? You can make this a primary dish by adding diced tofu or garbanzo beans to make it more filling without overwhelming its delicate sweetness.

Add seasonings. Why would you serve vegetables without any seasoning? In my family, we season vegetables and make sauces to drizzle over them. Personally, I’m a fan of infused vinegars. Choose your favorites to add varied flavors to different vegetables. 

Our teenaged nephew, who never liked vegetables, fell in love with my wife’s roasted Brussels sprouts and broccoli while on summer vacation together. He texted her afterward to ask for the recipes, which are surprisingly simple: place them on a roasting tray, add salt-free spices, and roast to your desired tenderness. Now, he makes them for himself. Resources for appealing vegetable dishes can be found at PCRM.org, mouthwateringvegan.com, and many other online resources.

Replace refined grains and starches. A study in the American Journal of Clinical Nutrition showed that replacing wheat or refined grains with whole wheat and whole grains significantly reduced central fat, or belly fat (4). The participants lost superficial fat found just below the skin, as well as visceral adipose tissue, the fat that lines organs and causes chronic diseases such as cancer.

For even better results, consider substituting riced cauliflower or mashed cauliflower for rice or potatoes. You can purchase frozen riced cauliflower in grocery stores now. Be sure to choose one that’s unsalted. If you prefer mashed potatoes, here’s a simple recipe for mashed cauliflower, which is delicious: https://medicalcompassmd.com/post/mashed-cauliflower-recipe-vegan. 

Offer healthy snacks. Choose to lay out trays of whole grain brown rice crackers, baby carrots, cherry tomatoes and healthy dips like low-salt hummus and salsa instead of creamy dips, cheese platters and candies. Help people choose wisely.

Improve dessert options. You might include a dairy-free, sugar-free pumpkin pudding or fruit salad. Both are light and won’t make you feel overstuffed.

Your overarching goal should be to increase your appealing, nutrient-dense options and decrease your empty-calorie foods. Express your gratitude for family and friends and promote their good health with a delicious, thoughtful, festive meal.

References:

(1) N Engl J Med. 2000 Mar 23;342(12):861–867. (2) www.heart.org. (3) Crit Rev Food Sci Nutr 2010;50(8):728–760. (4) Am J Clin Nutr 2010 Nov;92(5):1165-71.

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 or consult your personal physician.

 

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Minimize serious medication risks with modest lifestyle change

By David Dunaief M.D.

Dr. David Dunaief

If you are planning to enjoy a large Thanksgiving dinner, you’ll probably experience reflux afterward. Here, your stomach contents flow back into your esophagus when the valve between your stomach and your esophagus, the lower esophageal sphincter, relaxes. This is normal, especially after a meal, and doesn’t require medical treatment (1).

Gastroesophageal reflux disease (GERD), however, is more serious and can have long-term health effects. Among them are erosion or scarring of the esophagus, ulcers, and increased cancer risk. Approximately 20 percent of the U.S. adult population has been diagnosed with GERD, although researchers estimate it affects as much as 28 percent (2). It’s no surprise that pharmaceutical firms have lined drug store shelves with all kinds of solutions.

GERD risk factors range from lifestyle — obesity, smoking and diet — to medications, like calcium channel blockers and antihistamines. Other medical conditions, such as hiatal hernia and pregnancy, also play a role (3). Dietary triggers, such as spicy, salty, or fried foods, peppermint, and chocolate, might also contribute.

Medication options

The most common and effective medications for treating GERD are H2 receptor blockers and proton pump inhibitors (PPIs). H2 receptor blockers, such as Zantac and Tagamet, partially block acid production. PPIs, which include Nexium and Prevacid, almost completely block acid production (4). Both have two levels: over-the-counter and prescription strength. Let’s focus on PPIs, for which over 92 million prescriptions are written each year in the U.S. (5).

The most frequently prescribed PPIs include omeprazole (Prilosec) and pantoprazole (Protonix). Studies show they are effective with short-term use in treating Helicobacter pylori-induced peptic ulcers, GERD symptoms, gastric ulcer prophylaxis associated with NSAID use, and upper gastrointestinal bleeds.

Most of the package insert data is from short-term studies lasting weeks, not years. The landmark study supporting long-term use FDA approval was only one year. However, maintenance therapy is usually prescribed for many years.

Concerns about long-term use effects and overprescribing have prompted pharmacists to take an active role in educating patients about their risks and about the need to take them before eating for them to work (6).

PPI risks

PPI side effects after years of use can include increased bone fracture risk; calcium malabsorption; Clostridium difficile (C. difficile), a serious intestinal bacterial infection; potential vitamin B12 deficiencies; and weight gain (7).

The FDA has amplified its warnings about the increased risk of C. difficile, which must be treated with antibiotics. Unfortunately, it only responds to a few, and that number is dwindling. Patients must contact their physicians if they develop diarrhea when taking PPIs and it doesn’t improve (8).

Suppressing stomach acid over long periods can also result in malabsorption issues. In a study where PPIs were associated with B12 malabsorption, it took at least three years’ duration to cause this effect. While B12 was not absorbed properly from food, PPIs did not affect B12 levels from supplementation (9). If you are taking a PPI chronically, have your B12 and methylmalonic acid (a metabolite of B12) levels checked and discuss supplementation with your physician.

Before you stop taking PPIs, consult your physician. Rebound hyperacidity can result from stopping abruptly.

Lifestyle options

A number of lifestyle modifications can improve GERD, such as raising the head of the bed about six inches, not eating prior to bedtime and obesity treatment (10). 

Increase fiber and exercise. A study that quantified the increased risks of smoking and salt also found that fiber and exercise both had the opposite effect, reducing GERD risk (11). An analysis by Journal Watch suggests that the fiber effect may be due to its ability to reduce nitric oxide production, a relaxant for the lower esophageal sphincter (12).

Lose weight. In one study, researchers showed that obesity increases pressure on the lower esophageal sphincter significantly (13). Intragastric (within the stomach) pressures were higher in both overweight and obese patients on inspiration and on expiration, compared to those with lower body mass indexes.

Eat long before bedtime. A study showed a 700 percent increased risk of GERD for those who ate within three hours of bedtime, compared to those who ate four hours or more before bedtime (14).

While drugs have their place in the arsenal of options to treat GERD, lifestyle changes are the first, safest, and most effective approach in many instances. 

References:

(1) Gastroenterol Clin North Am. 1996;25(1):75. (2) Gut. 2014; 63(6):871-80. (3) niddk.nih.gov. (4) Gastroenterology. 2008;135(4):1392. (5) Kane SP. Proton Pump Inhibitor, ClinCalc DrugStats Database, Version 2024.08. Updated August 7, 2024. (6) US Pharm. 2019:44(12):25-31. (7) World J Gastroenterol. 2009;15(38):4794–4798. (8) FDA.gov. (9) Linus Pauling Institute; lpi.oregonstate.edu. (10) Arch Intern Med. 2006;166:965-971. (11) Gut 2004 Dec; 53:1730-1735. (12) JWatch Gastro. Feb. 16, 2005. (13) Gastroenterology 2006 Mar; 130:639-649. (14) Am J Gastroenterol. 2005 Dec;100(12):2633-2636.

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 or consult your personal physician.

 

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Immunosuppressives can help, but with serious side effects

By David Dunaief, M.D.

Dr. David Dunaief

Eczema is relatively common, affecting 20 percent of children and 10 percent of adults around the world (1). If you are one of the many who experiences eczema, you know the symptoms, which can include skin rashes, itching, pain and redness.

Eczema is a chronic inflammatory process, and it’s likely caused by a combination of genetics and environmental or lifestyle issues (2). Investigation into potential causes is a growing field.

The National Eczema Association details the seven different kinds of eczema on its website, nationaleczema.org. Atopic dermatitis is the most frequently occurring.

While there is no cure, some treatments can ease symptoms and reduce flare-ups. These range from over-the-counter creams and lotions, antihistamines for itchiness, prescription steroid creams, oral steroids, and injectable biologics. Some use phototherapy for severe cases, but there’s not a lot of research suggesting this is effective. Interestingly, diet may play an important role.

Two studies have shown an association between eczema and fracture risk, which we will look at more closely.

Eczema and diet

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 (3).

Elimination diets may also play a role in identifying allergic causes. One study’s results showed when eggs were removed from the diet of those who were allergic, according to IgE testing, eczema improved significantly (4).

In my practice, I have seen very good results when treating patients who have eczema with dietary changes. My practice has many patients who suffer from some level of eczema. For example, a young adult had eczema mostly on his extremities. When we first met, these were angry, excoriated, inflamed lesions. However, after several months of a vegetable-rich diet, the patient’s skin improved significantly. These results are not unique.

Do immunosuppressives provide a solution?

Injectable biologics are generally recommended for moderate to severe atopic dermatitis when other treatment options have failed (5). Three are approved by the FDA, dupilumab, tralokinumab-ldrm, and lebrikizumab-lbkz.

In trials, they showed good results when topical steroids alone were not effective. Like other monoclonal antibodies, they work by limiting your immune system response. 

Other oral immunosuppressives, such as those used to inhibit organ rejection in transplant patients, are options, as well.

Unfortunately, any suppression of the immune system’s response, whether oral or injectable, leaves the door open for side effects, including serious infections.

Can supplements help reduce symptoms?

Two well-known supplements are known to reduce inflammation, evening primrose oil and borage oil. Are they good replacements for – or additions to – medication? The research is mixed, leaning toward ineffective. There are also some important concerns about them.

In a meta-analysis of seven randomized controlled trials, evening primrose oil was no better than placebo in treating eczema (6). Researchers also looked at eight studies of borage oil and found there was no difference in symptom relief than placebo. 

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 (7). If you do try them, be sure to consult with your physician first.

What’s the relationship between eczema and bone fractures?

Several studies have examined the relationship between eczema and bone fractures. One observational study of 34,500 patients showed that those with eczema had a 44 percent increased risk of injury causing limitation and a 67 percent risk of bone fracture and bone or joint injury for those over age 29 (8).

Those with both fatigue or insomnia in combination with eczema are at higher risk for bone or joint injury. The researchers postulated that corticosteroid treatments could contribute, in addition to chronic inflammation, which may also add to bone loss risk. Steroids can weaken bone, ligaments and tendons and can cause osteoporosis by decreasing bone mineral density.

A study of over 500,000 patients found that the association between major osteoporotic fractures and atopic dermatitis remained, even after adjusting for a range of histories with oral corticosteroids (9). Also, fracture rates were higher in those with severe atopic dermatitis.

If you have eczema, talk to your physician about having a DEXA (bone) scan to monitor your bone health.

There is an array of possibilities in development, from topical to oral to injectable treatments, which might provide future relief. Until then, partner with your physician to identify solutions that will work for you, but ensure you understand the side effects of what you’re taking. Diet adjustments appear to be very effective, at least at the anecdotal level.

References:

(1) naiad.nih.gov. (2) Acta Derm Venereol (Stockh) 1985;117 (Suppl.):1-59. (3) Allergy. 2010 Jun 1;65(6):758-765. (4) J Am Acad Dermatol. 2004;50(3):391-404. (5) JAMA Dermatol. 2015;151(1):33-41. (6) Cochrane Database Syst Rev. 2013;4:CD004416. (7) mayoclinic.org (8) J Allergy Clin Immunol Pract. 2021 Sep 24;S2213-2198(21)01018-7. (9) nationaleczema.org.

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 or consult your personal physician.

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Relatively small amounts of exercise lead to big benefits

By David Dunaief, M.D.

Dr. David Dunaief

Last week, I had a conversation with a vibrant, independent 96-year-old, who was excited to share her thoughts about the current election cycle.

It’s becoming more common to live into your 90s: 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 in the U.S. (1). Researchers refer to this group as the “oldest-old,” which includes those over age 84.

What do these “oldest-old” have in common? According to one study, they tend to have fewer chronic medical conditions or diseases. As a result, they typically have greater physical functioning and mental acuity, which allows them a better quality of life (2).

A study of centenarians found that they tended to be healthy and then die rapidly, without prolonged suffering (3). In other words, they stayed mobile and mentally alert.

While genetics are a factor that can predict your ability to reach this exclusive club, lifestyle choices also play an important role. Let’s look at the research.

Does exercise really help extend our lives?

We’re repeatedly nudged to exercise. This is not vanity; it can have a direct impact on our longevity and health.

One study of over 55,000 participants from ages 18 to 100 showed that five-to-ten minutes of daily running, regardless of the pace, can significantly impact our life span by decreasing cardiovascular mortality and all-cause mortality (4).

Amazingly, even if participants ran fewer than six miles a 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. Those who ran for this very limited amount of time and modest pace potentially added three years to their life span.

An editorial that accompanied this study shared that more than 50 percent of people in the U.S. do not achieve the current recommendation of at least 30 minutes of moderate exercise a day (5).

One study of over a quarter-million people found that walking just 3867 steps a day started to reduce the risk of dying from any cause, and every additional 1000 steps reduced risk of death from all causes another 15 percent (6). The researchers could not find an upper limit to the benefits.

For those 85 and older, all-cause mortality risk was reduced 40 percent by walking just 60 minutes a week at a pace that qualified as physical activity, not even exercise.

What is the best protein source?

Many are questioning the value of a long-standing dietary paradigm that suggests we need to eat sufficient animal protein to support us as we age.

In an observational study of 7,000 participants from ages 50 to 65, researchers found that those who ate a high-protein diet with greater than 20 percent of their calories from protein had a had a 75 percent increase in overall mortality, a four-times increased risk of cancer mortality, and a four-times increased risk of dying from diabetes during the following 18 years (7). 

However, this did not hold true if plants were the protein source. Interestingly, they found a high-protein plant diet may actually reduce the risks, not increase them. The reason, according to the authors, is that animal protein may increase insulin growth factor-1 and growth hormones that have detrimental effects on the body.

The Adventists Health Study 2 of over 73,000 participants with a median age of 57 years reinforced these findings (8). It looked at Seventh-day Adventists, a group that emphasizes a plant-based diet, and found that those who ate animal protein once a week or less experienced a significantly reduced risk of dying over the next six years compared to those who were more frequent meat eaters. 

What does systemic inflammation tell us about longevity?

The Whitehall II study included 3,044 participants over the age of 35 who did not have a stroke, heart attack or cancer at the beginning of the study (9). Researchers measured a specific marker for inflammation, interleukin-6 (IL-6). They found that higher levels had negative impacts on participants’ healthy longevity. 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 good news is that inflammation can be improved significantly with lifestyle changes.

The bottom line is that lifestyle choices are important to healthy longevity. A small amount of exercise and consuming more plant protein than animal protein can contribute to a substantial increase in healthy life span. IL-6 may be a useful marker for inflammation, which could help predict healthy or unhealthy outcomes. Your doctor can test to see if you have an elevated IL-6. If you do, 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) J Am Coll Cardiol. 2014;64:472-481. (5) J Am Coll Cardiol. 2014;64:482-484. (6) Eur J Prev Cardiol. 2023 Dec 21;30(18):2045. (7) Cell Metab. 2014;19:407-417. (8) JAMA Intern Med. 2013;173:1230-1238. (9) CMAJ. 2013;185:E763-E770.

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 or consult your personal physician.

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The DASH diet is a flexible eating plan that helps create a heart-healthy eating style for life. Stock photo

By David Dunaief, M.D.

Dr. David Dunaief

Heart failure (HF) occurs when the heart’s pumping is not able to keep up with the body’s demands for blood and oxygen and may decompensate. Unlike a heart attack, it develops slowly over years and may take a long time to become symptomatic. According to the latest statistics, 6.7 million Americans over the age of 19 are affected (1).  These numbers are projected to increase to 8.7 million by 2030, with the greatest growth among those aged 35 to 64 (2).

There are two types of heart failure, systolic and diastolic. Put simply, the difference is that the output of blood with each contraction of the heart’s left ventricle is generally preserved in diastolic HF, while it can be significantly reduced in systolic HF.

Fortunately, both types can be diagnosed with an echocardiogram, an ultrasound of the heart. The signs and symptoms of both include shortness of breath during daily activities or when lying down; edema or swelling in the feet, legs, ankles or stomach, reduced exercise tolerance; and feeling tired or weak. These can have a significant impact on your quality of life.

Major lifestyle risk factors for heart failure include obesity, smoking, poor diet, being sedentary, excessive alcohol intake (3). Medical conditions that increase your risk include diabetes, coronary artery disease, high blood pressure, and valvular heart disease.

Heart failure can be treated with medication, including blood pressure medications, such as beta blockers, ACE inhibitors and angiotensin receptor blockers. All of these have side effects. We are going to look at recent studies that examine the role of diet in reducing your risk. 

The role of antioxidants in your diet

If we look beyond the risk factors mentioned above, some studies have explored the role oxidative stress may play an important role in contributing to HF.

In an analysis of the Swedish Mammography Cohort, researchers showed that a diet rich in antioxidants reduces the risk of developing HF (4). 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. The antioxidants were mainly from fruits, vegetables, whole grains, coffee and chocolate. Fruits and vegetables were responsible for most of the effect.

This study was the first to investigate the impact of dietary antioxidants on heart failure prevention.

This was a large study: it involved 33,713 women with 11.3 years of follow-up. Still, there are limitations, because it was an observational study, and the population involved only women. However, the results are very exciting, and there is little downside to applying this approach.

Applying the DASH diet

A 2022 study examined the effects of the Dietary Approaches to Stop Hypertension (DASH) diet on the risk of developing HF (5). This study included over 76,000 men and women, ages 45-83 and without previous HF, ischemic heart disease or cancer from the Cohort of Swedish Men and the Swedish Mammography Cohort.

The DASH diet emphasizes consuming fruit, vegetables, whole grains, nuts and legumes, and low-fat dairy and de-emphasizes red and processed meat, sugar-sweetened beverages, and sodium.

The researchers found that long-term adherence to the DASH diet was associated with a lower risk of HF. The greater the participants’ adherence, the greater the positive effect.

Interestingly, even replacing one serving per day of red and processed meat with one serving per day of other DASH diet foods was associated with an approximate 10 percent lower risk of HF.

Comparing a variety of diets

The REGARDS (REasons for Geographic and Racial Differences in Stroke) Trial examined the impact of five dietary patterns on later development of HF in over 16,000 patients followed for a median of 8.7 years. The dietary patterns included convenience, plant-based, sweets, Southern, and alcohol/salads (6). 

Researchers found that a plant-based dietary pattern was associated with a significantly lower risk of HF. Compared with the lowest quartile, the highest quartile of adherence to the plant-based dietary pattern was associated with a 41 percent lower risk of HF. 

The highest adherence to the Southern dietary pattern was associated with a 72 percent higher risk of HF after adjusting for age, sex, and race and for other potential confounding factors. Researchers found less effect after further adjusting for body mass index, waist circumference, hypertension, dyslipidemia, diabetes mellitus, atrial fibrillation, and chronic kidney disease.

They did not observe any associations with the other 3 dietary patterns.

These studies suggest that we should seek to prevent heart failure with dietary changes, including consuming higher amounts of antioxidant-rich foods, such as fruits and vegetables, and lower amounts of red and processed meats.

References:

(1) Circulation. 2024;149:e347–913. (2) hfsa.org. (3) cdc.gov. (4) Am J Med. 2013 Jun:126(6):494-500. (5) Eur J of Prev Cardiology 2022 May: 29(7): 1114–1123. (6) J Am Coll Cardiol. 2019 Apr 30; 73(16): 2036–2045.

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 or consult your personal physician.

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Lowering inflammation and expanding lung capacity are keys

By David Dunaief, M.D.

Welcome to autumn! It’s the time of year when we revel in the beauty of changing foliage, the joy of Halloween decorations and costumes, and the prevalence “pumpkin spice” everything.

Unfortunately, it’s also the time of year when we are most alert to influenza (the flu), respiratory syncytial virus (RSV), and COVID-19 variants circulating in our communities.

If you have a lung disease, such as chronic obstructive pulmonary disease (COPD) or asthma, or if you smoke or vape, the consequences of these viruses are especially concerning.

The good news is that you can do a lot to improve your lung function by exercising, eating a plant-based diet with a focus on fruits and vegetables, expanding your lung capacity with an incentive spirometer, and quitting smoking or vaping (1). 

Does diet improve lung function?

It’s no surprise that your dietary choices can help or hinder your health. What is surprising is diet’s impact on your lung health. Let’s review some of the studies.

In a randomized controlled trial (RCT), results show that asthma patients who ate a high-antioxidant diet had greater lung function after 14 days than those who ate a low-antioxidant diet (2). They also had lower inflammation at 14 weeks, which was measured using a c-reactive protein (CRP) biomarker. Participants in the low-antioxidant group were over two times more likely to have an asthma exacerbation.

The high-antioxidant group had a modest five servings of vegetables and two servings of fruit daily, while the low-antioxidant group ate no more than two servings of vegetables and one serving of fruit daily. Using carotenoid supplementation in place of antioxidant foods did not affect inflammation. The authors concluded that an increase in carotenoids from diet has a clinically significant impact on asthma in a very short period.

In a longer-term analysis of the Coronary Artery Risk Development in Young Adults (CARDIA) Study, researchers assessed and stratified diets into three tiers to identify the impacts of diet quality on long-term lung health (3). Researchers found that a nutritionally-rich plant-centered diet was associated with significantly less decline in lung function over 20 years, even after adjusting for demographic and lifestyle factors influencing lung health.

What is the impact of fiber on COPD risk?

Several studies demonstrate that higher consumption of fiber from plants decreases the risk of COPD in smokers and ex-smokers.

In one study of men, results showed that higher fiber intake was associated with significant 48 percent reductions in COPD incidence in smokers and 38 percent incidence reductions in ex-smokers (4). The high-fiber group ate at least 36.8 grams per day, compared to the low-fiber group, which ate less than 23.7 grams per day. Fiber sources were fruits, vegetables and whole grain. The “high-fiber” group was still below the American Dietetic Association’s recommended intake of 14 grams per 1,000 calories each day.

In another study, this time with women, participants who consumed at least 2.5 serving of fruit per day, compared to those who consumed less than 0.8 servings per day, experienced a highly significant 37 percent decreased risk of COPD (5).

Both studies used apples, bananas, and pears to reduce COPD risk.

What exercise helps improve lung function?

In a study involving healthy women aged 65 years and older, results showed that 20 minutes of high-intensity exercise three times a day improved FEV1 and FVC, both indicators of lung function, in just 12 weeks (7). Participants began with a 15-minute warm-up, then 20 minutes of high-intensity exercise on a treadmill, followed by 15 minutes of stretching.

You do not need special equipment. You can walk up steps or hills in your neighborhood, do jumping jacks, or even dance around your home. It’s most important to increase your heart rate and expand your lungs. If this is new for you, consult a physician and start slowly. Your stamina will improve quickly when you do it consistently.

What is incentive spirometry?

An incentive spirometer (IS) is a device that helps expand the lungs when you inhale through a tube and cause one or more balls to rise. This inhalation expands the lung’s alveoli.

Incentive spirometry has been used for patients with pneumonia, those who have had chest or abdominal surgery and those with asthma or COPD, but it has also been useful for healthy participants (8). A small study showed that those who trained with an incentive spirometer for two weeks increased their lung function and respiratory motion. Participants were 10 non-smoking healthy adults who took five sets of five deep breaths twice a day, totaling 50 deep breaths per day. 

In recent years, some small studies examined the impact of IS on patient COVID-19 outcomes. One study of 48 patients in an outpatient setting found that study participants using an IS three times a day experienced a 16 percent increase in maximal inspiratory volume over a span of 30 days (9).

Another pilot study followed 10 patients diagnosed with moderate COVID-19 to determine whether IS use prevented development of Acute Respiratory Distress Syndrome (ARDS) (10). IS users had improved PaO2/FiO2 ratio, improved chest X-ray findings, shorter hospital stays, and sooner improvement of symptoms than non-users.

We all should be working to strengthen our lungs. Using a three-pronged approach including diet, aerobic exercise, and incentive spirometer can make a tremendous difference.

References:

(1) Public Health Rep. 2011 Mar-Apr; 126(2): 158-159. (2) Am J Clin Nutr. 2012 Sep;96(3):534-43. (3) Res Sq  [Preprint]. 2023 Apr 26:rs.3.rs-2845326. [Version 1] (4) Epidemiology Mar 2018;29(2):254-260. (5) Int J Epidemiol Dec 1 2018;47(6);1897-1909. (6) J Phys Ther Sci. Aug 2017;29(8):1454-1457. (8) Ann Rehabil Med. Jun 2015;39(3):360-365. (9) Cureus. 2021 Oct 4;13(10):e18483. (10) Eur Resp J 2022 60: 268.

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 or consult your personal physician.

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Addressing sleep apnea can avert serious health consequences

By David Dunaief, M.D.

Dr. David Dunaief

Quality sleep feels like it can be elusive these days. Yet, our physical and mental wellbeing depends on getting restful sleep. For those with obstructive sleep apnea (OSA), it can be particularly challenging.

Sleep apnea is defined as an abnormal breathing pause that occurs at least five times an hour while sleeping. While there are many potential causes, the most common is airway obstruction. Some estimates suggest that about 39 million people suffer from sleep apnea in the United States (1).

OSA diagnoses are classified in tiers from mild to severe. The American Academy of Sleep Medicine (AASM) estimates that roughly 80 percent of moderate and severe OSA sufferers are undiagnosed.

Most risk factors for OSA are modifiable. They include excess weight or obesity, alcohol use, smoking, hypertension, type 2 diabetes, and hyperlipidemia (high cholesterol) (2). 

How do you know what to look for?

OSA symptoms include daytime fatigue, loud snoring, breathing cessation observed by another, impaired concentration, and morning headaches. While these are significant quality of life issues, OSA is also associated with an array of more serious health consequences, such as cardiovascular disease, high blood pressure and depression.

Fortunately, there is an array of treatment options, including continuous positive airway pressure (CPAP) devices, oral appliances, positional sleep therapy, and lifestyle modifications.

Sleep apnea and cardiovascular disease risk

In a study of 1,116 women over a six-year duration, cardiovascular mortality risk increased in a linear fashion with the severity of OSA (3). For those with mild-to-moderate untreated sleep apnea, there was a 60 percent increased risk of death; for those in the severe group, this risk jumped to 250 percent. However, the good news is that treating patients with CPAP decreased their risk by 81 percent for mild-to-moderate patients and 45 percent for severe OSA patients.

Another study of 1,500 men with a 10-year follow-up showed similar risks of cardiovascular disease with sleep apnea and benefits from CPAP treatment (4). The authors concluded that severe sleep apnea increases the risk of nonfatal and fatal cardiovascular events, and CPAP was effective in curbing these occurrences.

In a third study, this time involving the elderly, OSA increased the risk of cardiovascular death in mild-to-moderate patients and in those with severe OSA by 38 and 125 percent, respectively (5). But, as in the previous studies, CPAP decreased the risk in both groups significantly. In the elderly, an increased risk of falls, cognitive decline and difficult-to-control high blood pressure may be signs of OSA.

OSA and cancer risk

There have been conflicting study results about the associations between OSA and cancer risk. To reconcile these, a 2023 study of over 62,000 patients in Sweden were followed. Researchers found that OSA was associated with cancer prevalence, independent of other confounding factors (6). 

In a previous study of sleep apnea patients under age 65, researchers also showed an increased risk of cancer (7). The greater the percentage of time patients spend in hypoxia (low oxygen) at night, the greater the risk. The authors believe that intermittent low levels of oxygen, caused by the many frequent short bouts of breathing cessation, may be responsible for the development of tumors and their subsequent growth.

OSA and male sexual function

Erectile dysfunction (ED) may also be associated with OSA and, like other outcomes, CPAP may decrease this incidence. This was demonstrated in a small study involving 92 men with ED (8). The surprising aspects of this study were that, at baseline, the participants were overweight, not obese, on average and were only 45 years old. In those with mild OSA, CPAP had a beneficial effect in more than 50 percent of the men. For those with moderate and severe OSA, the effect was still significant, though not as robust, at 29 and 27 percent, respectively.

Other studies have varying results, depending on the age and existing health challenges of study participants. Researchers have suggested that other underlying health problems may be the cause in some patient populations.

Can diet help with OSA?

For some of my patients, their goal is to discontinue their CPAP. Diet may be an alternative to CPAP, or it may be used in combination with CPAP to improve results.

In a small study of those with moderate-to-severe OSA, a low-energy diet showed positive results. A low-energy diet implies a low-calorie approach, such as a diet that is plant-based and nutrient-rich. In the study, almost 50 percent of those who followed this type of diet were able to discontinue CPAP (9). The results endured for at least one year.

If you think you are suffering from sleep apnea, you should be evaluated at a sleep lab and follow up with your physician.

References:

(1) ncoa.org. (2) Diseases. 2021 Dec; 9(4): 88. (3) Ann Intern Med. 2012 Jan 17;156(2):115-122. (4) Lancet. 2005 Mar 19-25;365(9464):1046-1053. (5) Am J Respir Crit Care Med. 2012;186(9):909-916. (6) BMJ Open. 2023; 13(3): e064501. (7) Am J Respir Crit Care Med. 2012 Nov. 15. (8) Sleep. 2012;35:A0574. (9) BMJ. 2011;342:d3017.

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 or consult your personal physician.

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METRO photo
Emphasis put on screening, diet and exercise

By David Dunaief, M.D.

Dr. David Dunaief

Currently, approximately 30 percent of new cancer diagnoses in women are breast cancer (1). While age is a risk factor for breast cancer, 16 percent of 2024 diagnoses will be in women under age 50.

This October, for Breast Cancer Awareness month, let’s review the latest research on screening, treatments, and prevention strategies.

What are current screening recommendations?

In April 2024, the U.S. Preventive Services Task Force expanded their screening recommendations for women of average breast cancer risk. They lowered the recommended start point for mammograms to age 40, continuing every other year through age 74 (2).

The American College of Obstetricians and Gynecologists is reviewing their recommendations in light of this USPSTF shift. They currently encourage a process of shared decision-making between patient and physician to determine age and frequency of exams, including whether to begin exams before age 50 or to continue after age 75 (3). Generally, it recommends beginning annual or biennial mammograms starting no later than 50 and continuing until age 75. 

The American Cancer Society’s physician guidelines are to offer a mammogram beginning at age 40 and recommend annual exams from 45 to 54. At age 55 until life expectancy is less than 10 years, they recommend biennial exams (4).

You should consult with your physician to identify your risk profile and plan your regular screening schedule.

Does diet matter?

A small, eight-week randomized control trial of 32 women who had metastatic breast cancer and who were on stable treatment found that the 21 study subjects who ate a whole food, plant-based diet free from added oils and fats lost more weight and reported feeling healthier than the 11 who maintained their current, traditional American diet as part of the control group (5). In addition to losing weight and reporting better emotional well-being and quality of life, they reported less diarrhea and fatigue and experiencing less shortness of breath during activities.

Medical measures of improved health, in addition to weight loss, included reduced insulin resistance and better cholesterol measures. While cancer progression markers did not move significantly in eight weeks, they did show improvement.

The study authors recommend larger and longer follow-up studies to assess the longer-term impact of diet.

What’s the role of exercise?

We know exercise is important in diseases and breast cancer is no exception. An observational trial found that exercise reduced breast cancer risk in postmenopausal women significantly (6). These women exercised moderately; they walked four hours a week over a four-year period. If they exercised previously, five to nine years ago, but not recently, no benefit was seen. The researchers stressed that it is never too late to begin exercise.

Only about one-third of women get the recommended level of exercise every week: 30 minutes for five days a week. Once diagnosed with breast cancer, women tend to exercise less, not more. 

A recently published French study assessed cancer recurrence of over 10,000 women with an average age of 56 who were diagnosed with early-stage breast cancer between 2012 and 2018 (7). The researchers found that pre-menopausal women who completed 90 minutes to five hours of moderate exercise per week before starting treatment for hormone receptor-negative breast cancer had a lower risk of metastatic recurrence than women who didn’t exercise.

We need to expend as much energy and resources emphasizing exercise for prevention as we do screenings.

What about soy?

Soy may actually be beneficial in reducing breast cancer risk. In a meta-analysis, those who consumed more soy saw a significant reduction in breast cancer compared to those who consumed less (8). There was a dose-response curve among three groups: high intake of >20 mg per day, moderate intake of 10 mg and low intake of <5 mg.

Those in the highest group had a 29 percent reduced risk, and those in the moderate group had a 12 percent reduced risk when compared to those who consumed the least. In addition, higher soy intake has been associated with reduced recurrence and increased survival for those previously diagnosed with breast cancer (9). The benefit from soy is thought to come from isoflavones, plant-rich nutrients.

A more recent meta-analysis of six observational studies expanded on these outcomes (10). It concluded that post-menopausal women and women diagnosed with estrogen receptor-positive breast cancer lowered their breast cancer recurrence risk the most by eating 60 mg of soy isoflavones per day, or two-to-three servings. A serving consists of either one cup of soy milk, three ounces of tofu, or one-half cup of cooked soybeans.

Breast Cancer Awareness Month is a good time to reflect on the importance of mammography and breast self-exams. However, we need to give significantly more attention to prevention of breast cancer and its recurrence. Through potentially more soy intake, as well as a plant-based diet and modest exercise, we may be able to accelerate the trend toward a lower breast cancer incidence or recurrence.

References:

(1)breastcancer.org (2) uspreventiveservicestaskforce.org. (3) acog.org. (4) cancer.org. (5) Breast Cancer Res Treat. 2024 Jun;205(2):257-266. (6) Cancer Epidemiol Biomarkers Prev. 2014 Sep;23(9):1893-902. (7) J Clinical Oncology. 2024;42(25). (8) Br J Cancer. 2008; 98:9-14. (9) JAMA. 2009 Dec 9; 302(22): 2437–2443. (10) JNCI Cancer Spectrum, Volume 8, Issue 1, February 2024, pkad104.

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 or consult your personal physician.

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Pixabay photo
Dietary changes can reduce inflammatory factors

By David Dunaief, M.D.

Dr. David Dunaief

The common thread for more than 80 different autoimmune diseases is that the body’s immune system is attacking organs, tissues and cells and causing chronic inflammation (1). Type 1 diabetes, lupus, rheumatoid arthritis (RA), psoriasis, psoriatic arthritis, multiple sclerosis, Crohn’s disease, and inflammatory bowel disease are among the list of frequently occurring ones. Unfortunately, autoimmune diseases tend to cluster (2). This means that once you have one, you are at high risk for developing others.

Immunosuppressive therapies

Immunosuppressive therapies are the most prevalent treatment for autoimmune issues. As the name suggests, these reduce underlying inflammation by suppressing the immune system and interfering with inflammatory factors.

There are several concerning factors with these treatments.

First, they have substantial side effect profiles. They increase the risks for cancers, opportunistic infections and even death (3). Opportunistic infections can include diseases like tuberculosis and invasive fungal infections.

It makes sense that suppressing the immune system would increase the likelihood of infections. It’s also not surprising that cancer rates would increase, since the immune system helps fend off malignancies. One study showed that after 10 years of therapy, the risk of cancer increased by approximately fourfold with the use of immunosuppressives (4).

Second, these drugs were tested and approved using short-term clinical trials; however, many patients are prescribed these therapies for 20 or more years.

What other possibilities are there to treat autoimmune diseases? Studies are underway that test the efficacy of medical nutrition therapy using bioactive compounds and supplementation. Medical nutrition therapy may have immunomodulatory (immune system regulation) effects on inflammatory factors and on gene expression.

Medical nutrition 

Raising the level of beta-cryptoxanthin, a carotenoid bioactive food component, by a modest amount has a substantial impact in preventing RA. Several studies have also tested dietary interventions in RA treatment (5). Included were fasting followed by a vegetarian diet; a vegan diet; and a Mediterranean diet, among others. All mentioned here showed decreases in inflammatory markers, including c-reactive protein (CRP), and improvements in joint pain and other quality of life issues.

What are the effects of fish oil?

Fish oil may help your immune system by reducing inflammation and improving your blood chemistry, affecting as many as 1,040 genes (6). In a randomized clinical study, 1.8 grams of eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA) supplementation had anti-inflammatory effects, suppressing cell signals and transcription factors (proteins involved with gene expression) that are pro-inflammatory.

In RA patients, fish oil helps suppress cartilage degradative enzymes, while also having an anti-inflammatory effect (7). A typical recommendation is to consume about 2 grams of EPA plus DHA to help regulate the immune system. Don’t take these high doses of fish oil without consulting your doctor, because fish oil can have blood-thinning effects.

Do probiotics help?

Approximately 70 percent of your immune system lives in your gut. Probiotics have immune-modulating effects that decrease inflammation by populating the gut with live beneficial microorganisms. Lactobacillus salvirus and Bifidobacterium longum infantis are two strains that have been shown to have positive effects (8, 9).

In a study with Crohn’s disease patients, L. casei and L. bulgaricus reduced the inflammatory factor TNF-alpha (10). To provide balance, I recommend probiotics with Lactobacillus to my patients, especially with autoimmune diseases that affect the intestines, like Crohn’s and ulcerative colitis.

Does increasing fiber help?

Fiber has been shown to modulate inflammation by reducing biomarkers, such as CRP. In two separate clinical trials, fiber either reduced or prevented high CRP in patients. In one randomized controlled trial, 30 grams, or about one ounce, of fiber daily from either dietary sources or supplements reduced CRP significantly compared to placebo (11).

In the second trial, which was observational, participants who consumed the highest amount of dietary fiber (greater than 19.5 grams) had reductions in a vast number of inflammatory factors, including CRP, interleukin-1 (IL-1), interleukin-6 (IL-6) and TNF-alpha (12).

Can diet reduce medication needs?

Immune system regulation is complex and involves over 1,000 genes, as well as many biomarkers. Bioactive compounds found in high-nutrient foods and supplements can have a profound impact on your immune system’s regulation and may help reset the immune system. Even in severe cases, bioactive compounds in foods may work in tandem with medications to treat autoimmune diseases more effectively and help reduce dosing of some immunosuppressives, minimizing potential side-effects.

This is not hypothetical. I have seen these effects in my practice, where patients have been able to reduce – or even eliminate – immunosuppressives by altering their diets.

References:

(1) niaid.nih.gov. (2) J Autoimmun. 2007;29(1):1. (3) epocrates.com. (4) J Rheumatol 1999;26(8):1705-1714. (5) Front Nutr. 2017; 4: 52. (6) Am J Clin Nutr. 2009 Aug;90(2):415-424. (7) Drugs. 2003;63(9):845-853. (8) Gut. 2003 Jul;52(7):975-980. (9) Antonie Van Leeuwenhoek 1999 Jul-Nov;76(1-4):279-292. (10) Gut. 2002;51(5):659. (11) Arch Intern Med. 2007;167(5):502-506. (12) Nutr Metab (Lond). 2010 May 13;7:42.

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 or consult your personal physician.

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Irritable bowel syndrome (IBS) is a common disorder that affects the large intestine. Stock photo
Other disorders may contribute to the condition

By David Dunaief, M.D.

Dr. David Dunaief

If you are among the estimated 10 to 15 percent of the population that suffer from irritable bowel syndrome (IBS) symptoms, managing them can be all-consuming (1). IBS symptoms, which can include abdominal pain, cramping, bloating, constipation and/or diarrhea, have a direct effect on your quality of life.

While there is no single test that provides an IBS diagnosis, physicians eliminate other possibilities and use specific criteria to provide a diagnosis.

The Rome IV criteria are an international effort to help diagnose and treat disorders of gut-brain interaction (2). Using these criteria, which include questions about the frequency of pain over the past three months alongside a physical exam, helps provide a diagnosis.

Once diagnosed, first-line treatment typically involves lifestyle modifications, including dietary changes. Let’s look at what the research tells us.

Is IBS affected by mental state?

The “brain-gut” connection refers to the direct connection between mental state, such as nervousness or anxiety, to gastrointestinal issues, and vice versa.

Mindfulness-based stress reduction was used in a small, but randomized, eight-week clinical trial with IBS (3). Those in the mindfulness group (treatment group) showed statistically significant results in decreased severity of symptoms compared to the control group, both immediately after training and three months post-therapy.

Those in the treatment group were instructed to do meditation, gentle yoga and “body scanning” — focusing on one area of the body for muscle tension detection. The control group attended an IBS support group once a week.

A subsequent meta-analysis of six randomized controlled trials (RCTs) that studied the effects of mindfulness on IBS found that the combined study group achieved improved quality of life and lower pain scores, perceived stress anxiety, and visceral sensitivity than the control group (4).

Interestingly, a 2021 international study of more than 50,000 participants found that there were some genetic similarities among those who suffer from IBS and those who suffer from common mood and anxiety disorders such as anxiety, depression, and neuroticism, as well as insomnia. As the authors wrote, “Although IBS occurs more frequently in those who are prone to anxiety, we don’t believe that one causes the other – our study shows these conditions have shared genetic origins, with the affected genes possibly leading to physical changes in brain or nerve cells that in turn cause symptoms in the brain and symptoms in the gut” (5). In other words, they may have a common cause.

Is gluten a factor?

Gluten sensitivity may be an important factor for some IBS patients (6).

In a small randomized clinical trial, patients who were given gluten were more likely to complain of uncontrolled symptoms than those who were given a placebo, 68 percent vs. 40 percent, respectively (7). These results were highly statistically significant, and the authors concluded that nonceliac gluten intolerance may exist. 

What role does fructose play?

Some IBS patients may suffer from fructose intolerance. In a study, IBS researchers used a breath test to explore this possibility (8). The results were dose-dependent, meaning the higher the dose of fructose, the greater the effect researchers saw. When patients were given a 10 percent fructose solution, only 39 percent tested positive for fructose intolerance, but when they were given a 33 percent solution, 88 percent of patients did.

The symptoms of fructose intolerance included gas, abdominal pain, bloating, belching and alternating bowel habits. The authors concluded that fructose avoidance may reduce symptoms in some IBS sufferers.

According to another study, about one-third of IBS patients are fructose intolerant. When on a fructose-restricted diet, symptoms appeared to improve (9). Foods with high levels of fructose include certain fruits, like apples and pears.

Is lactose intolerance a contributor?

According to another small study, about one-quarter of patients with IBS also have lactose intolerance (10). 

Of the IBS patients who were also lactose intolerant, there was a marked improvement in symptoms at both six weeks and five years when placed on a lactose-restricted diet.

Though the trial was small, the results were statistically significant. Both the patient compliance and long-term effects were excellent, and outpatient clinic visits were reduced by 75 percent.

Will probiotics help?

A study that analyzed 42 trials focused on treatment with probiotics shows there may be a benefit to probiotics, although each trial’s objectives, or endpoints, were different (11).

Probiotics do show promise, including the two most common strains, Lactobacilli and Bifidobacteri, which were covered in the review.

All of these studies provide hope for IBS patients — and the research is continuing with assessments of peppermint oil consumption and gut-directed hypnotherapy, among others. Since the causes can vary, a strong patient-doctor relationship can assist in selecting an approach that provides the greatest relief for each patient’s symptoms.

References:

(1) American College of Gastroenterology [GI.org]. (2) J Neurogastroenterol Motil. 2017 Apr; 23(2): 151–163. (3) Am J Gastroenterol. 2011 Sep;106(9):1678-1688. (4) J Clin Med. 2022 Nov; 11(21): 6516. (5) Nat Genet 53, 1543–1552 (2021). (6) Am J Gastroenterol. 2011 Mar;106(3):516-518. (7) Am J Gastroenterol. 2011 Mar;106(3):508-514. (8) Am J Gastroenterol. 2003 June; 98(6):1348-1353. (9) J Clin Gastroenterol. 2008 Mar;42(3):233-238. (10) Eur J Gastroenterol Hepatol. 2001 Aug;13(8):941-944. (11) Aliment Pharmacol Ther. 2012 Feb;35(4):403-413.

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 or consult your personal physician.

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