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Our genes are not destiny. METRO photo

By David Dunaief, M.D.

Heart disease risk is influenced by family history and by lifestyle, including diet. But what if we could tackle genetic issues with diet?

A study involving the Paleo-type diet and other ancient diets suggests that there is a significant genetic component to cardiovascular disease, while another study looking at the Mediterranean-type diet implies that we may be able to reduce our risk factors with lifestyle adjustments. Most of the risk factors for heart disease, such as high blood pressure, high cholesterol, sedentary lifestyle, diabetes, smoking and obesity are modifiable (1). Let’s look at the evidence.

The role of genes in heart disease

Researchers used computed tomography scans to look at 137 mummies from ancient times across the world, including Egypt, Peru, the Aleutian Islands and Southwestern America (2). The cultures were diverse, including hunter-gatherers (consumers of a Paleo-type diet), farmer-gatherers and solely farmers. Their diets were not vegetarian; they involved significant amounts of animal protein, such as fish and cattle.

Researchers found that one-third of these mummies had atherosclerosis (plaques in the arteries), which is a precursor to heart disease. The ratio should sound familiar. It aligns with what we see in modern times.

The authors concluded that atherosclerosis could be part of the aging process in humans. In other words, it may be a result of our genes. Being human, we all have a genetic propensity toward atherosclerosis and heart disease, some more than others, but many of us can reduce our risk factors significantly.

However, other studies demonstrate that we can reduce our chances of getting heart disease with lifestyle changes, such as with a plant-rich diet, such as a Mediterranean-type diet.

Does diet affect our genetic response?

A New England Journal of Medicine study explores the Mediterranean-type diet and its potential impact on cardiovascular disease risk (3). Here, two variations on the Mediterranean-type diet were compared to a low-fat diet, with participants randomly assigned to three different groups. The two Mediterranean-type diet groups both showed about a 30 percent reduction in the risk of cardiovascular disease, compared to the low-fat diet. Study end points included heart attacks, strokes and mortality. Interestingly, risk improvement in the Mediterranean-type diet arms occurred even though there was no significant weight loss.

The study included three groups: a Mediterranean diet supplemented with mixed nuts (almonds, hazelnuts or walnuts), a Mediterranean diet supplemented with extra virgin olive oil (at least four tablespoons a day), and a low-fat control diet. The patient population included over 7,000 participants in Spain at high risk for cardiovascular disease.

The Mediterranean-type diet arms both included significant amounts of fruits, vegetables, nuts, beans, fish, olive oil and wine. I call them “Mediterranean diets with opulence,” because both groups consuming this diet had either significant amounts of nuts or olive oil and/or wine. If the participants in the Mediterranean diet groups drank wine, they were encouraged to drink at least one glass a day.

The strength of this study, beyond its high-risk population and its large size, was that it was a randomized clinical trial, the gold standard of trials. However, there was a significant flaw, and the results need to be tempered. The group assigned to the low-fat diet was not, in fact, able to maintain this diet throughout the study. Therefore, it really became a comparison between variations on the Mediterranean diet and a standard diet.

What do the leaders in the field of cardiovascular disease and integrative medicine think of the Mediterranean diet study? Interestingly there are two opposing opinions, split by field. You may be surprised by which group liked it and which did not.

Cardiologists, including well-known physicians Henry Black, M.D., who specializes in high blood pressure, and Eric Topol, M.D., former chairman of cardiovascular medicine at Cleveland Clinic, hailed the study as a great achievement. This group of physicians emphasized that now there is a large, randomized trial measuring meaningful clinical outcomes, such as heart attacks, stroke and death. 

On the other hand, the integrative medicine physicians, Caldwell Esselstyn, M.D., and Dean Ornish, M.D., both of whom stress a plant-rich diet that may be significantly more nutrient dense than the Mediterranean diet in the study, expressed disappointment with the results. They feel that heart disease and its risk factors can be reversed, not just reduced. Both clinicians have published small, well-designed studies showing significant benefits from plant-based diets (4, 5). Ornish showed a reversal of atherosclerosis in one of his studies (6).

So, who is correct about the Mediterranean diet? Each opinion has its merits. The cardiologists’ enthusiasm is warranted, because a Mediterranean diet, even one of “opulence,” will appeal to more people, who will then realize the benefits. However, those who follow a more focused diet, with greater amounts of nutrient-dense foods, will potentially see a reversal in heart disease, minimizing risk — and not just reducing it.

So, what have we learned? Even with a genetic propensity for cardiovascular disease, we can alter our cardiovascular destinies with diet.

References:

(1)www.uptodate.com (2) BMJ 2013;346:f1591. (3) N Engl J Med 2018; 378:e34. (4) J Fam Pract. 1995;41(6):560-568. (5) Am J Cardiol. 2011;108:498-507. (6) JAMA. 1998 Dec 16;280(23):2001-2007.

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.

METRO photo

By David Dunaief

Dr. David Dunaief

Happy 2024! If you’ve watched any media in the past week, you’ve probably been inundated by ads for weight loss plans, apps and other tools intended to help us achieve our New Year’s resolutions. Many of these are oriented around helping us increase the “stickiness factor” of our new habits.

Setting a goal that is simple and singular helps. We often overdo it by focusing on an array of resolutions, like eating better, exercising, developing better sleep habits, and managing stress better. While these are all admirable, their complexity diminishes your chances of success. Instead, pick one to focus on, and make the desired impact part of your goal, for example: improve health by losing weight and reversing disease. 

Changing habits is always hard. There are some things that you can do to make it easier, though. 

Your environment is very important. According to David Katz, M.D., Director, Yale-Griffin Prevention Research Center, it is not as much about willpower as it is about your environment. Willpower, Dr. Katz notes, is analogous to holding your breath underwater; it is only effective for a short time. Instead, he suggests laying the groundwork by altering your environment to make it conducive to attaining your goals. Recognizing your obstacles and making plans to avoid or overcome them reduces stress and strain on your willpower. 

According to a study, people with the most self-control utilize the least amount of willpower, because they take a proactive role in minimizing temptation (1). If your intention is to eat better, start by changing the environment in your kitchen to one that prompts healthy food choices.

Support is another critical element. It can come from within, but it is best when reinforced by family members, friends and coworkers. In my practice, I find that patients who are most successful with lifestyle changes are those whose household members are encouraging or, even better, when they participate in at least some portion of the intervention, such as eating the same meals.

How long does it take to form a new habit?

When does a change become a new habit, or automaticity? The rule of thumb used to be it takes approximately three weeks of daily practice. However, the results of a study at the University of London showed that the time to form a habit, such as exercising, ranged from 18 days to 254 days (2). The good news is that, though there was a wide variance, the average time to reach this automaticity was 66 days, or about two months.

How do you choose a diet that will help you achieve your goals?

US News and World Report ranks diets annually and sorts them by objective, such as weight loss, healthy eating, diabetes diets, heart-healthy diets, etc. (3). Three of the diets highlighted include the Mediterranean diet, the DASH (Dietary Approach to Stop Hypertension) diet, and the Flexitarian diet, ranked one through three, respectively. These were also the top three for healthy eating, for diabetes, and for heart health, although their rankings among the top three shift in some cases.

What do all the top diets have in common? They focus on nutrient-dense foods. In fact, the lifestyle modifications I recommend are based on a combination of the top diets and the evidence-based medicine that supports them.

For instance, in a randomized cross-over trial, which means patients, after a prescribed time, can switch to the more effective group, showed that the DASH diet is not just for patients with high blood pressure. The DASH diet was more efficacious than the control diet in terms of diabetes, decreasing hemoglobin A1C 1.7 percent and 0.2 percent, respectively; weight loss, with patients losing 5 kg/11 lbs. vs. 2 kg/4.4 lbs. It also achieved better results with HDL (“good”) cholesterol, LDL (“bad”) cholesterol and blood pressure (4).

Interestingly, patients still lost weight, although caloric intake and the percentages of fats, protein and carbohydrates were the same between the DASH and control diets. However, the DASH diet used different sources of macronutrients. The DASH diet also contained food with higher amounts of fiber, calcium and potassium and lower sodium than the control diet. 

Therefore, diets high in nutrient-dense foods may be an effective way to lose weight while also treating and preventing disease. 

I will share one more tip: take it day by day, rather than obsessing over the larger picture. I have found many patients make better headway by choosing to change one meal at a time — like starting with what they choose to eat for breakfast or for snacks each day. Once this is a habit, they shift their focus to another meal.

Best to you for optimal health in 2024!

References:

(1) J Pers Soc Psychol. 2012;102: 22-31. (2) European Journal of Social Psychology, 40: 998–1009. (3) www.usnews.com/best-diet. (4) Diabetes Care. 2011;34: 55-57.

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.

METRO photo

By David Dunaief, M.D.

Dr. David Dunaief

Dear Santa,

It’s that time of year again and, like so many others, I have a last-minute request. You are a model for kindness and generosity around the world, for which I’m grateful. I would like you to be a role model in another arena, as well — health.

Kids marvel at your round belly, which shakes when you laugh like a bowl full of jelly. They literally feed that belly by setting out cookies and other sweets for you on Christmas Eve to sustain you during your travels.

I have nothing against your round belly, but I’m concerned about the message it sends. We’re currently facing an epidemic of overweight kids and an ever-increasing number of children with type 2 diabetes. According to the CDC, the percentage of U.S. children between ages 10 and 19 with type 2 diabetes nearly doubled from 2001 to 2017. You, Santa, with your influence, can help reverse this trend.

Obesity has a high risk of shortening your life span, not to mention affecting your quality of life. The most dangerous type of obesity is visceral adipose tissue, which means central belly fat. An easy way to tell if someone is too rotund is if their waistline, measured from the navel, is 40 inches or more for a man and 35 inches or more for a woman. Risks for pancreatic cancer, breast cancer, liver cancer and heart disease increase dramatically with this increased fat.

Santa, here is your opportunity to lead by example — and, maybe fit back into that skinny tracksuit you’ve had in the back of your closet since the 16th century, when you were trim.

Think of the personal advantages of losing that extra belly weight. Your joints won’t ache with the winter cold; it will improve your posture, so your back doesn’t hurt as much; and you will have more energy. Plus, studies show that a diet that emphasizes fruits, vegetables and whole grains can reverse clogged arteries and help you avoid strokes, heart attacks and peripheral vascular disease. With a simple change, like eating a small handful of raw nuts each day, you can reduce your heart disease risk significantly.

Losing weight will also change your center of gravity, which will make it easier for you to keep your balance on those steep, snowy rooftops. No one wants you to take a tumble and risk a broken bone – or worse.

Exercise will help, as well. Maybe this Christmas Eve, you could walk or jog alongside the sleigh for the first continent or so. During the “offseason” you and the elves could form small groups of workout buddies to keep each other on track with your workout goals. And who doesn’t love an impromptu game of tag with the reindeer? With time, you’ll start to tighten your abs and slowly see fat disappear from your midsection.

This might also make it easier to steal a base or two during the North Pole Athletic League’s Softball season. The elves don’t even bother holding you on base anymore, do they?

Of course, the cookies don’t help. You might take a cue from the reindeer, who love their raw carrots and celery. Broadcast that the modern Santa enjoys fruits, especially berries and veggies, with an emphasis on cruciferous veggies like broccoli florets dipped in humus, which have substantial antioxidant qualities and can help reverse disease.

And, of course, skip putting candy in our stockings. We don’t need more sugar, and I’m sure that, over the long night, it’s hard to resist sneaking a few pieces. Why not reduce the temptation? This will also help you minimize the waves of fatigue you feel as you pull your worldwide all-nighter.

As for your loyal fans, you could place active games under the tree. You and your elves could create an app or website with free workout videos for those of us who need them; we could follow along as you showed us “12 Days of Dance-Offs with Santa and Friends.”

You could gift athletic equipment, such as baseball gloves, footballs and basketballs, instead of video games. Or wearable devices that track step counts and bike routes. Or stuff gift certificates for dance lessons into people’s stockings.

As you become more active, you’ll find that you have more energy all year round, not just on Christmas Eve. If you start soon, Santa, maybe by next year, you’ll be able to park the sleigh farther away and skip from chimney to chimney.

The benefits of a healthier Santa will ripple across the world. Your reindeer won’t have to work as hard. You might fit extra presents in your sleigh. And Santa, you will be sending kids and adults the world over the right message about taking control of their health through nutrition and exercise. That’s the best gift you could give!

Wishing you good health in the coming year,

David

P.S. If you have a little extra room in your sleigh, I could use a new baseball bat. I know the Yankees need help, so I’ve been practicing.

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.

Most thyroid nodules are found incidentally. METRO photo

By David Dunaief, M.D.

Dr. David Dunaief

Thyroid nodules are often diagnosed incidentally on radiologic exams, such as CT scans of the chest, MRI scans, PET scans and ultrasounds of the carotid arteries in the neck. It’s rarely because of symptoms. More than 50 percent of people have thyroid nodules detectable by high-resolution ultrasound. Fortunately, most are benign. Depending on the study, the percent that are malignant can range from 1.1 to 6.5 percent of nodules. 

This leaves us with the question of what to do with a thyroid nodule. What’s the short answer? It depends on the size. If it is over one centimeter, usually it is biopsied by fine needle aspiration (FNA). While most are asymptomatic, if there are symptoms, these might include difficulty swallowing, difficulty breathing, hoarseness, pain in the lower portion of the neck and a goiter.

FNA biopsy is becoming more common. In a study evaluating several databases, there was a greater than 100 percent increase in thyroid FNAs performed over a five-year period from 2006 to 2011. This resulted in a 31 percent increase in thyroidectomies, surgeries to remove the thyroid partially or completely.

However, the number of thyroid cancers diagnosed with surgery did not rise in this same period. Thyroid nodules in this study were least likely to be cancerous when the initial diagnosis was by incidental radiologic exam.

Addressing indeterminate FNA results

As much as 25 percent of FNA biopsies are indeterminate. We are going to look at two techniques to differentiate between benign and malignant thyroid nodules when FNA results are equivocal: a PET scan and a molecular genetics test.

A meta-analysis of six studies of PET scan results showed that it was least effective in resolving an unclear FNA biopsy. The PET scan was able to rule out patients who did not have malignancies, but it did not do a good job of identifying those who did have cancer.

On the other hand, a molecular-based test was able to potentially determine whether an indeterminate thyroid nodule by FNA was malignant or benign.

Unlike in the PET scan study above, the researchers were able to not only rule out the majority of malignancies but also to rule them in. It was not perfect, but the percent of negative predictive value (ruled out) was 94 percent, and the positive predictive value (ruled in) was 74 percent. The combination test improved the predictive results of previous molecular tests by 65 to 69 percent. This is important to help decide whether or not the patient needs surgery to remove at least part of the thyroid.

What is the significance of calcification?

Microcalcifications in the nodule can be detected with an ultrasound. The significance of this may be that patients with microcalcifications are more likely to have malignant thyroid nodules than those without them, according to a small prospective study involving 170 patients. This does not mean that a patient has malignancy with calcifications, but that there is a higher risk.

The ‘wait and follow-up’ approach

As I mentioned above, most thyroid nodules are benign. The results of one study go even further, showing that most asymptomatic benign nodules do not progress in size significantly after five years. The factors that did contribute to growth of about 11 percent of the nodules were age (<45 years old had more growth than >60 years old), the existence of multiple nodules, greater nodule volume at baseline, and being male.

The study authors’ suggestion is that, after the follow-up scan, the next ultrasound scan might be five years later instead of three. However, they did discover thyroid cancer in 0.3 percent after five years.

How does thyroid function affect outcomes?

In considering risk factors, it’s important to note that those who had normal thyroid stimulating hormone (TSH) were less likely to have a malignant thyroid nodule than those who had high TSH, implying hypothyroidism. There was an almost 30 percent prevalence of cancer in the nodule if the TSH was greater than >5.5 mU/L (13).

Fortunately, most nodules are benign and asymptomatic, but the number of cancerous nodules found is growing. Why the mortality rate remains the same, year over year for decades, may have to do with the slow rate at which most thyroid cancers progress, especially of the two most common forms, follicular and papillary.

References:

(1) uptodate.com. (2) AACE 2013 Abstract 1048. (3) Thyroid. 2005;15(7):708. (4) European Thyroid Journal. 2022 Jun 29;11(4) online. (5) AACE 2013 Abstract 1048. (6) thyroid.org. (7) AAES 2013 Annual Meeting. Abstract 36. (8) AACE 2013 Abstract 1048. (9) Cancer. 2011;117(20):4582-4594. (10) J Clin Endocrinol Metab. Online May 12, 2015. (11) Head Neck. 2008 Sep;30(9):1206-1210. (12) JAMA. 2015;313(9):926-935. (13) J Clin Endocrinol Metab. 2006;91(11):4295.

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.

METRO photo

By David Dunaief, M.D.

Dr. David Dunaief

Erectile dysfunction (ED) is a very common problem with a stigma. In fact, I have had several patients who resisted telling me they suffered from this malady. Because it can be a symptom of other diseases, it is crucial that you share this information with your doctor.

ED affects approximately 1 in 10 men on a chronic basis. If it occurs less than 20 percent of the time, it is normal; whereas if it occurs more than 50 percent of the time, there is a problem that requires therapy, according to the Cleveland Clinic (1). 

There are oral medications for ED. You’ve probably seen ads for them everywhere. Its prevalence has led pharmaceutical companies to saturate the airwaves, especially during sporting events. Approved medications include sildenafil (Viagra, or the “little blue pill”), tadalafil (Cialis), vardenafil (Levitra, Staxyn), and avanafil (Stendra). These drugs work by affecting the endothelium, or inner layer, of blood vessels and causing vasodilation, or enlargement of blood vessels, which increases blood flow to the penis. Unfortunately, this does not solve the medical problem, but it does provide a short-term fix for those who are good candidates for treatment.

ED’s prevalence increases with age. In a multinational MALES study, ED affected 8 percent of those aged 20-30 and 37 percent of 70-75-year-olds (2). What was surprising was that advanced age had the least association with ED, increasing the odds by only five percent. So, what contributes to the rest of the increase as we age? Disease processes and drug therapies.

What is the relationship between medical conditions and ED?

Chronic diseases significantly contribute to ED. The opposite may also be true; ED may be a harbinger of disease. Typical contributors include metabolic syndrome, diabetes, high blood pressure, cardiovascular disease and obesity. In the Look AHEAD trial, ED had a greater than two-fold association with hypertension and a three-fold association with metabolic syndrome (3). In another study, ED was associated with a 2.5-times increase in cardiovascular disease (4).

A randomized clinical trial (RCT) showed that patients with ED had significantly more calcification, or atherosclerosis, in the arteries when compared to a control group (5). They were more than three times as likely to have severe levels of calcification. They also had more inflammation, measured by C-reactive protein. 

How do medications contribute to ED?

About 25 percent of ED cases are thought to be associated with medications, such antidepressants; NSAIDs, such as ibuprofen and naproxen sodium; and hypertension medications. Unfortunately, the most common antidepressant medications, SSRIs, have the greatest impact on ED of all antidepressants. 

The California Men’s Health Study, with over 80,000 participants, showed that there was an association between NSAIDs and ED, with a 38 percent increase in ED in patients who use NSAIDs on a regular basis (6). The authors warn that patients should not stop taking NSAIDS without consulting their physicians.

Also, high blood pressure drugs have a reputation for causing ED. Beta blockers were thought to be the main culprit. A meta-analysis of 42 studies showed that beta blockers have a small effect, but thiazide diuretics (water pills) more than doubled ED, compared to placebo (7).

How does diet affect ED?

The Mediterranean-type diet has been shown to treat and prevent ED, improving one’s health and sex life at the same time. It’s the green leafy alternative to the little blue pill. The foods are rich in omega-3 fatty acids and high in monounsaturated fats and polyunsaturated fats, as well as in fiber. Components include whole grains, fruits, vegetables, legumes, walnuts, and olive oil. 

In two RCTs lasting two years, those who followed a Mediterranean-type diet saw improvements in their endothelial functioning (8, 9). They also had reduced inflammation and decreased insulin resistance.

In another study, men who had the greatest compliance with the Mediterranean-type diet were significantly less likely to have ED, compared to those with the lowest compliance (10). Even more impressive was that the group with the highest compliance had a 37 percent reduction in severe ED versus the low compliance group.

A study of participants in the Health Professionals Follow-up Study looked more closely at both the Mediterranean-type diet and an Alternative Healthy Eating Index 2010 diet, which emphasized consuming vegetables, fruits, nuts, legumes, and fish or other sources of long-chain fats, as well as avoiding red and processed meats (11). At this point, it probably won’t surprise you to hear that the greater participants’ compliance with either of these diets, the less likely they were to experience ED.

Therefore, it is important to bring ED to the attention of your physician. 

There are very effective lifestyle alternatives to oral medication that provide positive overall health effects and treat associated chronic diseases, while also helping patients eliminate medications that contribute to ED.

References:

(1) clevelandclinic.org. (2) Curr Med Res Opin. 2004;20(5):607. (3) J Sex Med. 2009;6(5):1414-22. (4) Int J Androl. 2010;33(6):853-60. (5) J Am Coll Cardiol. 2005;46(8):1503. (6) Medicine (Baltimore). 2018 Jul;97(28):e11367. (7) JAMA. 2002;288(3):351. (8) Int J Impot Res. 2006;18(4):405-10. (9) JAMA. 2004;292(12):1440-6. (10) J Sex Med. 2010 May;7(5):1911-7. (11) JAMA Netw Open. 2020 Nov 2;3(11):e2021701.

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.

Mood changes, headaches and itchy skin are some of the milder consequences of winter dehydration. METRO photo

By David Dunaief, M.D.

Dr. David Dunaief

Now that we’re settling into the cooler winter months, dehydration is resurfacing as a challenge. Dry heat makes it hard to stay hydrated or to keep any humidity in your home or office, which can dehydrate your body.

Complications and symptoms of dehydration can be mild to severe, ranging from constipation, mood changes, itchy skin, headaches and heart palpitations to heat stroke, migraines and heart attacks.

The dry air can also make our throats and sinuses dry, making us uncomfortable and more susceptible to irritations and viruses.

Let’s look at some suggestions for keeping hydration up and some consequences of dehydration.

How do you keep humidity in the air?

To reduce sinus inflammation and dry skin that heated air can promote, measure the humidity level in your home with a hygrometer and target keeping it between 30 and 50 percent (1). When the temperature outside drops below 10 degrees Fahrenheit, lower this to 25 percent.

Strategies for adding moisture to the air include using cool mist humidifiers, keeping the bathroom door open after you bathe or shower, and placing bowls of water strategically around your home, including on your stovetop when you cook. If you use a humidifier, take care to follow the manufacturer’s care instructions and clean it regularly, so you don’t introduce bacteria to the air.

Reducing headaches and migraines

In a review of studies published in the Handbook of Clinical Neurology, those who drank four cups or more of water had significantly fewer hours of migraine pain than those who drank less (2). Headache intensity decreased as well.

Decreasing heart palpitations

Heart palpitations are very common and are broadly felt as a racing heart rate, skipped beat, pounding sensation or fluttering. Dehydration and exercise contributing to this (3). They occur mainly when we don’t hydrate before exercising. If you drink one glass of water before exercise and then drink during exercise, it will help avoid palpitations. Though these symptoms are not usually life-threatening, they can make you anxious.

Lowering heart attack risk

The Adventist Health Study showed that men who drank more water had the least risk of death from heart disease (4). Group one, which drank more than five glasses of water daily, had less risk than group two, which drank more than three. Those in group three, which drank fewer than two glasses per day, saw the lowest benefit, comparatively. For women, there was no difference between groups one and two, although both fared better than group three.

The reason for this effect, according to the authors, may relate to blood or plasma viscosity (thickness) and fibrinogen, a substance that helps clots form.

Decreased concentration and fatigue

Mild dehydration resulted in decreased concentration, subdued mood, fatigue and headaches in women in a small study (5). The mean age of participants was 23, and they were neither athletes nor highly sedentary. Dehydration was caused by walking on a treadmill with or without taking a diuretic (water pill) prior to the exercise. The authors concluded that adequate hydration was needed, especially during and after exercise.

I would also suggest, from my practice experience, hydration prior to exercise.

How much water should you drink?

How much water we need to drink depends on circumstances, such as diet, activity levels, environment and other factors. It is not true necessarily that we all should be drinking eight glasses of water a day. In a review article, researcher analyzed the data, but did not find adequate studies to suggest that eight glasses is the magic number (6). It may actually be too much for some patients.

You may also get a significant amount of water from the foods in your diet. Nutrient-dense diets, like Mediterranean or Dietary Approaches to Stop Hypertension (DASH) diets, have a plant-rich focus. Diets with a focus on fruits and vegetables increase water consumption (7). As you may know, 95 percent of the weights of many fruits and vegetables are attributed to water. An added benefit is an increased satiety level without eating calorically dense foods.

Remember that salty foods can dehydrate you, including breads and pastries, so try to avoid these.

Should you avoid caffeinated beverages?

In a review, it was suggested that caffeinated coffee and tea don’t increase the risk of dehydration, even though caffeine is a mild diuretic (8). With moderate amounts of caffeinated beverages, the liquid in them has a more hydrating effect than its diuretic effect. It is important to stay hydrated to avoid uncomfortable — and sometimes serious — complications. Diet is a great way to ensure that you get the triple effect of high nutrients, increased hydration and sense of feeling satiated without calorie-dense foods. However, don’t go overboard with water consumption, especially if you have congestive heart failure or open-angle glaucoma (9).

References:

(1) epa.gov (2) Handb Clin Neurol. 2010;97:161-72. (3) my.clevelandclinic.org. (4) Am J Epidemiol 2002 May 1; 155:827-33. (5) J. Nutr. February 2012 142: 382-388. (6) AJP – Regu Physiol. 2002;283:R993-R1004. (7) Am J Lifestyle Med. 2011;5(4):316-319. (8) Exerc Sport Sci Rev. 2007;35(3):135-140. (9) Br J Ophthalmol. 2005:89:1298–1301.

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.

Focus on healthier holiday dinner options. METRO photo

By David Dunaief, M.D.

Dr. David Dunaief

How hard is it to maintain healthy eating habits during the holidays? Even when we have the best of intentions, it’s hard to resist indulging in seasonal favorites and secret family recipes spread before us in a sprawling buffet.

Unfortunately, that one meal, and perhaps subsequent leftover meals, can have striking health consequences. And if you tend to overeat, be aware that there are significant short-term consequences of stuffing ourselves.

Not surprisingly, Americans tend 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). If you can avoid weight gain during the holidays, think of the possibilities for the rest of the year.

Those who are obese and sedentary may already have heart disease. Overeating during a single meal increases your risk of heart attack over the near term, according to the American Heart Association (2). 

The good news is that, with a little planning, you can reap significant health benefits.

What can we do to turn a holiday dinner into a healthier meal? The secret is likely there on your table, hidden in the side dishes. By reconsidering how we prepare them, we can change the Thanksgiving health equation.

Focus on plants

Phytochemicals (plant nutrients) called carotenoids have antioxidant and anti-inflammatory effects and are found mostly in fruits and vegetables. Carotenoids make up a family of more than 600 different substances, such as beta-carotene, alpha-carotene, lutein, zeaxanthin, lycopene and beta-cryptoxanthin (3).

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 — heart disease and stroke. Foods that contain these substances are dark green leafy vegetables, as well as orange, yellow and red vegetables and fruits.

Focus on presentation and perception

Despite the knowledge that healthy eating has long-term positive effects, there are obstacles to healthy eating. Two critical factors are presentation and perception.

Vegetables are often prepared in either an unappetizing way — steamed to the point of no return – or smothered in cheese and butter, negating any benefits. Fruits are 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 relegated to side dishes or afterthoughts. 

Here are some suggestions to get you thinking about ways to shift the heavy holiday meal paradigm.

Make healthy, plant-based dishes more appetizing. You don’t have to forgo signature dishes, but 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? If you want to make this a primary dish, add diced tofu and/or garbanzo beans to make it more filling without overwhelming its delicate sweetness.

Season your vegetables. 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. Each adds a different flavor to the vegetables. 

My 17-year-old nephew, who has never liked cooked 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. Now, he makes them for himself. Good resources for appealing vegetable dishes can be found at PCRM.org, mouthwateringvegan.com, and many other online resources.

Replace refined grains. 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). Not only did participants lose subcutaneous fat found just below the skin, but also 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 many grocery stores now. Just be sure to get one that’s unsalted. If you prefer mashed, here’s a simple recipe for mashed cauliflower: https://medicalcompassmd.com/post/mashed-cauliflower-recipe-vegan. 

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

Improve dessert options. Options might include dairy-free, sugar-free pumpkin pudding and fruit salad.

The goal should be to increase your nutrient-dense choices and decrease your empty-calorie foods.

Instead of making Thanksgiving a holiday of regret, eating foods that cause weight gain, fatigue and that increase your risk for chronic diseases, promote good health while serving a delicious, festive meal.

References:

(1) N Engl J Med 2000; 342:861-867. (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.

METRO photo

By David Dunaief, M.D.

Dr. David Dunaief

As the weather has started to turn cooler, I’ve been hearing a lot more sniffling and sneezing. It’s a good reminder that cold season is upon us. Most frequently caused by the human rhinovirus, a cold’s effects can range from an annoyance to more serious symptoms that put us out of commission for a week or more.

The good news is that it may be possible to reduce the symptoms — or even reduce the duration — of a common cold with lifestyle management and a few dietary supplements.

What can you do to relieve cold symptoms?

If you have congestion or coughing symptoms, sitting in a steamy bathroom may help. It simulates a medical mist tent, moisturizing your nasal and bronchial passages. Dry heat is your enemy when you’re experiencing cold symptoms. If your home or office is dry, use a cool mist humidifier to put some humidity back in the air.

Eating salt-free soups loaded with vegetables can help increase your nutrient intake and loosen congestion. I start with a sodium-free soup 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.

Does Zinc reduce a cold’s duration?

You may have heard that zinc helps treat a cold. I have good news: it does!

According to a meta-analysis that included 13 trials, zinc in any form taken within 24 hours of your 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 your symptoms throughout, improving your quality of life. This may be due to an anti-inflammatory effect.

One of the studies, 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 was reduced by 33 percent (2). 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.

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

Not all studies showed a benefit. Also, 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.

Does vitamin C help cure a cold?

According to a review of 29 trials with a combined population of over 11,000, vitamin C did not show any significant benefit in preventing or reducing cold symptoms or duration in the general population (4). With this in mind, 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.

Is echinacea a possible cure?

After review of 24 controlled clinical trials, the Cochrane Database notes that the jury is still out on the effectiveness of echinacea for treatment of duration and symptoms, but the results are disappointing and inconsistent (5). There are no valid randomized clinical trials showing 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).

Should you exercise or not?

People with colds need rest — at least that was the theory. However, a study published in the British Journal of Sports Medicine may change 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 reported themselves as being highly fit had a 46 percent reduction in the number of days with colds compared to those who perceived themselves to have low fitness. Their cold symptoms were reduced significantly as well.

What are our takeaways?

For symptom relief, simple home remedies may actually work better than supplements. Zinc might be useful in treating and preventing the common cold. Use caution with dosing, however, to reduce its side effects. Echinacea and vitamin C have not been proven to provide benefits, but don’t stop taking them if you feel they help you. Lastly, exercise might actually reduce your cold’s duration.

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 or consult your personal physician.

 Increasing tomato sauce consumption is a simple way to                      decrease your prostate cancer risk

By David Dunaief, M.D.

Dr. David Dunaief

Welcome to “Movember,” a month dedicated to raising money to fund awareness and research initiatives focused on men’s health (1). An initiative of the Movember Foundation, its efforts have funded 1,320 men’s health projects globally, with focuses on mental health, suicide prevention, testicular and prostate cancer.

Its prostate cancer initiatives focus on early detection, treatment options, and quality of life considerations for different treatments. I’d like to add prevention options to the conversation. Regardless of your family history, you can reduce your risk of prostate cancer with some simple lifestyle changes.

How does obesity affect prostate cancer risk?

Obesity may slightly decrease the risk of nonaggressive prostate cancer; however, it may also increase your risk of aggressive disease (2). Because larger prostates make biopsies less effective, the study’s authors attribute a lower incidence of nonaggressive cancer to the possibility that it is more difficult to detect it in obese men. Ultimately, those who are obese have a greater risk of dying from prostate cancer when it is diagnosed.

Does consuming animal fat affect your risk?

There appears to be a direct effect between the amount of animal fat we consume and the incidence of prostate cancer. In the Health Professionals Follow-up Study, those who consumed the highest amount of animal fat had a 63 percent increased risk of advanced or metastatic prostate cancer, compared to those who consumed the least (3).

Also, in this study, red meat contributed to an even greater, approximately 2.5-fold, increased risk of advanced disease. If you continue to eat red meat, reduce your frequency as much as possible, targeting once a month or quarter.

In another large, prospective observational study, the authors concluded that red and processed meats increase the risk of advanced prostate cancer through heme iron, barbecuing/grilling and nitrate/nitrite content (4).

Should you cook your tomatoes?

Tomato sauce has been shown to potentially reduce the risk of prostate cancer. However, uncooked tomatoes have not demonstrated the same beneficial effects. It is believed that lycopene, which is a type of carotenoid found in tomatoes, is central to this benefit. Tomatoes need to be cooked to release lycopene (5). 

As part of this larger study, 32 patients with localized prostate cancer consumed 30 mg of lycopene per day via tomato sauce-based dishes over a three-week period before a radical prostatectomy. Key cancer indicators improved, and tissue tested before and after the intervention showed dramatic improvements in DNA damage in leukocyte and prostate tissue (6). 

In a prospective study involving 47,365 men who were followed for 12 years, prostate cancer risk was reduced by 16 percent with higher lycopene intake from a variety of sources (7). When the authors looked at tomato sauce alone, they saw a 23 percent risk reduction when comparing those who consumed at least two servings a week to those who consumed less than one serving a month. The reduction in severe, or metastatic, prostate cancer risk was even greater, at 35 percent. This was a statistically significant reduction in risk with a very modest amount of tomato sauce.

Unfortunately, many brands of prepared tomato sauce are loaded with salt, which has its own health risks. I recommend to patients that they either make their own sauce or purchase prepared sauce made with low sodium or no salt.

Do cruciferous vegetables help?

While results among studies vary, they all agree: consuming vegetables, especially cruciferous vegetables, helps reduce prostate cancer risk.

In a case-control study, participants who consumed at least three servings of cruciferous vegetables per week, versus those who consumed less than one per week, saw a 41 percent reduction in prostate cancer risk (8). What’s even more impressive is the effect was twice that of tomato sauce, while the intake was similarly modest. Cruciferous vegetables include broccoli, cauliflower, bok choy, kale and arugula, to name a few.

A separate study of 1,338 patients with prostate cancer in a larger cancer screening trial concluded that, while vegetable and fruit consumption did not appear to lower outright prostate cancer risk, increased consumption of cruciferous vegetables — specifically broccoli and cauliflower — did reduce the risk of aggressive prostate cancer, particularly of more serious stage 3 and 4 tumors (9). These results were seen with consumption of just one or more servings of each per week, when compared to less than one per month.

What about PSA screening?

In a retrospective analysis of 128 U.S. Veteran’s Health Administration facilities, those where Prostate-specific antigen (PSA) screening was less frequent found higher rates of metastatic prostate cancer (10). During the study period from 2005 to 2019, researchers found an inverse relationship between PSA screening rates and metastatic prostate cancer. When screening rates decreased, rates of metastatic cancer increased five years later, while in facilities where screening rates increased, metastatic cancer rates decreased. 

While the study authors caution about extending these findings to the general population, they do suggest they could help inform conversations between men and their physicians about the value of PSA screening. 

When it comes to preventing prostate cancer and improving prostate cancer outcomes, lifestyle modifications, including making dietary changes, can reduce your risk significantly.

References:

(1) www.movember.com. (2) Epidemiol Rev. 2007;29:88. (3) J Natl Cancer Inst. 1993;85(19):1571. (4) Am J Epidemiol. 2009;170(9):1165. (5) Exp Biol Med (Maywood). 2002; 227:914-919. (6) J Natl Cancer Inst. 2002;94(5):391. (7) Exp Biol Med (Maywood). 2002 Nov;227(10):886-93. (8) J Natl Cancer Inst. 2000;92(1):61. (9) J Natl Cancer Inst. 2007;99(15):1200-1209. (10) JAMA Oncol. 2022 Dec 1;8(12):1747-1755.

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.

Image from METRO
Increasing fiber consumption is crucial

By David Dunaief

Dr. David Dunaief

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), the most common type of heart disease (1). Annually in the U.S., there are 805,000 heart attacks. Of these, 200,000 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. In addition, lifestyle factors contribute to your risk; poor diet, lack of physical activity and high alcohol consumption are among the most significant contributors.

This is where we can dramatically reduce the occurrence of CAD. Evidence continues to highlight lifestyle changes, including diet, as the most important factors in preventing heart disease. Key changes that pack a wallop include the consumption of chocolate, legumes, nuts, fiber and omega-3 polyunsaturated fatty acids (PUFAs).

Chocolate – really?

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). The benefit may be attributed to micronutrients referred to as flavanols. 

However, the authors warned against the idea that more is better. High fat and sugar content and chocolate’s caloric density may have detrimental effects when consumed at much higher levels. There is a fine line between potential benefit and harm. 

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?

Will increasing dietary fiber help?

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

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 that 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).

Legumes have an outsized effect

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 saw this effect when compared to those who consumed less than one serving per week. The legumes used in this study included beans, peas and peanuts. There were over 9,500 men and women involved, and the study spanned 19 years of follow-up.

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

Focus on 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. Of course, be cautious about consuming too many nuts, since they’re also calorically dense.

Your ultimate goal should be to become “heart attack proof,” a term used by Dr. Sanjay Gupta and reinforced by Dr. Dean Ornish. While even modest dietary changes can significantly reduce your risk, 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 or consult your personal physician.