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Fiber has very powerful effects on our overall health

By David Dunaief

Dr. David Dunaief

Americans are woefully deficient in fiber, getting between eight and 15 grams per day, when they should be ingesting more than 40 grams daily.

Still, many people worry about getting enough protein, when they really should be concerned about getting enough fiber. Most of us — except perhaps professional athletes or long-distance runners — get enough protein in our diets. Protein has not prevented or helped treat diseases to the degree that studies illustrate with fiber. 

In order to increase our daily intake, several myths need to be dispelled. First, fiber does more than improve bowel movements. Also, fiber doesn’t have to be unpleasant. 

The attitude has long been that to get enough fiber, one needs to eat a cardboard box. With certain sugary cereals, you may be better off eating the box, but on the whole, this is not true. Though fiber comes in supplement form, most of your daily intake should be from diet. It is actually relatively painless to get enough fiber; you just have to become aware of which foods are fiber-rich.

All fiber is not equal

Does the type of fiber make a difference? One of the complexities is that there are a number of different classifications of fiber, from soluble to viscous to fermentable. Within each of the types, there are subtypes of fiber. Not all fiber sources are equal. Some are more effective in preventing or treating certain diseases. Take, for instance, a 2004 irritable bowel syndrome (IBS) study (1). 

It was a meta-analysis (a review of multiple studies) study using 17 randomized controlled trials with results showing that soluble psyllium improved symptoms in patients significantly more than insoluble bran.

Reducing disease risk and mortality

Fiber has very powerful effects on our overall health. A very large prospective cohort study showed that fiber may increase longevity by decreasing mortality from cardiovascular disease, respiratory diseases and other infectious diseases (2). Over a nine-year period, those who ate the most fiber, in the highest quintile group, were 22 percent less likely to die than those in lowest group. Patients who consumed the most fiber also saw a significant decrease in mortality from cardiovascular disease, respiratory diseases and infectious diseases. The authors of the study believe that it may be the anti-inflammatory and antioxidant effects of whole grains that are responsible for the positive results. 

Along the same lines of the respiratory findings, we see benefit with prevention of chronic obstructive pulmonary disease (COPD) with fiber in a relatively large epidemiologic analysis of the Atherosclerosis Risk in Communities study (3). The specific source of fiber was important. Fruit had the most significant effect on preventing COPD, with a 28 percent reduction in risk. Cereal fiber also had a substantial effect but not as great.

Fiber also has powerful effects on breast cancer treatment. In a study published in the American Journal of Clinical Nutrition, soluble fiber had a significant impact on breast cancer risk reduction in estrogen negative women (4). Most beneficial studies for breast cancer have shown results in estrogen receptor positive women. This is one of the few studies that has illustrated significant results in estrogen receptor negative women. 

The list of chronic diseases and disorders that fiber prevents and/or treats also includes cardiovascular disease, Type 2 diabetes, colorectal cancer, diverticulosis and weight gain. This is hardly an exhaustive list. I am trying to impress upon you the importance of increasing fiber in your diet.

Where do we find fiber?

Foods that are high in fiber are part of a plant-rich diet. They are whole grains, fruits, vegetables, beans, legumes, nuts and seeds. Overall, beans, as a group, have the highest amount of fiber. Animal products don’t have fiber. Even more interesting is that fiber is one of the only foods that has no calories, yet helps you feel full. These days, it’s easy to increase your fiber by choosing bean-based pastas. Personally, I prefer those based on lentils. Read the labels, though; you want those that are solely made from lentils without rice added.

If you have a chronic disease, the best fiber sources are most likely disease-dependent. However, if you are trying to prevent chronic diseases in general, I would recommend getting fiber from a wide array of sources. Make sure to eat meals that contain substantial amounts of fiber, which has several advantages, such as avoiding processed foods, reducing the risk of chronic disease, satiety and increased energy levels. Certainly, while protein is important, each time you sit down at a meal, rather than asking how much protein is in it, you now know to ask how much fiber is in it. 

References:

(1) Aliment Pharmacology and Therapeutics 2004;19(3):245-251. (2) Arch Intern Med. 2011;171(12):1061-1068. (3) Amer J Epidemiology 2008;167(5):570-578. (4) Amer J Clinical Nutrition 2009;90(3):664–671. 

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

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Dr. Paolo Boffetta

By Daniel Dunaief

Dr. Paolo Boffetta, who joined Stony Brook University as Associate Director for Population Sciences in the Cancer Center in the midst of the pandemic last April, asks the kinds of questions doctors, scientists and non-scientists also raise when they look at illnesses among groups of people.

An epidemiologist who worked for 20 years at the World Health Organization and at Mt. Sinai Hospital in New York City for 10 years, Boffetta joined Stony Brook because he saw an opportunity to replicate the kind of success he and others had at Mt. Sinai, where he helped the institution earn a National Cancer Institute designation. Cancer centers can apply for NCI designation when they have a well-established portfolio of research.

Dr. Paolo Boffetta

“The idea to try to get the Cancer Center” at Stony Brook “to the NCI level was very appealing,” Boffetta said. Stony Brook was looking to build out its population sciences work.

In addition to the big picture goal of helping Cancer Center Director Yusuf Hannun and other researchers earn that designation, Boffetta has partnered with several scientists at Stony Brook and elsewhere to address questions related to various illnesses.

Boffetta has applied for $12 million in funds over six years from the National Cancer Institute for a new water project.

The research will recruit people who are over 50 years old across several towns, primarily in Suffolk County to explore the link between the potential exposure these residents had to different chemicals in drinking water and types of cancers.

“The main idea is that people may be exposed to carcinogens through drinking water according to where they have been living,” Boffetta said.

The scientists will follow these residents over time to determine the health impact of their town of residency. “If this is funded, this will be a major project that will involve many institutions,” he added.

The chemicals they will study include nitrates, chlorinated solvents, 1,4-dioxane, and perfluoroalkyl substances.

While he awaits word on potential funding for the water effort, Boffetta and others are looking at another project to explore the link between various environmental factors and bladder cancer. This is not limited to drinking water contamination. The group plans to analyze tumor samples to see whether they can detect fingerprint mutations.

World Trade Center Studies

Boffetta also plans to continue and expand on work he’s done at Mt. Sinai with responders of the World Trade Center attacks, a group that has received considerable attention from numerous scientists at Stony Brook.

He has been “doing a number of quite detailed analyses on cancer, including survival of workers and responders to developing cancer,” he said. The WTC survivors are enrolled in a medical monitoring treatment program, sponsored by the Centers for Disease Control, which means they “should be getting good cancer care.”

Boffetta has been comparing their survival to the population at large in New York, analyzing how the risk of cancer evolved over the almost 20 years since the attacks.

Boffetta has started to look at one particular new project, in which he studies the prevalence of clonal hematopoiesis of indeterminate potential (or CHIP), which is an asymptomatic condition that increases the likelihood of leukemia and cardiovascular disease. He is studying 350 healthy World Trade Center responders and a group of historical controls from the literature.

He plans to use the results of his study to develop strategies to prevent these diseases in WTC responders.

In some of his WTC studies, Boffetta is working with Ben Luft, Director of the Stony Brook WTC Wellness Program at the Renaissance School of Medicine at SBU, who has been involved in providing extensive research and clinical support for WTC responders.

Boffetta is an “internationally renowned cancer epidemiologist” who contributed his “vast experience on the impact of environmental and occupational exposures [that were] seminal in our understanding of how the disaster of 9/11 would eventually lead to increased numbers of cancer cases among responders,” Luft wrote in an email.

Boffetta’s contribution and understanding will “transcend the events of 9/11 and its impact on the responder community to a general understanding of the increased incidence of cancer on Long Island,” said Luft.

While Boffetta has several academic affiliations with institutions including Harvard University, where he teaches a class for a week each year, and Vanderbilt University, his primary focus involves the work he conducts at Stony Brook and at the University of Bologna.

Boffetta plans to keep his research team considerably smaller than the 80 to 100 people who worked with him at the World Health Organization. Indeed, he said he mainly focuses on working with collaborators. He plans to hire his first post doctoral researchers soon.

As for teaching, Boffetta has been working with the program directors of the Masters of Public Health to develop a tract in epidemiology. He plans to start teaching next year.

Boffetta, who spoke with Times Beacon Record News Media through WhatsApp from Italy, said he often works double shifts to remain in contact with his colleagues in the United States and Europe. When he’s in the United States, meetings can start at 6 in the morning to connect with his European counterparts in the middle of their day. When he’s in Italy, his last meetings sometimes end at 11 p.m. or midnight.

Boffetta, however, said he has “a normal life,” which, prior to the pandemic, included trips to the opera and museums. He also enjoys skiing and hiking.

Married to Antonella Greco, who used to teach Italian, Boffetta lives in New York City. He has three daughters, who live in Brooklyn, Italy and Uruguay. He has been vaccinated against COVID-19 and is looking forward to the opportunity to interact with his colleagues in person once restrictions caused by the pandemic ease.

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Lemon Bars. Photo from Pexels

By Barbara Beltrami

With Memorial Day just around the corner, we will finally be gathering without guilt or fear with family, friends and neighbors to whoop up together at picnics, barbecues and maybe even pool parties. It will be a time to remember not just those Americans who have fallen on the battlefield but the more than 600,000 who have succumbed to the coronavirus over the past year. Like so many large get togethers, this one will probably be a cooperative effort with each guest bringing some part of the meal. If the answer you got to “What can I bring?” was “dessert,” then I suggest you think about dessert bars. Easier than cookies and good travelers, they will delight both young and old. 

Maria’s Pineapple-Coconut Bars

YIELD: Makes about two dozen bars

INGREDIENTS:

Nonstick cooking spray

2 cups flour

3/4 cup sugar

Pinch salt

2 sticks unsalted butter

12 ounces softened cream cheese

2 teaspoons vanilla

2 eggs

One 20-ounce can crushed pineapple, drained

1 1/3 cups sweetened flaked coconut

1 cup finely chopped almonds

DIRECTIONS:

Preheat oven to 350 F. Lightly grease a 13x9x2” baking dish. In a medium bowl combine flour, 1/2 cup sugar and salt. With pastry blender or fork, cut in 1 1/2 sticks of the butter until mixture resembles coarse meal. Spread over bottom of prepared pan and press into place with fingers; bake for 12 minutes. In medium bowl combine cream cheese, the remaining 1/4 cup sugar, vanilla and eggs. Spread over baked crust, then spread pineapple evenly on top.  Melt remaining 1/4 cup butter and let cool; In a separate bowl, combine coconut, melted butter and almonds; spread over pineapple — cream cheese mixture. Bake 20 to 25 minutes until coconut and almonds are nicely browned. Let cool 15 minutes, then chill until set. Cut into squares and serve with hot coffee or tea.

Mary Alice’s Golden Squares

YIELD: Makes about two dozen 2” squares

INGREDIENTS:

1/2 cup unsalted butter

1 cup sugar

2 eggs, well-beaten

1 teaspoon vanilla extract

1 1/2 cups sifted cake flour

1/2 teaspoon salt

1 teaspoon baking powder

1 egg white

1 cup firmly packed brown sugar

1/2 cup chopped nuts

DIRECTIONS:

Preheat oven to 375 F. Grease a 13x9x2”pan. With electric mixer on low speed, beat butter until fluffy; gradually add sugar while continuing to beat until mixture is light in color Add eggs and vanilla; beat to combine. Sift together flour, salt and baking powder, then thoroughly blend with wet mixture. Spread evenly in prepared pan. Beat egg white until stiff; add brown sugar and continue to beat until stiff again. Fold in nuts, then spread over batter in pan. Bake 25 minutes, remove from oven and let cool to room temperature; cut into squares and serve with iced tea, coffee, or lemonade.

Stephen’s Mother’s Lemon Bars

YIELD: Makes about 20 squares

INGREDIENTS:

Two 8-ounce sticks unsalted butter, softened

3 1/2 cups sugar

3 cups flour

Pinch coarse salt

6 extra-large eggs at room temperature

3 cups sugar

2 tablespoons finely grated lemon zest

1 cup freshly squeezed lemon juice

Confectioners’ sugar, if desired

DIRECTIONS:

Preheat oven to 350 F. In large electric mixer bowl cream the butter and 1/2 cup sugar; add two cups of the flour and the salt and mix on low speed just until combined. Turn dough onto a floured board and gather into a ball; flatten and press into a 13 x 9 x 2” baking dish; build up a two-inch edge on sides; refrigerate for 30 to 45 minutes, then bake 15 to 20 minutes until crust turns a light golden; remove, place on wire rack and let cool to room temperature. Whisk together the eggs, remaining sugar and flour, lemon zest and juice, then pour into crust; bake until set, about 30 minutes. Let cool to room temperature, then dust with confectioners’ sugar, if using, and cut into squares. Serve with raspberry sorbet.

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Photo from Smithtown Animal Shelter
Photo from Smithtown Animal Shelter
Photo from Smithtown Animal Shelter

MEET PRETZEL AND POPCORN!

Pretzel is a 10-month-old, grey/white male and Popcorn is a 10-month-old orange female. These cuties may or may not be siblings, but they are certainly friends. This dynamic duo came from a cat hoarding situation where they had very little human interaction. After a few months of care at the Smithtown Animal Shelter, they are slowly starting to come out of their shells and play. 

Popcorn is a bit more playful and outgoing, but Pretzel looks to her for guidance. Their ideal home would be quiet, adult only, dog free and humans with lots of patience and love to give. These cats are used to living with loads of other cats, so they would not mind kitty siblings.

They come spayed/neutered, microchipped and are up to date on their vaccines. 

If you are interested in meeting this duo, please call ahead to schedule an hour to properly interact with them in a domestic setting, which includes a Meet and Greet Room.

The Smithtown Animal & Adoption Shelter is located at 410 Middle Country Road, Smithtown. Shelter operating hours are currently Monday to Saturday from 10 a.m. to 3 p.m. (Sundays and Wednesday evenings by appointment only). 

For more information, call 631-360-7575 or visit www.smithtownanimalshelter.com.

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A scene from Stony Brook University's May 19 9 a.m. graduation ceremony. Photo by Greg Catalano

By Fr. Francis Pizzarelli

Father Frank Pizzarelli

Graduation 2021 — what a year! In the midst of this horrific pandemic, so many of you have had the courage, despite so many obstacles, to stay the course and graduate with distinction from high school, college and graduate school.

This year has been plagued by so much sickness, death, and divisiveness. Yet, so many of you have volunteered to help those in need by your commitment to community service.

Graduates, as you continue your journey, do not let the social filters of our time enable bigotry, exclusivity and social injustice. Always speak up and work for human rights; try to realize that being human and sensitive to others is more important than any successful academic record. Showing compassion and understanding rooted in justice is more significant than a science formula. These are difficult lessons to learn because they demand that you risk all that you are now for what you could become tomorrow.

Look around you! We are living in a very challenging world. A new revolution is afoot; your generation is moving away from the indifference and the complacency of yesterday and is moving toward a new idealism of freedom and responsibility. It’s happening around the world, especially in the Middle East and in Africa. It’s not happening among the political elite, but among our young, our students, your peers. It gives me hope that tomorrow will be better.

May a kind word, a reassuring touch and a warm smile be yours every day of your life. Remember the sunshine when the storm seems unending. Teach love to those who know hate and let that love embrace you as you continue in the world.

Photo by Greg Catalano

Let the teachings of those you admire become a part of you so that you may call upon them. It is the content and quality of your character that is important, not merely the actions you take. Don’t judge a book by its cover, or stop at the introduction. Read it through; seek the meaning and messages it offers for life. Everyone’s life is sacred, even those who are different from you or whom you do not like.

Don’t be blinded by those who tend to use shame, blame, guilt and religion to shackle people down and divide them; set people free with your respect and nonjudgmental way.

We live in a world that is very deceptive. Don’t let the corrupt political rhetoric of our time blind your eyes, impair your hearing or shackle your dreaming. As you graduate, the social landscape that you must navigate is treacherous; be prepared to sail stormy waters, but don’t lose heart, draw on the goodness that lives within and the goodness of others to stay the course.

May your moral compass be grounded in respect for all human beings, no matter what their color, their race, their creed or their sexual orientation. May this compass guide you on a path that is committed to working for peace and social justice. As Gandhi once said, “Be the change that you wish to see in the world.”

Congratulations graduates of 2021! Thanks for making the world a little richer, a little brighter, a little more hopeful and a better place to be! 

Father Francis Pizzarelli, SMM, LCSW-R, ACSW, DCSW, is the director of Hope House Ministries in Port Jefferson.

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State Sen. Mario Mattera speaks at the May 21 press conference. Photo by Julianne Mosher

Last week, May 21, dozens of people from all walks of life gathered in front of the state office in Hauppauge to talk about how New York needs to fix its roadways.

Spearheaded by county Legislator Nick Caracappa (R-Selden), he had a bipartisan group of local and state representatives, as well as advocates for the safety of drivers, riders and walkers. 

The idea behind the press conference was to demand that Gov. Andrew Cuomo (D) fund more money toward fixing our roadways.

Ironically enough, that morning, a $30.6 million investment for resurface and repair projects was granted for Long Island state roads. 

But the meeting was still relevant. 

We heard the stories of motorcyclists, bike riders and people who choose to walk alongside state-run roads. They said how terrifying it is to navigate through the craters within the streets that are otherwise called potholes.

They are dangerous, and we applaud the legislator for standing his ground demanding more. We all complain that the roads are terrible around here — some towns are better than others because they have jurisdiction over their lanes. But when it comes to state roads — roads like Route 25 which drives completely through our newspapers’ coverage area, the Long Island Expressway and the Northern State Parkway — not only is it scary when you unintentionally hit a pothole, but it can be damaging to our vehicles.

Is New York State going to pay us back for the blown-out tires we’ve gotten driving to work? Are they going to repair our dented rims? 

No, they won’t. But the least the state can do is continuously fix up the large holes that sink into the blacktop. 

We know that it’s hard to keep up with. We know a lot of work goes into it. But after Friday’s conference, we know that there are many of us who want our major roadways to be safe.

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Pixabay photo

By Daniel Dunaief

Daniel Dunaief

A few weeks ago, a Chicago White Sox player named Yermin Mercedes did what he was paid to do, hitting a ball far. His manager Tony La Russa was furious because his player broke an unwritten rule, swinging at a 3-0 pitch from an infielder for the Minnesota Twins when his team was already winning by 11 runs.

The next day, La Russa seemed fine with a Minnesota pitcher throwing a pitch behind the knees of Mercedes as punishment for a violation of that unwritten rule.

So, what are other possible random unwritten rules regarding life sportsmanship and what should the potential punishments be for violating those rules?

For starters, if you’ve lost a lot of weight, you don’t need to ask other people who clearly haven’t lost any weight, or perhaps have put on pandemic pounds, how they’re doing on their diet or if they’ve lost weight. They haven’t lost any weight. We know it, they know and you know it. You don’t need to contrast your success with their failure. The punishment for that kind of infraction should be that you have to eat an entire box of donuts or cookies in under a minute.

If you rescued a dog from the vet or the pound or from a box beneath a bridge in the middle of an urban war zone, you don’t need to ask where I got my overpriced and poorly trained dog. We get it: you did something great rescuing a dog, while those of us with designer dogs are struggling to get them to be quiet while we repeat the few answers we get right to the questions on “Jeopardy!” The punishment for such self-righteous dog ownership should be that you have to pick up the designer dog’s poop for a day. If you’ve been over virtuous, you also might have to compliment him on the excellent quality of his droppings and send other people a TikTok of your poop flattery.

If your kid just won the chess championship, you don’t need to wear a different T-shirt each day of the week that captures the moment of her triumph. The punishment for over bragging is that you have to wear a tee shirt that says, “Your kid is just as amazing as mine and certainly has better parents.”

If you’re in first class on a plane and you board first to sit in your larger, more comfortable seat, you don’t have to look away every time someone might make eye contact or, worse, through your fellow passengers. You aren’t obligated to look at everyone, but you can make periodic eye contact or provide a nod of recognition to the plebeians from group six. The punishment for such above-it-all behavior should be that you have to echo everything the flight attendant says as others board the plane, offering a chipper “good morning” or “welcome aboard.”

Finally, if you’ve taken a spectacular vacation, you don’t need to share every detail of your trip, from the type of alcohol you drank to the sweet smell of the ocean breeze to the sight of a baby bird hatching just outside your window. If you overdo the unsolicited details, you’ll have to listen to every mundane detail of the person’s life who was home doing his or her job while you were relaxing. Afterwards, you’ll have to take a test on his story. If you fail, you have to listen to more details, until you can pass.

Maybe Mr. La Russa has a point: unwritten rules could be a way to enforce life sportsmanship outside the lines.

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Pixabay photo

By Leah S. Dunaief

Leah Dunaief

Probably because of COVID-19, there has been more discussion in the media about depression, anxiety and mental health in general. CVS, the nation’s largest retail pharmacy, and the one owned by the Melville Corporation, (the company started by local philanthropist Ward Melville by the way) is creating a new niche for its many stores. It has been hiring licensed clinical social workers for a pilot project in several cities and will offer walk-in sessions or by appointment. 

The social workers are trained in cognitive behavior therapy or CBT. I believe that is generally a form of short term therapy in which the immediate problem is discussed and treated using evidence-based techniques. According to an article in The New York Times, May 10, social workers will offer assessments, referrals and counseling. They will be available during the day and also on evenings and weekends, and also by telemedicine. They will partner with the company’s nurse practitioners and pharmacists for prescriptions when needed.  This will be yet another nonemergency health care service the chain is providing, as they have most recently offered coronavirus vaccines for the public.

Now others beside pharmacies like Rite Aid and Walgreens, who are also planning mental health care, are seeing opportunity in the health field. Albertsons, a grocery chain, offers injectable antipsychotic drugs as well as injectable medication to help treat substance abuse. And a while ago, I got my first shingles vaccine in a drug store.

What a change from the pharmacy of my childhood. I well remember walking down to the drug store five blocks away in New York City with my dad, before I was even of elementary school age, to buy ice cream. That was the only place with a freezer, and the selections were Breyer’s vanilla, or chocolate, or vanilla, chocolate and strawberry together in half gallon containers. They were in a freezer chest, like a foot locker, and when I leaned in to pick the selection, the cold took my breath away. The pharmacy also had a counter where we could sit and get sundaes and milkshakes. But most of the time, we carried the ice cream carton home, hurriedly so it wouldn’t melt, to eat together with the rest of the family.

Another recent focus in the mental health field is on food. And sadly the foods we typically turn to when we are stressed, inevitably sugar-laden and of high fat like ice cream, pastries, pizza and hamburgers, now are on the mental wellness bad list. Nutritional psychiatry is an emerging field which looks at the relationship between diet and mental health. The idea that what we eat can affect our physical health is an accepted one, and now the same concept is extended to our mental wellbeing with the following physiological specifics thanks to research. 

“A healthy diet promotes a healthy gut, which communicates with the brain through what is known as the gut-brain axis. Microbes in the gut produce neurotransmitters like serotonin and dopamine, which regulate our mood and emotions, and the gut microbiome has been implicated in mental health outcomes,” states The New York Times in a May 18 article by Anahad O’Connor.

People who eat a lot of nutrient-dense foods, like fruits and vegetables “report less depression and greater levels of happiness and mental well-being,” according to the NYT.

There is a bit of a chicken-egg conundrum here concerning which comes first? Do anxiety and depression drive people to eat unhealthy foods or are those who are happy and optimistic more likely to choose nutritious foods that further brighten their moods? Recent research has borne out that healthy foods do improve moods.

“Seafood, greens, nuts and beans — and a little dark chocolate” is the basic dietary advice of Dr. Drew Ramsey, a psychiatrist and assistant clinical professor at Columbia University College of Physicians and Surgeons. His jingle comes with the message that food can be empowering.

*This article was revised on June 1, 2021.

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Moderation is the key. Photo from Pexels
Modest alcohol consumption may decrease stroke risk in women

By David Dunaief

Dr. David Dunaief

Alcohol is one of the most widely used over-the-counter drugs, and there is much confusion over whether it is beneficial or detrimental to your health. The short answer: it depends on your circumstances, including your family history and consideration of diseases you are at high risk of developing. 

Several studies have been published – some touting alcohol’s health benefits, with others warning of its risks. The diseases addressed by these studies include breast cancer, heart disease and stroke. Remember, context is the determining factor for alcohol intake.

Breast Cancer Impact

In a meta-analysis of 113 studies, there was an increased risk of breast cancer with daily consumption of alcohol (1). The increase was a modest, but statistically significant, four percent, and the effect was seen at one drink or less a day. The authors warned that women who are at high risk of breast cancer should not drink alcohol or should drink it only occasionally.

It was also shown in the Nurses’ Health Study that drinking three to six glasses a week increases the risk of breast cancer modestly over a 28-year period (2). This study involved over 100,000 women. Even a half-glass of alcohol was associated with a 15 percent elevated risk of invasive breast cancer. The risk was dose-dependent, with one to two drinks per day increasing risk to 22 percent, while those having three or more drinks per day had a 51 percent increased risk.

Alcohol’s impact on breast cancer risk is being actively studied, considering types of alcohol, as well as other mitigating factors that may increase or decrease risk. We still have much to learn.

Based on what we think we know, if you are going to drink, a drink several times a week may have the least impact on breast cancer. According to an accompanying editorial, alcohol may work by increasing the levels of sex hormones, including estrogen, and we don’t know if stopping diminishes the effect, although it might (3).

Stroke Effects

On the positive side, the Nurses’ Health Study demonstrated a decrease in the risk of both ischemic (caused by clots) and hemorrhagic (caused by bleeding) strokes with low to moderate amounts of alcohol (4). This analysis involved over 83,000 women. Those who drank less than a half-glass of alcohol daily were 17 percent less likely than nondrinkers to experience a stroke. Those who consumed one-half to one-and-a-half glasses a day had a 23 percent decreased risk of stroke, compared to nondrinkers. 

However, women who consumed more experienced a decline in benefit, and drinking three or more glasses daily resulted in a non-significant increased risk of stroke. The reasons for alcohol’s benefits in stroke have been postulated to involve an anti-platelet effect (preventing clots) and increasing HDL (“good”) cholesterol. Patients shouldn’t drink alcohol solely to get stroke protection benefits. 

Moderation is the key.
METRO photo

Heart effects

In the Health Professionals follow-up study, there was a substantial decrease in the risk of death after a heart attack from any cause, including heart disease, in men who drank moderate amounts of alcohol compared to those who drank more or were non-drinkers (5). Those who drank less than one glass daily experienced a 22 percent risk reduction, while those who drank one-to-two glasses saw a 34 percent risk reduction. The authors mention that binge drinking negates any benefits. This study has a high durability spanning 20 years.

Citrus benefits rival alcohol benefits for stroke risk

An analysis of the Nurses’ Health Study recently showed that those who consumed more citrus fruits had approximately a 19 percent reduction in stroke risk (6). These results were similar to the reduction seen in the Nurses’ Health Study with modest amounts of alcohol.

The citrus fruits used most often in this study were oranges and grapefruits. Of note, grapefruit may interfere with medications such as Plavix (clopidogrel), a commonly used antiplatelet medication used to prevent strokes (7). Grapefruit inhibits the CYP3A4 system in the liver, thus increasing the levels of certain medications.

Alcohol in Moderation

Moderation is the key. It is very important to remember that alcohol is a drug that does have side effects, including insomnia. The American Heart Association recommends that women drink up to one glass a day of alcohol. I would say that less is more. To get the stroke benefits and avoid the increased breast cancer risk, half a glass of alcohol per day may be the ideal amount for women. Moderate amounts of alcohol for men are up to two glasses daily, though one glass showed significant benefits. 

Remember, there are other ways of reducing your risk of these maladies that don’t require alcohol. However, if you enjoy alcohol, moderate amounts may reap some health benefits.

References:

(1) Alc and Alcoholism. 2012;47(3)3:204–212. (2) JAMA. 2011;306:1884-1890. (3) JAMA. 2011;306(17):1920-1921. (4) Stroke. 2012;43:939–945. (5) Eur Heart J. Published online March 28, 2012. (6) Stroke. 2012;43:946–951. (7) Medscape.com.

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

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