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Zinc supplements (available as tablets, syrup or lozenges) should be taken within 24 hours of the onset of a cold. Stock photo
Supplements and exercise for the common cold

By David Dunaief, M.D.

Dr. David Dunaief

All of us have suffered at some point from the common cold. Most frequently caused by the notorious human rhinovirus, for many, it is an all too common occurrence. Amid folklore about remedies, there is evidence that it may be possible to reduce the symptoms — or even reduce the duration — of the common cold with supplements and lifestyle management.

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

Zinc

You may have heard that zinc is an effective way to treat a cold. But what does the medical literature say?

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

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

The caveat is that not all studies showed a benefit. However, the benefits generally seem to outweigh the risks, except in the case of nasal administration, which the FDA has warned against.

Unfortunately, all of the studies where there was a proven benefit may have used different formulations, delivery systems and dosages, and there is no current recommendation or consensus on what is optimal.

Vitamin C

According to a review of 29 trials with a combined population of over 11,000, vitamin C did not show any significant benefit in prevention, reduction of symptoms or duration in the general population (3). Thus, there may be no reason to take mega-doses of vitamin C for cold prevention and treatment. However, in a subgroup of serious marathon runners and other athletes, there was substantial risk reduction when taking vitamin C prophylactically; they caught 50 percent fewer colds.

Echinacea

After review of 24 controlled clinical trials, according to the Cochrane Database, the jury is still out on the effectiveness of echinacea for treatment of duration and symptoms, but the results are disappointing presently and, at best, are inconsistent (4). There are no valid randomized clinical trials for cold prevention using echinacea.

In a randomized controlled trial with 719 patients, echinacea was no better than placebo for the treatment of the common cold (5).

Exercise

People with colds need rest — at least that was the theory. However, a 2010 study published in the British Journal of Sports Medicine may have changed this perception. Participants who did aerobic exercise at least five days per week, versus one or fewer days per week, had a 43 percent reduction in the number of days with colds over two 12-week periods during the fall and winter months (6). Even more interesting is that those who perceived themselves to be highly fit had a 46 percent reduction in number of days with colds compared to those who perceived themselves to have low fitness. The symptoms of colds were reduced significantly as well.

What does all of this mean?

Zinc is potentially of great usefulness the treatment and prevention of the common cold. Echinacea and vitamin C may or may not provide benefits, but don’t stop taking them, if you feel they work for you. And, if you need another reason to exercise, reduction of your cold’s duration may a good one.

References:

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

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

٭We invite you to check out our weekly Medical Compass MD Health Videos on Times Beacon Record News Media’s website, www.tbrnewsmedia.com.٭

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Fruit, like these Sumo Citrus, is a good source of fiber. Photo by Heidi Sutton
Modest lifestyle changes have a resounding effect

By David Dunaief, M.D.

Dr. David Dunaief

We can significantly reduce the occurrence of heart disease, the number one killer in the United States, by making modest lifestyle changes.

According to the Centers for Disease Control and Prevention, there are 790,000 heart attacks annually and 210,000 of these occur in those who’ve already had a first heart attack (1). Here, I will provide specifics on how to make changes to protect you and your family from heart disease, regardless of family history.

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

Chocolate effect

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

I usually recommend that patients have one to two squares – about one-fifth to two-fifths of an ounce – of dark chocolate daily. Who says prevention has to be painful?

Role of fiber

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

The average American consumes about 16 grams per day of fiber (4). 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 (5). Therefore, we can significantly reduce our risk of heart disease if we increase our consumption of fiber to reach the recommended levels. Good sources of fiber are whole grains and fruits.

Omega-3 fatty acids

In a study with over 45,000 men, there were significant reductions in coronary heart disease with omega-3 PUFAs. Both plant-based and seafood-based omega-3s showed these effects (7). Good sources of omega-3s from plant-based sources include nuts, such as walnuts, and ground flaxseed.

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

Legumes’ impact

In a prospective (forward-looking) cohort study, the First National Health and Nutrition Examination Survey Epidemiologic Follow-up Study (NHEFS), legumes reduced the risk of coronary heart disease by a significant 22 percent. Those who consumed four or more servings per week, compared to those who consumed less than one serving, saw this effect. The legumes used in this study included beans, peas and peanuts (6). There were over 9,500 men and women involved, spanning 19 years of follow-up. I recommend that patients consume at least one to two servings a day, or 7 to 14 a week. Imagine the impact that would have, compared to the modest four servings per week used to reach statistical significance.

References:

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

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

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Team G.O.A.T.
Junior Iron Chef 2019
The prizes
Junior Iron Chef 2019
Junior Iron Chef 2019
The Flaming Hot Cheetos
The Salt Shakers
Crepes with Strawberries
Quinoa Burgers
Junior Iron Chef 2019
Vanilla Fruit Crepes
Junior Iron Chef 2019
Team Bacon Bits
Gyro Style Veggie Burger on Whole Wheat Pita
Chef Jason Keubler and Anthony Cafaro with contestants
Potato Latkes
The Flaming Hot Cheetos
Quinoa Burger
Junior Iron Chef 2019
Crunchy Avocado French Toast with Egge, Cheese Mango Salsa
Celebrity chefs Kayla Mitchell and William Connor helped judge the event last Saturday.
Junior Iron Chef 2019
Team Almost Top Chef
Team Akatsuki
Team Almost Master Chef with their Mise en Place award.
Henry of Mount Sinai, center, takes part in a trivia contest with WEHM’s Anthony Cafaro

By Heidi Sutton

Teamwork was the key ingredient at this year’s Junior Iron Chef competition. The annual event, now in its 7th year, was held on March 9 at Whole Foods in Lake Grove. Hosted by Cornell Cooperative Extension of Suffolk County, the one-day cooking challenge, described as “part ‘Chopped,’ part ‘Iron Chef,’ and part ‘Food Network Challenge,’” gave middle and high school students the opportunity to work in groups of three to five to complete a delicious dish of their choosing in under an hour. Fifteen teams from all over Long Island competed this year for the ultimate title of Junior Iron Chef.

“This is an amazing event,” said DJ Anthony Cafaro, from WEHM, who has served as the event’s emcee since its inception. “It’s cool to see some repeat competitors from year’s past and it’s awesome to see a lot of new competitors here,” he said.

The purpose of the event was to encourage budding chefs to learn new cooking skills and lead a healthier lifestyle while promoting the use of local food to support our local farmers and environment. Each team was required to  create a new healthy vegetarian or vegan based recipe that used local ingredients and could be easily implemented into school cafeteria menus.

“This is the seventh year I’ve done this and by far this was the greatest year with the best flavors,” said Cafaro as he tasted all the dishes.

Celebrity chefs Kayla Mitchell and William Connor helped judge the event last Saturday.

Among the 11 judges who graded the dishes based on flavor, health value, creativity and presentation was 14-year-old William Connor from Northport, a past contestant on “Chopped Junior” on the Food Network,  and 13-year-old Kayla Mitchell of Center Moriches who was a contestant on the third season of “MasterChef Junior” on Fox Broadcasting.

High school teams were given a secret ingredient at the last minute, a Sumo Citrus, to incorporate into their dish. Some chose to use the peel, others the juice. While the teams created their dishes, Cafaro kept the ever-growing crowd entertained with fun trivia and giveaways to places like the Long Island Aquarium and concerts.

While the judges deliberated, Executive Chef Jason Keubler and Anthony Cafaro visited each station, tasting each dish and giving feedback to the aspiring chefs. While Cafaro raved over everything that was put in front of him, Keubler gave positive feedback, from “These eggs are spot on,” “Flavors are very balanced,” “Great knife skills,” to pointing out the cleanliness of their workstation and asking them what their greatest obstacle was. “It’s all about teamwork and it shows in your work,” he complimented one team.

First place in the middle school division went to Team G.O.A.T. (Greatest Of All Time) from Seneca Middle School in Holbrook. Students Leah Ferraro, Sofia Iacono, Jacqueline Volo and Gianna Scolaro, guided by coach Robert Frontino, won the judges over with their creative Caribbean Breakfast Salad, which was comprised of cinnamon sugared French toast, grilled pineapple and arugula salad with goat cheese, topped with a raspberry vinaigrette dressing.

“That’s insanely good,” drooled Cafaro as he reached for a napkin. “The cinnamon and the goat cheese go so well together,” agreed Chef Jason. “The color is super vibrant, the spiciness goes with the sweetness with nice textures. Beautiful presentation,” he said adding that he was impressed by how nicely they worked together “just like in a professional kitchen.”

Second place was awarded to The 3 Breakfasteers from Suffolk County 4-H Trailblazers of Yaphank for their Vanilla Fruit Crepes filled with whipped cream and diced strawberries and garnished with blueberries. Corey Burke, Alexis Vladikin, Nora Nemickas and coach Nicole Vickovich made up the team.

The Junior Porters from Greenport Union Free School District grabbed third place for their Mediterranean Breakfast Crepe with an Herbed Whipped Cream. Coached by Katherine Ryan, Rocio Azama, DeShawn Solla, Aleyana Gungar, Ayania Smith and Brynn Dinizio were awarded for their healthy crepe stuffed with baby spinach, sundried tomatoes, black olives and low-fat feta cheese.

Team Almost Master Chef from Sachem North High School in Ronkonkoma captured first place in the high school division. Kaitlyn Seitz, Hailey McKishi, Kayla Salvate and Victoria Corcaran, under the guidance of coach Lindsey Shelhorse, impressed the judges with their Brunch For Lunch Chilaquiles dish featuring homemade tortilla shells topped with fried egg, cheese, onion and cilantro.

Second place was awarded to the Greenport High School’s Bacon Bits – Jhon Ramirez, Tommy Tsaveras, Colin Rossetti, Mateo Arias and Charles Staples – for their Gyro Style Veggie Burger on Whole Wheat Pita, which was served with sautéed onions and tzatziki sauce with a cucumber garnish. The team was coached by Marianne Ladalia.

The Salt Shakers from the Suffolk County 4-H Trailblazers garnered third place. Olivia Unger and Lexington Carrera, under the guidance of coach Adrienne Unger, were given high marks for their crispy Potato Latkes topped with a dollop of sour cream and garnished with chives and scallions.

The Mise en Place (everything in its place) awards were presented to Seneca Middle School’s Taco Bellas (Emma Bollinger, Amanda Madigan, Madeline Turano and Adrianna Sigler with coach Robert Frontino) and Almost Master Chef.

The Public Presentation awards, for the team with the best poster/informational display and judge presentation, were presented to G.O.A.T. and Bacon Bits.

“The kids today were just tremendous,” said Vito Minei, executive director of Cornell Cooperative Extension of Suffolk County. “This is truly a Long Island Junior Iron Chef competition with teams coming all the way from Floral Park, Franklin Square and Greenport,” he added. “I want to thank all the parents and families.You should be proud. These kids were fabulous. They all practiced teamwork and each child had an opportunity to shine.”

Brunch for Lunch Chilaquiles 

by Team Almost Top Chef, first place winners in the high school division

Ingredients

Tortilla Shell

10.5 ounces of all purpose flour

1 teaspoon baking powder

½ teaspoon salt

¼ cup vegetable oil

7-8 ounces of hot water (110-120F)

Sauce

Diced yellow onion

Diced and seeded jalapeño

3 tablespoons olive oil

2 cloves of garlic

1 tablespoon ground chili powder

1 teaspoon ground cumin

3 tablespoons flour

½ teaspoon garlic powder

¼ teaspoon dried oregano

¼ teaspoon salt, to taste

Pinch of cinnamon

Can of tomato paste

2 cups vegetable broth

1 teaspoon distilled white vinegar

Freshly ground black pepper, to taste

Filling and Topping Ingredients

Can of drained and rinsed black beans

12 oz. Fiesta Blend Cheese (365 Everyday Value Brand)

3 oz. cotija

Diced red onion

Cilantro

6 Eggs

Directions

 Instructions for sauce

  1. Sauté the diced onion and jalapenos to the pan.
  2. Crush and smash cloves of garlic and salt and add to the onion mixture.  Add the cumin and chili powder.  Add the flour, oregano, garlic powder and salt into a small bowl and place it near the stove.
  3. Add the flour/spice mixture.
  4. While whisking constantly, cook until fragrant and slightly deepened in color, about 1 minute. Whisk the tomato paste into the mixture, then slowly pour in the broth while whisking constantly to remove any lumps.
  5. Raise heat to medium-high and bring the mixture to a simmer, then reduce heat as necessary to maintain a gentle simmer. Cook, whisking often, for about 5 to 7 minutes.
  6. Remove from heat, then whisk in the vinegar and season to taste with a generous amount of freshly ground black pepper. Add more salt, if necessary.
  7. Stir in the black beans

Instructions for tortillas

To make the dough: In a medium-sized bowl, whisk together the flour, baking powder, and salt. Pour in the lesser amount of hot water (plus the oil, if you’re using it), and stir briskly with a fork or whisk to bring the dough together into a shaggy dough.Turn the dough out onto a lightly floured counter and knead briefly, just until the dough forms a ball. Divide the dough into 8 pieces. Round the pieces into balls, flatten slightly, and allow them to rest, covered, for about 15 minutes.  Preheat ungreased cast iron griddle or skillet over medium high heat, about 400°F. Working with one piece of dough at a time, roll into a round about 8″ in diameter. Keep the remaining dough covered while you work. Fry the tortilla in the ungreased pan for about 30 seconds on each side. Then cut into wedges and fry them and add salt to taste.

Assembling

Fry the eggs. Layer the fried tortilla shell with spoonful of sauce and cheese.  Top with the fried egg, more cheese, dice red onion and cilantro.

Caribbean Breakfast Salad

By Team G.O.A.T., first place winners in the middle school division

Ingredients

16 oz of arugula

8 oz of goat cheese

2 boxes of raspberries (7 oz. each)

1 pineapple

1 loaf challah bread

1/2 cup olive oil

1/2 tsp Dijon mustard

1/4 tsp. oregano

1/4 cup white vinegar

1/2 cup brown sugar

1/3 cup white sugar

1/4 cinnamon

4 eggs

2 tbsp honey

Directions

Challah French Toast

Preheat skillet to 350 degrees. Mix eggs in large bowl. In a separate bowl mix sugars and cinnamon. Dip the challah bread slices into egg mixture and then the sugar blend. Cook until golden brown, 3 to 4 minutes.

Arugula Salad

Mix oil, vinegar, honey and mustard and whip until blended. Strain the raspberries. Add raspberry juice to oil mixture until smooth to taste. Toss arugula, whole raspberries and cheese together with liquid dressing.

Pineapple

Cut outside skin of pineapple. Cut one inch horizontal slices. Dip in sugar mixture. Grill on both sides for 2 to 3 minutes.

All photos by Heidi Sutton

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Dr. David Fiorella with patient Danielle Santilli who received a new treatment for aneurysms. Photo by Greg Filiano

By Daniel Dunaief

[email protected]

Danielle Santilli grappled with numerous discomforts, from headaches to nausea to dizziness, especially when she traveled in a car or stood up quickly. After a series of tests, however, she learned she had a wide-necked bifurcation aneurysm, which is one of the more common types of aneurysms.

A diagnosis that has potentially severe consequences, an aneurysm is an area in a blood vessel that grows like a balloon. If it ruptures, it can cause dangerous bleeding.

Santilli became a patient of Stony Brook Medicine’s interventional radiologist and professor of neurological surgery and radiology David Fiorella. Santilli was thrilled with the timing, as Fiorella was a co-principal investigator on a recently completed U.S. Food and Drug Administration study for a minimally invasive surgical technique that involves implanting a Woven EndoBridge or WEB.

“I feel very fortunate,” Santilli said of the opportunity to be one of the first to receive the treatment.

The FDA approved the use of the WEB in January. European doctors have used it effectively since 2011.

The WEB is a spherical structure that’s braided out of fine-shaped memory filaments of metal called nitinol, which is a combination of nickel and titanium. The WEB behaves more like a rubber band than a paper clip and wants to return to its original shape. Doctors insert it into a microcatheter in the femoral artery near the groin. Once they release it in an aneurysm and stretch it out, the WEB expands into a spherical shape inside the blood vessel.

The body grows new tissue over the aneurysm neck along the metal mesh, which is akin to sealing off a well.

The alternative for people with this type of aneurysm can often involve more invasive, open-brained surgery, Fiorella said.

The procedure takes about 40 minutes and often requires a one-night hospital stay. Patients with a WEB procedure also require aspirin for a short period, compared with six months of a blood thinner and then aspirin for much longer periods for other surgical alternatives.

Fiorella explained that there were two types of aneurysms. An unruptured version typically doesn’t have any symptoms. Doctors usually discover these through a screening for other symptoms or because of a family history. Patients in this group sometimes receive scans for different and unrelated reasons.

Robert Walsh, a 66-year-old retiree and resident of South Jamesport, went to a doctor to check himself out after his younger sister died earlier this year from an aneurysm. Tests revealed that he, too, had an aneurysm.

A month after his sister died, Walsh had the WEB procedure.

Fiorella and his staff “are probably the best I’ve ever encountered,” Walsh said. “I’m impressed with him and his entire staff for everything they did, with follow-ups, calling in prescriptions, getting my pre-op ready. I have a lot of confidence in Dr. Fiorella.”

People with a ruptured aneurysm are dealing with bleeding into their brain. This typically causes symptoms like the worst headache people have ever had, vomiting or a loss of consciousness of rapid neurological deterioration.

The survival rate for people in these circumstances is lower and depends on whether they make it to the hospital.

The WEB is helpful for patients who have a ruptured aneurysm. Other techniques, such as stents, are not usable for patients under these conditions.

“A lot of other tools are off the table” with a ruptured aneurysm, but the WEB is “very effective,” Fiorella said.

Some potential patients with a wide-necked bifurcation may not be good candidates for a WEB because their aneurysm is too small or too large for the device.

Stony Brook has extensive experience with the WEB. Doctors who want to perform a similar procedure at other hospitals need extensive training from experienced physicians who can prepare them for the procedure.

Long Island residents should know they have a “major center right here that’s doing work that surpasses anything going on in Long Island or, in most cases, in the city” with endovascular surgery, Fiorella said.

Santilli feels the doctor “saved my life,” and is delighted that she “doesn’t have to worry about using a blood thinner.”

The procedure changed the way Santilli and her family live. They are making healthier lifestyle choices. She and her husband Frank are cutting back on smoking, and she is also buying fruit instead of sugary snacks for the house.

Santilli said she feels fortunate that Fiorella was able to perform the procedure.

“I feel like I got a second chance,” she said.

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Leah Dunaief

By Leah S. Dunaief

So, how are those New Year’s resolutions going? Do you even remember what they were? If you are sticking to them, heartfelt congratulations. You are one of few with the discipline and tenacity to hang on. But if you are in the majority for having slipped or temporarily abandoned your resolves, here is some help. It’s called habits.

Habits can be a valuable tool to change your life, both for the better and not. By that I mean, we can slip into some unwelcome behaviors and they become habits almost before we realize it. Or we can consciously take control and set out to break or redefine or make new ones, and as they become part of a routine, they become easier to follow.

This is all far simpler than it sounds, of course. There is a whole branch of science dealing with habits, the unconscious behavioral patterns formed to deal with actions. “We do not so much direct our own actions as become shaped by them,” wrote Jeffrey Kluger in his introductory chapter for a special edition from Time Inc. called “The Power of Habits.”

He points out, by quoting Léon Dumont — the 19th century French psychologist and philosopher — that “a garment, after having been worn a certain amount of time, clings to the shape of the body better than when it was new. There has been a change in the tissue, and this change is a new habit of cohesion.” That is certainly true of the old, comfy pair of slippers that, despite their age, you hate to replace them, and the old pair of pants that have come to fit you like a glove.

Accordingly, the manner of our actions “fashion for themselves in the nervous system more and more appropriate paths.” Kluger here is again quoting Dumont, who studied the science of laughter, of gratitude, of empathy and, for our purposes here, the science of habits.

William James, the American philosopher greatly influenced by Dumont, suggested that people were little more than “bundles of habits.” The point of all this is to build on the idea that if we can shape our brains and the rest of our nervous systems the way we shape a pair of pants, we can control and redirect our lives to follow the actions we wish to take, namely our resolutions to be better.

Think about how many of our daily moves are just programmed in. We get up in the morning and automatically brush our teeth, take a shower, dress, put up the coffee, get our keys, slide behind the wheel of the car, place the coffee cup in the holder, drive to work, all probably while thinking of something else. Occasionally we are surprised to find we have arrived at our destination without consciously paying attention to the route. Almost all of that execution was the result of habit.

Well, suppose you built another step in there, like running 20 minutes on that treadmill or stationary bike collecting dust in your basement before you got into the shower. You like to watch the morning TV shows? Jog along with them as you watch. If you repeat that action for awhile, it could become a habit and presto! You are doing the recommended minutes of exercise a week without the ironclad discipline seemingly required each day.

It just becomes as much a habit as brushing your teeth. If you are forever locked into dipping into the candy jar in the evenings, and you find you are gaining weight, substitute chilled blueberries or red grapes from a cut-glass bowl within reach of your fingers. Of course you have to remember to buy the blueberries or grapes beforehand, wash them and keep them in the refrigerator at the ready.

Complex habits, like procrastination or chronic lateness or smoking are harder to unlearn — but not impossible. We can rewire ourselves, using substitutions or rewards, splinting a bad habit onto a good one for support or hanging out with those whose actions we would like to emulate.

Here’s the bottom line: We can do it. It will just take time for a new behavior to feel part of our routine, an average of two weeks or so. To become a habit will average 66 days.

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Too much milk may be bad for your health. Stock photo
Does dairy really build strong bones?

By David Dunaief, M.D.

Dr. David Dunaief

The prevalence of osteoporosis is increasing, especially as the population ages. Why is this important? Osteoporosis may lead to increased risk of fracture due to a decrease in bone strength (1). That is what we do know. But what about what we think we know?

For decades we have been told that if we want strong bones, we need to drink milk. This has been drilled into our brains since we were toddlers. Milk has calcium and is fortified with vitamin D, so milk could only be helpful, right? Not necessarily.

The data is mixed, but studies indicate that milk may not be as beneficial as we have been led to believe. Even worse, it may be harmful. The operative word here is “may.” We will investigate this further. Vitamin D and calcium are good for us. But do supplements help prevent osteoporosis and subsequent fractures? Again the data are mixed, but supplements may not be the answer for those who are not deficient.

Milk – it’s not what you think

The results of a large, observational study involving men and women in Sweden showed that milk may be harmful (2). When comparing those who consumed three or more cups of milk daily to those who consumed less than one, there was a 93 percent increased risk of mortality in women between the ages of 39 and 74. There was also an indication of increased mortality based on dosage.

For every one glass of milk consumed there was a 15 percent increased risk of death in these women. There was a much smaller, but significant, 3 percent per glass increased risk of death in men. Women experienced a small, but significant, increased risk of hip fracture, but no increased risk in overall fracture risk. There was no increased risk of fracture in men, but there was no benefit either. There were higher levels of biomarkers that indicate oxidative stress and inflammation found in the urine.

This study was 20 years in duration and is eye-opening. We cannot make any decisive conclusions, only associations, since it is not a randomized controlled trial. But it does get you thinking. The researchers surmise that milk has high levels of D-galactose, a simple sugar that may increase inflammation and ultimately contribute to this potentially negative effect, whereas other foods have many-fold lower levels of this substance.

Ironically, the USDA recommends that, from 9 years of age through adulthood, we consume three cups of dairy per day (3). This is interesting, since the results from the previous study showed the negative effects at this recommended level of milk consumption. The USDA may want to rethink these guidelines.

Prior studies show milk may not be beneficial for preventing osteoporotic fractures. Specifically, in a meta-analysis that used data from the Nurses’ Health Study for women and the Health Professionals Follow-up Study for men, neither men nor women saw any benefit from milk consumption in preventing hip fractures (4).

Calcium disappointments

Unfortunately, it is not only milk that may not be beneficial. In a meta-analysis involving a group of observational studies, there was no statistically significant improvement in hip fracture risk in those men or women ingesting at least 300 mg of calcium from supplements and/or food on a daily basis (5).

The researchers did not differentiate the types of foods containing calcium. In a group of randomized controlled trials analyzed in the same study, those taking 800 to 1,600 mg of calcium supplements per day also saw no increased benefit in reducing nonvertebral fractures. In fact, in four clinical trials the researchers actually saw an increase in hip fractures among those who took calcium supplements. A weakness of the large multivaried meta-analyses is that vitamin D baseline levels, exercise and phosphate levels were not taken into account.

Vitamin D benefit

Finally, though the data is not always consistent for vitamin D, when it comes to fracture prevention, it appears it may be valuable. In a meta-analysis (involving 11 randomized controlled trials), vitamin D supplementation resulted in a reduction in fractures (6). When patients were given a median dose of 800 IUs (ranging from 792 to 2,000 IUs) of vitamin D daily, there was a significant 14 percent reduction in nonvertebral fractures and an even greater 30 percent reduction in hip fractures in those 65 years and over. However, vitamin D in lower levels showed no significant ability to reduce fracture risk.

Just because something in medicine is a paradigm does not mean it’s correct. Milk may be an example of this. No definitive statement can be made about calcium, although even in randomized controlled trials with supplements, there seemed to be no significant benefit. Of course, the patients in these trials were not necessarily deficient in calcium or vitamin D.

In order to get benefit from vitamin D supplementation to prevent fracture, patients may need at least 800 IUs per day, which is the Institute of Medicine’s recommended amount for a relatively similar population as in the study.

Remember that studies, though imperfect, are better than tradition alone. Prevention and treatment therefore should be individualized, and deficiency in vitamin D or calcium should usually be treated, of course. Please, talk to your doctor before adding or changing any supplements.

References:

(1) JAMA. 2001;285:785-795. (2) BMJ 2014;349:g6015. (3) health.gov. (4) JAMA Pediatr. 2014;168(1):54-60. (5) Am J Clin Nutr. 2007 Dec;86(6):1780-1790. (6) N Engl J Med. 2012 Aug. 2;367(5):481.

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

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Elimination diets may play a role in treating eczema. Stock photo
Broken bones are a common side effect of eczema

By David Dunaief, M.D.

Dr. David Dunaief

Eczema is a common problem for both children and adults. In the United States, more than 10 percent of the adult population is afflicted (1), with twice as many females as males affected (2).

Referred to more broadly as atopic dermatitis, its cause is unknown, but it is thought that nature and nurture are both at play (3). Eczema is a chronic inflammatory process that involves symptoms of pruritus (itching) pain, rashes and erythema (redness) (4). There are three different severities: mild, moderate and severe. Adults tend to have eczema in the moderate-to-severe range.

Treatments for eczema run the gamut from over-the-counter creams and lotions to prescription steroid creams to systemic (oral) steroids and, now, injectable biologics. Some use phototherapy for severe cases, but the research on phototherapy is scant. Antihistamines are sometimes used to treat the itchiness. Also, lifestyle modifications may play an important role, specifically diet. Two separate studies have shown an association between eczema and fracture, which we will investigate further. Let’s look at the evidence.

Eczema doesn’t just scratch the surface

Eczema may also be related to broken bones. In an observational study, results showed that those with eczema had a 44 percent increased risk of injury causing limitation and an even more disturbing 67 percent risk of bone fracture and bone or joint injury for those 30 years and older (5). And if you have both fatigue or insomnia and eczema, you are at higher risk for bone or joint injury than having one or the other alone. One reason for increased fracture risk, the researchers postulate, is the use of corticosteroids in treatment.

Steroids may weaken bone, ligaments and tendons and may cause osteoporosis by decreasing bone mineral density. Chronic inflammation may also contribute to the risk of bone loss. There were 34,500 patients involved in the study, ranging in age from 18 to 85. For those who have eczema and have been treated with steroids, it may be wise to have a DEXA (bone) scan.

Are supplements the answer?

The thought of supplements somehow seems more appealing for some than medicine. There are two well-known supplements for helping to reduce inflammation, evening primrose oil and borage oil. Are these supplements a good replacement for – or addition to – medications? The research is really mixed, leaning toward ineffective.

In a meta-analysis (involving seven randomized controlled trials, the gold standard of studies), evening primrose oil was no better than placebo in treating eczema (6). The researchers also looked at eight studies of borage oil and found there was no difference from placebo in terms of symptom relief. One positive is that these supplements only had minor side effects. But don’t look to supplements for help.

Where are we on the drug front?

The FDA approved a biologic monoclonal antibody, dupilumab (7). In trials, this injectable drug showed good results, improving outcomes for moderate to severe eczema sufferers when topical steroids alone were not effective.

Do probiotics have a place?

When we think of probiotics, we think of taking a pill. However, there are also potentially topical probiotics with atopic dermatitis. In preliminary in-vitro (in a test tube) studies, the results look intriguing and show that topical probiotics from the human microbiome (gut) could potentially work as well as steroids (8). This may be part of the road to treatments of the future. However, this is in very early stage of development.

What about lifestyle modifications?

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 (9).

Elimination diets may also play a role. One study’s results showed when eggs were removed from the diet in those who were allergic, according to IgE testing, eczema improved significantly (10).

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

I also have a personal interest in eczema. I suffered from hand eczema, where my hands would become painful and blotchy and then crack and bleed. This all stopped for me when I altered my diet many years ago.

Eczema exists on a spectrum from annoying to significantly affecting a patient’s quality of life (11). Supplements may not be the solution, at least not borage oil or evening primrose oil. However, there may be promising topical probiotics ahead and medications for the hard to treat. It might be best to avoid long-term systemic steroid use; it could not only impact the skin but also may impact the bone. Lifestyle modifications appear to be very effective, at least at the anecdotal level.

References:

(1) J Allergy Clin Immunol. 2013;132(5):1132-1138. (2) BMC Dermatol. 2013;13(14). (3) Acta Derm Venereol (Stockh) 1985;117 (Suppl.):1-59. (4) uptodate.com. (5) JAMA Dermatol. 2015;151(1):33-41. (6) Cochrane Database Syst Rev. 2013;4:CD004416. (7) Medscape.com. (8) ACAAI 2014: Abstracts P328 and P329. (9) Allergy. 2010 Jun 1;65(6):758-765. (10) J Am Acad Dermatol. 2004;50(3):391-404. (11) Contact Dermatitis 2008; 59:43-47.

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

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Studies have shown that eating less animal protein may prolong your life. Stock photo
Plant protein trumps animal protein

By David Dunaief, M.D.

Dr. David Dunaief

When asked what is more important, longevity or healthy aging (quality of life), more people choose the latter. Well, it turns out the two are not mutually exclusive.

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

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

In a study of centenarians, genetics played a significant role. Characteristics of this group were that they tended to be healthy and then die rapidly, without prolonged suffering (3).

Factors that predict one’s ability to reach this exclusive club may involve both genetics and lifestyle choices. Let’s look at the research.

We are told time and time again to exercise. But how much do we need, and how can we get the best quality? In a 2014 study, the results showed that 5 to 10 minutes of daily running, regardless of the pace, can have a significant impact on life span by decreasing cardiovascular mortality and all-cause mortality (4).

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

An accompanying editorial to this study noted that more than 50 percent of people in the United States do not meet the current recommendation of at least 30 minutes of moderate exercise per day (5).

Diet

A long-standing paradigm is that we need to eat sufficient animal protein. However, there have been cracks developing in this façade, especially as it relates to longevity. In an observational study using NHANES III data, results show that those who ate a high-protein diet (greater than 20 percent from protein) had a twofold increased risk of all-cause mortality, a four times increased risk of cancer mortality and a four times increased risk of dying from diabetes (6). This was over a considerable duration of 18 years and involved almost 7,000 participants ranging in age at the start of the study from 50 to 65.

However, this did not hold true if the protein source was plants. In fact, a high-protein plant diet may 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.

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

The Adventists Health Study 2 trial reinforced this data. It looked at Seventh-day Adventists, a group that emphasizes a plant-based diet, and found that those who ate animal protein up to once a week had a significantly reduced risk of dying over the next six years compared to those who were more frequent meat eaters (7). This was an observational trial with over 73,000 participants and a median age of 57 years old.

Inflammation

In the Whitehall II study, a specific marker for inflammation was measured, interleukin-6. The study showed that higher levels did not bode well for participants’ longevity (8). In fact, if participants had elevated IL-6 (>2.0 ng/L) at both baseline and at the end of the 10-year follow-up period, their probability of healthy aging decreased by almost half.

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

The bottom line is that, although genetics are important for longevity, so too are lifestyle choices. A small amount of exercise, specifically running, can lead to a substantial increase in healthy life span. 

Protein from plants may trump protein from animal sources in reducing the risk of mortality from all causes, from diabetes and from heart disease. This does not necessarily mean that one needs to be a vegetarian to see the benefits. IL-6 may be a useful marker for inflammation, which could help predict healthy or unhealthy outcomes. Therefore, why not have a discussion with your doctor about testing to see if you have an elevated IL-6? Lifestyle modifications may be able to reduce these levels.

References:

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

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

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By Joanna Chikwe, M.D.

February means heart health awareness, but taking care of your heart requires a year-round commitment that has lifelong benefits. What will you do differently to take better care of your heart?

Dr. Joanna Chickwe

Heart disease can affect anyone, regardless of gender, age or background. That’s why all of our cardiac care experts at Stony Brook University Heart Institute remain focused on how to best prevent heart disease and heal the heart. 

When you come to Stony Brook Heart Institute, you can depend on quality and expertise for every aspect of your cardiac care — care that exceeds national outcomes. A few examples:

• Our renowned team of interventional cardiologists have long been on the forefront for treating acute myocardial infarction, or heart attack. In fact, we exceed national outcomes and have the best outcomes on Long Island when it comes to bringing lifesaving heart emergency care to heart attack victims, as reported on the Hospital Compare* website. 

• Our heart surgeons have a high degree of expertise in providing advanced approaches to coronary artery bypass grafting (CABG) — a surgical procedure that uses blood vessels from other areas of your body to restore blood flow to your heart. Our Heart Institute has received a three-star rating — the highest awarded — from The Society of Thoracic Surgeons (STS) for overall patient care and outcomes in isolated CABG surgery. This distinguished award is in recognition of the isolated CABG procedures we performed from January to December 2017. The STS ratings are regarded as the definitive national reporting system for cardiac surgery. 

• For patients with severe aortic stenosis (narrowing), Stony Brook is a leader in advancing the transcatheter aortic valve replacement (TAVR) procedure and is one of a select number of sites in the U.S. to offer this minimally invasive procedure for patients who are considered high, intermediate or low-risk for open surgery. Stony Brook has excellent long-term data on patient outcomes with TAVR, and we are a tertiary referral center for evaluation of aortic valve disease.

• And, for patients with heart failure, a condition where the heart can’t pump enough blood to meet the needs of the body, our world-renowned experts at the Heart Failure and Cardiomyopathy Center help patients to restore their quality of life, limit their symptoms and understand their disease. We are proud that our patient outcomes for survival with heart failure are the best on Long Island and among the best nationally, according to Hospital Compare. 

While we hope that you and your family never need acute cardiac services, you can be assured knowing that Long Island’s only Chest Pain Center with Primary PCI and Resuscitation is right in your community. 

And, if you suspect a heart attack, please remember it’s best to call 911. Ambulances are equipped with defibrillators and most are equipped with 12-lead EKGs (electrocardiograms), which means they can transmit results to the hospital while en route. At Stony Brook, we assemble the treatment team and equipment you need before you arrive.

Want to do something today to learn about your heart health? Take a free heart health risk assessment at www.stonybrookmedicine.edu/hearthealth. Seeking a solution to a cardiac problem? Call us at 631-44-HEART (444-3278). We’re ready to help.

*Hospital Compare is a consumer-oriented national website that provides information on how well hospitals provide recommended care to their patients managed by the Centers for Medicare & Medicaid Services.

Dr. Joanna Chikwe is the director of the Stony Brook University Heart Institute, chief of Cardiothoracic Surgery and the T.F. Cheng Endowed Professor of Surgery.

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

Taking your blood pressure medications at night has beneficial effects

By David Dunaief, M.D.

Dr. David Dunaief

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

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

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

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

Diet trumps drugs for prevention

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

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

Is wine really beneficial?

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

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

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

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

Drugs (not diabetes drugs) show good results

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

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

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

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

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

References:

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

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

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