Health

Switching to a Mediterranean diet will help treat elevated blood pressure. Metro Photo
Treating early with lifestyle changes can improve your long-term outcomes

By David Dunaief, M.D.

Dr. David Dunaief

We have focused a large amount of effort on the treatment and prevention of hypertension (high blood pressure) in the U.S, where it’s pervasive: it affects approximately 45 percent of adults over 18 in the U.S. (1).

Since 2017, this insidious disorder’s severity has been categorized into three stages, each with its recommended treatment regimen. One of the most interesting shifts with this recategorization was the recategorization of what we used to call “prehypertension” into what we now call “elevated” blood pressure and “hypertension stage 1.” 

Elevated blood pressure is defined as systolic blood pressure (the top number) of 120-129 mmHg and diastolic blood pressure (the bottom number) of less than 80 mmHg, while Stage 1 includes systolic blood pressure of 130-139 mmHg or diastolic blood pressure of less than 80-89 mmHg (2).

The consequences of both are significant, even though there are often no symptoms. For example, they increase the risk of cardiovascular disease and heart attack dramatically. In an analysis of the Framingham Heart Study, researchers found a 3.5-fold increase in the risk of heart attack and a 1.7-fold increase in the risk of cardiovascular disease among those with prehypertension (3). This is why it’s crucial to treat it in these early stages, even before it reaches the more severe levels of hypertension.

Another study, the Women’s Health Initiative, which followed more than 60,000 postmenopausal women for an average of 7.7 years, showed an increase in heart attack deaths, heart attacks and strokes compared to those with normal blood pressure (less than 120/80 mmHg). In the Strong Heart Study, prehypertension independently increased the risk for cardiovascular events at 12 years significantly (4).

This may or may not impact mortality, but it certainly does impact quality of life, which can be dramatically reduced with heart disease, heart attack and hypertension.

Elevated blood pressure treatment

In my view, it would be foolish not to treat elevated blood pressure. Updated recommendations for treatment, according to the Joint National Commission (JNC) 8, the association responsible for guidelines on the treatment of hypertension, are lifestyle modifications (5).

Lifestyle changes include a Mediterranean-type diet or the DASH (Dietary Approaches to Stop Hypertension) diet. It’s important to focus on fruits, vegetables, reduction in sodium to a maximum of 1500 mg (2/3 of a teaspoon on a daily basis), exercise, weight loss and no more than moderate amounts of alcohol (1 or fewer drinks for women and 2 or fewer drinks for men on a daily basis) (6). Some studies have also shown that a diet rich in potassium helps to reduce blood pressure (7). 

Fortunately, foods like fruits, vegetables, beans and legumes have significant amounts of potassium. However, do not take potassium supplements unless instructed for other reasons by a physician; high potassium can be very dangerous and may precipitate a heart attack.

The danger in treating elevated blood pressure comes only when medication is used, due to side effects. For example, the Trial of Preventing Hypertension (TROPHY), suggests the use of a hypotensive agent, the blood pressure drug Atacand (candesartan) to treat prehypertensive patients (8)(9). The drug reduced the incidence of hypertension significantly compared to placebo over two years. However, after stopping therapy, the following two years showed only a small benefit over placebo. Still, the authors implied that this may be a plausible treatment. The study was funded by Astra-Zeneca, the makers of the drug. 

In an editorial, Jay I. Meltze, M.D., a clinical specialist in hypertension at Columbia University’s College of Physicians and Surgeons, noted that the results were interpreted in an unusually favorable way (10). 

Elevated blood pressure is an asymptomatic disorder that has been shown to respond well to lifestyle changes — why create symptoms with medication? Therefore, I don’t recommend treating elevated blood pressure patients with medication. Thankfully, the JNC8 agrees.

However, it should be treated — and treated with lifestyle modifications. The side effects from this approach are only better overall health.

References:

(1) cdc.gov. (2) heart.org. (3) Stroke 2005; 36: 1859–1863. (4) Hypertension 2006;47:410-414. (5) Am Fam Physician. 2014 Oct 1;90(7):503-504. (6) J Am Coll Cardiol. 2018 May, 71 (19) 2176–2198. (7) Archives of Internal Medicine 2001;161:589-593. (8) N Engl J Med. 2006;354:1685-1697. (9) J Am Soc Hypertens. Jan-Feb 2008;2(1):39-43. (10) Am J Hypertens. 2006;19:1098-1100.

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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By Julie Freedman, M.D.

The shriek of the pager cut through my half-sleep. Willing myself to sit up on the plastic mattress, I pressed my thumbs along my eyebrows to clear a fleeting dream. It was 2:00 a.m. The emergency room had a new patient for me. She was 71 years old and recently diagnosed with amyotrophic lateral sclerosis, or ALS. She was having trouble breathing. After a near-lifetime of dutiful function, the neurons that moved her muscles had simply started to die. Even those muscles we never think about — her diaphragm or the ribbons that lifted her ribs to expand her lungs — had become unreliable. I switched on the fluorescent, call-room light and found my clogs.

Eleanor had a fever. The pneumonia on her X-ray looked like smudged chalk across both lower lungs. The ER physician had started BIPAP — Bilevel Positive Airway Pressure — strapping a cushioned plastic mask tightly over her face, forcing oxygenated air into her mouth. We call this “non-invasive” ventilation, but it is not comfortable. Her vital signs conjured a grim picture — heart racing, breathing fast — but the woman wearing the mask gave a different impression, despite the odd way the machine was ironing out her cheeks with each breath. She was calm. Her unstrained eyes were the chalky blue of flax blossoms. She was feeling better, she mouthed. Actually, she was hungry. Could she eat something?

Her husband, Bill, at her bedside, was calm too. He was tall and trim and moved with a youthful quickness. His neatly-tucked shirt made me suddenly aware of my own pajama-like hospital scrubs. Since Eleanor’s diagnosis, Bill explained, they had been managing everything at home. He was a retired electrician, so he was comfortable with all of the medical equipment. They even had a BIPAP unit there for nighttime. 

They had been living close to this edge for some time. It had become normal for her to strap on a mask to breathe. Bill said they wanted to return home as soon as possible. He could handle everything, he assured me, seeming a little irritated by my hovering at Eleanor’s bedside. They had no illusions, he explained, deftly untangling the tangle of wires lying across his wife’s chest. They knew her disease was progressive, and fatal, but they still had things under control. 

She was still gardening, he said, with an edge of pride. He showed me a picture of sunlight, caught in the bowls of tulips. Not that life wasn’t messy. It had been messy even before the day Eleanor admitted to him that she could not get her fingers to button her blouse. Bill’s retirement money never quite stretched enough. There were grandchildren to scramble after three days a week. They were sweet kids, but Bill didn’t have the patience. Eleanor did, though. She gave me a stretched-out smile from behind the mask. She was hungry, he reminded me. Was there a sandwich somewhere she could have?

I wasn’t reassured. Her heart was working like she was running up stairs, just to lie still. A patient with weak respiratory muscles and pneumonia in both lungs might soon need the more “invasive” kind of breathing support, a mechanical ventilator. A ventilator blows air into a patient’s lungs through a tube we insert directly into her trachea. Bill and Eleanor hoped to avoid a ventilator, but she would accept it if necessary, at least for a time. To use a ventilator, we would need to sedate and paralyze her, which meant that Eleanor’s stomach should stay empty. So, no sandwich for now.

Over the next two hours, I sat at the ICU nurses’ station across from Eleanor’s room, propped awake by a familiar anxiety, the prickly weight of my own hesitation. If Eleanor’s breathing muscles tired out before the antibiotics took hold, she could quickly worsen. Not intubating her early might endanger her, but it is my nature as a doctor to try to avoid aggressive interventions. I tend to see their burdens in the foreground. 

When we intubate someone, we affect a strange transformation. The patient becomes a chimera, part woman and part machine. We lose the expression in her face. The ventilator’s vocabulary of alarms replaces her voice. Her family’s eyes track the cardiac monitor. They touch her skin without knowing if she can feel it. We lose all of the small, animal ways we read each other. A mechanical ventilator can save a life, but when a patient dies despite using one, I struggle to accept what we have done. I was not impartial here. I wanted to get Eleanor back to her tulips and their brief season, but I really did not want to intubate her. So I watched, tracking the cursive of Eleanor’s heart rhythm on the monitor. Eventually, she closed her eyes, her breathing more even, and I returned to my plastic mattress to sleep too.

In the morning, Eleanor smiled brightly when I walked in the room, the only plastic on her face the slender oxygen tubing. Could she finally have breakfast? I was grateful, not sure she grasped the fate she had outrun. Yes to breakfast. Yes, she could. She returned home the following day.

Three months later, Eleanor was back in the hospital with another pneumonia. This one was milder, just some stray sketch lines on her X-ray. At home, she could walk only a few steps now. A truck brought steel oxygen tanks to their house each week. Bill had been half-lifting her, wrapping her arm across his shoulders, to pivot to a portable toilet at her bedside. He had learned some simple cooking because she could no longer manage that, and was getting pretty good at roast chicken. Despite his efforts, Eleanor had lost weight. The space between the bones of her forearm was a furrow under my fingers. Each day though, she spent time in their garden. There was a shady spot for her wheelchair.

Eleanor did not seem to defy her medical numbers this time. She looked weary as her heart jogged along. Her thin shoulders kept slumping leftward despite the pillows that the nurses had tucked around her. I was at her bedside on her third hospital day when she took a sip of water and started to choke. 

She coughed again and again, a flash of the pale blue of her eyes each time, then finally recovered. She began to cry. “I’m sorry. I’m sorry,” she said. 

She shouldn’t be like this, she explained. Anger ridged her quiet voice. She was supposed to make cookies with her smallest granddaughter. The girl was four. What would she remember? This being lifted to the toilet, this fragility, it did not suit her. She was a mother and a grandmother. She stirred thick dough and weeded and bound her family together. Except that now, she did not. I had focused on her vital signs. I was missing her suffering. I sat and held her papery hand and told her that none of this was her fault. 

The next day, Eleanor was stable enough to return home. Busy with other patients, I sped by her room for a quick hug, taking in the sharp ridge of her shoulder against my chest.

Two months later, she returned. At home, she was in bed all the time. Her neurologist had actually sent two hospice nurses to the house a few weeks before. They set up an array of syringes and tablets in the dining room. Bill sent them away again after only two days. He didn’t like how they did things. Those nurses had brought morphine. They had started to teach Bill to administer it. That had scared them both. “We don’t believe in morphine,” Bill told me. Eleanor, watery-eyed behind her oxygen mask, nodded agreement. She pointed to a spiral-bound notebook and I handed it to her. In shaky letters, all capital, she wrote, “I WANT CONTROL.” 

It’s not often that patients tell me that they “don’t believe” in a medication, but morphine can spark intense reactions. I fell silent, trying to resolve what it was they did not believe in. Eleanor’s thin legs barely rippled the hospital blankets. Breathing itself was work. Both she and Bill knew she was dying. What did “control” mean for her now? 

The pharmacology of morphine is complex. It is an essential medicine at the end of life. It relieves pain, and, because there are opiate receptors in the lungs, also soothes the drowning feeling that comes with end-stage respiratory illness. I remembered Eleanor choking on that thread of water. If she felt that again, morphine would help. But it is an imprecise drug. It causes sedation as it relieves physical suffering. Was this the loss of control she feared? It can also cause euphoria, restlessness, hallucinations, and, at high doses, death. My training taught me to show it due respect: start with low doses, lower still for someone frail, then assess for effect. 

Medical ethics teaches that intention matters. If I give a reasonable dose of morphine with the intention to relieve suffering, and I cause an unwanted outcome ­— sedation or agitation, or even death — I am still keeping my oath not to harm. This is the “doctrine of double effect,” derived from the teachings of 13th-century Catholic theologian Thomas Aquinas. It offers a clear enough theory, but it never really sets me at ease. If I give a drug and a bad thing happens, my patients and their families experience that bad thing. I have hurt them, and Aquinas does not offer much comfort. 

To be clear, morphine relieves suffering almost all of the time. Patients usually welcome that relief, but I’ve also spoken with grieving family members who look back on someone’s death from a long, terrible illness, convinced that morphine was the thing that killed her. These conversations play in my mind when I care for a dying patient in the hospital. I am aware of the family’s eyes on my hands, of how my words might replay in their heads, that they will relive my patient’s last moments again and again. In this sense, the family becomes my patient too. 

Eleanor’s words on that notebook page were wildly impossible: she did not have control. They seemed like a request for relief that I was not trained to give, spiritual or existential. Eleanor and Bill had faced her illness by asserting control in the face of the uncontrollable. They voiced acceptance, but they were defiant. All along, they had been letting out rope, in stepwise retreat, giving up the gardening, the cooking, the not needing help. With each retreat, they had established another defensive position, and now she was staked out at just remaining awake. Eleanor’s cardiac monitor alarmed in shrill tones as her heartbeat became briefly irregular, then quieted. I dropped the subject of morphine for the moment. I could not find words to resolve Eleanor’s desire for control with how near she was to death. I didn’t want to push anything on them that they might later look back on as a violation. 

A few hours later, Eleanor was struggling. There was sweat on the sides of her nose. I tentatively asked her if she would accept some morphine to help ease her breathing. She nodded. I ordered a small dose, and returned to the room with the nurse while she gave it. I talked with Bill and with Laura, their daughter, consciously modeling a sense of calm routine. The drug helped. Eleanor’s face relaxed. She even gave a hint of a smile.

That evening, Eleanor was mostly peaceful. When she did become uncomfortable, she received more morphine, and was able to rest. The next morning, Bill asked me about bringing her home. She wanted to see her garden. He wanted her there too.

As we talked, Eleanor began to cough, nearly silently. Her shoulders jerked. She lurched her hand clumsily for Bill’s wrist. Her nurse gave morphine. Ten minutes later, she was still breathing fast, grunting, heavy eyelids startling open with each cough. Bill sat down, then stood again, then sat. He reached to adjust her monitor wire, her oxygen cannula, then stopped, suddenly unsure of where to put his hands. Laura reached for Eleanor’s shoulder. I asked her nurse for another dose of morphine. A few minutes passed. Eleanor’s breathing quieted and she leaned her face into a pillow. Bill let out a long breath, then turned to me. He began to ask about the logistics of ambulance transportation home. 

Suddenly, Laura nudged her father. Eleanor’s eyes had closed, and her breathing pattern had changed. With each inhalation, she lifted her chin up and forward, like a swimmer reaching for the surface of the water. Bill called her name. She didn’t answer. Suddenly, she was gone from in front of us. Bill looked at me, eyes flashing something that might have been anger. My own heart pounded. I knew the morphine doses had been appropriate. Still, I worried he might hold me accountable if these were her final moments. Willing myself calm, I encouraged them to stand close to her, to hold her hands and touch her hair and talk to her. After a few minutes, I left them alone.

An hour passed. I crept back to her room, but hesitated before parting the polyester curtain. My patients are usually strangers to me, but Eleanor was not. It was an accidental gift of my call schedule that had let me care for her through her three hospitalizations, to watch over her and her family, even in this interrupted way. I was afraid I had failed them anyway. Gathering a breath, I went in. More family members had arrived, seven in all. At the center of this crowd, awake and laughing, was Eleanor. She had spent fifteen minutes beyond the reach of their voices, and then woke up to find them staring at her. She had jokingly asked for lipstick so she could face the occasion more glamorously. They were almost giddy with relief. But relief for what? Relief that she had not died, certainly, but she would soon and they all knew it. They now knew what her death could be like. They had had their dress rehearsal, and, in the extinction of that mystery, it was like they no longer feared it. Suddenly, they had these minutes, and maybe hours or even days, and each one was a gift.

Eleanor was too fragile to send home. Laura and Bill would instead stay with her overnight. She struggled briefly that evening, but by sunrise, she was mostly dozing. A few hours later, her breathing slowed. Again, she reached her chin upward for air. Again, she was beyond the reach of her family’s voices. I counted to 20 after one breath ended before the next one came. And then, none came. Bill wept. “My girl,” he said, taking her hand.

Julie Freedman is a hospitalist and palliative care physician at a community hospital in the San Francisco Bay Area. She received her medical degree from Harvard University and trained in internal medicine at the University of California, San Francisco. She believes that we need narrative almost as we need shelter: We build stories around ourselves in the face of serious illness. Understanding, and sometimes entering, these stories is an essential part of caring for patients. On the other hand, after this last year, she is thinking it might also be lovely to become a florist. She is on Twitter @jfreedmanmd

* This article was first published in the Spring 2021 Intima: A Journal of Narrative Medicine (theintima.org) and is reprinted with permission.

 

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By Melissa Arnold

Just about everyone knows the throbbing discomfort of a headache, whether it comes after a long day of work, too little sleep or an oncoming cold. It’s also likely that you’ve heard someone say they have a migraine when the pain becomes severe.

But the truth is that migraine is more than just a bad headache, and the term has taken on a variety of meanings, not all of them accurate.

According to the American Migraine Foundation, migraine is an incurable brain disease that affects approximately 40 million people in the United States — that’s 1 in 4 households. In the majority of those cases, at least one close relative has migraines as well, but it’s still uncertain what causes the disease. 

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Migraine can come with a wide range of neurological symptoms that differ from person to person and day to day. These symptoms exist on a spectrum from sporadic to chronic, mild to incapacitating, and some people can even experience trouble speaking, weakness and numbness in ways that mimic a stroke.

“Migraine is more than just pain. While the pain is often moderate to severe, one sided and throbbing, there are other characteristics,” said headache specialist Dr. Noah Rosen, director of the Northwell Headache Center in Great Neck. 

“The individual must also have either sensitivity to light and noise or nausea to meet the full definition. This can worsen with movement, and many people also develop associated skin or hair sensitivity. Many people may also experience changes in mood, energy level and appetite. About 20% of migraine patients may also have aura with their migraines, which is a brief, fully reversible neurological deficit. Auras can cause visual changes, sensation changes and sometimes weakness.”

For Cat Charrett-Dykes, migraines have been a regular part of her life since she was 13 years old. She would see sparkles and spots and go through bouts of nausea and vomiting, all while feeling like a knife was stabbing through her head. At school, she had trouble reading and finding the right words. “I felt like Dorothy in ‘The Wizard of Oz.’ Some of my siblings also had migraine occasionally, but not to the same degree,” said Charrett-Dykes, who lives in Holtsville. 

The attacks were relatively easy to tame until after the birth of her first child. Then, as is common, her migraines became more severe and frequent. She saw countless healthcare providers, who couldn’t agree on a diagnosis: They suggested she had anxiety, allergies, epilepsy. One even asked if her ponytail was too tight.

Unfortunately, getting a proper diagnosis and care can be a problem in the migraine community. The World Health Organization reports that more than half of all people with migraine haven’t seen a doctor for their condition in at least a year. Many more have never been formally diagnosed. While seeing a neurologist can be useful, not all neurologists are experts in headache disorders.

“Only about 700 people in the country are certified headache specialists, and the field of headache medicine is not yet formally recognized by the federal government, so there are limits on the field’s growth despite how common the condition is,” Rosen explained. “During my time as a resident physician I was seeing severely disabled patients with headache disorders end up in the emergency room, yet I had almost no education in that area, in part because of how underserved the condition is. It is often ignored, stigmatized and mistreated.”

Charrett-Dykes waited decades to find someone who understood her. 

“It wasn’t until 2003 that I was finally diagnosed. As soon as the physician’s assistant walked into the room, he took one look at me and turned off the lights,” she recalled. “No one had ever done that before. He said, ‘You have migraines, don’t you? I know that face. My wife has migraines, too.’ It was such a relief.”

Still, a diagnosis is only the beginning of the migraine journey. Treatment is focused on identifying the person’s unique triggers — perhaps certain foods, scents, strenuous activity, or an irregular schedule — along with the precise combination of medications and other options to help ease their symptoms. There is no magic bullet, and finding treatment that helps can be challenging. 

“Trigger identification and avoidance is a great thing to try, but not always possible.  Raising the ‘threshold’ required to set off a migraine can be done with pharmacological or non-pharmacological approaches,” Rosen said. “Of the medications that are available now, some are preventive and some are acute (or abortive). The preventive treatments help avoid getting the headache in the first place. Healthy habits like regulating sleep, diet, hydration and stress can reduce frequency, as can some vitamin supplements, complementary practices like acupuncture, biofeedback, mindfulness and regular cardiovascular exercise.”  

Nancy Harris Bonk

The process of trial and error is exhausting for many people with migraine, including Nancy Harris-Bonk of Albany, who’s tried countless doctors and medications since her first migraine attack as a young teen. At one point, she was taking the highest dose of oxycodone allowed under a doctor’s care and still having 25 or more migraine days each month.

“I just wasn’t recovering, so I went online and started looking for answers,” said Bonk, whose episodic migraines turned chronic after a fall left her with a traumatic brain injury. “I was able to make contact with someone else who had migraine attacks, and it opened a door for me. I learned that I wasn’t alone and that there were treatment options. It made me want to help educate others about migraine disease and how to live with it.”

Downstate, Charrett-Dykes had similar goals. She founded Chronic Migraine Awareness, Inc. (CMA) in 2009, a simple chat group that later grew into a multifaceted nonprofit connecting people with resources, specialists, and one another. CMA’s main Facebook group now has 12,000 members around the world, with several smaller groups for specific demographics and topics. They also provide care packages for people with migraine, support caregivers, and lead advocacy efforts.

Bonk eventually qualified for Social Security Disability Insurance, freeing her up to focus on her well-being while acting as a resource for others. She still has about 15 migraine days a month, but medication changes and a knowledgeable healthcare team have made life a lot more manageable, she said. She serves on the board of CMA and works with the National Headache Foundation’s Patient Leadership Council; the Coalition for Headache and Migraine Patients (CHAMP); and Migraine.com.

“Learning all you can about migraine disease, knowing what it is and what it isn’t, can make a big difference when it comes to seeking care and advocating for yourself,” Bonk said. “Forming connections with others who have similar experiences is important so we know we’re not alone. This disease can leave us feeling isolated, frustrated and overwhelmed … talking with others who are going through a similar journey is validating and a great comfort. ”

While each of these organizations has a unique focus, they all share a desire to increase knowledge and awareness of migraine disease.

“The pain of migraine is not like other pain and should not be treated like that. It needs to be discussed and not just treated,” Rosen said. “The stigma of people with migraine having a low pain tolerance is also nonsense. I have been impressed on a daily basis by the strength, resilience and resourcefulness of these patients.”

June is Migraine and Headache Awareness Month. To learn more, visit www.migraine.com. To connect with others, visit CMA’s website at www.chronicmigraineawareness.org. The Northwell Headache Center has several locations on Long Island and telehealth appointments are available. For information, call 516-325-7000 or visit www.northwell.edu/neurosciences/our-centers/headache-center.

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

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

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

#1: KNOW YOUR NUMBERS

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

#2: EAT HEALTHY

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

#3: MOVE MORE

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

#4: HAVE A HEALTHY PREGNANCY

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

#5: MANAGE STRESS

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

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#6: STOP SMOKING 

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

#7: AIM FOR A HEALTHY WEIGHT

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

#8: WORK WITH YOUR DOCTOR

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

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

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You’re not alone and help is available

By Jeffrey L. Reynolds

Jeffrey L. Reynolds

As COVID hit and stay-at-home orders began, alcohol sales and consumption skyrocketed.  Nielsen reported a 54% increase in national sales of alcohol for the week ending March 21, 2020, compared with the year prior; online sales increased 262% from 2019. In several national surveys, more than half of adult respondents said that they were drinking more frequently — often daily — and many said that they were having more drinks at each sitting, with about a third engaging in potentially dangerous binge drinking. 

The jump in alcohol use was largest among women and not surprisingly, people of all ages cited increased stress, anxiety and grief coupled with increased alcohol availability and boredom as contributing factors.  

As the world returns to “normal” and day drinking memes on social media begin to fade, some of those who have become accustomed to a 3 p.m. drink or who have increased the number of glasses of wine or beer they consume with dinner will have a hard time going back.  

How do you know if you’re drinking too much? 

According to the federal government’s Dietary Guidelines for Americans, moderate alcohol consumption is defined as having up to one drink per day for women and up to two drinks per day for men. This definition refers to the amount consumed on any single day and is not intended as an average over several days. The Dietary Guidelines, however, also say that people who don’t usually drink alcohol shouldn’t take that as a green light to start.

The Dietary Guidelines define a one alcoholic drink equivalent as containing 14 g (0.6 fl oz) of pure alcohol, which includes 12 fluid ounces of regular beer (5% alcohol), 5 fluid ounces of wine (12% alcohol), or 1.5 fluid ounces of 80 proof distilled spirits (40% alcohol).

In comparison to moderate alcohol consumption, high-risk drinking is the consumption of four or more drinks on any day or eight or more drinks per week for women and five or more drinks on any day or 15 or more drinks per week for men. Binge drinking is the consumption within about two hours of four or more drinks for women and five or more drinks for men.

Excessive alcohol consumption, which includes binge drinking, high-risk drinking, and any drinking by pregnant women or those under 21 years of age comes with significant risks. Excessive drinking increases the risk of many chronic diseases and violence and, over time, can impair short- and long-term cognitive function. Binge drinking is associated with a wide range of health and social problems, including sexually transmitted diseases, unintended pregnancy, accidental injuries, and violent crime.

As scary as all that can be, there’s a ton of help available both in our local communities and online, where trained professionals can help you assess your drinking and if need be, help you come up with strategies to cut-back or quit. At FCA, we operate two state licensed outpatient treatment centers, two recovery centers and recovery coaching (Call 516-746-0350 or visit FCALI.org). LICADD runs a 24-hour assessment and referral hotline at 631-979-1700 as does Response at 631-751-7500 and Project Hope at 1-844-863-9314.

There are also a number of free or low-cost addiction recovery smartphone apps that give consumers 24/7 access to self-help and tracking tools, 12-step programs, motivational tools, and reminders. Sober Grid, SoberTool, Nomo, WEconnect, rTribe, and 24 Hours a Day are just a few of the popular resources. Alcoholics Anonymous and other 12-step programs have meetings online, along with a host of other online sobriety support groups. Of these, Self-Management and Recovery Training (SMART), Loosid, LifeRing, Club Soda, Women for Sobriety, and Tempest are among the top-rated. 

Emerging from COVID and returning to normal is going to look different for everyone. If it’s proving to be challenging for you or someone you love, pick up the phone, fire up your computer and reach out for help today. You are not alone.

Dr. Reynolds is the President/CEO of Family and Children’s Association (FCA), one of Long Island’s oldest and largest nonprofits providing addiction prevention, treatment and recovery services. 

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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. 

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. 

Sunset Yoga Flow at the Vanderbilt Museum

Save the date! Suffolk County Vanderbilt Museum, 180 Little Neck Road, Centerport hosts a Sunset Yoga Flow event on Friday, May 28 from 7 to 8 p.m. Kick off your weekend with a beautiful view on the Great Lawn overlooking Northport Harbor. All props and mats will be provided upon request. Check in begins at 6:30 p.m. Tickets are $30 adults, $15 children. To register, visit www.vanderbiltmuseum.org.

The Town of Smithtown, in partnership with Kings Park Central School District and Rite Aid, successfully hosted the second and final round of COVID-19 Booster vaccines for 160 school employees and residents ages 50 and up, over the weekend. On Saturday, May 15, a temporary COVID-19 Vaccine Site was implemented at Kings Park High School. Rite Aid facilitated and administered 160 Moderna vaccines to those individuals who previously received their first dose, four weeks prior.

Kings Park Fire Department was on standby protocol in the event of an adverse reaction. Six KPHS National Honor Society students volunteered to assist with logistics and registration during the event, alongside staff from the Smithtown Senior Center and Supervisor Wehrheim’s Office.

“The entire event was smooth sailing thanks to an incredible partnership with Kings Park School District and Rite Aid. I am especially grateful to the team at our Smithtown Senior Center, as well as some incredible high school students, all who volunteered their Saturdays to serve the people of our community,” said Supervisor Ed Wehrheim.

Approximately 160 Moderna vaccines were supplied and administered to Smithtown residents and surrounding school district employees courtesy of Rite Aid Pharmacy. Vaccines were administered by healthcare professionals from Rite Aid. Residents were then monitored during the required 20 minute observation period. The average appointment took a total of 30 minutes, with the bulk of time going towards monitoring. The Moderna booster vaccines were administered exactly four weeks from the date of each first vaccine appointment, held on Saturday, April 17th..