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Studies show that running just 5 to 10 minutes each day may help reduce your risk of death from heart attacks, strokes, and other common diseases. Pixabay photo
Add quality years with modest lifestyle changes

By David Dunaief, M.D.

Dr. David Dunaief

The number of 90-year-olds is growing in the U.S. 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 greater physical functioning 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). In other words, they grew old “gracefully,” staying mobile and mentally alert.

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

Get modest exercise

We are told repeatedly to exercise. Here’s one reason. Results of one study showed that 5 to 10 minutes of daily running, regardless of the pace, can have a significant impact on life span by decreasing cardiovascular 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. 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).

Reduce animal protein

A long-standing paradigm has been that we need to eat sufficient animal protein. However, cracks have developed in this theory, 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 of calories 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.

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 once a week or less 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.

Reduce systemic 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 good news is that inflammation can be improved significantly with lifestyle changes.

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 and replacing animal protein with plant protein can contribute to a substantial increase in healthy life span. IL-6 may be a useful marker for inflammation, which could help predict healthy or unhealthy outcomes. Therefore, why not have a discussion with your doc-tor 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. 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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Comsewogue Public Library, 170 Terryville Road, Port Jefferson Station will host a Shed the Meds event on Thursday, Sept. 23 from 10 a.m. to 1 p.m. Drop by with any unused prescriptions and they will be safely discarded by the Suffolk County Sheriff’s office. Open to all. No registration required. For more information, call 631-928-1212, option 3.

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Studies show that taking blood pressure medication at night lowers the risk of diabetes. METRO photo
Controlling sleep-time blood pressure may help

By David Dunaief, M.D.

Dr. David Dunaief

Our understanding of diabetes – its risks and treatment paradigms – is continually evolving. Because so many are affected by diabetes and prediabetes in the U.S., and because the potential health consequences, including significant cardiovascular risks, are so much greater in this population, studies frequently target this population.

To provide a sense of scale, the current rate of diabetes among the U.S. adult population is 13 per-cent, while another estimated 88 million U.S. adults have prediabetes, based on fasting glucose levels (HbA1C) of 5.7 to 6.4 percent (1).

For those with diabetes, cardiovascular risk and severity may not be equal between the sexes. In two trials, women with type 2 diabetes had greater cardiovascular risk than men. In one retrospective 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).

What may reduce risks of disease and/or complications? Fortunately, we are not without options. These include lifestyle modifications, timing of blood pressure medications, and, oddly, modest wine consumption.

Diet bests Metformin 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 a disservice; lifestyle changes may be more effective in preventing this disease. In a head-to-head comparison study, diet plus exercise bested 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 over-weight 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. Note that, while these are impressive results that speak to the use of lifestyle modification and to metformin, this is not an optimal diabetes diet.

Blood pressure medications’ timing

Interestingly, taking blood pressure medications at night has an odd benefit, lowering the risk of diabetes (4). 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 (ARBs) 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.

Reducing complications with wine?

Diabetes patients are often warned to limit or eliminate alcohol. A significant part of the reasoning relates to how the body metabolizes alcohol and sugars. So, the results of a study that showed small amounts of wine could have benefits in reducing diabetes-associated complications among those who were well-controlled sent ripples throughout the medical community.

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 (5).

Patients were randomized into three groups, each receiving a drink with dinner nightly. One group received five ounces of red wine, another five ounces of white wine, and the control group drank five ounces of water. Those who drank the red wine saw a significant increase in their “good chomlesterol” 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 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. Remember, participants were well-controlled type 2 diabetes patients who generally were nondrinkers.

We need to reverse the trend toward higher diabetes prevalence. Diet and exercise are the first line for prevention. Even a good, but nonideal, diet had better results than medication. 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) Diabetologia. Online Sept. 23, 2015. (5) Ann Intern Med. 2015;163(8):569-579.

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 David Dunaief, M.D.

Dr. David Dunaief

Heart failure (HF) occurs when the heart’s pumping is not able to keep up with the body’s demands for blood and oxygen and may decompensate. Unlike a heart attack, which is acute, heart failure is a slowly developing disease that may take years to become symptomatic.

As of 2018, there were about 6.2 million Americans living with heart failure, and heart failure was a potential contributing factor in 13.4 percent of deaths (1).

There are two types of heart failure, systolic and diastolic. The basic difference is that the ejection fraction, the output of blood with each contraction of the left ventricle of the heart, is more or less preserved in diastolic HF, while it can be significantly reduced in systolic HF.

We have more evidence-based medicine, or medical research, on systolic heart failure. Fortunately, both types can be diagnosed with the help of an echocardiogram, an ultrasound of the heart. The signs and symptoms may be similar, as well, and include shortness of breath on exertion or when lying down, edema or swelling, reduced exercise tolerance, weakness and fatigue.

Major lifestyle risk factors for heart failure include obesity; smoking; poor diet, including consuming too much sodium; being sedentary; and drinking alcohol excessively. Pre-existing conditions that are significant risk factors include diabetes, coronary artery disease and high blood pressure.

Typically, heart failure is treated with blood pressure medications, such as beta blockers, ACE inhibitors and angiotensin receptor blockers. We are going to look at how diet, iron and the supplement CoQ10 impact heart failure.

Antioxidant diet’s impact

If we look beyond the usual risk factors mentioned above, oxidative stress may play an important role as a contributor to HF. Oxidative stress is thought to result in damage to the inner lining of the blood vessels, or endothelium, oxidation of cholesterol molecules and a decrease in nitric oxide, which helps vasodilate blood vessels.

In a population-based, prospective (forward-looking) study, called the Swedish Mammography Cohort, results show that a diet rich in antioxidants reduces the risk of developing HF (2). In the group that consumed the most nutrient-dense foods, there was a significant 42 percent reduction in the development of HF, compared to the group that consumed the least. According to the authors, the antioxidants were derived mainly from fruits, vegetables, whole grains, coffee and chocolate. Fruits and vegetables were responsible for the majority of the effect.

This nutrient-dense approach to diet increased oxygen radical absorption capacity. Oxygen radicals have been implicated in cellular and DNA damage, potentially as a result of increasing chronic inflammation. What makes this study so impressive is that it is the first of its kind to investigate antioxidants from the diet and their impacts on heart failure prevention.

This was a large study, involving 33,713 women, with good duration — follow-up was 11.3 years. There are limitations to this study, because it is observational and the population involved only women. Still, the results are very exciting, and it is unlikely there is a downside to applying this approach to the population at large.

CoQ10 benefits

Coenzyme Q10 is a substance produced by the body that helps the mitochondria (the powerhouse of the cell) produce energy. It is thought of as an antioxidant. 

Results of the Q-SYMBIO study, a randomized double-blind control trial, showed an almost 50 percent reduction in the risk of all-cause mortality and 50 percent fewer cardiac events with CoQ10 supplementation (3). This one randomized controlled trial followed 420 patients for two years who had severe heart failure. This involved using 100 mg of CoQ10 three times a day compared to placebo.

The lead author goes as far as to suggest that CoQ10 should be part of the paradigm of treatment. CoQ10 is the first supplement to show survival benefits in heart failure.

This study’s rigor is impressive; it assesses the supplement as if it were a drug. A subsequent 2019 sub-group analysis of Q-SYMBIO confirmed the short- and long-term effects and also found a significant improvement in left ventricular ejection fraction among CoQ10 therapy adherents (4).

A meta-analysis involving 13 studies of CoQ10 supplementation with HF confirmed that CoQ10 resulted in ejection fraction improvements among patients with less severe stages of HF, although the authors suggest that studies with more diverse demographics and that refine and compare dose responses are warranted (5). If you have heart failure, you may want to discuss CoQ10 supplementation with your physician.

Iron deficiency challenges

An observational study that followed 753 heart failure patients for almost two years showed that iron deficiency without anemia increased the risk of mortality in heart failure patients by 42 percent (6).

In this study, iron deficiency was defined as a ferritin level less than 100 μg/L (the storage of iron) or, alternately, transferrin saturation less than 20 percent (the transport of iron) with a ferritin level in the range 100–299 μg/L.

The authors conclude that iron deficiency is potentially more predictive of clinical outcomes than anemia, contributes to the severity of HF and is common in these patients. Thus, it behooves us to try to prevent heart failure through dietary changes, including high levels of antioxidants, because it is not easy to reverse the disease. Those with HF should have their ferritin and iron levels checked, for these are correctable.

Based on study results, CoQ10 appears to be a compelling therapy to reduce risk of further complications and potentially death. Consult with your doctor before taking CoQ10 or any other supplements.

References:

(1) cdc.gov. (2) Am J Med. 2013 Jun:126(6):494-500. (3) JACC Heart Fail. 2014 Dec;2(6):641-649. (4) Cardiol J. 2019;26(2):147-156. (5) Am J Clin Nutr. 2013 Feb; 97(2): 268–275. (6) Am Heart J. 2013;165(4):575-582.

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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View the Memorial Parade of Boats before race. Photo by Bob Savage

The 12th annual Village Cup Regatta, a friendly competition between Mather Hospital and the Village of Port Jefferson, will sail with full crews this Saturday, September 11. 

Join Ralph Macchio in supporting a most worthy cause. File photo by Bob Savage

Presented by the Port Jefferson Yacht Club, the Regatta raises funds for Mather’s Palliative Medicine Program and the Lustgarten Foundation, which funds pancreatic cancer research. The event has raised almost $640,500 for the two organizations. Last year’s event was held without crew members due to the pandemic. The event raised $40,000, which was divided between Mather and Lustgarten.

Actor/director and local resident Ralph Macchio will again act as community ambassador for the event. This is the ninth year Macchio has helped to publicize the important work of the two programs funded by the Regatta. Macchio’s wife, Phyllis, is a nurse practitioner in Mather’s Palliative Medicine Program.

The Regatta consists of Yacht Club-skippered sailboats divided into two teams representing Mather Hospital and the Village of Port Jefferson. Employees from the Hospital and Village help crew the boats, which race in one of three classes based on boat size. 

The festivities will begin at Harborfront Park in Port Jefferson Village at 10 a.m., where you can purchase t-shirts signed by Ralph Macchio, along with the event’s commemorative hats, nautical bags and mugs. The Memorial Parade of Boats begins at 11 a.m. at the Port Jefferson Village dock. All sailboats participating in the Regatta will pass by the park dressed in banners and nautical flags on their way out to the racecourse on Long Island Sound.

Following the race, a celebratory Skipper’s Reception and presentation of the Village Cup will take place in a restored 1917 shipyard building that now serves as the Port Jefferson Village Center.

Businesses, organizations and individuals can support the Regatta and the programs it funds by making a donation or purchasing tickets to attend the Skipper’s Reception or view the event on a spectator boat.. Sponsorships also are available. For more information and to purchase tickets please visit http://portjeffersonyachtclub.com/community/village-cup/ or www.facebook.com/villagecupregatta

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Photo from Statepoint

September, which is World Alzheimer’s Month, is an excellent reminder to keep your mind and body healthy through the years. Experts say that doing so can reduce your risk for cognitive decline. Try taking on these new hobbies to keep your mind sharp as you age:

• Cooking: Not only can the development of a new complicated skill such as cooking improve cognitive functions like problem-solving and concentration, but having the ability to create your own nutritious meals at home has the added benefit of being good for brain health. From TikTok tutorials to online classes taught by master chefs, today, there are more avenues for picking up culinary know-how than ever before.

• Music: Learning to play a musical instrument has countless benefits for brain health, helping improve memory, hand-eye coordination and more. It’s also a mood booster, which is important, as depression is considered a risk factor for dementia. Check out instruments designed to build skills quickly. Whether you’re a total novice or taking up the piano after a long hiatus, Casiotone Keyboards, for example, are portable, easy to use and connect to an app that features lessons and more.

• Exercise: The mind-body connection is strong. For ultimate brain health, stay physically active; and if you can do so outdoors, all the better. Research suggests that connecting with nature is good for one’s mental well-being, reducing stress, anxiety and depression. Support your journey with tools that track your activity and inspire you to delve further into adventures, whether that be hiking, fishing or rock climbing. The watches in the Pro Trek line feature Quad Sensor technology to provide you with temperature and barometric pressure so you can keep your eye on the weather conditions while out and about, as well as sunrise and sunset times, an app for anglers and much more.

• Camaraderie: Having an active social life can improve brain function. Unfortunately, if you aren’t proactive about it, there are not always that many opportunities to make new friends in adulthood. Whether it’s a sewing circle or a bowling league, consider joining a club or team for camaraderie and fun.

• Fast fingers: Did you know that you can use your calculator to keep your mind engaged when there’s downtime or you’re on-the-go? Calculator games can build math skills, improve memory and keep your mind nimble.

Just as it is important to maintain physical fitness as you age, it’s also critical to exercise your mind. Stay mentally active by trying new hobbies, building new skills and seeking out new experiences.

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Tropical Storm Ida’s heavy rains may create a breeding ground for the mosquitoes that carry West Nile Virus, health officials warn.

“Following the recent heavy rainfall, we are concerned that standing water and summer temperatures will allow mosquitoes to proliferate,” Gregson Pigott, Suffolk County health commissioner, said in a statement. “While there is no cause for alarm, we ask residents to cooperate with us in our efforts to reduce exposure to West Nile virus and other mosquito-borne diseases.”

As of last week, 92 mosquito samples and four birds had tested positive for West Nile virus. From Aug. 25 to Aug. 26, 21 samples tested positive for the virus.

At least one mosquito from samples collected in Cold Spring Harbor, Huntington Station, Northport, Stony Brook, Port Jefferson Station and Rocky Point tested positive for the virus, according to the Suffolk County Health Department.

Most people infected with West Nile Virus, which was first detected in Suffolk County in 1999, have mild or no symptoms. Some, however, can develop high fever, headaches, neck stiffness, disorientation, coma, tremors, convulsions, muscle weakness, vision loss, numbness and paralysis, according to the health department.

Over the last 20 years, the number of mosquito samples testing positive for West Nile ranged from a low of eight in 2004 to a high of 295 in 2010, a year that also saw 25 human cases with three deaths.

Pigott urges residents to wear shoes and socks, long pants and long-sleeved shirts when mosquitoes are active. He also suggested using mosquito repellent, while reading and following directions carefully.

The Centers for Disease Control and Prevention recommends repellents containing DEET, oil of lemon eucalyptus, picaridin and IR3535, which can be used on skin and clothing. For children, lower concentrations of DEET are preferable, according to the CDC.

Insect repellents with permethrin should only be used on clothing and not directly on the skin.

Effective screens on windows and doors can keep mosquitoes out of homes and living areas.

Emptying containers that hold water, such as vases, pet water bowls, flowerpot saucers, birdbaths, trash cans and rain barrels can reduce available water sources for mosquitoes to lay their eggs. Scrubbing containers like pet water bowls can remove insect eggs that might otherwise survive.

Adrian Popp, chair of Infection Control at Huntington Hospital, explained that most disease doctors are on the lookout for West Nile infections. He tests everybody with an unexplained fever or other symptoms.

In a typical year, Huntington Hospital sees a few cases of West Nile. So far, Popp said, the hospital hasn’t reported any such illnesses.

“It is hard to say if it will be more prevalent this year since we had only a few cases in New York State so far and it is already the end” of the summer season, Popp wrote in an email.

While Popp said anyone is vulnerable to West Nile Virus if he or she is bitten by a mosquito, most cases are asymptomatic. Fewer than one percent of those who contract West Nile Virus develop more severe symptoms.

For those people who have more severe symptoms, doctors don’t have many tools at their disposal.

“There is no etiologic therapy,” Popp explained in an email. “Therapy is supportive, symptomatic care.”

The county urged residents concerned about West Nile Virus to download a copy of an informational brochure called “Get the Buzz on Mosquito Protection” on www.suffolkcountyny.gov.

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