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Design strategies that get you up and moving

By David Dunaief, M.D.

Dr. David Dunaief

Exercise helps build long-term physical and mental health, but regular exercise is often a challenge. Even with all the fitness-related apps to prompt us, modern society has an equal number of tech demotivators. It’s just too easy to let the next episode of our favorite series autoplay or to answer those last few emails.

Even if we want to exercise, we “don’t have time.”

I have good news. There is an easy way to get tremendous benefit in very little time. You don’t need expensive equipment, and you don’t have to join a gym. You can even sharpen your wits with your feet.

Esther Tuttle was profiled in a New York Times’ Science Times article a few years ago, when she was 99. Esther was sharp as a tack and was independently mobile, with no mobility aids. She remained active by walking in the morning for 30 minutes and then walking again in the afternoon. 

Of course, this story is only anecdotal; however, evidence-based medicine supports her claim that walking is a simple way to get exercise that shows incredible benefits. One mile of walking a day will help keep the doctor away. For the step-counters among you, that’s about 2,000 steps a day for an adult with an average stride length.

Does walking improve mental acuity?

Walking has a dramatic effect, preserving brain function and even growing certain areas of the brain (1). Study participants who walked between six and nine miles a week, or just one mile a day, reduced the risk of cognitive impairment over 13 years and actually increased the amount of gray matter tissue in the brain over nine years.

Participants who had an increase in brain tissue volume also experienced a substantially reduced risk of developing cognitive impairment. Interestingly, the parts of the brain that grew included the hippocampus, involved with memory, and the frontal cortex, involved with short-term memory and executive decision making. There were 299 participants with a mean age of 78. All were dementia-free at the trial’s start.

In another study, moderate exercise reduced the risk of mild cognitive impairment with exercise begun in mid-to-late life (2).

If you’re pressed for time or building your stamina, you can split a mile into two half-mile increments. How long does it take you to walk a half-mile?

Does walking affect one’s mood?

Researchers performed a meta-analysis of studies related to the relationship between exercise and depression. They found that adults who walked briskly for about 75 minutes per week cut their risk of depression by 18 percent (3).

If you ratchet up your exercise to running, a study showed that mood also improves, reducing anger (4). The act of running increases your levels of serotonin, a hormone that, when low, can make people agitated or angry.

How do I build better habits?

A common challenge I hear is that working from home reduces much of the opportunity to walk. There’s no walking down the hall to a meeting or to get lunch or even from the car or train to the office. Instead, everything is only a few steps away. Our work environment is working against us.

If you need a little help getting motivated, here is a terrific strategy to get you started: set an alarm for specific points throughout your day and use that as a prompt to get up and walk, even if it’s for only 15 minutes. The miles will add up quickly.

A client of my wife’s schedules meetings for no more than 50 minutes, so she can walk a “lap” around her house’s interior between meetings or even do some jumping jacks. She also looks for opportunities to have an old-fashioned phone call, rather than a video call, so she can walk up and down the hallway while she’s meeting. Of course, this is one person, but it might prompt some ideas that will work for you.

Walking has other benefits as well. Weight-bearing exercise helps prevent osteoporosis and osteoporotic fractures. Sadly, if you don’t use them, bones weaken and break. Walking is a weight-bearing exercise that helps strengthen your joints, bones and muscles.

Remember to use your feet to keep your mind sharp and yourself even-tempered. Activities like walking will help you keep a positive attitude, preserve your bones and help increase the plasticity of your brain.

References:

(1) Neurology Oct 2010, 75 (16) 1415-1422. (2) Arch Neurol. 2010;67(1):80-86. (3) JAMA Psychiatry 2022. 79(6), 500-559. (4) J Sport Exerc Psychol. 2010 Apr;32(2):253-261.

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

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Examining heredity vs. dietary impact

By David Dunaief, M.D.

Dr. David Dunaief

Your heart disease risk is influenced by your family’s history. Can you overcome these genetic issues by making lifestyle changes that improve your health trajectory? It’s the classic heredity vs. environment dilemma. Let’s look at the evidence.

A study involving the Paleo-type diet and other ancient diets suggests that cardiovascular disease is influenced by genetics, while another study considering the Mediterranean-type diet suggests that we might be able to reduce our risk factors with lifestyle adjustments. Most of the risk factors for heart disease, such as high blood pressure, high cholesterol, sedentary lifestyle, diabetes, smoking and obesity are modifiable (1). 

How do our genes affect our heart disease risk?

Researchers used computed tomography scans to look at 137 mummies from Egypt, Peru, the Aleutian Islands, Southwestern America, and others (2). The represented cultures included hunter-gatherers (consumers of a Paleo-type diet), farmer-gatherers and solely farmers. All the diets included significant amounts of animal protein, such as fish and cattle.

Researchers found that one-third of these mummies had atherosclerosis, or plaques in their arteries, which is a precursor to heart disease. This is a familiar ratio; it’s what we still see in modern times.

The authors concluded that atherosclerosis could be part of the human aging process. In other words, it may be embedded in our genes. We all have genetic propensity toward atherosclerosis and heart disease, some more than others.

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

How does diet affect our genetic response?

A study of 7,000+ participants in Spain who were at high risk for cardiovascular disease examined the impacts of a Mediterranean-type diet and a low-fat diet on cardiovascular disease risk (3). Two variations on the Mediterranean-type diet were compared to a low-fat diet, with participants randomly assigned to three different groups. The two Mediterranean-type diet groups indicated about a 30 percent reduction in the risk of cardiovascular disease, compared to the low-fat diet. Risk indicators they studied included heart attacks, strokes and mortality. Interestingly, risk improvement in the Mediterranean-type diets occurred without significant weight loss.

The study included three groups: a Mediterranean diet supplemented with mixed nuts (almonds, hazelnuts or walnuts), a Mediterranean diet supplemented with extra virgin olive oil (at least four tablespoons a day), and a low-fat control diet.

The Mediterranean-type diet arms both included significant amounts of fruits, vegetables, nuts, beans, fish, olive oil and wine. Both groups consuming this diet had either significant amounts of nuts or olive oil and/or wine. If the participants in the Mediterranean diet groups were wine drinkers, they were encouraged to drink at least one glass a day.

This study was well-designed; however, there was a significant flaw that should temper our enthusiasm. The group assigned to the low-fat diet was not able to maintain this diet throughout the study. As a result, it really became a comparison between variations on the Mediterranean diet and a standard diet.

How have leading cardiovascular and integrative medicine physicians responded to the study? Interestingly, there are two opposing opinions, split by field. You may be surprised by which group liked it and which did not.

Well-known cardiologists hailed the study as a great achievement. They emphasized that we now have a large, randomized diet trial measuring meaningful clinical outcomes. 

On the other hand, leading integrative medicine physicians, including Caldwell Esselstyn, M.D. and Dean Ornish, M.D., expressed disappointment with the results. Both promote plant-rich diets that may be significantly more nutrient-dense than the Mediterranean diet in the study. Both have published their own small, well-designed studies showing significant benefits from plant-based diets (4, 5). Ornish showed a reversal of atherosclerosis in one of his studies (6).

Their objections to the study revolve around their belief that heart disease and its risk factors can be reversed, not just reduced. In other words, the study didn’t go far enough.

Both opinions have merit. The cardiologists’ enthusiasm is warranted, because a Mediterranean diet, even with an abundance of included fats, will appeal to a wide audience. However, those who follow a more focused diet that includes more nutrient-dense foods, could potentially see a more significant reversal of heart disease.

Either way, it is encouraging to know that we can alter our cardiovascular destinies by altering our diet.

References:

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

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

 

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Lifestyle modifications including diet can help

By David Dunaief, M.D.

Dr. David Dunaief

In my practice, many patients have resisted telling me they suffered from erectile dysfunction (ED). However, it’s a common problem. Because it can indicate other medical issues, it’s important that you share this information with your doctor.

ED affects about 24 percent of men, on average. If it occurs less than 20 percent of the time, it is considered normal; however, if it occurs more than 50 percent of the time, you should seek help (1). 

Of course, there are oral medications for ED. You’ve probably seen the ads for approved medications, including sildenafil (Viagra, or the “little blue pill”), tadalafil (Cialis), vardenafil (Levitra, Staxyn), and avanafil (Stendra). They work by causing vasodilation, or enlargement of blood vessels, which increases blood flow to the penis. Unfortunately, this does not solve the medical problem, but it does provide a short-term solution for those who are good treatment candidates.

ED’s prevalence generally increases with age. An analysis of the 2021 National Survey of Sexual Wellbeing found that ED affected 12.7 percent of 35-44-year-olds, increased to 25.3 percent of 45-54- year-olds, 33.9 percent of those aged 55-64, 48 percent of those aged 65-74, and 52.2 percent of those aged 75 and older (2).

So, what contributes to the increase as we age? Disease processes and drug therapies.

What is the connection between medical conditions and ED?

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

Patients with ED had significantly more calcification, or atherosclerosis, in their arteries when compared to a control group in a randomized clinical trial (RCT) (5). They were also more than three times as likely to have severe calcification. In addition, they had more inflammation, measured by C-reactive protein. 

Which medications contribute to ED?

About 25 percent of ED cases are thought to be associated with medications, such antidepressants, NSAIDs (e.g., ibuprofen and naproxen sodium), and hypertension medications. Unfortunately, the most common antidepressant medications, SSRIs, have significant impacts on ED. 

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

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

How can diet affect ED?

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

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

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

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

References:

(1) clevelandclinic.org. (2) J Sex Med. 2024;21(4): 296–303. (3) J Sex Med. 2009;6(5):1414-22. (4) Int J Androl. 2010;33(6):853-60. (5) J Am Coll Cardiol. 2005;46(8):1503. (6) Medicine (Baltimore). 2018 Jul;97(28):e11367. (7) JAMA. 2002;288(3):351. (8) Int J Impot Res. 2006;18(4):405-10. (9) JAMA. 2004;292(12):1440-6. (10) J Sex Med. 2010 May;7(5):1911-7. (11) JAMA Netw Open. 2020 Nov 2;3(11):e2021701.

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

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Improve fatigue, mood, headaches and itchy skin

By David Dunaief, M.D.

Dr. David Dunaief

Brrr! It’s been super cold this winter, and heating systems have been in overdrive. All the dry heat pumping into our homes, offices and cars can have a dehydrating effect on our bodies. Symptoms of dehydration can range from itchy skin and constipation to fatigue, mood changes and headaches. Our dry throats and sinuses can also make us uncomfortable and more susceptible to irritations and viruses. More serious complications of dehydration can include migraines, heart palpitations and heart attacks. 

Let’s look at techniques for improving hydration and reducing the symptoms and consequences of all this dry air.

Improve ambient humidity

Measure the humidity level in your home with a hygrometer and target keeping it between 30 and 50 percent (1). When the temperature outside drops below 10 degrees Fahrenheit, lower this to 25 percent. You can add moisture to the air in several ways. Use cool mist humidifiers, keep the bathroom door open after you shower or bathe, and place bowls of water strategically around your home, including on your stovetop when you cook or on radiators. If you use humidifiers, take care to follow the manufacturer’s care instructions and clean them regularly, so you don’t introduce mold or bacteria into the air.

Reduce headaches and migraines

A review of studies found that those who drank four cups or more of water had significantly fewer hours of migraine pain than those who drank less (2). Headache intensity decreased as well.

Decrease heart palpitations

Heart palpitations are common and are broadly felt as a racing heart rate, skipped beat, pounding sensation or fluttering. Although they are not usually life-threatening, they can make you anxious. Dehydration and exercise contribute to this (3). Palpitations can be prompted when we don’t hydrate before exercising. If you drink one glass of water before exercise and continue to drink during exercise, it will help avoid palpitations.

Lower your heart attack risk

The Adventist Health Study showed that men who drank more water had the least risk of death from heart disease (4). Group one, which drank more than five glasses of water daily, had less risk than group two, which drank more than three. Those in group three, which drank fewer than two glasses per day, saw the lowest benefit, comparatively. For women, there was no difference between groups one and two, although both fared better than group three. The reason for this effect, according to the authors, may relate to blood or plasma viscosity (thickness) and fibrinogen, a substance that helps clots form.

Resolve decreased concentration and fatigue

Mild dehydration resulted in decreased concentration, subdued mood, fatigue and headaches in women in a small study (5). Dehydration was prompted by walking on a treadmill and taking a diuretic (water pill) prior to the exercise. Results were compared to a control group that did not take the diuretic. The authors concluded that adequate hydration was needed, especially during and after exercise.

Consume hydrating foods

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How much water you need to drink depends on your diet, activity levels, environment and other factors. In a review article, researchers analyzed the data, but did not find adequate studies to suggest that eight glasses a day is a magic number (6). It may be too much for some patients.

You can increase your hydration by altering your diet. Diets with a focus on fruits and vegetables increase water consumption (7). As you may know, 95 percent of the weights of many fruits and vegetables are attributed to water. An added benefit is an increased satiety level without eating calorically dense foods.

In a review, it was suggested that caffeinated coffee and tea don’t increase the risk of dehydration, even though caffeine is a mild diuretic (8). With moderate amounts of caffeinated beverages, the liquid in them has a more hydrating effect than its diuretic effect. Remember that salty foods can dehydrate you, including soups, breads and pastries, so try to avoid these.

It is important to stay hydrated to avoid uncomfortable — and sometimes serious — complications. Diet is a great way to ensure that you get the triple effect of high nutrients, increased hydration and sense of feeling satiated without calorie-dense foods. However, don’t go overboard with water consumption, especially if you have congestive heart failure or open-angle glaucoma (9).

References:

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

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

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Home remedies may be more helpful than supplements

By David Dunaief, M.D.

Dr. David Dunaief

These past few weeks, I’ve been hearing a lot more sniffling, sneezing and coughing. Cold season is here. A cold’s effects can range from mild annoyance to more serious symptoms that put us out of commission for weeks.

First, you might be able to prevent catching a cold with some common-sense tactics: wash your hands frequently and avoid touching your face to help minimize your exposure. Frankly, this is good practice to avoid many of the viruses circulating at this time of year.

If you do catch a common cold, you might be able to reduce your symptoms or the cold’s duration with some simple homestyle remedies and a few dietary supplements. 

How do you relieve cold symptoms?

Congestion or coughing symptoms can be eased by sitting in a steamy bathroom. This simulates a medical mist tent, moisturizing your nasal and bronchial passages. 

You might also try nasal irrigation, which uses a saline rinse or spray to flush your sinuses. This can help clear immediate congestion and thin secretions (1). There are pre-filled versions on the market, which make them easier to use. If you mix your own, the Cleveland Clinic’s website has detailed instructions and guidance (2). A few key points: do not share equipment, clean your equipment properly, and do not use tap water without boiling it.

Dry heat is your enemy when you’re experiencing cold symptoms. If your home or office is dry, use a cool mist humidifier to put some humidity back in the air. Take care to clean your humidifier to avoid mildew and mold buildup.

You can eat salt-free soups loaded with vegetables to increase your nutrient intake and loosen congestion. I start with a sodium-free soup base and add spices, onions, spinach, broccoli, and other greens until it’s stew-like. High levels of sodium can dehydrate you and make you feel worse. Caffeine-free hot teas will also help loosen congestion and keep you hydrated.

Does Zinc reduce a cold’s duration?

According to a meta-analysis that included 13 trials, zinc in any form taken within 24 hours of your first symptoms may reduce the duration of a cold by at least one day (3). Even more importantly, zinc may significantly reduce the severity of your symptoms throughout, improving your quality of life. This may be due to an anti-inflammatory effect.

One of the studies found that zinc reduced the duration of the common cold by almost 50 percent from seven days to four days, cough symptoms were reduced by greater than 60 percent, and nasal discharge was reduced by 33 percent (4). 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.

There are a few serious concerns with zinc. First, the dose researchers used was well above the maximum recommended intake is 40 mg per day for adults (5). Also, the FDA has warned against nasal zinc administration with sprays, which can result in permanent loss of smell.

Studies that showed a benefit have used different formulations, delivery systems and dosages, and there is no current recommendation or consensus on what is optimal.

Does vitamin C or echinacea help?

According to a review of 29 trials, vitamin C did not show any significant benefit in preventing or reducing cold symptoms or duration for the general population (6). However, a sub-group of serious marathon runners and other athletes who took vitamin C prophylactically caught 50 percent fewer colds.

The jury is still out on the effectiveness of echinacea for treatment of duration and symptoms, but the results are inconsistent and disappointing (7). In a randomized controlled trial with 719 patients, echinacea was no better than placebo for the treatment of common cold symptoms (8). There are ongoing studies to determine whether prophylactic use helps prevent colds (9). 

Should you exercise or not?

A study published in the British Journal of Sports Medicine may challenge your perceptions about exercising when you have a cold. 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 (10). Even more interesting is that those who reported themselves as being highly fit had 46 percent fewer days with colds compared to those who perceived themselves as having low fitness. Their cold symptoms were reduced significantly as well.

References:

(1) Am Fam Physician. 2009 Nov 15;80(10):1117-9. (2) clevelandclinic.org (3) Open Respir Med J. 2011; 5: 51–58. (4) J Infect Dis. 2008 Mar 15;197(6):795-802. (5) ods.od.nih.gov. (6) Cochrane Database of Syst Reviews 2013, Issue 1. Art. No.: CD000980. (7) Cochrane Database of Syst Reviews 2014, Issue 2. Art. No.: CD000530. (8) Ann Intern Med. 2010;153(12):769-777. (9) nccih.nih.gov. (10) British J Sports Med 2011;45:987-992.

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

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Don’t fall victim to Quitters Day

By David Dunaief, M.D.

Dr. David Dunaief

It’s a shiny new year, full of possibilities. To harness the energy that accompanies flipping the calendar page, many of us have started to eat healthier, to work out more, or to manage our stress differently. Terrific!

To help us along the way, there are oodles of weight loss plans, apps, memberships and other tools on the market to help us achieve our resolutions. Still, January 10 is “Quitters Day” this year. This is the day by which most of us will abandon our plans to develop new habits. Giving up on our resolutions is so ubiquitous, it now has a designated day. Changing habits is always hard. There are some things that you can do to make it easier, though. 

Set a simple, singular goal

We often overdo it by focusing on an array of habits, like eating, exercising, sleep routines, and stress management. While these are all worthy, their complexity diminishes your chances of success. Instead, pick one outcome to focus on, and limit the number of habits involved, for example: “increase my energy by eating better and moving more.”

Consider your environment

According to David Katz, M.D., Director, Yale-Griffin Prevention Research Center, successfully changing a habit is more about your environment than it is about willpower. Willpower, Dr. Katz notes, is analogous to holding your breath underwater; you can only do it for a short time. Instead, he suggests laying the groundwork by altering your environment to make it conducive to attaining your goals. Recognizing your obstacles and making plans to avoid or overcome them reduces stress and strain on your willpower. 

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

Build a supportive network

Support is another critical element. People do best when family members, friends and coworkers help reinforce their new behaviors. In my practice, I find that patients who are most successful with lifestyle changes are those whose household members encourage them or, even better, when they participate, such as eating the same meals.

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How long does it take to build a new habit?

Conventional wisdom used to tell us that it takes about three weeks of daily practice. However, a University of London study showed that the time to form a habit, such as exercising, ranged from 18 days to 254 days (2). The good news is that, though there was a wide variance, the average time to reach this automaticity was 66 days, or about two months.

How do you choose the best diet?

US News and World Report ranks diets annually and sorts them by objective, such as weight loss, healthy eating, diabetes, heart health, etc. (3). Three of the diets highlighted include the Mediterranean diet, the DASH diet, and the Flexitarian diet, in rank order.

What do all the top diets have in common? They focus on nutrient-dense foods, they are sustainable, they are flexible, and they are supported by research. For these reasons, the lifestyle modifications I recommend are based on a combination of the top diets and the evidence-based medicine that supports them.

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

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

Final Tip: Don’t try to do too much at once

Here’s one more tip: take it day by day and celebrate small wins. In my experience, many patients make better progress by choosing to change one meal at a time – like starting with what they eat for breakfast or for lunch each day. Once this is a habit, they alter another meal or their between-meal snacks.

Here’s to your optimal health in 2025!

References

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

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

 

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By David Dunaief, M.D.

Dr. David Dunaief

Dear Santa,

I’m sure you have a lot on your mind these days, with an abundance of Christmas requests and only a few remaining days to fill them.

My message is intended as a gift for you, not a request for myself. Your kindness and generosity toward others deserve to be returned. I am concerned about your growing belly, which has been compared to a bowl full of jelly when you laugh. Honestly, your upcoming journey around the world will likely make it worse. The cookies and milk, along with other sweets left for you on Christmas Eve, are only likely to make it worse.  

I’m concerned about your health and about the message it sends to kids. We’re currently dealing with an epidemic of overweight kids, which has contributed to the growing number of children with type 2 diabetes. According to the CDC, these numbers only get worse as children age.

You, Santa, can help reverse this trend and stem the increased risks of pancreatic cancer, breast cancer, liver cancer and heart disease that central belly fat promotes. Help children improve health outcomes that will follow them throughout their lives.

This is your opportunity to model the way — and, maybe fit back into that clingy tracksuit you’ve had in the back of your closet since the early 18th century, when you were still trim.

Think of the advantages of losing that extra weight. Your joints won’t ache as much in the cold; your back doesn’t hurt as much; and you will have more energy. Studies show that eating more fruits, vegetables and whole grains can reverse clogged arteries and help you avoid strokes, heart attacks and peripheral vascular disease. Even a simple change, like eating a small handful of raw nuts each day, can reduce your heart disease risk significantly.

Losing weight will also make it easier for you to keep your balance on steep, icy rooftops. No one wants you to take a tumble and break a bone — or worse.

Exercise will help, as well. Maybe this Christmas Eve, you could walk or jog alongside the sleigh for the first continent or two. During the “offseason” you and the elves could train for the North Pole After Christmas 5k. Having a team to train with is much more fun.

If you add some weight training into your routine, you’ll strengthen your core. In addition, your new muscles will help melt away fat from your midsection.

It doesn’t have to be a chore. After all, who doesn’t love a game of tag with the reindeer? 

If you really want to make a strong start, take a cue from the reindeer, who love their raw carrots and celery. Broadcast that the modern Santa enjoys fruits, especially berries and veggies, with an emphasis on cruciferous veggies like broccoli florets dipped in humus, which have antioxidant qualities and can help reverse disease.

And, of course, don’t put candy in our stockings. We don’t need more sugar, and I’d guess that, over the long night, it’s hard to resist sneaking a few pieces, yourself. Why not reduce the temptation? This will also eliminate the sugar highs and lows you feel during your all-night expedition.

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

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

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

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

Wishing you good health in the coming year,

David

P.S. If it’s not too late to ask, I could use a bucket of baseballs and a new glove. I hear the Yankees have an opening for an outfielder, so I need to start practicing.

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

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Legumes can reduce your risk significantly

By David Dunaief, M.D.

Dr. David Dunaief

How would you like to be “heart attack proof?” This term was introduced by Dr. Sanjay Gupta and later gained traction when it was iterated by Dr. Dean Ornish. While it’s probably not possible to be completely heart attack proof, research shows us that it is possible to significantly reduce your risk by important lifestyle choices.

About five percent of U.S. adults over age 19 have coronary artery disease (CAD), the most common type of heart disease (1). This contributes to a heart attack rate of one every 40 seconds. We can do better.

Many of the biggest contributors to heart disease risk are well-known: high blood pressure, high cholesterol, and smoking. In addition, if you have diabetes or are overweight or obese, your risk increases significantly. Lifestyle factors, such as poor diet, lack of physical activity and high alcohol consumption are among the significant risk contributors.

This is where we can dramatically reduce the occurrence of CAD. Evidence continues to highlight that lifestyle changes, including diet, are the most critical factors in preventing heart disease. Dietary changes that have a significant impact include consuming dietary fiber, legumes, nuts, omega-3 polyunsaturated fatty acids (PUFAs), and chocolate.

Increase your dietary fiber

We can significantly reduce our heart disease risk if we increase our fiber consumption to recommended levels.

The more fiber you eat, the greater you reduce your risk. In a meta-analysis of 10 studies that included over 90,000 men and 200,000 women, results showed that for every 10-gram increase in fiber, participants experienced a corresponding 14 percent reduction in their risk of a cardiovascular event and a 27 percent reduction in their risk of heart disease mortality (2).

According to a 2021 analysis of National Health and Nutrition Examination Survey (NHANES) data from 2013 to 2018, only 5 percent of men and 9 percent of women get the recommended daily amount of fiber (3). The average American consumes about 16 grams per day of fiber (4).

The Academy of Nutrition and Dietetics recommends 14 grams of fiber for every 1,000 calories consumed, or roughly 25 grams for women and 38 grams for men (5).

Good sources of fiber are fruits and vegetables eaten with edible skin or peel, beans, lentils, and whole grains.

Various legumes.

Eat your legumes 

In a prospective (forward-looking) cohort study, legumes reduced the risk of coronary heart disease by 22 percent (6). Those who consumed four or more servings a week saw this effect when compared to those who consumed less than one serving a week. The legumes used in this study included beans, peas and peanuts. There were over 9,500 men and women involved, and the study spanned 19 years of follow-up.

I recommend that patients consume a minimum of one to two servings a day, significantly more than the relatively modest four servings a week used to achieve statistical significance in this study.

Include healthy nuts

Why should you include nuts? In a study with over 45,000 men, consuming omega-3 polyunsaturated fatty acids (PUFAs) led to significant reductions in CAD. 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. Of course, be cautious about consuming too many nuts, since they’re also calorically dense.

Consume a modest amount of chocolate

In an analysis of six studies with over 336,000 participants, researchers found that eating chocolate at least once a week was associated with an 8 percent decreased risk of coronary artery disease when compared with consuming chocolate less than once a week (8).

The author notes that chocolate contains heart healthy nutrients such as flavonoids, methylxanthines, polyphenols and stearic acid which may reduce inflammation and increase good cholesterol. The study did not examine whether any particular type of chocolate is more beneficial or whether there is an ideal portion size.

An earlier study did show that two pieces of chocolate a week may decrease the risk of a heart attack by 37 percent, compared to those who consume less (9). 

Both study’s authors warn against the idea that more is better. High fat and sugar content and chocolate’s caloric density may have detrimental effects when consumed at much higher levels. 

I typically recommend that patients have one to two squares — about one-fifth to two-fifths of an ounce — of high-cocoa-content dark chocolate daily. Aim for chocolate labeled with 80 percent cocoa content.

You can also get chocolate’s benefits without the fat and sugar by adding unsweetened, cocoa powder to a fruit and vegetable smoothie. Do not use Dutch-process cocoa, also known as alkalized cocoa; the processing can remove up to 90 percent of the flavanols (10).

References:

(1) cdc.gov. (2) Arch Intern Med. 2004 Feb 23;164(4):370-376. (3) nutrition.org (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. (8) Eur J Prev Cardiol. 2021 Oct 13;28(12):e33-e35. (9) BMJ 2011; 343:d4488. (10) J Agric Food Chem. 2008 Sep 24;56(18):8527-33.

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

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Diabetes complications can include permanent vision loss

By David Dunaief, M.D.

Dr. David Dunaief

Diabetic retinopathy (DR) is the leading cause of blindness among U.S. adults, ages 20 to 74 years old (1). As the name implies, it’s a follow-on to diabetes, and it occurs when the blood vessels that feed the light-sensitive tissue at the back of your eye become damaged. It can progress to blurred vision and blindness, typically affecting both eyes.

As of 2023, only about 66 percent of adults with diabetes had a recommended annual eye screening (2). Why is this important? Because the earlier you catch it, the more likely you will be able to prevent or limit permanent vision loss with treatments that target its early stages.

A consequence of DR can be diabetic macular edema (DME) (3). With DME, swelling of the macula, which is an oval spot in the central portion of the retina, can cause significant vision loss. Those with the longest duration of diabetes have the greatest risk for DME.

Unfortunately, the symptoms of vision loss often don’t occur until the later stages of the disorder, after it’s too late to reverse the damage.

How do you treat diabetic macular edema?

DME treatments often include eye injections of anti-VEGF medications, either alone or alongside laser treatments. They work by inhibiting overproduction of a protein called vascular endothelial growth factor (VEGF) (4). These can slow the progression of DME or reverse it (4).

The results from a randomized controlled trial showed that eye injections with ranibizumab (Lucentis) in conjunction with laser treatments, whether laser treatments were given promptly or delayed for at least 24 weeks, were effective in treating DME (5).

Other treatments can include NSAID and/or steroid drops that attempt to reduce swelling of the macula.

Can you reduce DME risk by treating diabetes?

Unfortunately, medications that treat type 2 diabetes do not lower your risk of DME. The THIN trial, a retrospective study, found that a class of diabetes drugs, thiazolidinediones, which includes Avandia and Actos, actually increased the occurrence of DME compared to those who did not use these oral medications (6). Those receiving these drugs had a 1.3 percent incidence of DME at year one, whereas those who did not had a 0.2 percent incidence. This persisted through the 10 years of follow-up. In addition to DME occurrence, the FDA warns of other significant side effects from these drugs.

To make matters worse, of the 103,000 diabetes patients reviewed, those who received both thiazolidinediones and insulin had an even greater incidence of DME. It was unclear whether the findings were caused by the drugs or by the severity of the diabetes, itself.

This contradicts a previous ACCORD eye sub-study, a cross-sectional analysis, which did not show an association between thiazolidinediones and DME (7). This study involved review of 3,473 participants who had photographs taken of the fundus (the back of the eye).

What does this ultimately mean? Both studies had weaknesses. It was not clear how long the patients had been using the thiazolidinediones in either study or whether their sugars were controlled and to what degree. The researchers were also unable to control for all other possible confounding factors (8). There are additional studies underway to clarify these results.

Can glucose control and diet                   change the equation?

The risk of progression of DR was significantly lower with intensive blood sugar controls using medications, one of the few positive highlights of the ACCORD trial (9). Unfortunately, medication-induced intensive blood sugar control also resulted in increased mortality and no significant change in cardiovascular events. However, an inference can be made: a nutrient-dense, plant-based diet that intensively controls blood sugar is likely to decrease the risk of diabetic retinopathy and further vision complications (10, 11).

If you have diabetes, the best way to avoid DR and DME is to maintain effective control of your sugars. It is also crucial that you have a yearly eye exam by an ophthalmologist. This will help detect issues early, before permanent vision loss occurs. If you are taking the oral diabetes class thiazolidinediones, this is especially important.

References:

(1) cdc.gov. (2) odphp.health.gov. (3) mayoclinic.org. (4) Community Eye Health. 2014; 27(87): 44–46. (5) ASRS. Presented 2014 Aug. 11. (6) Arch Intern Med. 2012;172:1005-1011. (7) Arch Ophthalmol. 2010 March;128:312-318. (8) Arch Intern Med. 2012;172:1011-1013. (9) www.nei.nih.gov. (10) OJPM. 2012;2:364-371. (11) Am J Clin Nutr. 2009;89:1588S-1596S.

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

 

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Honor your friends and family with healthier Thanksgiving option

By David Dunaief, M.D.

Dr. David Dunaief

Research tells us that Americans are more likely to gain weight between Thanksgiving and New Year’s Day. This is when many accumulate the greatest weight gain of the year, and most do not lose the weight they gain during this time (1). In the study group, those who were already overweight or obese had the greatest weight gains. If you can avoid weight gain during the holidays, think of the possibilities for the rest of the year.

It’s difficult to maintain healthy eating habits during the Thanksgiving holidays, and the additional stress of the season doesn’t help. Even when we intend to resist, it’s too tempting to indulge in a sprawling buffet or seasonal treats.

Unfortunately, this can have significant health consequences. And if you tend to overeat, be aware that there are short-term consequences of stuffing ourselves. Overeating during a single meal can increase your heart attach risk in the near term, according to the American Heart Association (2).  

How can you turn Thanksgiving dinner into a healthier meal? The secret is often hidden in the side dishes on your table and the snacks you offer. 

Increase the carotenoids

Carotenoids help to prevent and potentially reverse diseases, such as breast cancer, amyotrophic lateral sclerosis (Lou Gehrig’s disease), age-related macular degeneration, and cardiovascular disease. Foods that contain these substances are dark green leafy vegetables, as well as orange, yellow and red vegetables and fruits. These phytochemicals (plant nutrients) have antioxidant and anti-inflammatory effects (3).

Prepare veggies in an appetizing way

Vegetables are often prepared in either an unappetizing way or smothered in cheese and butter, negating any benefits. Fruits are often buttered and sugared beyond recognition or used as a garnish for more decadent dishes. 

Other plant-based foods, like whole grains and leafy greens, are often afterthoughts. Here are some suggestions to get you thinking about ways to shift the heavy holiday meal paradigm:

Elevate plant-based dishes. Supplement tradition by adding mouthwatering vegetable-based dishes. One of my favorites is steamed “sweet” vegetables – cauliflower, broccoli, snap peas, onions and garlic. To make it sweet, I sauté it in a splash of citrus-infused balsamic vinegar and add sliced apples. Who doesn’t love poached apples? You can make this a primary dish by adding diced tofu or garbanzo beans to make it more filling without overwhelming its delicate sweetness.

Add seasonings. Why would you serve vegetables without any seasoning? In my family, we season vegetables and make sauces to drizzle over them. Personally, I’m a fan of infused vinegars. Choose your favorites to add varied flavors to different vegetables. 

Our teenaged nephew, who never liked vegetables, fell in love with my wife’s roasted Brussels sprouts and broccoli while on summer vacation together. He texted her afterward to ask for the recipes, which are surprisingly simple: place them on a roasting tray, add salt-free spices, and roast to your desired tenderness. Now, he makes them for himself. Resources for appealing vegetable dishes can be found at PCRM.org, mouthwateringvegan.com, and many other online resources.

Replace refined grains and starches. A study in the American Journal of Clinical Nutrition showed that replacing wheat or refined grains with whole wheat and whole grains significantly reduced central fat, or belly fat (4). The participants lost superficial fat found just below the skin, as well as visceral adipose tissue, the fat that lines organs and causes chronic diseases such as cancer.

For even better results, consider substituting riced cauliflower or mashed cauliflower for rice or potatoes. You can purchase frozen riced cauliflower in grocery stores now. Be sure to choose one that’s unsalted. If you prefer mashed potatoes, here’s a simple recipe for mashed cauliflower, which is delicious: https://medicalcompassmd.com/post/mashed-cauliflower-recipe-vegan. 

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

Improve dessert options. You might include a dairy-free, sugar-free pumpkin pudding or fruit salad. Both are light and won’t make you feel overstuffed.

Your overarching goal should be to increase your appealing, nutrient-dense options and decrease your empty-calorie foods. Express your gratitude for family and friends and promote their good health with a delicious, thoughtful, festive meal.

References:

(1) N Engl J Med. 2000 Mar 23;342(12):861–867. (2) www.heart.org. (3) Crit Rev Food Sci Nutr 2010;50(8):728–760. (4) Am J Clin Nutr 2010 Nov;92(5):1165-71.

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

 

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