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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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Minimize serious medication risks with modest lifestyle change

By David Dunaief M.D.

Dr. David Dunaief

If you are planning to enjoy a large Thanksgiving dinner, you’ll probably experience reflux afterward. Here, your stomach contents flow back into your esophagus when the valve between your stomach and your esophagus, the lower esophageal sphincter, relaxes. This is normal, especially after a meal, and doesn’t require medical treatment (1).

Gastroesophageal reflux disease (GERD), however, is more serious and can have long-term health effects. Among them are erosion or scarring of the esophagus, ulcers, and increased cancer risk. Approximately 20 percent of the U.S. adult population has been diagnosed with GERD, although researchers estimate it affects as much as 28 percent (2). It’s no surprise that pharmaceutical firms have lined drug store shelves with all kinds of solutions.

GERD risk factors range from lifestyle — obesity, smoking and diet — to medications, like calcium channel blockers and antihistamines. Other medical conditions, such as hiatal hernia and pregnancy, also play a role (3). Dietary triggers, such as spicy, salty, or fried foods, peppermint, and chocolate, might also contribute.

Medication options

The most common and effective medications for treating GERD are H2 receptor blockers and proton pump inhibitors (PPIs). H2 receptor blockers, such as Zantac and Tagamet, partially block acid production. PPIs, which include Nexium and Prevacid, almost completely block acid production (4). Both have two levels: over-the-counter and prescription strength. Let’s focus on PPIs, for which over 92 million prescriptions are written each year in the U.S. (5).

The most frequently prescribed PPIs include omeprazole (Prilosec) and pantoprazole (Protonix). Studies show they are effective with short-term use in treating Helicobacter pylori-induced peptic ulcers, GERD symptoms, gastric ulcer prophylaxis associated with NSAID use, and upper gastrointestinal bleeds.

Most of the package insert data is from short-term studies lasting weeks, not years. The landmark study supporting long-term use FDA approval was only one year. However, maintenance therapy is usually prescribed for many years.

Concerns about long-term use effects and overprescribing have prompted pharmacists to take an active role in educating patients about their risks and about the need to take them before eating for them to work (6).

PPI risks

PPI side effects after years of use can include increased bone fracture risk; calcium malabsorption; Clostridium difficile (C. difficile), a serious intestinal bacterial infection; potential vitamin B12 deficiencies; and weight gain (7).

The FDA has amplified its warnings about the increased risk of C. difficile, which must be treated with antibiotics. Unfortunately, it only responds to a few, and that number is dwindling. Patients must contact their physicians if they develop diarrhea when taking PPIs and it doesn’t improve (8).

Suppressing stomach acid over long periods can also result in malabsorption issues. In a study where PPIs were associated with B12 malabsorption, it took at least three years’ duration to cause this effect. While B12 was not absorbed properly from food, PPIs did not affect B12 levels from supplementation (9). If you are taking a PPI chronically, have your B12 and methylmalonic acid (a metabolite of B12) levels checked and discuss supplementation with your physician.

Before you stop taking PPIs, consult your physician. Rebound hyperacidity can result from stopping abruptly.

Lifestyle options

A number of lifestyle modifications can improve GERD, such as raising the head of the bed about six inches, not eating prior to bedtime and obesity treatment (10). 

Increase fiber and exercise. A study that quantified the increased risks of smoking and salt also found that fiber and exercise both had the opposite effect, reducing GERD risk (11). An analysis by Journal Watch suggests that the fiber effect may be due to its ability to reduce nitric oxide production, a relaxant for the lower esophageal sphincter (12).

Lose weight. In one study, researchers showed that obesity increases pressure on the lower esophageal sphincter significantly (13). Intragastric (within the stomach) pressures were higher in both overweight and obese patients on inspiration and on expiration, compared to those with lower body mass indexes.

Eat long before bedtime. A study showed a 700 percent increased risk of GERD for those who ate within three hours of bedtime, compared to those who ate four hours or more before bedtime (14).

While drugs have their place in the arsenal of options to treat GERD, lifestyle changes are the first, safest, and most effective approach in many instances. 

References:

(1) Gastroenterol Clin North Am. 1996;25(1):75. (2) Gut. 2014; 63(6):871-80. (3) niddk.nih.gov. (4) Gastroenterology. 2008;135(4):1392. (5) Kane SP. Proton Pump Inhibitor, ClinCalc DrugStats Database, Version 2024.08. Updated August 7, 2024. (6) US Pharm. 2019:44(12):25-31. (7) World J Gastroenterol. 2009;15(38):4794–4798. (8) FDA.gov. (9) Linus Pauling Institute; lpi.oregonstate.edu. (10) Arch Intern Med. 2006;166:965-971. (11) Gut 2004 Dec; 53:1730-1735. (12) JWatch Gastro. Feb. 16, 2005. (13) Gastroenterology 2006 Mar; 130:639-649. (14) Am J Gastroenterol. 2005 Dec;100(12):2633-2636.

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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Stock photo
Immunosuppressives can help, but with serious side effects

By David Dunaief, M.D.

Dr. David Dunaief

Eczema is relatively common, affecting 20 percent of children and 10 percent of adults around the world (1). If you are one of the many who experiences eczema, you know the symptoms, which can include skin rashes, itching, pain and redness.

Eczema is a chronic inflammatory process, and it’s likely caused by a combination of genetics and environmental or lifestyle issues (2). Investigation into potential causes is a growing field.

The National Eczema Association details the seven different kinds of eczema on its website, nationaleczema.org. Atopic dermatitis is the most frequently occurring.

While there is no cure, some treatments can ease symptoms and reduce flare-ups. These range from over-the-counter creams and lotions, antihistamines for itchiness, prescription steroid creams, oral steroids, and injectable biologics. Some use phototherapy for severe cases, but there’s not a lot of research suggesting this is effective. Interestingly, diet may play an important role.

Two studies have shown an association between eczema and fracture risk, which we will look at more closely.

Eczema and diet

In a Japanese study involving over 700 pregnant women and their offspring, results showed that when the women ate either a diet high in green and yellow vegetables, beta carotene or citrus fruit there was a significant reduction in the risk of the child having eczema of 59 percent, 48 percent and 47 percent, respectively, when comparing highest to lowest consumption quartiles (3).

Elimination diets may also play a role in identifying allergic causes. One study’s results showed when eggs were removed from the diet of those who were allergic, according to IgE testing, eczema improved significantly (4).

In my practice, I have seen very good results when treating patients who have eczema with dietary changes. My practice has many patients who suffer from some level of eczema. For example, a young adult had eczema mostly on his extremities. When we first met, these were angry, excoriated, inflamed lesions. However, after several months of a vegetable-rich diet, the patient’s skin improved significantly. These results are not unique.

Do immunosuppressives provide a solution?

Injectable biologics are generally recommended for moderate to severe atopic dermatitis when other treatment options have failed (5). Three are approved by the FDA, dupilumab, tralokinumab-ldrm, and lebrikizumab-lbkz.

In trials, they showed good results when topical steroids alone were not effective. Like other monoclonal antibodies, they work by limiting your immune system response. 

Other oral immunosuppressives, such as those used to inhibit organ rejection in transplant patients, are options, as well.

Unfortunately, any suppression of the immune system’s response, whether oral or injectable, leaves the door open for side effects, including serious infections.

Can supplements help reduce symptoms?

Two well-known supplements are known to reduce inflammation, evening primrose oil and borage oil. Are they good replacements for – or additions to – medication? The research is mixed, leaning toward ineffective. There are also some important concerns about them.

In a meta-analysis of seven randomized controlled trials, evening primrose oil was no better than placebo in treating eczema (6). Researchers also looked at eight studies of borage oil and found there was no difference in symptom relief than placebo. 

While these supplements only had minor side effects in the study, they can interact with other medications. For example, evening primrose oil in combination with aspirin can cause clotting problems (7). If you do try them, be sure to consult with your physician first.

What’s the relationship between eczema and bone fractures?

Several studies have examined the relationship between eczema and bone fractures. One observational study of 34,500 patients showed that those with eczema had a 44 percent increased risk of injury causing limitation and a 67 percent risk of bone fracture and bone or joint injury for those over age 29 (8).

Those with both fatigue or insomnia in combination with eczema are at higher risk for bone or joint injury. The researchers postulated that corticosteroid treatments could contribute, in addition to chronic inflammation, which may also add to bone loss risk. Steroids can weaken bone, ligaments and tendons and can cause osteoporosis by decreasing bone mineral density.

A study of over 500,000 patients found that the association between major osteoporotic fractures and atopic dermatitis remained, even after adjusting for a range of histories with oral corticosteroids (9). Also, fracture rates were higher in those with severe atopic dermatitis.

If you have eczema, talk to your physician about having a DEXA (bone) scan to monitor your bone health.

There is an array of possibilities in development, from topical to oral to injectable treatments, which might provide future relief. Until then, partner with your physician to identify solutions that will work for you, but ensure you understand the side effects of what you’re taking. Diet adjustments appear to be very effective, at least at the anecdotal level.

References:

(1) naiad.nih.gov. (2) Acta Derm Venereol (Stockh) 1985;117 (Suppl.):1-59. (3) Allergy. 2010 Jun 1;65(6):758-765. (4) J Am Acad Dermatol. 2004;50(3):391-404. (5) JAMA Dermatol. 2015;151(1):33-41. (6) Cochrane Database Syst Rev. 2013;4:CD004416. (7) mayoclinic.org (8) J Allergy Clin Immunol Pract. 2021 Sep 24;S2213-2198(21)01018-7. (9) nationaleczema.org.

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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METRO photo
Relatively small amounts of exercise lead to big benefits

By David Dunaief, M.D.

Dr. David Dunaief

Last week, I had a conversation with a vibrant, independent 96-year-old, who was excited to share her thoughts about the current election cycle.

It’s becoming more common to live into your 90s: 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 in the U.S. (1). Researchers refer to this group as the “oldest-old,” which includes those over age 84.

What do these “oldest-old” have in common? According to one study, they tend to have fewer chronic medical conditions or diseases. As a result, they typically have greater physical functioning and mental acuity, which allows them a better quality of life (2).

A study of centenarians found that they tended to be healthy and then die rapidly, without prolonged suffering (3). In other words, they stayed mobile and mentally alert.

While genetics are a factor that can predict your ability to reach this exclusive club, lifestyle choices also play an important role. Let’s look at the research.

Does exercise really help extend our lives?

We’re repeatedly nudged to exercise. This is not vanity; it can have a direct impact on our longevity and health.

One study of over 55,000 participants from ages 18 to 100 showed that five-to-ten minutes of daily running, regardless of the pace, can significantly impact our life span by decreasing cardiovascular mortality and all-cause mortality (4).

Amazingly, even if participants ran fewer than six miles a 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 limited amount of time and modest pace potentially added three years to their life span.

An editorial that accompanied this study shared that more than 50 percent of people in the U.S. do not achieve the current recommendation of at least 30 minutes of moderate exercise a day (5).

One study of over a quarter-million people found that walking just 3867 steps a day started to reduce the risk of dying from any cause, and every additional 1000 steps reduced risk of death from all causes another 15 percent (6). The researchers could not find an upper limit to the benefits.

For those 85 and older, all-cause mortality risk was reduced 40 percent by walking just 60 minutes a week at a pace that qualified as physical activity, not even exercise.

What is the best protein source?

Many are questioning the value of a long-standing dietary paradigm that suggests we need to eat sufficient animal protein to support us as we age.

In an observational study of 7,000 participants from ages 50 to 65, researchers found that those who ate a high-protein diet with greater than 20 percent of their calories from protein had a had a 75 percent increase in overall mortality, a four-times increased risk of cancer mortality, and a four-times increased risk of dying from diabetes during the following 18 years (7). 

However, this did not hold true if plants were the protein source. Interestingly, they found a high-protein plant diet may actually 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 of over 73,000 participants with a median age of 57 years reinforced these findings (8). 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 experienced a significantly reduced risk of dying over the next six years compared to those who were more frequent meat eaters. 

What does systemic inflammation tell us about longevity?

The Whitehall II study included 3,044 participants over the age of 35 who did not have a stroke, heart attack or cancer at the beginning of the study (9). Researchers measured a specific marker for inflammation, interleukin-6 (IL-6). They found that higher levels had negative impacts on participants’ healthy longevity. 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 bottom line is that lifestyle choices are important to healthy longevity. A small amount of exercise and consuming more plant protein than animal 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. Your doctor can test to see if you have an elevated IL-6. If you do, 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) Eur J Prev Cardiol. 2023 Dec 21;30(18):2045. (7) Cell Metab. 2014;19:407-417. (8) JAMA Intern Med. 2013;173:1230-1238. (9) 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 or consult your personal physician.

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The DASH diet is a flexible eating plan that helps create a heart-healthy eating style for life. Stock photo

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, it develops slowly over years and may take a long time to become symptomatic. According to the latest statistics, 6.7 million Americans over the age of 19 are affected (1).  These numbers are projected to increase to 8.7 million by 2030, with the greatest growth among those aged 35 to 64 (2).

There are two types of heart failure, systolic and diastolic. Put simply, the difference is that the output of blood with each contraction of the heart’s left ventricle is generally preserved in diastolic HF, while it can be significantly reduced in systolic HF.

Fortunately, both types can be diagnosed with an echocardiogram, an ultrasound of the heart. The signs and symptoms of both include shortness of breath during daily activities or when lying down; edema or swelling in the feet, legs, ankles or stomach, reduced exercise tolerance; and feeling tired or weak. These can have a significant impact on your quality of life.

Major lifestyle risk factors for heart failure include obesity, smoking, poor diet, being sedentary, excessive alcohol intake (3). Medical conditions that increase your risk include diabetes, coronary artery disease, high blood pressure, and valvular heart disease.

Heart failure can be treated with medication, including blood pressure medications, such as beta blockers, ACE inhibitors and angiotensin receptor blockers. All of these have side effects. We are going to look at recent studies that examine the role of diet in reducing your risk. 

The role of antioxidants in your diet

If we look beyond the risk factors mentioned above, some studies have explored the role oxidative stress may play an important role in contributing to HF.

In an analysis of the Swedish Mammography Cohort, researchers showed that a diet rich in antioxidants reduces the risk of developing HF (4). 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. The antioxidants were mainly from fruits, vegetables, whole grains, coffee and chocolate. Fruits and vegetables were responsible for most of the effect.

This study was the first to investigate the impact of dietary antioxidants on heart failure prevention.

This was a large study: it involved 33,713 women with 11.3 years of follow-up. Still, there are limitations, because it was an observational study, and the population involved only women. However, the results are very exciting, and there is little downside to applying this approach.

Applying the DASH diet

A 2022 study examined the effects of the Dietary Approaches to Stop Hypertension (DASH) diet on the risk of developing HF (5). This study included over 76,000 men and women, ages 45-83 and without previous HF, ischemic heart disease or cancer from the Cohort of Swedish Men and the Swedish Mammography Cohort.

The DASH diet emphasizes consuming fruit, vegetables, whole grains, nuts and legumes, and low-fat dairy and de-emphasizes red and processed meat, sugar-sweetened beverages, and sodium.

The researchers found that long-term adherence to the DASH diet was associated with a lower risk of HF. The greater the participants’ adherence, the greater the positive effect.

Interestingly, even replacing one serving per day of red and processed meat with one serving per day of other DASH diet foods was associated with an approximate 10 percent lower risk of HF.

Comparing a variety of diets

The REGARDS (REasons for Geographic and Racial Differences in Stroke) Trial examined the impact of five dietary patterns on later development of HF in over 16,000 patients followed for a median of 8.7 years. The dietary patterns included convenience, plant-based, sweets, Southern, and alcohol/salads (6). 

Researchers found that a plant-based dietary pattern was associated with a significantly lower risk of HF. Compared with the lowest quartile, the highest quartile of adherence to the plant-based dietary pattern was associated with a 41 percent lower risk of HF. 

The highest adherence to the Southern dietary pattern was associated with a 72 percent higher risk of HF after adjusting for age, sex, and race and for other potential confounding factors. Researchers found less effect after further adjusting for body mass index, waist circumference, hypertension, dyslipidemia, diabetes mellitus, atrial fibrillation, and chronic kidney disease.

They did not observe any associations with the other 3 dietary patterns.

These studies suggest that we should seek to prevent heart failure with dietary changes, including consuming higher amounts of antioxidant-rich foods, such as fruits and vegetables, and lower amounts of red and processed meats.

References:

(1) Circulation. 2024;149:e347–913. (2) hfsa.org. (3) cdc.gov. (4) Am J Med. 2013 Jun:126(6):494-500. (5) Eur J of Prev Cardiology 2022 May: 29(7): 1114–1123. (6) J Am Coll Cardiol. 2019 Apr 30; 73(16): 2036–2045.

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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