CLOSE
Medical Compass

by -
0 613
Find this recipe for Shrimp, Broccoli and Potato Skewers below. Photo courtesy of Family Features
Offer a mouthwatering array of fruits and veggies with your bbq choices

By David Dunaief, M.D.

Dr. David Dunaief

Independence Day makes me think of fireworks and summer barbecues and picnics. What if you could launch yourself on a journey to better health during these celebratory moments?

I have written about the dangers of processed meats, which are barbecue and picnic staples, and their roles in prompting chronic diseases, such as cancer, diabetes, heart disease and stroke. What if there were appetizing, healthier alternatives?

Green leafy vegetables, fruit, nuts and seeds, beans and legumes, whole grains and small amounts of fish and olive oil are the foundations of the Mediterranean-style diet. The options are far from tasteless.

I love a family barbecue, and I always strive to have an array of succulent choices. Three-bean salad, mandarin orange salad with mixed greens and a light raspberry vinaigrette, ratatouille with eggplant and zucchini, salmon fillets baked with mustard and slivered almonds, roasted corn on the cob, roasted vegetable shish kebobs, and large bowl of melons and berries. These drool-worthy buffet items help me keep my health journey on the right path. Let’s look at the scientific evidence that explains why these foods help us.

Preventing cancer

One systematic review provides a comprehensive look at the results of studies that weigh the effects of to a Mediterranean-type diet on cancer risk and progression (1, 2). The authors found an inverse relationship between cancer mortality risk and high adherence to the diet. This means that the more compliant participants were, the lower their risk of cancer mortality.

When comparing the results of high adherence and low adherence to the diet from studies of specific cancers, they identified risk reductions for colorectal, prostate, gastric, and liver cancers (1). Further study also found high adherence reduced the risks of breast, head and neck, gallbladder, and biliary tract cancers (2).

The authors note that, while it’s improbable that any single component of the diet led to these effects, they were able to demonstrate significant inverse correlations between specific food groups and overall cancer risk. For example, the higher the regular consumption of fruits, vegetables, and whole grains, the lower the risk. All three of these fit right in at a summer feast.

Looking closely at specific cancers, another study found that increased consumption of fruits and vegetables may help prevent pancreatic cancer. This is crucial, pancreatic cancer often spreads to other organs before there are symptoms (3). In another study, cooked vegetables showed a 43 percent reduction and non-citrus fruits showed an even more impressive 59 percent reduction in risk of pancreatic cancer (4). Interestingly, cooked vegetables, not just raw ones, had a substantial effect.

Preventing and treating diabetes 

Fish might play an important role in reducing the risk of diabetes. In a large prospective study that followed Japanese men for five years, those in the highest quartile of fish and seafood intake had a substantial decrease in risk of type 2 diabetes (5). Smaller fish, such as mackerel and sardines, had a slightly greater effect than large fish and seafood. Therefore, there is nothing wrong with some grilled fish to help protect you from developing diabetes.

Nuts are beneficial in diabetes treatment. In a randomized control trial, mixed nuts led to a substantial reduction of hemoglobin A1C, a very important biomarker for sugar levels for the previous three months (6). They also significantly reduced LDL, bad cholesterol, which reduced the risk of cardiovascular disease.

The nuts used in the study were raw almonds, pistachios, pecans, peanuts, cashews, hazelnuts, walnuts and macadamias. How easy is it to grab a small handful of unsalted raw nuts, about 2 ounces, daily to help treat diabetes?

Preventing a stroke

The Three City study showed that olive oil may have a substantial, protective effect against stroke. There was a 41 percent reduction in stroke events in those who used olive oil (7). Study participants, who were followed for a mean of 5.2 years, did not have a history of stroke at the start of the trial.

Though these are promising results, I caution you to use no more than one tablespoon of olive oil per day, since it’s calorically dense. Overindulging can lead to other health problems.

It’s easy to substitute a beneficial Mediterranean-style diet for processed meats, or at least add them to the selection you offer. This plant-rich diet can help you prevent many chronic diseases. 

This Independence Day and beyond, plan to include some delicious, healthy choices for your celebrations.

References:

(1) Curr Nutr Rep. 2016; 5: 9–17. (2) Nutrients. 2017 Oct; 9(10): 1063. (3) Nature. 2010;467:1114-1117. (4) Cancer Causes Control. 2010;21:493-500. (5) Am J Clin Nutr. 2011 Sep;94(3):884-891. (6) Diabetes Care. 2011 Aug;34(8):1706-11. (7) Neurology. 2011 Aug 2;77(5):418-25.

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.

—————————————————————

Shrimp, Broccoli and Potato Skewers

 Shrimp, Broccoli and Potato Skewers 
Photo courtesy of Family Features

Prep time: 5 minutes
Cook time: 20 minutes
Servings: 4

Ingredients: 

1 pound bagged Little Potatoes
1 bunch broccoli
12 large shrimp, peeled and deveined
1 1/2 lemons, juice only
3 tablespoons fresh thyme, chopped
2 tablespoons olive oil
salt, to taste
pepper, to taste

Directions:

In large, microwave-safe bowl, microwave potatoes on high 5 minutes. Chop broccoli into large pieces. Add broccoli and shrimp to bowl once potatoes are steamed. Add lemon juice, thyme and olive oil; evenly coat potatoes, shrimp and broccoli. Season with salt and pepper, to taste. Build skewers and grill 10-15 minutes on medium-high heat, until shrimp is cooked through.

 

by -
0 580
Soy may reduce breast cancer recurrance. METRO photo

By David Dunaief, M.D.

Dr. David Dunaief

A common question in my practice revolves around soy. Should you consumed or avoid it, especially for women who have breast cancer risk factors? It is a valid question, and the medical research has begun to debunk the myth that soy is detrimental. The form of soy is important; soy from food seems to be safe, but soy in high supplement form has shown mixed results.

Why are patients worried? Soy contains phytoestrogens (plant estrogens). The thought is that phytoestrogens have similar effects as estrogen produced by humans or other animals. However, the story is complex: soy may actually help prevent breast cancer and its recurrence. It may also have other positive health effects. In some cellular and animal studies, high doses of isoflavones or isolated soy protein stimulate cancer growth (1). 

Further research shows that these findings don’t translate to humans, most likely because humans metabolize these differently.

Breast Cancer

The Shanghai Breast Cancer Survival Study, an over 5,000 patient observational trial that followed patients for a median of 3.9 years, has had resounding effects on the way we think of soy in relation to breast cancer. The population consisted of women who had already had one occurrence of breast cancer that was in remission. The women who consumed the most soy from food, measured as soy isoflavones or soy proteins, had a 32 percent reduction in a second occurrence of breast cancer and a 29 percent reduction in breast cancer mortality, compared to those who consumed the least (2).

This inverse relationship was seen in both estrogen receptor-positive and estrogen receptor-negative women. It is more difficult to treat estrogen receptor-negative women; therefore, making these results even more impressive.

One prospective study followed over 6,000 women in the U.S. and Canada. It found that women who ate the highest amounts of soy isoflavones had a 21 percent lower risk of death compared with women with the lowest intakes (3). The Shanghai Women’s Health Study followed 73,223 Chinese women for more than 7 years and was the largest study of soy and breast cancer risk in a population with high soy consumption (4). It found that women who ate the most soy had a 59 percent lower risk of premenopausal breast cancer compared with those who ate the lowest amounts of soy. There was no association with postmenopausal breast cancer.

The study authors published a follow-up analysis from the same cohort seven years later to evaluate any association between soy foods and specific types of breast cancer, breaking out the results by type (5). In all cases, risk was lower with higher soy intakes.

Menopause

Soy and soy isoflavones may help improve cognitive function in postmenopausal women. This effect was seen only in women who increased their soy intake before age 65. There may be a “critical window” of therapeutic opportunity in early stages of post-menopause where soy has the greatest impact on cognitive function (6).

Soy is not the food with the greatest phytoestrogens, flaxseed is. In a randomized control trial, a daily flaxseed bar did no better at reducing vasomotor symptoms in postmenopausal women, such as hot flashes, than a fiber placebo bar. This took the study’s authors by surprise; preliminary studies had suggested the opposite (7). Reinforcing these results, another randomized controlled trial failed to show any beneficial effect of soy isoflavones on menopausal symptoms or on preventing bone loss (8). 

Lung Cancer

Soy isoflavones help to boost the effect of radiation on cancer cells by blocking DNA repair in these cells (9). They also protect surrounding healthy cells with an antioxidant effect. Soybeans contain three powerful components, genistein, daidzein and glycitein, that provide this effect. Pretreating lung cancer patients may promote better outcomes.

The risk of lung cancer was also shown to be reduced 23 percent in one meta-analysis of 11 trials (10). In subset data, when analysis was restricted to the five highest quality studies, there was an even greater reduction: 30 percent.

Cholesterol Levels

Soy may have modest effects in reducing cholesterol levels. Interestingly, people who convert a soy enzyme to a substance called equol, an estrogen-like compound, during digestion were considered the only ones to benefit; however, one study showed that equol non-producers also benefited with a reduction in LDL “bad” cholesterol (11). The equol producers maintained their HDL “good” cholesterol whereas the non-producers saw a decline.

What does all of this tell us? Soy is most likely beneficial for men and women alike, even in those with a risk of breast cancer. It does not mean we should eat a soy-based diet, but rather have soy in moderation – on a daily basis, perhaps. It is best to eat whole soy, not soy isolates. Also, soy supplements are not the same as foods that contain soy, so it is best to consume soy in food form.

References:

(1) Cancer Research. 2001 Jul 1;61(13):5045-50. (2) JAMA. 2009;302(22):2437-2443. (3) Cancer. 2017 Jun 1;123(11):2070-9. (4) Am J Clin Nutr. 2009 Apr 29;89(6):1920-6. (5) Int J of Cancer. 2016 Aug 15;139(4):742-8. (6) Obstet Gynecol. 2011;18:732-753. (7) Menopause. 2012 Jan;19(1):48-53. (8) Arch Intern Med. 2011;171:1363-1369. (9) J Thorac Oncol. 6(4):688-698, April 2011. (10) Am J Clin Nutr. 2011 Dec;94(6):1575-83. (11) Am J Clin Nutr. March 2012 vol. 95 no. 3 564-571.

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.

 

by -
0 695
Call 911 at the first sign of a heart attack. METRO photo

By David Dunaief, M.D.

One person every 40 seconds: that’s how prevalent heart attacks still are in the U.S. (1). Your gender and race don’t matter, we’re all susceptible. Of these 805,000 annual heart attacks, one in five is “silent” — you might not be aware you’ve had it, but your body is still affected. The good news is that your potential outcomes are significantly better if you recognize the symptoms while having a heart attack and receive immediate medical attention.

What are heart attack symptoms?

The most recognizable symptom is chest pain. However, there are an array of more subtle symptoms, such as discomfort or pain in the neck, back, jaw, arms and upper abdominal areas. You might also experience nausea, shortness of breath, sweating, light-headedness and tachycardia (racing heart rate). Unfortunately, most people don’t recognize these as symptoms of heart attack (2). According to one study, about 10 percent of patients present with atypical symptoms and no chest pain (3).

Are heart attack symptoms really different for men and women?

There has been much discussion about whether men and women have different symptoms when it comes to heart attacks. What does the research tell us?

There is data showing that, although men have heart attacks more commonly, women are more likely to die from a heart attack (4). In a Swedish study of 54,000 heart attack patients, one-third were women.  After having a heart attack, a significantly greater number of women died in the hospital or near-term when compared to men. The women received aggressive treatments, such as reperfusion therapy, artery opening treatment that includes medications or invasive procedures, less often than the men.

However, recurrent heart attacks occurred at the same rate, regardless of sex. Both men and women had similar findings on an electrocardiogram.

One theory about why women receive less aggressive treatment when first presenting in the ER is that they have different and more subtle symptoms — even chest pain symptoms may be different. Is this true? Not according to studies.

In one observational study of 2,500 patients, results showed that, though there were some subtle differences, when men and women presented with chest pain as the main symptom, it was of a similar nature (5). There were 34 chest pain characteristic questions used to determine if a difference existed. These included location, quality or type of pain and duration. Of these, there was some small amount of divergence: the duration was shorter for a man (2 to 30 minutes), and pain subsided more for men than for women. The authors concluded that determination of heart attacks with chest pain symptoms should not factor in the sex of patients.

This trial involved an older population; patients were a median age of 70 for women and 59 for men, with more men having had a prior heart attack. The population difference was a conspicuous weakness of an otherwise solid study, since age and previous heart attack history are important factors.

In the GENESIS-PRAXY study, another observational study, the median age of both men and women was 49. Results showed that chest pain remained the most prevalent presenting symptom in both men and women (6). However, of the patients who presented without distinct chest pain and with less specific EKG findings, significantly more were women than men.

Those who did not have chest pain symptoms may have experienced back discomfort, weakness, discomfort or pain in the throat, neck, right arm and/or shoulder, flushing, nausea, vomiting and headache. If the patients did not have chest pain, regardless of sex, the symptoms were diffuse and nonspecific. 

Some studies imply that up to 35 percent of patients do not present with chest pain as their primary complaint (7).

Is someone having a heart attack?

Call 911 immediately, and have the patient chew an adult aspirin (325 mg) or four baby aspirins, provided they do not have a condition that precludes taking aspirin. The purpose of aspirin is to thin the blood quickly, but not if the person might have a ruptured blood vessel. The 911 operator or emergency medical technician who responds can help you determine whether aspirin is appropriate.

Don’t hesitate to seek immediate medical attention; it’s better to have a medical professional rule out a heart attack than to ignore one.

The most frequently occurring heart attack symptoms

Most patients have similar types of chest pain, regardless of gender. However, this is where the complexity begins. The percentage of patients who present without chest pain seems to vary depending on which study you review — ranging from less than 10 percent to 35 percent.

Non-chest pain heart attacks have a bevy of diffuse symptoms, including obscure pain, nausea, shortness of breath and light-headedness. This is seen in both men and women, although it occurs more often in women. It’s important to recognize heart attack symptoms, since quick action can save your life or a loved one’s.

References:

(1) csc.gov. (2) MMWR. 2008;57:175–179. (3) Chest. 2004;126:461-469. (4) Int J Cardiol. 2013;168:1041-1047. (5) JAMA Intern Med. 2014 Feb. 1;174:241-249. (6) JAMA Intern Med. 2013;173:1863-1871. (7) JAMA. 2012;307:813-822.

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.

by -
0 837
METRO Photo
PPIs may affect vitamin absorption and increase fracture risk

By David Dunaief, M.D.

Dr. David Dunaief

Who hasn’t had “reflux” or “heartburn” after a meal? Most of us have experienced these symptoms on occasion. When they are more frequent, you should see a physician to rule out serious causes, like Gastroesophageal reflux disease (GERD).

GERD is estimated to affect between 18.1 and 27.8 percent of U.S. adults, although the real number might be higher, since many self-treat with over-the-counter (OTC) medications (1).

Proton pump inhibitors (PPIs), first launched in 1989, have become one of the top-10 drug classes prescribed or taken OTC. Familiar OTC brands include Prilosec (omeprazole), Nexium (esomeprazole), and Prevacid (lansoprazole), among others. They are also available by prescription.

PPIs are not intended for long-term use, because of their robust side effect profile. The FDA currently suggests that OTC PPIs should be taken for no more than a 14-day treatment once every four months. Prescription PPIs should be taken for 4 to 8 weeks (2).

However, their OTC availability can lead patients to take them too long or too often to manage reflux rebound effects when PPIs are discontinued without physician oversight.

Among potential associations with long-term use are chronic kidney disease, dementia, bone fractures, increased cardiac and vascular risks, vitamin malabsorption issues and Clostridium difficile, a bacterial infection of the gastrointestinal tract.

Do PPIs affect the kidneys?

In two separate studies, results showed that there was an increase in chronic kidney disease with prolonged PPI use (3). All patients started the study with normal kidney function, based on glomerular filtration rate (GFR). In the Atherosclerosis Risk in Communities (ARIC) study, there was a 50 percent increased risk of chronic kidney disease, while the Geisinger Health System cohort study found there was a 17 percent increased risk.

The first study had a 13-year duration, and the second had about a six-year duration. Both demonstrated modest, but statistically significant, increased risk of chronic kidney disease. But as you can see, the medications were used on a chronic basis for years. In an accompanying editorial to these published studies, the author suggests that there is overuse of the medications or that they are used beyond the resolution of symptoms and suggests starting with diet and lifestyle modifications and a milder drug class, H2 blockers (4).

Do PPIs increase dementia risk?

A German study looked at health records from a large public insurer and found there was a 44 percent increased risk of dementia in the elderly who were using PPIs, compared to those who were not (5). These patients were 75 or older. The authors surmise that PPIs may cross the blood-brain barrier and potentially increase beta-amyloid levels, markers for dementia. With occasional use, meaning once every 18 months for a few weeks to a few months, there was a much lower, 16 percent, increased risk.

The researchers also suggested that PPIs may be significantly overprescribed in the elderly. The research was not perfect. For example, researchers did not consider high blood pressure, excessive alcohol use or family history of dementia, all of which can influence dementia occurrence.

Do PPIs increase fracture risk?

In a meta-analysis of 18 observational studies, results showed that PPIs can increase the risk of hip fractures, spine fractures and any-site fractures (6). Interestingly, when it came to bone fractures, it did not make a difference whether patients were taking PPIs for more or less than a year.

They found increased fracture risks of 58, 26 and 33 percent for spine, hip and any-site, respectively. It is not clear what may potentially increase the risk; however, it has been proposed that it may have to do with calcium absorption. PPIs reduce acid, which may be needed to absorb insoluble calcium salts. In another study, seven days of PPIs were shown to lower the absorption of calcium carbonate supplements when taken without food (7).

PPIs & vitamin absorption

In addition to calcium absorption issues, PPIs may have lower absorption effects on magnesium and B12. In one observational study, PPIs combined with diuretics caused a 73 percent increased risk of hospitalization due to low magnesium (8). Diuretics are commonly prescribed for high blood pressure, heart failure and swelling.

Another study’s results showed long-term use of over two years increased vitamin B12 deficiency risk by 65 percent (9).

The bottom line

It’s best if you confer with your doctor before starting PPIs. You might benefit from a milder medication, such as an H2 blocker (Zantac, Pepcid). In addition, PPIs can interfere with other drugs you are taking, such as Plavix (clopidogrel).

Even better, start with lifestyle changes. Try not eating later at night, raising the head of the bed, losing weight and stopping smoking, if needed, before you consider medications (10).

If you do need medication, recognize that PPIs don’t give immediate relief and should only be taken for a short duration to minimize their side effects.

References:

(1) nih.gov. (2) fda.gov. (3) JAMA Intern Med. 2016;176(2). (4) JAMA Intern Med. 2016;176(2):172-174. (5) JAMA Neurol. online Feb 15, 2016. (6) Osteoporos Int. online Oct 13, 2015. (7) Am J Med. 118:778-781. (8) PLoS Med. 2014;11(9):e1001736. (9) Mayo Clinic Proceedings. 2018 Feb;93(2):240-246. (10) Am J Gastroenterol 2015; 110:393–400.

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.

by -
0 589
METRO photo
If you’re over 50, bone health should be on your radar

By David Dunaief, M.D.

Dr. David Dunaief

As the U.S. population ages, the prevalence of osteoporosis is increasing. Fifty percent of women and 25 percent of men will break a bone due to osteoporosis in their lifetimes, according to the Bone Health & Osteoporosis Foundation (1). 

Hip fractures are most concerning, because they increase mortality risk dramatically. In addition, more than 50 percent of hip fracture survivors are no longer able to live independently (2).

Does dairy consumption reduce osteoporosis risk?

The importance of drinking milk for strong bones has been drilled into us since we were toddlers. Milk has calcium and is fortified with vitamin D, so milk could only be helpful, right? Not necessarily.

The data are mixed, but studies suggest that milk may not be as beneficial as we have been raised to believe.

The results of a large, observational study involving men and women in Sweden showed that milk may be harmful (3). When comparing those who consumed three or more cups of milk daily to those who consumed less than one, there was a 93 percent increased risk of mortality in women between the ages of 39 and 74. 

There was also an indication of increased mortality based on dosage: for every one glass of milk consumed, there was a 15 percent increased risk of death for women. There was a much smaller, but significant, three percent per glass increased risk of death in men. For both men and women, biomarkers were found in the urine that indicate higher levels of oxidative stress and inflammation.

This 20-year study was eye-opening. We cannot make any decisive conclusions, only associations. It does get you thinking, though. The researchers surmise that milk has high levels of D-galactose, a simple sugar that may increase inflammation and ultimately contribute to this potentially negative effect.

Ironically, the USDA recommends that, from the age of 9 years through adulthood, we consume about three cups of dairy per day (4). Previous studies also showed milk may not be beneficial for preventing osteoporotic fractures. Specifically, in a meta-analysis that used data from the Nurses’ Health Study for women and the Health Professionals Follow-up Study for men, neither men nor women saw any benefit from milk consumption in preventing hip fractures (5).

In a 2020 meta-analysis of an array of past studies, researchers concluded that increased consumption of milk and other dairy products did not lower osteoporosis and hip fracture risks (6).

Do calcium supplements reduce risk?

We know calcium is a required element for strong bones, but do supplements really prevent osteoporosis and subsequent fractures? Again, the data are mixed, but supplements may not be the answer for those who are not deficient.

In a meta-analysis involving a group of observational studies, there was no statistically significant improvement in hip fracture risk in those men or women ingesting at least 300 mg of calcium from supplements and/or food daily (7).

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

Do vitamin D supplements reduce risk?

Finally, though the data are not always consistent for vitamin D, it appears it may be valuable when it comes to fracture prevention. In a meta-analysis involving 11 randomized controlled trials, vitamin D supplementation resulted in a reduction in fractures (8). 

When patients were given a median dose of 800 IUs (ranging from 792 to 2,000 IUs) of vitamin D daily, those who were ages 65 and over experienced a significant 14 percent reduction in nonvertebral fractures and an even greater 30 percent reduction in hip fractures. However, vitamin D in lower levels showed no significant ability to reduce fracture risk.

Where does that leave us?

Our knowledge of dietary approaches is continually evolving. Milk and dairy may be an example of this. No definitive statement can be made about calcium, although even in randomized controlled trials with supplements, there seemed to be no significant benefit. However, the patients in these trials were not necessarily deficient in calcium nor vitamin D.

In order to get benefit from vitamin D supplementation to prevent fracture, older patients may need at least 800 IUs per day.

Remember that treatment and prevention approaches should be individualized, and deficiencies in vitamin D or calcium should usually be treated, of course. Please, talk to your doctor before adding or changing any supplements.

References:

(1) www.bonehealthandosteoporosis.org. (2) EndocrinePractice. 2020 May;26(supp 1):1-46. (3) BMJ 2014;349:g6015. (4) health.gov. (5) JAMA Pediatr. 2014;168(1):54-60. (6) Crit Rev Food Sci Nutr. 2020;60(10):1722-1737. (7) Am J Clin Nutr. 2007 Dec;86(6):1780-1790. (8) N Engl J Med. 2012 Aug. 2;367(5):481.

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.

by -
0 638
Not all fruit raises your sugars. METRO photo

By David Dunaief, M.D.

Dr. David Dunaief

Our understanding of type 2 diabetes management is continually evolving. With this, we need to retire some older guidance. Here, we review a few common myths and the research that debunks them.

Myth: Fruit should be limited or avoided.

Fact: Diabetes patients are often advised to limit fruit in any form — whether whole, juiced, or dried — because it can raise your sugars. This is only partly true.

Yes, fruit juice and dried fruit should be avoided, because they do raise or spike glucose (sugar) levels. This includes dates, raisins, and apple juice, which are often added to “no sugar” foods to sweeten them. The same does not hold true for whole fruit, whether fresh or frozen. Studies have shown that patients with diabetes don’t experience sugar level spikes, whether they limit whole fruits or consume an abundance (1). In a different study, whole fruit was even shown to reduce the risk of type 2 diabetes (2).

In yet another study, researchers considered the impacts of different types of whole fruits on glucose levels. They found that berries reduced glucose levels the most, but even bananas and grapes reduced these levels (3). That’s right, bananas and grapes, two fruits people associate with spiking sugar levels and increasing carbohydrate load, actually lowered these levels. The only fruit tested that seemed to have a mildly negative impact on sugars was cantaloupe.

Whole fruit is not synonymous with sugar. One reason for the beneficial effect is the fruits’ flavonoids, or plant micronutrients, but another is their fiber.

Myth: All carbohydrates raise your sugars.

Fact: Fiber is one type of carbohydrate that has distinct benefits. It is important for reducing risk for an array of diseases and for improving their outcomes. This is also true for type 2 diabetes. 

Two very large prospective observational studies, the Nurses’ Health Study (NHS) and NHS II, showed that plant fiber helped reduce the risk of type 2 diabetes (4). Researchers looked at lignans, a type of plant fiber, specifically examining the metabolites enterodiol and enterolactone. They found that patients with type 2 diabetes have substantially lower levels of these metabolites in their urine, compared to the control group without diabetes. There was a direct relationship between the amount of metabolites and the reduction in diabetes risk: the more they consumed and the more metabolites in their urine, the lower the risk. The authors encourage patients to eat more of a plant-based diet to get this benefit.

Foods with lignans include cruciferous vegetables, such as broccoli and cauliflower; an assortment of fruits and whole grains; flaxseed; and sesame seeds (5). The researchers could not determine which plants contributed the greatest benefit; however, they believe antioxidant activity drives this effect.

Myth: You should you avoid soy when you have diabetes.

Fact: In diabetes patients with nephropathy (kidney damage or disease), soy consumption was associated with kidney function improvements (6). There were significant reductions in urinary creatinine levels and proteinuria (protein in the urine), both signs that the kidneys are beginning to function better.

This was a four-year, small, randomized control trial with 41 participants. The control group’s diet comprised 70 percent animal protein and 30 percent vegetable protein, while the treatment group’s diet consisted of 35 percent animal protein, 35 percent textured soy protein and 30 percent vegetable protein.

This is very important, since diabetes patients are 20 to 40 times more likely to develop nephropathy than those without diabetes (7). It appears that soy protein may put substantially less stress on the kidneys than animal protein. However, those who have hypothyroidism and low iodine levels should be cautious about soy consumption; some studies suggest it might interfere with synthetic thyroid medications’ effectiveness (8).

Myth: Bariatric surgery is a good alternative to lifestyle changes.

Fact: Bariatric surgery has grown in prevalence for treating severely obese (BMI>35 kg/m²) and obese (BMI >30 kg/m²) diabetes patients. In a meta-analysis of 16 randomized control trials and observational studies, the procedure led to better results than conventional medicines over a 17-month follow-up period for HbA1C (three-month blood glucose), fasting blood glucose and weight loss (9). During this period, 72 percent of those patients treated with bariatric surgery went into diabetes remission and had significant weight loss.

However, after 10 years without proper management involving lifestyle changes, only 36 percent remained in diabetes remission, and many regained weight. Thus, even with bariatric surgery, altering diet and exercise are critical to maintaining long-term benefits.

We still have a lot to learn with diabetes, but our understanding of how to manage lifestyle modifications, specifically diet, is becoming clearer. Emphasizing a plant-based diet focused on whole fruits, vegetables, beans and legumes can improve your outcomes. If you choose a medical approach, bariatric surgery is a viable option, but you still need to make significant lifestyle changes to sustain its benefits.

References:

(1) Nutr J. 2013 Mar. 5;12:29. (2) Am J Clin Nutr. 2012 Apr.;95:925-933. (3) BMJ online 2013 Aug. 29. (4) Diabetes Care. online 2014 Feb. 18. (5) Br J Nutr. 2005;93:393–402. (6) Diabetes Care. 2008;31:648-654. (7) N Engl J Med. 1993;328:1676–1685. (8) Thyroid. 2006 Mar;16(3):249-58. (9) Obes Surg. 2014;24:437-455.

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.

by -
0 882
Dr. Suzanne Fields, Professor of Clinical Medicine and Chief of the Division of General, Geriatric and Hospital Medicine. Photo courtesy of Stony Brook Medicine

By Daniel Dunaief

A year after its formation, the Center for Healthy Aging has not only brought groups of scientists and doctors across the Stony Brook University campus together, but has also funded several early-stage projects.

An initiative started by SBU President Maurie McInnis and that received financial support from the Stony Brook University Presidential Innovation and Excellence Fund, the CHA is currently jointly run by interim co-directors Dr. Suzanne Fields, Professor of Clinical Medicine and Chief of the Division of General, Geriatric and Hospital Medicine and Dr. Christine DeLorenzo, Professor of Psychiatry and Biomedical Engineering and Director of the Center for Understanding Biology using Imaging Technology.

The CHA has several themes, including helping people live longer and healthier lives. In addition, it will serve as a research center that will include basic science, translational, clinical and health services research.

McInnis spoke with Dr. Peter Igarashi, the Dean of the Renaissance School of Medicine at Stony Brook University, to create this initiative.

Dr. Igarashi wanted to make it a center where people from different departments in the university, the five Health Sciences Schools and the Program in Public Health, as well as affiliated institutions such as the Northport VA and the Long Island State Veterans Home collaborated on innovative projects related to aging.

Fields and DeLorenzo anticipate the collaborative research with bioinformatics, pharmacology and bioengineering, for example, will help clinical providers prescribe effective medications for older patients safely through special alerts/ suggestions, identify patients at risk for falling through mobility sensors, and assist clinical providers with AI diagnostic tools.

‘Shark Tank’

Last June, the CHA held a workshop in the style of the “Shark Tank” television show.

Over 100 faculty members attended that meeting from different parts of the university, where they formed groups with other attendees to pose research questions and address challenges people face as they age.

“There was so much enthusiasm there,” said DeLorenzo. “We have so much expertise on campus. We have brilliant researchers who are working on everything from age-related effects at the cellular level all the way through to lifestyle interventions for elderly folks.”

After that meeting, the CHA provided $40,000 to two projects, hoping the support could help ideas get off the ground enough that the principal investigators could then apply to larger funding agencies, such as the National Institutes of Health and the National Institute on Aging, for additional funding.

Led by Adam Singer, the chair of the Emergency Room department, one group of faculty developed ideas to help people who suffered from falls.

“When people who are elderly come into the ER and they’ve fallen, the chances” of them falling again doubles, according to the Centers for Disease Control and Prevention,” said DeLorenzo. “What I love about that pitch the table gave, which was a mixture of clinicians, biomedical engineers, a respiratory therapist, and a physical therapist is that people were coming at this question from all angles.”

The group pitched an idea to create an intervention program that helps explain how to change a person’s lifestyle to prevent another fall.

Senescent cells

Markus Riessland, an Assistant Professor in the Empire Innovation Program in the Department of Neurobiology and Behavior, led the other funded pitch.

Riessland’s project looks at a particular type of cell that can become problematic as people age.

Older cells sometimes get stuck in a senescent state, where they don’t die, but give off signals that cause an inflammatory response.

Riessland’s group “got together and asked, ‘How can we intervene to clear away these senescent cells?’” said DeLorenzo.

Young immune systems typically recognize senescent cells and remove them. As people age, the immune system has a diminished ability to detect and remove these cells, causing inflammaging, which describes a build up of inflammation during the aging process, Riessland explained in an email.

“If you remove senescent cells from an old mouse, these mice show improvements in the function of virtually all tissue” including heart, liver, lung and brain and the lifespan increases by 30 percent, Riessland added.

Researchers have hypothesized that there is also a threshold number of senescent cells a human body can tolerate. If a person exceeds that threshold, it “causes inflammaging and age-related symptoms,” he wrote.

Based on his laboratory work, Riessland found that specific neurons in the brain become senescent and that these neurons secrete proinflammatory factors.

Riessland and his colleagues aim to ameliorate this inflammation and have found a molecular regulator that could be a drug target.

Based on the work Riessland did through the CHA study, he and his colleagues are writing a grant proposal for the National Institutes of Health. In the future, he, DeLorenzo and Dr. Carine Maurer will perform a clinical trial on Long Island that will assess the feasibility to ameliorate the inflammaging process in patients with Parkinson’s disease.

Fall awards

In the fall, the center gave out six awards for $40,000 each and six for $100,000, many of which were in basic science, according to Dr. Fields.

“There was a broad array of topics, with some translational and some basic,” said Fields. “We’re following up with those people.”

Nancy Reich, a Professor of Microbiology & Immunology, received support as a part of the fall round.

The funding from CHA has “allowed us to begin to investigate the development of pancreatic cancer in the older population versus the young using a mouse cancer model,” Reich explained in an email. “Our hypothesis centers on the immune defense response.”

Search for a new director

Now that the center has made some headway and brought various teams together, the university is searching for a permanent director.

“It’s a real joy and pleasure to see this center start up,” said DeLorenzo.

DeLorenzo urges anyone interested in learning more to check the center’s web site, Center for Healthy Aging | Renaissance School of Medicine at Stony Brook University.

“We have events, and we would love for the community to go to them,” said DeLorenzo.

DeLorenzo encourages community members to reach out to Fields and her with any questions.

Riessland added that the CHA-funded projects will “have an impact on the understanding of the aging process itself.”

by -
0 747
Walking routinely can reduce your risk of dialysis.Stock photo

By David Dunaief, M.D.

Dr. David Dunaief

In my recent article about chronic kidney disease (CKD), I wrote that about 90 percent  of the estimated 35.5 million U.S. adults who have CKD are not even aware they have it (1).

How is this possible?

CKD is typically asymptomatic in its early stages. Once it reaches moderate stages, vague symptoms like fatigue, malaise and loss of appetite can surface. It’s when it reaches advanced stages that symptoms become more evident. Those at highest risk for CKD include patients with diabetes, high blood pressure and those with first-degree relatives who have advanced disease.

What is the effect of CKD?

Your kidneys are essentially little blood filters. They remove waste, toxins, and excess fluid from your body. They also play roles in controlling your blood pressure, producing red blood cells, maintaining bone health, and regulating natural chemicals in your blood. When your kidneys aren’t operating at full capacity, it can cause heart disease, stroke, anemia, infection, and depression — among others.

How often should you be screened for CKD?

If you have diabetes, you should have your kidney function checked every year (2). If you have other risk factors, like high blood pressure, heart disease, or a family history of kidney failure, talk to your physician about a regular screening schedule. A 2023 Stanford School of Medicine study recommends screening all U.S. residents over age 35. The authors conclude that the cost of screening and early treatment would be lower than the long-term cost of treatment for those undiagnosed until they are in advanced stages (3). In addition, they project it will improve life expectancy.

Does basic exercise help?

One study shows that walking reduces the risk of death by 33 percent and the need for dialysis by 21 percent (4). Those who walked more often saw greater results: participants who walked one-to-two times a week had a 17 percent reduction in death and a 19 percent reduction in kidney replacement therapy, while those who walked at least seven times per week experienced a more impressive 59 percent reduction in death and a 44 percent reduction in the risk of dialysis. The study included 6,363 participants with an average age of 70 who were followed for an average of 1.3 years.

How does protein consumption affect CKD?

With CKD, more protein is not necessarily better. It may even be harmful. In a meta-analysis of 17 studies of non-diabetic CKD patients who were not on dialysis, results showed that the risk of progression to end-stage kidney disease, including the need for dialysis or a kidney transplant, was reduced 36 percent in those who consumed a very low-protein diet, rather than a low-protein or a normal protein diet (5).

How much should I reduce my sodium consumption?

In a study, results showed that a modest sodium reduction in our diet may be sufficient to help prevent proteinuria (protein in the urine) (6). Here, less than 2000 mg per day was shown to be beneficial, something all of us can achieve.

Are some high blood pressure medications better than others?

We routinely give certain medications, ACE inhibitors or ARBs, to patients who have diabetes to protect their kidneys. What about patients who do not have diabetes? ACEs and ARBs are two classes of high blood pressure medications that work on the kidney systems responsible for blood pressure and water balance (7). Results of a study show that these medications reduced the risk of death significantly in patients with moderate CKD. Most of the patients were considered hypertensive.

However, there was a high discontinuation rate among those taking the medications. If you include the discontinuations and regard them as failures, then all who participated showed a 19 percent reduction in risk of death, which was significant. However, if you exclude discontinuations, the results are much more robust with a 63 percent reduction. To get a more realistic picture, this result, including both participants and dropouts, is probably close to what will occur in clinical practice unless patients are highly motivated.

Should you take NSAIDs?

Non-steroidal anti-inflammatory drugs (NSAIDs), which include ibuprofen and naproxen, have been associated with CKD progression and with kidney injury in those without CKD (1). NSAIDs can also interfere with the effectiveness of ACE inhibitors or ARBs. Talk to your doctor about your prescription NSAIDs and any other over-the-counter medications and supplements you are taking.

What should I remember?

It’s critical to protect your kidneys. Fortunately, basic lifestyle modifications can help; lowering sodium modestly, walking frequently, and lowering your protein consumption may all be viable options. Talk to your physician about your medications and supplements and about whether you need regular screening. High-risk patients with hypertension or diabetes should definitely be screened; however, those with vague symptoms of lethargy, aches and pains might benefit, as well.

References:

(1) cdc.gov. (2) niddk.nih.gov (3) Annals of Int Med. 2023;176(6):online. (4) Clin J Am Soc Nephrol. 2014;9(7):1183-9. (5) Cochrane Database Syst Rev. 2020;(10):CD001892. (6) Curr Opin Nephrol Hypertens. 2014;23(6):533-540. (7) J Am Coll Cardiol. 2014;63(7):650-658.

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.

by -
0 561
Simple tests can confirm your kidney's health. METRO photo
Simple tests can confirm your kidney’s health.

By David Dunaief, M.D.

Dr. David Dunaief

Your kidneys perform an array of critical functions that help maintain your body’s systems. They filter waste and fluid from your body and maintain your blood’s health. They also help control your blood pressure, make red blood cells and vitamin D, and control your body’s acid levels.

If your kidney function degrades, it can lead to hypertension or cardiovascular problems and it may require dialysis or a kidney transplant in later stages. For the best outcomes, it’s critical to identify chronic kidney disease (CKD) early and strive to arrest its advance to more serious stages. However, of the estimated 35.5 million U.S. adults who have CKD, as many as 9 in 10 are not even aware they have it (1).

One of the challenges with identifying early-stage CKD is that symptoms are not obvious and can be overlooked. Among them are foamy urine, urinating more or less frequently than usual, itchy or dry skin, fatigue, nausea, appetite loss, and unintended weight loss (2).

Fortunately, there are simple tests, such as a basic metabolic panel and a urinalysis, that will confirm your kidney function. These indices for kidney function include an estimated glomerular filtration rate (eGFR), creatinine level and protein in the urine. eGFR is a calculation and, while the other two indices have varying ranges depending on the laboratory used, a patient with an eGFR of 30 to 59 is considered to have mild disease. The eGFR and the kidney function are inversely related, meaning as eGFR declines, the severity of CKD increases.

What can be done to address early-stage CKD, before complications occur? There are several studies that have evaluated different lifestyle modifications and their impacts on its prevention, treatment and reversal.

What causes the greatest risk to your kidneys?

Among the greatest risks for your kidneys are uncontrolled diseases and medical disorders, such as diabetes and hypertension (1). If you have — or are at risk for — diabetes, be sure to control your blood sugar levels to limit kidney damage. Similarly, if you currently have hypertension, controlling it will put less stress on your kidneys. For these diseases, it’s crucial that you have your kidney function tested at least once a year.

In addition, obesity and smoking have been identified as risk factors and can be managed by making lifestyle changes to reduce your risk.

Can changing your diet help protect your kidneys?

Fruits and vegetables may play a role in helping patients with CKD. In a one-year study with 77 patients, results showed that fruits and vegetables work as well as sodium bicarbonate in improving kidney function by reducing metabolic acidosis levels (3).

What is the significance of metabolic acidosis? It means that body fluids become acidic, and it is associated with CKD. The authors concluded that both sodium bicarbonate and a diet including fruits and vegetables were renoprotective, helping to protect the kidneys from further damage in patients with CKD. Alkali diets are primarily plant-based, although not necessarily vegetarian or vegan. Animal products tend to cause an acidic environment.

In the Nurses’ Health Study, results show that animal fat, red meat and sodium all negatively impact kidney function (4). The risk of protein in the urine, a potential indicator of CKD, increased by 72 percent in those participants who consumed the highest amounts of animal fat compared to the lowest, and by 51 percent in those who ate red meat at least twice a week. With higher amounts of sodium, there was a 52 percent increased risk of having lower eGFR levels.

The most interesting part with sodium was that the difference between higher mean consumption and the lower mean consumption was not that large, 2.4 grams compared to 1.7 grams. In other words, a difference of approximately a quarter-teaspoon of sodium per day was responsible for the decrease in kidney function.

The National Kidney Foundation recommends diets that are higher in fruit and vegetable content and lower in animal protein, including the Dietary Approaches to Stop Hypertension (DASH) diet and plant-based diets (2). 

In my practice, when CKD patients follow a vegetable-rich, nutrient-dense diet, there are substantial improvements in kidney functioning. For instance, for one patient, his baseline eGFR was 54. After one month of dietary changes, his eGFR improved by 9 points to 63, which is a return to “normal” functioning of the kidney. Note that this is anecdotal, not a study.

When should you have your kidney function tested?

It is important to have your kidney function checked. If your levels are low, you should address the issue through medications and lifestyle modifications to manage and reverse early-stage CKD. If you have common risk factors, such as diabetes, smoking, obesity or high blood pressure, or if you are over 60 years old, talk to your doctor about regular testing. 

Don’t wait until symptoms and complications occur. In my experience, it is much easier to treat and reverse CKD in its earlier stages.

References:

(1) CDC.gov. (2) kidney.org. (3) Clin J Am Soc Nephrol. 2013;8:371-381. (4) Clin J Am Soc Nephrol. 2010; 5:836-843.

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.

by -
0 723
Sodium’s effects are insidious

By David Dunaief, M.D.

Dr. David Dunaief

Most of us consume far too much sodium. Americans consume an average of 3400 mg per day, well over the recommended 2300 mg per day recommended upper limit for those who are 14 and over (1). These consumption numbers are even higher for some demographics. It’s become such a health problem that the FDA is getting involved, working with food manufacturers and restaurants to drive these numbers down (2). 

Why all the concern? Because even if we don’t have hypertension, sodium can have a dramatic impact on our health.

Sodium is everywhere, including in foods that don’t taste salty. Bread products are among the worst offenders. Other foods with substantial amounts of sodium include cold cuts and cured meats, cheeses, pizza, poultry, soups, pastas, sauces and, of course, snack foods. Packaged foods and those prepared by restaurants are where most of our consumption occurs.

On the flip side, only about two percent of people get enough potassium from their diets (3). According to the National Institutes of Health, adequate intake of potassium is between 2600 mg and 3400 mg for adult women and men, respectively.

What is the relationship between sodium and potassium?

A high sodium-to-potassium ratio increases our risk of cardiovascular disease by 46 percent, according to a 15-year study of more than 12,000 (4). To improve our overall health, we need to shift the sodium-to-potassium balance so that we consume more potassium and less sodium. And if you struggle with – or are at risk for – high blood pressure, this approach could help you win the battle.

Why lower your sodium consumption?

Two studies illustrate the benefits of reducing sodium in high blood pressure and normotensive (normal blood pressure) patients, ultimately preventing cardiovascular disease, including heart disease and stroke.

The first was a meta-analysis that evaluated data from 34 randomized clinical trials, totaling more than 3,200 participants. It demonstrated that salt reduction from 9-to-12 grams per day to 5-to-6 grams per day had a dramatic effect. Blood pressure was reduced by a significant mean of −4.18 mm Hg systolic (top number) and −2.06 mm Hg diastolic (bottom number) involving both normotensive and hypertensive participants (5). 

When looking solely at hypertensive patients, the reduction was even greater, with a systolic blood pressure reduction of −5.39 mm Hg and a diastolic reduction of −2.82 mm Hg. The researchers believe that the more we reduce the salt intake, the greater the effect of reducing blood pressure. The authors recommend further reduction to 3 grams per day as a long-term target for the population and concluded that the effects on blood pressure will most likely result in a decrease in cardiovascular disease.

In the second study, a meta-analysis of 42 clinical trials including both adults and children, there was a similarly significant reduction in both systolic and diastolic blood pressures (6). Both demographics saw a blood pressure reduction, although the effect was greater in adults. Interestingly, an increase in sodium caused a 24 percent increased risk of stroke incidence but, more importantly, a 63 percent increased risk of stroke mortality. The risk of mortality from heart disease was increased alongside an increase in sodium, as well, by 32 percent.

Can you consume too little sodium?

Some experts warn that too-low sodium levels can be a problem. While this is true, it’s very rare, unless you take medication or have a health condition that depletes sodium. We hide sodium everywhere, so even if you don’t use a salt shaker, you’re probably consuming more than the recommended amount of sodium.

Why is potassium consumption important?

In a meta-analysis involving 32 studies, results showed that as the amount of potassium was increased, systolic blood pressure decreased significantly (7). When foods containing 3.5 to 4.7 grams of potassium were consumed, there was an impressive −7.16 mm Hg reduction in systolic blood pressure with high blood pressure patients. Anything more than this amount of potassium did not provide additional benefit. Increased potassium intake also reduced the risk of stroke by 24 percent.

Blood pressure reduction was greater with increased potassium consumption than with sodium restriction, although this was not a head-to-head comparison. The good news is that it’s easy to increase your potassium intake; it’s found in many whole foods and is richest in fruits, vegetables, beans and legumes.

The bottom line: decrease your sodium intake and increase potassium intake from foods. First, consume less sodium, and give yourself a brief period to adapt — it takes about six weeks to retrain your taste buds. You can also improve your odds by increasing your dietary potassium intake, striking a better sodium-to-potassium balance.

References:

(1) Dietary Reference Intakes for Sodium and Potassium. Washington (DC): National Academies Press (US); 2019 Mar. (2) fda.gov. (3) nih.gov. (4) Arch Intern Med. 2011;171(13):1183-1191. (5) BMJ. 2013 Apr 3;346:f1325. (6) BMJ. 2013 Apr 3;346:f1326. (7) BMJ. 2013; 346:f1378.

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.

Prev1...456...63Next Page 5 of 63
TBR News Media is your local news and entertainment website.
We provide you with the latest breaking news and information for your community.
Contact us: [email protected]

Most Viewed

©