Statins are one of the most commonly prescribed medications in the United States. Yet, some in the medical community believe that more patients should be on this class of drugs while others think it is one of the most overprescribed medications. Suffice to say, this is one of the most polarizing topics in medicine — probably rightfully so.

The debate is over primary prevention with statins. Primary prevention is treating people with high cholesterol and/or inflammation who may be at risk for a cardiovascular event, such as a stroke or heart attack. Fortunately, most physicians would agree that statins have their place in secondary prevention — treating patients who have had a stroke or heart attack already or have coronary artery disease.

We are going to look at benefits and risks for the patient population that could take statins for primary prevention. On one side, we have the statin as Rocky Balboa, coming out to fight off cancer risk, both overall and esophageal, as well as improving quality of life and eye disease (glaucoma). On the other, we have the statin as Evel Knievel, demonstrating that being reckless doesn’t provide longevity, promotes fatigue and increases eye disease (cataracts). Let’s look at some of the evidence.

Effect on cancer

A recent study published in The New England Journal of Medicine involved 300,000 Danish participants and investigated 13 cancers. It showed that statin users may have a 15 percent decreased risk of death from cancer (N Engl J Med 2012;367:1792-1802). This is exciting news.

However, there were major limitations with the study. First, the researchers did not control for smoking, which we know is a large contributor to cancer. Secondly, it was unknown which of the statin-using population might have received conventional cancer treatments, such as radiation and chemotherapy. Thirdly, the dose of statins did not correlate to risk reduction. In fact, those who took 1 percent to 75 percent of prescribed statin levels showed more benefit in terms of cancer-mortality risk than those who took more. There needs to be a better-designed trial that is prospective (forward looking) to determine whether there really is an effect. I would say that Rocky Balboa came out of this fight pretty banged up.

Another study showed that statins may play a role in reducing the risk of esophageal cancer. This is important, since esophageal cancer, especially adenocarcinoma that develops from Barrett’s esophagus, is on the rise. The results showed a 30 percent risk reduction in this type of cancer. The authors of the study surmise that statins may have a protective effect. This was meta-analysis of 13 observational studies. The study abstract was presented at the American College of Gastroenterology 2012 Annual Scientific Meeting (Abstract 1 May 22, 2012).

Although there is an association, these results need to be confirmed with randomized controlled trials. Remember, aspirin has about the same 30 percent reduction in colorectal cancer, yet is not recommended solely for this use because of side effects.

Eye diseases: mixed results

In two common eye diseases, glaucoma and cataracts, statins have vastly different results. In one new study, statins were shown to decrease the risk of glaucoma by 5 percent over one year and 9 percent over two years (Ophthalmology 2012;119(10):2074-2081). It is encouraging that the longer the duration of statin use, the greater the positive effect on preventing glaucoma.

Statins also help to slow glaucoma progression in patients suspected of having early-stage disease at about the same rate. This was a retrospective study (backward-looking) analyzing statin use with patients at risk for open-angle glaucoma. There is a need for prospective (forward-looking) studies. With cataracts, it is a completely different story. Statins increase the risk of cataracts by over 50 percent, as shown in the Waterloo Eye Study (Optom Vis Sci 2012;89:1165-1171). Statins exacerbate the risk of cataracts in an already high-risk group: diabetes patients. For more details on this topic, see my Oct. 18 article, “Taking cataracts seriously to maintain good health.”

Quality of life and longevity: a mixed bag again

In a meta-analysis involving 11 randomized controlled trials, considered the gold standard of studies, statins did not reduce the risk of all-cause mortality in moderate to high-risk primary prevention participants (Arch Intern Med 2010;170(12):1024-31). This study analysis involved over 65,000 participants with high cholesterol and at significant risk for heart disease.

However, in this same study in Archives of Internal Medicine, participants at high risk of coronary heart disease saw a substantial improvement in their quality of life with statins. In other words, the risk of a nonfatal heart attack was reduced by more than half and nonfatal strokes by almost half, avoiding the potentially disabling effects of these cardiovascular events.

Fatigue effect

Some of my patients who are on statins ask if statins can cause fatigue. The answer is “maybe,” but now there is a randomized controlled trial that reinforces the idea that statins increase the possibility of fatigue (Arch Intern Med 2012;172(15):1180-1182).

Women, especially, complained of lower energy levels, both overall and on exertion, when they were blindly assigned to a statin-taking group. The trial was composed of three groups: two that took statins, simvastatin 20 mg and pravastatin 40 mg; and a placebo group. The participants were at least 20 years old and had LDL (bad) cholesterol of 115 to 190 mg/dl, with less than 100 mg/dl considered ideal.

In conclusion, some individuals who are at high risk for cardiovascular disease may need a statin, but with the evidence presented it is more likely that statins are overprescribed in primary prevention. As www.update.com points out, evidence of the best results points to lifestyle modification, with or without statins, and all patients with elevated LDL (bad) cholesterol should make changes that include a nutrient-dense diet and exercise.

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

Diabetes seems to be getting more and more unclear in terms of the appropriate path to treat and prevent the disease. The Accord trial, a large, randomized controlled trial, which I wrote about in my Jan. 25, 2011 article, showed that intensive lowering of glucose (sugars) with medications disappointingly showed no improvement in cardiovascular disease. Even worse, there was an increase in fatalities in the treatment group, compared to the placebo group (NEJM 2008;358:2560-2572).

So what about intensive lifestyle modification? We are constantly told that diet and exercise are very important for preventing and treating Type 2 diabetes. Many of us can relate to being told we need to lose 10 or 20 pounds. But the problem is that we are not given a road map as to how to best go about this process. Are all diets the same? How about exercise — does it matter how much and what we do? What does the evidence tell us?

Diet’s impact

We know that not all diets are equal and that diets fail patients all the time. In fact, there was a recent randomized clinical trial, the gold standard of studies, called the Look Ahead study, that looked at Type 2 diabetes patients and dietary effects. This trial involved intensive lifestyle modifications — dietary changes and increased fitness for one group were compared to a group given only diabetes support and education. The trial was halted because of its failure to impact cardiovascular disease.

We expect dietary trials to fail, but not one that is large, following 5,000 overweight or obese patients over 11 years, and funded by the National Institutes of Health. Part of the problem was that the amount of weight loss was less than 5 percent. The goal had been 7 percent, which should not be difficult to achieve when the patients’ mean starting weight was high. We know that the impact is greater with the more weight lost.

Worse still is that the interim analysis at year four of this study, published in 2010, showed encouraging results for reducing cardiovascular risk. There were significant improvements in parameters such as HbA1c (a three-month history of sugar levels), blood pressure, weight, HDL (“good cholesterol”), triglycerides, and number of medications. This is because patients had lost more weight at this point (Diabetes Care. 2010 Jun;33(6):1153-58; Arch Intern Med. 2010;170(17):1565-75).

At year one, analysis of the Look Ahead trial showed substantially more effect on reducing cardiovascular risk factors in Type 2 diabetes patients, with greater weight loss in the intensive treatment group. Those who lost 5 percent to 10 percent of their body weight saw results similar to the year four analysis above. And those who had a 10 to percent 15 percent loss of body weight experienced even greater risk reduction (Diabetes Care. 2011;34(7):1481-6).

However, there was good news with the trial: according to the authors, patients had lost weight and their physical conditioning had improved. The authors note that there was a low incidence of cardiovascular events (nonfatal heart attacks, nonfatal strokes, hospitalization from angina (chest pain), and death) for both groups, which made it difficult to observe a difference between the groups. Thus, this trial may have not been large enough to show an effective difference. I would argue that the weight difference may not have been great enough.

The treatment group with intensive lifestyle changes was following a calorie-restricted diet. This is not the same as a nutrient-rich, plant-based diet. Calorie restriction may help you lose modest amounts of weight, but trials have shown it does not necessarily add to longevity nor reduce risk factors for cardiovascular disease in Type 2 diabetes patients.

What is the message that this study is conveying? Does this mean that all diets are ineffective? Should we, to quote Marie Antoinette, “Let them eat cake”? I know some patients would like to be told that, but diet can play a significant role in Type 2 diabetes and its cardiovascular risk.

What is more important is diet composition. It appears to have more of an impact than just calorie restriction. In my Sept. 11, 2012 article, I go into much more detail on diet composition and an example of a nutrient-rich diet, with its beneficial impact on cardiovascular disease (Arch Intern Med. 2008;168:713-720).

In another recent trial, a meta-analysis (a group of 24 studies) with a dietary approach that involved a high-protein group compared to standard-protein group, the results disappointed (Am J Clin Nutr. online Oct 24, 2012). Though a high-protein diet showed a very modest reduction in weight, 1.8 extra pounds over three months, there was not a corresponding change in cardiovascular risk parameters, such as blood pressure, cholesterol and insulin levels. This analysis involved over 1,000 patients.
Again, it goes to the composition of the diet. In this case, the focus was on macronutrients, such as protein and carbohydrates, rather than micronutrients, including phytochemicals (plant nutrients).

Sedentary lifestyle

Though we are encouraged to exercise for 150 minutes per week — or five days a week for 30 minutes each — this does not take into account what we do the other 23.5 hours on the days that we are exercising.

In a meta-analysis (a group of 18 trials), there was a greater than two-fold increased risk of developing Type 2 diabetes in those who were most sedentary, compared to those who were least sedentary (Diabetologia. 2012;55:2895-2905). If that is not enough, there was also a greater than two-times risk of having a cardiovascular event, such as a heart attack or stroke, in those most sedentary. It is a good idea to at least stand up, but also to walk around, for a few minutes every hour if possible during your waking hours.

Therefore, if there is one message I could hammer home, it would be that diet and movement do play significant roles in treating, preventing and reversing Type 2 diabetes and reducing its risk for complications. Weight and diet composition are very important to achieving these goals. Even very little exercise can have a substantial effect on diabetes risk reduction.

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

Most of us would like to achieve longevity, as long we also maintain a good quality of life. We are finding, however, as I mentioned in my Sept. 20 article, that calorie restriction alone may not be the route to achieving this goal.

There was a very interesting article published in the New York Times Magazine on Oct. 28 entitled, “The Enchanted Island of Centenarians,” by Dan Buettner, a modern-day explorer and educator who focuses on longevity. Of course, there was no way I was going to pass up an opportunity to read an in-depth article on this subject. He wrote about a man named Stamatis Moraitis who was born on Ikaria, a small Greek island.

At this point, you may ask yourself, “What does this have to do with me, since there are numerous stories about the Greek lifestyle?” Well, Moraitis immigrated to the United States around 1943 and lived initially in Port Jefferson. He eventually moved to Florida, where he was diagnosed with lung cancer and given less than a year to live. In response, he decided to move back to Ikaria to get his affairs in order.

Approximately 35 years after his diagnosis, he is 97 years old and fully functional, with no signs of lung cancer. One might say he overcame advanced lung cancer. The skeptics at this point are probably thinking that he was misdiagnosed initially and never had cancer. However, he had received multiple second opinions from physicians, and they all concurred on his diagnosis.

So what was on this island that helped him not only recover from his disease, but live a long and prosperous life? His recovery involved a multitude of factors, such as diet, social support, sleep, physical activity and regular sex.

While his story is anecdotal, we have seen these same results in studies looking at other societies, such as the Okinawans, the Seventh-day Adventist community of California and some provinces of China. What does the research tell us?

Diet and physical activity impact

The Women’s Health and Aging Studies I and II, one of the most recent studies on lifestyle modification, suggests that substantial disease and mortality risk reductions are possible. There were 713 participants ranging in age from 70 to 79 (J Am Geriatr Soc. 2012;60(5):862-868).

The results showed that women who were more physically active, compared to those who were least active, were significantly less likely to die with a 72 percent reduction in five-year mortality risk. And in terms of diet, there was a 50 percent reduction in death for women in the highest third of fruit and vegetable consumption compared to the lowest third. This is important, since the most rapidly expanding age group in the U.S. is those 65 and over (Demographic Res. 2000;3:1–20).

To confirm fruit and vegetable consumption in the different groups, the researchers measured carotenoid levels in the participants’ blood. Carotenoids are phytochemicals, or nutrients, found in a plant-based diet. This is the same technique I use to measure whether my patients are achieving a vegetable-rich diet. The Ikarians’ diet is also composed of vegetables, with an emphasis on greens and a variety of beans and a de-emphasis on dairy and other animal products. According to Dan Buettner, who spent time in Ikaria, most Ikarians walked up at least 20 different hills throughout the day.

The role of napping

While we have heard conflicting reports about napping, recent studies suggest that it may have beneficial effects. In the Greek portion of the European Prospective Investigation into Cancer and Nutrition (EPIC) trial, there was a 34 percent reduction in the risk of death from heart disease when taking a siesta (midday nap), regardless of frequency and duration (Arch Intern Med. 2007;167(3):296-301). This study involved 23,681 participants. For men, those who were working saw more significant results in mortality reduction than those who were not. In the Ikarian society, most of the individuals took naps in the middle of the day.

The influence of social connections

Who you associate with may have a significant effect on your health. In the Framingham Heart Study, the chance of becoming obese (BMI of greater than 30) increased if you had a friend who had become obese (N Engl J Med. 2007;357:370-379). In this study, which involved 12,067 participants, there was a 57 percent increased risk of obesity if your friend was obese well. The authors describe this phenomenon as a social contagion, much like how a virus spreads. Among Seventh-day Adventist communities, Buettner observed that there is a positive social contagion: at picnics you see a predominance of fruit and vegetable dishes, rather than the typical American barbecue with beef or chicken.

Though there are no formally published studies on the Ikarian society, there are studies on other societies with increased longevity, such as the Okinawans, the Seventh-day Adventists and Sardinians. Unlike many of the other society studies, which are mainly international, the Seventh-day Adventists studied live in Loma Linda, Calif., outside Los Angeles.

In a study looking at approximately 34,000 Californian Seventh-day Adventists, those at age 30 had a considerably higher life expectancy than other Caucasian Californians (Arch Intern Med. 2001;161(13):1645-1652). For men, there was a 7.28 year increase in life expectancy, and for women, there was 4.42 year advantage. The factors that play a role are similar to those that are important to the Ikarians: diet, physical activity and not smoking.

What do all of these different societies have in common? They eat a high-nutrient, plant-rich diet, physical activity is a given and strong societal networking is integral to their lifestyles.

Though we may not be able to emigrate to Ikaria or many of the other societies with greater lifespans, we can modify our lifestyles to emulate many of the benefits. We can improve our diet, make sure we get enough sleep – naps should be encouraged, rather than frowned upon – and strengthen our social connections. These changes will help to foster prevention and reversal of chronic disease and potentially increase our longevity.

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

Multivitamins are one of the most commonly consumed supplements in the United States, taken by at least one-third of the population (J Nutr. 2011;141(2):261-266). We are bombarded by vitamin advertising. Yet we hear so much conflicting information about them from physicians and marketers. Are they beneficial or are they detrimental? At least with multivitamins, I will attempt to address these questions with several studies.

The quick and dirty answer is that it appears to depend on the demographics utilizing them and also the content of the multivitamins themselves. So the real question becomes, who should and who should not be taking them? There are studies that have been done on men and women looking at mortality risk and chronic diseases, such as cancer and age-related macular degeneration.

Cancer benefit in men

The Physicians’ Health Study II is the only well-designed, randomized, double-blinded, placebo-controlled trial (RCT), the gold standard of studies, to date that looks at multivitamins. This study was published in JAMA and indicates that multivitamins may be beneficial for men to prevent the overall risk of cancer (JAMA online Oct. 17, 2012). The results showed that men who took a daily multivitamin were 8 percent less likely to develop cancer overall compared to the placebo group. Even though this is a modest effect, the results were statistically significant.

For those who did have cancer, there was also a trend toward reduction in cancer mortality of 12 percent, but it did not reach the threshold of statistical significance. When they analyzed cancers individually, such as prostate and colorectal cancers, there was no difference with the placebo group. The duration of the study was considered substantially long at 11 years. The demographics included 14,641 healthy male U.S. physicians who were at least 50 years old. The multivitamin used in the study was Centrum Silver.

It may be well worth the effort for men over the age of 50 to take a multivitamin, since it is an easy way to reduce the risk of a broad category of chronic diseases, including cancer that is difficult to treat in many circumstances. The authors stressed that this should not replace a good diet and exercise, which are more likely to have larger beneficial effects on cancer.

Cancer effect for postmenopausal women

In the Women’s Health Initiative, a large observational study, there was neither an increase nor a decrease in the risk of cancer with multivitamins (Arch Intern Med. 2009(3);169:294-304). Does this mean that multivitamins don’t have the same effect in women? Not necessarily.

The design of each of the two studies was different. The previous study was a randomized controlled trial comparing a group of males who took a multivitamin to those who took a placebo, whereas this study was large, but observational — participants were observed over time — and thus is not as well designed. Therefore, the Physicians’ Health Study II had a better design and more definitive results. Interestingly, the authors of this study concluded that diet, with an emphasis on fruits and vegetables, and exercise are more beneficial than a multivitamin. This conclusion is a similar to the previous study.

Mortality effect for postmenopausal women

For postmenopausal women, taking a multivitamin may be detrimental. There was an increased risk of mortality of 6 percent in women taking a multivitamin which, though modest, is still statistically significant, according to the Iowa Women’s Health Study (Arch Intern Med. 2011;171(18):1625-1633).

However, according to this study, copper was found to have a 45 percent increased risk of mortality in postmenopausal women. I described this study in more detail in my Oct. 25, 2011 article.
So why do I mention this study? To emphasize the fact that, though this is a large observational study like the Women’s Health Initiative, it is not as well designed, nor are the results as definitive as a RCT like the Physician’s Health Study II mentioned above. For instance, I could not find details about the dose of copper nor whether one standard multivitamin was used.

Regardless, there needs to be a RCT to determine if multivitamins are harmful in postmenopausal women. What I might suggest is that postmenopausal women think twice about taking the multivitamin in the Physician’s Health Study II, since it contained copper. It is important to ask your doctor whether multivitamins are appropriate for you and, if so, which one.

Age-related macular degeneration (AMD) and multivitamins

A multivitamin was shown to be beneficial in preventing the progression of AMD to advanced stage disease. This was a well-designed RCT called the AREDS study (Arch Ophthalmol. 2001;119:1417-1436). The results showed a significant 28 percent reduction in risk of worsening disease in patients between the ages of 55 and 80 years old. The study’s duration was 6.3 years. The multivitamin used contained a combination of vitamin C (500 mg), vitamin E (400 IU), beta carotene (15 mg), zinc (80 mg) and copper (2 mg).

This multivitamin combination also prevented visual acuity loss by 27 percent. These results are impressive, since advanced AMD is the leading cause of central vision loss in patients 65 years and older (Arch Ophthalmol. 1998;116(5):653-658). The study’s conclusion suggests that patients with AMD take this multivitamin combination as long as they don’t have contraindications, such as smoking. Before starting this type of multivitamin, please consult an ophthalmologist.

To review or summarize, multivitamins in the right population have substantial risk reduction effects, such as in cancer with men. However, benefits may be dependent on the population, for with postmenopausal women, multivitamins may actually increase the risk of mortality. They may also depend on the multivitamin’s composition — not all multivitamins are created equal. For example, a certain combination of elements is beneficial for macular degeneration, not just any multivitamin. Thus, one size does not fit all. And remember, a supplement is just that, it should supplement a healthy diet.

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

In last week’s article on fall risk, I briefly mentioned cataracts as a contributor. Cataracts, the nuclear type, reduce visual acuity in an insidious process. What is important about cataracts is that they affect so many Americans, and their incidence is rising. Well, as it turns out, cataract surgery may not only reduce the risk of falls and hip fracture but, at the same time, pressure in the eye.
A diet rich in carotenoids may also prevent the occurrence of cataracts, whereas statins may have the reverse effect by increasing risk.

Cataract surgery and hip fracture

In a recent study, elderly cataract patients who underwent surgery were significantly less likely to experience a hip fracture during a year of follow-up than those who did not have surgery (JAMA. 2012;308:493-501). This was a retrospective (backward-looking) observational study, and its size was considerable, with over one million patients 65 and older. The results showed a 16 percent reduction in the risk of hip fractures overall. Those who were older — between 80 and 84 — had the most to gain, with a 28 percent reduction in hip fracture risk.

The reason for the increased fall risk and subsequent hip fracture risk in those with cataracts is the decrease in visual acuity and depth perception and the reduction in visual field that accompanies cataracts (J Am Geriatr Soc. 2009 Oct;57(10):1825-1832). As we know, hip fractures have tremendous impact on the ability of elderly patients to remain independent. Thus, avoiding them is the best strategy, since many of these patients do not regain their prior mobility.

Cataract surgery and intraocular pressure

Yet another benefit of cataract surgery is the potential reduction in intraocular pressure (IOP). Why is intraocular pressure (pressure within the eye) important? High IOP has been associated with an increased risk of glaucoma. A comparative case series (looking at those with and without cataract surgery) utilizing data from the Ocular Hypertension Treatment Study showed that those cataract patients with ocular hypertension (higher than normal pressure in the eye) who underwent cataract surgery saw an immediate reduction in IOP (Ophthalmology. 2012;119:1826-1831). This effect lasted at least three years. The removal of the cataract lowered the IOP by 16.5 percent from 23.9 mm Hg to 19.8 mm Hg. This would be close to the lower end of pressure reduction goals in glaucoma treatments, 20 to 40 percent. Therefore, cataract surgery may be synergistic with traditional glaucoma treatment.

Cataract surgery and macular degeneration risk

In a May 15, 2011 article, I wrote about a study that suggested cataract surgery increased the risk of progression of age-related macular degeneration (AMD). However, this may not be the case after all. There is conflicting evidence from a second study. Rather than increasing AMD risk, cataract surgery may uncover underlying AMD pathology that is hidden because the cataract obfuscates the view of the retina (back of the eye) (Arch Ophthalmol. 2009;127:1412-1419). The study’s strengths were the use color retinal photographs and fluorescein angiography (dye in blood vessels of eye), both very thorough approaches.

Cataract prevention with dietary carotenoids

Diet may play a significant role in prevention of cataracts. In the Women’s Health Initiative Observational Study, carotenoids, specifically lutein and zeaxanthin, seem to decrease cataract risk by 23 percent in women with high blood levels, compared to those with low blood levels (Arch Ophthalmol. 2008;126(3):354-364). In fact, those in the highest quintile (the top 20 percent) had an even more dramatic 32 percent risk reduction when compared to those in the bottom quintile (the lowest 20 percent). As the authors commented, it may not have been just lutein and zeaxanthin. There are more than 600 carotenoids, but these were the ones measured in the study. Some of the foods that are high in carotenoids include carrots, spinach, kale, apricots and mango, according to the USDA. Interestingly, half a cup of one of the first three on a daily basis will far exceed the recommended daily allowance. Thus, it takes a modest consistency in dietary carotenoids to see a reduction in risk.

Vitamin C effect

The impact of vitamin C on cataract risk may depend on the duration of daily consumption. In other words, 10 years seems to be the critical duration needed to see an effect. According to one study, those participants who took 500mg of vitamin C supplements for 10 or more years saw a 77 percent reduction in risk (Am J Clin Nutr. 1997 Oct;66(4):911-916). However, only very few women achieved this goal in the study, demonstrating how difficult it is to maintain supplementation for a 10-year period.

Those who took vitamin C for fewer than 10 years saw no effect in prevention of cataracts. In the well-designed AREDS study, a randomized controlled trial, the gold standard of studies, those who received 500 vitamin C supplements along with other supplements did not show any cataract risk reduction, compared to those who did not receive these supplements. There were 4,757 patients involved in the study with duration of 6.3 years of daily supplement consumption. Therefore, I would not rush to take vitamin C as a cataract preventative.

Statin use

Statins have both positive and negative effects, and the effect on the eyes is negative. In the Waterloo Eye Study with over 6,000 participants, those patients taking statins were at a 57 percent increased the risk of cataracts (Optom Vis Sci 2012;89:1165-1171). Diabetes patients saw an increased risk of cataracts as well. And in diabetes patients, statins seem to increase the rate at which cataracts occurred. The authors surmise that this is because higher levels of cholesterol may be needed for the development of epithelial (outer layer) cells and transparency of the lens. This process may be blocked with the use of statins. Before considering discontinuing statins, it is important to weigh the risks with the benefits.

Thus, if you have diminished vision, it may be due to cataracts. It is important to consult an ophthalmologist for cataract surgery, which can reduce your risks of falls, hip fractures and intraocular pressure. For those who do not have cataracts, a diet rich in carotenoids may significantly reduce the risk of occurrence.

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

Falling is not a big deal when you are young, but that changes with age. Most of us have seen the commercial where the woman has fallen and can’t get up. Although this commercial has been mocked, for older adults, falling can be seriously debilitating or cause life-threatening complications. In a study, 24 percent of people over the age of 71 who had at least one fall experienced reduced quality of life (J Gerontol A Biol Sci Med Sci. 1998;53A(2):M112-M119).

In a survey, 80 percent of women said they preferred death over the risk of a “bad” hip fracture from a fall that would cause loss of independence and nursing home admission (BMJ. 2000;320(7231):341-345). Unfortunately, falls in those over age 65 are quite common, with 30 to 40 percent falling annually (Clin Geriatr Med. 2002;18(2):141-158).

Now that I have your attention, what increases the risk of falls and what can we do to prevent them? When we think of the risk, we think of making the home safer by, for example, making sure that there are no loose rugs or by providing adequate lighting. But the potential causes and prevention go far beyond these steps. The factors that increase risk include chronic diseases, such as osteoarthritis, Parkinson’s, dementia, atrial fibrillation, AMD and cataracts, as well as obesity and medications.

Medication’s impact

Many patients over the age of 65 are on blood pressure medications. It turns out that diuretics (water pills) may increase the risk of falls. In a case-control study (those with high blood pressure compared to those without), nursing home patients who newly started diuretics or had their dose increased had a significant twofold increased risk of fall, especially the first day (Pharmacoepidemiol Drug Saf. 2012 May;21(5):560-563). Loop diuretics, such as Lasix (furosemide), had the most damaging effects on risk.

The authors recommend close surveillance of elderly patients for at least two days when initiating diuretic medications to treat high blood pressure. High blood pressure can be effectively treated with lifestyle modifications, such as an antioxidant-rich diet like the DASH diet that focuses on fruit, vegetables and low saturated fat (Circulation. 2010;122:A18589).

Chronic diseases

Those with osteoarthritis (OA), especially of the knee, are more likely to fall. This makes sense, since it is more difficult to walk with OA. In the GLOW study, a prospective (forward-looking) study involving postmenopausal women, those with OA had a 27 percent greater risk of falling, compared with those who didn’t have the disease (Ann Rheum Dis. online June 23, 2012). There was also a 21 percent increased risk of fracture that occurred, as well. Over 50,000 women with a mean age of 68 participated in the study. I recommend reading my article on the treatment and prevention of OA from July 10 for more details.

Obesity effect

We tend to associate falls and fractures with elderly patients who are gaunt and frail. However, it turns out that obesity increases the risk of falls. In an observational study, there was a linear relationship between obesity and fall risk (J Am Geriatr Soc. 2012 Jan;60(1):124-129). In other words, as patients increased their BMI, their fall risk went up proportionally.

Even more interesting, the risk of fracture increased with increasing BMI associated with obesity. Just a reminder that obesity is a BMI of 30 kg/m2 or over. According to the authors, the reason for obesity’s effect is that people who are obese have difficulty with balance. In this study, underweight patients did not have an increase in falls. To treat obesity, lifestyle modifications have shown significant results. And as you decrease weight and inflammation, it also helps to treat osteoarthritis.

Vitamin D

Although it is not surprising that vitamin D helps to prevent falls, since this supplement strengthens bones and muscle in the elderly, dose and frequency are determining factors of whether it is beneficial or detrimental. In a randomized controlled trial (RCT), the gold standard of studies, annual oral doses of 500,000 IUs of vitamin D3 actually increased the risk of falls and fracture in elderly patients, 15 percent and 26 percent respectively (JAMA. 2010;303:1815-1822).

However, when given on a daily basis, vitamin D does what we have come to expect, decreases the risk of falls and fractures with the appropriate dose. In a secondary analysis of a RCT, it was the lower doses of 200 IUs, 400 IUs and 600 IUs that were ineffective, while the higher dose of 800 IUs taken daily showed a large, statistically significant 72 percent reduction in the risk of falls (J Am Geriatr Soc. 2007;55(2):234-239).

The difference between this and the previous study on vitamin D was the frequency and dosing regimen. Hence, taking vitamin D is an easy and very efficient way to reduce falls and fractures in the elderly. Many elderly are deficient in vitamin D and should have their blood levels checked. Regardless of the results, they should receive at least 800 IUs of vitamin D — if not more — on a daily basis. This will either maintain or improve blood levels of vitamin D.

Exercise

In a RCT, exercise in women with a mean age of 65 increased the bone mineral density (BMD) of the spine by 77 percent compared to a control group, which had a 66 percent reduction in BMD. In other words, the women developed stronger bones with increased exercise. The trial design looked at the exercise group, which focused on increased exercise intensity, and compared it to a control group with low-intensity and low-frequency exercise. This translated into a significant reduction in fall risk for the exercise group.

We should be aware of the risk factors for falls. Complications from falls are the leading cause of mortality in older adults. This is not something to be taken lightly. Fortunately, many of the risk factors are modifiable with lifestyle changes, including a nutrient-dense diet, vitamin D supplementation and increased exercise.

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

In last week’s article, (dated Sept. 27), I wrote about general dementia prevention. I thought it would be appropriate to follow up with an article on Alzheimer’s disease, one of the most debilitating neurodegenerative diseases. Its incidence continues to rise in lockstep with the fact that we are living longer, for as we age, our risk for the disease increases exponentially (Neurology 1998;51(3):728).

There is more and more evidence that points to an association between diet and Alzheimer’s disease.  Also, there may be a more definitive way to estimate disease risk and progression. This involves white matter hyperintensities (WMH) found in an MRI scan of the brain. These WMH may be tied, at least partially, to diet. Vitamin D levels are also potentially important in Alzheimer’s risk. This article will discuss and explore the potential associations in more detail by looking at the evidence.

The potential significance of white matter hyperintensities

What are WMH and why are they important? White matter hyperintensities represent small vessel cerebrovascular disease. Cerebrovascular disease involves a group of disorders that affect blood vessels, causing a significantly diminished or lack of blood flow to the brain (www.medicalnewstoday.com). For example, atherosclerosis or plaques in the arteries can be a cause, potentially leading to a cerebrovascular accident — or what we typically call a stroke.

One study utilized the Washington Heights/Inwood Columbia Aging Project (WHICAP), an observational study in Manhattan. It found significantly increased risk of Alzheimer’s with WMH, while the atrophy of the hippocampus did not correlate with disease diagnosis (Arch. Neurol. online Sept. 2012). The hippocampus is the part of the brain involved in formation, organization and storage of memory.
The study suggests that these WMH may be important for predicting disease risk and progression, even potentially more so than hippocampal atrophy or shrinkage. Further study is needed for these preliminary findings, though they are very intriguing.

If we are looking at the WMH, then the risk factors for cerebrovascular disease, including high blood pressure, diabetes and obesity, become important. This is where dietary aspects may play a role. The authors suggest that lifestyle modifications would impact cerebrovascular disease risk, which ultimately could reduce Alzheimer’s risk.

Dietary aspects

In an observational study called the Kame Project cohort, a modest dietary change had dramatically beneficial results. Those who drank fruit juice and vegetable juice three times or more a week, compared to those who drank less than once a week, saw a 76 percent reduction in the risk of Alzheimer’s disease (Am. J. Med. 2006 Sep;119(9):751-759). The authors concluded that fruit/vegetable juice may play a vital role in delaying the onset of dementia.

Ironically, at the same time that the WMH results of the previously mentioned study were published, Mark Bittman wrote in a recent article that Alzheimer’s disease has been referred to as “type 3 diabetes” (www.nytimes.com). This phrase has been around since the publication of a 2005 journal article (J. Alzheimers Dis. 2005 Feb;7(1):63-80). The reason for this phrase is that there is potentially an impaired insulin response in the brain of Alzheimer’s disease patients. It is not the phrase itself, but rather the implication of the phrase, that is important. Insulin helps the body regulate and utilize blood sugar. If the brain is not able to metabolize sugar in early Alzheimer’s, this mechanism may contribute to the disease.

To compound this potential lack of insulin response, a recent study focused on macronutrients, or more specifically carbohydrates, and their impact on Alzheimer’s. But what does Alzheimer’s disease have to do with carbohydrates?

The results of the study showed that those who ate a high-carbohydrate diet were at an 89 percent increased risk of developing dementia, such as Alzheimer’s disease (J. Alzheimers Dis. Online July 17, 2012). This should not be shocking, since carbohydrates become sugar when broken down in the body. It seems to fit what the authors are saying in the previously mentioned 2005 study conclusions.

Diabetes

It turns out that type 2 diabetes patients have twice the risk of developing Alzheimer’s (Medscape.org). If we control the glucose (sugar) levels intensely in diabetics, will this reduce their risk of Alzheimer’s? Unfortunately, the ACCORD-MIND trial, a randomized clinical trial, considered the gold standard of studies, did not show a difference after 40 months between the group that had intensive control of sugars compared to standard control (Lancet Neurol. 2011;10:969-977).

The impact of vitamin D

We can’t seem to get away from vitamin D. It appears to be involved in so many different chronic diseases. In the most recent meta-analysis (a group of 37 studies), it was found that those with Alzheimer’s have a lower vitamin D blood level than those without the disease (Neurology. 2012;79:1397-1405). I have a patient with moderately severe Alzheimer’s who is not only insufficient (<30 ng/ml) but deficient (<20 ng/ml) in vitamin D. When I first tested the blood levels, the patient had a vitamin D level of 13 ng/ml.

What is also interesting is that this same patient, after being on a high nutrient, plant-rich diet for a month, had an approximately 45-minute lucid moment, something that had not been seen for years according to the caregiver. This is only anecdotal, and it has only been a month, so that the lucid moment may have been a coincidence. We will have to stay tuned to see what happens.

Ultimately, what is critically important is to realize that Alzheimer’s disease, just like many other chronic diseases, has modifiable risk factors that involve lifestyle choices. Pardon the pun, but I hope this gives you food for thought.

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

Dementia may be diagnosed when someone experiences loss of memory plus loss of another faculty, such as executive functioning (decision-making) or language abilities (speaking, writing or reading). The latter is known as aphasia. Alzheimer’s disease is responsible for approximately 60 to 80 percent of dementia cases (www.uptodate.com).

This past weekend, there was a torrent of support for Alzheimer’s research through fundraising walks. More research is certainly needed, since there are no definitive studies that show reversal or cure for Alzheimer’s disease. This is why prevention is central to Alzheimer’s — and dementia in general — as I discussed in my May 19, 2011, article.

In terms of dementia, there is good news and some disappointing news.
We will start with the good news. Though chronological age is a risk factor that cannot be changed, biological age may be adjustable. There are studies that suggest we may be able to prevent dementia through the use of both lifestyle modifications and medications.

Telomeres’ length and biological age

Biological age may be different from chronologic age depending on a host of environmental factors that include diet, exercise and smoking. There are substances called telomeres that are found at the ends of our chromosomes. They provide stability to this genetic material. As our telomeres get shorter and shorter, our cellular aging and, ultimately, biological aging, increases.
In a recent preliminary case control study, dementia patients were shown to have significantly shorter telomere length than healthy patients (Arch Neurol. 2012 Jul 23:1-8). Interestingly, according to the authors, men have shorter telomere length and may be biologically older by four years than women of the same chronological age. The researchers caution that this is a preliminary finding and may not have clinical implications.

What I find most intriguing is that intensive lifestyle modifications increased telomere length in a small three-month study with patients who had low-risk prostate cancer (Lancet Oncol. 2008;9(11):1048-57). By adjusting their lifestyles, study participants were potentially able to decrease their biological ages.

Beta-carotene and vitamin C effect

Lifestyle modifications play a role in many chronic diseases and disorders. Dementia is no exception. In a small, preliminary case-control study (disease vs. healthy patients), higher blood levels of vitamin C and beta-carotene significantly reduced the risk of dementia, by 71 percent and 87 percent respectively (J Alzheimers Dis. 2012;31:717-724). The blood levels were dramatically different in those with the highest and lowest blood levels of vitamin C (74.4 vs. 28.9 µmol/L) and beta-carotene (0.8 vs 0.2 µmol/L).

The reason for this effect may be that these nutrients help reduce oxidative stress and thus have neuroprotective effects, preventing the breakdown of neurons. This study was done in the elderly, average 78.9 years old, which is a plus, since as we age we’re more likely to be afflicted by dementia.
It is critically important to delineate the sources of vitamin C and beta-carotene in this study. These numbers came from food, not supplements. Why is this important? First, beta-carotene is part of a family of nutrients called carotenoids. There are at least 600 carotenoids in food, all of which may have benefits that are not achieved when taking beta-carotene supplements. Second of all, beta-carotene in supplement form may increase the risk of small cell lung cancer in smokers (Am. J. Epidemiol. 2009; 169(7):815-828).

Foods that contain beta-carotene include fruits and vegetables such as berries; green leafy vegetables; and orange, red or yellow vegetables like peppers, carrots and sweet potato. It may surprise you, but fish also contains carotenoids. In my practice, I test for beta-carotene and vitamin C as a way to measure nutrient levels and track patients’ progress when they are eating a nutrient-dense diet. Interestingly, many patients achieve more than three times higher than the highest beta-carotene blood levels seen in this small study.

Impact of high blood pressure medications

For those patients who have high blood pressure, it is important to know that not all blood pressure medications are created equal. When comparing blood pressure medications in an observational study, two classes of these medications stood out. Angiotensin II receptor blockers (known as ARBs) and angiotensin-converting enzyme inhibitors (known as ACE inhibitors) reduce the risk of dementia by 53 percent and 24 percent respectively, when used in combination with other blood pressure medications.
Interestingly, when ARBs were used alone, there was still a 47 percent reduction in risk, however ACE inhibitors lost their prevention advantage. High blood pressure is a likely risk factor for dementia and can also be treated with lifestyle modifications (Neurology. 2005;64(2):277). Otherwise, ARBs or ACE inhibitors may be the best choices for reducing dementia risk.

Ginkgo biloba disappoints

Ginkgo biloba, a common herbal supplement taken to help prevent dementia, may have no benefit. In the recent GuidAge study, ginkgo biloba was shown to be no more effective than placebo in preventing patients from progressing to Alzheimer’s disease (Lancet Neurol. 2012;11(10):851-859). This randomized controlled trial, considered the gold standard of study designs, was done in elderly patients over a five-year period with almost 3,000 participants. There was no difference seen between the treatment and placebo groups. This reinforces the results of an earlier study, Ginkgo Evaluation of Memory trial (JAMA. 2008;300(19):2253-2262). Longer studies may be warranted. The authors stressed the importance of preventive measures with dementia.

Fish oil: not the last word

Many of us take fish oil supplements in the hope of preventing dementia. However, in a meta-analysis (a group of three randomized controlled trials), the results did not show a difference between treatment groups and placebo in older patients taking fish oil with omega-3 fatty acids (Cochrane Summaries online June 13, 2012). The authors stress that this is not the final word, since studies have been mixed. The longest of the three studies was 40 months yet may not have been long enough to see a beneficial effect. Also participants in the meta-analysis did not necessarily have low omega-3 levels at the beginnings of the studies. This doesn’t necessarily mean fish oil doesn’t work for dementia prevention, it is just discouraging, as the authors emphasize. Fish consumption, however, has shown an inverse association with Alzheimer’s and dementia overall (Neurology. 2007;69(20):1921).

There may be ways to prevent dementia from occurring, whether through lifestyle modifications or through the selection of medications, if they are necessary. It is great that there is such enthusiasm to raise money for dementia research and, in particular, for Alzheimer’s disease. However, it’s just as important to take action now in the form of preventing this disabling disorder.

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

Eye tremor may be an early indication Parkinson’s disease is a neurodegenerative disease, which means there is progressive breakdown of neurons. Traditional medications that focus on dopamine levels and receptors help improve symptoms, sometimes dramatically, yet they have limitations. Medications can’t prevent the breakdown of the neurons themselves. Also, drug benefits may eventually “wear off.”
Parkinson’s typically affects people who are older than 60. There are over one million people in North America directly affected by this disease, but countless family member caregivers are indirectly affected as well (N Engl J Med 1998;339(15):1044).

This article’s focus is to provide an overview of Parkinson’s, including risk factors, diagnosis and alternative treatments that may enhance traditional treatments.

Significance of eye tremors

The common triad of symptoms for diagnosing Parkinson’s are rigidity, tremor and bradykinesia (slow gait). Parkinson’s tremors typically occur in the limbs, but this may not be the whole story. We may also want to look at the eyes. It appears that Parkinson’s disease patients have ocular fixation instability, meaning that when they focus on a point on a computer screen, their eyes oscillate and may have trouble focusing. This happens to a greater degree in the vertical direction than the horizontal (Arch Neurol. 2012;69(8):1011-1017).

In this case-control trial, which compared Parkinson’s patients with healthy participants, 63 percent of the Parkinson’s patients, in addition to eye tremors, experienced difficulty with vision at some point during the testing. The eye area affected was the fovea — part of the retina (back of the eye) responsible for sharp central vision. The authors believe that eye testing may provide an accurate way to diagnose the disease.

Role of pesticides

It appears in meta-analysis (a group of 46 trials) that pesticides increase the risk of Parkinson’s disease (Environ Health Perspect. 2012;120(3):340-347). Insecticides and herbicides appeared to have more impact, whereas fungicides were not associated with increased risk.

The studies were not completely consistent, even though there was a 62 percent overall increased risk. However, it would be premature to declare that pesticides are definitely associated with Parkinson’s disease. There were no randomized clinical trials, and there were several different types of trials analyzed. Many past studies have had mixed results. Also, it was unclear what type of pesticide exposure occurred and at what level. The authors did not definitively say that it was from consumption of foods, but the results are interesting and may give a boost to the validity of organic foods.

Dairy’s potential negative impact

The National Dairy Council wants you to believe that dairy makes you big and strong. However, in the prospective (forward-looking) Cancer Prevention Study II, men who consumed the most dairy were found to have as much as an 80 percent increased Parkinson’s disease risk compared to those who consumed the least (Am J Epidemiol. 2007 May 1;165(9):998-1006).The risk is higher than the pesticide study mentioned above. There was also an increased risk with women, but not as dramatic. When results combined both sexes, there was an overall 60 percent increased risk. Therefore, if there is a family history of Parkinson’s, it might be wise to consider keeping dairy to a minimum.

Dietary effect

In a meta-analysis that looked at the Nurses’ Health Study and the Health Professionals Follow-up Study, results showed diets that focused on fruit, vegetables, whole grain, nuts and seeds, fish and poultry demonstrated a 30 percent reduction in Parkinson’s disease risk (Am J Clin Nutr. 2007 Nov;86(5):1486-94). This effect may be due to flavonoids, bioactive compounds in plant-rich diets. It is surmised that these compounds may have neuroprotective effects, because of their antioxidant and anti-inflammatory properties (Eur J Pharmacol. 2006;545(1):51-64).

Exercise and Parkinson’s treatment

Exercise may be used in concert with therapeutics in treating Parkinson’s disease, and goes beyond medications in helping with motor function and stability. Two that have shown good results are resistance training and tai chi.

Resistance training — specifically weight training — may have significant benefits, according to preliminary data (AAN 2012 abstract #S02.003). The patients involved in the study had Parkinson’s for a mean of seven years and were not on medication. They exercised twice a week for one hour, and they saw a significant improvement in motor function as they gradually increased the level of resistance. This was sustained for the 24-month study. Though this study was small, these results are encouraging.
Postural stability is important to the functionality of a Parkinson’s disease patient. In an NIH-funded randomized clinical trial, the gold standard of trials, tai chi significantly improved postural stability when comparing it to both resistance training and stretching (N Engl J Med 2012;366:511-519). Tai chi was instrumental also in reducing falls — even three months after patients stopped tai chi. The mild to moderate Parkinson’s patients in the study performed tai chi for one hour twice a week.

It is exciting that there may be a more definitive way to diagnose Parkinson’s disease by testing the eyes for tremors, rather than the traditional compilation of symptoms. Even though it is not clear where pesticide exposure occurred, it may be prudent for people with a high risk of Parkinson’s to lean toward an organic, plant-rich diet for prevention.

In addition, if a Parkinson’s disease patient exercised four times a week, alternating between tai chi and resistance training, they would get the best of both worlds: potential improvement in postural stability and in motor skills.

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

You would think that all of us, if given a choice, would want to live longer. However, in a recent informal survey involving 30,000 participants over the last three years, more than half did not want to live past the 80-year current life expectancy for developed countries (NYTimes.com Aug. 25). This would be surprising, except that the most frequent reason offered had to do with not wanting to be old and debilitated. What if we could propose improving longevity — and health — so that people would feel vivacious throughout their lives, regardless of age?

Calorie restriction impact
Recent thinking has been that if we restrict our calorie intake significantly, by 30 percent, then we are more apt to live longer and healthier lives. That is what we were led to believe by earlier studies in monkeys, like the 2009 University of Wisconsin study (Science. 2009 Jul 10;325(5937):201-4). The problem with the study was that the researchers discounted a number of monkeys who died, claiming this did not have to due with aging.

However, a newly published study with rhesus monkeys reported different results (Nature online Aug. 29). Severely restricting these monkeys’ calories did not increase their longevity, nor did they live healthier lives. These results were disappointing in that calorie restriction is not necessarily the panacea that we thought. This was a 25-year study and the results had been eagerly anticipated.

There were some benefits to calorie restriction, though. For older males and females, heart disease risk was reduced due to lowered triglyceride levels. This was true, ironically, only when calorie restriction was begun when the monkeys were already old.

However, the monkeys — calorie restricted or not — did still experience chronic diseases such as heart disease and cancer.

What about chronic disease?

It appears that chronic disease is the greatest hindrance to achieving or maintaining a better quality of life. Coincidently, the Centers for Disease Control and Prevention has released data that show chronic disease is on the rise, with increasing numbers of patients having two or more diseases. Also, it appears that the United States lags behind European nations in reducing the number of preventable deaths, called “amenable mortality.” Most of these deaths are caused by chronic disorders, such as high blood pressure, stroke and cancers. The U.S. is seeing a decline in its rates of preventable deaths but at half the pace of France and the United Kingdom. So what can we do to slow the rise in chronic disease and accelerate the decrease in our rate of preventable deaths?

Diet composition effect

Dietary choices can have a tremendous effect on health. Not surprisingly, poor diet composition is one of the leading contributors to many chronic diseases such as high cholesterol, diabetes and heart disease, and thus amenable mortality rates (Ann Intern Med 2010;153:736-750). The CDC showed that only about one-quarter of Americans consumed the most basic levels of fruits and vegetables recommended.

However, there are several diets that have been promoted because they are known to have powerful effects on reversing this dismal trend of increasing chronic disease such as the DASH diet and the Mediterranean-type diet. In 2010, the DASH diet was highlighted because of its beneficial effects on prevention and treatment of disease (www.cnpp.usda.gov). At the basis of this diet is the emphasis on nutrient-rich foods, including fruits, vegetables, nuts and seeds, beans and legumes, and whole grains, as well as a modest amount of lean animal protein.

The DASH diet was originally designed to lower blood pressure. In a randomized controlled trial, the gold standard of studies, DASH showed significantly lower systolic blood pressure results compared to those on a standard diet, even though both groups were intentionally given the same level of sodium intake, which is very interesting (N Engl J Med 1997;336:1117-1124). The difference was that DASH increased the amounts of fruits, vegetables and low-fat dairy, while lowering saturated fat.

Subsequent prospective studies, such as the Nurses’ Health Study, have borne out the benefits of the DASH diet in lowering heart disease risk in patients followed for a 25-year duration (Arch Intern Med 2008;168:713-720).

Fitness at any age — a greater impact than expected

We used to think that fitness helped delay disease, but a new study suggests that fitness in middle age, defined as people in their 50s, actually decreased the risk of chronic disease significantly. It didn’t just delay it (Arch Int. Med online Aug. 27). Ultimately, fitness at any age seems to provide us with a higher quality of life. This study involved 18,600 participants. There was an approximately 45 percent reduction across the board for both men and women in incidence of the top eight chronic diseases.
The good news is that you may not have to make yourself miserable by eating a very low calorie diet in the hopes of achieving a longer life.

Rather than suffering — or imagining suffering — through severe calorie restriction, why not focus on consistent, modest fitness routines and diets that are rich in nutrients and high in volume? The potential disease-modifying effects could play a crucial role in preventing what we perceive as age-related decline. Then, you can have a positive attitude toward living longer, since you will be able to maintain, if not improve, your health as you age.

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