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Dr. David Dunaief

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A good pace and mindset may improve your outcomes

By David Dunaief, M.D.

Dr. David Dunaief

Medical professionals (including me!) often press you to exercise. This sage advice seems simple enough; however, the type, intensity level and frequency of exercise may not be well-defined. For instance, any type of walking is beneficial, right? Well, as one study that quantifies walking pace notes that some types of walking are better than others.

We know exercise is beneficial for prevention and treatment of chronic disease. But another very important aspect of exercise is the impact it has on specific diseases, such as diabetes and osteoarthritis. Also, certain supplements and drugs may decrease the beneficial effects of exercise. They are not necessarily the ones you think. They include resveratrol and nonsteroidal anti-inflammatory drugs (such as ibuprofen). Let’s look at the evidence.

Walk with a spring in your step

While pedometers give a sense of how many steps you take on a daily basis, this number isn’t all that’s important. Intensity, rather than quantity or distance, may be the primary indicator of walking’s benefit.

In the National Walkers’ Health Study, results showed that those who walk with more pace are more likely to decrease their mortality from all causes and to increase their longevity (1). This is one of the first studies to quantify specific speed and its impact. In the study, there were four groups. The fastest group was almost jogging, walking at a mean pace of less than 13.5 minutes per mile, while the slowest group was walking at a pace of 17 minutes or more per mile.

The slowest walkers had a higher probability of dying, especially from dementia and heart disease. Those in the slowest group stratified even further: those whose pace equaled 24-minute miles or greater had twice the risk of death, compared to those who walked with greater speed.

However, the most intriguing aspect of the study was that there were big differences in mortality reduction in the second slowest category compared to the slowest, which might only be separated by a minute-per-mile pace. So, don’t fret: you don’t have to be a speedwalker to realize significant benefit.

Align your mind and body

The mind also plays a significant role in exercise. The results of one study note that a positive mindset while exercising makes a big difference in the exercise’s impact (2). Researchers created two groups. The first was told to find four positive phrases, chosen by the participants, to motivate them while on a stationary bike and repeat these phrases consistently for the next two weeks while exercising.

Members of the group who repeated these motivating phrases consistently throughout each workout were able to increase their stamina for intensive exercise after only two weeks, while the same could not be said for the control group, which did not use reinforcing phrases.

‘Longevity’ supplement may negate exercise benefits

Resveratrol is a substance that is thought to provide increased longevity through proteins called Sirtuin 1. So how could it negate some benefit from exercise? Well it turns out that we need acute inflammation to achieve some exercise benefits, and resveratrol has anti-inflammatory effects. Acute inflammation is short-term inflammation and is different from chronic inflammation, the basis for many diseases.

In a small randomized controlled study, treatment group participants were given 250 mg supplements of resveratrol and saw significantly less benefit from aerobic exercise over an eight-week period, compared to those who were in the control group (3). Participants in the control group had improvements in both cholesterol and blood pressure that were not seen in the treatment group. This was a small study of short duration, although it was well-designed.

Impact on diabetes complications

The majority of Type 2 diabetes patients suffer from cardiovascular disease. The good news is that exercise may improve outcomes. In a prospective (forward-looking) observational study, results show that diabetes patients who exercise less frequently, once or twice a week for 30 minutes, are at a higher risk of developing cardiovascular disease and almost a 70 percent greater risk of dying from it than those who exercised at least three times a week for 30 minutes each session. In addition, those who exercised only twice a week had an almost 50 percent increased risk of all-cause mortality (4).

The study followed more than 15,000 men and women with a mean age of 60 for five years. The authors stressed the importance of exercise and its role in reducing diabetes complications.

Calculate your fitness age

You can calculate your fitness age without the use of a treadmill, according to the HUNT study (5). An online calculator utilizes basic parameters – age, gender, height, weight, waist circumference and frequency and intensity of exercise – to help you judge where you stand with exercise health. This calculator can be found at www.ntnu.edu/cerg/vo2max. Your results may surprise you.

Even in winter, you can walk and talk yourself to improved health by increasing your intensity while repeating positive phrases that help you overcome premature exhaustion. Exercise can also have a significant impact on complications of chronic diseases, such as cardiovascular disease and resulting death with diabetes. As a bonus, getting outside during the day may also help you avoid the effects of the “winter blues.”

References:

(1) PLoS One. 2013;8:e81098. (2) Med Sci Sports Exerc. 2013 Oct. 10. (3) J Physiol Online. 2013 July 22. (4) Eur J Prev Cardiol Online. 2013 Nov. 13. (5) Med Sci Sports Exerc. 2011;43:2024-2030.

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

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By David Dunaief, M.D.

Dr. David Dunaief

There are some compelling studies that show exercise’s powerful effects in altering our genes. Recent studies show its impact on specific diseases. Exercise has effects on diabetes and a host of other chronic diseases, including kidney stones, osteoarthritis, cardiovascular disease and breast, colorectal and endometrial cancers (1).

There are also studies on simple ways to motivate yourself during exercise. One showed that those who repeat positive mantras like “feels good” while exercising were able to persist in their exercise routines for longer periods (2).

Why is this so important and why am I harping on exercise during the holidays? Because we are too sedentary, and this is the time of the year when we are inclined to overeat. According to data from the 2015-2016 National Health & Nutrition Examination Survey, we spend 6.4 hours a day sedentary (3). And this percentage is trending up.

Exercise and your genes

While you may be waiting for gene therapy to cure our chronic illnesses, it turns out that exercise may have a significant impact on our genes.

No waiting required; this is here and now.

Photo from Pixabay

In a study, results showed that thousands upon thousands of genes in fat cells were affected when participants exercised (4). The study involved sedentary men and asked them to exercise twice a week at a one-hour spin class. According to the researchers, the genes impacted were those involved most likely in storing fat and in risk for subsequent diabetes and obesity development. Participants’ gene expression was altered by DNA methylation, the addition of a methyl group made up of a carbon and hydrogens. These participants also improved their biometrics, reducing fat and subsequently shrinking their waist circumferences, and improved their cholesterol and blood-pressure indices.

The effect is referred to as epigenetics, where lifestyle modifications can ultimately lead to changes in gene expression, turning them on and off. This has been shown with dietary changes, but this is one of the first studies to show that exercise also has significant impacts on our genes. It took only six months to see these numerous gene changes with modest amounts of cardiovascular exercise.

If this was not enough, another study showed substantial gene changes in muscle cells after one workout on a stationary bike (5).

Exercise versus drug therapy

We don’t think of exercise as being a drug, but what if it had similar benefits to certain drugs in cardiovascular diseases and mortality risk? A meta-analysis — a group of 57 studies that involved drugs and exercise — showed that exercise potentially has equivalent effects to statins in terms of mortality with secondary prevention of coronary heart disease (6).

This means that, in patients who already have heart disease, both statins and exercise reduce the risk of mortality by similar amounts. The same was true with prediabetes and the use of metformin vs. exercise. It didn’t matter which one was used, the drug or the lifestyle change.

Don’t change your medication without consulting your physician.

Kidney stones and exercise

Anyone who has tried to pass a kidney stone knows it can be an excruciating experience. Most of the treatment revolves around pain medication, fluids and waiting for the stone to pass. However, the best way to treat kidney stones is to prevent them. In the Women’s Health Initiative Observational Study, exercise reduced the risk of kidney stones by as much as 31 percent (7).

Even better, the intensity of the exercise was irrelevant to its beneficial effect. What mattered more was exercise quantity. One hour of jogging or three hours of walking got the top results. But lesser amounts of exercise also saw substantial reductions. This study involved 84,000 postmenopausal women, the population most likely to suffer from kidney stones.

Sex as exercise

We have heard that sex may be thought of as exercise, but is this myth or is there actual evidence? Try to keep a straight face. Well, it turns out this may be true. In a study published in the PLoS One journal, researchers found that young healthy couples exert 6 METs — metabolic energy, or the amount of oxygen consumed per kilogram per minute — during sexual activity (8).

How does this compare to other activities? Well, we exert about 1 MET while sitting and 8.5 METs while jogging. Sexual activity falls between walking and jogging, in terms of the energy utilized, and thus may be qualified as moderate activity. Men and women burned slightly less than half as many calories with sex as with jogging, burning a mean of 85 calories over about 25 minutes. Who says exercise can’t be fun?

I can’t stress the importance of exercise enough. It not only influences the way you feel, but also may influence gene expression and, ultimately, affects the development and prevention of disease. In certain circumstances, it may be as powerful as drugs and, in combination, may pack a powerful punch. Therefore, make exercise a priority — part of the fabric of your life. It may already be impacting the fabric of your body: your genes.

References:

(1) JAMA. 2009;301(19):2024. (2) Med Sci Sports Exerc. 2013 Oct 10. (3) JAMA Netw Open. 2019;2(7):e197597. (4) PLoS Genet. 2013 Jun;9(6):e1003572. (5) Cell Metab. 2012 Mar 7;15(3):405-11. (6) BMJ 2013; 347. (7) JASN online 2013, Dec. 12. (8) PLoS One 8(10): e79342.

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

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Diet choices trump exercise for weight loss

By David Dunaief, M.D.

Dr. David Dunaief

To quash guilt about Thanksgiving meal indiscretions, many of us will resolve to exercise to burn off the calories from this seismic meal and the smaller, calorically dense aftershock meals, whether with a vigorous family football game or with a more modest walk.

Unfortunately, exercise without dietary changes may not actually help many people lose weight, no matter what the intensity or the duration (1). If it does help, it may only modestly reduce fat mass and weight for the majority of people. However, it may be helpful with weight maintenance. Ultimately, it may be more important to reconsider what you are eating than to succumb to the rationalization that you can eat with abandon during the holidays and work it off later.

Don’t give up on exercise just yet, though. There is very good news: Exercise does have beneficial effects on a wide range of conditions, including chronic kidney disease, cognitive decline, diabetes, cardiovascular disease, osteoporosis, fatigue, insomnia and depression.

Let’s look at the evidence.

Exercise for weight loss

The well-known weight-loss paradigm is that when more calories are burned than consumed, we will tip the scale in favor of weight loss. The greater the negative balance with exercise, the greater the loss. However, study results say otherwise. They show that in premenopausal women there was neither weight nor fat loss from exercise (2). This involved 81 women over a short duration, 12 weeks. All of the women were overweight to obese, although there was great variability in weight.

However, more than two-thirds of the women (55) gained a mean of 1 kilogram, or 2.2 pounds, of fat mass by the end of the study. There were a few who gained 10 pounds of predominantly fat. A fair amount of variability was seen among the participants, ranging from significant weight loss to substantial weight gain. These women were told to exercise at the American College of Sports Medicine’s optimal level of intensity (3). This is to walk 30 minutes on a treadmill three times a week at 70 percent VO2max — maximum oxygen consumption during exercise — or, in other words, a moderately intense pace.

The good news is that the women were in better aerobic shape by the end of the study. Also, women who had lost weight at the four-week mark were more likely to continue to do so by the end of the study. This was a preliminary study, so no definitive conclusions can be made.

Other studies have shown modest weight loss. For instance, in a meta-analysis involving 14 randomized controlled trials, results showed that there was a disappointing amount of weight loss with exercise alone (4). In six months, patients lost a mean of 1.6 kilograms, or 3.5 pounds, and at 12 months, participants lost 1.7 kilograms, or about 3.75 pounds.

Exercise and weight maintenance

However, exercise may be valuable in weight maintenance, according to observational studies. Premenopausal women who exercised at least 30 minutes a day were significantly less likely to regain lost weight (5). When exercise was added to diet, women were able to maintain 30 percent more weight loss than with diet alone after a year in a prospective study (6).

Exercise and disease

As just one example of exercise’s impact on disease, let’s look at chronic kidney disease (CKD), which affects 15 percent, or one in seven, adults in the United States, according to the Centers for Disease Control and Prevention (7).

Trial results showed that walking regularly could reduce the risk of kidney replacement therapy and death in patients who have moderate to severe CKD, stages 3-5 (8). Yes, this includes stage 3, which most likely is asymptomatic. There was a 21 percent reduction in the risk of kidney replacement therapy and a 33 percent reduction in the risk of death when walkers were compared to non-walkers.

Walking had an impressive impact; results were based on a dose-response curve. In other words, the more frequently patients walked during the week, the better the probability of preventing complications. Those who walked between one and two times per week had 17 and 19 percent reductions in death and kidney replacement therapy, respectively, while those who walked at least seven times per week saw 44 and 59 percent reductions in death and kidney replacement. These are substantial results. The authors concluded that the effectiveness of walking on CKD was independent of kidney function, age or other diseases.

Therefore, while it is important to enjoy the holidays, remember that food choices will have the greatest impact on our weight and body composition. However, exercise can help maintain weight loss and is extremely beneficial for preventing progression of chronic diseases, such as CKD.

So, by all means, exercise during the holidays, but also focus on more nutrient-dense foods. At a minimum, strike a balance rather than eating purely calorically dense foods. You won’t be able to exercise them away.

References:

(1) uptodate.com. (2) J Strength Cond Res. Online Oct. 28, 2014. (3) ACSM.org. (4) Am J Med. 2011;124(8):747. (5) Obesity (Silver Spring). 2010;18(1):167. (6) Int J Obes Relat Metab Disord. 1997;21(10):941. (7) cdc.gov. (8) Clin J Am Soc Nephrol. 2014 Jul;9(7):1183-1189.

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

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Simple strategies can improve health for everyone around the table

By David Dunaief, M.D.

Dr. David Dunaief

Many of us give thanks for good health on Thanksgiving. This is especially relevant this year. While eating healthy may be furthest from our minds during the holidays, it is so important.

Instead of making Thanksgiving a holiday of regret, eating foods that cause weight gain, fatigue and that increase your risk for chronic diseases, you can reverse this trend while maintaining the traditional theme of a festive meal.

What can we do to turn Thanksgiving into a bonanza of good health? Phytochemicals (plant nutrients) called carotenoids have antioxidant and anti-inflammatory activity and are found mostly in fruits and vegetables. Carotenoids make up a family of more than 600 different substances, such as beta-carotene, alpha-carotene, lutein, zeaxanthin, lycopene and beta-cryptoxanthin (1).

Carotenoids help to prevent and potentially reverse diseases, such as breast cancer; amyotrophic lateral sclerosis, also known as Lou Gehrig’s disease; age-related macular degeneration; and cardiovascular disease — heart disease and stroke. Foods that contain these substances are orange, yellow and red vegetables and fruits, and dark green leafy vegetables. Examples include sweet potato, acorn squash, summer squash, spaghetti squash, green beans, carrots, cooked pumpkin, spinach, kale, papayas, tangerines, tomatoes and Brussels sprouts.

Let’s look at the evidence.

Breast cancer

We know that breast cancer risk is high among U.S.-born women, where the average lifetime risk of getting breast cancer is 12.8 percent (2). In a meta-analysis (a group of eighteen prospective studies), results show that women who consumed higher levels of carotenoids, such as alpha-carotene, beta-carotene, and lutein and zeaxanthin, had significantly reduced risk of developing estrogen-negative breast cancer (3).

Lou Gehrig’s disease

ALS is a disabling and feared disease. Unfortunately, there are no effective treatments for reversing this disease. Therefore, we need to work double time in trying to prevent its occurrence. In a meta-analysis of five prestigious observational studies, including The Nurses’ Health Study and the Health Professionals Follow-Up Study, results showed that people with the greatest amount of carotenoids in their blood from foods like spinach, kale and carrots had a decreased risk of developing ALS and/or delaying the onset of the disease (4). This study involved over 1 million people with more than 1,000 who developed ALS.

Those who were in the highest carotenoid level quintile had a 25 percent reduction in risk, compared to those in the lowest quintile. According to the authors, the beneficial effects may be due to antioxidant activity and more efficient function of the power source of the cell: the mitochondrion.

Strategies for healthy holiday eating

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Despite the knowledge that healthy eating has long-term positive effects, there are obstacles to healthy eating. Two critical factors are presentation and perception.

Vegetables are often prepared in either an unappetizing way — steamed to the point of no return – or smothered in cheese, negating their benefits, but clearing our consciences.

Many consider Thanksgiving a time to indulge and not think about the repercussions. Plant-based foods like whole grains, leafy greens and fruits are relegated to side dishes or afterthoughts. Why is it so important to change our mindsets? There are significant short-term consequences of gorging ourselves.

Not surprisingly, people tend to gain weight from Thanksgiving to New Year. This is when most gain the predominant amount of weight for the entire year. However, most do not lose the weight they gain during this time (5). If you can fend off weight gain during the holidays, think of the possibilities for the rest of the year.

Also, if you are obese and sedentary, you may already have heart disease. Overeating at a single meal increases your risk of heart attack over the near term, according to the American Heart Association (6). However, with a little Thanksgiving planning, you can reap significant benefits:

Make healthy, plant-based dishes part of the main course. You don’t have to forgo signature dishes, but add to tradition by adding mouthwatering vegetable-based dishes.

Improve vegetable options. Most people don’t like grilled chicken without any seasoning. Why should vegetables be different? In my family, we season vegetables and make sauces to drizzle over them. Good resources for appealing dishes can be found at PCRM.org, DrFuhrman.com, mouthwateringvegan.com, and many other resources.

Replace refined grains. A study in the American Journal of Clinical Nutrition, showed that replacing wheat or refined grains with whole wheat and whole grains significantly reduced central fat, or fat around the belly (7). Not only did participants lose subcutaneous fat found just below the skin, but also visceral adipose tissue, the fat that lines organs and causes chronic diseases such as cancer. For even better results, consider substituting riced or mashed cauliflower for rice or potatoes.

Create a healthy environment. Instead of putting out creamy dips, cheese platters and candies as snacks, choose whole grain brown rice crackers, baby carrots, cherry tomatoes and healthy dips like hummus and salsa. Help people choose wisely.

Offer healthy dessert options. Options might include dairy-free pumpkin pudding and fruit salad.

The goal should be to increase your nutrient-dense choices and decrease your empty-calorie foods. You don’t have to be perfect, but improvements during this time period have a tremendous impact — they set the tone for the coming year and put you on a path to success. Why not turn this holiday into an opportunity to de-stress, rest, and reverse or prevent chronic disease?

References:

(1) Crit Rev Food Sci Nutr 2010;50(8):728–760. (2) SEER Cancer Statistics Review, 1975–2016, National Cancer Institute. (3) Am J Clin Nutr. 2012 Mar; 95(3): 713–725. (4) Ann Neurol 2013;73:236–245. (5) N Engl J Med 2000; 342:861-867. (6) www.heart.org. (7) Am J Clin Nutr 2010 Nov;92(5):1165-71.

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

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Out of every 100 American men, about 13 will get prostate cancer during their lifetime. METRO photo
What you consume may have a dramatic effect on your risk

By David Dunaief, M.D.

Dr. David Dunaief

Happy “Movember!” The Movember Foundation is in its 17th year of raising awareness and research money for men’s health issues (1). What better time to discuss prostate cancer prevention?

The best way to avoid prostate cancer is through lifestyle modifications. There are a host of things that may increase your risk and others that may decrease your likelihood of prostate cancer, regardless of family history.

What may increase the risk of prostate cancer? Contributing factors include obesity, animal fat and supplements, such as vitamin E and selenium. Equally as important, factors that may reduce risk include vegetables, especially cruciferous, and tomato sauce or cooked tomatoes.

Vitamin E and selenium

In the SELECT trial, a randomized clinical trial (RCT), a dose of 400 mg of vitamin E actually increased the risk of prostate cancer by 17 percent (2). Though significant, this is not a tremendous clinical effect. It does show that vitamin E should not be used for prevention of prostate cancer. Interestingly, in this study, selenium may have helped to reduce the mortality risk in the selenium plus vitamin E arm, but selenium trended toward a slight increased risk when taken alone. I would not recommend that men take selenium or vitamin E for prevention.

Obesity and aggressive disease risk

Obesity showed conflicting results, prompting the study authors to analyze the results further. According to a review of the literature, obesity may slightly decrease the risk of nonaggressive prostate cancer, however increase risk of aggressive disease (3). The authors attribute the lower incidence of nonaggressive prostate cancer to the possibility that it is more difficult to detect the dis-ease in obese men, since larger prostates make biopsies less effective. What the results tell us is that those who are obese have a greater risk of dying from prostate cancer when it is diagnosed.

Animal fat and meat intake

It seems there is a direct effect between the amount of animal fat we consume and incidence of prostate cancer. In the Health Professionals Follow-up Study, a large observational study, those who consumed the highest amount of animal fat had a 63 percent increased risk, compared to those who consumed the least (4).

Here is the kicker: It was not just the percent increase that was important, but the fact that it was an increase in advanced or metastatic prostate cancer. Also, in this study, red meat had an even greater, approximately 2.5-fold, increased risk of advanced disease. If you are going to eat red meat, I recommend decreased frequency, like lean meat once every two weeks or once a month.

In another large, prospective observational study, the authors concluded that red and processed meats increase the risk of advanced prostate cancer through heme iron, barbecuing/grilling and nitrate/nitrite content (5).

Unexpected Omega-3 findings

When we think of omega-3 fatty acids or fish oil, we often think “protective” or “beneficial.” However, these may increase the risk of prostate cancer, according to one epidemiological study (6). This study, called the Prostate Cancer Prevention Trial, involving a seven-year follow-up period, showed that docosahexaenoic acid (DHA), a form of omega-3 fatty acid, increased the risk of high-grade disease 2.5-fold. This finding was unexpected.

If you choose to eat fish, salmon or sardines in water with no salt are among the best choices.

Lycopene from tomato sauce

Tomato sauce has been shown to potentially reduce the risk of prostate cancer. However, uncooked tomatoes have not shown the same beneficial effects. It is believed that lycopene, which is a type of carotenoid found in tomatoes, is central to this benefit. Tomatoes need to be cooked to release lycopene (7).

In a prospective study involving 47,365 men who were followed for 12 years, the risk of prostate cancer was reduced by 16 percent with higher lycopene intake from a variety of sources (8). When the authors looked at tomato sauce alone, they saw a reduction in risk of 23 percent when comparing those who consumed at least two servings a week to those who consumed less than one serving a month. The reduction in severe, or metastatic, prostate cancer risk was even greater, at 35 per-cent. There was a statistically significant reduction in risk with a very modest amount of tomato sauce.

In the Health Professionals Follow-Up Study, the results were similar, with a 21 percent reduction in the risk of prostate cancer (9). Again, tomato sauce was the predominant food responsible for this effect.

Although tomato sauce may be beneficial, many brands are loaded with salt. I recommend to patients that they either make their own sauce or purchase a sauce made without salt.

Cruciferous vegetables

Vegetables, especially cruciferous vegetables, reduce the risk of prostate cancer significantly. In a case-control study, participants who consumed at least three servings of cruciferous vegetables per week, versus those who consumed less than one per week, saw a 41 percent reduction in prostate cancer risk (10). What’s even more impressive is the effect was twice that of tomato sauce, yet the intake was similarly modest. Cruciferous vegetables include broccoli, cauliflower, bok choy, kale and arugula, to name a few.

When it comes to preventing prostate cancer, lifestyle modification, including making dietary changes, can reduce your risk significantly.

References:

(1) www.movember.com. (2) JAMA. 2011; 306: 1549-1556. (3) Epidemiol Rev. 2007;29:88. (4) J Natl Cancer Inst. 1993;85(19):1571. (5) Am J Epidemiol. 2009;170(9):1165. (6) Am J Epidemiol. 2011 Jun 15;173(12):1429-1439. (7) Exp Biol Med (Maywood). 2002; 227:914-919. (8) J Natl Cancer Inst. 2002;94(5):391. (9) Exp Biol Med (Maywood). 2002; 227:852-859; Int. J. Cancer. 2007;121: 1571–1578. (10) J Natl Cancer Inst. 2000;92(1):61.

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

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Chronic stress can cause wear and tear on your mind and body. METRO photo
Cortisol resistance can increase susceptibility to viruses and infection

By David Dunaief, M.D.

Dr. David Dunaief

This has been a tough year, where many of us have been under continual stress. While some stress is valuable to help motivate us and keep our minds sharp, high levels of constant stress can have detrimental effects on the body.

Nowhere is the mind-body connection clearer: although stress may start in the mind, it can lead to acute or chronic disease promotion. It can also play a role with your emotions, causing irritability and outbursts of anger and possibly leading to depression and anxiety.

Stress symptoms can include stiff neck, headaches, stomach upset and difficulty sleeping. Stress may also be associated with cardiovascular disease, with an increased susceptibility to infection from viruses causing the common cold, and with cognitive decline and Alzheimer’s (1).

A stress steroid hormone, cortisol, is released from the adrenal glands and can have beneficial effects in small bursts. We need cortisol in order to survive. Some of its functions include raising glucose (sugar) levels when they are low and helping reduce inflammation and stress levels (2). However, when cortisol gets out of hand, higher chronic levels may cause inflammation, leading to disorders such as cardiovascular disease, as research suggests.

Let’s look at the evidence.

Inflammation

Inflammation may be a significant contributor to more than 80 percent of chronic diseases. In a meta-analysis (a group of two observational studies), high levels of C-reactive protein (CRP), a biomarker for inflammation, were associated with increased psychological stress (3).

A study of over 73,000 adults found that with CRP higher than 3.0 there was a greater than twofold increase in depression risk. The researchers suggest that CRP may heighten stress and depression risk by increasing levels of inflammatory communicators among cells (4).

In one study, results suggested that stress may influence and increase the number of hematopoietic stem cells (those that develop all forms of blood cells), resulting specifically in an increase in inflammatory white blood cells (5). The researchers suggest that this may lead to these white blood cells accumulating in atherosclerotic plaques in the arteries, which ultimately could potentially increase the risk of heart attacks and strokes. Chronic stress overactivates the sympathetic nervous system — our “fight or flight” response — which may alter the bone marrow where the stem cells are found. This research is preliminary and needs well-controlled trials to confirm these results.

Infection

Stress may increase the risk of colds and infection. Over the short term, cortisol is important to help suppress the symptoms of colds, such as sneezing, cough and fever. These are visible signs of the immune system’s infection-fighting response. However, the body may become resistant to the effects of cortisol, similar to how a type 2 diabetes patient becomes resistant to insulin.

In one study of 296 healthy individuals, participants who had stressful events and were then exposed to viruses had a higher probability of catching a cold. It turns out that these individuals also had resistance to the effects of cortisol. This is important because those who were resistant to cortisol had more cold symptoms and more proinflammatory cytokines (6).

Lifestyle changes can reduce effects of stress

Lifestyle plays an important role in stress at the cellular level, specifically at the level of the telomere, which determines cell survival. The telomeres are to cells as the plastic tips are to shoelaces; they prevent them from falling apart. The longer the telomere, the slower the cell ages and the longer it survives.

In a one-year study of women aged 50 to 65, those who followed a healthy lifestyle — one standard deviation over the average lifestyle — were able to withstand life stressors better since they had longer telomeres (7). This healthy lifestyle included regular exercise, a healthy diet and a sufficient amount of sleep. On the other hand, the researchers indicated that those who had poor lifestyle habits lost substantially more telomere length than the healthy lifestyle group.

In another study, chronic stress and poor diet (high sugar and high fat) together increased metabolic risks, such as insulin resistance, oxidative stress and central obesity, more than a low-stress group eating a similar diet (8). The high-stress group members were caregivers, specifically those caring for a spouse or parent with dementia. This is a good reminder that it’s especially important to eat a healthy diet when under stress.

Interestingly, in terms of sleep, the Evolution of Pathways to Insomnia Cohort (EPIC) study shows that those who deal directly with stressful events are more likely to have good sleep quality. Using medication, alcohol or, most surprisingly, distractors, such as television watching or other activities, to deal with stress all resulted in insomnia after being followed for one year (9). Cognitive intrusions or repeat thoughts about the stressor also resulted in insomnia.

The most important message from this study is that how a person reacts to and deals with stressors may determine whether they suffer from insomnia.

We need to recognize the effects of constant stress. If it’s not addressed, it can lead to suppressed immune response or increased levels of inflammation. To address chronic stress and lower CRP, it is important to adopt a healthy lifestyle that includes sleep, exercise and diet modifications. Good lifestyle habits may also be protective against the effects of stress on cell aging.

References:

(1) Curr Top Behav Neurosci. 2014 Aug. 29. (2) Am J Physiol. 1991;260(6 Part 1):E927-E932. (3) JAMA Psychiatry. 2013;70:176-184. (4) Chest. 2000;118:503-508. (5) Nat Med. 2014;20:754-758. (6) Proc Natl Acad Sci U S A. 2012;109:5995-5999. (7) Mol Psychiatry Online. 2014 July 29. (8) Psychoneuroendocrinol Online. 2014 April 12. (9) Sleep. 2014;37:1199-1208.

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

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Veggies such as broccoli , cauliflower, cabbage and brussel sprouts provide easily absorbable nutrients needed to support the pancreas. METRO photo
Lifestyle changes can reduce your risk

By David Dunaief, M.D.

Dr. David Dunaief

Acute pancreatitis is the most frequent gastrointestinal cause for patients to be admitted to a hospital (1). Typically, severe abdominal pain is what compels patients to go to the emergency room.

A rudimentary definition of pancreatitis is an inflammation of the pancreas. There are both acute and chronic forms. Acute pancreatitis, which is what we will address, is abrupt and of short duration. Acute types are characterized as mild, moderately severe and severe. Those with the mild type don’t experience organ failure or local complications, while those with moderately severe acute pancreatitis experience short-term or transient (less than 48 hours) organ failure and/or local complications. Those with the severe type have persistent organ failure (2).

Symptoms of acute pancreatitis

To diagnosis this disease, the American College of Gastroenterology guidelines suggest that two of three symptoms be present. The three symptoms include severe abdominal pain; enzymes (amylase or lipase) that are at least three times greater than normal; and radiologic imaging that shows characteristic disease findings (3). Most of the time, the abdominal pain is in the central upper abdomen near the stomach, and it may also present with pain in the right upper quadrant of the abdomen (4). Approximately 90 percent of patients also experience nausea and vomiting (5). In half of patients, there is also pain that radiates to the back.

Risk factors

Acute pancreatitis risk factors include gallstones, alcohol, obesity and, to a much lesser degree, drugs. Gallstones and alcohol may cause up to 75 percent of the cases (2). Many other cases of acute pancreatitis are considered idiopathic (of unknown cause). Although medications are potentially responsible for between 1.4 and 5.3 percent of cases, making it rare, the number of medications implicated is diverse (6, 7). These include certain classes of diabetes therapies, some antibiotics — metronidazole (Flagyl) and tetracycline — and immunosuppressive drugs used to treat ailments like autoimmune diseases. Even calcium may potentially increase risk.

Obesity’s role

In a study using the Swedish Mammography Cohort and the Cohort of Swedish Men, results showed that central obesity is an important risk factor, not body mass index or obesity overall (8). In other words, it is the fat in the belly that is very important, since this may increase risk more than twofold for the occurrence of a first-time acute pancreatitis episode. Those who had a waist circumference of greater than 105 cm (41 inches) experienced this significantly increased risk compared to those who had a waist circumference of 75 to 85 cm (29.5 to 33.5 inches). The association between central obesity and acute pancreatitis occurred in both gallbladder-induced and non-gallbladder-induced disease.

A more recent meta-analysis of 19 studies including almost 10,000 patients showed a direct association between BMI and acute pancreatitis severity and mortality (9). Those with a BMI over 25 had an almost three-fold increased risk of severe acute pancreatitis, when compared with those who had a normal BMI, and a BMI over 30 was associated with a three-times greater risk of mortality than those with a BMI under this threshold.

Diabetes risks

The pancreas is a critical organ for balancing glucose (sugar) in the body. In a meta-analysis (24 observational trials), results showed that more than one-third of patients diagnosed with acute pancreatitis went on to develop prediabetes or diabetes (10). Within the first year, 15 percent of patients were newly diagnosed with diabetes. After five years, the risk of diabetes increased 2.7-fold. By reducing the risk of pancreatitis, we may also help reduce the risk of diabetes.

Surgical treatments

Gallstones and gallbladder sludge are major risk factors, accounting for 35 to 40 percent of acute pancreatitis incidences (11). Gallstones are thought to cause pancreatitis by temporarily blocking the duct shared by the pancreas and gallbladder that leads into the small intestine. When the liver enzyme ALT is elevated threefold (measured through a simple blood test), it has a positive predictive value of 95 percent that it is indeed gallstone-induced pancreatitis (12).

If it is gallstone-induced, surgery plays an important role in helping to resolve pancreatitis and prevent recurrence. In a retrospective study with 102 patients, results showed that surgery to remove the gallbladder was better than medical treatment when comparing hospitalized patients with this disease (13). Surgery trumped medical treatment in terms of outcomes, complication rates, length of stay in the hospital and overall cost for patients with mild acute pancreatitis.

Can diet have an impact?

The short answer is: Yes. What foods specifically? In a large, prospective observational study, results showed that there was a direct linear relationship between those who consumed vegetables and a decreased risk of non-gallstone acute pancreatitis (14). For every two servings of vegetables, there was 17 percent drop in the risk of pancreatitis. Those who consumed the most vegetables — the highest quintile (4.6 servings per day) — had a 44 percent reduction in disease risk, compared to those who were in the lowest quintile (0.8 servings per day). There were 80,000 participants involved in the study with an 11-year follow-up. The authors surmise that the reason for this effect with vegetables may have to do with their antioxidant properties, since acute pancreatitis increases oxidative stress on the pancreas.

References:

(1) Gastroenterology. 2013 Jun; 144(6): 1252–1261. (2) Gastroenterol. 2013 Sep; 108(9):1400-1415. (3) Am Fam Physician. 2014 Nov 1;90(9):632-639. (4) JAMA. 2004;291:2865-2868. (5) Am J Gastroenterol. 2006;101:2379-2400. (6) Gut. 1995;37:565-567. (7) Dig Dis Sci. 2010;55:2977-2981. (8) Am J Gastroenterol. 2013;108:133-139. (9) World J Gastroenterol. 2019 Feb 14; 25(6): 729–743. (10) Gut. 2014;63:818-831. (11) Gastroenterology. 2007;132:2022-2044. (12) Am J Gastroenterol. 1994;89:1863-1866. (13) Am J Surg online. 2014 Sept. 20. (14) Gut. 2013;62:1187-1192.

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

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Daily exercise is protective against breast cancer. METRO photo
Exercise and diet can significantly reduce risk

By David Dunaief, M.D.

Dr. David Dunaief

October is Breast Cancer Awareness Month, and everyone agrees that awareness is crucial. The incidence of invasive breast cancer in 2020 in the U.S. is estimated to be over 270,000 new cases, with approximately 40,000 patients dying from this disease each year (1).

A primary objective of raising awareness is to promote screening for early detection. But at what age should screening start and how often should we be screened?

Here is where divergence occurs; experts can’t agree on age and frequency. The U.S. Preventive Services Task Force recommends mammograms every other year, from age 50 through age 74 (2). The American College of Obstetricians and Gynecologists recommends consideration of beginning mammograms at 40, but starting no later than 50, and continuing until age 75. They encourage a process of shared decision-making between patient and physician (3).

Just as important as screening is prevention, whether it is primary, preventing the disease from occurring, or secondary, preventing recurrence. Potential ways of doing this may include lifestyle modifications, such as diet, exercise, obesity treatment and normalizing cholesterol levels. Additionally, although results are mixed, it seems that bisphosphonates do not reduce the risk of breast cancer.

Bisphosphonates

Bisphosphonates include Fosamax (alendronate), Zometa (zoledronic acid) and Boniva (ibandronate) used to treat osteoporosis. Do they have a role in breast cancer prevention? It depends on the population, and it depends on study quality.

In a meta-analysis involving two randomized controlled trials (RCTs), FIT and HORIZON-PFT, results showed no benefit from the use of bisphosphonates in reducing breast cancer risk (4). The study population involved 14,000 postmenopausal women from ages 55 to 89 women who had osteoporosis, but who did not have a personal history of breast cancer. In other words, the bisphosphonates were being used for primary prevention.

In a more recent meta-analysis of 10 studies with over 950,000 total participants, results showed that bisphosphonates did indeed reduce the risk of primary breast cancer in patients by as much as 12 percent (5). However, when the researchers dug more deeply into the studies, they found inconsistencies in the results between observational and case-control trials versus RCTs, along with an indication that longer-term use of bisphosphonates is more likely to be protective than use of less than one year. 

Randomized controlled trials are better designed than observational trials. Therefore, it is more likely that bisphosphonates do not work in reducing breast cancer risk in patients without a history of breast cancer or, in other words, in primary prevention.

Exercise

We know exercise is important in diseases and breast cancer is no exception. In an observational trial, exercise reduced breast cancer risk in postmenopausal women significantly (6). These women exercised moderately; they walked four hours a week over a four-year period. If they exercised previously, but not recently, five to nine years ago, no benefit was seen. The researchers stressed that it is never too late to begin exercise.

Only about one-third of women get the recommended level of exercise every week: 30 minutes for five days a week. Once diagnosed with breast cancer, women tend to exercise less, not more. We need to expend as much energy and resources emphasizing exercise as a prevention method as we do screenings.

Soy intake

Contrary to popular belief, soy may be beneficial in reducing breast cancer risk. In a meta-analysis (a group of eight observational studies), those who consumed more soy saw a significant reduction in breast cancer compared to those who consumed less (7). There was a dose-response curve among three groups: high intake of >20 mg per day, moderate intake of 10 mg and low intake of <5 mg.

Those in the highest group had a 29 percent reduced risk, and those in the moderate group had a 12 percent reduced risk when compared to those who consumed the least. In addition, higher soy intake has been associated with reduced recurrence and increased survival for those previously diagnosed with breast cancer (8). Why have we not seen this in U.S. trials? The level of soy used in U.S. trials is a fraction of what is used in Asian trials. The benefit from soy is thought to come from isoflavones, plant-rich nutrients.

Western vs. Mediterranean diets

A Mediterranean diet may decrease the risk of breast cancer significantly.

In an observational study, results showed that, while the Western diet increases breast cancer risk by 46 percent, the Spanish Mediterranean diet has the inverse effect, decreasing risk by 44 percent (9). The effect of the Mediterranean diet was even more powerful in triple-negative tumors, which tend to be difficult to treat. The authors concluded that diets rich in fruits, vegetables, beans, nuts and oily fish were potentially beneficial.

Hooray for Breast Cancer Awareness Month stressing the importance of mammography and breast self-exams. However, we need to give significantly more attention to prevention of breast cancer and its recurrence. Through potentially more soy intake, as well as a Mediterranean diet and modest exercise, we may be able to accelerate the trend toward a lower breast cancer incidence.

References:

(1)breastcancer.org.(2)uspreventiveservicestaskforce.org. (3) acog.org. (4) JAMA Inter Med online. 2014 Aug. 11. (5) Clin Epidemiol. 2019; 11: 593–603. (6) Cancer Epidemiol Biomarkers Prev online. 2014 Aug. 11. (7) Br J Cancer. 2008;98:9-14. (8) JAMA. 2009 Dec 9; 302(22): 2437–2443. (9) Br J Cancer. 2014;111:1454-1462.

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

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Ask your doctor before starting gluten withdrawal. Stock photo

By David Dunaief, M.D.

Dr. David Dunaief

A quick trip to the grocery store or a restaurant will confirm what you already know: gluten-free is a “thing.” Pizza, pasta, bread, and even breadcrumb-encrusted products have been reformulated, and everyday products, like frozen vegetables, have been relabeled with splashy language promising “gluten-free.” The marketers are on board: gluten-free diets are hot.

“Gluten-free” is not necessarily synonymous with healthy. Still, we keep hearing how more people feel better without gluten. Is this a placebo effect? What is myth and what is reality in terms of gluten? In this article I will try to distill what we know about gluten and gluten-free diets, who may benefit and who may not.

Why gluten-free?

Gluten is a plant protein found mainly in wheat, rye and barley. While more popular recently, going gluten-free is not a fad, since we know that patients who suffer from celiac disease, an autoimmune disease, benefit tremendously when gluten is removed (1). In fact, it is the main treatment.

But what about people who don’t have celiac disease? There seems to be a spectrum of physiological reaction to gluten, from intolerance to gluten (sensitivity) to gluten tolerance (insensitivity). Obviously, celiac disease is the extreme of intolerance, but even these patients may be asymptomatic.

Then, there is nonceliac gluten sensitivity (NCGS), referring to those in the middle portion of the spectrum (2). The prevalence of NCGS is half that of celiac disease, according to the NHANES data from 2009-2010 (3). However, many disagree with this assessment, indicating that it is much more prevalent and that its incidence is likely to rise (4). The term was not even coined until 2011.

Celiac disease vs. gluten sensitivity

Both may present intestinal symptoms, such as bloating, gas, cramping and diarrhea, as well as extraintestinal (outside the gut) symptoms, including gait ataxia (gait disturbance), malaise, fatigue and attention deficit disorder (5). Surprisingly, they both may have the same results with serological (blood) tests.

The first line of testing includes anti-gliadin antibodies and tissue transglutaminase. These measure a reaction to gluten; however, they don’t have to be positive for there to be a reaction to gluten. HLA–DQ phenotype testing is the second line of testing and is more specific for celiac disease.

What is unique to celiac disease is a histological change in the small intestine, with atrophy of the villi (small fingerlike projections) contributing to gut permeability, what might be called “leaky gut.” Biopsy of the small intestine is the most definitive way to diagnose celiac disease. Though the research has mainly focused on celiac disease, there is some evidence that shows NCGS has potential validity, especially in irritable bowel syndrome.

Before we look at the studies, what does it mean when a food says it’s “gluten-free”? The FDA requires that “gluten-free” labeled foods have no more than 20 parts per million of gluten (6). Effective October 13, 2020, new FDA guidelines go into effect for proving fermented foods, such as sauerkraut and yogurt, and hydrolyzed ingredients found in many packaged products meet the same criteria.

Irritable bowel syndrome

Irritable bowel syndrome (IBS) is a nebulous disease diagnosed through exclusion, and the treatments are not obvious. That is why the results from a 34-patient, randomized controlled trial, the gold standard of studies, showing that a gluten-free diet significantly improved symptoms in IBS patients, is so important (7). Patients were given a muffin and bread on a daily basis.

Of course, one group was given gluten-free products and the other given products with gluten, though the texture and taste were identical. In six weeks, many of those who were gluten-free saw the pain associated with bloating and gas mostly resolve; they had significant improvement in stool composition, such that they were not suffering from diarrhea, and their fatigue diminished. In one week, those in the gluten group were in substantially more discomfort than those in the gluten-free group.

As part of a well-written editorial in Medscape by David Johnson, M.D., a professor of gastroenterology, questioned whether this beneficial effect from the IBS trial was due to gluten withdrawal or to withdrawal of fermentable sugars because of the elimination of some grains themselves (8). In other words, gluten may be just one part of the picture. He believes that nonceliac gluten sensitivity is a valid concern.

Antibiotics

The microbiome in the gut may play a pivotal role in whether a person develops celiac disease. In an observational study using data from the Swedish Prescribed Drug Register, results indicate that those who were given antibiotics within the last year had a 40 percent greater chance of developing celiac disease and a 90 percent greater risk of developing gut inflammation (9). The researchers believe that this results from a misbalance in the microbiota, or flora, of the gastrointestinal tract from antibiotic use.

Not everyone will benefit from a gluten-free diet. In fact, most of us will not. Ultimately, people who may benefit are those who have celiac disease and those who have symptomatic gluten sensitivity. Also, patients who have positive serological tests, including tissue transglutaminase or anti-gliadin antibodies, are good candidates for gluten-free diets.

There is a downside to a gluten-free diet: potential development of macronutrient and micronutrient deficiencies. Therefore, it is wise to ask your doctor before starting gluten withdrawal. The research in patients with gluten sensitivity is relatively recent, and most gluten research relates to celiac disease. Hopefully, we will see broader studies in the future.

References:

(1) Am J Gastroenterol. 2013;108:656-676. (2) Gut 2013;62:43–52. (3) Scand J Gastroenterol. (4) Neurogastroenterol Motil. 2013 Nov;25(11):864-871. (5) medscape.com. (6) fda.gov. (7) Am J Gastroenterol. 2011; 106(3):508-514. (8) medscape.com. (9) BMC Gastroenterol. 2013:13(109).

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

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Not so fast! Soy milk may have a negative impact on the thyroid. METRO photo
Use extreme caution when taking supplements

By David Dunaief, M.D.

Dr. David Dunaief

Hypothyroidism can cause weight gain and low energy, but diagnosing and treating it can be tricky. The thyroid is a butterfly-shaped organ at the base of the neck, and it is responsible for maintaining our metabolism. The prefix “hypo,” derived from Greek, means “under” (1). Therefore, hypothyroidism indicates an underactive thyroid and results in slowing of the metabolism.

Blood tests determine if a person has hypothyroidism. Items that are tested include thyroid stimulating hormone (TSH), which is usually increased, thyroxine (free T4) and triiodothyronine (free T3 or T3 uptake). Both of these last two may be suppressed, or lowered (2).

There are two types of primary hypothyroidism: subclinical and overt. In the overt (more obvious) type, classic symptoms include weight gain, fatigue, thinning hair, cold intolerance, dry skin and depression, as well as the changes in all three thyroid hormones on blood tests mentioned above.

In the subclinical, there may be less obvious or vague symptoms and only changes in the TSH. The subclinical can progress to the overt stage rapidly in some cases (3). Subclinical is substantially more common than overt; its prevalence may be as high as 10 percent of the U.S. population (4).

The most common type of hypothyroidism is Hashimoto’s thyroiditis, where antibodies attack thyroid gland tissues (5). Several blood tests are useful to determine if a patient has Hashimoto’s: thyroid peroxidase (TPO) antibodies and antithyroglobulin antibodies.

Medications

Levothyroxine and Armour Thyroid are two main medications for hypothyroidism. The difference is that Armour Thyroid converts T4 into T3, while levothyroxine does not. Therefore, one medication may be more appropriate than the other, depending on the circumstance. T3 can also be given with levothyroxine, which is similar to using Armour Thyroid.

What about supplements?

A study tested 10 different thyroid support supplements; the results were downright disappointing, if not a bit scary (6). Of the supplements tested, 90 percent contained actual medication, some to levels higher than what are found in prescription medications. These supplements could cause toxic effects. There is a narrow therapeutic window when it comes to the appropriate medication dosage for treating hypothyroidism, and it is sensitive. Therefore, if you are going to consider using supplements, check with your doctor and tread very lightly.

Soy impact

In a randomized controlled trial, the treatment group that received higher amounts of soy supplementation had a threefold greater risk of conversion from subclinical hypothyroidism to overt hypothyroidism than those who received considerably less supplementation (7). According to this small, yet well-designed, study, soy has a negative impact on the thyroid. Therefore, those with hypothyroidism may want to minimize or avoid soy.

The reason that soy may have this negative impact was illustrated in a study involving rat thyrocytes (thyroid cells) (8). Researchers found that soy isoflavones, especially genistein, which are usually beneficial, may contribute to autoimmune thyroid disease, such as Hashimoto’s thyroiditis. They also found that soy may inhibit the absorption of iodide in the thyroid.

Weight loss

Wouldn’t it be nice if the silver lining of hypothyroidism is that, with medication to treat the disease, we were guaranteed to lose weight? In a retrospective study, results showed that only about half of those treated with medication for hypothyroidism lost weight (9). This was a small study, and we need a large randomized controlled trial to test it further.

WARNING: The FDA has a black box warning on thyroid medications — they should never be used as weight loss drugs (10). They could put a patient in a hyperthyroid state or worse, with potentially catastrophic results.

Coffee

Taking levothyroxine and coffee together may decrease the absorption of levothyroxine significantly, according to one study (11). It did not seem to matter whether they were taken together or an hour apart. This was a very small study involving only eight patients. Still, I recommend avoiding coffee for several hours after taking the medication.

Vegetables

There is a theory that vegetables, specifically cruciferous ones such as cauliflower, cabbage and broccoli, may exacerbate hypothyroidism. In one animal study, results suggested that very high intake of these vegetables reduces thyroid functioning (12). This study was done over 30 years ago, and it has not been replicated.

Importantly, this may not be the case in humans. In the recently published Adventist Health Study-2, results showed that those who had a vegan-based diet were less likely to develop hypothyroidism than those who ate an omnivore diet (13). And those who added lactose and eggs to the vegan diet also had a small increased risk of developing hypothyroidism. However, this trial did not focus on raw cruciferous vegetables, where additional study is much needed.

There are two take-home points, if you have hypothyroid issues: Try to avoid soy products, and don’t think supplements that claim to be thyroid support and good for you are harmless because they are over the counter and “natural.” In my clinical experience, an anti-inflammatory, vegetable-rich diet helps improve quality of life issues, especially fatigue and weight gain, for those with Hashimoto’s thyroiditis.

References:

(1) dictionary.com. (2) nlm.nih.gov. (3) Endocr Pract. 2005;11:115-119. (4) Arch Intern Med. 2000;160:526-534. (5) mayoclinic.org. (6) Thyroid. 2013;23:1233-1237. (7) J Clin Endocrinol Metab. 2011 May;96:1442-1449. (8) Exp Biol Med (Maywood). 2013;238:623-630. (9) American Thyroid Association. 2013;Abstract 185. (10) FDA.gov. (11) Thyroid. 2008;18:293-301. (12) Crit Rev Food Sci Nutr. 1983;18:123-201. (13) Nutrients. 2013 Nov. 20;5:4642-4652.

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

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