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Diet and exercise together are the key to success

By David Dunaief, M.D.

Dr. David Dunaief

If you suffer from osteoarthritis, you know it can affect your quality of life and make it difficult to perform daily activities. Osteoarthritis (OA) most often affects the knees, hips and hands and can affect your mood, mobility, and sleep quality.

Common first-line medications that treat arthritis pain are acetaminophen and nonsteroidal anti-inflammatory drugs, such as ibuprofen or naproxen. Unfortunately, these medications have side effects, especially with long-term use. Also, while they might relieve your immediate symptoms of pain and inflammation, they don’t slow osteoarthritis’ progression.

Fortunately, there are approaches you can use to ease your pain without reaching for medications. Some can even help slow the progression of your OA or even reverse your symptoms.

What role does weight play?

Weight management is a crucial component of any OA pain management strategy. In a study involving 112 obese patients, those who lost weight reported easing of knee symptoms (1). Even more exciting, the study authors observed disease modification, with a reduction in the loss of cartilage volume around the medial tibia. Those who gained weight saw the opposite effect.

The relationship was almost one-to-one; for every one percent of weight lost, there was a 1.2 mm3 preservation of medial tibial cartilage volume, while the opposite occurred when participants gained weight. A reduction of tibial cartilage is often associated with the need for a knee replacement.

Does vitamin D help?

In a randomized controlled trial (RCT), vitamin D provided no OA symptom relief, nor any disease-modifying effects (2). This two-year study of almost 150 men and women raised blood levels of vitamin D on average to 36 ng/ml, which is considered respectable. Researchers used MRI and X-rays to track their results.

In another study of 769 participants, ages 50-80, researchers found that low vitamin D levels – below 25 nmol/l led to increased OA knee pain over the five-year study period and hip pain over 2.4 years (3). The researchers postulate that supplementing vitamin D might reduce pain in those who are deficient, but that it will likely have no effect on others.

How does dairy factor into OA?

With dairy, specifically milk, there is conflicting information. Some studies show benefits, while others show that it may contribute to the inflammation that makes osteoarthritis pain feel worse.

In the Osteoarthritis Initiative study, researchers looked specifically at joint space narrowing that occurs in those with affected knee joints (4). Results showed that low-fat (1 percent) and nonfat milk may slow the progression of osteoarthritis in women. Compared to those who did not drink milk, patients who did saw significantly less narrowing of knee joint space over a 48-month period.

The result curve was interesting, however. For those who drank from fewer than three glasses a week up to 10 glasses a week, the progression of joint space narrowing was slowed. However, for those who drank more than 10 glasses per week, there was less beneficial effect. There was no benefit seen in men or with the consumption of higher fat products, such as cheese or yogurt.

However, the study was observational and had significant flaws. First, the 2100 patients were only asked about their milk intake at the study’s start. Second, patients were asked to recall their weekly milk consumption for the previous 12 months before the study began — a challenging task.

On the flip side, a study of almost 39,000 participants from the Melbourne Collaborative Cohort Study found that increases in dairy consumption were associated with increased risk of total hip replacements for men with osteoarthritis (5).

Getting more specific, a published analysis of the Framingham Offspring Study found that those who consumed yogurt had statistically significant lower levels of interleukin-6 (IL-6), a marker for inflammation, than those who didn’t eat yogurt, but that this was not true with milk or cheese consumption (6).

Would I recommend consuming low-fat or nonfat milk or yogurt? Not necessarily, but I might not dissuade osteoarthritis patients from yogurt.

Does exercise help with OA pain?

Diet and exercise trumped the effects of diet or exercise alone in a well-designed study (7). In an 18-month study, patients with osteoarthritis of the knee who lost at least 10 percent of their body weight experienced significant improvements in function and a 50 percent reduction in pain, as well as reduction in inflammation. This was compared to those who lost a lower percent of their body weight.

Researchers used biomarker IL6 to measure inflammation. The diet and exercise group and the diet-only group lost significantly more weight than the exercise-only group, 23.3 pounds and 19.6 pounds versus 4 pounds. The diet portion consisted of a meal replacement shake for breakfast and lunch and then a vegetable-rich, low-fat dinner. Low-calorie meals replaced the shakes after six months. The exercise regimen included one hour of a combination of weight training and walking “with alacrity” three times a week.

To reduce pain and possibly improve your OA, focus on lifestyle modifications. The best effects shown are with weight loss and with a vegetable-rich diet. In terms of low-fat or nonfat milk, the results are controversial, at best. For yogurt, the results suggest it may be beneficial for osteoarthritis, but stay on the low end of consumption, since dairy can increase inflammation.

References:

(1) Ann Rheum Dis. 2015 Jun;74(6):1024-9. (2) JAMA. 2013;309:155-162. (3) Ann. Rheum. Dis. 2014;73:697–703. (4) Arthritis Care Res online. 2014 April 6. (5) J Rheumatol. 2017 Jul;44(7):1066-1070. (6) Nutrients. 2021 Feb 4;13(2):506. (7) JAMA. 2013;310:1263-1273.

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

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Nutrition is a popular topic of conversation, particularly among those embarking on a weight loss or maintenance plan. Individuals carefully study food macros and pore over various diets to get the most out of the foods they eat. When the end goal is simply looking good, it may be easy to forget about the other benefits of nutritious diets, including their link to overall health. 

A close relationship exists between nutritional status and health. Experts at Tufts Health Plan recognize that good nutrition can help reduce the risk of developing many diseases, including heart disease, stroke, diabetes, and some cancers. The notion of “you are what you eat” still rings true.

The World Health Organization indicates better nutrition means stronger immune systems, fewer illnesses and better overall health. However, according to the National Resource Center on Nutrition, Physical Activity, and Aging, one in four older Americans suffers from poor nutrition. And this situation is not exclusive to the elderly. A report examining the global burden of chronic disease published in The Lancet found poor diet contributed to 11 million deaths worldwide — roughly 22 percent of deaths among adults — and poor quality of life. 

Low intake of fruits and whole grains and high intake of sodium are the leading risk factors for illness in many countries. Common nutrition problems can arise when one favors convenience and routine over balanced meals that truly fuel the body. 

Improving nutrition

Guidelines regarding how many servings of each food group a person should have each day may vary slightly by country, but they share many similarities. The U.S. Department of Agriculture once followed a “food pyramid” guide, but has since switched to the MyPlate resource, which emphasizes how much of each food group should cover a standard 9-inch dinner plate. 

Food groups include fruits, vegetables, grains, proteins, and dairy. The USDA dietary guidelines were updated for its 2020-2025 guide. Recommendations vary based on age and activity levels, but a person eating 2,000 calories a day should eat 2 cups of whole fruits; 2 1⁄2 cups of colorful vegetables; 6 ounces of grains, with half of them being whole grains; 5 1⁄2 ounces of protein, with a focus on lean proteins; and 3 cups of low-fat dairy. 

People should limit their intake of sodium, added sugars and saturated fats. As a person ages he or she generally needs fewer calories because of less activity. Children may need more calories because they are still growing and tend to be very active.

Those who are interested in preventing illness and significantly reducing premature mortality from leading diseases should carefully evaluate the foods they eat, choosing well-balanced, low-fat, nutritionally dense options that keep saturated fat and sodium intake to a minimum.

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Start the year out right by substituting green leafy vegetables for breads and other baked goods. METRO photo
Simple modifications can help you achieve your health goals

By David Dunaief, M.D.

Dr. David Dunaief

2020 has been a most unusual year. In some ways, it’s been a case study in new habit formation, as many of us altered our routines to adapt to a COVID-19 world.

As our thoughts turn to a brighter 2021, many of us will make resolutions to develop healthy new habits – and in some cases to undo bad habits we’ve picked up during the past year. If this is you, cheers!

Changing habits can be incredibly difficult. You can make it easier on yourself, though. 

Set a goal that is simple and singular. Don’t overdo it by focusing on multiple resolutions, like eating better, exercising more and sleeping better. Complexity will diminish your chances of success. Instead, pick one to focus on, and make the desired impact part of your goal, for example: improve your health by substituting green leafy vegetables for breads and other baked goods.

Manage your environment. According to a study, people with the most self-control utilize the least amount of willpower, because they take a proactive role in minimizing temptation (1). Start by changing the environment in your kitchen. In our example resolution above, that means eliminating or reducing the breads and baked goods in your home and keeping a refrigerator stocked with leafy greens you like.

If one obstacle is the time available to cook when you’re hungry, consider in advance the ways you can make in-the-moment food preparation simpler. This could be as simple as pre-washing and chopping greens when you arrive home from the store or while watching your favorite TV program, or it could be as detailed as precooking meals.

The latter is my personal favorite, and it’s easily accomplished by cooking more than you need for a single meal. For example, rather than chop and roast just the tray of broccoli we’ll eat tonight, we’ll prepare two trays at a time – one to eat today, and one to have in the fridge. I try to always have at least one prepared healthy meal at the ready for reheating, in case we don’t have the time or energy to cook later.

Rally your support network. Support is another critical element. It can come from within, but it is best when reinforced by family members, friends and coworkers. In my practice, I find that patients who are most successful with lifestyle changes are those where household members are encouraging or, even better, when they participate in at least some portion of the intervention, such as eating the same meals.

One reason so many have turned to baking during their at-home time is that it provides a fun group activity with a shared outcome. You can produce the same experience by experimenting with new greens-intensive recipes together. Making pots of vegetable stews and chilis, vegan spinach lasagnas with bean noodles, bean-and-green tacos, and cheeseless eggplant/spinach rollatini can be more fun as a group – with the same delicious outcomes. Bonus: if you double the recipes, you can refrigerate or even freeze the leftovers for reheating later.

Be consistent. When does a change become a new habit? The rule of thumb used to be it takes approximately three weeks. However, the results of a study at the University of London showed that the time to form a habit, such as exercising, ranged from 18 days to 254 days (2). The good news is that the average time to reach this automaticity was 66 days, or about two months.

Choose a diet that targets your health needs. U.S. News and World Report released its annual ranking of diets this week (3). Three of the diets highlighted include the DASH (Dietary Approach to Stop Hypertension) diet, the Ornish diet and the Mediterranean diet. These were the top three for heart health. The Mediterranean diet was ranked number one overall – for the fourth consecutive year – and the DASH diet tied for second overall with the Flexitarian diet. The Flexitarian and Mediterranean diets tied for the top spot for diets that help manage diabetes.

What do all of the top diets have in common? They focus on nutrient-dense foods. In fact, the lifestyle modifications I recommend are based on a combination of the top diets and the evidence-based medicine that supports them.

Of course, if you’ve tried to change your diet in the past, you probably know that not every diet is easy to follow, even after you get beyond the “changing my eating habits” part of the equation. Choosing a diet that works for both you and others in your household can be tricky. And, let’s face it, no one wants to make two meals – or more – to accommodate everyone’s needs.

According to U.S. News and World Report, the easiest to follow are the Mediterranean diet, which took the top spot, the recently redesigned WW (Weight Watchers) diet, which took second place, and the Flexitarian diet, which came in third. If you’re not familiar with a Flexitarian diet, which we noted also tied for the second-best diet overall, its name is a combination of “flexible” and “vegetarian,” and its focus is on increasing your intake of fruits and vegetables and minimizing – but not necessarily eliminating – your intake of animal products. For many, this lack of rigidity can help, whether the goal is to transition to a complete vegetarian lifestyle eventually or to manage different palates around the table.

I encourage you to read more about each of these diets and select one, in consultation with your physician, that will help you meet your personal health goals – from both nutritional and manageability standpoints.

Here’s to a happy, healthy 2021!

References:

(1) J Pers Soc Psychol. 2012;102:22-31. (2) European Journal of Social Psychology, 40: 998–1009. (3) www.usnews.com.

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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The dawn of a new year is a great time to take stock of the year that just passed and set goals for the next 12 months. Resolutions focused on improving personal health are especially popular, and for good reason. Improving one’s overall health can have positive implications for years to come. Even with the best intentions, resolutions have historically proven hard to keep. Simplifying health-based resolutions can lead to a higher success rate and a healthier you.

• Walk more. It is easy to get preoccupied with the “10,000 steps per day” mantra that many people follow and that certain fitness trackers promote. Walking 10,000 steps daily, which equates to roughly five miles per day, is a healthy goal, but it may not be realistic for everyone. Take stock of how many steps you currently take each day, and then resolve to walk 2,000 more. As your body acclimates to walking more, add another 2,000 steps, continuing to do so until you reach 10,000 steps.

• Learn something new about being healthy. Informed health decisions require gaining a greater understanding of your body. Rely on a reputable source such as the Centers for Disease Control and Prevention to learn more about how to be healthy.

• Spend less time on social media. Staring at your phone or tablet for multiple hours browsing tweets or checking messages might not be the best thing for your physical and mental health. Browsing the internet may take up time that could be better spent engaging in physical activity. According to Dr. Elia Abi-Jaoude, a staff psychiatrist at the Hospital for Sick Children and Toronto Western Hospital, various studies have shown how excessive social media usage can adversely affect relationships, sense of self, sleep, academic performance, and emotional well-being.

• Eat more whole foods. Whole foods, including vegetables, fruits, nuts, seeds, whole grains, and fish, contain various nutrients the body needs to function at peak capacity. These foods may help reduce the risk of many diseases and help people maintain healthy body weights. Start slowly by introducing a new whole food to your diet each day. A gradual approach is more manageable than going on a drastic diet.

• Avoid sweetened beverages. You are what you eat, but also what you drink. A report published in 2006 in the American Journal of Clinical Nutrition found consumption of sugar-sweetened beverages, particularly carbonated soft drinks, may be a key contributor in the epidemic of overweight and obesity. Skip sweetened beverages (even fruit juices can be unhealthy if consumed in excess) and opt for more water or unsweetened teas.

• Find a physical activity you like. Rather than resolving to join the gym or signing up for a 5K because it’s what everyone is doing, find a physical activity you truly enjoy and aim to do it a few times a week. Maybe it’s a sport like tennis or recreational cycling with the family. But if the idea of a gym membership excites you, then by all means sign up. Avoid restrictive health and wellness resolutions that can be unsustainable. By downsizing expectations and taking small steps en route to your goals, you may be more motivated to stay the course and realize your resolutions.

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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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Foods that comfort the mind and body protect you from chronic diseases in the long term. Stock photo
Focusing on real ‘comfort food’ will improve your outcomes

By David Dunaief, M.D.

Dr. David Dunaief

I think it’s fair to say that our world has been radically altered by the current COVID-19 pandemic. If you are at home weathering this storm, it can feel like you are in a literal silo. 

So naturally, we need to find things that make us feel “better.” Many of us reach for food to help comfort us. Guess which food item has had the largest sales increase in the U.S. from 2019. Here is a hint: it’s not broccoli. It’s frozen cookie dough, where sales are up 454 percent (1). 

But there is a difference between food that comforts just the mind and food that comforts both the mind and the body. What is the difference? Let’s look at two recent examples from my clinical practice. 

Food that comforts the mind and body 

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First, let’s look at the results of a 71-year-old male who stopped eating out during COVID-19, like so many of us. Apparently, for this patient, eating out meant indiscretions with his diet. While at home, there was less temptation to stray from his dietary intentions. The results speak for themselves. 

In a month, his nutrient level improved, measured using serum beta carotene levels. His inflammation, measured by c-reactive protein (CRP), was reduced 40 percent. What is the importance of inflammation? It is the potential basis for many of the chronic diseases that are rampant in the U.S. (2). His kidney function increased by about 14 percent with an increase in his glomerular filtration rate (GFR), which helps remove waste from the kidney, from 51 to 58. This patient, who suffers from gout, also found his uric acid dropped. Finally, and most importantly, his symptoms improved, and he garnered more energy. He described himself as enjoying food more.

I am not suggesting you don’t order out, but do it wisely. Diametrically opposed is our second example. 

Food that comforts the mind only

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This 72-year-old female decided to embrace ultra-processed foods, adding cookies, cakes and sour-dough breads to her diet. Her kidney function decreased by more than 15 percent, with the GFR shifting from 88 to 63. Her inflammation, measured by CRP, went up by 75 percent. Her LDL, “bad cholesterol,” increased by more than 20 percent. Her allergy symptoms worsened. She described herself as more sluggish and, to boot, she gained five pounds.

What makes these examples even more interesting is that both patients are deemed in the high-risk category for getting severe COVID-19 and being hospitalized. COVID-19 is associated with elevated CRP, which may increase the risk for more lung lesions and the risk of severe disease (3).

What is the moral of the story? Use this time to focus on foods that comfort both the mind and the body. Make food work for you and against the common enemies of COVID-19 and chronic diseases that are putting people at higher risk for viruses.

What about exercise? 

Just because we are cooped up indoors most of the time does not mean we can’t exercise. Time and again, exercise benefits have been shown. Yet, we are sitting more and, with social distancing, we have less incentive to go outside or opportunities to socialize, go to the gym or do many of our usual activities.

However, not to fret. There was a recent small study with eight volunteers equally split between men and women. Results showed that four-minute intervals of exercise throughout the day that interrupted continuous sitting led to a substantial improvement in triglycerides and metabolized more fat after high-fat meals the next day, compared to continuous sitting for eight hours uninterrupted and then eating a high fat meal the next day (4).  

The participants used a stationary bike, exercising intensely for four seconds and then resting for 45 seconds, repeating the sequence five times in a row. They completed this four-minute sequence once an hour for eight hours. Their daily intense exercise totaled 160 seconds. This bodes well for very short bursts of exercise rather than sitting for long periods without movement.

Not everyone has a stationary bike, but you can do jumping jacks, run in place, or even dance vigorously to your favorite tunes once an hour.

Ventilator vs. Incentive Spirometer

As I’m sure you’ve been reading, some with severe COVID-19 require ventilators. Unfortunately, the statistics with ventilators are dismal. According to a recent study of 5700 COVID-19 patients in the New York region, 88.1 percent of patients died (5). Hospitals are trying alternate approaches while using oxygen masks not ventilators, such as proning (turning patients on their stomach instead of lying on their backs in bed) and having them sit up in a chair in order to help with oxygenation in the lungs in those who have low oxygen saturation.

However, the ultimate exercise for the lung and the ability to improve oxygenation is an incentive spirometer. This device expands your lungs as you inhale. The more you do it, the better your lung functioning. One study, which I mentioned in previous articles on lung function, involved inhaling a total of 50 breaths a day which in two increments (6). 

The brand of spirometer used was a Teleflex Triflo II. This costs less than five dollars online at medicalvitality.com

What about incentive spirometer in sick patients? There was a small study with patients who had COPD exacerbations (7). Those who were given an incentive spirometer plus medical treatment saw a significant increase in the blood gases over a two-month period. Also, the quality of life improved for those using the incentive spirometer. 

Remember, one of the factors that may be a sign that someone is at high risk for severe COVID-19 is very low oxygen saturation. If you can improve oxygen saturation with incentive spirometer that is readily available, how can you pass this up? 

While it is tempting to gorge yourself with food that comforts the mind, DON’T! Foods that comfort the mind and the body protect you not only in the short term, but also the longer term from the consequences of chronic diseases.

Therefore, focus on DGLV (dark green leafy vegetables) that raise beta-carotene, which in turn lowers CRP. This can be achieved with diet by increasing consumption of beta-carotene-rich fruits and vegetables while limiting consumption of beta-carotene-poor ultra-processed and fatty foods. Interestingly, it is much easier right now to get DGLVs than it is to get certain ultra-processed foods. Add in exercise and an incentive spirometer and you will comfort your body plus your mind.

References:

(1) CNBC.com April 23,2020. (2) Front Immunol. 2018; 9: 1302. (3) Med Mal Infect. 2020 Mar 31;S0399-077X(20)30086-X. (4) Medicine & Science in Sports & Exercise. Online April 17, 2020. (5) JAMA. 2020 Apr 22;e206775. (6) Ann Rehabil Med. Jun 2015;39(3):360-365. (7) Respirology. 2005 Jun;10(3):349-53. 

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, visit www.medicalcompassmd.com.     

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