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The microbiome affects our immune system responses

By David Dunaief, M.D.

Dr. David Dunaief

We have been hearing more frequent references to the microbiome recently in health discussions and healthcare marketing. So, what is it, and why is it important to our health?

We each have a microbiome, trillions of microbes that include bacteria, viruses and single-cell eukaryotes that influence our body’s functions. When “good” and “bad” microbes are in balance, we operate without problems. However, when the balance is tipped, often by environmental factors, such as diet, infectious diseases, and antibiotic use, it can make us more susceptible to inflammation, diseases and disorders.

We are going to focus on the gut microbiome, where much of our immune system response lives. Research into the specifics of our microbiome’s role in healthy functioning is still in its infancy. Current research into the microbiome’s effects include its role in obesity, diabetes, irritable bowel syndrome, autoimmune diseases, such as rheumatoid arthritis and Crohn’s, and infectious diseases, such as colitis.

What affects our microbiome?

Lifestyle choices, like diet, can impact your microbiome positively or negatively. Microbiome diversity may vary significantly in different geographic locations throughout the world, because diet and other environmental factors play such a large role.

When we take medications, like antibiotics, we can wipe out our microbial diversity, at least in the short term. This is why antibiotics can cause gastrointestinal upset. Antibiotics don’t differentiate between good and bad bacteria.

One way to counteract an antibiotic’s negative effects is to take a probiotic during and after your course of antibiotics. I recommend taking Renew Life’s 30-50 billion units once a day, two hours after an antibiotic dose and continuing for 14 days after you have finished taking your prescription. If you need more protection, you can take one dose of probiotics two hours after each antibiotic dose.

Does the microbiome affect weight?

Many obese patients continually struggle to lose weight. Obese and overweight patients now outnumber malnourished individuals worldwide (1).

For a long time, the weight loss “solution” had been to reduce caloric intake. However, extreme low-calorie diets were not having a long-term impact. It turns out that our gut microbiome may play important roles in obesity and weight loss, determining whether we gain or lose weight.

The results from a study involving human twins and mice are fascinating (2). In each pair of human twins, one was obese, and the other was lean. Gut bacteria from obese twins was transplanted into thin mice. The result: the thin mice became obese. However, when the lean human twins’ gut bacteria were transplanted to thin mice, the mice remained thin.

By pairing sets of human twins, one obese and one thin in each set, with mice that were identical to each other and raised in a sterile setting, researchers limited the confounding effects of environment and genetics on weight.

The most intriguing part of the study compared the effects of diet and gut bacteria. When the mice who had received gut transplants from obese twins were provided gut bacteria from thin twins and given fruit- and vegetable-rich, low-fat diet tablets, they lost significant weight. Interestingly, they only lost weight when on a good diet. The authors believe this suggests that an effective diet may alter the microbiome of obese patients, helping them lose weight. These are exciting, but preliminary, results. It is not yet clear which bacteria may be contributing to these effects.

Gut bacteria and autoimmune disease

Rheumatoid arthritis (RA) is an autoimmune disease that can be disabling, with patients typically suffering from significant joint soreness and joint breakdown. What if gut bacteria influences RA risk? In a study, the gut bacteria in mice that were made susceptible to RA by deletion of certain genes (HLA-DR genes) were compared to those who were more resistant to developing RA (3). Researchers found that the RA-susceptible mice had a predominance of Clostridium bacteria and that those resistant to RA were dominated by bacteria such as bifidobacteria and Porphyromonadaceae species. The significance is that the bacteria in the RA-resistant mice are known for their anti-inflammatory effects.

Diet and other lifestyle considerations, such as eating and sleeping patterns or their disruptions, can affect the composition and diversity of gut bacteria (4). Studies have already demonstrated prebiotic effects of fiber and significant short-term changes to the microbiome when eating fruits, vegetables, and plant fiber. Others are considering the effects of specific diets on the immune system and development of non-communicable diseases (5).

The promise of personalized medicine that helps individuals identify the perfect mix of microbes for them is still out in the future; however, many preliminary studies suggest important learnings that we can all use.

References:

(1) “The Evolution of Obesity”; Johns Hopkins University Press; 2009. (2) Science. 2013;341:1241214. (3) PLoS One. 2012;7:e36095. (4) Nutrients. 2019 Dec;11(12):2862. (5) Nutrients. 2021 Feb 22;13(2):699.

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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Get out and enjoy Spring!

By David Dunaief, M.D.

Dr. David Dunaief

Ah, the paradox of Spring. Trees and bushes are in full bloom, and flowers are popping up everywhere. For those with seasonal allergies — also known as allergic rhinitis or hay fever — it’s challenging to balance the desire to be outside with the discomfort it can bring.

According to the Centers for Disease Control and Prevention, 25.7 percent of U.S. adults and 18.9 percent of children were diagnosed with seasonal allergies in 2021 (1). Triggers include pollen from leafy trees, shrubs, grass, flowering plants, and weeds.

What prompts allergic reactions?

Sufferers experience a chain reaction when they inhale pollen. It interacts with immunoglobulin E (IgE), antibodies that are part of our immune system and causes mast cells in the body’s tissues to degrade and release inflammatory mediators. These include histamines, leukotrienes, and eosinophils in those who are susceptible. In other words, it is an allergic inflammatory response.

The revved up immune system then responds with sneezing; red, itchy and watery eyes; scratchy throat; congestion; sinus headaches; postnasal drip; runny nose; diminished taste and smell; and even coughing (3). It can feel like a common cold, but without the virus. If you have symptoms that last more than 10 days and are recurrent, then it is more likely you have allergies than a virus.

If allergic rhinitis is not treated, it can lead to complications like ear infections, sinusitis, irritated throat, insomnia, chronic fatigue, headaches and even asthma (4).

What medications help? 

If you don’t want to seal yourself inside, to prevent allergy attacks, you might consider medications to reduce your symptoms.

Options include intranasal glucocorticoids (steroids), oral antihistamines, allergy shots, decongestants, antihistamine and decongestant eye drops.

The guidelines for treating seasonal allergic rhinitis with medications suggest that you use intranasal corticosteroids (steroids) when your quality of life suffers (5). Two commonly used inhaled steroids are triamcinolone (Nasacort) and fluticasone propionate (Flonase). They need to be used daily and can cause side effects, including headaches.

If itchiness and sneezing are your greatest challenges, second-generation oral antihistamines may be appropriate. These can be taken “as needed.” Examples include loratadine (Claritin), cetirizine (Zyrtec) and fexofenadine (Allegra). These have less sleepiness as a side effect than first-generation antihistamines, like Benadryl, but they don’t work for everyone.

Is butterbur an effective treatment?

Butterbur (Petasites hybridus) leaf extract has several small studies that indicate its efficacy in treating seasonal allergies. Butterbur is a shrub found in Europe, Asia and North America. 

In one randomized controlled trial (RCT) involving 131 patients, results showed that butterbur was as effective as cetirizine (Zyrtec) (6). In another RCT, results showed that high doses of butterbur — 1 tablet given three times a day for two weeks — was significantly more effective than placebo (7). Researchers used butterbur Ze339 (carbon dioxide extract from the leaves of Petasites hybridus L., 8 mg petasines per tablet) in the trial.

A post-marketing follow-up study of 580 patients showed that, with butterbur Ze339, symptoms improved in 90 percent of patients with allergic rhinitis over a two-week period (8). Gastrointestinal upset occurred as the most common side effect in 3.8 percent of the study population.

There are several important caveats about using butterbur. The leaf extract used in studies was free of pyrrolizidine alkaloids (PAs). PAs have been implicated in causing liver and lung damage and may cause cancer (9). Also, studies used well-measured doses, which may not be the case with over-the-counter extracts. Finally, there are interactions with some prescription medications.

If you are allergic to butterbur-related plants, such as ragweed, chrysanthemums, marigolds, and daisies, butterbur may cause an allergic reaction (9).

Can dietary changes treat seasonal allergies? 

There are no significant studies specifically on using diet; however, there is one literature review that suggests a plant-based diet may reduce symptoms of seasonal allergies in teens, as well as eczema and asthma (10). In my clinical practice, many patients with seasonal allergies have improved and even reversed the course of allergies over time with a vegetable-rich, plant-based diet. This might be due to its anti-inflammatory effects. Analogously, some physicians suggest that their patients have improved after removing dairy from their diets.

While allergies can make you miserable, there are many over-the-counter and prescription options to help. Diet may play a role by reducing inflammation. There does seem to be promise with butterbur extracts, there are caveats. Always consult your doctor before starting any supplements, herbs or over-the-counter medications.

References:

(1) CDC.gov. (2) acaai.org/allergies/types/pollen-allergy. (3) J Allergy Clin Immunol. 2003 Dec;112(6):1021-31.. (4) J Allergy Clin Immunol. 2010 Jan;125(1):16-29.. (5) Otolaryngol Head Neck Surg. 2015 Feb;2:197-206. (6) BMJ 2002;324:144. (7) Arch Otolaryngol Head Neck Surg. 2004 Dec;130(12):1381-6. (8) Adv Ther. Mar-Apr 2006;23(2):373-84. (9) ncchih.nih.gov. (10) Eur Respir J. 2001;17(3):436-443.

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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Photo courtesy of StatePoint

Ongoing measles outbreaks across the country have many families, pediatricians and public health experts concerned. Most of the people who have gotten sick, including a child who died in Texas, were not vaccinated against measles.

The best way to protect your family is by choosing to have your child immunized against measles. The MMR vaccine—which protects against measles, mumps and rubella—is the only way to prevent measles. Vitamin A, cod liver oil and other alternatives have been discussed as ways to lessen the severity of measles. However, none of these alternatives will prevent measles. Too much vitamin A can also cause severe illness. Always talk with your pediatrician first.

“The reason many parents in the United States have not had to worry about measles in decades is because of widespread immunization with this safe and effective vaccine,” said AAP president and pediatrician, Susan Kressly. “However, when immunization rates drop in a community, the disease can spread, putting everyone—especially young children—at risk.”

Before the measles vaccine was available in the United States, an average of 450 people died from measles every year, according to the Centers for Disease Control and Prevention. Most of them were previously healthy children. Children who contract measles are at higher risk for developing more serious conditions such as pneumonia or a brain infection called encephalitis.

These complications can become deadly. Additionally, a rare but universally fatal form of brain swelling called subacute sclerosing panencephalitis can occur in healthy children years after they have recovered from measles infection.

Measles is highly contagious. The virus can live for up to two hours in the air where infected people have coughed or sneezed. Nine out of 10 people exposed to the virus who don’t have immunity from the vaccine will also become infected, according to the CDC. To prevent the virus from spreading and potentially causing an outbreak, creating community immunity by reaching a high level of vaccination rate is crucial to protect those who cannot be vaccinated.

The vast majority of parents get their children vaccinated. But because measles is so infectious, if a community’s rate of vaccination dips below 95% of the population, the disease can easily spread, impacting individuals and groups of people. Check with your pediatrician today if you’re unsure about your child’s protection. Learn more at HealthyChildren.org.

“No parent should have to experience the loss of a child to a preventable disease. Vaccines save lives,” said Dr. Kressly. “Pediatricians are here to talk with families about their children’s health, including how they can access vaccines. We must support immunization programs so that children in every community get the opportunity to grow up healthy and strong.” (StatePoint)

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Exercises that involve balance, strength, movement, flexibility and endurance all play significant roles in fall prevention. METRO photo

By David Dunaief, M.D.

Dr. David Dunaief

Taking a tumble can cause broken bones and torn ligaments. While these might not be life-altering in younger folks, they can have serious consequences for older patients, including a decrease in functional ability and a decline in physical and social activities, which can lead to a loss of independence (1)(2). One recent study found that older adults who had suffered a fall had poorer health and well-being two years later when compared to those who had not fallen (3).

What increases your fall risk?

Obviously, environmental factors, like slippery or uneven surfaces, can increase your risk of falling. Age and medication use are also contributing factors. Some medications, like those used to treat high blood pressure or those targeting anxiety, depression and insomnia, are of particular concern. Chronic diseases may also contribute.

If you have upper and lower body strength weakness, decreased vision, a hearing disorder or psychological issues, such as anxiety and depression, these conditions predispose you to falling (4).

How can you reduce your fall risk?

Most importantly, exercise. Exercises that involve balance, strength, movement, flexibility and endurance all play significant roles in fall prevention (5). The good news is that many of these can be done inside with no equipment or with items found around the home. We will look more closely at the research.

Nonslip shoes are a big help. Look for slippers and shoes with non-skid soles. During the winter, choose footwear that prevents sliding on ice, such as boots with cleats or slip-on ice cleats that fit over your shoes.

In the home, secure area rugs, remove tripping hazards, install grab-bars in your bathroom showers and tubs, and add motion-activated nightlights.

And, of course, always pay attention when you’re walking. Don’t text, read or video chat while you’re moving around. A recently published study of young, healthy adults found that texting while walking affected their gait stability and postural balance when they were exposed to a slip hazard (6).

How do medications increase risk?

Several medications heighten fall risk, including psychotropic drugs and high blood pressure medications.

A well-designed study showed that those taking moderate doses of blood pressure medication had the greatest risk of serious injuries from falls, a 40 percent increase (7).

Because these medications can reduce cardiovascular risks, physicians must consider the risk-benefit ratio in older patients before prescribing or stopping a medication. We also should consider whether lifestyle modifications can reverse your need for medication or your dosage (8).

Using exercise to reduce fall risk

A meta-analysis showed that regular exercise significantly reduced the risk of a fall (9). It led to a 37 percent reduction in falls that resulted in injury and a 30 percent reduction in falls that required medical attention. Even more impressive was a 61 percent reduction in fracture risk. The author summarized that exercise not only helps to prevent falls but also fall injuries.

Unfortunately, those who have fallen before often develop a fear that leads them to limit their activities. This leads to a dangerous cycle of reduced balance and increased gait disorders, ultimately resulting in an increased fall risk (10).

Any consistent exercise program that focuses on flexibility and muscle tone and includes core strengthening can help improve your balance. Among those that have been studied, tai chi, yoga and aquatic exercise have all been shown to reduce falls and injuries from falls.

A randomized controlled trial showed that those who did an aquatic exercise program had a significant improvement in the risk of falls (11). The goal of the aquatic exercise was to improve balance, strength and mobility. Results showed a reduction in the overall number of falls and a 44 percent decline in the number of exercising patients who fell during the six-month trial, with no change in the control group.

Tai chi, which requires no equipment, was also shown to reduce both fall risk and fear of falling in older adults (12).

Another pilot study used modified chair yoga classes with a small, over-65 assisted-living population where participants had experienced a recent fall and had a resulting fear of falling (13). While the intention was to assess exercise safety, researchers found that participants had less reliance on assistive devices and three of the 16 participants were able to eliminate their use of mobility assistance devices.

Our best defense against fall risk is prevention with exercise and managing our environments to reduce fall opportunities. In addition, if you are 65 and older, or if you have arthritis and are over 45, it may mean reviewing your medication list with your doctor. Before you consider changing your blood pressure medications, review your risk-to-benefit ratio with your physician.

References:

(1) MMWR. 2014; 63(17):379-383. (2) J Gerontol A Biol Sci Med Sci. 1998;53(2):M112. (3) Aging Ment Health. 2021 Apr;25(4):742-748. (4) JAMA. 1995;273(17):1348. (5) Cochrane Database Syst Rev. 2012;9:CD007146. (6) Heliyon. 2023 Aug; 9(8): e18366. (7) JAMA Intern Med. 2014 Apr;174(4):588-595. (8) JAMA Intern Med. 2014;174(4):577-587. (9) BMJ. 2013;347:f6234. (10) Age Ageing. 1997 May;26(3):189-193. (11) Menopause. 2013;20(10):1012-1019. (12) Mater Sociomed. 2018 Mar; 30(1): 38–42. (13) Int J Yoga. 2012 Jul-Dec; 5(2): 146–150.

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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It doesn’t take much exercise to improve health outcomes. METRO photo

By David Dunaief, M.D.

As I wrote last week, exercise is not the sole solution for weight loss. However, it can improve our outcomes with diseases and other health issues. It may also play a significant role in altering how our genes express themselves. The list of conditions it can improve includes diabetes, kidney stones, osteoarthritis, cardiovascular disease and breast, colorectal and endometrial cancers (1).

Even knowing all the positive impacts, motivating yourself to exercise can be difficult. There are some simple ways to motivate yourself during exercise. One study showed that those who repeated positive mantras to themselves during exercise were able to continue for longer periods (2).

Why is this so important? Because we are too sedentary. According to data from the 2017-2020 Behavioral Risk Factor Surveillance System, New York had among the highest levels of physical inactivity in the U.S., at 25.9 percent of the population (3).

Can exercise alter your genes?

While it may not change our genes, exercise may change how our genes express themselves.

One study’s results showed that, when participants exercised for six months, many thousands of genes in fat cells were affected (4). During the study, previously sedentary men took a one-hour spin class twice a week. According to the researchers, this exercise affected genes involved in storing fat and in risk for subsequent diabetes and obesity development. The participants also improved other important health metrics, including cholesterol, blood-pressure, fat percent and, over time, waist circumferences.

Epigenetics is when lifestyle changes ultimately lead to changes in how genes express themselves, turning genes on and off. While this effect has been shown with dietary changes, this is one of the first studies to show that exercise also impacts our genes. It took only six months to see these numerous gene changes with a modest amount of cardiovascular exercise.

Need more inspiration? Another study showed considerable gene changes in muscle cells after one stationary bike workout (5). Yet another introduced six weeks of endurance exercise to healthy, but sedentary, young men and identified an abundance of genetic changes to skeletal muscle, which broadly affects physical and cognitive health (6).

How does exercise affect cardiovascular disease?

One meta-analysis examined 57 studies that involved drugs and exercise. It showed similar mortality benefits with statins and exercise for patients who already have coronary heart disease (7). Both statins and exercise reduced the risk of mortality by similar amounts. The same study also showed that, for those with pre-diabetes, it didn’t matter whether they took metformin or exercised — each had the same effect.

While these results are exciting, don’t change your medication without consulting your physician.

Exercise and kidney stone prevention

Passing a kidney stone can be excruciating. Most treatments involve taking pain medication and fluids and just waiting for the stone to pass. Honestly, the best way to treat kidney stones is to prevent them.

The Women’s Health Initiative Observational Study involved 84,000 postmenopausal women, the population most likely to suffer from kidney stones. It found exercise reduced kidney stone risk by as much as 31 percent (8). Even better, exercise intensity did not alter its beneficial effect. What mattered more was exercise quantity. One hour of jogging or three hours of walking got the top results; however, lesser amounts of exercise also saw substantial reductions.

Exercise can have strong influences on the way you feel; however, it may also influence your genes’ expression and, ultimately, affect the development and prevention of disease. In certain circumstances, it may be as powerful as medications and, in combination, can pack a powerful punch.

References:

(1) JAMA. 2009;301(19):2024. (2) Med Sci Sports Exerc. 2013 Oct 10. (3) cdc.gov. (4) PLoS Genet. 2013 Jun;9(6):e1003572. (5) Cell Metab. 2012 Mar 7;15(3):405-11. (6) Mol Metab. 2021 Nov;53:101290. (7) BMJ. 2013; 347. (8) JASN. 2013;24(3):p 487-497.

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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Studies have shown that adding blueberries to your diet can lower your blood pressure. Pixabay photo
Non-clinical readings may paint a more complete picture of your risks

By David Dunaief, M.D.

Dr. David Dunaief

Nearly 120 million U.S. adults, just under half of the population, have hypertension (1). Of these, only 25 percent have successfully controlled their blood pressure to less than 130/80 mmHg, the high end of “normal” blood pressure.

For the remaining 75 percent, the risk of complications, including cardiovascular events and mortality, is significantly higher.

What increases our risk of developing hypertension? An observational study involving 2,763 participants showed that the top three influencers on the risk of developing high blood pressure were poor diet, modest obesity, and cigarette smoking, all of which are modifiable (2).

What increases your risk of complications?

Being significantly overweight or obese, smoking, poor diet, lack of exercise, family history, age, increased sodium, depression, diabetes, low vitamin D, and too much alcohol all increase your risk (3).

The good news is that you can improve your risk profile (4).

What is the effect of gender?

One of the most concerning complications of hypertension is cardiovascular disease. A large observational study with a 31-year duration found that isolated systolic (top number) hypertension increased the risk of cardiovascular disease and death in both men and women between 18 and 49 years old, compared to those who had optimal blood pressure (5). These complications were not affected by onset age.

When the results were sorted by gender, women experienced the greatest effect, with a 55 percent increased risk of cardiovascular disease and 112 percent increased risk of heart disease death.

When  to measure your blood pressure

Most of us have our blood pressure measured when we’re at a doctor’s office. While measuring blood pressure in a clinic can be useful, a meta-analysis of nine studies showed that high blood pressure measured at nighttime was potentially a better predictor of myocardial infarctions (heart attacks) and strokes, compared to daytime and clinic readings (5).

For every 10 mmHg rise in nighttime systolic blood pressure, there was a corresponding 25 percent increase in cardiovascular events. The nighttime readings were achieved using 24-hour ambulatory blood pressure measurements (ABPM).

A factor that might increase the risk of nighttime cardiovascular events is masked uncontrolled hypertension (MUCH).  MUCH occurs in those who are well-controlled during clinic readings for blood pressure; however, out-of-clinic readings indicate their blood pressure is uncontrolled.

A study of 167 patients found that medication non-compliance was not a significant factor in those experiencing MUCH (6). Of the participants experiencing MUCH, 85.2 percent were fully adherent with their prescribed medications, a number similar to the group that did not experience MUCH.

Interestingly, in the Spanish Society of Hypertension ABPM Registry, MUCH was most often seen during nocturnal hours (7). The study’s authors suggest that ABPM may be a better way to monitor those with higher risk factors for MUCH, such as those whose pressure is borderline in the clinic and those who are smokers, obese or have diabetes.

A previous study of patients with chronic kidney disease (CKD) and hypertension suggested that taking at least one antihypertensive medication at night may be more effective than taking them all in the morning (8). Those who took one or more of their blood pressure medications at night saw a two-third reduction in cardiovascular event risk.

Blueberries and blood pressure

Diet plays an important role in controlling high blood pressure. Lowering sodium is critically important, but adding berries may also be beneficial.

In a study of post-menopausal women with pre-hypertension or stage one hypertension, daily consumption of 22 grams of blueberry powder, the equivalent of one cup of fresh blueberries, reduced systolic blood pressure by a respectable 7 mmHg and diastolic blood pressure by 5 mmHg over two months (9).

This addition of a modest amount of fruit had a significant impact. Blueberries increase nitric oxide, which helps blood vessels relax and reduces blood pressure. While the study used blueberry powder, an equivalent amount of real fruit might lead to an even greater reduction.

High blood pressure and possible cardiovascular complications can be scary, but lifestyle modifications, such as making dietary changes and taking antihypertensive medications at night, can reduce your risks.

References:

(1) millionhearts.hhs.gov. (2) BMC Fam Pract 2015;16(26). (3) uptodate.com. (4) Diabetes Care 2011;34 Suppl 2:S308-312. (5) J Am Coll Cardiol 2015;65(4):327-335. (6) Hypertension. 2019 Sep;74(3):652-659. (7) Eur Heart J 2015;35(46):3304-3312. (8) J Am Soc Nephrol 2011 Dec;22(12):2313-2321. (9) J Acad Nutr Diet 2015;115(3):369-377.

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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Suffolk County Executive Ed Romaine

There have been reports of deceased birds being found across the county. The New York State Department of Environmental Conservation (DEC) recommends the following guidance if you encounter this situation on your property.

In cases where DEC field staff cannot collect samples or carcasses from the landscape, please limit direct contact with dead wildlife and keep children and pets away. To dispose of a dead bird safely, DEC provides the following guide:

  • Wear disposable gloves, a mask, and eye protection, like safety glasses or goggles.
  • Avoid direct contact with the carcass or carcass fluids by using a shovel or a garbage bag to pick up the bird.
  • Carcasses should be triple bagged (garbage or contractor bags) and placed in an outdoor trash receptacle.
  • Remove and throw away your gloves. Wash your hands with soap and water immediately after removing gloves.
  • Change your clothes and wash them after disposing of the bird.
  • If you use a shovel, clean it with hot, soapy water and disinfect it with diluted bleach (1/3 cup bleach added to a gallon of water).

For additional information or to make a report, please call the DEC at 844-332-3267.

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METRO photo
Design strategies that get you up and moving

By David Dunaief, M.D.

Dr. David Dunaief

Exercise helps build long-term physical and mental health, but regular exercise is often a challenge. Even with all the fitness-related apps to prompt us, modern society has an equal number of tech demotivators. It’s just too easy to let the next episode of our favorite series autoplay or to answer those last few emails.

Even if we want to exercise, we “don’t have time.”

I have good news. There is an easy way to get tremendous benefit in very little time. You don’t need expensive equipment, and you don’t have to join a gym. You can even sharpen your wits with your feet.

Esther Tuttle was profiled in a New York Times’ Science Times article a few years ago, when she was 99. Esther was sharp as a tack and was independently mobile, with no mobility aids. She remained active by walking in the morning for 30 minutes and then walking again in the afternoon. 

Of course, this story is only anecdotal; however, evidence-based medicine supports her claim that walking is a simple way to get exercise that shows incredible benefits. One mile of walking a day will help keep the doctor away. For the step-counters among you, that’s about 2,000 steps a day for an adult with an average stride length.

Does walking improve mental acuity?

Walking has a dramatic effect, preserving brain function and even growing certain areas of the brain (1). Study participants who walked between six and nine miles a week, or just one mile a day, reduced the risk of cognitive impairment over 13 years and actually increased the amount of gray matter tissue in the brain over nine years.

Participants who had an increase in brain tissue volume also experienced a substantially reduced risk of developing cognitive impairment. Interestingly, the parts of the brain that grew included the hippocampus, involved with memory, and the frontal cortex, involved with short-term memory and executive decision making. There were 299 participants with a mean age of 78. All were dementia-free at the trial’s start.

In another study, moderate exercise reduced the risk of mild cognitive impairment with exercise begun in mid-to-late life (2).

If you’re pressed for time or building your stamina, you can split a mile into two half-mile increments. How long does it take you to walk a half-mile?

Does walking affect one’s mood?

Researchers performed a meta-analysis of studies related to the relationship between exercise and depression. They found that adults who walked briskly for about 75 minutes per week cut their risk of depression by 18 percent (3).

If you ratchet up your exercise to running, a study showed that mood also improves, reducing anger (4). The act of running increases your levels of serotonin, a hormone that, when low, can make people agitated or angry.

How do I build better habits?

A common challenge I hear is that working from home reduces much of the opportunity to walk. There’s no walking down the hall to a meeting or to get lunch or even from the car or train to the office. Instead, everything is only a few steps away. Our work environment is working against us.

If you need a little help getting motivated, here is a terrific strategy to get you started: set an alarm for specific points throughout your day and use that as a prompt to get up and walk, even if it’s for only 15 minutes. The miles will add up quickly.

A client of my wife’s schedules meetings for no more than 50 minutes, so she can walk a “lap” around her house’s interior between meetings or even do some jumping jacks. She also looks for opportunities to have an old-fashioned phone call, rather than a video call, so she can walk up and down the hallway while she’s meeting. Of course, this is one person, but it might prompt some ideas that will work for you.

Walking has other benefits as well. Weight-bearing exercise helps prevent osteoporosis and osteoporotic fractures. Sadly, if you don’t use them, bones weaken and break. Walking is a weight-bearing exercise that helps strengthen your joints, bones and muscles.

Remember to use your feet to keep your mind sharp and yourself even-tempered. Activities like walking will help you keep a positive attitude, preserve your bones and help increase the plasticity of your brain.

References:

(1) Neurology Oct 2010, 75 (16) 1415-1422. (2) Arch Neurol. 2010;67(1):80-86. (3) JAMA Psychiatry 2022. 79(6), 500-559. (4) J Sport Exerc Psychol. 2010 Apr;32(2):253-261.

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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Lifestyle modifications including diet can help

By David Dunaief, M.D.

Dr. David Dunaief

In my practice, many patients have resisted telling me they suffered from erectile dysfunction (ED). However, it’s a common problem. Because it can indicate other medical issues, it’s important that you share this information with your doctor.

ED affects about 24 percent of men, on average. If it occurs less than 20 percent of the time, it is considered normal; however, if it occurs more than 50 percent of the time, you should seek help (1). 

Of course, there are oral medications for ED. You’ve probably seen the ads for approved medications, including sildenafil (Viagra, or the “little blue pill”), tadalafil (Cialis), vardenafil (Levitra, Staxyn), and avanafil (Stendra). They work by causing vasodilation, or enlargement of blood vessels, which increases blood flow to the penis. Unfortunately, this does not solve the medical problem, but it does provide a short-term solution for those who are good treatment candidates.

ED’s prevalence generally increases with age. An analysis of the 2021 National Survey of Sexual Wellbeing found that ED affected 12.7 percent of 35-44-year-olds, increased to 25.3 percent of 45-54- year-olds, 33.9 percent of those aged 55-64, 48 percent of those aged 65-74, and 52.2 percent of those aged 75 and older (2).

So, what contributes to the increase as we age? Disease processes and drug therapies.

What is the connection between medical conditions and ED?

Chronic diseases can contribute significantly to ED. ED might also be an indicator of disease. Typical contributors include metabolic syndrome, diabetes, high blood pressure, cardiovascular disease and obesity. In the Look AHEAD trial, ED had a greater than two-fold association with hypertension and a three-fold association with metabolic syndrome (3). In another study, ED was associated with a 2.5-times increase in cardiovascular disease (4).

Patients with ED had significantly more calcification, or atherosclerosis, in their arteries when compared to a control group in a randomized clinical trial (RCT) (5). They were also more than three times as likely to have severe calcification. In addition, they had more inflammation, measured by C-reactive protein. 

Which medications contribute to ED?

About 25 percent of ED cases are thought to be associated with medications, such antidepressants, NSAIDs (e.g., ibuprofen and naproxen sodium), and hypertension medications. Unfortunately, the most common antidepressant medications, SSRIs, have significant impacts on ED. 

The California Men’s Health Study, with over 80,000 participants, showed that there was an association between NSAIDs and ED, with a 38 percent increase in ED in patients who use NSAIDs on a regular basis (6). The authors warn that patients should not stop taking NSAIDs without consulting their physicians.

Also, high blood pressure drugs have a reputation for causing ED. A meta-analysis of 42 studies showed that beta blockers have a small effect, but thiazide diuretics (water pills) more than doubled ED, compared to placebo (7).

How can diet affect ED?

The Mediterranean-type diet has been shown to treat and prevent ED. It’s a green leafy alternative to the little blue pill. Foods are rich in omega-3 fatty acids and high in monounsaturated fats and polyunsaturated fats, as well as fiber. Components include whole grains, fruits, vegetables, legumes, walnuts, and olive oil. 

In two RCTs lasting two years, those who followed a Mediterranean-type diet experienced improvements in their endothelial functioning (8, 9). They also experienced both lower inflammation and lower insulin resistance.

In another study, those who had the highest compliance with a Mediterranean-type diet were significantly less likely to have ED, compared to those with the lowest compliance (10). Even more impressive was that the group with the highest compliance had a 37 percent reduction in severe ED versus the low-compliance group.

A study of participants in the Health Professionals Follow-up Study looked closely at both the Mediterranean-type diet and the Alternative Healthy Eating Index 2010 diet, which emphasized consuming vegetables, fruits, nuts, legumes, and fish or other sources of long-chain fats, as well as avoiding red and processed meats (11). At this point, it probably won’t surprise you to hear that the greater participants’ compliance with either of these diets, the less likely they were to experience ED.

References:

(1) clevelandclinic.org. (2) J Sex Med. 2024;21(4): 296–303. (3) J Sex Med. 2009;6(5):1414-22. (4) Int J Androl. 2010;33(6):853-60. (5) J Am Coll Cardiol. 2005;46(8):1503. (6) Medicine (Baltimore). 2018 Jul;97(28):e11367. (7) JAMA. 2002;288(3):351. (8) Int J Impot Res. 2006;18(4):405-10. (9) JAMA. 2004;292(12):1440-6. (10) J Sex Med. 2010 May;7(5):1911-7. (11) JAMA Netw Open. 2020 Nov 2;3(11):e2021701.

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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