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Health

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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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To take care of your heart, it’s important to know and track your blood pressure. Millions of Americans have high blood pressure, also called hypertension, but many don’t realize it or aren’t keeping it at a healthy level. 

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For most adults, healthy blood pressure is 120/80 millimeters of mercury or less. Blood pressure consistently above 130/80 millimeters of mercury increases your risk for heart disease, kidney disease, eye damage, dementia and stroke. Your doctor might recommend lowering your blood pressure if it’s between 120/80 and 130/80 and you have other risk factors for heart or blood vessel disease.

High blood pressure is often “silent,” meaning it doesn’t usually cause symptoms but can damage your body, especially your heart over time. Having poor heart health also increases the risk of severe illness from COVID-19. While you can’t control everything that increases your risk for high blood pressure – it runs in families, often increases with age and varies by race and ethnicity – there are things you can do. Consider these tips from experts with the National Heart, Lung, and Blood Institute’s (NHLBI) The Heart Truth program: 

#1: KNOW YOUR NUMBERS

Everyone ages 3 and older should get their blood pressure checked by a health care provider at least once a year. Expert advice: 30 minutes before your test, don’t exercise, drink caffeine or smoke cigarettes. Right before, go to the bathroom. During the test, rest your arm on a table at the level of your heart and put your feet flat on the floor. Relax and don’t talk.

#2: EAT HEALTHY

Follow a heart-healthy eating plan, such as NHLBI’s Dietary Approaches to Stop Hypertension (DASH). For example, use herbs for flavor instead of salt and add one fruit or vegetable to every meal.

#3: MOVE MORE

Get at least 2 1/2 hours of physical activity each week to help lower and control blood pressure. To ensure you’re reducing your sitting throughout the day and getting active, try breaking your activity up. Do 10 minutes of exercise, three times a day or one 30-minute session on five separate days each week. Any amount of physical activity is better than none and all activity counts.

#4: HAVE A HEALTHY PREGNANCY

High blood pressure during pregnancy can harm the mother and baby. It also increases a woman’s risk of having high blood pressure later in life. Talk to your health care provider about high blood pressure. Ask if your blood pressure is normal and track it during and after pregnancy. If you’re planning to become pregnant, start monitoring it now.

#5: MANAGE STRESS

Stress can increase your blood pressure and make your body store more fat. Reduce stress with meditation, relaxing activities or support from a counselor or online group. 

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#6: STOP SMOKING 

The chemicals in tobacco smoke can harm your heart and blood vessels. Seek out resources, such as smoke free hotlines and text message programs,  that offer free support and information.

#7: AIM FOR A HEALTHY WEIGHT

If you’re overweight, losing just 3-5% of your weight can improve blood pressure. If you weigh 200 pounds, that’s a loss of 6 to 10 pounds. To lose weight, ask a friend or family member for help or to join a weight loss program with you. Social support can help keep you motivated.

#8: WORK WITH YOUR DOCTOR

Get help setting your target blood pressure. Write down your numbers every time you get your blood pressure checked. Ask if you should monitor your blood pressure from home. Take all prescribed medications as directed and keep up your healthy lifestyle. If seeing a doctor worries you, ask to have your blood pressure taken more than once during a visit to get an accurate reading. 

To find more information about high blood pressure as well as resources for tracking your numbers, visit nhlbi.nih.gov/hypertension.

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Long-term proton pump inhibitor use may have serious side effects

By David Dunaief, M.D.

Dr. David Dunaief

Reflux (GERD) disease, sometimes referred to as heartburn, though this is more of a symptom, is one of the most commonly treated diseases. In line with this, proton pump inhibitors (PPIs) have become one of the top-10 drug classes prescribed or taken in the United States.

The class of drugs called PPIs includes Prevacid (lansoprazole), Prilosec (omeprazole), Nexium (esomeprazole), Protonix (pantoprazole) and Aciphex (rabeprazole). Several of these medications are now available over-the-counter, rather than by prescription. When they were first approved, they were touted as having one of the cleanest side-effect profiles. This may still be true, if we use them correctly. They are intended to be used only for the short term. This can range from 7 to 14 days for over-the-counter PPIs to 4 to 8 weeks for prescription PPIs.

Dangers of long-term use

While PPI pre-approval trials were short-term, not longer than a year, many physicians put patients on these medications for decades. And the longer people are on them, the more complications arise. Among potential associations with long-term use are chronic kidney disease, dementia, bone fractures and Clostridium difficile, a bacterial infection of the gastrointestinal tract.

Though PPIs may increase the risk of a number of complications, keep in mind that none of the data are from randomized controlled trials (RCTs), which are the gold standard of studies, but mostly observational studies that suggest an association, not a link.

Chronic kidney disease

In two separate studies, results showed that there was an increase in chronic kidney disease with prolonged PPI use (1). All of the patients started the study with normal kidney function based on glomerular filtration rate (GFR). In the Atherosclerosis Risk in Communities (ARIC) study, there was a 50 percent increased risk of chronic kidney disease, while the Geisinger Health System cohort study found there was a modest 17 percent increased risk. 

The first study had a 13-year duration, and the second had about a six-year duration. Both demonstrated modest, but statistically significant, increased risk of chronic kidney disease. But as you can see, the medications were used on a chronic basis for years. In an accompanying editorial to these published studies, the author suggests that there is overuse of the medications or that they are used beyond the resolution of symptoms and suggests starting with diet and lifestyle modifications as well as a milder drug class, H2 blockers (2).

Dementia

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A German study looked at health records from a large public insurer and found there was a 44 percent increased risk of dementia in the elderly who were using PPIs, compared to those who were not (3). These patients were at least age 75. The authors surmise that PPIs may cross the coveted blood-brain barrier and potentially increase beta-amyloid levels, markers for dementia. With occasional use, meaning once every 18 months for a few weeks to a few months, there was a much lower increased risk of 16 percent.

The researchers also suggested that PPIs may be significantly overprescribed in the elderly. Unfortunately, there were confounding factors that may have conflated the risk. Researchers also did not take into account family history of dementia, high blood pressure or excessive alcohol use, all of which have effects on dementia occurrence.

Bone fractures

In a meta-analysis of 18 observational studies, results showed that PPIs can increase the risk of hip fractures, spine fractures and any-site fractures (4). Interestingly, when it came to bone fractures, it did not make a difference whether patients were taking PPIs for more or less than a year.

They found increased fracture risks of 58, 26 and 33 percent for spine, hip and any site, respectively. It is not clear what may potentially increase the risk; however, it has been proposed that it may have to do with calcium absorption through the gut. PPIs reduce acid, which may be needed to absorb insoluble calcium salts. In another study, seven days of PPIs were shown to lower the absorption of calcium carbonate supplements when taken without food (5).

Need for magnesium

PPIs may have lower absorption effects on several electrolytes including magnesium, calcium and B12. In one observational study, PPIs combined with diuretics caused a 73 percent increased risk of hospitalization due to low magnesium (6). Diuretics are commonly prescribed for high blood pressure, heart failure and swelling.

Another study confirmed these results. In this second study, which was a meta-analysis of nine studies, PPIs increased the risk of low magnesium in patients by 43 percent, and when researchers looked only at higher quality studies, the risk increased to 63 percent (7). The authors note that a significant reduction in magnesium could lead to cardiovascular events.

The bottom line is that it’s best if you confer with your doctor before starting PPIs. You may not need PPIs, but rather a milder medication, such as H2 blockers (Zantac, Pepcid). Even better, start with lifestyle modifications including diet, not eating later at night, raising the head of the bed, losing weight and stopping smoking, if needed, and then consider medications (8).

If you do need medications, know that PPIs don’t give immediate relief and should only be taken for a short duration: 7 to 14 days, according to the FDA, without a doctor’s consult, and 4 to 8 weeks with one (9).

References:

(1) JAMA Intern Med. 2016;176(2). (2) JAMA Intern Med. 2016;176(2):172-174. (3) JAMA Neurol. online Feb 15, 2016. (4) Osteoporos Int. online Oct 13, 2015. (5) Am J Med. 118:778-781. (6) PLoS Med. 2014;11(9):e1001736. (7) Ren Fail. 2015;37(7):1237-1241. (8) Am J Gastroenterol 2015; 110:393–400. (9) fda.gov.

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

Micronutrients are vitamins and minerals needed by the body in very small amounts. METRO photo
Micronutrient focus may reduce cravings

By David Dunaief, M.D.

Dr. David Dunaief

If we needed any more proof, this past year has been a good reminder that many things influence our eating behavior, including food addictions, boredom, lack of sleep and stress. This can make weight management or weight loss very difficult to achieve.

Unfortunately, awareness of a food’s caloric impact doesn’t always matter, either. Studies assessing the impact of nutrition labeling in restaurants gave us a clear view of this issue: knowing an item’s calories either doesn’t alter behavior or encourages higher calorie purchases (1, 2).

Does this mean we are doomed to acquiesce to temptation? Actually, no: It is not solely about willpower. Changing diet composition is more important.

How can we alter the dynamic? In my clinical experience, increasing the quality of food has a tremendous impact. Foods that are the most micronutrient dense, such as plant-based foods, rather than those that are solely focused on macronutrient density, such as protein, carbohydrates and fats, tend to be the most satisfying. In a week to a few months, one of the first things patients notice is a significant reduction in cravings. But don’t take my word for it. Let’s look at the evidence.

Examining refined carbohydrates

Many of us know that refined carbohydrates are not beneficial. Worse, however, a randomized control trial showed refined carbohydrates may cause food addiction (3). Certain sections of the brain involved in cravings and reward are affected by high-glycemic foods, as shown by MRI scans of trial subjects.

Study participants consumed a 500-calorie shake with either a high-glycemic index or a low-glycemic index. They were blinded (unaware) as to which they were drinking. The ones who drank the high-glycemic shake had higher levels of glucose in their blood initially, followed by a significant decline in glucose levels and increased hunger four hours later. The region of the brain that is related to addiction, the nucleus accumbens, showed a spike in activity with the high-glycemic intake.

According to the authors, this effect may occur regardless of the number of calories consumed. Granted, this was a very small study, but it was well designed. High-glycemic foods include carbohydrates, such as white flour, sugar and white potatoes. The conclusion: Everyone, but especially those trying to lose weight, should avoid refined carbohydrates. Calorie composition matters.

Comparing macronutrients

We tend to focus on macronutrients when looking at diets. These include protein, carbohydrates and fats, but are these the elements that have the greatest impact on weight loss? In an RCT, when comparing different macronutrient combinations, there was very little difference among groups, nor was there much success in helping obese patients reduce their weight (4, 5). Only 15 percent of patients achieved a 10 percent reduction in weight after two years.

The four different macronutrient diet combinations involved overall calorie restriction. In addition, each combination had either high protein, high fat; average protein, high fat; high protein, low fat; or low protein, low fat. Carbohydrates ranged from low to moderate (35 percent) in the first group to high (65 percent) in the last group. This was another well-designed study, involving 811 participants with an average BMI of 33 kg/m², which is classified as obese.

Again, focusing primarily on macronutrient levels and calorie counts did very little to improve results.

Adding micronutrients

In an epidemiological study looking at National Health and Nutrition Examination Survey data, results demonstrate that those who are overweight and obese tend to be lacking in micronutrients (6). These include carotenoids, such as lutein, zeaxanthin, beta-carotene, alpha-carotene and beta-cryptoxanthin, as well as vitamin B12, folate and vitamins C, E and D.

Unfortunately, taking supplements won’t solve the problem; supplements don’t compensate for missing micronutrients. Quite the contrary, micronutrients from supplements are not the same as those from foods. With a few exceptions, such as vitamin D and potentially B12, most micronutrient levels can be raised without supplementation, by adding variety to your diet. Please ask your doctor.

Lowering cortisol levels

The good news is that once people lose weight, they may be able to continue to keep the weight off. In a prospective (forward-looking) study, results show that once obese patients lose weight, the levels of cortisol metabolite excretion decrease significantly (7).

Why is this important? Cortisol is a glucocorticoid, which means it raises the level of glucose and is involved in mediating visceral or belly fat. This type of fat has been thought to coat internal organs, such as the liver, and result in nonalcoholic fatty liver disease. Decreasing the level of cortisol metabolite may also result in a lower propensity toward insulin resistance and may decrease the risk of cardiovascular mortality. This is an encouraging preliminary, yet small, study involving women.

Controlling or losing weight is not solely about willpower or calorie-counting. While calories have an impact, the nutrient density of the food may be more important. Thus, those foods high in a variety of micronutrients may also play a significant role in reducing cravings, ultimately helping to manage weight.

References:

(1) Am J Pub Health 2013 Sep 1;103(9):1604-1609. (2) Am J Prev Med.2011 Oct;41(4):434–438. (3) Am J Clin Nutr Online 2013;Jun 26. (4) N Engl J Med 2009 Feb 26;360:859. (5) N Engl J Med 2009 Feb 26;360:923. (6) Medscape General Medicine. 2006;8(4):59. (7) Clin Endocrinol.2013;78(5):700-705.

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. 

Yoga can improve balance and strength, which are risk factors for falls. METRO photo
Fear of falling can lead to greater risk

By David Dunaief, M.D.

Dr. David Dunaief

Earlier in life, falls usually do not result in significant consequences. However, once we reach middle age, falls become more substantial. Even without icy steps and walkways, falls can be a serious concern for older patients, where consequences can be devastating. They can include brain injuries, hip fractures, a decrease in functional ability and a decline in physical and social activities (1). Ultimately, a fall can lead to loss of independence (2).

Contributors to fall risk

Many factors contribute to fall risk. A personal history of falling in the recent past is the most prevalent. But there are many other significant factors, such as age and medication use. Some medications, like antihypertensive medications used to treat high blood pressure and psychotropic medications used to treat anxiety, depression and insomnia, are of particular concern. Chronic diseases can also contribute.

Circumstances that predispose us to falls also involve weakness in upper and lower body strength, decreased vision, hearing disorders and psychological issues, such as anxiety and depression (3).

Simple fall prevention tips

Of the utmost importance is exercise. But what do we mean by “exercise”? Exercises involving balance, strength, movement, flexibility and endurance all play significant roles in fall prevention (4).

Many of us in the Northeast are also low in vitamin D, which may strengthen muscle and bone. This is an easy fix with supplementation. Footwear also needs to be addressed. Nonslip shoes are crucial indoors, and outside in winter, footwear that prevents sliding on ice is a must. Inexpensive changes in the home, like securing area rugs, can also make a big difference.

Medication side-effects

There are a number of medications that may heighten fall risk. As I mentioned, psychotropic drugs top the list. But what other drugs might have an impact?

High blood pressure medications have been investigated. A propensity-matched sample study (a notch below a randomized control trial in terms of quality) showed an increase in fall risk in those who were taking high blood pressure medication (5). Those on moderate doses of blood pressure medication had the greatest risk of serious injuries from falls, a 40 percent increase.

While blood pressure medications may contribute to fall risk, they have significant benefits in reducing the risks of cardiovascular disease and events. Thus, we need to weigh the risk-benefit ratio in older patients before considering stopping a medication. When it comes to treating high blood pressure, lifestyle modifications may also play a significant role in treating this disease (6).

How exercise helps

All exercise has value. A meta-analysis of a group of 17 trials showed that exercise significantly reduced the risk of a fall (7). If the categories are broken down, exercise led to a 37 percent reduction in falls that resulted in injury and a 30 percent reduction in those falls requiring medical attention. Even more impressive was a 61 percent reduction in fracture risk.

Remember, the lower the fracture risk, the more likely you are to remain physically independent. Thus, the author summarized that exercise not only helps to prevent falls but also fall injuries.

Unfortunately, those who have fallen before, even without injury, often develop a fear that causes them to limit their activities. This leads to a dangerous cycle of reduced balance and increased gait disorders, ultimately resulting in an increased risk of falling (8).

What types of exercise?

Tai chi, yoga and aquatic exercise have been shown to have benefits in preventing 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 (9). The aim of the aquatic exercise was to improve balance, strength and mobility. Results showed a reduction in the number of falls from a mean of 2.00 to a fraction of this level — a mean of 0.29. There was also a 44 percent decline in the number of exercising patients who fell during the six-month trial, with no change in the control group.

If you don’t have a pool available, Tai Chi, which requires no equipment, was also shown to reduce both fall risk and fear of falling in older adults in a randomized control trial of 60 male and female participants (10).

Another pilot study used modified chair yoga classes with a small assisted living population (11). Participants were those over 65 who had experienced a recent fall and had a resulting fear of falling. 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.

Thus, our best line of defense against fall risk is prevention. Does this mean stopping medications? Not necessarily. But for those 65 and older, or for those who have arthritis and are at least 45 years old, it may mean reviewing your medication list with your doctor. Before considering changing your blood pressure medications, review the 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) JAMA. 1995;273(17):1348. (4) Cochrane Database Syst Rev. 2012;9:CD007146. (5) JAMA Intern Med. 2014 Apr;174(4):588-595. (6) JAMA Intern Med. 2014;174(4):577-587. (7) BMJ. 2013;347:f6234. (8) Age Ageing. 1997 May;26(3):189-193. (9) Menopause. 2013;20(10):1012-1019. (10) Mater Sociomed. 2018 Mar; 30(1): 38–42. (11) 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. 

Sleep clears toxins from the brain. METRO photo
Exercise and sleep are crucial to clearing the clutter

By David Dunaief, M.D.

Dr. David Dunaief

Considering the importance of our brain to our functioning, it’s startling how little we know about it. 

We do know that certain drugs, head injuries and lifestyle choices negatively impact the brain. There are also numerous disorders and diseases that affect the brain, including neurological (dementia, Parkinson’s, stroke), infectious (meningitis), rheumatologic (lupus and rheumatoid arthritis), cancer (primary and secondary tumors), psychiatric mood disorders (depression, anxiety, schizophrenia), diabetes and heart disease.

Although these diseases vary widely, they generally have three signs and symptoms in common: they either cause altered mental status, physical weakness or change in mood — or a combination of these.

Probably our greatest fear regarding the brain is a loss of cognition. Fortunately, there are several studies that show we may be able to prevent cognitive decline by altering modifiable risk factors. They involve rather simple lifestyle changes: sleep, exercise and possibly omega-3s.

Let’s look at the evidence.

Clutter slows us down as we age

The lack of control over our mental capabilities as we age frightens many of us. Those who are in their 20s seem to be much sharper and quicker. But are they really?

In a study, German researchers found that educated older people tend to have a larger mental database of words and phrases to pull from since they have been around longer and have more experience (1). When this is factored into the equation, the difference in terms of age-related cognitive decline becomes negligible.

This study involved data mining and creating simulations. It showed that mental slowing may be at least partially related to the amount of clutter or data that we accumulate over the years. The more you know, the harder it becomes to come up with a simple answer to something. We may need a reboot just like a computer. This may be possible through sleep, exercise and omega-3s.

Get enough sleep

Why should we dedicate 33 percent of our lives to sleep? There are several good reasons. One involves clearing the mind, and another involves improving our economic outlook.

For the former, a study done in mice shows that sleep may help the brain remove waste, such as those all-too-dangerous beta-amyloid plaques (2). When we have excessive plaque buildup in the brain, it may be a sign of Alzheimer’s. When mice were sleeping, the interstitial space (the space between brain gyri, or structures) increased by as much as 60 percent.

This allowed the lymphatic system, with its cerebrospinal fluid, to clear out plaques, toxins and other waste that had developed during waking hours. With the enlargement of the interstitial space during sleep, waste removal was quicker and more thorough, because cerebrospinal fluid could reach much farther into the spaces. A similar effect was seen when the mice were anesthetized.

In another study, done in Australia, results showed that sleep deprivation may have been responsible for an almost one percent decline in gross domestic product for the country (3). The reason? People are not as productive at work when they don’t get enough sleep. They tend to be more irritable, and concentration may be affected. We may be able to turn on and off sleepiness on short-term basis, depending on the environment, but we can’t do this continually.

According to the Centers for Disease Control and Prevention, four percent of Americans reported having fallen asleep in the past 30 days behind the wheel of a car (4). And “drowsy driving” led to 83,000 crashes in a four-year period ending in 2009, according to The National Highway Traffic Safety Administration.

Prioritize exercise

How can I exercise, when I can’t even get enough sleep? Well there is a study that just may inspire you.

In the study, which involved rats, those that were not allowed to exercise were found to have rewired neurons in the area of their medulla, the part of the brain involved in breathing and other involuntary activities. There was more sympathetic (excitatory) stimulus that could lead to increased risk of heart disease (5). In rats allowed to exercise regularly, there was no unusual wiring, and sympathetic stimuli remained constant. This may imply that being sedentary has negative effects on both the brain and the heart.

This is intriguing since we used to think that our brain’s plasticity, or ability to grow and connect neurons, was finite and stopped after adolescence. This study’s implication is that a lack of exercise causes unwanted new connections. Human studies should be done to confirm this impact.

Consume omega-3 fatty acids

In the Women’s Health Initiative Memory Study of Magnetic Resonance Imaging Study, results showed that those postmenopausal women who were in the highest quartile of omega-3 fatty acids had significantly greater brain volume and hippocampal volume than those in the lowest quartile (6). The hippocampus is involved in memory and cognitive function.

Specifically, the researchers looked at the levels of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in red blood cell membranes. The source of the omega-3 fatty acids could either have been from fish or supplementation.

It’s never too late to improve brain function. Although we have a lot to learn about the functioning of the brain, we know that there are relatively simple ways we can positively influence it.

References:

(1) Top Cogn Sci. 2014 Jan.;6:5-42. (2) Science. 2013 Oct. 18;342:373-377. (3) Sleep. 2006 Mar.;29:299-305. (4) cdc.gov. (5) J Comp Neurol. 2014 Feb. 15;522:499-513. (6) Neurology. 2014;82:435-442.

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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Resolutions that focus on health and fitness are made each year. Numerous people are eager to lose weight, improve their physical fitness levels or even stop habits that can hinder their mental or physical wellness.

People have many options when they seek to lose weight. Fad diets may promise quick results, but highly restrictive eating plans or marathon workout sessions can be dangerous. Taking shortcuts or risks in the hopes of losing weight can lead to various health issues and ultimately put people’s overall health in serious jeopardy. Thankfully, there are many safe ways people can lose weight. The first step in safe weight loss is to visit a doctor and let him or her know your plans. The doctor can help determine if a specific eating plan or exercise routine is safe based on your current health.

Certain medications can affect metabolism and even contribute to weight gain, so a discussion with the doctor can help ensure people aren’t putting their health in jeopardy when their goal is to get healthy. It’s also vital that people trying to lose weight do not believe everything they read online.

Research published in The American Journal of Public Health in October 2014 found that most people who search the internet for tips on how to lose weight come across false or misleading information on weight loss, particularly in regard to how quickly they can shed some pounds. The Centers for Disease Control and Prevention advises the safest amount of weight to lose per week is between one and two pounds. People who lose more per week, particularly on fad diets or programs, oftentimes are much more likely to regain weight later on than people who took more measured approaches to losing weight.

In addition, the Academy of Nutrition and Dietetics notes it is better to lose weight gradually because if a person sheds pounds too fast, he or she can lose muscle, bone and water instead of fat. The calories in, calories out concept is something to keep in mind when attempting to lose weight. But metabolism and other factors, including body composition and physical activity levels, also are factors. How well one’s body turns calories into fuel also needs to be considered. The best ways to experiment are to start slowly. • Calculate the average daily calories consumed in a day using a tracker. This can be a digital app on a phone or simply writing down calories on a piece of paper. Track over a few days and see, on average, how many calories you’ve been consuming.

• Notice extra calories. Many diets can be derailed by eating extra calories that you don’t realize you’re consuming. That cookie a coworker insists you eat or the leftover mac-and-cheese from your toddler’s plate can be sources of extra calories. Be mindful of what’s being consumed, including sweetened beverages.

• Explore the science. According to the Scotland-based health service NHS Inform, one pound of fat contains 3,500 calories on average. Cutting calorie intake by 500 calories per day should see you lose 1 pound per week. The same goes in the other direction. Eating 500 more calories per day for a year can result in gaining close to 50 pounds. Small changes really add up.

• Eat filling foods. Choose low-calorie, high quality foods, like vegetables, whole grains and lean proteins. Meals that provide satiety can help eliminate between-meals snacks that can derail your weight loss efforts.

• Seek support as a way to create accountability. Share weight loss plans with a friend or relative who can help monitor your progress and keep you on track.

• Incorporate strength training. Good Housekeeping says the more lean muscle you have, the faster you can slim down. Start slowly with strength training, using free weights or body weights. Aim for strength workouts three to four times per week and alternate with calorie-blasting cardio. Explore safer ways to lose weight, including taking a gradual approach that promotes long-term weight loss.

A sign of the times outside Smithtown Town Hall. Photo courtesy of Smithtown Library

Even before some family gatherings provide a potential breeding ground for the coronavirus, Suffolk County residents have tested positive for COVID-19 at rates not seen since the worst of the first wave, in April.

In the last day, 501 people have tested positive for the coronavirus which is the highest number since April. That represents a 4 percent positive test rate, which is also the highest figure since May 18.

“It is unclear if we are plateauing or whether [these numbers] will continue to go up,” County Executive Steve Bellone (D) said on a conference call with reporters. He is concerned about “where we may go after the Thanksgiving holidays.”

Indeed, Dr. Shahida Iftikhar, Deputy Commissioner for the Department of Health, said the numbers were likely climbing as a result of smaller gatherings, which is what triggered an increase after the Halloween weekend.

Long Island surpassed 1,000 cases on Tuesday, according to officials. More communities on Long Island are close to being named so-called yellow zones by the state, which might mean more restrictions and the potential rolling back of the phased reopening seen earlier this year.

Gov. Andrew Cuomo (D) said during his Wednesday livestream the virus is being spread mainly by bars and restaurants that sell alcohol, gyms and small gatherings. New restrictions have been placed on all three earlier this month. Cuomo also said places like Monroe County, whose officials said cases were mainly due to small gatherings and not places like gyms, were outliers, and stressed people limit gatherings on Thanksgiving.

I give thanks for the intelligence of New Yorkers, but we have to stay safe, we have to keep the infection rate down through the thanksgiving holiday,” he said. ““Don’t be a turkey, wear a mask this Thanksgiving.”

Despite the move away from contact tracing in other regions with widespread community spread, Suffolk County continues to use contact tracers to call people who have received positive tests and to warn anyone they might have infected.

For those residents who have received a negative COVID test and plan to gather with family and friends, Dr. Gregson Pigott, Commissioner in the County Department of Health, cautioned that people can have a negative test and still transmit the virus after they are exposed.

There is a lot of “asymptomatic spread,” Pigott warned.

To limit the spread of the virus, Bellone urged people to follow state guidelines, limiting gatherings to 10 people, washing their hands, wearing face coverings where possible and keeping a distance of at least six feet, particularly from vulnerable members of the population.

In anticipation of gatherings, the Suffolk County Police Department has added patrols and will perform compliance checks with bars and restaurants to ensure that these businesses are adhering to the state requirements that they shut down indoor food and beverage service after 10 p.m.

The SCPD will not go from house to house counting cars, but they will respond to any reports of private residences that exceed the 10-person limit.

New York State has designated Riverhead and Hampton Bays as yellow zones. Bellone encouraged residents living within these zones to get tested. Residents can find testing sites at the web site suffolkcountyny.gov.

Cuomo said New York, among other states, has started adding field hospitals again, much like what was seen during the first wave of the pandemic. The first field hospital has been set up in Staten Island, though more be on the way.

Free testing sites, supported by New York State, are opening Monday at the Northwell Health Dolan Family Healthy Center in Huntington and on Tuesday at Sun River Health in Patchogue.

As the Board of Elections continues to count votes, Bellone said one of the people who worked for the elections tested positive. The county has tested 111 people who worked in the building, with eight people testing positive and 37 quarantined because of close contact.

On the positive side, Suffolk County’s testing in schools in Riverhead and Hampton Bays has demonstrated a low rate of infection. In Riverhead, 12 out of 524 people tested positive, while Hampton Bays had four positive tests out of 417 people tested.

“While we continue to monitor the rise in cases, we are not currently seeing community spread happening in our schools,” Bellone said. “As long as students and faculty are kept safe, schools should remain open.”

Additional reporting by Kyle Barr

METRO photo
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.

Suffolk County Executive Steve Bellone. File photo by Alex Petroski

On the night before Thanksgiving, high school and college students typically come together to reconnect, share stories and share a drink.

This year, as COVID-19 cases climb throughout the U.S., including in Suffolk County, County Executive Steve Bellone (D), along with the Suffolk County Police Department and local enforcement offices, are discouraging gatherings that might cause further spread of the virus.

Enforcement efforts will using social host laws, which fine residents for allowing underage drinking, and state-mandated gathering restrictions, which combined, could lead to “serious consequences,” Bellone said on a conference call with reporters Nov. 17.

“No matter where you are or what you are doing, social distancing and mask guidelines must be followed,” Bellone said. “We’ve come too far to go back now.”

With new state restrictions that limit the sale of alcohol after 10 p.m. through bars and restaurants, Bellone said enforcement efforts would be on the look out for gatherings at private residences. Some of these viral spreading events have occurred during smaller gatherings.

“The spread of COVID-19 at these types of parties is very, very real,” Bellone said. “We’ve seen it countless times. We all need to take personal responsibility,” which includes parents who need to comply with social host laws and the state’s gathering limits in homes.

Bellone announced a partnership between the Suffolk County Department of Health and the nonprofit Partners in Prevention, which is starting a social media campaign to inform the community about social host laws. Bellone called this information “critical” leading up to Thanksgiving celebrations.

While Suffolk County enforcement efforts will respond to calls about larger group gatherings, Bellone said police would use “common sense” and would not be “going door to door to check on the number of individuals in a house.”

As for the infection rates, the numbers continue to rise, returning to levels not seen in months.

“We expect our numbers [of positive tests] to be around 400 today,” Bellone said. The positivity rate is about 3.4 percent, while the number of people hospitalized with symptoms related to the virus approaching 100.

“We have not been above 100 since June 18,” Bellone said. In the last 24 hours, the number of people who have required hospitalization from the virus increased by 16.

While the virus has exhausted people physically and mentally, the county cannot “jeopardize our continued economic recovery” and the health of the population by stepping back from measures such as social distancing, mask wearing and hand washing that proved so effective in reducing the spread earlier this year, Bellone said.

“Now is the time to double down on common sense measures that work,” he added.

Some of the positive tests are coming from people in nursing homes, who are among the most vulnerable population.

“With the nursing homes, that is obviously a big concern,” Bellone said. The county is “making sure they have the PPE [personal protective equipment] they need.”

The Department of Health is staying in close contact with these facilities as cases continue to climb.

Bellone urged residents who dined at a Friendly’s restaurant in Riverhead on Nov. 5 or 6 to monitor their symptoms for the next two weeks. Six adults who worked at the restaurant have tested positive for the virus.

Anyone who is exhibiting symptoms of the virus, which include fever, a runny nose, lost of taste or smell, fatigue, shortness of breath, can find a testing site at suffolkcountyny.gov/covid19.

Separately, when asked about the possibility of schools closing in response to the increasing incidence of positive tests, Bellone urged schools to remain open at this testing level.

“We are not seeing the spread happening in the schools,” Bellone said. “The protocols being put in place and the execution in the schools has really worked.”