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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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Join Sweetbriar Nature Center, 62 Eckernkamp Drive, Smithtown for a transformative Year of the Snake Sound Healing Workshop on Friday, Jan. 31 at 6:30 p.m. Immerse yourself in soothing sounds and vibrations that will help you release stress, find balance, and connect with your inner self. This workshop is designed to promote relaxation and rejuvenation as we welcome the energy of the new year. Don’t miss this opportunity to tap into the healing power of sound and meet some of Sweetbriar’s resident snakes. Reserve your spot today and start the Year of the Snake with clarity and intention. $25 per person. To register, visit www.sweetbriarnc.org. For more information, call 631-979-6344.

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Improve fatigue, mood, headaches and itchy skin

By David Dunaief, M.D.

Dr. David Dunaief

Brrr! It’s been super cold this winter, and heating systems have been in overdrive. All the dry heat pumping into our homes, offices and cars can have a dehydrating effect on our bodies. Symptoms of dehydration can range from itchy skin and constipation to fatigue, mood changes and headaches. Our dry throats and sinuses can also make us uncomfortable and more susceptible to irritations and viruses. More serious complications of dehydration can include migraines, heart palpitations and heart attacks. 

Let’s look at techniques for improving hydration and reducing the symptoms and consequences of all this dry air.

Improve ambient humidity

Measure the humidity level in your home with a hygrometer and target keeping it between 30 and 50 percent (1). When the temperature outside drops below 10 degrees Fahrenheit, lower this to 25 percent. You can add moisture to the air in several ways. Use cool mist humidifiers, keep the bathroom door open after you shower or bathe, and place bowls of water strategically around your home, including on your stovetop when you cook or on radiators. If you use humidifiers, take care to follow the manufacturer’s care instructions and clean them regularly, so you don’t introduce mold or bacteria into the air.

Reduce headaches and migraines

A review of studies found that those who drank four cups or more of water had significantly fewer hours of migraine pain than those who drank less (2). Headache intensity decreased as well.

Decrease heart palpitations

Heart palpitations are common and are broadly felt as a racing heart rate, skipped beat, pounding sensation or fluttering. Although they are not usually life-threatening, they can make you anxious. Dehydration and exercise contribute to this (3). Palpitations can be prompted when we don’t hydrate before exercising. If you drink one glass of water before exercise and continue to drink during exercise, it will help avoid palpitations.

Lower your heart attack risk

The Adventist Health Study showed that men who drank more water had the least risk of death from heart disease (4). Group one, which drank more than five glasses of water daily, had less risk than group two, which drank more than three. Those in group three, which drank fewer than two glasses per day, saw the lowest benefit, comparatively. For women, there was no difference between groups one and two, although both fared better than group three. The reason for this effect, according to the authors, may relate to blood or plasma viscosity (thickness) and fibrinogen, a substance that helps clots form.

Resolve decreased concentration and fatigue

Mild dehydration resulted in decreased concentration, subdued mood, fatigue and headaches in women in a small study (5). Dehydration was prompted by walking on a treadmill and taking a diuretic (water pill) prior to the exercise. Results were compared to a control group that did not take the diuretic. The authors concluded that adequate hydration was needed, especially during and after exercise.

Consume hydrating foods

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How much water you need to drink depends on your diet, activity levels, environment and other factors. In a review article, researchers analyzed the data, but did not find adequate studies to suggest that eight glasses a day is a magic number (6). It may be too much for some patients.

You can increase your hydration by altering your diet. Diets with a focus on fruits and vegetables increase water consumption (7). As you may know, 95 percent of the weights of many fruits and vegetables are attributed to water. An added benefit is an increased satiety level without eating calorically dense foods.

In a review, it was suggested that caffeinated coffee and tea don’t increase the risk of dehydration, even though caffeine is a mild diuretic (8). With moderate amounts of caffeinated beverages, the liquid in them has a more hydrating effect than its diuretic effect. Remember that salty foods can dehydrate you, including soups, breads and pastries, so try to avoid these.

It is important to stay hydrated to avoid uncomfortable — and sometimes serious — complications. Diet is a great way to ensure that you get the triple effect of high nutrients, increased hydration and sense of feeling satiated without calorie-dense foods. However, don’t go overboard with water consumption, especially if you have congestive heart failure or open-angle glaucoma (9).

References:

(1) epa.gov (2) Handb Clin Neurol. 2010;97:161-72. (3) my.clevelandclinic.org. (4) Am J Epidemiol 2002 May 1; 155:827-33. (5) J. Nutr. February 2012 142: 382-388. (6) AJP – Regu Physiol. 2002;283:R993-R1004. (7) Am J Lifestyle Med. 2011;5(4):316-319. (8) Exerc Sport Sci Rev. 2007;35(3):135-140. (9) Br J Ophthalmol. 2005:89:1298–1301.

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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Home remedies may be more helpful than supplements

By David Dunaief, M.D.

Dr. David Dunaief

These past few weeks, I’ve been hearing a lot more sniffling, sneezing and coughing. Cold season is here. A cold’s effects can range from mild annoyance to more serious symptoms that put us out of commission for weeks.

First, you might be able to prevent catching a cold with some common-sense tactics: wash your hands frequently and avoid touching your face to help minimize your exposure. Frankly, this is good practice to avoid many of the viruses circulating at this time of year.

If you do catch a common cold, you might be able to reduce your symptoms or the cold’s duration with some simple homestyle remedies and a few dietary supplements. 

How do you relieve cold symptoms?

Congestion or coughing symptoms can be eased by sitting in a steamy bathroom. This simulates a medical mist tent, moisturizing your nasal and bronchial passages. 

You might also try nasal irrigation, which uses a saline rinse or spray to flush your sinuses. This can help clear immediate congestion and thin secretions (1). There are pre-filled versions on the market, which make them easier to use. If you mix your own, the Cleveland Clinic’s website has detailed instructions and guidance (2). A few key points: do not share equipment, clean your equipment properly, and do not use tap water without boiling it.

Dry heat is your enemy when you’re experiencing cold symptoms. If your home or office is dry, use a cool mist humidifier to put some humidity back in the air. Take care to clean your humidifier to avoid mildew and mold buildup.

You can eat salt-free soups loaded with vegetables to increase your nutrient intake and loosen congestion. I start with a sodium-free soup base and add spices, onions, spinach, broccoli, and other greens until it’s stew-like. High levels of sodium can dehydrate you and make you feel worse. Caffeine-free hot teas will also help loosen congestion and keep you hydrated.

Does Zinc reduce a cold’s duration?

According to a meta-analysis that included 13 trials, zinc in any form taken within 24 hours of your first symptoms may reduce the duration of a cold by at least one day (3). Even more importantly, zinc may significantly reduce the severity of your symptoms throughout, improving your quality of life. This may be due to an anti-inflammatory effect.

One of the studies found that zinc reduced the duration of the common cold by almost 50 percent from seven days to four days, cough symptoms were reduced by greater than 60 percent, and nasal discharge was reduced by 33 percent (4). Researchers used 13 grams of zinc acetate per lozenge taken three-to-four times daily for four days. This translates into 50-65 mg per day.

There are a few serious concerns with zinc. First, the dose researchers used was well above the maximum recommended intake is 40 mg per day for adults (5). Also, the FDA has warned against nasal zinc administration with sprays, which can result in permanent loss of smell.

Studies that showed a benefit have used different formulations, delivery systems and dosages, and there is no current recommendation or consensus on what is optimal.

Does vitamin C or echinacea help?

According to a review of 29 trials, vitamin C did not show any significant benefit in preventing or reducing cold symptoms or duration for the general population (6). However, a sub-group of serious marathon runners and other athletes who took vitamin C prophylactically caught 50 percent fewer colds.

The jury is still out on the effectiveness of echinacea for treatment of duration and symptoms, but the results are inconsistent and disappointing (7). In a randomized controlled trial with 719 patients, echinacea was no better than placebo for the treatment of common cold symptoms (8). There are ongoing studies to determine whether prophylactic use helps prevent colds (9). 

Should you exercise or not?

A study published in the British Journal of Sports Medicine may challenge your perceptions about exercising when you have a cold. Participants who did aerobic exercise at least five days per week, versus one or fewer days per week, had a 43 percent reduction in the number of days with colds over two 12-week periods during the fall and winter months (10). Even more interesting is that those who reported themselves as being highly fit had 46 percent fewer days with colds compared to those who perceived themselves as having low fitness. Their cold symptoms were reduced significantly as well.

References:

(1) Am Fam Physician. 2009 Nov 15;80(10):1117-9. (2) clevelandclinic.org (3) Open Respir Med J. 2011; 5: 51–58. (4) J Infect Dis. 2008 Mar 15;197(6):795-802. (5) ods.od.nih.gov. (6) Cochrane Database of Syst Reviews 2013, Issue 1. Art. No.: CD000980. (7) Cochrane Database of Syst Reviews 2014, Issue 2. Art. No.: CD000530. (8) Ann Intern Med. 2010;153(12):769-777. (9) nccih.nih.gov. (10) British J Sports Med 2011;45:987-992.

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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Individuals who have had multiple Covid-19 infections appear prone to contracting Long Covid, which may include symptoms such as fatigue, respiratory distress and mental fog.

Study published in The Lancet provides a basis for investigating Long Covid in the post-pandemic era

A new study that identified 475 patients with post-acute sequelae of Covid-19 (PASC), also known as Long Covid, revealed that nearly 85 percent (403) of these patients had multiple Covid-19 infections over the course of a four-year period (March 2020 to February 2024). Additionally, vaccination independently reduced the risk of Long Covid in patients who had received the vaccination prior to contracting the infection.

Conducted by a team of researchers at the Renaissance School of Medicine (RSOM) at Stony Brook University, in conjunction with the Stony Brook World Trade Center (WTC) Health and Wellness Program, the study may serve as a foundational assessment of Long Covid patients in the post-pandemic era. To date there are few studies with such a patient sample size that investigates what puts patients at risk for Long Covid and what causes this chronic condition.

The findings are published early online in the February edition of The Lancet Regional Health – Americas.

“While it is possible that the causes of Long Covid could be many and variable depending on the patient population studied, with this cohort the evidence is clear that by having Covid numerous times, patients became more at-risk for developing Long Covid,” says lead author Sean Clouston, PhD, Professor, Department of Family, Population and Preventive Medicine in the RSOM, and Program in Public Health.

He adds that after adjusting for relevant demographic, lifestyle, and clinical variables, the findings reveal a statistically significant association between experiencing multiple Covid-19 infections and the risk of experiencing PASC (aka Long Covid).

The patients were identified from a group of more than 2,500 first responders who previously had Covid and are prospectively monitored for infection complications by the Stony Brook WTC Health and Wellness Program. The 475 identified with Long Covid by the Program’s physicians, led by Benjamin Luft, MD, Director of the Program, continually experienced Long Covid symptoms ranging from fatigue, mental fog, other neurological conditions, as well as multiple respiratory problems and gastrointestinal symptoms.

Given that some of the first responder patients have had symptoms over the years related to their environmental exposures, such as respiratory illnesses, Long Covid symptoms were identified and charted separately and after each subsequent Covid infection.

Since there is no diagnostic test for Long Covid, the researchers followed the World Health Organization’s guidelines as to identifying Long Covid. They identified participants with Long Covid as having experienced the continuation or development of at least one new symptom that emerged within three months after their initial Covid-19 infection and persisted for at least two months without other concurrent medical explanation. In contrast, those without such experiences after having Covid were placed in the non-Long Covid group.

“There are some possible pathogenic mechanisms that cause Long Covid, but the entire spectrum of its risk factors remains unknown,” explains Dr. Luft, a co-author, the Edmund D. Pellegrino Professor of Medicine in the RSOM, and an infectious diseases specialist. “This is why our study and future ones are so important. Identifying specific risk factors such as re-infection or lack of vaccination can assist in better understanding and managing the condition.”

The authors point out that the safest way to avoid contracting Long covid is to prevent the infection in the first place. However, they emphasize that the role of vaccination in the risk of developing Long Covid cannot be underestimated. They wrote, “Among those who later developed PASC, we found that the risk of PASC was much higher among individuals who were unvaccinated at the time of their first (Covid-19) infection.”

Dr. Luft adds that the vaccine is imperfect, and of those who develop Covid – even though vaccinated – are at risk and should take measures to mitigate the severity of infection.

This research was supported in part by the National Institutes of Health’s National Institute on Aging (NIA) and National Institute for Occupational Safety and Health (NIOSH) – grants (NIH/NIA R01 AG049953), and the Centers for Disease Control and Prevention – grants (CDC/NIOSH U01 OH011864) and (CDC/NIOSH U01 OH012275).

 

 

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Stress is a part of life. In small doses, stress can have a positive effect. But when stress is chronic, it can take its toll on the body and mind. Stress can make people irritable and cause them to lash out at others. Stress also can contribute to high blood pressure and adversely affect sleep. When confronting chronic stress, individuals may have to take action to find relief. These stress-busting strategies can help.

• Engage in physical activity. The Mayo Clinic says any form of exercise can help relieve stress. Physical activity boosts chemicals in the brain and endorphins that help a person feel good. Exercise also can refocus attention so a person is not preoccupied with a stressful thought or situation.

• Listen to music. Music can be calming and serve as a distraction from stressful feelings. Simply listening to music can be a quick fix for a stressful situation and a bad mood.

• Review your lifestyle. It’s easy to take on too much, but doing so can lead to feelings of being overwhelmed, says the Mental Health Foundation. Prioritizing some things over others and delegating when possible can tame stress.

• Practice mindfulness. Breathing and mindfulness exercises can be practiced anywhere. Research has shown that mindfulness can reduce the effects of stress and anxiety. Deep breathing and being in a quiet moment when stress peaks may help to reduce stress.

• Step away for a few minutes. If possible, step away from a stressful situation, whether it is a difficult project at work or a loud room with a lot of activity going on. Many people find commuting stressful. Changing the route to one that avoids busy roads, even if it takes a bit longer to get from point A to point B, might help.

• Talk it out. Sometimes connecting with others and sharing experiences can help to relieve stress. Keeping feelings in and fixating on a situation may exacerbate feelings of stress. Social situations that encourage talking and laughing can lighten a person’s mental load, says the Mayo Clinic.

• Don’t turn to substances. Alcohol and drugs may temporarily relieve stress, but this approach can lead to addiction and even worsen the physical and mental toll stress takes on the body.

Stress is a part of life, but finding ways to manage chronic stress is vital to long-term health.

Source: MetroCreative Connection

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From wearables to apps, New Year’s fitness resolutions are getting a tech boost that’s catching on, with many spending 23% more time on average on fitness-related apps in the last year.

At midnight on New Year’s Eve, many make a familiar pledge: to get fit.

For the nearly half of all U.S. adults who make fitness-related resolutions, technology such as wearable devices and apps can be key to keeping this pledge, said A’Naja Newsome, Ph.D., a Researcher and Assistant Professor at the University of Central Florida who has written about fitness technology. Newsome also hosts a podcast, Strength in the Details, on which she talks about the impact of mental health, nutrition and leadership on strength training.

“Technology has really been adapted and modified to be appealing to a wide genre of exercisers,” Newsome said. “People just really have to prioritize what’s going to be important to them right now and invest in that.”

Your Goals, Your Way

There’s no one-size-fits-all for fitness technology. Start with an assessment of what you value and what your fitness goals are, Newsome says. Whether you’re planning to run an ultramarathon or signing up for your first gym membership, there’s something for everyone to keep their resolutions.

“We have so many of these wearable devices that can track things like heart rate, calories, steps and more,” Newsome said. “And then we have things like mobile apps where people can use paid or free services to track their daily physical activity behaviors.”

Beginners can start with mobile apps that come with quick and simple workouts – and if they value aesthetics, they can invest in wearables that also serve as a fashion piece, she says.

Physical activity tracking devices have historically been geared to sport-specific athletes, particularly in running and cycling. However, “we’re also seeing it expand to outdoor sports like hiking, climbing and swimming, and we’re even starting to see tech for things like flexibility and mobility training and special populations like pre- and postnatal individuals,” Newsome said.

The expansion of these technologies is leading to a shift back to basic fitness practices, she says, with a focus on everyday activities and movements such as time spent standing, daily steps, breathing and meditation rather than specific, structured exercise routines.

“Wearable technology now is telling us what is happening with the rest of our day,” Newsome said. “What is happening with our sleep? What is happening with our steps? What is happening with our sedentary behavior?”

The fitness technology market has grown as more people turn to apps to support their goals. For example, among T-Mobile customers, the average time spent per month using fitness-related apps – such as running, weight and fitness trackers – increased by 23% between 2023 and 2024.

Newsome said she expects the mobile apps and wearable device markets to continue to grow in 2025. The next frontier is integrating these technologies into healthcare in the future, allowing for more holistic treatment plans and monitoring capabilities, she added.

Make It Personal

Choosing new fitness technology is a personal decision based on individual values and priorities. Now, artificial intelligence is taking personalization even further by creating workout plans tailored to an individual’s unique data, Newsome said.

“AI is generating these customizable workouts for your home gym, for on-the-go, your travel, for those that are short on time,” she said. “That’s going to reach a demographic of people who maybe thought that they didn’t have the time to exercise or for those that just didn’t have the know-how to exercise.”

Wearable tech, mobile apps and AI can be even more supercharged with human input, Newsome said. She advised people to consult with an exercise professional or their medical provider before embarking on a new fitness regimen or making significant changes based on their wearable technology data.

Social support is the key factor in helping people change their behavior, she said, so supplement the benefits from wearable devices and mobile apps by seeking out peers and professionals. She also advises to not rely on technology so much that it creates a barrier to reaching your goals, like skipping a workout because your smart watch ran out of battery.

With all the innovations that promise to up performance and get people moving, there’s never been a better time to conquer your fitness goals. So as the clock strikes midnight on New Year’s Eve, remember: Fitness technology can give you a push, but the most important piece of equipment is your willpower, and all it takes is the first step. You’ve got this! (BPT)

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By David Dunaief, M.D.

Dr. David Dunaief

Dear Santa,

I’m sure you have a lot on your mind these days, with an abundance of Christmas requests and only a few remaining days to fill them.

My message is intended as a gift for you, not a request for myself. Your kindness and generosity toward others deserve to be returned. I am concerned about your growing belly, which has been compared to a bowl full of jelly when you laugh. Honestly, your upcoming journey around the world will likely make it worse. The cookies and milk, along with other sweets left for you on Christmas Eve, are only likely to make it worse.  

I’m concerned about your health and about the message it sends to kids. We’re currently dealing with an epidemic of overweight kids, which has contributed to the growing number of children with type 2 diabetes. According to the CDC, these numbers only get worse as children age.

You, Santa, can help reverse this trend and stem the increased risks of pancreatic cancer, breast cancer, liver cancer and heart disease that central belly fat promotes. Help children improve health outcomes that will follow them throughout their lives.

This is your opportunity to model the way — and, maybe fit back into that clingy tracksuit you’ve had in the back of your closet since the early 18th century, when you were still trim.

Think of the advantages of losing that extra weight. Your joints won’t ache as much in the cold; your back doesn’t hurt as much; and you will have more energy. Studies show that eating more fruits, vegetables and whole grains can reverse clogged arteries and help you avoid strokes, heart attacks and peripheral vascular disease. Even a simple change, like eating a small handful of raw nuts each day, can reduce your heart disease risk significantly.

Losing weight will also make it easier for you to keep your balance on steep, icy rooftops. No one wants you to take a tumble and break a bone — or worse.

Exercise will help, as well. Maybe this Christmas Eve, you could walk or jog alongside the sleigh for the first continent or two. During the “offseason” you and the elves could train for the North Pole After Christmas 5k. Having a team to train with is much more fun.

If you add some weight training into your routine, you’ll strengthen your core. In addition, your new muscles will help melt away fat from your midsection.

It doesn’t have to be a chore. After all, who doesn’t love a game of tag with the reindeer? 

If you really want to make a strong start, take a cue from the reindeer, who love their raw carrots and celery. Broadcast that the modern Santa enjoys fruits, especially berries and veggies, with an emphasis on cruciferous veggies like broccoli florets dipped in humus, which have antioxidant qualities and can help reverse disease.

And, of course, don’t put candy in our stockings. We don’t need more sugar, and I’d guess that, over the long night, it’s hard to resist sneaking a few pieces, yourself. Why not reduce the temptation? This will also eliminate the sugar highs and lows you feel during your all-night expedition.

As for your loyal fans, you could place active games under the tree. You and your elves could create a phone app with free workout videos for those of us who need them; we could join in as you showed us “12 Days of Dance-Offs with Santa.”

Think about giving athletic equipment, such as baseball gloves, soccer balls, and basketballs, instead of video games. Or wearable devices that track step counts and bike routes. Or stuff gift certificates for dance lessons into people’s stockings.

As you become more active, you’ll find that you have more energy all year round, not just on Christmas Eve. If you start soon, Santa, maybe by next year, you’ll be able to park the sleigh farther away and skip to each of the neighborhood chimneys.

The benefits of a healthier Santa will be felt across the world. Your reindeer won’t have to work as hard. You could fit extra presents in your sleigh. And Santa, you will be sending kids and adults the world over the right message about taking control of their health with nutrition and exercise. That’s the best gift you could give!

Wishing you good health in the coming year,

David

P.S. If it’s not too late to ask, I could use a bucket of baseballs and a new glove. I hear the Yankees have an opening for an outfielder, so I need to start practicing.

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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Legumes can reduce your risk significantly

By David Dunaief, M.D.

Dr. David Dunaief

How would you like to be “heart attack proof?” This term was introduced by Dr. Sanjay Gupta and later gained traction when it was iterated by Dr. Dean Ornish. While it’s probably not possible to be completely heart attack proof, research shows us that it is possible to significantly reduce your risk by important lifestyle choices.

About five percent of U.S. adults over age 19 have coronary artery disease (CAD), the most common type of heart disease (1). This contributes to a heart attack rate of one every 40 seconds. We can do better.

Many of the biggest contributors to heart disease risk are well-known: high blood pressure, high cholesterol, and smoking. In addition, if you have diabetes or are overweight or obese, your risk increases significantly. Lifestyle factors, such as poor diet, lack of physical activity and high alcohol consumption are among the significant risk contributors.

This is where we can dramatically reduce the occurrence of CAD. Evidence continues to highlight that lifestyle changes, including diet, are the most critical factors in preventing heart disease. Dietary changes that have a significant impact include consuming dietary fiber, legumes, nuts, omega-3 polyunsaturated fatty acids (PUFAs), and chocolate.

Increase your dietary fiber

We can significantly reduce our heart disease risk if we increase our fiber consumption to recommended levels.

The more fiber you eat, the greater you reduce your risk. In a meta-analysis of 10 studies that included over 90,000 men and 200,000 women, results showed that for every 10-gram increase in fiber, participants experienced a corresponding 14 percent reduction in their risk of a cardiovascular event and a 27 percent reduction in their risk of heart disease mortality (2).

According to a 2021 analysis of National Health and Nutrition Examination Survey (NHANES) data from 2013 to 2018, only 5 percent of men and 9 percent of women get the recommended daily amount of fiber (3). The average American consumes about 16 grams per day of fiber (4).

The Academy of Nutrition and Dietetics recommends 14 grams of fiber for every 1,000 calories consumed, or roughly 25 grams for women and 38 grams for men (5).

Good sources of fiber are fruits and vegetables eaten with edible skin or peel, beans, lentils, and whole grains.

Various legumes.

Eat your legumes 

In a prospective (forward-looking) cohort study, legumes reduced the risk of coronary heart disease by 22 percent (6). Those who consumed four or more servings a week saw this effect when compared to those who consumed less than one serving a week. The legumes used in this study included beans, peas and peanuts. There were over 9,500 men and women involved, and the study spanned 19 years of follow-up.

I recommend that patients consume a minimum of one to two servings a day, significantly more than the relatively modest four servings a week used to achieve statistical significance in this study.

Include healthy nuts

Why should you include nuts? In a study with over 45,000 men, consuming omega-3 polyunsaturated fatty acids (PUFAs) led to significant reductions in CAD. Both plant-based and seafood-based omega-3s showed these effects (7). 

Good sources of omega-3s from plant-based sources include nuts, such as walnuts, and ground flaxseed. Of course, be cautious about consuming too many nuts, since they’re also calorically dense.

Consume a modest amount of chocolate

In an analysis of six studies with over 336,000 participants, researchers found that eating chocolate at least once a week was associated with an 8 percent decreased risk of coronary artery disease when compared with consuming chocolate less than once a week (8).

The author notes that chocolate contains heart healthy nutrients such as flavonoids, methylxanthines, polyphenols and stearic acid which may reduce inflammation and increase good cholesterol. The study did not examine whether any particular type of chocolate is more beneficial or whether there is an ideal portion size.

An earlier study did show that two pieces of chocolate a week may decrease the risk of a heart attack by 37 percent, compared to those who consume less (9). 

Both study’s authors warn against the idea that more is better. High fat and sugar content and chocolate’s caloric density may have detrimental effects when consumed at much higher levels. 

I typically recommend that patients have one to two squares — about one-fifth to two-fifths of an ounce — of high-cocoa-content dark chocolate daily. Aim for chocolate labeled with 80 percent cocoa content.

You can also get chocolate’s benefits without the fat and sugar by adding unsweetened, cocoa powder to a fruit and vegetable smoothie. Do not use Dutch-process cocoa, also known as alkalized cocoa; the processing can remove up to 90 percent of the flavanols (10).

References:

(1) cdc.gov. (2) Arch Intern Med. 2004 Feb 23;164(4):370-376. (3) nutrition.org (4) NHANES 2009-2010 Data Brief No. 12. Sep 2014. (5) eatright.org. (6) Arch Intern Med. 2001 Nov 26;161(21):2573-2578. (7) Circulation. 2005 Jan 18;111(2):157-164. (8) Eur J Prev Cardiol. 2021 Oct 13;28(12):e33-e35. (9) BMJ 2011; 343:d4488. (10) J Agric Food Chem. 2008 Sep 24;56(18):8527-33.

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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The DASH diet is a flexible eating plan that helps create a heart-healthy eating style for life. Stock photo

By David Dunaief, M.D.

Dr. David Dunaief

Heart failure (HF) occurs when the heart’s pumping is not able to keep up with the body’s demands for blood and oxygen and may decompensate. Unlike a heart attack, it develops slowly over years and may take a long time to become symptomatic. According to the latest statistics, 6.7 million Americans over the age of 19 are affected (1).  These numbers are projected to increase to 8.7 million by 2030, with the greatest growth among those aged 35 to 64 (2).

There are two types of heart failure, systolic and diastolic. Put simply, the difference is that the output of blood with each contraction of the heart’s left ventricle is generally preserved in diastolic HF, while it can be significantly reduced in systolic HF.

Fortunately, both types can be diagnosed with an echocardiogram, an ultrasound of the heart. The signs and symptoms of both include shortness of breath during daily activities or when lying down; edema or swelling in the feet, legs, ankles or stomach, reduced exercise tolerance; and feeling tired or weak. These can have a significant impact on your quality of life.

Major lifestyle risk factors for heart failure include obesity, smoking, poor diet, being sedentary, excessive alcohol intake (3). Medical conditions that increase your risk include diabetes, coronary artery disease, high blood pressure, and valvular heart disease.

Heart failure can be treated with medication, including blood pressure medications, such as beta blockers, ACE inhibitors and angiotensin receptor blockers. All of these have side effects. We are going to look at recent studies that examine the role of diet in reducing your risk. 

The role of antioxidants in your diet

If we look beyond the risk factors mentioned above, some studies have explored the role oxidative stress may play an important role in contributing to HF.

In an analysis of the Swedish Mammography Cohort, researchers showed that a diet rich in antioxidants reduces the risk of developing HF (4). In the group that consumed the most nutrient-dense foods, there was a significant 42 percent reduction in the development of HF, compared to the group that consumed the least. The antioxidants were mainly from fruits, vegetables, whole grains, coffee and chocolate. Fruits and vegetables were responsible for most of the effect.

This study was the first to investigate the impact of dietary antioxidants on heart failure prevention.

This was a large study: it involved 33,713 women with 11.3 years of follow-up. Still, there are limitations, because it was an observational study, and the population involved only women. However, the results are very exciting, and there is little downside to applying this approach.

Applying the DASH diet

A 2022 study examined the effects of the Dietary Approaches to Stop Hypertension (DASH) diet on the risk of developing HF (5). This study included over 76,000 men and women, ages 45-83 and without previous HF, ischemic heart disease or cancer from the Cohort of Swedish Men and the Swedish Mammography Cohort.

The DASH diet emphasizes consuming fruit, vegetables, whole grains, nuts and legumes, and low-fat dairy and de-emphasizes red and processed meat, sugar-sweetened beverages, and sodium.

The researchers found that long-term adherence to the DASH diet was associated with a lower risk of HF. The greater the participants’ adherence, the greater the positive effect.

Interestingly, even replacing one serving per day of red and processed meat with one serving per day of other DASH diet foods was associated with an approximate 10 percent lower risk of HF.

Comparing a variety of diets

The REGARDS (REasons for Geographic and Racial Differences in Stroke) Trial examined the impact of five dietary patterns on later development of HF in over 16,000 patients followed for a median of 8.7 years. The dietary patterns included convenience, plant-based, sweets, Southern, and alcohol/salads (6). 

Researchers found that a plant-based dietary pattern was associated with a significantly lower risk of HF. Compared with the lowest quartile, the highest quartile of adherence to the plant-based dietary pattern was associated with a 41 percent lower risk of HF. 

The highest adherence to the Southern dietary pattern was associated with a 72 percent higher risk of HF after adjusting for age, sex, and race and for other potential confounding factors. Researchers found less effect after further adjusting for body mass index, waist circumference, hypertension, dyslipidemia, diabetes mellitus, atrial fibrillation, and chronic kidney disease.

They did not observe any associations with the other 3 dietary patterns.

These studies suggest that we should seek to prevent heart failure with dietary changes, including consuming higher amounts of antioxidant-rich foods, such as fruits and vegetables, and lower amounts of red and processed meats.

References:

(1) Circulation. 2024;149:e347–913. (2) hfsa.org. (3) cdc.gov. (4) Am J Med. 2013 Jun:126(6):494-500. (5) Eur J of Prev Cardiology 2022 May: 29(7): 1114–1123. (6) J Am Coll Cardiol. 2019 Apr 30; 73(16): 2036–2045.

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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