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Exercise without dietary changes may not help you lose weight. METRO photo
Exercise without dietary changes may not help you lose weight

By David Dunaief

Dr. David Dunaief

We’re just past the point on the calendar when those who committed to exercising more in the new year are likely to have fallen off their resolutions. If you’re still following through, congratulations!

Exercise has benefits for a wide range of medical conditions, from depression, insomnia, fatigue and balance to cognitive decline, chronic kidney disease, diabetes, cardiovascular disease and osteoporosis.

Will it help you lose weight, though? While gym membership ads emphasize this in January, exercise without dietary changes may not 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. It may, however, be helpful with weight maintenance.

Ultimately, it may be more important to examine what you are eating than to succumb to the rationalization that you can eat without care and work it off later.

Will exercise help you lose weight?

The well-known weight-loss paradigm is that when you burn more calories than you consume, you will tip the scale in favor of weight loss. The more you burn, the more you will lose. 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 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. This is 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.

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 3.5 pounds, and at 12 months, participants lost about 3.75 pounds.

Does exercise play a role in weight maintenance?

Exercise may help with 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 (6).

How does exercise help with disease?

Let’s look at chronic kidney disease (CKD), which affects roughly one in seven U.S. adults, as a simple example of exercise’s impact on disease (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 (8). 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, and 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.

There are many benefits to exercise; however, food choices will have a greater impact on weight and body composition. The good news: exercise can help maintain weight loss and is extremely beneficial for preventing progression of chronic diseases, such as CKD.

By all means, exercise, but to lose weight, also focus on consuming nutrient-dense foods instead of calorie-dense foods that you may not be able to exercise away.

References:

(1) uptodate.com. (2) J Strength Cond Res. 2015 Feb;29(2):297-304. (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 or consult your personal physician.

 

You’ll be surprised at how much better you will feel — and how much sharper your thinking is if you add walking to your daily regimen. METRO photo

By David Dunaief, M.D.

Dr. David Dunaief

What does it take to get us out of our seats? We know that exercise is good for our long-term physical and mental health, but it’s still elusive for many of us. It’s just too tempting to let the next episode of our new favorite series autoplay or to answer those last few emails.

Many of us tried to get out of gym class as kids and, as adults, we “want” to exercise, but we “don’t have time.” I once heard that the couch is as bad as the worst deep-fried food; it perpetuates inactivity. Even sleeping burns more calories than sitting and watching TV.

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

The New York Times’ Science Times carried an article a few years ago about Esther Tuttle. At the time, Esther was 99 years old, sharp as a tack and was independently mobile, with no mobility aids required. She continued to stay active by walking in the morning for 30 minutes and then walking again in the afternoon. The skeptic might say that this is a nice story, but its value is anecdotal at best.

Well, evidence-based medicine backs up her claim that walking is a rudimentary and simple way to get exercise that shows incredible benefits. One mile of walking a day will help keep the doctor away. For the step-counters among you, that’s about 2,000 steps a day for an adult with an average stride length.

Does walking improve brain function?

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

Participants who had an increase in brain tissue volume also had a substantially reduced risk of developing cognitive impairment. Interestingly, the parts of the brain that grew included the hippocampus, involved with memory, and the frontal cortex, involved with short-term memory and executive decision making. There were 299 participants who were dementia free at the start of the trial. The mean participant age was 78. Imagine if you started younger?

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

Even better news is that, if you’re pressed for time or if you’re building up your stamina, you can split a mile into two half-mile increments. How long does it take you to walk a half-mile? You’ll be surprised at how much better you will feel — and how much sharper your thinking is.

How does walking affect mood?

Researchers performed a meta-analysis of other studies related to the relationship between exercise and depression. They found that adults who walked briskly for about 75 minutes per week cut their risk of depression by 18 percent (3). That’s only half of what the Centers for Disease Control recommend. 

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

How do I reset my sitting ‘habit?’

A particular challenge I hear these days is that working from home reduces much of the opportunity to walk. There’s less walking down the hall to a meeting or to refill your water bottle. Instead, everything is only a few steps away. It’s as if our work environment is actually working against us.

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

A client of my wife’s schedules meetings for no more than 50 minutes, so she can walk a “lap” around her house’s interior between meetings. She also looks for opportunities to have a good old-fashioned phone call, rather than a video call, so she can walk around while she’s talking or listening. Of course, this is one person, but it might give you some ideas that will work for you.

Walking has other benefits as well. We’ve all heard about the importance of doing weight-bearing exercise to prevent osteoporosis and osteoporotic fractures. Sadly, if you don’t use them, bones weaken and break. Walking is a weight-bearing exercise that helps strengthen your joints, bones and muscles.

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

References:

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

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

Pixabay photo

By Daniel Dunaief

Decades ago, doctors endorsed cigarette smoking, promoting it in advertisements. That was back in the 1950’s, in the decade after the U.S. government shipped cigarettes to members of the armed forces during World War II.

On Jan. 11, 1964, Surgeon General Luther Terry released a landmark report that showed a nine to 10-fold higher risk of lung cancer for smokers compared with non smokers. At the time, about 40% of the adult population smoked. The report helped dramatically alter the perception of smoking. Indeed, a Gallup Survey from 1958 showed that 44% of Americans believed smoking caused cancer. By 1968, that number surged to 78%, according to a report from the National Institutes of Health.

Pulmonologist Dr. Norman Edelman, a professor of medicine at Stony Brook University and a core member of the program in public health at Stony Brook, celebrated the legacy of that landmark report, even as he urged ongoing efforts to reduce smoking.

Dr. Norman Edelman. Photo courtesy Stony Brook University

“It was a momentous occasion,” said Dr. Edelman, who suggested that the number of deaths in the country would be even higher without this report. 

“By the beginning of the 1960’s, the medical literature was pretty clear that smoking causes lung cancer” but the tobacco lobby fought against warnings about the hazards of smoking, Edelman said.

Dr. Gregson Pigott, Suffolk County Health Commissioner, described the report as the “first step towards protecting the American people from the deleterious effects of tobacco use.”

Adult smoking rates have fallen from about 43% in 1965 to about 11.5% in 2011, according to Dr. Pigott.

The report, which was followed by 34 studies from the CDCs Office of Smoking and Health on the health consequences of smoking, validated the concerns of organizations like the American Cancer Society and helped reduce the prevalence of a habit that can have significant and fatal consequences.

“Smoking levels in teenagers are going down,” said Dr. Edelman. “It’s beginning to show up in the health effects” with lung cancer declining in men and plateauing in women.

Lung cancer deaths in men have fallen to 25.5 per 100,000 in 2021 from 65 per 100,000 in 1990, according to Dr. Pigott. More recently, smoking exacerbated the threat from Covid. An analysis of 22,900 people published in BMC Public Health in 2021 showed that 33.5% of people with a history of smoking experienced disease progression, compared with 21.9% of non-smokers. 

A ways to go

While smoking is not as prevalent as it had been in the 1960’s, it is still a killer, accounting for an estimated 480,000 deaths each year in the United States, according to the Centers for Disease Control and Prevention. That’s about one in five deaths each year.

“Smoking still kills more people than other preventable causes of death,” said Dr. Edelman.

Dr. Edelman recognized the severity of other problems like the opioid and overdose crisis. In 2023, the CDC estimates that over 112,000 people died from overdoses.

Still, even with a reduction in smoking, the number of people who are smoking is high enough that the public should continue to look for ways to cut back on the harmful habit.

Over 16 million people live with at least one disease caused by smoking and 58 million non smoking Americans are exposed to secondhand smoke, explained Dr. Pigott, citing CDC data. Second hand smoke causes 40,000 to 60,000 deaths per year in the country, while smoking-related illnesses, which combine direct medical expenses, lost productivity and second hand smoke exposure, cost over $300 billion per year. 

Increasing the cost of cigarettes has helped serve as a deterrent, Dr. Edelman said.

Suffolk County operates a smoking cessation program, which provides behavior modification and supportive pharmaceuticals to medically eligible participants, Dr. Pigott explained in an email. A nurse practitioner oversees the cessation groups, which the county provides at no cost to participants, who also receive personalized follow-up.Stony Brook has several cessation resources. Students interested in smoking cessation can consult a student health care provider who will help them develop a program.

Prescription medications, which are covered under student’s health insurance, are available at a pharmacy after a consultation with a student’s health care provider. 

As for vaping, Dr. Pigott described it as “highly addictive” and explained that its long-term effect is not yet fully understood.

The 2023 Annual National Youth Tobacco Survey found that more than 2.1 million youth currently use e-cigarettes, which represents 7.7% of students in high school and middle school. 

“We are especially concerned about the effect of vaping on young people,” Dr. Pigott added. 

By Daniel Dunaief

For the first time since May 2023, Brookhaven National Laboratory required masks on site at its facility starting on Jan. 8, as the rate of hospital admissions for the virus that caused the pandemic climbed.

Following the Safer Federal Workforce Task Force, BNL, which is a Department of Energy-sponsored site, reinstituted the mask policy once Covid admissions climbed above 20 per 100,000 people in the county, as determined by the Centers for Disease Control and Prevention data.

The CDC level rose to 24.8 on the evening of Jan. 5 and the lab re-implemented its mask requirement on the following Monday. Area doctors said they’ve seen an increase in illnesses tied to Covid, particularly after people traveled during the December holidays.

“We’ve seen a lot more Covid,” said Dr. Sharon Nachman, chief of the Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital. 

Dr. Nachman said people who are talking to friends and neighbors are hearing regularly about those who are sick with Covid.

Stony Brook University Hospital is not requiring masking at all times. The hospital is recommending that people consider wearing masks. Medical staff entering patient rooms are wearing them.

People walking into the hospital will see “more people wearing masks” in general, she added. In addition to Covid, hospitals in the area are also seeing a “huge amount of flu,” Dr. Nachman said.

 

Graphic showing the number of pertussis cases from 2019 to 2023 in Suffolk County. Photo courtesy Suffolk County Department of Health

Cases of whooping cough, which is caused by the Bordatella pertussis bacteria, have spiked in Suffolk County this year, raising concerns for the health of newborn babies who don’t have the kind of immunological tools to fight off the infection and its potential consequences.

The Suffolk County Department of Health reported that 113 people had whooping cough, which is dramatically higher than the four people suspected of contracting this bacteria last year.

Whooping cough is “highly contagious,” explained Dr. Gregson Pigott, Suffolk County Health Commissioner in an email. “It is a cyclical disease with outbreaks occurring every three to five years.”

A large majority of people who have pertussis – 105 of the 113 – reported contracting the illness after November 28th, according to Dr. Pigott. Most of those who are sick are school aged children and their families, he added. 

The surge in infections this year may be because immunity from the routine vaccination series, which is given between ages two months to six years, wanes over time.

The Centers for Disease Control and Prevention recommends that people receive the TDaP booster, which offers immunological protection from diphtheria, tetanus and pertussis, every 10 years.

Vaccination rates are “fairly high in Suffolk County, but we do know that some residents fell behind in their vaccinations during the height of the Covid pandemic,” Dr. Pigott added. 

A preventable problem

Doctors urged residents, particularly those who might be interacting with young children or whose health is compromised, to check with their doctors on their vaccination status.

“Pertussis is a completely preventable disease,” said Dr. Adrian Popp, Chair of Infection Control at Huntington Hospital.

Indeed, doctors suggested that some of the people who aren’t receiving the vaccine may have pulled back from their normal inoculations amid the political discussion about the Covid vaccine.

“Covid has polarized our society in terms of vaccinations,” said Dr. Popp. Pertussis has “fallen prey” to this kind of thinking.

The pertussis shot has been around for over 50 years and can prevent bacterial infection, doctors said.

The vaccine is “completely safe and efficacious,” said Dr. Galinkin, infectious disease specialist at Port Jefferson-based St. Charles Hospital.

Dr. Galinkin, who has been practicing medicine in Suffolk County since 2004, said this is the highest level of whooping cough he’s seen in the county.

Indeed, even before the pandemic, the number of people infected with pertussis was 64 in 2019, according to the Department of Health.

The pertussis vaccine doesn’t completely prevent infection, but it does create a much milder case than it would for those who have no immunity, doctors said.

The incidence of pertussis can wax and wane, said Dr. Sharon Nachman, chief of the Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital. The increase in cases this year likely means that “it won’t happen next year” as people do what they can to protect themselves, their family and their community when the numbers rise, as they have this year.

Indistinct early symptoms

Like other respiratory illnesses that are actively circulating among the Suffolk County population, whooping cough starts out as a cough and can include a runny nose and a low grade fever.

 A whooping cough, however, often transitions into a more distinctive sound, as people who have it struggle to catch their breath after they cough.

Threat to infants

Health care providers suggested that pregnant mothers receive a booster for pertussis between the 27th and 36th week of pregnancy, which can not only reduce the risk of infection for the mom but can also provide some immunological benefit to the unborn child.

Doctors urged who are expecting a newborn to encourage anyone who has regular contact with the child in the first few months after birth to have updated immunizations, including for pertussis.

“The household of a newborn should consider being vaccinated,” said Dr. Popp. Infants who contract pertussis and who don’t have protection can develop complications such as encephalitis.

Pertussis is “an incredibly big problem for infants in the first year of life,” said Dr. Nachman.

Adults who contract pertussis can receive antibiotics, which generally eradicates the illness within five days. Untreated, however, pertussis symptoms and contagiousness can persist for weeks or even months.

Untreated pertussis can also lead to secondary pneumonia, added Dr. Nachman.

Respiratory illnesses climb

The combination of respiratory syncytial virus (RSV), flu, and Covid continues to keep emergency rooms busy during the start of the new year.

Doctors urged adults who are immunocompromised or who are vulnerable to follow the same habits that reduced their risk during the worst of the pandemic, which includes washing their hands, keeping a safe distance from anyone who is sick, and wearing masks when they are in densely-populated indoor areas with less ventilation.

“You don’t necessarily want to isolate yourself to an extreme, but there are certain ways to decrease the chance of getting exposed to illnesses in general,” said Dr. Popp. People who are riding on crowded trains to and from work might want to search for cars that have fewer people when that’s an option, he suggested.

Hospitals are taking precautions to limit the likelihood of passing along infections. The staff in the emergency room at Stony Brook is wearing masks on rounds, said Dr. Nachman.

At this point, people who come to the hospital are offered masks, but are not required to wear them.

METRO photo

By David Dunaief, M.D.

Dr. David Dunaief

Erectile dysfunction (ED) is a very common problem with a stigma. In fact, I have had several patients who resisted telling me they suffered from this malady. Because it can be a symptom of other diseases, it is crucial that you share this information with your doctor.

ED affects approximately 1 in 10 men on a chronic basis. If it occurs less than 20 percent of the time, it is normal; whereas if it occurs more than 50 percent of the time, there is a problem that requires therapy, according to the Cleveland Clinic (1). 

There are oral medications for ED. You’ve probably seen ads for them everywhere. Its prevalence has led pharmaceutical companies to saturate the airwaves, especially during sporting events. Approved medications include sildenafil (Viagra, or the “little blue pill”), tadalafil (Cialis), vardenafil (Levitra, Staxyn), and avanafil (Stendra). These drugs work by affecting the endothelium, or inner layer, of blood vessels and 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 fix for those who are good candidates for treatment.

ED’s prevalence increases with age. In a multinational MALES study, ED affected 8 percent of those aged 20-30 and 37 percent of 70-75-year-olds (2). What was surprising was that advanced age had the least association with ED, increasing the odds by only five percent. So, what contributes to the rest of the increase as we age? Disease processes and drug therapies.

What is the relationship between medical conditions and ED?

Chronic diseases significantly contribute to ED. The opposite may also be true; ED may be a harbinger 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).

A randomized clinical trial (RCT) showed that patients with ED had significantly more calcification, or atherosclerosis, in the arteries when compared to a control group (5). They were more than three times as likely to have severe levels of calcification. They also had more inflammation, measured by C-reactive protein. 

How do medications contribute to ED?

About 25 percent of ED cases are thought to be associated with medications, such antidepressants; NSAIDs, such as ibuprofen and naproxen sodium; and hypertension medications. Unfortunately, the most common antidepressant medications, SSRIs, have the greatest impact on ED of all antidepressants. 

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. Beta blockers were thought to be the main culprit. 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 does diet affect ED?

The Mediterranean-type diet has been shown to treat and prevent ED, improving one’s health and sex life at the same time. It’s the green leafy alternative to the little blue pill. The foods are rich in omega-3 fatty acids and high in monounsaturated fats and polyunsaturated fats, as well as in 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 saw improvements in their endothelial functioning (8, 9). They also had reduced inflammation and decreased insulin resistance.

In another study, men who had the greatest compliance with the 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 more closely at both the Mediterranean-type diet and an 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.

Therefore, it is important to bring ED to the attention of your physician. 

There are very effective lifestyle alternatives to oral medication that provide positive overall health effects and treat associated chronic diseases, while also helping patients eliminate medications that contribute to ED.

References:

(1) clevelandclinic.org. (2) Curr Med Res Opin. 2004;20(5):607. (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.

METRO photo

By David Dunaief, M.D.

Dr. David Dunaief

Obesity is an ongoing struggle for many in the United States. If you, like many, are struggling to shed those extra “COVID-era pounds,” I’m sure you can relate.

Obesity is defined as a BMI (body mass index) of >30 kg/m2. More importantly, obesity can also be defined by excess body fat, which is more important than BMI.

While the medical community has known for some time that excess body fat contributes to poor health outcomes, it became especially visible during the first few rounds of COVID-19.

In the U.S., poor COVID-19 outcomes have been associated with obesity. In a study involving 5700 COVID-19 patients hospitalized in the New York City area, 41.7 percent were obese. The most common comorbidities contributing to hospitalization were obesity, high blood pressure and diabetes (1). In other words, obesity contributed to more severe symptoms.

In a study in China, results showed that those who were overweight were 86 percent more likely to have severe COVID-19 pneumonia, and that percentage increases to 142 percent when patients qualify as obese (2).

And though age is a risk factor for COVID-19, among those younger than 60 and obese, there is a two-times increased risk of being admitted to the hospital, according to a 3,615-patient study at NYU Langone Health (3).

While these studies were on early variants of COVID, the attention and wide-ranging research provide us with an interesting series of studies in how excess weight might impact progression of other acute respiratory diseases.

Why is the risk for severe COVID-19 higher with obesity? 

According to the prevailing theory, obesity may interfere with mechanical aspects of breathing, thus increasing airway resistance and making gas in exchange more difficult in the lung. It may also impede lung volume by exerting pressure on the lungs and may involve weaker muscles necessary for respiration (4).

Why does excess fat affect health outcomes? 

First, some who have elevated BMI may not have a significant amount of fat; they may have more innate muscle, instead. These people are not necessarily athletes. It’s just how they were genetically put together.

More than 25 percent of my patient population is “solidly built,” which means they have greater muscle mass, but also too much excess fat. Visceral fat, which is wrapped around the organs, including the lungs, is the most important.

Fat cells have adipokines, specific cell communicators that “talk” with other fat cells but also other systems such as the brain, immune system, muscles, and liver. Adipokines can be mediators of both inflammation and insulin resistance (5). It’s the inflammation among obese patients that could be the exacerbating factor for hospitalizations and severe illness, according to the author of a 4000-patient COVID-19 study (6). 

How can you reduce inflammation and lose excess fat?

In a randomized controlled trial with 75 participants comparing a plant-based diet to a control diet, there was a greater than 14 lbs. weight reduction and roughly 10 lbs. fat reduction over a 14-week period (7). Of the weight lost, about 70 percent was excess fat. Remember, excess body fat, through adipokines, may be inflammatory and increase the risk of severe disease. 

Weight reduction with a plant-based approach may be results of dietary fiber increases and dietary fat reductions with plant-based diets, according to Physician’s Committee for Responsible Medicine (PCRM) (8). You also want a diet that has been shown to reduce inflammation.

We published a study involving 16 patients from my clinical practice in 2020. It shows that those who ate a whole food plant-based LIFE (low inflammatory foods everyday) diet over a seven-day period had a significant decrease in inflammation measured by hsCRP (high sensitivity c-reactive protein). This occurred in those who completely changed their diets to the LIFE diet, but also occurred in those who simply added a daily greens-and-fruit-based smoothie to their existing diet (9).

In my practice, I have seen many patients lose substantial amounts of weight over a short period. More importantly, they also lost body fat. For instance, a 70-year-old male lost 19 lbs. of weight and 12 lbs. of body fat over a six-week period. His inflammation, which was very high to start, dropped substantially to the border of optimal levels. This patient and many others have seen tandem reductions in both weight and inflammation. To boot, this was a cardiac patient whose cardiologist had considered a stent, but later said he did not need it after reducing his inflammation.

The most recent health crisis shone a spotlight on the importance of losing excess fat. It’s not just about COVID-19 or other respiratory disease severity, although those are concerning. It’s also about excess fat’s significant known contributions to many other chronic diseases, like cardiovascular disease, high blood pressure, and high cholesterol.

References:

(1) JAMA. online April 22, 2020. (2) Clin Med (Lond). 2020 Jul; 20(4): e109–e113. (3) Clin Infect Dis. 2020 Jul 28;71(15):896-897. (4) Chron. Respir. Dis. 5, 233–242 (2008). (5) Front Endocrinol (Lausanne). 2013; 4:71. (6) MedRxiv.com. (7) Nutr Diabetes. 2018; 8: 58. (8) Inter Journal of Disease Reversal and Prevention 2019;1:1. (9) Amer J Lifestyle Med. 2022;16(6):753-764.

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.

METRO photo
Diet may have a significant impact on heart failure risk and outcomes

By David Dunaief, M.D.

Dr. David Dunaief

Unlike a heart attack, which is acute, heart failure develops slowly and may take years to become symptomatic. 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. According to the American Heart Association, over six million Americans are affected, and the numbers are projected to increase significantly by 2030 (1).

There are two types of heart failure, systolic and diastolic. The basic difference is that the ejection fraction, the output of blood with each contraction of the left ventricle of the heart, is more or less preserved in diastolic HF, while it can be significantly reduced in systolic HF.

Fortunately, both types can be diagnosed with the help of an echocardiogram, an ultrasound of the heart. The signs and symptoms of both include shortness of breath on exertion or when lying down, edema or swelling, reduced exercise tolerance, weakness and fatigue. Each of these can impact quality of life significantly.

Major lifestyle risk factors for heart failure include obesity; smoking; poor diet, including consuming too much sodium; being sedentary; and drinking alcohol excessively. Conditions that increase your risk include diabetes, coronary artery disease and high blood pressure.

Typically, heart failure is treated with blood pressure medications, such as beta blockers, ACE inhibitors and angiotensin receptor blockers. We are going to look at how diet and iron levels can affect heart failure outcomes.

Can diet improve heart failure?

If we look beyond the usual risk factors mentioned above, oxidative stress may play an important role as a contributor to HF.

In a population-based, prospective study, the Swedish Mammography Cohort, results show that a diet rich in antioxidants reduces the risk of developing HF (2). 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. According to the authors, the antioxidants were derived mainly from fruits, vegetables, whole grains, coffee and chocolate. Fruits and vegetables were responsible for the majority of the effect.

What makes this study so impressive is that it is the first of its kind to investigate antioxidants from the diet and their impacts on heart failure prevention.

This was a large study, involving 33,713 women, with good duration — follow-up was 11.3 years. There are limitations to this study, because it is observational, and the population involved only women. Still, the results are very exciting, and it is unlikely there is a downside to applying this approach to the population at large.

More recently, 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 (3). Researchers found that a plant-based dietary pattern was associated with a significantly lower risk of HF.

Does iron supplementation improve heart failure outcomes?

An observational study that followed 753 heart failure patients for almost two years showed that iron deficiency without anemia increased the risk of mortality in heart failure patients by 42 percent (4).

In this study, iron deficiency was defined as a ferritin level less than 100 μg/L (the storage of iron) or, alternately, transferrin saturation less than 20 percent (the transport of iron) with a ferritin level in the range 100–299 μg/L.

The authors conclude that iron deficiency is potentially more predictive of clinical outcomes than anemia, contributes to the severity of HF and is common in these patients. However, studies of oral iron supplementation has not been shown to improve results, while intravenous supplementation has been shown to reduce hospitalizations and mortality (5).

These studies suggest that we should try to prevent heart failure through dietary changes, including high levels of antioxidants, because it is not easy to reverse the disease. Those with HF should have their ferritin and iron levels checked, because these can be addressed with medical supervision.

References:

(1) Circulation. 2020;141:e139–e596. (2) Am J Med. 2013 Jun:126(6):494-500. (3) J Am Coll Cardiol. 2019 Apr 30; 73(16): 2036–2045. (4) Am Heart J. 2013;165(4):575-582. (5) Eur J Heart Fail. 2018;20(1):125–133.

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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Flu, RSV and COVID-19 are especially tough on those with impaired lung function

By David Dunaief, M.D.

Dr. David Dunaief

Our experiences over the past several years with COVID-19 have increased our awareness of how chronic ailments can make us more vulnerable to the consequences of acute diseases circulating in our communities.

For those with chronic obstructive lung diseases such as chronic obstructive pulmonary disease (COPD) and asthma, as well as those who smoke and vape, the consequences of the flu, RSV and COVID-19 are especially severe.

The good news is that we can do a lot to improve our lung function by exercising, eating a plant-based diet with a focus on fruits and vegetables, expanding lung capacity with an incentive spirometer, and quitting smoking and vaping, which damage the lungs (1). Studies suggest that everyone will benefit from these simple techniques, not only people with compromised lungs.

Do antioxidants improve asthma?

In a randomized controlled trial, results show that, after 14 days, asthma patients who ate a high-antioxidant diet had greater lung function than those who ate a low-antioxidant diet (2). They also had lower inflammation at 14 weeks. Inflammation was measured using a c-reactive protein (CRP) biomarker. Participants in the low-antioxidant group were over two-times more likely to have an asthma exacerbation.

The good news is that there was only a small difference in behavior between the high- and low-antioxidant groups. The high-antioxidant group had a modest five servings of vegetables and two servings of fruit daily, while the low-antioxidant group ate no more than two servings of vegetables and one serving of fruit daily. Using carotenoid supplementation in place of antioxidant foods did not affect inflammation. The authors concluded that an increase in carotenoids from diet has a clinically significant impact on asthma in a very short period.

Can increasing fiber lower COPD risk?

Several studies demonstrate that higher consumption of fiber from plants decreases the risk of COPD in smokers and ex-smokers.

In one study of men, results showed that higher fiber intake was associated with significant 48 percent reductions in COPD incidence in smokers and 38 percent incidence reductions in ex-smokers (3). The high-fiber group ate at least 36.8 grams per day, compared to the low-fiber group, which ate less than 23.7 grams per day. Fiber sources were fruits, vegetables and whole grain, essentially a whole foods plant-based diet. The “high-fiber” group was still below the American Dietetic Association’s recommended intake of 14 grams per 1,000 calories each day.

In another study, this time with women, participants who consumed at least 2.5 serving of fruit per day, compared to those who consumed less than 0.8 servings per day, experienced a highly significant 37 percent decreased risk of COPD (4).

The highlighted fruits shown to reduce COPD risk in both men and women included apples, bananas, and pears.

What devices can help improve lung function?

An incentive spirometer is a device that helps expand the lungs when you inhale through a tube and cause a ball (or multiple balls) to rise in a tube. This inhalation opens the alveoli and may help you breathe better.

Incentive spirometry has been used for patients with pneumonia, those who have had chest or abdominal surgery and those with asthma or COPD, but it has also been useful for healthy participants (5). A small study showed that those who trained with an incentive spirometer for two weeks increased their lung function and respiratory motion. Participants were 10 non-smoking healthy adults who were instructed to take five sets of five deep breaths twice a day, totaling 50 deep breaths per day. Incentive spirometers are inexpensive and easily accessible.

In another small, two-month study of 27 patients with COPD, the incentive spirometer improved blood gasses, such as partial pressure carbon dioxide and oxygen, in COPD patients with exacerbation (6). The authors concluded that it may improve quality of life for COPD patients.  

How does exercise help improve lung function?

Exercise can have a direct impact on lung function. In a study involving healthy women aged 65 years and older, results showed that 20 minutes of high-intensity exercise three times a day improved FEV1 and FVC, both indicators of lung function, in just 12 weeks (7). Participants began with a 15-minute warm-up, then 20 minutes of high-intensity exercise on a treadmill, followed by 15 minutes of cool-down with stretching.

Note that you don’t need special equipment to do aerobic exercise. You can walk up steps or steep hills in your neighborhood, do jumping jacks, or even dance around your living room. Whatever you choose, you want to increase your heart rate and expand your lungs. If this is new for you, consult a physician and start slowly. You’ll find that your stamina improves quickly when you do it consistently.

We all should be working to strengthen our lungs. This three-pronged approach of lifestyle modifications — diet, exercise and incentive spirometer — can help.

References:

(1) Public Health Rep. 2011 Mar-Apr; 126(2): 158-159. (2) Am J Clin Nutr. 2012 Sep;96(3):534-43. (3) Epidemiology Mar 2018;29(2):254-260. (4) Int J Epidemiol Dec 1 2018;47(6);1897-1909. (5) Ann Rehabil Med. Jun 2015;39(3):360-365. (6) Respirology. Jun 2005;10(3):349-53. (7) J Phys Ther Sci. Aug 2017;29(8):1454-1457.

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.

Studies suggest lifestyle approaches to improve symptoms

By David Dunaief, M.D.

Dr. David Dunaief

Irritable bowel syndrome (IBS) symptoms, such as abdominal pain, cramping, bloating, constipation and diarrhea, can directly affect your quality of life. If you are among the estimated 10 to 15 percent of the population that suffers from IBS symptoms, managing these symptoms can become all-consuming (1).

While diagnosing IBS is challenging, physicians use discrete criteria physicians to provide a diagnosis and eliminate more serious possibilities. The Rome IV criteria comprise an international effort to help diagnose and treat functional gastrointestinal disorders. Using these criteria, which include frequency of pain and discomfort over the past three months, alongside a physical exam helps provide a diagnosis.

Fortunately, there are several approaches to improving symptoms that require only modest lifestyle changes.

How is IBS affected by mental state?

The “brain-gut” connection refers to the direct connection between mental state, such as nervousness or anxiety, to gastrointestinal issues, and vice versa.

Mindfulness-based stress reduction was used in a small, but randomized, eight-week clinical trial with IBS (2). Those in the mindfulness group (treatment group) showed statistically significant results in decreased severity of symptoms compared to the control group, both immediately after training and three months post-therapy.

Those in the treatment group were instructed to do meditation, gentle yoga and “body scanning” — focusing on one area of the body for muscle tension detection. The control group attended an IBS support group once a week.

Could gluten be a factor in IBS?

Gluten sensitivity may be an important factor for some IBS patients (3). In a small randomized clinical trial, patients who were given gluten were more likely to complain of uncontrolled symptoms than those who were given a placebo, 68 percent vs. 40 percent, respectively (4). These results were highly statistically significant, and the authors concluded that nonceliac gluten intolerance may exist. 

I suggest to my patients that they might want to start avoiding gluten and then add it back into their diets slowly to see the results.

Does fructose play a role in IBS?

Some IBS patients may suffer from fructose intolerance. In a study, IBS researchers used a breath test to examine this possibility (5). The results were dose-dependent, meaning the higher the dose of fructose, the greater the effect researchers saw. When patients were given a 10 percent fructose solution, only 39 percent tested positive for fructose intolerance, but when they were given a 33 percent solution, 88 percent of patients tested positive.

The symptoms of fructose intolerance included gas, abdominal pain, bloating, belching and alternating bowel habits. The authors concluded that avoidance of fructose may reduce symptoms in some IBS patients.

According to another study, about one-third of IBS patients are fructose intolerant. When on a fructose-restricted diet, symptoms appeared to improve (6). Foods with high levels of fructose include certain fruits, like apples and pears, but not bananas.

Are lactose intolerance and IBS connected?

Another small study found that about one-quarter of patients with IBS also have lactose intolerance (7). 

Of the IBS patients who were also lactose intolerant, there was a marked improvement in symptoms at both six weeks and five years when placed on a lactose-restricted diet.

Though the trial was small, the results were statistically significant, which is impressive. Both the patient compliance and long-term effects were excellent, and visits to outpatient clinics were reduced by 75 percent. This demonstrates that it is probably worthwhile to test patients who have IBS symptoms for lactose intolerance.

Will probiotics help with IBS?

A study that analyzed 42 trials focused on treatment with probiotics shows there may be a benefit to probiotics, although the objectives, or endpoints, were different in each trial (8).

Probiotics do show promise, including the two most common strains, Lactobacilli and Bifidobacteri, which were covered in the review.

Is there a link between IBS and migraines?

A preliminary study has suggested there may be a link between IBS and migraine and tension-type headaches. The study of 320 participants, 107 with migraine, 107 with IBS, 53 with episodic tension-type headaches (ETTH), and 53 healthy individuals, identified significant occurrence crossover among those with migraine, IBS and ETTH. Researchers also found that these three groups had at least one gene that was distinct from healthy participants. Their hope is that this information will lead to more robust studies that could result in new treatment options (9).

All of these studies provide hope for IBS patients. These are treatment options that involve modest lifestyle changes. Since the causes can vary, a strong patient-doctor connection can help in selecting an approach that provides the greatest symptom reduction for each patient.

References:

(1) American College of Gastroenterology [GI.org]. (2) Am J Gastroenterol. 2011 Sep;106(9):1678-1688. (3) Am J Gastroenterol. 2011 Mar;106(3):516-518. (4) Am J Gastroenterol. 2011 Mar;106(3):508-514. (5) Am J Gastroenterol. 2003 June;98(6):1348-1353. (6) J Clin Gastroenterol. 2008 Mar;42(3):233-238. (7) Eur J Gastroenterol Hepatol. 2001 Aug;13(8):941-944. (8) Aliment Pharmacol Ther. 2012 Feb;35(4):403-413. (9) American Academy of Neurology 2016, Abstract 3367.

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.