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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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Photo courtesy of Brandpoint

When it comes to health, women’s intuition isn’t just a hunch – it’s practically a superpower. According to recent research from MD Live by Evernorth, more than two-thirds of women say they have a sixth sense when it comes to their health. This “ill-tuition” is the innate ability to sense when something may be wrong with your body – and 81% of women trust it. Yet, despite this trust, most women hold off on seeking care until their symptoms interfere with their daily lives, instead of being proactive at the first sign that something is off. This delay can lead to unnecessary worsening of symptoms.

“Many common symptoms can be early warning signs of an underlying health condition. Ignoring your body’s signals can prevent timely diagnosis and treatment,” explains Dr. Vontrelle Roundtree, Associate Chief Medical Officer for MD Live by Evernorth. “Trusting your intuition and acting on it early can make all the difference in managing your health.”

Roundtree discusses five common symptoms that women tend to dismiss, according to the research, what conditions they may point to and why it’s important to seek timely medical care when your intuition sounds the alarm.

1. Itching that doesn’t go away

Itching may seem like just a minor annoyance, but if it’s persistent, it may point to various underlying health issues. Itching could signal hormonal fluctuations, skin conditions like eczema, or even liver or kidney problems. Itching without a visible rash can be a sign of broader health issues because it often indicates that the root cause lies beneath the surface of the skin rather than on it. For pregnant women, persistent itching may be a symptom of cholestasis, a liver condition that requires immediate medical attention.

2. Persistent bloating

Bloating is normal after eating a big meal or when experiencing the occasional digestive issue. But, when bloating occurs frequently, it could be a sign of gastrointestinal disorders such as irritable bowel syndrome (IBS). Bloating that gets worse over time could be a symptom of stomach inflammation or certain cancers. In fact, bloating is one of the more common early warning signs of ovarian cancer, caused by the buildup of fluids in the stomach.

3. Fatigue

Feeling tired is often unavoidable, especially for women balancing work, family and other responsibilities. However, when that tiredness becomes persistent and starts affecting your quality of life, it might point to fatigue, a debilitating condition that significantly impacts your daily life. Fatigue is often a symptom of an underlying chronic condition, such as diabetes, heart disease, depression or thyroid disorders. If a good night’s sleep or taking time to rest doesn’t make a noticeable difference in your energy levels, it’s time to consult a doctor to explore the potential causes.

4. Unexplained weight fluctuations

It’s not uncommon for a woman’s weight to naturally fluctuate, especially during their menstrual cycle. However, unexpected weight gain or loss can indicate hormonal imbalances, thyroid problems or metabolic disorders. When weight changes are sudden and not resulting from changes in your diet or exercise routine, it’s important to rule out any larger health issues, like cancer or chronic illness.

5. Chronic anxiety

Although anxiety is commonly associated with mental health disorders, its presence can also point to underlying physical health issues. If you’re feeling anxious without a clear reason, or your anxiety is constant, it’s important to explore whether a physical condition could be contributing. Anxiety is often linked to cardiovascular diseases and endocrine problems, like hyperthyroidism. Regardless of whether it stems from something physical or mental, early intervention is critical.

Your first call: A doctor

These symptoms may not always seem urgent, but it’s important not to ignore them, especially if they become persistent or chronic. “If you feel something is off with your health, trust your intuition and seek medical advice promptly,” Roundtree advises. “Doctors are here to help you get to the bottom of your symptoms – no matter how big or small they may seem.” When your instincts tell you something is off, you can schedule a virtual visit with an MD Live board-certified doctor to get an expert medical opinion without unnecessary delays.

Remember, it’s always better to address a potential health concern when it’s small rather than wait until it becomes more serious. The next time your ill-tuition kicks in, trust it. (BPT)

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Photo courtesy of Brandpoint

Cold and flu season typically runs from October to May, but with summer colds, COVID outbreaks, RSV and allergies, it’s a pretty safe bet that you and your family may be dealing with a variety of symptoms of one kind or another, no matter the season.

Given this year-round battle against illness, the ever-rising costs of medications can put a strain on your wallet and cause confusion as to how best to guard against all of those various bugs out there.

“It’s vital for families to get reliable information on how to prevent illnesses, especially during cold and flu season when many bugs are at their worst, and what to do if they do come down with something,” said Preeti Parikh, Executive Medical Director at GoodRx, the leading prescription savings platform in the U.S. “This includes information about how to get the best price on any medications they need.”

That’s where GoodRx comes in. It is an online platform that does double duty. GoodRx can save you up to 80% off retail prices of medications, plus it offers trusted information on the myriad health conditions that families deal with. GoodRx’s articles, written by a team of doctors, pharmacists, health economists and public health experts, provide you with authoritative and trustworthy answers to your most pressing health questions so you can make better decisions for your family’s health.

When it comes to navigating cold and flu season, Dr. Parikh offers the following tips to prevent illness and manage treatment if you do become sick.

* Get vaccinated. Everyone should get their flu shot and COVID booster by the end of October, and these shots can be done at the same time. It’s the most important thing you can do to prevent illness, not only for yourself, but for vulnerable people in your community, such as children, the elderly and people with chronic conditions.

* Older Americans should investigate the RSV vaccine. All Americans aged 75 and older should receive one dose of the RSV vaccine. Adults aged 60 to 74 with serious chronic conditions, pregnant women, and young babies may also need to get vaccinated. Work with your healthcare provider to determine if the vaccine is best for you.

* Wash your hands. Everyone should practice good disease prevention! Wash your hands, avoid touching your face, and sneeze or cough into your elbow.

* Protect others. If you’re sick, stay home. Don’t go to the office or out shopping or dining. If you must go out, wear a mask to help avoid passing those bugs around.

* If you do become sick, GoodRx can help you save on treatments, including antibiotics that can treat your infection, cold medications to help with symptoms, and antivirals, which can shorten the duration or alleviate the symptoms of your illness. On average, GoodRx users save $34 on cold and flu treatment medications.

So, how do the savings work? It’s actually very easy. Just go to GoodRx.com or the mobile app and type in the name of the medications you have been prescribed. You’ll get a listing of local pharmacies and their prices. Choose the lowest one, and a coupon will pop up. Bring your phone with you to the pharmacy and show the coupon to your pharmacist to get the lowest possible price on your medications.

To arm yourself with information about how to battle the bugs, and ways to save at the pharmacy, visit GoodRx.com/go/fluseason. (BPT)

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Photo courtesy of StatePoint

Foot ulcers develop in about 15% of the 25 million Americans living with diabetes and are a top cause of hospitalization. These ulcers can lead to serious complications, such as infection and amputation. According to foot and ankle surgeons, there are steps you can take to prevent complications and keep your feet healthy, as well as breakthrough treatments that are saving limbs, restoring mobility and improving lives.

“The majority of lower-extremity amputations are preceded by a reoccurring foot sore or an ulcer that won’t heal,” says John S. Steinberg, DPM, FACFAS, a board-certified foot and ankle surgeon and a Fellow Member and Past President of the American College of Foot and Ankle Surgeons (ACFAS). “Patients do best when they take charge of their foot health with the help of a foot and ankle surgeon.”

The surgeon members of ACFAS are sharing some important insights into preventing foot ulcers associated with diabetes and treating them if they do occur.

Make these precautions part of your foot care routine:

• Inspect feet daily using a flashlight and mirror to see the bottoms of your feet.

• Moisturize dry, cracking feet to prevent sores. Use powder to control moisture that can result in blisters.

• To prevent injury, wear protective, well-fitting shoes and socks at all times, even in the house. Change socks daily and more often if your feet get wet or sweaty. Avoid socks with holes or seams. Sometimes diabetic shoes are prescribed to avoid pressure and rubbing on the feet.

• Get regular foot exams from a foot and ankle surgeon, which can reduce amputation risk by 45-85%. The surgeon can also screen feet for loss of protective sensation.

• Manage your diabetes. Out-of-control blood sugar levels can lead to nerve cell damage, making it harder to detect foot problems.

Look for telltale signs that an ulcer may be developing:

• Swelling. The foot or ankle may look puffy or engorged and larger than the other.

• Temperature. Cold feet might mean a circulatory issue, whereas hot feet might mean infection.

• Color changes. Redness and even other colors might appear before an ulcer forms.

• Calluses. If a callus changes colors or develops dark, “dried blood” colored spots, it may be time to have a foot and ankle surgeon offer a proper diagnosis.

Ask your foot and ankle surgeon about innovative treatments:

If you do experience a non-healing ulcer, talk to your foot and ankle surgeon right away about innovative technologies that stimulate healing.

Groundbreaking approaches include stem cell therapy, the use of bioengineered skin substitutes to accelerate growth of healthy skin, and negative pressure wound therapy (NPWT) to promote healing and enable healthy, new tissue to grow. Today, foot and ankle surgeons rarely do a skin graft without NPWT. Skin grafting for foot ulcers has also advanced. Surgeons now use advanced reconstructive surgery and grafting techniques to promote wound healing and decrease wound recurrence.

The success rate of these advanced therapies is high, providing substantial improvement over treatments of the not-too-distant past, when doctors would clean and bandage the wound and hope for the best.

“Thanks to the many advances in diabetic foot care, patients today are having simpler surgeries, avoiding amputations, and getting back to everyday life sooner than ever before,” says Dr. Steinberg.

For more information or to find a foot and ankle surgeon near you, visit FootHealthFacts.org, the patient education website of the American College of Foot and Ankle Surgeons. (StatePoint)

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Photo from Brandpoint

College student Jamie Schanbaum was studying at the University of Texas at Austin, just 19 years old, when she was rushed to the hospital with severe symptoms that seemed related to asthma or the flu.

Jamie Schanbaum

Two days later, Jamie and her family were stunned to learn she had contracted meningococcal disease, a serious, life-threatening illness. Meningococcal bacteria can infiltrate the brain and spinal cord, known as meningitis, or the blood, causing septicemia. People can carry the bacteria in their nose or throat without being aware of it and spread it to others. Jamie ‘caught’ the bacteria and developed septicemia.

While Jamie fortunately survived, her life would not be the same. Her legs and fingers needed to be amputated due to the infection. But her strength and determination have caused her to become an effective advocate for meningitis awareness, and after two years of walking on prosthetics, Jamie joined the USA Paralympic Cycling team in 2011.

“Jamie is making a difference for others every day,” said her mother, Patsy Schanbaum, “including inspiring the founding of the J.A.M.I.E. Group, a nonprofit organization that raises meningitis awareness and educates people about the importance of prevention through vaccination. We work with many other meningitis groups, often started by families impacted by this horrible disease, to help save lives.”

The J.A.M.I.E. Group has also worked to pass legislation requiring meningitis vaccination for college students, who are at higher risk for meningitis.

What is meningitis?

Meningitis is a devastating and debilitating infection that can affect anyone, anywhere, at any time. Those at higher risk of meningococcal infection include young children, adolescents, older adults, people living with chronic and immunocompromising conditions (such as HIV) and those living in close quarters – including college students and military recruits.

Bacterial meningitis is the most common type of meningitis. Even with prompt diagnosis and treatment, death and brain damage in survivors are common outcomes. Most cases of bacterial meningitis are caused by three different bacteria: Haemophilus influenzae type b (Hib), Pneumococcus (Pnc) and Meningococcus.

Meningococcal disease is transmitted person-to-person, through droplets of secretions from people who are carriers. Carriers are healthy people who have meningococcus in their nose and throat. Transmission is also through contact with contaminated items such as utensils and living in close quarters with a carrier.

Symptoms of meningococcal disease may begin like influenza (the flu), but can worsen rapidly to include fever, severe headache, stiff neck and a skin rash.

Approximately 10-20 percent of people with bacterial meningitis will die within 24-48 hours after onset of symptoms, and 10-30 percent of people will sustain permanent damage and disability, leading to life-changing events including brain injury, depression, hearing loss and/or limb loss.

The good news: Meningitis is preventable

Vaccination has been shown to be highly effective in reducing the risk of illness and disease transmission, which is especially crucial during the winter months when more people are spending time together indoors and many different viruses are spreading.

Routine use of vaccines in infants and children against Hib, Pnc and the common groups of meningococcus that cause the majority of illness have been very successful in preventing disease. The CDC Advisory Committee on Immunization Practices (ACIP) recommends routine administration of a single dose of quadrivalent meningococcal conjugate vaccine against serogroups A, C, Y and W to children 11 or 12 years of age, with a booster dose at age 16. Meningococcal B vaccination is available to all adolescents and young adults (ages 16-23).

Vaccine protection can decrease within five years following vaccination, so getting vaccinated at the recommended times maintains your protection and reduces the risk of illness and disease transmission.

Prevention is power. Talk to your doctor about vaccination against meningococcal disease for you and your family members, especially those who may be at higher risk. Visit MeningitisAwareness.org to learn more. (BPT)

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Photo from Brandpoint

As many in the type 1 diabetes community can attest, it can be difficult at first to understand the purpose of screening or the subsequent tests before and following a type 1 diabetes diagnosis, and what the results can mean for you or a loved one.

To help alleviate any uncertainties around which screening or test to take (and why), it’s time to bring it back to basics. Below are the “ABCs” of some of the screenings and tests (e.g., Autoantibody Screening, Blood Glucose Test, and A1C Test) that are currently available for type 1 diabetes, with the goal of empowering people of all ages with the tools and information necessary to advocate for their health when they are speaking to their doctor. It’s important to note that while a blood glucose test and an A1C test are crucial to the diagnosis, monitoring, and management of type 1 diabetes, an autoantibody test is the only test that can confirm your risk of developing the disease.

Autoantibody Screening

Autoantibody screening is a blood test that can detect whether someone is at risk for developing type 1 diabetes. The blood test looks for type 1 diabetes-related autoantibodies, which are proteins that appear in the blood in the early stages of the disease before there are noticeable symptoms, which tend to occur when type 1 diabetes has already progressed to a later stage after weeks, months, or even years.

When it comes to detecting type 1 diabetes early, knowledge is power. As a nurse who lives with type 1 diabetes herself, Grace Cochran could not agree more: “Having insights into whether you are at risk of developing type 1 diabetes is incredibly important. Early information can give you more time to educate yourself and your family about the disease and prepare for what will eventually come,” Cochran shared.

“People may think ‘ignorance is bliss’ when it comes to a future type 1 diabetes diagnosis, but as someone who not only received an unexpected diagnosis that required a hospital stay myself but also as a nurse who cares for people who might be in a similar situation, I can tell you that it’s 100% worth it to get screened,” Cochran continued.

The1Pledge.com has useful information about the importance of early screening and detection and how to start a conversation with your doctor. By the time someone is in the later stage of disease, complications of untreated type 1 diabetes can lead to an emergency room visit and hospital stay, as they did for Cochran, and lifelong insulin dependence begins – which brings up the “B” of the ABCs.

Blood Glucose Test

A blood glucose test not only confirms a type 1 diabetes diagnosis, but also helps people living with type 1 diabetes regularly monitor their disease. Doing so is important, as it gives a person insights into whether their blood glucose or sugar levels are within a normal range. Many factors can impact blood glucose levels, such as food, activity level, stress, illness, and certain medications and dehydration.

“There are a lot of tools these days that can help make routinely monitoring blood glucose levels easier and more convenient,” Cochran said. “For example, a doctor can test a person’s blood glucose levels, and many people living with type 1 diabetes also use devices to self-monitor their blood glucose levels throughout each day because this condition requires 24/7 care and attention. In addition to working with my care team, I’ve learned tips and tricks since I was first diagnosed 17 years ago to manage my glucose levels – but I, of course, still monitor my blood glucose levels multiple times a day, every day.”

Indeed, finding the right care team is incredibly important for people living with type 1 diabetes. For instance, an endocrinologist, a specialist who cares for people with diabetes, can work with someone living with type 1 diabetes and help them maintain normal blood glucose levels. Not only that, but they can also measure how someone is managing their disease over time, leading to the “C.”

A1C Test

An A1C test, which is also referred to as an “estimated average glucose,” can be used to show average blood sugar levels over two to three months. For people with type 1 diabetes, an A1C test can provide an overview of blood glucose management over a set period of time and help them, along with their endocrinologist, understand if any adjustments need to be made in the way they are managing their disease.

ABC Recap

It’s important to understand the role of screening before a type 1 diabetes diagnosis and the tests that are used following a diagnosis to monitor the disease and guide appropriate management. You can learn more about how to get screened early for type 1 diabetes and what to expect after screening by talking to your doctor. (BPT)

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Irritable bowel syndrome (IBS) is a common disorder that affects the large intestine. Stock photo
Other disorders may contribute to the condition

By David Dunaief, M.D.

Dr. David Dunaief

If you are among the estimated 10 to 15 percent of the population that suffer from irritable bowel syndrome (IBS) symptoms, managing them can be all-consuming (1). IBS symptoms, which can include abdominal pain, cramping, bloating, constipation and/or diarrhea, have a direct effect on your quality of life.

While there is no single test that provides an IBS diagnosis, physicians eliminate other possibilities and use specific criteria to provide a diagnosis.

The Rome IV criteria are an international effort to help diagnose and treat disorders of gut-brain interaction (2). Using these criteria, which include questions about the frequency of pain over the past three months alongside a physical exam, helps provide a diagnosis.

Once diagnosed, first-line treatment typically involves lifestyle modifications, including dietary changes. Let’s look at what the research tells us.

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 (3). 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.

A subsequent meta-analysis of six randomized controlled trials (RCTs) that studied the effects of mindfulness on IBS found that the combined study group achieved improved quality of life and lower pain scores, perceived stress anxiety, and visceral sensitivity than the control group (4).

Interestingly, a 2021 international study of more than 50,000 participants found that there were some genetic similarities among those who suffer from IBS and those who suffer from common mood and anxiety disorders such as anxiety, depression, and neuroticism, as well as insomnia. As the authors wrote, “Although IBS occurs more frequently in those who are prone to anxiety, we don’t believe that one causes the other – our study shows these conditions have shared genetic origins, with the affected genes possibly leading to physical changes in brain or nerve cells that in turn cause symptoms in the brain and symptoms in the gut” (5). In other words, they may have a common cause.

Is gluten a factor?

Gluten sensitivity may be an important factor for some IBS patients (6).

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 (7). These results were highly statistically significant, and the authors concluded that nonceliac gluten intolerance may exist. 

What role does fructose play?

Some IBS patients may suffer from fructose intolerance. In a study, IBS researchers used a breath test to explore this possibility (8). 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 did.

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

According to another study, about one-third of IBS patients are fructose intolerant. When on a fructose-restricted diet, symptoms appeared to improve (9). Foods with high levels of fructose include certain fruits, like apples and pears.

Is lactose intolerance a contributor?

According to another small study, about one-quarter of patients with IBS also have lactose intolerance (10). 

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. Both the patient compliance and long-term effects were excellent, and outpatient clinic visits were reduced by 75 percent.

Will probiotics help?

A study that analyzed 42 trials focused on treatment with probiotics shows there may be a benefit to probiotics, although each trial’s objectives, or endpoints, were different (11).

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

All of these studies provide hope for IBS patients — and the research is continuing with assessments of peppermint oil consumption and gut-directed hypnotherapy, among others. Since the causes can vary, a strong patient-doctor relationship can assist in selecting an approach that provides the greatest relief for each patient’s symptoms.

References:

(1) American College of Gastroenterology [GI.org]. (2) J Neurogastroenterol Motil. 2017 Apr; 23(2): 151–163. (3) Am J Gastroenterol. 2011 Sep;106(9):1678-1688. (4) J Clin Med. 2022 Nov; 11(21): 6516. (5) Nat Genet 53, 1543–1552 (2021). (6) Am J Gastroenterol. 2011 Mar;106(3):516-518. (7) Am J Gastroenterol. 2011 Mar;106(3):508-514. (8) Am J Gastroenterol. 2003 June; 98(6):1348-1353. (9) J Clin Gastroenterol. 2008 Mar;42(3):233-238. (10) Eur J Gastroenterol Hepatol. 2001 Aug;13(8):941-944. (11) Aliment Pharmacol Ther. 2012 Feb;35(4):403-413.

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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Can increasing your nutrient consumption improve your quality of life?

By David Dunaief, M.D.

Dr. David Dunaief

What percent of U.S. adults do you think meet the daily requirements for vegetable intake? How about for fruit intake?

According to a 2022 report by the Centers for Disease Control and Prevention (CDC), an average of 10 percent of U.S. adults meet vegetable intake recommendations, and only 12.3 percent meet the daily requirements for fruit intake (1). That’s abysmal. As you might expect, it follows that we are deficient in many key micronutrients (2).

Why should we care? Fruits and vegetables include fiber, along with critical nutrients and micronutrients that reduce our risks of developing chronic diseases.

Many chronic diseases can be prevented, modified and even reversed by focusing on increasing our nutrients.

Do you want another stunning statistic? More than 50 percent of American adults have one chronic disease, and 27 percent have more than one (3). This is a likely contributor to the slowing pace of life expectancy increases in the U.S., which have plateaued in the past decade.

How do you know if you’re getting enough nutrients? One indicator that we can measure is carotenoid levels. Carotenoids are incredibly important for tissue and organ health. I measure my patients’ levels regularly, because they give me a sense of whether the patient might be low in potentially disease-fighting nutrients. A high nutrient intake dietary approach can increase both carotenoid and other critical nutrient levels.

What is a high nutrient intake diet?

A high nutrient intake diet focuses on micronutrients, which literally means “small nutrients.” Micronutrients are bioactive compounds found mostly in foods and in some supplements. They interact with each other in synergistic ways, meaning the sum of them is greater than their parts. Diets that are plant-rich can raise your micronutrient levels considerably.

While fiber is not considered a micronutrient, it also has significant disease modifying effects. A high nutrient intake diet will also increase your fiber intake, adding to the benefits.

A 2017 study included 73,700 men and women who were participants in the Nurses’ Health Study and the Health Professionals Follow-up Study. During the study, participants’ diets were rated over a 12-year period using three established dietary scores: the Alternate Healthy Eating Index–2010 score, the Alternate Mediterranean Diet score, and the Dietary Approaches to Stop Hypertension (DASH) diet score (4).

A 20 percent increase in diet scores, which indicated improved diet quality, was significantly associated with reducing total mortality by 8 to 17 percent, depending on whether two or three scoring methods were used. Participants who maintained a high-quality diet over a 12-year period reduced their risk of death by 9 to 14 percent more than participants with consistently low diet scores. By contrast, worsening diet quality over 12 years was associated with an increase in mortality of 6 to 12 percent. As expected, longer periods of healthy eating had a greater effect than shorter periods.

This study reinforces the findings of the Greek EPIC trial, a large, prospective cohort study, where the Mediterranean-type diet decreased mortality significantly — the greater the participants’ compliance, the greater the effect (5).

Can diet improve your quality of life?

Quality of life is as important as longevity. Let’s examine some studies that consider the impact of diet on diseases that may reduce our quality of life as we age.

A study showed olive oil reduces the risk of stroke by 41 percent (6). The authors attribute this effect partially to oleic acid, a bioactive compound found in olive oil. While olive oil is important, I recommend limiting consumption to one tablespoon a day. If you eat too much of even good fat, it can be counterproductive. The authors commented that the Mediterranean-type diet had only recently been used in trials with neurologic diseases and results suggest benefits in several disorders, such as Alzheimer’s disease.

In a case-control study that compared those with and without disease, high intake of antioxidants from food was associated with a significant decrease in the risk of early Age-related Macular Degeneration (AMD), even when participants had a genetic predisposition for the disease (7). AMD is the leading cause of blindness in those over age 54 (7).

Of the 2,167 people enrolled in the study, representing several different genetic variations that made them high risk for AMD, those with the highest nutrient intake, including B-carotene, zinc, lutein, zeaxanthin, EPA and DHA- substances found in fish, had an inverse relationship with risk of early AMD. Nutrients, thus, may play a role in modifying how their genes were expressed. 

Though many Americans are malnourished, increasing our nutrient consumption can improve our outcomes. With a focus on a high nutrient intake diet, we can improve life expectancy and, on an individual level, improve our quality of life.

References:

(1) cdc.gov. Morb Mortal Wkly Rep 2022;71:1–9. (2) cdc.gov/nutritionreport (3) cdc.gov. (4) N Engl J Med 2017; 377:143-153. (5) BMJ. 2009;338:b2337. (6) Neurology June 15, 2011. (7) Arch Ophthalmol. 2011;129(6):758-766.

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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