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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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Drink plenty of water each day to prevent the reoccurence of kidney stones. METRO photo

By David Dunaief, M.D.

Dr. David Dunaief

How do you know you have a kidney stone? Most often, you’ll have classic symptoms of blood in the urine and pain. The pain can range from dull to extremely painful, described by some as being worse than giving birth, being shot or being burned, and it might radiate from the kidneys to the bladder and even to the groin in males, depending on the obstruction (1).

Stones are usually diagnosed by a physician through the symptoms, urine tests, and either an abdominal x-ray, a non-contrast CT scan, or an ultrasound.

Unfortunately, the first line treatment for passing kidney stones – at least small ones – involves supportive care. This means that patients are given pain medications and plenty of fluids until the stone passes. Usually stones that are smaller than four millimeters pass spontaneously. If they’re close to the opening of the urethra, they are more likely to pass on their own (2).

In the case of a stone too large to pass naturally, a urologist may use surgery, ultrasound, or a combination of methods to break it into smaller pieces, so you can pass it naturally.

Unfortunately, once you’ve formed one stone, your likelihood of having more increases significantly over time. The good news is that there are lifestyle changes you can make to reduce your risk.

The number one cause of kidney stones is lifestyle factors, including excessive animal protein or salt intake or too little consumption of items like citrate, fiber, and alkali foods, such as leafy greens and other non-starchy vegetables (3).

Stay hydrated

First, it is crucial that you stay hydrated by drinking plenty of fluids (4). You can help yourself in this process by consuming plenty of fruits and vegetables that are moisture-filled.

Reduce calcium supplements

One of the simplest methods is to reduce your intake of calcium supplements, including foods fortified with calcium. There are several types of stones. Calcium oxalate stones are the most frequent type, occurring approximately 80 percent of the time (5). Calcium supplements, therefore, increase the risk of kidney stones.

When physicians started treating women for osteoporosis with calcium supplements, the rate of kidney stones increased by 37 percent (6). According to findings from the Nurses’ Health Study, those who consumed highest amount of supplemental calcium were 20 percent more likely to have kidney stones than those who consumed the lowest amount (7). It did not matter whether study participants were taking calcium citrate or calcium carbonate supplements.

Interestingly, calcium from dietary sources has the opposite effect, decreasing risk. In the same study, participants who consumed the highest amount of dietary calcium had a 35 percent reduction in risk, compared to those who were in the lowest consumption group. Paradoxically, calcium intake shouldn’t be too low, either, since that also increases risk. Changing your source of calcium is an important key to preventing kidney stones.

Lower your sodium intake

Again, in the Nurses’ Health Study, participants who consumed 4.5 grams of sodium per day had a 30 percent higher risk of kidney stones than those who consumed 1.5 grams per day (7). Why would that be? Increased sodium causes increased urinary excretion of calcium. When there is more calcium going through the kidneys, there is a higher risk of stones.

Reduce your animal protein consumption

Animal protein may play a role. In a five-year, randomized clinical trial of men with a history of kidney stones, men who reduced their consumption of animal protein to approximately two ounces per day, as well as lowering their sodium, were 51 percent less likely to experience a kidney stone than those who consumed a low-calcium diet (8).

The reason animal protein may increase the risk of calcium oxalate stones more than vegetable protein is that animal protein’s higher sulfur content produces more acid. The acid is neutralized by release of calcium from the bone (9). That calcium then promotes kidney stones.

Manage your blood pressure

Some medical conditions may increase the likelihood of stone formation. For example, in a cross-sectional study with Italian men, those with high blood pressure had a two times greater risk of kidney stones than those who had a normal blood pressure (10). Amazingly, it did not matter whether or not the patients were treated for high blood pressure with medications; the risk remained. This is just one more reason to treat the underlying cause of blood pressure, not just the symptoms.

While the causes of kidney stones are complex, making relatively simple lifestyle changes is the most constructive way to avoid the potentially excruciating experience of kidney stones. The more that you implement, the lower your likelihood of stones.

References:

(1) emedicine January 1, 2008. (2) J Urol. 2006;175(2):575. (3) Adv Urol. 2018; 2018: 3068365. (4) J Urol. 1996;155(3):839. (5) N Engl J Med. 2004;350(7):684. (6) Kidney Int 2003;63:1817–23. (7) Ann Intern Med. 1997;126(7):497-504. (8) N Engl J Med. 2002 Jan 10;346(2):77-84. (9) J Clin Endocrinol Metab. 1988;66(1):140. (10) BMJ. 1990;300(6734):1234.

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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Supplements may not have the same benefits

By David Dunaief, M.D.

Dr. David Dunaief

A cataract is an opacity or cloudiness of the eye’s lens, which decreases vision as it progresses. Although there are different types of cataracts, most often it’s caused by oxidative stress. As we age, the likelihood increases that cataracts will affect our vision.

In the U.S., estimates suggest that 26.6 million Americans over age 40 have a cataract in at least one eye or have had surgery to remove a cataract (1). By age 80, this increases to approximately 50 percent of Americans.

Chronic diseases, such as diabetes and metabolic syndrome; steroid use; and physical inactivity can contribute to your risk.

The good news is that we can take an active role in preventing cataracts. Protecting your eyes from the sun and injuries, quitting smoking, and increasing your consumption of fruits and vegetables can improve your odds. Here, we will focus on the dietary factor.

What effect does meat consumption have on cataracts?

Diet has been shown to have substantial effect on cataract risk (2). One of the most expansive studies on cataract formation and diet was the Oxford (UK) group, with 27,670 participants, of the European Prospective Investigation into Cancer and Nutrition (EPIC) trial. Participants completed food frequency questionnaires between 1993 and 1999. Then, they were checked for cataracts between 2008 and 2009.

There was an inverse relationship between cataract risk and the amount of meat consumed. In other words, those who ate more meat were at higher risk of cataracts. “Meat” included red meat, fowl and pork.

Compared to high meat eaters, every other group demonstrated a significant reduction in risk as they progressed along a spectrum that included low meat eaters (15 percent reduction), fish eaters (21 percent reduction), vegetarians (30 percent reduction) and finally vegans (40 percent reduction).

There was not much difference in meat consumption between high meat eaters, those having at least 3.5 ounces, and low meat eaters, those having less than 1.7 ounces a day, yet there was a substantial decline in cataracts. This suggests that you can achieve a meaningful effect by reducing or replacing your average meat intake, rather than eliminating meat from your diet.

I’ve had several patients experience cataract reversal after they transitioned to a nutrient-dense, plant-based diet. This positive outcome and was confirmed by their ophthalmologists.

Do antioxidants help prevent cataracts?

Oxidative stress is one of the major contributors to cataract development. In a review article that looked at 70 different trials for the development of cataract and/or maculopathies, such as age-related macular degeneration, the authors concluded antioxidants, which are micronutrients found in foods, play an integral part in eye disease prevention (3).

The authors go on to say that a diet rich in fruits and vegetables, as well as lifestyle modification with cessation of smoking and treatment of obesity at an early age, help to reduce the risk of cataracts. You are never too young or too old to take steps to protect your vision.

Among antioxidant-rich foods studied that have shown positive effects is citrus. The Blue Mountains Eye Study found that participants who had the highest dietary intake of vitamin C reduced their 10-year risk for nuclear cataracts (4). The same effect was not seen with vitamin C supplements. Instead, a high dose of a single-nutrient vitamin C supplement actually increased cataract incidence (5).

How effective is cataract surgery?

The only effective way to correct cataracts is with surgery; the most typical type is phacoemulsification. Ophthalmologists remove the opaque lens and replace it with a synthetic intraocular lens in an outpatient procedure. Fortunately, this surgery has a very high success rate.

Of course, there are always potential risks with invasive procedures, such as infection, even when the chances of complications are low. In a small percentage of cases, surgery complications have resulted in blindness.

You can reduce your risk of cataracts with diet and other lifestyle modifications, plus avoid potential consequences from cataract surgery, all while reducing your risk of other chronic diseases. Why not choose the win-win scenario?

References:

(1) nei.nih.gov. (2) Am J Clin Nutr. 2011 May; 93(5):1128-1135. (3) Exp Eye Res. 2007; 84: 229-245. (4) Am J Clin Nutr. 2008 Jun; 87(6):1899-1305. (5) Nutrients. 2019 May; 11(5): 1186.

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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There are 8 grams of fiber in one cup of raspberries. Source: Mayo Clinic, Pixabay photo

Most Americans consume only half   the recommended daily fiber.

By David Dunaief, M.D.

Dr. David Dunaief

Based on an abundance of research, we should all be concerned with getting enough fiber in our diets (1). Most Americans are woefully deficient in fiber, consuming between 10 and 15 grams per day, which is about half of what we should be consuming. Probably not surprising, our consumption of legumes and dark green vegetables is the lowest in comparison to other fiber subgroups (2). This has significant implications for our health.

USDA fiber intake recommendations vary based on gender and age. For adult women, they recommend between 22 and 28 grams per day, and for adult men, the targets are between 28 and 35 grams (2). Some argue that even these recommendations are on the low end of the scale for optimal health.

Though fiber comes in supplement form, most of your daily intake should be from diet. It is actually relatively painless to increase your fiber consumption; you just have to be aware of which foods are fiber-rich.

What difference does fiber type make?

There are a number of different fiber classifications, including soluble, viscous, and fermentable. Within each of the types, there are subtypes. Not all fiber sources are equal.

At a high level, we break dietary fiber into two overarching categories: soluble and insoluble. Soluble fibers slow digestion and nutrient absorption and make us feel fuller for longer. Sources include oats, peas, beans, apples, citrus fruits, flax seed, barley and psyllium.

On the other hand, insoluble fibers accelerate intestinal transit, which promotes digestive health. Sources include wheat bran, nuts, berries, legumes and beans, dark leafy greens, broccoli, cabbage and other vegetables. 

Many plant-based foods contain both soluble and insoluble fiber.

How does fiber affect disease progression and longevity?

Fiber has powerful effects on our health. A very large prospective cohort study showed that fiber may increase longevity by decreasing mortality from cardiovascular disease, respiratory diseases and other infectious diseases (3). Over a nine-year period, those who ate the most fiber were 22 percent less likely to die than those consuming the lowest amount.

Patients who consumed the most fiber also saw a significant decrease in mortality from cardiovascular disease, respiratory diseases and infectious diseases. The authors of the study believe that it may be the anti-inflammatory and antioxidant effects of whole grains that are responsible for the positive results.

A study published in 2019 that performed systematic reviews and meta-analyses on data from 185 prospective studies and 58 clinical trials found that higher intakes of dietary fiber and whole grains provided the greatest benefits in protecting participants from cardiovascular diseases, type 2 diabetes, and colorectal and breast cancers, along with a 15-30 percent decrease in all-cause mortality for those with the highest fiber intakes, compared to those with the lowest (4).

We also see a benefit with fiber and prevention of chronic obstructive pulmonary disease (COPD) in a relatively large epidemiologic analysis of the Atherosclerosis Risk in Communities (ARIC) study (5). The specific source of fiber was important. Fruit had the most significant effect on preventing COPD, with a 28 percent reduction in risk. Cereal fiber also had an effect, but it was not as great.

Fiber also has powerful effects on breast cancer treatment. In a study published in the American Journal of Clinical Nutrition, soluble fiber had a significant impact on breast cancer risk reduction in estrogen receptor negative women (6). This is one of the few studies that has illustrated significant results for this population. Most beneficial studies for breast cancer have shown results in estrogen receptor positive women.

The list of chronic diseases and disorders that fiber prevents and/or treats is continually expanding.

How do I increase my fiber intake?

Emphasize plants on your plate. Animal products don’t contain natural fiber. It’s easy to increase your fiber by choosing bean- or lentil-based pastas, which are becoming easier to find in general grocery stores. Sometimes, they are tucked in the gluten-free section, rather than with wheat pastas. Personally, I prefer those based on lentils, but that’s a personal preference. Read the labels, though; you want those that are made from only beans or lentils and not those that include rice.

If you are trying to prevent chronic diseases in general, aim to consume fiber from a wide array of sources. Ensuring you consume substantial amounts of fiber has several health protective advantages: it helps you avoid processed foods, it reduces your risk of chronic disease, and it increases your satiety and energy levels.

References:

(1) Nutrients. 2020 Oct; 12(10): 3209. (2) USDA.gov. (3) Arch Intern Med. 2011;171(12):1061-1068. (4) Lancet. 2019 Feb 2;393(10170):434-445. (5) Amer J Epidemiology 2008;167(5):570-578. (6) Amer J Clinical Nutrition 2009;90(3):664–671.

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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METRO photo
Physical inactivity is the greatest risk factor for women over 30

By David Dunaief, M.D.

Dr. David Dunaief

Heart disease is still the number one cause of death in the U.S., responsible for one in five deaths (1). 

Many risk factors are obvious, but others are not. Family history, high cholesterol, high blood pressure, obesity, sedentary lifestyle, diabetes and smoking are among the more obvious ones. In addition, age can a role in your risk: men at least 45 years old and women at least 55 years old are at greater risk. Less obvious risks include atrial fibrillation, gout and osteoarthritis. 

In practice, we have more control than we think. You can significantly reduce your risk by making some simple lifestyle changes. How much does lifestyle really affect heart disease risk? Here’s one indicator.

In the Nurses’ Health Study, which followed 120,000 women for 20 years, those who routinely exercised, ate a quality diet, did not smoke and were a healthy weight demonstrated a whopping 84 percent reduction in the risk of cardiovascular events, such as heart attacks (2). Inspired? Let’s take a closer look at different factors.

Does your weight really affect your heart disease risk?

Obesity is always a part of the heart disease risk discussion. How important is it, really?

Results from the Copenhagen General Population Study showed an increased heart attack risk in those who were overweight and in those who were obese – with or without metabolic syndrome, which includes a trifecta of high blood pressure, high cholesterol and high sugar levels (3). “Obese” was defined as a body mass index (BMI) over 30 kg/m², while “overweight” included those with a BMI over 25 kg/m².

Heart attack risk increased in direct proportion to weight. heart attack risk increased 26 percent for those who were overweight and 88 percent for those who were obese without metabolic syndrome.

What does this suggest? Obesity, by itself, without blood pressure, cholesterol or sugar level issues, increases your risk. Of course, those with metabolic syndrome and obesity together were at greatest risk, but without these, your risk is still higher if you’re carrying extra pounds.

How important is physical activity to heart disease risk?

Let’s consider another lifestyle factor, activity levels. An observational study found that these had a surprisingly high impact on women’s heart disease risk (4). Of four key factors — weight, blood pressure, smoking and physical inactivity — lack of exercise was the most dominant risk factor for heart disease, including heart attacks, for those over age 30.

For women over age 70, the study found that increasing physical activity may actually have a greater positive impact on heart disease risk than addressing high blood pressure, losing weight, or even quitting smoking. The researchers noted that women should exercise on a regular basis to most significantly reduce their heart disease risk.

What effect does increasing your fiber have?

Studies show that dietary fiber decreases the risks of heart attack and death after a heart attack. In an analysis using data from the Nurses’ Health Study and the Health Professionals Follow-up Study, results showed that higher fiber plays an important role in reducing the risk of death after a heart attack (6).

Those who consumed the most fiber had a 25 percent reduction in post-heart attack mortality when compared to those who consumed the least. Even more impressive is that those who increased their fiber intake after a cardiovascular event experienced a 31 percent mortality risk reduction.

The most intriguing part of the study was the dose response. For every 10-gram increase in fiber consumption, there was a 15 percent reduction in the risk of post-heart attack mortality. For perspective, 10 grams of fiber is just over eight ounces of raspberries or six ounces of cooked black beans or lentils.

You can substantially reduce your risk of heart attacks and even potentially the risk of death after sustaining a heart attack with simple lifestyle modifications. Managing your weight, increasing your physical activity and making some updates to your diet can lead to tremendous improvements.

How long do you suffer with osteoarthritis?

Traditional advice for those who suffer from osteoarthritis is that it is best to live with hip or knee pain as long as possible before having surgery. But when do we cross the line and consider joint replacement?

In a study, those with osteoarthritis of the hip or knee joints that caused difficulty walking on a flat surface were at substantially greater risk of cardiovascular events, including heart attack (5). Those who had surgery for the affected joint saw substantially reduced heart attack risk. If you have osteoarthritis, it is important to improve your mobility, either with surgery or other treatments.

References:

(1) cdc.gov. (2) N Engl J Med. 2000;343(1):16. (3) JAMA Intern Med. 2014;174(1):15-22. (4) Br J Sports Med. 2014, May 8. (5) PLoS ONE. 2014, 9: e91286 (6) BMJ. 2014;348:g2659.

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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Find this recipe for Shrimp, Broccoli and Potato Skewers below. Photo courtesy of Family Features
Offer a mouthwatering array of fruits and veggies with your bbq choices

By David Dunaief, M.D.

Dr. David Dunaief

Independence Day makes me think of fireworks and summer barbecues and picnics. What if you could launch yourself on a journey to better health during these celebratory moments?

I have written about the dangers of processed meats, which are barbecue and picnic staples, and their roles in prompting chronic diseases, such as cancer, diabetes, heart disease and stroke. What if there were appetizing, healthier alternatives?

Green leafy vegetables, fruit, nuts and seeds, beans and legumes, whole grains and small amounts of fish and olive oil are the foundations of the Mediterranean-style diet. The options are far from tasteless.

I love a family barbecue, and I always strive to have an array of succulent choices. Three-bean salad, mandarin orange salad with mixed greens and a light raspberry vinaigrette, ratatouille with eggplant and zucchini, salmon fillets baked with mustard and slivered almonds, roasted corn on the cob, roasted vegetable shish kebobs, and large bowl of melons and berries. These drool-worthy buffet items help me keep my health journey on the right path. Let’s look at the scientific evidence that explains why these foods help us.

Preventing cancer

One systematic review provides a comprehensive look at the results of studies that weigh the effects of to a Mediterranean-type diet on cancer risk and progression (1, 2). The authors found an inverse relationship between cancer mortality risk and high adherence to the diet. This means that the more compliant participants were, the lower their risk of cancer mortality.

When comparing the results of high adherence and low adherence to the diet from studies of specific cancers, they identified risk reductions for colorectal, prostate, gastric, and liver cancers (1). Further study also found high adherence reduced the risks of breast, head and neck, gallbladder, and biliary tract cancers (2).

The authors note that, while it’s improbable that any single component of the diet led to these effects, they were able to demonstrate significant inverse correlations between specific food groups and overall cancer risk. For example, the higher the regular consumption of fruits, vegetables, and whole grains, the lower the risk. All three of these fit right in at a summer feast.

Looking closely at specific cancers, another study found that increased consumption of fruits and vegetables may help prevent pancreatic cancer. This is crucial, pancreatic cancer often spreads to other organs before there are symptoms (3). In another study, cooked vegetables showed a 43 percent reduction and non-citrus fruits showed an even more impressive 59 percent reduction in risk of pancreatic cancer (4). Interestingly, cooked vegetables, not just raw ones, had a substantial effect.

Preventing and treating diabetes 

Fish might play an important role in reducing the risk of diabetes. In a large prospective study that followed Japanese men for five years, those in the highest quartile of fish and seafood intake had a substantial decrease in risk of type 2 diabetes (5). Smaller fish, such as mackerel and sardines, had a slightly greater effect than large fish and seafood. Therefore, there is nothing wrong with some grilled fish to help protect you from developing diabetes.

Nuts are beneficial in diabetes treatment. In a randomized control trial, mixed nuts led to a substantial reduction of hemoglobin A1C, a very important biomarker for sugar levels for the previous three months (6). They also significantly reduced LDL, bad cholesterol, which reduced the risk of cardiovascular disease.

The nuts used in the study were raw almonds, pistachios, pecans, peanuts, cashews, hazelnuts, walnuts and macadamias. How easy is it to grab a small handful of unsalted raw nuts, about 2 ounces, daily to help treat diabetes?

Preventing a stroke

The Three City study showed that olive oil may have a substantial, protective effect against stroke. There was a 41 percent reduction in stroke events in those who used olive oil (7). Study participants, who were followed for a mean of 5.2 years, did not have a history of stroke at the start of the trial.

Though these are promising results, I caution you to use no more than one tablespoon of olive oil per day, since it’s calorically dense. Overindulging can lead to other health problems.

It’s easy to substitute a beneficial Mediterranean-style diet for processed meats, or at least add them to the selection you offer. This plant-rich diet can help you prevent many chronic diseases. 

This Independence Day and beyond, plan to include some delicious, healthy choices for your celebrations.

References:

(1) Curr Nutr Rep. 2016; 5: 9–17. (2) Nutrients. 2017 Oct; 9(10): 1063. (3) Nature. 2010;467:1114-1117. (4) Cancer Causes Control. 2010;21:493-500. (5) Am J Clin Nutr. 2011 Sep;94(3):884-891. (6) Diabetes Care. 2011 Aug;34(8):1706-11. (7) Neurology. 2011 Aug 2;77(5):418-25.

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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Shrimp, Broccoli and Potato Skewers

 Shrimp, Broccoli and Potato Skewers 
Photo courtesy of Family Features

Prep time: 5 minutes
Cook time: 20 minutes
Servings: 4

Ingredients: 

1 pound bagged Little Potatoes
1 bunch broccoli
12 large shrimp, peeled and deveined
1 1/2 lemons, juice only
3 tablespoons fresh thyme, chopped
2 tablespoons olive oil
salt, to taste
pepper, to taste

Directions:

In large, microwave-safe bowl, microwave potatoes on high 5 minutes. Chop broccoli into large pieces. Add broccoli and shrimp to bowl once potatoes are steamed. Add lemon juice, thyme and olive oil; evenly coat potatoes, shrimp and broccoli. Season with salt and pepper, to taste. Build skewers and grill 10-15 minutes on medium-high heat, until shrimp is cooked through.

 

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