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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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METRO photo
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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METRO photo

By Leah S. Dunaief

Leah Dunaief,
Publisher

Speaking of our health, which we often do with friends, there were a couple of interesting bits of news this week in that department.

Probably the most dramatic is the idea that by delaying the onset of menopause, a woman’s life and good health might be extended. The health benefits that women have before menopause lessen as we age past that mark. So current longevity research is asking if the whole picture could be slowed. And so, Dr. Jill Biden announced from the White House a new health initiative to pursue this concept, with Dr. Renee Wegrzyn steering the research.

Ovaries, which seem to play a role throughout a woman’s lifetime, not just until menopause, are the main focus. “Researchers think that prolonging their function, better aligning the length of their viability with that of other organs, could potentially alter the course of a woman’s health—and longevity research overall,” according to Tuesday’s front page story in The New York Times.

Using hormones like estrogen and progesterone, ovaries communicate with every other organ in the body. When they stop communicating, “all kinds of problems arise.” They stop when the eggs that they carry are gone, at which point risk increases for dementia, cardiovascular disease, osteoporosis and other age-related diseases and lifespan, according to The Times. Women whose ovaries have been prematurely removed for other health reasons are at greater risk, which suggests that even after all the eggs are gone, ovaries may still play a protective role.

All of this is subject to much further investigation. Researchers are not sure whether aging negatively affects the ovaries or if the ovaries cause other organs to age. But prolonging ovarian function in lab animals does seem to improve their health and longevity. This encourages further research into reducing the number of eggs lost by a woman during each menstrual cycle, thus preserving ovarian function. (Women shed may eggs many cycle but one ovulates). A current drug, rapamycin, which is an immunosuppressant used in organ transplants, is being studied for that role.

Anti-aging research is highly popular among scientists these days.

Another surprising article in the same issue of The Times, this one in the ScienceTimes section, has to do with our sense of smell. Though it lessens with age (and might as the result of infections, like Covid), “A diminished ability to smell is associated with worsening memory, cognition and overall well-being—as well as dementia and depression.”  The good news is that such a situation may be reversible. 

We can train our noses with smelling exercises, and our ability to smell, in turn, may improve not only depression but also help remember words faster. One explanation for this is “the areas of the brain involved in smelling are uniquely connected to parts involved in cognition, such as the prefrontal cortex.”  Further to the point, “The olfactory system is the only sensory system that has a direct superhighway projection into the memory centers and the emotional centers of your brain,” according to Professor Michael Leon of the University of California, Irvine.

So take out products from your kitchen cabinets and alternately smell cinnamon, honey, coffee, wine or others and sniff each of them at least 30 seconds at a time, once in the morning and once more at night. Small studies have indicated this not only tests one’s power to smell but also enhance cognitive abilities.

Finally for this column, I would like to quote the Times’ article on the Walking Cure for Lower Back Pain. Although those with pain may be loathe to exercise, movement can strengthen muscles that support the back and ease the pain. This is a conclusion that is supported with any number of studies over the past few years. 

“Researchers found that regular exercise combined with physical education was the most effective way to prevent lower back pain from recurring,” according to The NYT.

Walking can help strengthen the support muscles at the base of the spine. When they weaken, it can lead to pain.

So, as the song goes, “Shake, Shake, Shake Your Booty,” for good health. 

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Call 911 at the first sign of a heart attack. METRO photo

By David Dunaief, M.D.

One person every 40 seconds: that’s how prevalent heart attacks still are in the U.S. (1). Your gender and race don’t matter, we’re all susceptible. Of these 805,000 annual heart attacks, one in five is “silent” — you might not be aware you’ve had it, but your body is still affected. The good news is that your potential outcomes are significantly better if you recognize the symptoms while having a heart attack and receive immediate medical attention.

What are heart attack symptoms?

The most recognizable symptom is chest pain. However, there are an array of more subtle symptoms, such as discomfort or pain in the neck, back, jaw, arms and upper abdominal areas. You might also experience nausea, shortness of breath, sweating, light-headedness and tachycardia (racing heart rate). Unfortunately, most people don’t recognize these as symptoms of heart attack (2). According to one study, about 10 percent of patients present with atypical symptoms and no chest pain (3).

Are heart attack symptoms really different for men and women?

There has been much discussion about whether men and women have different symptoms when it comes to heart attacks. What does the research tell us?

There is data showing that, although men have heart attacks more commonly, women are more likely to die from a heart attack (4). In a Swedish study of 54,000 heart attack patients, one-third were women.  After having a heart attack, a significantly greater number of women died in the hospital or near-term when compared to men. The women received aggressive treatments, such as reperfusion therapy, artery opening treatment that includes medications or invasive procedures, less often than the men.

However, recurrent heart attacks occurred at the same rate, regardless of sex. Both men and women had similar findings on an electrocardiogram.

One theory about why women receive less aggressive treatment when first presenting in the ER is that they have different and more subtle symptoms — even chest pain symptoms may be different. Is this true? Not according to studies.

In one observational study of 2,500 patients, results showed that, though there were some subtle differences, when men and women presented with chest pain as the main symptom, it was of a similar nature (5). There were 34 chest pain characteristic questions used to determine if a difference existed. These included location, quality or type of pain and duration. Of these, there was some small amount of divergence: the duration was shorter for a man (2 to 30 minutes), and pain subsided more for men than for women. The authors concluded that determination of heart attacks with chest pain symptoms should not factor in the sex of patients.

This trial involved an older population; patients were a median age of 70 for women and 59 for men, with more men having had a prior heart attack. The population difference was a conspicuous weakness of an otherwise solid study, since age and previous heart attack history are important factors.

In the GENESIS-PRAXY study, another observational study, the median age of both men and women was 49. Results showed that chest pain remained the most prevalent presenting symptom in both men and women (6). However, of the patients who presented without distinct chest pain and with less specific EKG findings, significantly more were women than men.

Those who did not have chest pain symptoms may have experienced back discomfort, weakness, discomfort or pain in the throat, neck, right arm and/or shoulder, flushing, nausea, vomiting and headache. If the patients did not have chest pain, regardless of sex, the symptoms were diffuse and nonspecific. 

Some studies imply that up to 35 percent of patients do not present with chest pain as their primary complaint (7).

Is someone having a heart attack?

Call 911 immediately, and have the patient chew an adult aspirin (325 mg) or four baby aspirins, provided they do not have a condition that precludes taking aspirin. The purpose of aspirin is to thin the blood quickly, but not if the person might have a ruptured blood vessel. The 911 operator or emergency medical technician who responds can help you determine whether aspirin is appropriate.

Don’t hesitate to seek immediate medical attention; it’s better to have a medical professional rule out a heart attack than to ignore one.

The most frequently occurring heart attack symptoms

Most patients have similar types of chest pain, regardless of gender. However, this is where the complexity begins. The percentage of patients who present without chest pain seems to vary depending on which study you review — ranging from less than 10 percent to 35 percent.

Non-chest pain heart attacks have a bevy of diffuse symptoms, including obscure pain, nausea, shortness of breath and light-headedness. This is seen in both men and women, although it occurs more often in women. It’s important to recognize heart attack symptoms, since quick action can save your life or a loved one’s.

References:

(1) csc.gov. (2) MMWR. 2008;57:175–179. (3) Chest. 2004;126:461-469. (4) Int J Cardiol. 2013;168:1041-1047. (5) JAMA Intern Med. 2014 Feb. 1;174:241-249. (6) JAMA Intern Med. 2013;173:1863-1871. (7) JAMA. 2012;307:813-822.

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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John Perkins and Mike Gugliotti, chief navigation officer and his ‘water Sherpa.’ Photo courtesy Maggie Fischer Memorial Swim

By Daniel Dunaief

What are you planning to do this Saturday?

John Perkins, Community Outreach Manager at St. Charles Hospital and St. Catherine of Siena Hospital and Islip Terrace resident, is planning to swim 12.5 miles around Key West. The swim isn’t just an exercise in rugged outdoor activities or a test of his endurance, but is a way to raise money to support St. Charles Hospital’s stroke support group and promote stroke awareness and prevention.

As of Tuesday morning Perkins, who is 56 years old, has raised $4,900 out of his goal of collecting $5,000.

“Stroke survivors can have challenges for the rest of their lives,” said Perkins. “My hundreds of hours of training and hundreds of miles I’ve swam over the last year is nothing in comparison to someone who has a stroke” and then has a gate impairment, a speech impediment or is visually impaired.

Perkins added that about 80 percent of the estimated 800,000 strokes in the United States are preventable, through efforts like managing high blood pressure and/or diabetes, increasing physical activity and eating a healthier diet.

Perkins hopes the money he raises can add a new piece of equipment in the emergency room or help with the stroke survivor and support group.

Challenging conditions, with help

Getting ready for this swim took considerable work, especially given that Perkins didn’t even know how to swim until he was 50.

That’s when a group of childhood friends called him up in 2017 and suggested he join them for a two mile swim in the Straight of Messina, between Sicily and Calabria.

He rose to the challenge and raised $1,200.

To prepare for this much longer swim, which he estimates could take eight hours of more, he has been getting up at 4 am and is in the pool by 5 a.m.

Three days during the week, he swims two miles before work, often surrounded by people who are training for grueling races like triathlons and ironman competitions. On weekends, he does longer swims. He has been increasing the distances he swims in the pool, recently covering 10 miles in six and a half hours.

When he’s doing these longer swims, he gets out of the pool every two miles to take a 30-second break, which could involve hydrating and a quick restroom stop.

“You can not be a marathon swimmer without considering the nutrition aspect,” he said.

When he’s swimming around Key West, he plans to bring a special blend of carbohydrates, with calcium and magnesium and some protein, making sure he consumes about 300 calories per hour.

In expending over 6,000 calories for the swim itself, he wants to ensure he doesn’t tire or get cramps.

When he swims around Key West, Perkins said his wife Pamela, who is a registered nurse and whom he calls his chief nutritionist, will be in a two-person kayak. She will signal to him every 20 minutes or so to take a break for some liquid nutrition.

Meanwhile, his chief navigation officer, Michael Gugliotti, whom he also refers to as his “water Sherpa,” will ensure that he stays the course, not straying from the checkpoints so that he doesn’t wind up adding any distance to the long swim.

When he’s swimming, Perkins tends to think about the struggles stroke survivors have that they have to deal with for the rest of their lives.

“Strokes impact your life, your community’s life, your family’s life,” he said.

People interested in donating can do so through the following link: St. Charles Host Your Own Fundraiser

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Not all fruit raises your sugars. METRO photo

By David Dunaief, M.D.

Dr. David Dunaief

Our understanding of type 2 diabetes management is continually evolving. With this, we need to retire some older guidance. Here, we review a few common myths and the research that debunks them.

Myth: Fruit should be limited or avoided.

Fact: Diabetes patients are often advised to limit fruit in any form — whether whole, juiced, or dried — because it can raise your sugars. This is only partly true.

Yes, fruit juice and dried fruit should be avoided, because they do raise or spike glucose (sugar) levels. This includes dates, raisins, and apple juice, which are often added to “no sugar” foods to sweeten them. The same does not hold true for whole fruit, whether fresh or frozen. Studies have shown that patients with diabetes don’t experience sugar level spikes, whether they limit whole fruits or consume an abundance (1). In a different study, whole fruit was even shown to reduce the risk of type 2 diabetes (2).

In yet another study, researchers considered the impacts of different types of whole fruits on glucose levels. They found that berries reduced glucose levels the most, but even bananas and grapes reduced these levels (3). That’s right, bananas and grapes, two fruits people associate with spiking sugar levels and increasing carbohydrate load, actually lowered these levels. The only fruit tested that seemed to have a mildly negative impact on sugars was cantaloupe.

Whole fruit is not synonymous with sugar. One reason for the beneficial effect is the fruits’ flavonoids, or plant micronutrients, but another is their fiber.

Myth: All carbohydrates raise your sugars.

Fact: Fiber is one type of carbohydrate that has distinct benefits. It is important for reducing risk for an array of diseases and for improving their outcomes. This is also true for type 2 diabetes. 

Two very large prospective observational studies, the Nurses’ Health Study (NHS) and NHS II, showed that plant fiber helped reduce the risk of type 2 diabetes (4). Researchers looked at lignans, a type of plant fiber, specifically examining the metabolites enterodiol and enterolactone. They found that patients with type 2 diabetes have substantially lower levels of these metabolites in their urine, compared to the control group without diabetes. There was a direct relationship between the amount of metabolites and the reduction in diabetes risk: the more they consumed and the more metabolites in their urine, the lower the risk. The authors encourage patients to eat more of a plant-based diet to get this benefit.

Foods with lignans include cruciferous vegetables, such as broccoli and cauliflower; an assortment of fruits and whole grains; flaxseed; and sesame seeds (5). The researchers could not determine which plants contributed the greatest benefit; however, they believe antioxidant activity drives this effect.

Myth: You should you avoid soy when you have diabetes.

Fact: In diabetes patients with nephropathy (kidney damage or disease), soy consumption was associated with kidney function improvements (6). There were significant reductions in urinary creatinine levels and proteinuria (protein in the urine), both signs that the kidneys are beginning to function better.

This was a four-year, small, randomized control trial with 41 participants. The control group’s diet comprised 70 percent animal protein and 30 percent vegetable protein, while the treatment group’s diet consisted of 35 percent animal protein, 35 percent textured soy protein and 30 percent vegetable protein.

This is very important, since diabetes patients are 20 to 40 times more likely to develop nephropathy than those without diabetes (7). It appears that soy protein may put substantially less stress on the kidneys than animal protein. However, those who have hypothyroidism and low iodine levels should be cautious about soy consumption; some studies suggest it might interfere with synthetic thyroid medications’ effectiveness (8).

Myth: Bariatric surgery is a good alternative to lifestyle changes.

Fact: Bariatric surgery has grown in prevalence for treating severely obese (BMI>35 kg/m²) and obese (BMI >30 kg/m²) diabetes patients. In a meta-analysis of 16 randomized control trials and observational studies, the procedure led to better results than conventional medicines over a 17-month follow-up period for HbA1C (three-month blood glucose), fasting blood glucose and weight loss (9). During this period, 72 percent of those patients treated with bariatric surgery went into diabetes remission and had significant weight loss.

However, after 10 years without proper management involving lifestyle changes, only 36 percent remained in diabetes remission, and many regained weight. Thus, even with bariatric surgery, altering diet and exercise are critical to maintaining long-term benefits.

We still have a lot to learn with diabetes, but our understanding of how to manage lifestyle modifications, specifically diet, is becoming clearer. Emphasizing a plant-based diet focused on whole fruits, vegetables, beans and legumes can improve your outcomes. If you choose a medical approach, bariatric surgery is a viable option, but you still need to make significant lifestyle changes to sustain its benefits.

References:

(1) Nutr J. 2013 Mar. 5;12:29. (2) Am J Clin Nutr. 2012 Apr.;95:925-933. (3) BMJ online 2013 Aug. 29. (4) Diabetes Care. online 2014 Feb. 18. (5) Br J Nutr. 2005;93:393–402. (6) Diabetes Care. 2008;31:648-654. (7) N Engl J Med. 1993;328:1676–1685. (8) Thyroid. 2006 Mar;16(3):249-58. (9) Obes Surg. 2014;24:437-455.

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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Walking routinely can reduce your risk of dialysis.Stock photo

By David Dunaief, M.D.

Dr. David Dunaief

In my recent article about chronic kidney disease (CKD), I wrote that about 90 percent  of the estimated 35.5 million U.S. adults who have CKD are not even aware they have it (1).

How is this possible?

CKD is typically asymptomatic in its early stages. Once it reaches moderate stages, vague symptoms like fatigue, malaise and loss of appetite can surface. It’s when it reaches advanced stages that symptoms become more evident. Those at highest risk for CKD include patients with diabetes, high blood pressure and those with first-degree relatives who have advanced disease.

What is the effect of CKD?

Your kidneys are essentially little blood filters. They remove waste, toxins, and excess fluid from your body. They also play roles in controlling your blood pressure, producing red blood cells, maintaining bone health, and regulating natural chemicals in your blood. When your kidneys aren’t operating at full capacity, it can cause heart disease, stroke, anemia, infection, and depression — among others.

How often should you be screened for CKD?

If you have diabetes, you should have your kidney function checked every year (2). If you have other risk factors, like high blood pressure, heart disease, or a family history of kidney failure, talk to your physician about a regular screening schedule. A 2023 Stanford School of Medicine study recommends screening all U.S. residents over age 35. The authors conclude that the cost of screening and early treatment would be lower than the long-term cost of treatment for those undiagnosed until they are in advanced stages (3). In addition, they project it will improve life expectancy.

Does basic exercise help?

One study shows that walking reduces the risk of death by 33 percent and the need for dialysis by 21 percent (4). Those who walked more often saw greater results: participants who walked one-to-two times a week had a 17 percent reduction in death and a 19 percent reduction in kidney replacement therapy, while those who walked at least seven times per week experienced a more impressive 59 percent reduction in death and a 44 percent reduction in the risk of dialysis. The study included 6,363 participants with an average age of 70 who were followed for an average of 1.3 years.

How does protein consumption affect CKD?

With CKD, more protein is not necessarily better. It may even be harmful. In a meta-analysis of 17 studies of non-diabetic CKD patients who were not on dialysis, results showed that the risk of progression to end-stage kidney disease, including the need for dialysis or a kidney transplant, was reduced 36 percent in those who consumed a very low-protein diet, rather than a low-protein or a normal protein diet (5).

How much should I reduce my sodium consumption?

In a study, results showed that a modest sodium reduction in our diet may be sufficient to help prevent proteinuria (protein in the urine) (6). Here, less than 2000 mg per day was shown to be beneficial, something all of us can achieve.

Are some high blood pressure medications better than others?

We routinely give certain medications, ACE inhibitors or ARBs, to patients who have diabetes to protect their kidneys. What about patients who do not have diabetes? ACEs and ARBs are two classes of high blood pressure medications that work on the kidney systems responsible for blood pressure and water balance (7). Results of a study show that these medications reduced the risk of death significantly in patients with moderate CKD. Most of the patients were considered hypertensive.

However, there was a high discontinuation rate among those taking the medications. If you include the discontinuations and regard them as failures, then all who participated showed a 19 percent reduction in risk of death, which was significant. However, if you exclude discontinuations, the results are much more robust with a 63 percent reduction. To get a more realistic picture, this result, including both participants and dropouts, is probably close to what will occur in clinical practice unless patients are highly motivated.

Should you take NSAIDs?

Non-steroidal anti-inflammatory drugs (NSAIDs), which include ibuprofen and naproxen, have been associated with CKD progression and with kidney injury in those without CKD (1). NSAIDs can also interfere with the effectiveness of ACE inhibitors or ARBs. Talk to your doctor about your prescription NSAIDs and any other over-the-counter medications and supplements you are taking.

What should I remember?

It’s critical to protect your kidneys. Fortunately, basic lifestyle modifications can help; lowering sodium modestly, walking frequently, and lowering your protein consumption may all be viable options. Talk to your physician about your medications and supplements and about whether you need regular screening. High-risk patients with hypertension or diabetes should definitely be screened; however, those with vague symptoms of lethargy, aches and pains might benefit, as well.

References:

(1) cdc.gov. (2) niddk.nih.gov (3) Annals of Int Med. 2023;176(6):online. (4) Clin J Am Soc Nephrol. 2014;9(7):1183-9. (5) Cochrane Database Syst Rev. 2020;(10):CD001892. (6) Curr Opin Nephrol Hypertens. 2014;23(6):533-540. (7) J Am Coll Cardiol. 2014;63(7):650-658.

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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