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Health

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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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Leaders from Northwell’s Cancer Institute and its Center for Genomic Medicine celebrate the opening of the Molecular Diagnostic Laboratory. From left to right, Joseph Castagnaro, Jeff Boyd, Dwayne Breining, Richard Barakat, Naima Loayza, Anna Razumova, Angelo Carbone, Rita Mercieca and Kathryn Cashin. Photo courtesy of Northwell Health

By Daniel Dunaief

Northwell Health Cancer Institute and its Center for Genomic Medicine opened a Molecular Diagnostics Laboratory, which will reduce the cost of testing and shorten the time to get test results for cancer tests.

At a cost of $3.2 million, the 2,800 square foot facility will use next generation sequencing to provide tumor and patient genomic profiling and to assist in testing for biomarkers and determining the choice of cancer therapy.

The MDL, which is using the space Northwell Health Labs owned, will offer an array of tests in a phased approach. It is starting with a set of single gene tests to inform precision therapies for lung, melanoma, pancreatic, and colorectal cancer, which can be conducted in 24 to 72 hours.

“We like to get cancer therapy started as soon as possible for patients with metastatic disease,” said Jeff Boyd, vice president and chief scientific officer and director of the Northwell Health Cancer Institute’s Center for Genomic Medicine. When Northwell sent out similar tests to for-profit centers, the results, depending on the test, could take weeks.

The MDL is performing these tests on patients with advanced stage disease and/or recurrent diseases, which increases the need to generate results quickly.

“That makes a huge difference for the ordering oncologist and, most especially and importantly to the patient,” said Boyd. “The sooner they can get on precision therapeutics to treat the disease, the better. Outcomes will reflect wait time until you get therapy.”

Northwell treats more New York residents for cancer than any provider in the state, according to the Statewide Planning and Research Cooperative System, inpatient and ambulatory surgery data. 

The center, which is located in Lake Success, started conducting tests several weeks ago.

The lab is using high-end DNA sequencing to extract and define the genomic details of each tumor. Each patient tumor is different, which affects decisions about the best possible treatment.

“When the diagnosis isn’t totally clear to the pathology team, the genetics of the cancer will often inform the diagnosis,” said Boyd. Some patients with the same type of tumor will respond differently to radiation.

The lab is offering four single-gene tests: EGF for non-small cell lung cancer, BRAF for melanoma, KRAS for colorectal, pancreatic and lung cancers, and BRAF/NRAS for melanoma.The MDL plans to offer a 161-gene NGS panel for solid malignancies, a 45-gene NGS panel for hematologic malignancies, and MSI-H, a genetic test that reveals whether tumors will respond to immunotherapy.

Long road

Northwell recruited Boyd to start a molecular diagnostic lab four years ago. He started working in February of 2020, a month before the pandemic caused local, state, national and worldwide disruption.

While he has other responsibilities, Boyd suggested that his “primary reason” for joining Northwell was to “create and direct a Center for Genomic Medicine.”

Northwell conducted extensive physical renovation of the core lab facility that houses the MDL. Northwell also hired six people for the MDL, which includes a lab director, a lab manager, two certified lab technicians, a director of bioinformatics and an LIMS administrator.

In addition, New York State Department of Health had to certify the tests. Northwell is working through certification for additional tests.

Patients don’t need to go to the Lake Success facility to benefit from the services offered by the lab.The cost to patients for these tests is less than it would be for a for profit lab, Boyd said.

“We are a non profit and all we’re looking for is the sustainability of the lab infrastructure,” he added.

At this point, the lab isn’t conducting any germ line testing to determine if there are genetic predispositions to various cancers.

“That might be one of those tests we role out in the future,” Boyd said.

For Boyd, who earned a PhD in toxicology and biochemistry from North Carolina State University in Raleigh, the work is particularly rewarding.

To see his job “impact care tomorrow” based on a particular genetic alteration, “it doesn’t get much better than that for an individual with my background and profession,” he said.

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Sodium’s effects are insidious

By David Dunaief, M.D.

Dr. David Dunaief

Most of us consume far too much sodium. Americans consume an average of 3400 mg per day, well over the recommended 2300 mg per day recommended upper limit for those who are 14 and over (1). These consumption numbers are even higher for some demographics. It’s become such a health problem that the FDA is getting involved, working with food manufacturers and restaurants to drive these numbers down (2). 

Why all the concern? Because even if we don’t have hypertension, sodium can have a dramatic impact on our health.

Sodium is everywhere, including in foods that don’t taste salty. Bread products are among the worst offenders. Other foods with substantial amounts of sodium include cold cuts and cured meats, cheeses, pizza, poultry, soups, pastas, sauces and, of course, snack foods. Packaged foods and those prepared by restaurants are where most of our consumption occurs.

On the flip side, only about two percent of people get enough potassium from their diets (3). According to the National Institutes of Health, adequate intake of potassium is between 2600 mg and 3400 mg for adult women and men, respectively.

What is the relationship between sodium and potassium?

A high sodium-to-potassium ratio increases our risk of cardiovascular disease by 46 percent, according to a 15-year study of more than 12,000 (4). To improve our overall health, we need to shift the sodium-to-potassium balance so that we consume more potassium and less sodium. And if you struggle with – or are at risk for – high blood pressure, this approach could help you win the battle.

Why lower your sodium consumption?

Two studies illustrate the benefits of reducing sodium in high blood pressure and normotensive (normal blood pressure) patients, ultimately preventing cardiovascular disease, including heart disease and stroke.

The first was a meta-analysis that evaluated data from 34 randomized clinical trials, totaling more than 3,200 participants. It demonstrated that salt reduction from 9-to-12 grams per day to 5-to-6 grams per day had a dramatic effect. Blood pressure was reduced by a significant mean of −4.18 mm Hg systolic (top number) and −2.06 mm Hg diastolic (bottom number) involving both normotensive and hypertensive participants (5). 

When looking solely at hypertensive patients, the reduction was even greater, with a systolic blood pressure reduction of −5.39 mm Hg and a diastolic reduction of −2.82 mm Hg. The researchers believe that the more we reduce the salt intake, the greater the effect of reducing blood pressure. The authors recommend further reduction to 3 grams per day as a long-term target for the population and concluded that the effects on blood pressure will most likely result in a decrease in cardiovascular disease.

In the second study, a meta-analysis of 42 clinical trials including both adults and children, there was a similarly significant reduction in both systolic and diastolic blood pressures (6). Both demographics saw a blood pressure reduction, although the effect was greater in adults. Interestingly, an increase in sodium caused a 24 percent increased risk of stroke incidence but, more importantly, a 63 percent increased risk of stroke mortality. The risk of mortality from heart disease was increased alongside an increase in sodium, as well, by 32 percent.

Can you consume too little sodium?

Some experts warn that too-low sodium levels can be a problem. While this is true, it’s very rare, unless you take medication or have a health condition that depletes sodium. We hide sodium everywhere, so even if you don’t use a salt shaker, you’re probably consuming more than the recommended amount of sodium.

Why is potassium consumption important?

In a meta-analysis involving 32 studies, results showed that as the amount of potassium was increased, systolic blood pressure decreased significantly (7). When foods containing 3.5 to 4.7 grams of potassium were consumed, there was an impressive −7.16 mm Hg reduction in systolic blood pressure with high blood pressure patients. Anything more than this amount of potassium did not provide additional benefit. Increased potassium intake also reduced the risk of stroke by 24 percent.

Blood pressure reduction was greater with increased potassium consumption than with sodium restriction, although this was not a head-to-head comparison. The good news is that it’s easy to increase your potassium intake; it’s found in many whole foods and is richest in fruits, vegetables, beans and legumes.

The bottom line: decrease your sodium intake and increase potassium intake from foods. First, consume less sodium, and give yourself a brief period to adapt — it takes about six weeks to retrain your taste buds. You can also improve your odds by increasing your dietary potassium intake, striking a better sodium-to-potassium balance.

References:

(1) Dietary Reference Intakes for Sodium and Potassium. Washington (DC): National Academies Press (US); 2019 Mar. (2) fda.gov. (3) nih.gov. (4) Arch Intern Med. 2011;171(13):1183-1191. (5) BMJ. 2013 Apr 3;346:f1325. (6) BMJ. 2013 Apr 3;346:f1326. (7) BMJ. 2013; 346:f1378.

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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Exercise and diet are keys to improving discomfort for osteoarthritis pain. METRO photo
Exercise and diet are keys to improving discomfort

By David Dunaief, M.D.

Dr. David Dunaief

Osteoarthritis (OA) can make it difficult to perform daily activities and affect your quality of life. It affects the knees, hips and hands most often, and it can disturb your mobility, mood, and sleep quality.

First-line medications can help treat arthritis pain. Acetaminophen and nonsteroidal anti-inflammatory drugs, such as ibuprofen or naproxen are common. Unfortunately, they do have side effects, especially with long-term use. Also, while they might relieve your immediate symptoms of pain and inflammation, they don’t slow osteoarthritis’ progression.

However, you can ease your pain without reaching for medications. Some approaches might even help slow you OA’s progression or reverse your symptoms.

Does losing weight really help with OA pain?

Weight management is a crucial component of any OA pain management strategy. In a study of 112 obese patients, those who lost weight reported that their knee symptoms improved (1). Even more exciting, the study authors observed disease modification, with a reduction in the loss of cartilage volume around the medial tibia. Those who gained weight saw the opposite effect.

The relationship was almost one-to-one; for every one percent of weight lost, there was a 1.2 mm3 preservation of medial tibial cartilage volume, while the opposite occurred when participants gained weight.

A reduction of tibial cartilage is often associated with the need for a knee replacement.

Does increasing vitamin D help reduce OA pain?

In a randomized controlled trial (RCT), vitamin D provided no OA symptom relief, nor any disease-modifying effects (2). This two-year study of almost 150 men and women raised blood levels of vitamin D on average to 36 ng/ml, which is considered respectable. Researchers used MRI and X-rays to track their results.

In another study of 769 participants, ages 50-80, researchers found that low vitamin D levels – below 25 nmol/l led to increased OA knee pain over the five-year study period and hip pain over 2.4 years (3). The researchers postulate that supplementing vitamin D might reduce pain in those who are deficient, but that it will likely have no effect on others.

Does consuming dairy help with OA?

With dairy, specifically milk, there is conflicting information. Some studies show benefits, while others show that it might actually contribute to the inflammation that makes osteoarthritis pain feel worse.

In the Osteoarthritis Initiative study, researchers looked specifically at joint space narrowing that occurs in those with affected knee joints (4). Results showed that low-fat (1 percent) and nonfat milk may slow the progression of osteoarthritis in women. Compared to those who did not drink milk, patients who did saw significantly less narrowing of knee joint space over a 48-month period.

The result curve was interesting, however. For those who drank fewer than three glasses a week up to 10 glasses a week, the progression of joint space narrowing was slowed. However, for those who drank more than 10 glasses per week, there was less benefit. There was no benefit seen in men or with the consumption of higher fat products, such as cheese or yogurt.

However, the study was observational and had significant flaws. First, the 2100 patients were only asked about their milk intake at the study’s start. Second, patients were asked to recall their weekly milk consumption for the previous 12 months before the study began – a challenging task.

On the flip side, a study of almost 39,000 participants from the Melbourne Collaborative Cohort Study found that increases in dairy consumption were associated with increased risk of total hip replacements for men with osteoarthritis (5).

What about yogurt? A published Framingham Offspring Study analysis found that those who consumed yogurt had statistically significant lower levels of interleukin-6 (IL-6), a marker for inflammation, than those who didn’t eat yogurt, but that this was not true with milk or cheese consumption (6).

Would I recommend consuming low-fat or nonfat milk or yogurt? Not necessarily, but I might not dissuade osteoarthritis patients from yogurt.

Which is better, diet or exercise, for reducing OA pain?

Diet and exercise together actually trumped the effects of diet or exercise alone in a well-designed, 18-month study (7). Patients with osteoarthritis of the knee who lost at least 10 percent of their body weight experienced significant functional improvements and a 50 percent pain reduction, as well as inflammation reduction. This was compared to those who lost a lower percent of their body weight.

Researchers used biomarker IL6 to measure inflammation. The diet and exercise group and the diet-only group lost significantly more weight than the exercise-only group, 23.3 pounds and 19.6 pounds versus 4 pounds. The diet portion consisted of a meal replacement shake for breakfast and lunch and then a vegetable-rich, low-fat dinner. Low-calorie meals replaced the shakes after six months. The exercise regimen included one hour of a combination of weight training and walking “with alacrity” three times a week.

To reduce pain and possibly improve your OA, focus on lifestyle modifications. The best effects shown are with weight loss – which is most easily achieved with a vegetable-rich diet and exercise. In terms of low-fat or nonfat milk, the results are controversial, at best. For yogurt, the results suggest it may be beneficial for osteoarthritis, but stay on the low end of consumption, since dairy can increase inflammation.

References:

(1) Ann Rheum Dis. 2015 Jun;74(6):1024-9. (2) JAMA. 2013;309:155-162. (3) Ann. Rheum. Dis. 2014;73:697–703. (4) Arthritis Care Res online. 2014 April 6. (5) J Rheumatol. 2017 Jul;44(7):1066-1070. (6) Nutrients. 2021 Feb 4;13(2):506. (7) JAMA. 2013;310:1263-1273.

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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Try eating a more plant-based, whole foods diet. METRO photo
Cardiac biomarkers can help you monitor your progress

By David Dunaief, M.D.

Dr. David Dunaief

Heart disease is on the decline in the U.S. Several factors have influenced this, including better awareness, improved medicines, earlier treatment of risk factors and lifestyle modifications (1). Still, we can do better. Heart disease still underpins one in four deaths, and it is preventable.

What are the baseline risks for heart disease?

Significant risk factors for heart disease include high cholesterol, high blood pressure and smoking. In addition, diabetes, excess weight and excessive alcohol intake increase your risks. Unfortunately, both obesity and diabetes rates are increasing. For patients with type 2 diabetes, 70 percent die of cardiovascular causes (2).

Inactivity and the standard American diet, which is rich in saturated fat and calories, also contribute to atherosclerosis, or fatty streaks in the arteries, the underlying culprit in heart disease risk (3).

A less-discussed risk factor is a resting heart rate greater than 80 beats per minute (bpm). A normal resting heart rate is typically between 60 and 100 bpm. If your resting heart rate is in the high-normal range, your risk increases.

In one study, healthy men and women had 18 and 10 percent increased risks of dying from a heart attack, respectively, for every increase of 10 bpm over 80 (4). The good news is that you can reduce your risks.

Does medication lower heart disease risk?

Cholesterol and blood pressure medications have been credited to some extent with reducing the risk of heart disease. Unfortunately, according to 2018 National Health and Nutrition Examination Survey (NHANES) data, only 43.7 percent of those with hypertension have it controlled (5). While the projected reasons are complex, a significant issue among those with diagnosed hypertension is their failure to consistently take their prescribed medications.

Statins have played a key role in primary prevention, as well. They lower lipid levels, including total cholesterol and LDL (“bad” cholesterol). They also lower inflammation levels that contribute to cardiovascular disease risk. The JUPITER trial showed a 55 percent combined reduction in heart disease, stroke and mortality from cardiovascular disease in healthy patients — those with a slightly elevated level of inflammation and normal cholesterol profile — with statins.

The downside of statins is their side effects. Statins have been shown to increase the risk of diabetes in intensive dosing, when compared to moderate dosing (6).

Unfortunately, another side effect of statins is myopathy (muscle pain). I have a number of patients who suffered from statin muscle pain and cramps shift their focus to diet and exercise to get off their prescriptions. Lifestyle modification is a powerful ally.

Do lifestyle changes really reduce heart disease risk?

The Baltimore Longitudinal Study of Aging, a prospective (forward-looking) study, investigated 501 healthy men and their risk of dying from cardiovascular disease. The authors concluded that those who consumed five servings or more of fruits and vegetables daily with <12 percent saturated fat had a 76 percent reduction in their risk of dying from heart disease compared to those who did not (7). The authors theorized that eating more fruits and vegetables helped to displace saturated fats from the diet. These results are impressive and, to achieve them, they only required modest dietary changes.

The Nurses’ Health Study shows that these results are also seen in women, with lifestyle modification reducing the risk of sudden cardiac death (SCD). Many times, this is the first manifestation of heart disease in women. The authors looked at four parameters of lifestyle modification, including a Mediterranean-type diet, exercise, smoking and body mass index. The decrease in SCD was dose-dependent, meaning the more parameters adopted, the greater the risk reduction. SCD risk was reduced up to 92 percent when all four parameters were followed (8). Thus, it is possible to almost eliminate the risk of SCD for women with lifestyle modifications.

How can you monitor your progress in lowering heart disease risk?

To monitor your progress, cardiac biomarkers, such as blood pressure, cholesterol, body mass index, and inflammatory markers like C-reactive protein can tell us a lot.

In a cohort study of high-risk participants and those with heart disease, patients began extensive lifestyle modifications: a plant-based, whole foods diet accompanied by exercise and stress management (9). The results showed improvements in biomarkers, as well as in cognitive function and overall quality of life. Most exciting is that results occurred over a very short period to time — three months from the start of the trial. Many of my patients have experienced similar results.

Ideally, if a patient needs medications to treat risk factors for heart disease, it should be for the short term. For some patients, it makes sense to use medication and lifestyle changes together; for others, lifestyle modifications may be sufficient, provided the patient takes an active role.

References:

(1) cdc.gov/heartdisease/facts. (2) Diabetes Care. 2010 Feb; 33(2):442-449. (3) Lancet. 2004;364(9438):93. (4) J Epidemiol Community Health. 2010 Feb;64(2):175-181. (5) Hypertension. 2022;79:e1–e14. (6) JAMA. 2011;305(24):2556-2564. (7) J Nutr. March 1, 2005;135(3):556-561. (8) JAMA. 2011 Jul 6;306(1):62-69. (9) Am J Cardiol. 2011;108(4):498-507.

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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Antibiotic use can affect the microbiome

By David Dunaief, M.D.

Dr. David Dunaief

Each of us has a microbiome — trillions of microbes that include bacteria, viruses and single-cell eukaryotes that influence our body’s functions. When “good” and “bad” microbes are in balance, we operate without problems. However, when the balance is tipped, often by environmental factors, such as diet, infectious diseases, and antibiotic use, it makes us more susceptible to diseases and disorders.

While the microbiome is found throughout our bodies, including the skin, the eyes and the gut, we’re going to focus on the gut, where most of our microbiome lives.

Research into the specifics of our microbiome’s role in healthy functioning is still in its infancy. Current research into the microbiome’s effects include its role in obesity, diabetes, irritable bowel syndrome, autoimmune diseases, such as rheumatoid arthritis and Crohn’s, and infectious diseases, such as colitis.

What influences our microbiome?

Lifestyle, such as diet, can impact our microbiome positively or negatively. Microbiome diversity may be significantly different in distinct geographic locations throughout the world, because diet and other environmental factors play such a large role.

When we take drugs, such as antibiotics, we can wipe out our microbial diversity, at least in the short term. This is why many have gastrointestinal upset while taking antibiotics. Antibiotics don’t differentiate between good and bad bacteria when they go to work.

One way to counteract these negative effects is to take a probiotic during and after your course of antibiotics. I recommend Renew Life’s 30-50 billion units once a day, two hours after an antibiotic dose and continuing once a day for 14 days after you have finished your prescription. If you really want to ratchet up the protection, you can take one dose of probiotics two hours after each antibiotic dose.

How does the microbiome affect weight?

Many obese patients continually struggle to lose weight. Obese and overweight patients now outnumber malnourished individuals worldwide (1).

For a long time, the paradigm for weight loss had been to cut calories. However, extreme low-calorie diets were not having a long-term impact. It turns out that our guts may play important roles in obesity and weight loss, determining whether we gain or lose weight.

The results from a study involving human twins and mice are fascinating (2). In each pair of human twins, one was obese and the other was lean. Gut bacteria from obese twins was transplanted into thin mice. The result: the thin mice became obese. However, when the lean human twins’ gut bacteria were transplanted to thin mice, the mice remained thin.

By pairing sets of human twins, one obese and one thin in each set, with mice that were identical to each other and raised in a sterile setting, researchers limited the confounding effects of environment and genetics on weight.

The most intriguing part of the study compared the effects of diet and gut bacteria. When the mice who had received gut transplants from obese twins were provided gut bacteria from thin twins and given fruit- and vegetable-rich, low-fat diet tablets, they lost significant weight. Interestingly, they only lost weight when on a good diet. The authors believe this suggests that an effective diet may alter the microbiome of obese patients, helping them lose weight. These are exciting, but preliminary, results. It is not yet clear which bacteria may be contributing these effects.

Does gut bacteria contribute to the development of rheumatoid arthritis?

Rheumatoid arthritis (RA) is an autoimmune disease that can be disabling, with patients typically suffering from significant joint soreness and joint breakdown. What if gut bacteria influenced RA risk? In a study, the gut bacteria in mice that were made susceptible to RA by deletion of certain genes (HLA-DR genes) were compared to those who were more resistant to developing RA (3). Researchers found that the RA-susceptible mice had a predominance of Clostridium bacteria and that those resistant to RA were dominated by bacteria such as bifidobacteria and Porphyromonadaceae species. The significance is that the bacteria in the RA-resistant mice are known for their anti-inflammatory effects.

Although we can’t yet say what the ideal gut bacteria should consist of, we do know a few things that can help you. Diet and other lifestyle considerations, such as eating and sleeping patterns or their disruptions, can affect the composition and diversity of gut bacteria (4). Studies have already demonstrated prebiotic effects of fiber and significant short-term changes to the microbiome when eating fruits, vegetables, and plant fiber. The research is continuing, but we’ve learned a lot already.

References:

(1) “The Evolution of Obesity”; Johns Hopkins University Press; 2009. (2) Science. 2013;341:1241214. (3) PLoS One. 2012;7:e36095. (4) Nutrients. 2019 Dec;11(12):2862.

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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