CLOSE
Tags Posts tagged with "Medical Compass"

Medical Compass

by -
0 570
It doesn’t take much exercise to improve health outcomes. METRO photo

By David Dunaief, M.D.

As I wrote last week, exercise is not the sole solution for weight loss. However, it can improve our outcomes with diseases and other health issues. It may also play a significant role in altering how our genes express themselves. The list of conditions it can improve includes diabetes, kidney stones, osteoarthritis, cardiovascular disease and breast, colorectal and endometrial cancers (1).

Even knowing all the positive impacts, motivating yourself to exercise can be difficult. There are some simple ways to motivate yourself during exercise. One study showed that those who repeated positive mantras to themselves during exercise were able to continue for longer periods (2).

Why is this so important? Because we are too sedentary. According to data from the 2017-2020 Behavioral Risk Factor Surveillance System, New York had among the highest levels of physical inactivity in the U.S., at 25.9 percent of the population (3).

Can exercise alter your genes?

While it may not change our genes, exercise may change how our genes express themselves.

One study’s results showed that, when participants exercised for six months, many thousands of genes in fat cells were affected (4). During the study, previously sedentary men took a one-hour spin class twice a week. According to the researchers, this exercise affected genes involved in storing fat and in risk for subsequent diabetes and obesity development. The participants also improved other important health metrics, including cholesterol, blood-pressure, fat percent and, over time, waist circumferences.

Epigenetics is when lifestyle changes ultimately lead to changes in how genes express themselves, turning genes on and off. While this effect has been shown with dietary changes, this is one of the first studies to show that exercise also impacts our genes. It took only six months to see these numerous gene changes with a modest amount of cardiovascular exercise.

Need more inspiration? Another study showed considerable gene changes in muscle cells after one stationary bike workout (5). Yet another introduced six weeks of endurance exercise to healthy, but sedentary, young men and identified an abundance of genetic changes to skeletal muscle, which broadly affects physical and cognitive health (6).

How does exercise affect cardiovascular disease?

One meta-analysis examined 57 studies that involved drugs and exercise. It showed similar mortality benefits with statins and exercise for patients who already have coronary heart disease (7). Both statins and exercise reduced the risk of mortality by similar amounts. The same study also showed that, for those with pre-diabetes, it didn’t matter whether they took metformin or exercised — each had the same effect.

While these results are exciting, don’t change your medication without consulting your physician.

Exercise and kidney stone prevention

Passing a kidney stone can be excruciating. Most treatments involve taking pain medication and fluids and just waiting for the stone to pass. Honestly, the best way to treat kidney stones is to prevent them.

The Women’s Health Initiative Observational Study involved 84,000 postmenopausal women, the population most likely to suffer from kidney stones. It found exercise reduced kidney stone risk by as much as 31 percent (8). Even better, exercise intensity did not alter its beneficial effect. What mattered more was exercise quantity. One hour of jogging or three hours of walking got the top results; however, lesser amounts of exercise also saw substantial reductions.

Exercise can have strong influences on the way you feel; however, it may also influence your genes’ expression and, ultimately, affect the development and prevention of disease. In certain circumstances, it may be as powerful as medications and, in combination, can pack a powerful punch.

References:

(1) JAMA. 2009;301(19):2024. (2) Med Sci Sports Exerc. 2013 Oct 10. (3) cdc.gov. (4) PLoS Genet. 2013 Jun;9(6):e1003572. (5) Cell Metab. 2012 Mar 7;15(3):405-11. (6) Mol Metab. 2021 Nov;53:101290. (7) BMJ. 2013; 347. (8) JASN. 2013;24(3):p 487-497.

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.

by -
0 493
METRO photo
Exercise is an inadequate weight-loss tool

By David Dunaief, M.D.

Dr. David Dunaief

We hear continuously about the importance of exercise. Why is it so important, though? Exercise has benefits for preventing and improving a wide range of medical conditions, from cardiovascular disease, chronic kidney disease, and diabetes to depression, insomnia, fatigue, balance, cognitive decline, and osteoporosis. Will it help you lose weight, though? While gym equipment ads emphasize this, exercise without dietary changes may not help many people lose weight, no matter what the intensity or the duration (1). It may only reduce fat mass and weight modestly for most people. It might, however, be helpful with weight maintenance.

Ultimately, it may be more important to examine what you are eating than to succumb to the rationalization that you can eat without care and work out to compensate for that extra cookie.

Does exercise help with weight loss?

The well-known weight-loss paradigm is that when you burn more calories than you consume, you will promote weight loss. However, study results say otherwise. They show that in premenopausal women there was neither weight nor fat loss from exercise (2). This involved 81 women over a short duration, 12 weeks. All of the women were overweight to obese.

However, more than two-thirds of the women gained a mean of 1 kilogram, or 2.2 pounds, of fat mass by the end of the study. There were a few who gained 10 pounds of predominantly fat. A fair amount of variability was seen among the participants, ranging from significant weight loss to substantial weight gain. These women were told to exercise at the American College of Sports Medicine’s optimal level of intensity (3). This is to walk 30 minutes on a treadmill three times a week at 70 percent VO2max — maximum oxygen consumption during exercise, which is characterized as a moderately intense pace.

On the positive side, the women were in better aerobic shape by the study’s end. Also, women who had lost weight at four-weeks were more likely to continue to do so by the end of the study.

Other studies have shown modest weight loss. For instance, in a meta-analysis involving 14 randomized controlled trials, results showed that exercise alone led to a disappointing amount of weight loss (4). In six months, patients lost a mean of 3.5 pounds, and at 12 months, they lost about 3.75 pounds.

A recent meta-analysis of aerobic exercise studies found that, in order to break through to meaningful reductions in waist circumference and body fat, participants had to exercise more than 150 minutes per week, up to 300 minutes weekly, at moderate to vigorous aerobic intensity (5).

However, exercise may help with weight maintenance, according to observational studies. Premenopausal women who exercised at least 30 minutes a day were significantly less likely to regain lost weight (6). In another study, when exercise was added to dietary changes, women were able to maintain 30 percent more weight loss than with diet alone after a year (7).

How does exercise help with disease?

Let’s look at chronic kidney disease (CKD), which affects about 14 percent of U.S. adults, as one example of exercise’s impact on disease (8).

Trial results showed that walking regularly could reduce the risk of kidney replacement therapy and death in patients who have moderate to severe CKD (9). When walkers were compared to non-walkers, walkers experienced a 21 percent reduction in the risk of kidney replacement therapy and a 33 percent reduction in the risk of death.

The more frequently patients walked during the week, the better the probability of preventing complications. Those who walked between one and two times per week had 17 and 19 percent reductions in death and kidney replacement therapy, respectively, while those who walked at least seven times a week saw a 44 percent reduction in death and a 59 percent reduction in kidney replacement. This is significant. The authors concluded that the effectiveness of walking on CKD was independent of kidney function, age or other diseases.

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

References:

(1) Diabetes Spectr. 2017 Aug;30(3):157–160. (2) J Strength Cond Res. 2015 Feb;29(2):297-304. (3) ACSM.org. (4) Am J Med. 2011;124(8):747. (5) JAMA Netw Open. 2024;7(12):e2452185. (6) Obesity (Silver Spring). 2010;18(1):167. (7) Int J Obes Relat Metab Disord. 1997;21(10):941. (8) cdc.gov. (9) Clin J Am Soc Nephrol. 2014 Jul;9(7):1183-1189.

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

by -
0 554
Studies have shown that adding blueberries to your diet can lower your blood pressure. Pixabay photo
Non-clinical readings may paint a more complete picture of your risks

By David Dunaief, M.D.

Dr. David Dunaief

Nearly 120 million U.S. adults, just under half of the population, have hypertension (1). Of these, only 25 percent have successfully controlled their blood pressure to less than 130/80 mmHg, the high end of “normal” blood pressure.

For the remaining 75 percent, the risk of complications, including cardiovascular events and mortality, is significantly higher.

What increases our risk of developing hypertension? An observational study involving 2,763 participants showed that the top three influencers on the risk of developing high blood pressure were poor diet, modest obesity, and cigarette smoking, all of which are modifiable (2).

What increases your risk of complications?

Being significantly overweight or obese, smoking, poor diet, lack of exercise, family history, age, increased sodium, depression, diabetes, low vitamin D, and too much alcohol all increase your risk (3).

The good news is that you can improve your risk profile (4).

What is the effect of gender?

One of the most concerning complications of hypertension is cardiovascular disease. A large observational study with a 31-year duration found that isolated systolic (top number) hypertension increased the risk of cardiovascular disease and death in both men and women between 18 and 49 years old, compared to those who had optimal blood pressure (5). These complications were not affected by onset age.

When the results were sorted by gender, women experienced the greatest effect, with a 55 percent increased risk of cardiovascular disease and 112 percent increased risk of heart disease death.

When  to measure your blood pressure

Most of us have our blood pressure measured when we’re at a doctor’s office. While measuring blood pressure in a clinic can be useful, a meta-analysis of nine studies showed that high blood pressure measured at nighttime was potentially a better predictor of myocardial infarctions (heart attacks) and strokes, compared to daytime and clinic readings (5).

For every 10 mmHg rise in nighttime systolic blood pressure, there was a corresponding 25 percent increase in cardiovascular events. The nighttime readings were achieved using 24-hour ambulatory blood pressure measurements (ABPM).

A factor that might increase the risk of nighttime cardiovascular events is masked uncontrolled hypertension (MUCH).  MUCH occurs in those who are well-controlled during clinic readings for blood pressure; however, out-of-clinic readings indicate their blood pressure is uncontrolled.

A study of 167 patients found that medication non-compliance was not a significant factor in those experiencing MUCH (6). Of the participants experiencing MUCH, 85.2 percent were fully adherent with their prescribed medications, a number similar to the group that did not experience MUCH.

Interestingly, in the Spanish Society of Hypertension ABPM Registry, MUCH was most often seen during nocturnal hours (7). The study’s authors suggest that ABPM may be a better way to monitor those with higher risk factors for MUCH, such as those whose pressure is borderline in the clinic and those who are smokers, obese or have diabetes.

A previous study of patients with chronic kidney disease (CKD) and hypertension suggested that taking at least one antihypertensive medication at night may be more effective than taking them all in the morning (8). Those who took one or more of their blood pressure medications at night saw a two-third reduction in cardiovascular event risk.

Blueberries and blood pressure

Diet plays an important role in controlling high blood pressure. Lowering sodium is critically important, but adding berries may also be beneficial.

In a study of post-menopausal women with pre-hypertension or stage one hypertension, daily consumption of 22 grams of blueberry powder, the equivalent of one cup of fresh blueberries, reduced systolic blood pressure by a respectable 7 mmHg and diastolic blood pressure by 5 mmHg over two months (9).

This addition of a modest amount of fruit had a significant impact. Blueberries increase nitric oxide, which helps blood vessels relax and reduces blood pressure. While the study used blueberry powder, an equivalent amount of real fruit might lead to an even greater reduction.

High blood pressure and possible cardiovascular complications can be scary, but lifestyle modifications, such as making dietary changes and taking antihypertensive medications at night, can reduce your risks.

References:

(1) millionhearts.hhs.gov. (2) BMC Fam Pract 2015;16(26). (3) uptodate.com. (4) Diabetes Care 2011;34 Suppl 2:S308-312. (5) J Am Coll Cardiol 2015;65(4):327-335. (6) Hypertension. 2019 Sep;74(3):652-659. (7) Eur Heart J 2015;35(46):3304-3312. (8) J Am Soc Nephrol 2011 Dec;22(12):2313-2321. (9) J Acad Nutr Diet 2015;115(3):369-377.

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.

by -
0 543
METRO photo
Many risk factors can be managed with lifestyle changes

By David Dunaief, M.D.

Dr. David Dunaief

February has been named American Heart Month by the American Heart Association, providing us with a reminder during the Valentine’s Day month to build heart-healthy habits.

Improved medicines, earlier treatment of risk factors, and an embrace of lifestyle modifications have helped reduce the prevalence of heart disease and remind us that it is ultimately preventable.

How do you reduce heart disease risk?

Major heart disease risk factors include obesity, high cholesterol, high blood pressure, smoking and diabetes. Unfortunately, rates of obesity and diabetes are both still rising. For patients with type 2 diabetes, 70 percent die of cardiovascular causes (1).

A key contributor is the standard American diet, which is rich in saturated fat and calories (2). This drives atherosclerosis, fatty streaks in the arteries.

A high resting heart rate is another potential risk factor. 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 beats per minute (bpm) over 80 (3). A normal resting heart rate is typically between 60 and 100 bpm, so a high-normal rate has increased risk.

When does medication help?

Cholesterol and blood pressure medications have reducing some heart disease risk. according to the American Society of Hypertension, compliance with taking blood pressure medications has increased over the last 10 years from 33 to 50 percent.

Statins have also played a role in primary prevention. They lower lipid levels, including total cholesterol and LDL — the “bad” cholesterol. In addition, they lower inflammation levels that contribute to cardiovascular disease risk. The Jupiter trial showed statins contributed to a 55 percent combined reduction in heart disease, stroke and mortality from cardiovascular disease in healthy patients, those with slightly elevated levels of inflammation and normal cholesterol profiles.

Statins do have side effects, though. They’ve been shown to increase the risk of diabetes in intensive dosing, compared to moderate dosing (4). Many who are on statins also suffer from myopathy (muscle pain and cramping).

I’m often approached by patients on statins with this complaint. Their goal is to reduce and ultimately discontinue statins by modifying their diet and exercise plans.

Lifestyle modification is a powerful ally.

Which lifestyle changes reduce heart disease risk the most?

METRO photo

The Baltimore Longitudinal Study of Aging investigated 501 healthy men and their risk of dying from cardiovascular disease. The authors concluded that those who consumed five or more servings of fruits and vegetables daily with <12 percent saturated fat reduced their risk of dying from heart disease by 76 percent, compared to those who did not meet these criteria (5). The authors theorized that eating more fruits and vegetables helped to displace saturated fats from the diet.

The Nurses’ Health Study shows that these results are also seen in women. Lifestyle modification reduced the risk of sudden cardiac death (SCD) (6). This is often 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 factors incorporated, the greater the risk reduction. There was as much as a 92 percent decrease in SCD risk when all four parameters were followed.

In a cohort study of high-risk participants and those with heart disease, patients implemented extensive lifestyle modification: a plant-based, whole foods diet accompanied by exercise and stress management. Study results showed an improvement in biomarkers, as well as in cognitive function and overall quality of life over a very short period — three months from the start of the trial (7). Outside of this study environment, many of my own patients have experienced similar results.

How do you monitor your heart disease risk?

Physicians use cardiac biomarkers, including blood pressure, cholesterol and body mass index, alongside inflammatory markers like C-reactive protein to monitor your risk. Ideally, if you need to use medications to treat risk factors for heart disease, you should strive for short-term intervention. For some, it may be best to use medication and lifestyle changes together; for patients who take an active role, lifestyle modifications may be sufficient.

By focusing on developing heart-healthy habits, you can improve the likelihood that you will be around for a long time.

References:

(1) Diabetes Care. 2010 Feb; 33(2):442-449. (2) Lancet. 2004;364(9438):93. (3) J Epidemiol Community Health. 2010 Feb;64(2):175-181. (4) JAMA. 2011;305(24):2556-2564. (5) J Nutr. March 1, 2005;135(3):556-561. (6) JAMA. 2011 Jul 6;306(1):62-69. (7) 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.

by -
0 517
METRO photo
Acetaminophen and NSAIDS are not risk-free

By David Dunaief, M.D.

Dr. David Dunaief

What do you do when you have a headache or a sore knee? Most of us head to our medicine cabinet to grab one of the analgesics we keep on hand for such occasions.

Analgesics are, first and foremost, pain relievers, but they also help lower fever and reduce inflammation. The most common over the counter (OTC) medications include acetaminophen and a variety of non-steroidal anti-inflammatory drugs (NSAIDs), like aspirin, ibuprofen, and naproxen sodium.

Americans consume more than 30 billion doses of NSAIDs a year, including both OTC and prescription-strength (1). As for acetaminophen, one quarter of Americans take it weekly.  Because they’re so accessible and commonplace, many consider them low risk. Many patients don’t even include them in a list of current medications. I need to specifically ask about them.

They are not risk-free, though. According to a poll of regular OTC NSAID users, 60 percent were not aware that they can have dangerous side effects (2).

What are NSAID risks?

NSAIDs, according to the Centers for Disease Control and Prevention, are responsible for more than 70,000 hospitalizations and 7,600 deaths annually (3). 

They increase the risk of heart attacks, gastrointestinal bleeding, stroke, exacerbation of diverticular disease, chronic arrhythmia (abnormal heartbeat) and erectile dysfunction. In some instances, the cardiovascular effects can be fatal.

The FDA strengthened warning labels on non-aspirin NSAID labels 10 years ago, advising that those taking NSAIDs should immediately seek medical attention if they experienced chest pain, shortness of breath or trouble breathing, weakness in one part or side of their body, or slurred speech (4).

Five years ago, the FDA added a warning label to non-aspirin NSAIDs about the risks of fetal kidney damage and pregnancy complications beginning around week 20 of a pregnancy (4).

In a case control study using the UK Primary Care Database, chronic users of NSAIDs between ages 40 and 89 had a significantly increased risk of a serious arrhythmia called atrial fibrillation (5).

Interestingly, researchers defined “chronic users” as patients who took NSAIDs for more than 30 days. These users had a 57 percent increased risk of atrial fibrillation. A Danish study reinforces these results after the first month of use (6). This is not very long to have such a substantial risk. For patients who used NSAIDs longer than one year, the risk increased to 80 percent. 

NSAIDs also increase the risk of mortality in chronic users. Older patients who have heart disease or hypertension (high blood pressure) and are chronic NSAID users are at increased risk of death, according to an observational study (7). Compared to those who never or infrequently used them over about 2.5 years, chronic users had a greater than twofold increase in death due to cardiovascular causes. High blood pressure was not a factor in this study, since chronic users had lower blood pressure; however, I have seen that NSAID use can increase blood pressure with some of my patients.

What are acetaminophen risks?

The FDA announced in 2011 that acetaminophen consumption should not exceed 325 mg every four to six hours when used in a prescription combination pain reliever (4). The goal is to reduce and avoid severe injury to the liver, which can cause liver failure.

There is an intriguing paradox with acetaminophen: Hospitals typically dispense regular-strength 325-mg doses of the drug, whereas OTC doses frequently are found in “extra strength” 500-mg tablets, and often the suggested dose is two tablets, or 1 gram. At the FDA’s request, Tylenol lowered its recommended daily dosage for its extra strength version to no more than 3 grams a day.

One study that showed acute liver failure was due primarily to unintentional overdoses of acetaminophen (8). Accidental overdosing is more likely to occur when taking acetaminophen at the same time as a combination sinus, cough or cold remedy that also contains acetaminophen. OTC and prescription cold medications can contain acetaminophen.

If you already have liver damage or disease, consult your physician before taking any medication.

To protect yourself from potentially adverse events, you must be your own best advocate; read labels, and remember to tell your physician if you are taking any OTC medications.

If you are a chronic user of NSAIDs or acetaminophen because of underlying inflammation, you may find an anti-inflammatory diet and other lifestyle changes can be an effective alternative.

References:

(1) medscape.com. (2) J Rheumatol. 2005;32;2218-2224. (3) Annals of Internal Medicine, 1997;127:429-438. (4) fda.gov. (5) Arch Intern Med. 2010;170(16):1450-1455. (6) BMJ 2011;343:d3450. (7) Am J Med. 2011 Jul;124(7):614-620. (8) Am J Gastroenterol. 2007;102:2459-2463.

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.

by -
0 852
METRO photo
Design strategies that get you up and moving

By David Dunaief, M.D.

Dr. David Dunaief

Exercise helps build long-term physical and mental health, but regular exercise is often a challenge. Even with all the fitness-related apps to prompt us, modern society has an equal number of tech demotivators. It’s just too easy to let the next episode of our favorite series autoplay or to answer those last few emails.

Even if we want to exercise, we “don’t have time.”

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

Esther Tuttle was profiled in a New York Times’ Science Times article a few years ago, when she was 99. Esther was sharp as a tack and was independently mobile, with no mobility aids. She remained active by walking in the morning for 30 minutes and then walking again in the afternoon. 

Of course, this story is only anecdotal; however, evidence-based medicine supports her claim that walking is a simple way to get exercise that shows incredible benefits. One mile of walking a day will help keep the doctor away. For the step-counters among you, that’s about 2,000 steps a day for an adult with an average stride length.

Does walking improve mental acuity?

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

Participants who had an increase in brain tissue volume also experienced a substantially reduced risk of developing cognitive impairment. Interestingly, the parts of the brain that grew included the hippocampus, involved with memory, and the frontal cortex, involved with short-term memory and executive decision making. There were 299 participants with a mean age of 78. All were dementia-free at the trial’s start.

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

If you’re pressed for time or building your stamina, you can split a mile into two half-mile increments. How long does it take you to walk a half-mile?

Does walking affect one’s mood?

Researchers performed a meta-analysis of studies related to the relationship between exercise and depression. They found that adults who walked briskly for about 75 minutes per week cut their risk of depression by 18 percent (3).

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

How do I build better habits?

A common challenge I hear is that working from home reduces much of the opportunity to walk. There’s no walking down the hall to a meeting or to get lunch or even from the car or train to the office. Instead, everything is only a few steps away. Our work environment is working against us.

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

A client of my wife’s schedules meetings for no more than 50 minutes, so she can walk a “lap” around her house’s interior between meetings or even do some jumping jacks. She also looks for opportunities to have an old-fashioned phone call, rather than a video call, so she can walk up and down the hallway while she’s meeting. Of course, this is one person, but it might prompt some ideas that will work for you.

Walking has other benefits as well. Weight-bearing exercise helps prevent osteoporosis and osteoporotic fractures. Sadly, if you don’t use them, bones weaken and break. Walking is a weight-bearing exercise that helps strengthen your joints, bones and muscles.

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

References:

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

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

by -
0 977
METRO photo
Examining heredity vs. dietary impact

By David Dunaief, M.D.

Dr. David Dunaief

Your heart disease risk is influenced by your family’s history. Can you overcome these genetic issues by making lifestyle changes that improve your health trajectory? It’s the classic heredity vs. environment dilemma. Let’s look at the evidence.

A study involving the Paleo-type diet and other ancient diets suggests that cardiovascular disease is influenced by genetics, while another study considering the Mediterranean-type diet suggests that we might be able to reduce our risk factors with lifestyle adjustments. Most of the risk factors for heart disease, such as high blood pressure, high cholesterol, sedentary lifestyle, diabetes, smoking and obesity are modifiable (1). 

How do our genes affect our heart disease risk?

Researchers used computed tomography scans to look at 137 mummies from Egypt, Peru, the Aleutian Islands, Southwestern America, and others (2). The represented cultures included hunter-gatherers (consumers of a Paleo-type diet), farmer-gatherers and solely farmers. All the diets included significant amounts of animal protein, such as fish and cattle.

Researchers found that one-third of these mummies had atherosclerosis, or plaques in their arteries, which is a precursor to heart disease. This is a familiar ratio; it’s what we still see in modern times.

The authors concluded that atherosclerosis could be part of the human aging process. In other words, it may be embedded in our genes. We all have genetic propensity toward atherosclerosis and heart disease, some more than others.

However, other studies demonstrate that we can reduce our heart disease risk with lifestyle changes, such as with a plant-rich diet, like the Mediterranean-type diet.

How does diet affect our genetic response?

A study of 7,000+ participants in Spain who were at high risk for cardiovascular disease examined the impacts of a Mediterranean-type diet and a low-fat diet on cardiovascular disease risk (3). Two variations on the Mediterranean-type diet were compared to a low-fat diet, with participants randomly assigned to three different groups. The two Mediterranean-type diet groups indicated about a 30 percent reduction in the risk of cardiovascular disease, compared to the low-fat diet. Risk indicators they studied included heart attacks, strokes and mortality. Interestingly, risk improvement in the Mediterranean-type diets occurred without significant weight loss.

The study included three groups: a Mediterranean diet supplemented with mixed nuts (almonds, hazelnuts or walnuts), a Mediterranean diet supplemented with extra virgin olive oil (at least four tablespoons a day), and a low-fat control diet.

The Mediterranean-type diet arms both included significant amounts of fruits, vegetables, nuts, beans, fish, olive oil and wine. Both groups consuming this diet had either significant amounts of nuts or olive oil and/or wine. If the participants in the Mediterranean diet groups were wine drinkers, they were encouraged to drink at least one glass a day.

This study was well-designed; however, there was a significant flaw that should temper our enthusiasm. The group assigned to the low-fat diet was not able to maintain this diet throughout the study. As a result, it really became a comparison between variations on the Mediterranean diet and a standard diet.

How have leading cardiovascular and integrative medicine physicians responded to the study? Interestingly, there are two opposing opinions, split by field. You may be surprised by which group liked it and which did not.

Well-known cardiologists hailed the study as a great achievement. They emphasized that we now have a large, randomized diet trial measuring meaningful clinical outcomes. 

On the other hand, leading integrative medicine physicians, including Caldwell Esselstyn, M.D. and Dean Ornish, M.D., expressed disappointment with the results. Both promote plant-rich diets that may be significantly more nutrient-dense than the Mediterranean diet in the study. Both have published their own small, well-designed studies showing significant benefits from plant-based diets (4, 5). Ornish showed a reversal of atherosclerosis in one of his studies (6).

Their objections to the study revolve around their belief that heart disease and its risk factors can be reversed, not just reduced. In other words, the study didn’t go far enough.

Both opinions have merit. The cardiologists’ enthusiasm is warranted, because a Mediterranean diet, even with an abundance of included fats, will appeal to a wide audience. However, those who follow a more focused diet that includes more nutrient-dense foods, could potentially see a more significant reversal of heart disease.

Either way, it is encouraging to know that we can alter our cardiovascular destinies by altering our diet.

References:

(1)www.uptodate.com(2) BMJ 2013;346:f1591. (3) N Engl J Med 2018; 378:e34. (4) J Fam Pract. 1995;41(6):560-568. (5) Am J Cardiol. 2011;108:498-507. (6) JAMA. 1998 Dec 16;280(23):2001-2007.

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.

 

by -
0 643
METRO photo
Lifestyle modifications including diet can help

By David Dunaief, M.D.

Dr. David Dunaief

In my practice, many patients have resisted telling me they suffered from erectile dysfunction (ED). However, it’s a common problem. Because it can indicate other medical issues, it’s important that you share this information with your doctor.

ED affects about 24 percent of men, on average. If it occurs less than 20 percent of the time, it is considered normal; however, if it occurs more than 50 percent of the time, you should seek help (1). 

Of course, there are oral medications for ED. You’ve probably seen the ads for approved medications, including sildenafil (Viagra, or the “little blue pill”), tadalafil (Cialis), vardenafil (Levitra, Staxyn), and avanafil (Stendra). They work by causing vasodilation, or enlargement of blood vessels, which increases blood flow to the penis. Unfortunately, this does not solve the medical problem, but it does provide a short-term solution for those who are good treatment candidates.

ED’s prevalence generally increases with age. An analysis of the 2021 National Survey of Sexual Wellbeing found that ED affected 12.7 percent of 35-44-year-olds, increased to 25.3 percent of 45-54- year-olds, 33.9 percent of those aged 55-64, 48 percent of those aged 65-74, and 52.2 percent of those aged 75 and older (2).

So, what contributes to the increase as we age? Disease processes and drug therapies.

What is the connection between medical conditions and ED?

Chronic diseases can contribute significantly to ED. ED might also be an indicator of disease. Typical contributors include metabolic syndrome, diabetes, high blood pressure, cardiovascular disease and obesity. In the Look AHEAD trial, ED had a greater than two-fold association with hypertension and a three-fold association with metabolic syndrome (3). In another study, ED was associated with a 2.5-times increase in cardiovascular disease (4).

Patients with ED had significantly more calcification, or atherosclerosis, in their arteries when compared to a control group in a randomized clinical trial (RCT) (5). They were also more than three times as likely to have severe calcification. In addition, they had more inflammation, measured by C-reactive protein. 

Which medications contribute to ED?

About 25 percent of ED cases are thought to be associated with medications, such antidepressants, NSAIDs (e.g., ibuprofen and naproxen sodium), and hypertension medications. Unfortunately, the most common antidepressant medications, SSRIs, have significant impacts on ED. 

The California Men’s Health Study, with over 80,000 participants, showed that there was an association between NSAIDs and ED, with a 38 percent increase in ED in patients who use NSAIDs on a regular basis (6). The authors warn that patients should not stop taking NSAIDs without consulting their physicians.

Also, high blood pressure drugs have a reputation for causing ED. A meta-analysis of 42 studies showed that beta blockers have a small effect, but thiazide diuretics (water pills) more than doubled ED, compared to placebo (7).

How can diet affect ED?

The Mediterranean-type diet has been shown to treat and prevent ED. It’s a green leafy alternative to the little blue pill. Foods are rich in omega-3 fatty acids and high in monounsaturated fats and polyunsaturated fats, as well as fiber. Components include whole grains, fruits, vegetables, legumes, walnuts, and olive oil. 

In two RCTs lasting two years, those who followed a Mediterranean-type diet experienced improvements in their endothelial functioning (8, 9). They also experienced both lower inflammation and lower insulin resistance.

In another study, those who had the highest compliance with a Mediterranean-type diet were significantly less likely to have ED, compared to those with the lowest compliance (10). Even more impressive was that the group with the highest compliance had a 37 percent reduction in severe ED versus the low-compliance group.

A study of participants in the Health Professionals Follow-up Study looked closely at both the Mediterranean-type diet and the Alternative Healthy Eating Index 2010 diet, which emphasized consuming vegetables, fruits, nuts, legumes, and fish or other sources of long-chain fats, as well as avoiding red and processed meats (11). At this point, it probably won’t surprise you to hear that the greater participants’ compliance with either of these diets, the less likely they were to experience ED.

References:

(1) clevelandclinic.org. (2) J Sex Med. 2024;21(4): 296–303. (3) J Sex Med. 2009;6(5):1414-22. (4) Int J Androl. 2010;33(6):853-60. (5) J Am Coll Cardiol. 2005;46(8):1503. (6) Medicine (Baltimore). 2018 Jul;97(28):e11367. (7) JAMA. 2002;288(3):351. (8) Int J Impot Res. 2006;18(4):405-10. (9) JAMA. 2004;292(12):1440-6. (10) J Sex Med. 2010 May;7(5):1911-7. (11) JAMA Netw Open. 2020 Nov 2;3(11):e2021701.

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

by -
0 705
METRO photo
Improve fatigue, mood, headaches and itchy skin

By David Dunaief, M.D.

Dr. David Dunaief

Brrr! It’s been super cold this winter, and heating systems have been in overdrive. All the dry heat pumping into our homes, offices and cars can have a dehydrating effect on our bodies. Symptoms of dehydration can range from itchy skin and constipation to fatigue, mood changes and headaches. Our dry throats and sinuses can also make us uncomfortable and more susceptible to irritations and viruses. More serious complications of dehydration can include migraines, heart palpitations and heart attacks. 

Let’s look at techniques for improving hydration and reducing the symptoms and consequences of all this dry air.

Improve ambient humidity

Measure the humidity level in your home with a hygrometer and target keeping it between 30 and 50 percent (1). When the temperature outside drops below 10 degrees Fahrenheit, lower this to 25 percent. You can add moisture to the air in several ways. Use cool mist humidifiers, keep the bathroom door open after you shower or bathe, and place bowls of water strategically around your home, including on your stovetop when you cook or on radiators. If you use humidifiers, take care to follow the manufacturer’s care instructions and clean them regularly, so you don’t introduce mold or bacteria into the air.

Reduce headaches and migraines

A review of studies found that those who drank four cups or more of water had significantly fewer hours of migraine pain than those who drank less (2). Headache intensity decreased as well.

Decrease heart palpitations

Heart palpitations are common and are broadly felt as a racing heart rate, skipped beat, pounding sensation or fluttering. Although they are not usually life-threatening, they can make you anxious. Dehydration and exercise contribute to this (3). Palpitations can be prompted when we don’t hydrate before exercising. If you drink one glass of water before exercise and continue to drink during exercise, it will help avoid palpitations.

Lower your heart attack risk

The Adventist Health Study showed that men who drank more water had the least risk of death from heart disease (4). Group one, which drank more than five glasses of water daily, had less risk than group two, which drank more than three. Those in group three, which drank fewer than two glasses per day, saw the lowest benefit, comparatively. For women, there was no difference between groups one and two, although both fared better than group three. The reason for this effect, according to the authors, may relate to blood or plasma viscosity (thickness) and fibrinogen, a substance that helps clots form.

Resolve decreased concentration and fatigue

Mild dehydration resulted in decreased concentration, subdued mood, fatigue and headaches in women in a small study (5). Dehydration was prompted by walking on a treadmill and taking a diuretic (water pill) prior to the exercise. Results were compared to a control group that did not take the diuretic. The authors concluded that adequate hydration was needed, especially during and after exercise.

Consume hydrating foods

METRO photo

How much water you need to drink depends on your diet, activity levels, environment and other factors. In a review article, researchers analyzed the data, but did not find adequate studies to suggest that eight glasses a day is a magic number (6). It may be too much for some patients.

You can increase your hydration by altering your diet. Diets with a focus on fruits and vegetables increase water consumption (7). As you may know, 95 percent of the weights of many fruits and vegetables are attributed to water. An added benefit is an increased satiety level without eating calorically dense foods.

In a review, it was suggested that caffeinated coffee and tea don’t increase the risk of dehydration, even though caffeine is a mild diuretic (8). With moderate amounts of caffeinated beverages, the liquid in them has a more hydrating effect than its diuretic effect. Remember that salty foods can dehydrate you, including soups, breads and pastries, so try to avoid these.

It is important to stay hydrated to avoid uncomfortable — and sometimes serious — complications. Diet is a great way to ensure that you get the triple effect of high nutrients, increased hydration and sense of feeling satiated without calorie-dense foods. However, don’t go overboard with water consumption, especially if you have congestive heart failure or open-angle glaucoma (9).

References:

(1) epa.gov (2) Handb Clin Neurol. 2010;97:161-72. (3) my.clevelandclinic.org. (4) Am J Epidemiol 2002 May 1; 155:827-33. (5) J. Nutr. February 2012 142: 382-388. (6) AJP – Regu Physiol. 2002;283:R993-R1004. (7) Am J Lifestyle Med. 2011;5(4):316-319. (8) Exerc Sport Sci Rev. 2007;35(3):135-140. (9) Br J Ophthalmol. 2005:89:1298–1301.

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.

by -
0 724
METRO photo
Home remedies may be more helpful than supplements

By David Dunaief, M.D.

Dr. David Dunaief

These past few weeks, I’ve been hearing a lot more sniffling, sneezing and coughing. Cold season is here. A cold’s effects can range from mild annoyance to more serious symptoms that put us out of commission for weeks.

First, you might be able to prevent catching a cold with some common-sense tactics: wash your hands frequently and avoid touching your face to help minimize your exposure. Frankly, this is good practice to avoid many of the viruses circulating at this time of year.

If you do catch a common cold, you might be able to reduce your symptoms or the cold’s duration with some simple homestyle remedies and a few dietary supplements. 

How do you relieve cold symptoms?

Congestion or coughing symptoms can be eased by sitting in a steamy bathroom. This simulates a medical mist tent, moisturizing your nasal and bronchial passages. 

You might also try nasal irrigation, which uses a saline rinse or spray to flush your sinuses. This can help clear immediate congestion and thin secretions (1). There are pre-filled versions on the market, which make them easier to use. If you mix your own, the Cleveland Clinic’s website has detailed instructions and guidance (2). A few key points: do not share equipment, clean your equipment properly, and do not use tap water without boiling it.

Dry heat is your enemy when you’re experiencing cold symptoms. If your home or office is dry, use a cool mist humidifier to put some humidity back in the air. Take care to clean your humidifier to avoid mildew and mold buildup.

You can eat salt-free soups loaded with vegetables to increase your nutrient intake and loosen congestion. I start with a sodium-free soup base and add spices, onions, spinach, broccoli, and other greens until it’s stew-like. High levels of sodium can dehydrate you and make you feel worse. Caffeine-free hot teas will also help loosen congestion and keep you hydrated.

Does Zinc reduce a cold’s duration?

According to a meta-analysis that included 13 trials, zinc in any form taken within 24 hours of your first symptoms may reduce the duration of a cold by at least one day (3). Even more importantly, zinc may significantly reduce the severity of your symptoms throughout, improving your quality of life. This may be due to an anti-inflammatory effect.

One of the studies found that zinc reduced the duration of the common cold by almost 50 percent from seven days to four days, cough symptoms were reduced by greater than 60 percent, and nasal discharge was reduced by 33 percent (4). Researchers used 13 grams of zinc acetate per lozenge taken three-to-four times daily for four days. This translates into 50-65 mg per day.

There are a few serious concerns with zinc. First, the dose researchers used was well above the maximum recommended intake is 40 mg per day for adults (5). Also, the FDA has warned against nasal zinc administration with sprays, which can result in permanent loss of smell.

Studies that showed a benefit have used different formulations, delivery systems and dosages, and there is no current recommendation or consensus on what is optimal.

Does vitamin C or echinacea help?

According to a review of 29 trials, vitamin C did not show any significant benefit in preventing or reducing cold symptoms or duration for the general population (6). However, a sub-group of serious marathon runners and other athletes who took vitamin C prophylactically caught 50 percent fewer colds.

The jury is still out on the effectiveness of echinacea for treatment of duration and symptoms, but the results are inconsistent and disappointing (7). In a randomized controlled trial with 719 patients, echinacea was no better than placebo for the treatment of common cold symptoms (8). There are ongoing studies to determine whether prophylactic use helps prevent colds (9). 

Should you exercise or not?

A study published in the British Journal of Sports Medicine may challenge your perceptions about exercising when you have a cold. Participants who did aerobic exercise at least five days per week, versus one or fewer days per week, had a 43 percent reduction in the number of days with colds over two 12-week periods during the fall and winter months (10). Even more interesting is that those who reported themselves as being highly fit had 46 percent fewer days with colds compared to those who perceived themselves as having low fitness. Their cold symptoms were reduced significantly as well.

References:

(1) Am Fam Physician. 2009 Nov 15;80(10):1117-9. (2) clevelandclinic.org (3) Open Respir Med J. 2011; 5: 51–58. (4) J Infect Dis. 2008 Mar 15;197(6):795-802. (5) ods.od.nih.gov. (6) Cochrane Database of Syst Reviews 2013, Issue 1. Art. No.: CD000980. (7) Cochrane Database of Syst Reviews 2014, Issue 2. Art. No.: CD000530. (8) Ann Intern Med. 2010;153(12):769-777. (9) nccih.nih.gov. (10) British J Sports Med 2011;45:987-992.

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.

Prev123...41Next Page 2 of 41
TBR News Media is your local news and entertainment website.
We provide you with the latest breaking news and information for your community.
Contact us: [email protected]

Most Viewed

©